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Objectives Central diabetes insipidus (CDI) is a rare but important disease of varying etiology that poses challenges in diagnosis and follow-up. Identifying diagnostic difficulties in patients with CDI will help ensure an optimal approach to their management and follow-up. This study aimed to characterize the clinical and etiological characteristics of CDI in pediatric patients. Methods We analyzed the admission and follow-up data of CDI patients aged 0–18 years who were followed in our center between 2010 and 2019. Results The study included 56 patients with a mean age at diagnosis of 7.92 ± 5.11 years and symptom duration of 8.65 ± 21.3 months. The patients were grouped by etiology into those with organic causes, such as structural anomalies, tumors, and trauma (group 1, n=41) and other causes (group 2, n=15). The prevalence of idiopathic CDI was 16%. At least one pituitary hormone deficiency was detected in 60.7%, the most common being thyroid stimulating hormone deficiency. Patients in group 1 had a higher mean age at diagnosis, shorter symptom duration, and higher frequency of other pituitary hormone deficiencies compared to group 2. Additionally, germinoma was detected 1 year subsequent to normal MRI findings at diagnosis and another patient was diagnosed with Langerhans cell histiocytosis (LCH) 5 years after diagnosis. All patients responded well to replacement therapies, but two patients with germinoma died during follow-up. Conclusions In the pediatric age group, intracranial organic pathologies are an important etiology of CDI, and despite a short symptomatic period, determining the cause may be challenging and prolonged. Patients presenting at a young age with a long history of symptoms and no other pituitary hormone deficiency are unlikely to have organic CDI. However, organic causes such as LCH should be evaluated at all ages. Patients with idiopathic disease are candidates for further etiological studies, and repeated cranial imaging is important during follow-up.

The species composition and abundance of benthic macroinvertebrates in the Eastern Black Sea were determined seasonally, between May 2013 and February 2014. Sediment was collected using a Van Veen ...

Purpose. In modern times, every country acts as a provider of sustainable socio-economic development of its regions, effectively using the potential of natural resources. Among these resources, tourism resources attract more attention. Thus, the potential of tourism resources is higher and plays a direct role in the development of the regions. Tourism provides a basis for high income and quick return on investment. In a broader sense, tourism is a means affecting the formation of the state budget, the improvement of villages and cities, the preservation of historical and architectural monuments, and the development of small and medium enterprises. The purpose of the article is to study the existing tourism potential in Tovuz region and to identify opportunities for effective use of this potential. In addition, it is to analyse the tourism facilities operating in Tovuz region and make recommendations for the organisation of new tourist routes. Methods. Comparative approach, historical-territorial, typological, field research, systematic analysis, and cartographic (GIS) method have been used during the study. Results. The article studies both natural and anthropogenic tourism resources of Tovuz region, analyses hotel industry, and provides tourist routes and their advantages. The article also identifies opportunities to use the tourism potential of Tovuz region, and finally gives the results and proposals developed on a scientific basis. Scientific novelty. The state programs adopted in connection with the development of the tourism sector in Azerbaijan have been analysed, the natural-climatic conditions in terms of tourism organisation in Tovuz region have been studied, as well as the advantages and disadvantages of accommodation enterprises operating in the region have been revealed. For the first time, both natural and anthropogenic monuments of Tovuz region have been analysed in a complex way, and a map reflecting “Tourism objects and tourist routes of Tovuz region” have been provided. The organisation of the following tourist routes in Tovuz region have been proposed: Tovuz-Govlar-Abdal-Aghdara-Aghabashlar; Tovuz-Dondar Gushchu-Vahidli; Tovuz-Yukhari Oysuzlu-Alibeyli; and Tovuz-Gushchu-Azafli-Bayramli-Asrik Jirdakhan. The practical significance. The obtained results can be used in the Tourism Agency of the Republic of Azerbaijan, the tourism information centre operating in the region, as well as in the implementation of tourism-oriented activities.

Akut miyokard enfarktüsü (AMI) üreme çağında nadirdir, ancak hamile kadınlarda hamile olmayan kadınlara göre üç ila dört kat daha yaygındır. Hamilelik sırasında AMI, yüksek maternal ve fetal mortalite ile ilişkilidir. Acil servise göğüs ağrısı ile başvuran ve takibinde AMI tanısı alan 22 yaşındaki 28 haftalık gebeliği olan hastayı sunuyoruz., Acute myocardial infarction (AMI) is rare during reproductive ages, but is three to four times more common in pregnant women than nonpregnant women. AMI during pregnancy is associated with high maternal and fetal mortality. We present a 22-year-old patient with 28 weeks pregnancy who was admitted to emergency department with chest pain and diagnosed with AMI in her follow-up.

Aim: Fournier’s gangrene (FG) is a rapidly progressive, fulminant necrotizing fasciitis of the anogenital region. Treatment of FG consists of aggressive surgical debridements. The current scoring systems in FG focus on mortality. However, simple biomarkers could be useful. Here we aim to investigate the clinical usefulness of monocyte-to-lymphocyte ratio (MLR) in determining the number of debridements in FG patients. Method: Fifty-nine patients were diagnosed with FG and operated in the emergency unit between 2010 and 2016. The patients were separated into a single-debridement group and a multiple-debridement group. The groups were compared in terms of mean age, gender, duration of symptoms, predisposing factors, wound culture positivity, MLR values at admission, treatment protocols, and mortality rates. Results: The two groups differed significantly in wound culture results and colostomy status (p=0.001 and p=0.008). There was no significant difference in mortality rate (p=0.749). Furthermore, there were no significant differences between the groups in terms of predisposing factors or duration of symptoms (p=0.069 and p=0.091). The multiple-debridement group had a significantly higher MLR value (p

Background and Objective: Chest pain is a common and important admission complaint of patients in the emergency department (ED). The differential diagnosis especially in terms of acute coronary syndrome (ACS) should be done carefully by emergency physicians. The present study aims to identify patients with chest pain according to presence of ACS in the ED. Material and Methods: The patients who admitted to the ED of a university hospital in a year period with chest pain complaint were enrolled into the study prospectively. The information that include age, gender, type of chest pain, duration of pain, medical history, transporting way to the ED, duration time of electrocardiography (ECG) recording, main diagnosis, consultation status, last condition of patients and length of stay of patients were recorded. The data were analyzed by SPSS 17.0 program.Results: Totally 325 patients with chest pain complaint were enrolled into the study. 24.3% of patients with chest pain were diagnosed as ACS.It was found that most of the patients (42.5%) came to ED by the ambulance.110 (33.8%) of 325 patients with chest pain were consulted with cardiologists. The older age was found to be related with ACS significantly (p, Giriş ve Amaç: Göğüs ağrısı, acil serviste yaygın ve önemli bir başvuru şikayetidir. Özellikle akut koroner sendromu (AKS) içeren ayırıcı tanı acil servis hekimleri tarafından dikkatlice yapılmalıdır. Sunulan bu calışma acil servise göğüs ağrısı şikayeti ile gelen hastaların AKS olup olmamalarına göre incelenmesini amaçlamaktadır

Bu çalışma, Kars’ta bir üniversite hastanesinin acil servisine başvuran kritik hasta yakınlarının gereksinimlerinin saptanması amacı ile tanımlayıcı olarak yapılmıştır. Çalışma, 15 Ocak-15 Eylül 2015 tarihleri arasında 640 kritik hasta yakını ile yürütüldü. Araştırmanın verileri acil serviste kritik hasta yakınlarının gereksinimlerini saptama ölçeği ve demografik özelliklere yönelik formlarla toplanmıştır. En yüksek puan aile üyelerinin desteklenme süreci gereksinimi alt boyutundan alınmıştır. En önemli ilk iki gereksinim maddesi sırasıyla: yakınınıza verilebilecek en iyi bakımın verildiğinden emin olunması ve nakil planları yapılırken bilgi verilmesi şeklindedir. Hasta yakınlarına acil servisten memnuniyet durumu sorulduğunda %61.9’u memnun olduğunu, %28.9’u memnun olmadığını ve %9.2’si fikri olmadığını belirtmiştir. Acil servise başvurma saatine göre toplam ölçek ve alt ölçek puanlarına bakıldığında 00:01-07:59 arasında gelenlerin konfor alt ölçeği puanının daha yüksek olduğu ve farkın anlamlı olduğu saptanmıştır. Hasta yakınlarının gereksinimlerinin genellikle bilgilendirme ve etik davranışa yönelik olduğu görülmektedir. Bu nedenle acil serviste her aşamada bilgilendirilmenin yapılması ve etik davranılması önerilmiştir.

Objectives Methemoglobinemia (MetHb) is a rare condition that may have mortal consequences. Literature shows cases of methemoglobinemia due to the use of lidocaine and other local anesthetics. This is a cross-sectional study to determine the incidence of methemoglobinemia after the application of lidocaine. Methods In this study, 88 patients admitted to the emergency department of a university hospital between May 2014 and May 2015 and needed lidocaine application for small surgical procedures were included. When compared before and after the administration of lidocaine 2 mg/kg, there was not a significant difference in the level of methemoglobin, hemoglobin, or in the hematocrit (p=0.604, p=0.502, and p=0.367, respectively). Results Mean age of the patients was 33.85 (±17.58) years, and 83% of the patients were male. Methemoglobin levels were not significantly different before and after the procedures (p>0.05). Conclusion The results of our study were consistent with the literature; lidocaine associated methemoglobinemia is a rare complication.

Yıldırım, Ali Cihat (Balikesir Author), Despite its relatively protected position, the liver is the most frequently injured solid intra-abdominal organ.1Most liver injuries can be managed conservatively, but about 5% to 10% require urgent laparotomy, usually when the mechanism of injury involves a vehicle accident and hemodynamic instability persists, in spite of 40 mL/kg of blood transfusion.2,3In particular, grades IV and V liver injuries may pose a challenge to the surgeon trying to control hemorrhage, the leading cause of mortality.4Traumatic injuries to the portal vein are rare but devastating. The mortality rate for portal vein injury ranges from 50% to 70%. A recent study of portal triad injuries has highighted the higher mortality rates associated with combination injuries involving multiple portal triad components, especially those that include portal vein injury.5This case study describes a unique case of relatively minor trauma in a child resulting in portal triad injury, sudden demise, and surgical repair.

Acute appendicitis is the most frequent emergency procedure that requires acute surgical intervention. The mortality risk is higher in geriatric patients. There is not a single parameter to diagnose it easily and negative appendectomy is traditionally accepted however the operation itself can cause morbidity and mortality especially in elderly patients. The neutrophil-to-lymphocyte ratio is a predictor of acute inflammation and was recently studied for the diagnosis of AA. The aim of this study is to analyze the diagnostic value of NLR on positive appendectomy rates amongst geriatric and nongeriatric patients.755 patients admitted to the emergency department, with abdominal pain who underwent urgent laparotomy after diagnosed as acute appendicitis. Patients' ages, genders, laboratory results, and intraoperative findings were collected. Geriatric patients were analyzed in group one, and nongeriatric patients were in group 2. Groups then sorted into subgroups by means of positive and negative appendectomies.Although NLR was higher in positive appendectomy subgroup in group 1 it was not statistically significant. NLR could not independently predict positive appendectomy in geriatric patients. In group 2, male gender was significantly higher in the positive appendectomy group (p0.001). NLR was also significantly higher in the positive appendectomy group (p0.001). In group 2 NLR could independently predict positive appendectomy (p0.001).NLR could not predict positive appendectomy rates in the geriatric population but could in the nongeriatric patient group. To find the optimal NLR levels, prospective randomized studies are needed.

Introduction: The aim of the present study was to investigate whether there was a significant difference in thedevelopment of a severe event during the 30-day follow-up between low-risk andhigh-risk patients according to the San Francisco Syncope Criteria (SFSC) who visitedto our emergency department with symptoms of syncope.Materialand Methods: Patients over the age of 18 years who visited our hospital emergencydepartment between June 2011 and September 2011 with a symptom of syncope wereincluded in the study. The study was conducted prospectively. The patients weredivided into 2 groups. Patients with a score of 1 or above on the San FranciscoSyncope Criteria were accepted as the high-risk group and others as thelow-risk group. The patients were followed up for 30 days after their visit tothe emergency department and the severe events that developed within thisperiod were investigated.Results: We included91 of the 95 patients who showed symptoms of syncope in the study. Thedistribution of the patients to the at-risk and no-risk groups was 26.4% and73.6%, respectively. Follow-up of the at-risk group for 30 days revealed that75% experienced no problem, 16.7% experienced other problems that were notsevere and 8.3% died. In the no-risk group, 76.1% of the patients had noproblem during the 30-day follow-up while 23.9% had other problems that werenot severe and no one died.Conclusion: The at-risk group according to San Francisco SyncopeCriteria had a higher risk of a severe event developing within 30 days.Patients with high-risk factors should not be discharged and they should behospitalized so that the etiology can be investigated., Giriş: Bu çalışmada amacımız acil servisimize (AS) senkop şikâyeti ile başvuran San Francisco Senkop Kriterlerine (SFSK) göre düşük riskli kabul edilen hastaların yüksek riskli kabul edilenlere göre başvurudan itibaren 30 günlük takiplerinde ciddi olay gelişip gelişmediğini ve bu iki grup arasında anlamlı bir fark olup olmadığını araştırmaktır.Gereç ve Yöntem: Haziran 2011- Eylül 2011 tarihleri arasında hastanemiz acil servisine senkop şikâyeti ile başvuran 18 yaş üstü hastalar çalışmaya dâhil edildi. Çalışma prospektif olarak düzenlendi. Hastalar iki gruba ayrıldı. Birinci grup San Francisco Senkop Kriterlerine uyanlar olup, 1 puan ve üzeri alan hastalar yüksek riskli olarak, ikinci grup ise San Francisco Senkop Kriterlerine uymayan hastalar olup düşük risk grubu olarak değerlendirildi. Hastalar acil servise başvurularından itibaren bir ay süreyle takip edildi ve bu süre içerisinde gelişen ciddi olaylar araştırıldı.Bulgular: Senkop şikâyeti ile başvuran 95 hastanın 91’i çalışmaya alındı. Yüksek riskli ve düşük riskli hastaların dağılımı %26.4’e %73.6 şeklinde oldu. Riskli gruptaki hastaların 30 günlük ciddi olay gelişimi takip edildiğinde %8.3’nün öldüğü, %75’nin hiçbir sorun yaşamadığı ve %16.7’nin ise ciddi olmayan diğer sorunlar yaşadığı tespit edildi. Risksiz grubun 30 gün takiplerinde ise hiçbir hastanın ölmediği, %23.9’nun ciddi olmayan diğer sorunlar yaşadığı ve %76.1‘nin ise hiçbir sorun yaşamadığı belirlendi.Sonuç: San Francisco Senkop Kriterine göre riskli grupta olan hastaların 30 günlük süre içinde ciddi olay geçirme ihtimalleri daha yüksektir. Yüksek risk faktörlerine sahip hastaların taburcu edilmeyip, hospitalize edilerek; etiyolojiye yönelik araştırmalar yapılmasının uygun olacağını düşünmekteyiz.

Background: Headache is one of the most common problems in emergency services. A symptomatic approach is sufficient for dealing with primary headaches. However, it is vital to identify life-threatening secondary headaches as soon as possible. Our study aimed to investigate the relationship between secondary headaches and the time of admission to the emergency department. The study’s objective was to determine whether clues for early diagnosis could be spotted at the time of admission.Materials and methods: The files of 1,350 patients were investigated retrospectively. According to the inclusion criteria, 711 patients were included in the study and divided into two groups. Those with primary headache diagnoses according to the 2004 criteria of the International Headache Society were included in Group A, while those with secondary headache diagnoses were included in Group B. Patients who contacted emergency services between 08:00 and 18:00 complaining of headache were placed in subgroup 1, while those who made contact between 18:00 and 08:00 were placed in subgroup 2. The aim of the study was to investigate the relationship between secondary headaches and the time of admission.Results: No parameter acted as an independent factor in affecting headache type based on research regarding the common effect of age, gender, and time of admission (p:0.078, p:0.705, and p:0.547, respectively).Conclusion: The time that patients contacted emergency services complaining of headache was not significant., Amaç: Baş ağrısı acil servislerde görülen en sık şikayetlerdendir. Birincil baş ağrılarına semptomatik yaklaşım gereklidir. Ancak, hayatı tehdit eden ikincil baş ağrılarını en kısa zamanda tanımlamak gereklidir. Çalışmamızda, acil servise başvuru zamanı ile ikincil baş ağrıları arasındaki ilişkiyi araştırmayı amaçladık. Çalışmanın amacı, başvuru zamanının erken tanı için ipucu verip vermeyeceğini belirlemek. Materyal ve metot: 1350 hastanın dosyası retrospektif olarak incelendi. Çalışmaya dahil etme kriterlerine göre 711 hasta çalışmaya alındı ve iki gruba ayrıldı. Uluslararası Baş ağrısı Derneği 2004 kriterlerine göre birincil baş ağrısı tanısı alanlar Grup A içerisine, ikincil baş ağrısı tanısı alanlar Grup B içerisine alındı. 08:00 ile 18:00 arasında baş ağrısı şikayetiyle başvuran hastalar Alt grup 1 içerisine, 18:00 ile 08:00 arasında başvuran hastalar Alt grup 2 içerisine alındı. Çalışmanın amacı, ikincil baş ağrıları ile başvuru zamanı arasındaki ilişkiyi incelemektir. Bulgular: Yaş, cinsiyet ve başvuru zamanına ilişkin yapılan araştırmada, hiçbir parametre baş ağrısı tipini etkileyen bağımsız faktör olarak değerlendirilmedi (sırasıyla p:0.078, p:0.705 ve p:0.547).Sonuç: Acil servise baş ağrısıyla başvuran hastaların başvuru zamanı tanı koyma açısından anlamlı bulunmadı.

Amaç: Baş ağrısı acil servislerde görülen en sık şikayetlerdendir. Birincil baş ağrılarına semptomatik yaklaşım gereklidir. Ancak, hayatı tehdit eden ikincil baş ağrılarını en kısa zamanda tanımlamak gereklidir. Çalışmamızda, acil servise başvuru zamanı ile ikincil baş ağrıları arasındaki ilişkiyi araştırmayı amaçladık. Çalışmanın amacı, başvuru zamanının erken tanı için ipucu verip vermeyeceğini belirlemek. Materyal ve metot: 1350 hastanın dosyası retrospektif olarak incelendi. Çalışmaya dahil etme kriterlerine göre 711 hasta çalışmaya alındı ve iki gruba ayrıldı. Uluslararası Baş ağrısı Derneği 2004 kriterlerine göre birincil baş ağrısı tanısı alanlar Grup A içerisine, ikincil baş ağrısı tanısı alanlar Grup B içerisine alındı. 08:00 ile 18:00 arasında baş ağrısı şikayetiyle başvuran hastalar Alt grup 1 içerisine, 18:00 ile 08:00 arasında başvuran hastalar Alt grup 2 içerisine alındı. Çalışmanın amacı, ikincil baş ağrıları ile başvuru zamanı arasındaki ilişkiyi incelemektir. Bulgular: Yaş, cinsiyet ve başvuru zamanına ilişkin yapılan araştırmada, hiçbir parametre baş ağrısı tipini etkileyen bağımsız faktör olarak değerlendirilmedi (sırasıyla p:0.078, p:0.705 ve p:0.547). Sonuç: Acil servise baş ağrısıyla başvuran hastaların başvuru zamanı tanı koyma açısından anlamlı bulunmadı.

Pneumomediastinumis the presence of air in the mediastinum. It can be divided into two asspontaneous and skonder pneumomediastinum.Spontaneous pneumomediastinum is a self-limitting rare clinical entity withgood prognosis without an apparent cause. It occurs in young male patients mostfrequently. It is a benign disease with symptoms such as chest pain, dyspnea,coughing, odinophagia, subcutaneous emphysema, swelling of neck. Chest pain andsubcutaneous emphysema are most common symptoms. Most of the patients admit toemergency department (ED) with chest pain. Plain chest radiogram is oftenadequate for diagnosis but computarized tomography (CT) is golden standard. We aimed to present the patient that admitted to EDwith chest pain, whose chest radiogram was clear but thorax CT was performedbecause of clinical suspicion and diagnosed with pneumomediastinum., Pnömodiastinum mediastende serbest hava bulunmasıdır.Spontan ve sekonder pnömomediastinum olarak ikiye ayrılır. Spontanpnömomediastinum presipite edici bir faktör olmaksızın gelişen iyi seyirli vekendini sınırlayıcı nadir görülen bir hastalık olarak tanımlanır. Genç erkekhastalarda daha sık görülmektedir. Benign seyirli bir hastalık olup,semptomları arasında göğüs ağrısı, dispne, öksürük, odinofaji, subkutanamfizem, boyunda şişlik vardır. Semptomlardan göğüs ağrısı ve boyunda subkutanamfizem en sik görülenidir. Hastaların çoğu ise acil kliniğine göğüs ağrısışikâyeti ile başvuruda bulunurlar. Genellikle göğüs direkt grafisi ile tanıkoyulsa da bilgisayarlı tomografi tanıda altın standarttır. Olgumuzda sadece göğüs ağrısı şikâyeti ile acil servise başvurup, akciğergrafisinde patoloji tesbit edilmese de klinik şüphe doğrultusunda çekilentoraks bilgisayarlı tomografide pnömomediastenium tesbit ettiğimiz hastayısunmayı hedefledik.

Analitik felsefenin önemli temsilcilerden biri; mantıkçı, matematikçi, yazar ve eleştirmen olarak çok yönlü kişiliği ile tanınmış ünlü bir İngiliz filozofu olan Bertrand Russell (1872-1970)'ın Tanrı'nın varlığı problemi ve agnostisizmi hakkındaki görüşlerini ortaya koymaya çalıştığımız bu tez çalışması giriş ve iki bölümden oluşmaktadır. Girişte, Russell'ın düşünsel gelişim evreleri ve agnostisizmin tarihçesi genel hatlarıyla anlatılmış, birinci bölüm, Tanrı'nın varlığının lehine ve aleyhine getirilen çeşitli argümanlara dair görüşlere ayrılmış, çalışmanın ana hedefini belirleyen ikinci bölümde ise Russell'ın agnostik tutumu temellendirilmeye çalışılmıştır.Çalışmanın sonucunda, Tanrı`nın lehine getirilen tüm argümanları eleştirerek bunları Tanrı'nın varlığını kanıtlamak için yetersiz gören Russell'ın dogmatik bir karakter taşımayan agnostisizminin, bir taraftan dinî, diğer taraftan ise ateistik özelliklere sahip bir agnostisizm olduğu ortaya çıkmaktadır. Agnostisizminin en önemli dayanağı hiç kuşkusuz onun sahip olduğu bilimsel tavırdır. Argümanların yetersizliğinden dolayı Tanrı'nın varlığının bugün için imkânsızlığını savunmuşsa da Russell, bunun değişebileceği ihtimalini teorik olarak her zaman muhafaza etmiştir. Bertrand Russell (1872-1970), one of the important representatives of analytic philosophy, is also known as a writer, a logician, a mathematician and a critic. This study consistes of an introduction and two chapters in which basically examine Russell?s ideas on the problem of God and agnosticism. The introduction part touch upon Russell?s intellectual biography and short history of agnosticism. The first chapter analyzes the arguments on existence of God and the second chapter examines Russell?s understanding of agnosticism.In conclusion, it is discussed that whether Russell has an undogmatic understanding of agnosticism or not as he criticized all the arguments in favour of the existence of God claiming that all those arguments are not convincing, while, in fact, his understanding has both religious and atheistic charecteristics. The basis of his understansding of agnosticism is absolutely based on his scientific approach. Because of unsatisfactory arguments in favour of God?s existence, he claimed that God?s existence is impossible to prove for the time being. However, he thought that there is a possibility that God?s existence can be proved in the future. 100