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Aim The Glasgow Prognostic Score (GPS) is a scoring system obtained by using inflammatory (C-reactive protein) and nutritional (albumin) parameters together, and it has been shown to have prognostic value in various cardiac pathologies in previous studies. In this study, we aimed to investigate the usability of the Glasgow Prognostic Score (GPS) in predicting 1-year mortality in patients who underwent transcatheter aortic valve implantation (TAVI). Method Patients who underwent TAVI with the diagnosis of severe, symptomatic aortic stenosis in our hospital between 2013 and 2017 were included in this single center study retrospectively. Demographic, clinical and laboratory data were obtained by reviewing patient files. GPS value was calculated by using C-reactive protein and albumin values which was obtained on admission to. Two groups were formed as survivors and non-survivors according to 1-year mortality data. Results A total of 170 patients were included in this retrospective study and 59 patients constituted the non-survivors group. History of chronic obstructive pulmonary disease and cerebrovascular disease were higher in non-survivors’ group. High STS-TAVR, Euro SCORE II and GPS levels were also higher in non-survivors group. High GPS value calculated with pre-procedural data was determined as a predictor of 1-year mortality. Conclusion The Glasgow Prognostic Score allows the evaluation of inflammation and nutritional status together, is a practical method that can be obtained from routine laboratory parameters. It can be used as a predictor of mortality in patients undergoing TAVI. It can guide clinicians in taking preventive measures to reduce mortality before the procedure.

Despite separate evidence regarding illness perception (IP) and group medical visits (GMVs) for hypertension, research on both is limited. Here, we have assessed and compared the effectiveness of GMVs and usual care (UC) on IP and blood pressure (BP) in patients with hypertension. This was a two-group parallel randomized controlled study with 1:1 allocation. Patients with essential hypertension on antihypertensive medication and no cognitive impairments were screened for BP control status and eligibility. A web-based program randomly assigned them to the GMV and UC groups. Group medical visits were held once a month for 3 months. Primary and secondary outcome measures included improvements in IP and BP control. Among 152 participants, 40 and 43 were assigned to the GMV and UC groups, respectively. The control group had a 9.3% dropout rate. The chronic timeline and illness coherence improved significantly in the intervention group ( p.01). Systolic BP in the intervention group decreased significantly compared with that of the control group (Δ: -18.8 ± 18.4 mm Hg vs. Δ: -10.6 ± 12.5 mm Hg, p = .025). The participation in GMVs had a significant association with the odds of an increase in BP regulation (OR 3.8, 95% confidence interval 1.4-10.3, p = .007). Therefore, GMVs may be feasible for BP control in hypertensive patients with similar characteristics.

The synthesis of the novel phthalonitrile containing (2,4,5-trimethylphenyl)ethynyl moieties was performed using the palladium-catalyzed Sonogashira crosslinking methodology. Cobalt phthalocyanine was obtained with the cyclotetramerization reaction of this dinitrile derivative, while the synthesis of zinc and manganese phthalocyanines was reported by the Sonogashira coupling reaction of the appropriate iodo phthalocyanines. Voltammetric and electrochromic analyses were applied to determine the possible applications of these complexes in different electrochemical/display technologies. The rich redox responses of the complexes had a good influence on the spectroelectrochemical characters of them. Electrochromic measurements of the complexes indicated fast, and reversible color changes with reasonable optical contrasts.

IntroductionSodium-glucose co-transporter 2 (SGLT-2) inhibitors have been shown to reduce the risk of atrial fibrillation (AF) occurrence in patients with diabetes mellitus (DM). In this prospective study, we aimed to analyze the effect of SGLT-2 inhibitors as an add-on therapy to metformin on P wave indices and atrial electromechanics in patients with type 2 DM. MethodsA total of 144 patients enrolled. Electrocardiographic indices were recorded on admission and at 3rd and 6th month of the combination therapy. P wave indices and atrial electromechanical coupling intervals were measured and compared. ResultsAlthough decrease in P wave dispersion (62.78 +/- 9.59 vs. 53.62 +/- 10.65; p = .002) became significant at 6th month of combination therapy, significant decreases in P wave terminal force in V-1 (37.79 +/- 3.45 vs. 32.01 +/- 5.74; p = .035), left atrial volume index (35.87 +/- 6.57 vs. 31.33 +/- 7.31; p = .042), left sided intra-atrial electromechanical delay (32.09 +/- 9.17 vs. 27.61 +/- 8.50; p = .016), right sided intra-atrial electromechanical delay (31.82 +/- 4.92 vs. 27.65 +/- 8.05; p = .042), and interatrial electromechanical delay (29.65 +/- 7.52 vs. 25.96 +/- 4.30; p = .044) were seen as early as 3rd month of treatment. Besides, there was no statistically significant difference between Empagliflozin and Dapagliflozin subgroups in terms of mentioned parameters. ConclusionSGLT-2 inhibitors as an add-on therapy to metformin were shown to significantly improve P wave indices and atrial electromechanics in type 2 DM patients as early as the 3rd month of treatment. It was thought that this may be one of the underlying mechanisms of the decrease in the frequency of AF with the use of SGLT2 inhibitors.

Mukoepidermoid karsinom (MEK), minör ve majör tükürük bezlerinin en sık görülen malign tümörüdür. Bu tümörler sıklıkla majör tükürük bezlerinde, özellikle parotis bezinde görülür ve en sık ağız içinde damakta yerleşim gösterirler. Ağızdaki MEK ile diğer odontojenik kistlerin benzerliği klinik muayenede dikkat edilmesi gereken kritik bir durumdur. Asemptomatik büyüme, çok büyük boyutlara kolayca ulaşması, nüks potansiyeli ve malign karakterin tanısında erken teşhis çok önemlidir. MEK'nin tedavisi ve protetik rehabilitasyonu, tümörlerin histopatolojik derecesi, yeri ve invazyon paternine göre belirlenir. Bu vakanın amacı, damakta yüksek dereceli minör tükürük bezi MEK'si olan 19 yaşında bir kadın hastayı sunmaktır., Mucoepidermoid carcinoma (MEC) is the most common malignant tumor of the minor and major salivary glands. These tumors occur commonly in the major salivary glands, especially the parotid, and they are the most frequently located in the palate intraorally. The similarity between MEC and other odontogenic cysts in the mouth is a critical situation that needs attention in clinical examination. Early diagnosis is very important in the diagnosis of asymptomatic growth, reaching very large sizes easily, its recurrence potential, and malignant character. The treatment and prosthetic rehabilitation of MEC are specified according to histopathological grade, location, and invasion pattern of the tumors. The purpose of this case is to present a 19-years-old female with high-grade MEC of minor salivary glands at the palate.

Objective: In the literature, it is still unclear whether the trabecular structure of the jaw in subjects with hypodontia is different from those without hypodontia. Hence, the aim was to determine whether the mandibular trabecular bone structure of children and adolescents with hypodontia differs from the control group by using the fractal analysis method in this study.Materials and Methods: A total of 138 radiographs of 69 cases and 69 control subjects (mean age 13.2±10.1) were evaluated. The age and gender of subjects in the case and control groups were matched. Three regions of interest (ROI) were selected from the panoramic radiographs. Mann-Whitney U and Wilcoxon tests were used. pResults: The mean fractal dimension (FD) values of ROI1, ROI2, and ROI3 were 1,25, 1,20, and 1,13, respectively. The means FD values obtained from the ramus region were higher than the other regions (p0.05). The FD values of the case group were lower than the control group for ROI3 (pConclusions: The results of this study showed that the mandibular trabecular bone quality of pediatric patients with one missing tooth was different from the healthy group. The difference in the mean FD values from the ROIs indicates that the ramus has a denser structure than the mandibular corpus. Therefore, it shows that individuals with hypodontia may need additional procedures in cases that require orthodontic and implant treatment.Clinical Relevance: Clinicians should consider that individuals with hypodontia may need additional procedures in cases requiring orthodontic and implant treatment.

Amaç: Bu çalışmada, Çukurova Üniversitesi Aile Hekimliği polikliniklerine başvuran üniversite öğrencilerinin riskli davranışlarının değerlendirilmesi ve riskli davranışların yaşam doyumu ile ilişkisinin ortaya konulması amaçlandı. Gereç ve Yöntem: Çukurova Üniversitesi Aile Hekimliği polikliniklerine 01-31 Aralık 2018 tarihleri arasında başvuran öğrenciler arasından evreni %95 güvenirlik ve %5 hata payı ile temsil eden en az örneklem büyüklüğüne basit tesadüfi örnekleme yöntemi ile ulaşıldı. Riskli Davranışlar Ö̈lçeği- Üniversite Formu, Yaşam Doyumu Ölçeği ve sosyodemografik veri toplama anketi ile toplanan veriler istatistik paket programı ile analiz edildi. Bulgular: Yaş ortalaması 20,53±1,92 (16-28) yıl olan %63,3’ü kadın 338 öğrencinin %41,4’ü devlet yurdunda kalmaktaydı. Yaşı 22 ve üzeri olan grubun sigara kullanım puanı, yaşı 20-21 olan gruba göre daha yüksek bulundu (p=0,048). Erkeklerin antisosyal davranış (p=0,000), alkol kullanımı (p=0,000), sigara kullanımı (p=0,000), okul terki (p=0,001) ve madde kullanımı (p=0,000) puanları kadınlara göre daha yüksek iken intihar eğilimi ve beslenme alışkanlıkları açısından cinsiyetler arasında istatiksel olarak anlamlı fark saptanmadı. Antisosyal davranışlar (p=0,004), alkol kullanımı (p=0,000) ve sigara kullanımı (p=0,000) puan ortalamaları “evde arkadaş ile” kalan grupta “devlet yurdunda” kalan gruba göre daha yüksekti. Alkol (p=0,000) ve sigara (p=0,000) kullanımı puan ortalamaları fen bilimlerinde öğrenim gören öğrencilerde daha yüksek iken okul terki (p=0,023) sosyal bilimlerde öğrenim gören öğrencilerde daha yüksekti. Riskli davranışların bütün alt boyutları ile yaşam doyumu arasında istatistiksel olarak anlamlı düzeyde negatif yönde ilişki bulundu. Sonuç: Aile hekimlerinin üniversite öğrencilerine hizmet verirken bu çalışmada saptanan bulguları göz önünde bulundurmaları, riskli davranışların azaltılması/önlenmesi dolayısıyla yaşam doyumunun arttırılması konusunda disipline özgü ilkelerden yararlanarak fırsatları değerlendirmeleri önerilir.

Purpose: The aim of this study was to investigate the screen time of preschool children in relation to their parents’ screen-use habits and family functions. Materials and Methods: We included 198 parents whose children were attending a kindergarten in Sarıçam district of Adana. Data were collected using a questionnaire and the Family Assessment Scale. Screen times were calculated by adding up the time spent in front of tablets, TV, mobile phones, and computers. Results: The screen times were >2 h in 57.6% children on weekdays and in 76.3% on weekends, and screen times increased as age increased. Further, 88.9% parents indicated that they had family rules about screen use, 62.6% stated that their children were in front of the screen while eating, and 44.4% said their children had a screen of their own, whereas 90.9% told that they had not received any recommendations regarding screen use from family physicians or pediatricians. Low education level of parents, lack of family rules on screen use, children having their own screens, and having received no recommendations from doctors regarding screen use were noted to increase the screen times of children. There was a relationship between the screen times of children and that of parents as well as between screen times of children on weekdays and the communication subscale of family functions. Conclusion: From the results of the study, individual and institutional initiatives are recommended for family physicians and pediatricians who have many contacts with this age group to turn it into an opportunity and have a more active role in advising parents regarding screen use

COVID-19 pandemic continues to threaten human health as novel mutant variants emerge and disease severity ranges from asymptomatic to fatal. Thus, studies are needed to identify the patients with ICU need as well as those who have subsequent mortality. Global Registry of Acute Coronary Events (GRACE) risk score is a validated score in acute coronary syndrome. We aimed to evaluate if GRACE score can indicate adverse outcomes and major ischemic events in hospitalized COVID-19 patients.All hospitalized patients due to COVID-19 at our institution between March 2020 and September 2020 were included in this retrospective study. Patients were grouped according to GRACE risk scores: low risk 0-108 points, intermediate risk 109-140 and high risk ≥141.A total of 787 patients were enrolled; 434 patients formed group 1. One-hundred forty-one patients in group 2 and 212 patients formed group 3. We found that inhospital mortality, length of hospital stay, ICU and advanced ventilatory support need were associated with increasing GRACE risk score. In addition, major ischemic events were more frequently observed in higher risk groups and strong positive correlations between GRACE risk score and pro-BNP, procalcitonin and moderate positive correlation with D-dimer, CRP, NLR was found. Regression analysis showed that only GRACE risk score was an independent risk factor associated with inhospital mortality, major ischemic events, advanced ventilatory support and ICU need.The GRACE risk score is easy to apply on hospital admission and useful for classifying those in medium-high-intensity care units and to raise the assignments of sources.

Background Despite the accumulated evidence suggesting the positive aspects of using group visits in obesity, the number of qualitative studies that examine why and how the effects occur at an individual level is limited. Objectives This qualitative study aimed to explore the experiences and perspectives of women who participated in group visits and had different weight loss outcomes in the programme. Method Purposive maximum variation sampling was performed. Data collection and analysis were performed iteratively, and the data saturation method was used as a guideline for sample size. All participants who completed the group visits were approached, and finally, 20 individuals were included in the study. Semi-structured in-depth interviews were audio-recorded, transcribed verbatim, and analysed thematically using a phenomenological approach. Results The mean age of the individuals was 38.5 ± 9.8 years, the education level ranged from incomplete-high school to university degree, and the weight changes were between +4.1% and −17.1%. Two main themes emerged from the thematic analysis revealing barriers: weight stigma (two sub-themes: internal and external stigma) and traumatic life events (three sub-themes: ‘loss of relatives,’ ‘childhood traumas,’ and ‘conflicting intimate partner relationships’). Conclusion Considering the barriers to weight loss efforts in this study, these issues need to be explicitly investigated before and during the group visits in addition to weight loss practices and behavioural changes.

The objective of this study is to assess the prognostic effects of T ranscatheter aortic valve replacement (TAVR) on the patients with different degrees of left ventricular systolic (LVS) function and severe symptomatic aortic stenosis. Also examines the prognostic association of LV remodelling after TAVR.Patients stratified into four subgroups with respect to baseline LV ejection fraction (LVEF) (LVEF25%, LVEF 25%-40%, LVEF 41%-49% and LVEF ≥ 50%). We compared the baseline characteristics and temporal changes in echocardiographic parameters of the patients after TAVR, and determined all-cause mortality (ACM) in a follow-up period of mean 20.7 ± 15.8 months (up to 84). There were 495 patients at 8 centres. ACM was similar in all groups (28.1%, 29.5%, 22.5% and 24.1% respectively;This study shows that TAVR is beneficial in the whole range of LVS function, irrespective of the baseline EF. Early recovery in LVEF after TAVR is critical for survival, however, it seems to be more eye catching in the patients with advanced heart failure with reduced EF.

The effect of physiological circulatory changes during pregnancy on hypertrophic cardiomyopathy (HCM) has been reported with limited data. This study aimed to provide information regarding outcomes of pregnant women with HCM and to identify predictors of major adverse cardiac event (MACE).A total of 45 pregnancies with HCM were retrospectively reviewed. The primary endpoint was a MACE that occurred within an 8‑week period after delivery, including maternal death, heart failure (HF), syncope, and malignant ventricular arrhythmias (VAs). Baseline and outcome data were analyzed for all patients. Patients with and without MACE were compared, and patients with obstructive HCM were compared with those who had non-obstructive HCM. The study population was divided into two subgroups of patients having or not having an implantable cardioverter defibrillator implantation (ICD).At least one MACE occurred in 11 patients (24.4%); six patients developed HF (13.3%), six had a ventricular tachyarrhythmia (13.3%), and two had syncope (4.4%). New York Heart Association functional class of ≥ II, presence of HF signs before pregnancy, increased left ventricular outflow tract (LVOT) gradient were significantly associated with MACE. Fatal VAs were seen during pregnancy in one of five HCM patients with ICD. In the ROC curve analysis, an LVOT gradient higher than 53.5 mm Hg predicted the presence of MACE with a sensitivity of 90.9% and a specificity of 73.5%. This study is the largest series in the literature representing pregnant women who had HCM and ICD.The current data suggest that HF and high LVOT gradients are important risk factors for the development of cardiac complications.HINTERGRUND: Über die Auswirkungen physiologischer Kreislaufveränderungen während der Schwangerschaft auf eine hypertrophe Kardiomyopathie (HCM) wurde bisher anhand begrenzt vorhandener Daten berichtet. Ziel der vorliegenden Studie war, Informationen über die Ergebnisse schwangerer Frauen mit HCM zu erhalten und Prädiktoren schwerer unerwünschter kardialer Ereignisse (MACE) zu identifizieren.Retrospektiv wurden dazu die Daten von 45 Schwangerschaften mit HCM ausgewertet. Primäerer Endpunkt war ein MACE, das innerhalb einer 8‑Wochen-Phase nach Entbindung auftrat, einschließlich Tod der Mutter, Herzinsuffizienz, Synkope und maligner ventrikulärer Arrhythmien (VA). Die Ausgangsdaten und die Daten des Ergebnisses im Verlauf wurden für sämtliche Patientinnen ausgewertet. Verglichen wurden einerseits Patientinnen mit und ohne MACE, andererseits Patientinnen mit obstruktiver HCM und mit nichtobstruktiver HCM. Die Studienpopulation wurde in 2 Subgruppen unterteilt: Bei den einen wurde ein implantierbarer Kardioverter-Defibrillator (ICD) implantiert, bei den anderen nicht.Bei 11 Patientinnen trat mindestens ein MACE auf (24,4 %); eine Herzinsuffizienz entwickelte sich bei 6 Patientinnen (13,3 %), ebenfalls bei 6 eine ventrikuläre Tachyarrhythmie (13,3 %), und bei 2 trat eine Synkope auf (4,4 %). Eine Funktionsklasse ≥ II gemäß New York Heart Association, das Vorliegen von Herzinsuffizienzsymptomen vor der Schwangerschaft und eine erhöhter linksventrikulärer Ausflusstrakt(LVOT)-Gradient waren signifikant mit MACE vergesellschaftet. Eine tödliche VA wurde während der Schwangerschaft bei einer von 5 HCM-Patientinnen mit ICD beobachtet. In der Receiver-Operator-Characteristic(ROC)-Kurven-Analyse war ein LVOT-Gradient über 53,5 mm Hg ein Prädiktor für das Vorliegen eines MACE mit einer Sensitivität von 90,9 % und einer Spezifität von 73,5 %. Die vorliegende Studie enthält die größte Serie schwangerer Frauen mit HCM und ICD in der Literatur.Den aktuellen Daten zufolge stellen Herzinsuffizienz und hohe LVOT-Gradienten entscheidende Risikofaktoren für das Auftreten kardialer Komplikationen dar.

Objective: Fabry disease (FD) is a progressive, X-linked inherited disorder of glycosphingolipid metabolism which arises due to deficient or absent activity of lysosomal α-galactosidase A (α-Gal A). This may be associated with increased left ventricular (LV) wall thickness and may mimic the morphological features of hypertrophic cardiomyopathy. The purpose of this study was to define the ratio of occurrence of FD to the manifestation of unexplained left ventricular hypertrophy (LVH). Methods: We studied a prospectively assembled a consecutive cohort of 190 patients with unexplained LVH on echocardiography. The criterion for LVH diagnosis was a maximum LV wall thickness of 13 mm or greater. All patients were tested for mutations in the GLA gene. Results: The majority of patients were male (n=119, 63%) and the mean patient age was 47.2+-15 years. In 190 patients diagnosed with LVH, we identified 2 patients (1.05%) with documented GLA mutations [c.427G>A (p.A143T)(p.Ala143Thr)] and [c.937G>T (p.D313Y)(p.Asp313Tyr)]. After the family screening, 3 additional patients with FD were identified in 2 families, including 5 individuals who are now receiving enzyme replacement therapy. Conclusion: We identified 2 index patients with FD and unexplained LVH. Cardiologists should, therefore, be aware of FD in cases of unexplained LVH. Family screening is crucial for the earlier identification of unaffected new patients who may benefit from enzyme replacement therapy.

There are no major tools that could predict disease severity in COVID-19. The aim of this study is to evaluate if serum galectin-3 levels can identify disease progression in COVID-19.Patients that were hospitalized due to COVID-19 between March and June 2020 were included in this cross-sectional prospective study. Baseline demographic and clinical data in addition to levels of serum parameters including galectin-3 were measured at the time of hospital admission. Patients with COVID-19 were categorized into two groups (non-severe and severe illness). The need for ICU during hospital stay, duration from hospital admission to the transfer to the ICU, and the total length of hospital stay were recorded.A total of 175 patients were included in the study and among these, 64 patients formed the severe illness group whereas 111 comprised the non-severe illness group. There was statistically significant difference in terms of galectin-3 levels between groups (1.07 ± 0.75 vs 0.484 ± 0.317, p 0.0001, respectively). Our results showed that galectin-3, IL-6 and CRP levels at admission were independent risk factors associated with transfer to the ICU whereas only galectin-3 was an independent factor for the need for advanced ventilatory support. Also, galectin-3 and IL-6 were independent risk factors related to in-hospital mortality.In conclusion, our results indicated that galectin-3 had moderate power in outlining disease severity and the need for ICU transfer throughout the clinical course in COVID-19.

There are studies in the literature showing the clinical importance of fragmented QRS (fQRS) in many systemic diseases. In this study, we aimed to investigate the frequency and prognostic value of fQRS on electrocardiogram (ECG) in patients with acute ischemic stroke.We prospectively enrolled 241 patients with acute ischemic stroke between January 2018 and January 2020. ST depression and elevation, QRS duration, PR interval, RR interval, QTc interval, QTc dispersion (QTcd), T negativity, Q wave, and fQRS were evaluated on ECG. Brain computed tomography (CT) and diffusion magnetic resonance imaging (MRI) images were obtained in the acute period and the National Institute of Health Stroke Scale (NIHSS) score was calculated for each patient. Patients were followed up for a period of two years.The 241 patients comprised 121 (50.2%) men and 120 (49.8%) women with a mean age of 67.52 ± 13.00 years. In Cox regression analysis, age, NIHSS, QTcd, and fQRS were found to be independent predictors of mortality (age, hazard ratio [HR]: 1.063, p 0.001; NIHSS, HR: 1.116, p = 0.006; QTcd, HR: 1.029, p = 0.042; fQRS, HR: 2.048, p = 0.037). Two-year mortality was higher in patients with fQRS than in patients without fQRS (31% vs. 9%, p = 0.001).The fQRS is associated with poor prognosis in patients with acute ischemic stroke.

Aim: Research is ongoing to discover biomarkers that can be used to monitor disease progression and predict prognosis in peripheral artery disease (PAD). Ischemia-modified albumin (IMA) is known to predict the risk for PAD. The aim of this study was to investigate whether serum IMA levels were associated with PAD lesions and ankle-brachial index (ABI) values, and to determine the accuracy of IMA levels in predicting PAD prognosis. Material and Method: Seventy-three patients with PAD who applied to our hospital between July and September 2018 were included in the study. The lesion levels of patients with an ankle-brachial index (ABI) value lower than or equal to 0.9 were determined by computed tomography angiography (CTA). Patients were grouped according to their lesion levels and Fontaine classification. Serum IMA concentrations were measured and compared with regard to lesion levels and ABI values. Results: Sixty-five of the patients (89%) were male. The mean age of the patients was 62.2 ± 8.8 (43–77) years. The mean serum IMA level was 25.9 ± 26.7 (10–218) ng/ml. Serum IMA levels were found to be lower in patients with bilateral iliac artery lesions (p = 0.040). There was no statistically significant relationship between other parameters and serum IMA levels (p >0.05 for all). Conclusion: There is a need for biomarkers that can predict lesion level and prognosis in patients with PAD. Although no statistically significant relationship was found between lesion level and serum IMA concentrations in this study, further studies involving a higher number of patients may provide more informative data on this subject.

Amaç: Bu çalışmada, Adana’daki aile hekimlerine kayıtlı gebelerin prekonsepsiyonel bakım durumlarının risk taraması ve danışmanlık boyutları açısından değerlendirilmesi amaçlanmıştır. Yöntem: Örneklemi Adana ili merkez ilçelerinden rastgele seçilen 20 aile sağlığı merkezinden çalışmaya katılmaya onay veren 48 aile hekimine kayıtlı gebelerden çalışmayı kabul edenler (n=250) oluşturdu. Araştırmada sosyodemografik verileri ve prekonsepsiyonel durumu değerlendiren tarafımızca oluşturulan bir anket formu kullanıldı. Bulgular: Çalışmaya katılan gebelerin yaş ortalaması 27,8±5,6 yıldı. Gebelerin %2,8’i 18 yaş ve altı, %12,8’i 35 yaş ve üzeri olup riskli gruba girmekteydi. Katılımcıların % 6,8’i birinci dereceden akraba evliliği olduğunu, % 8,4’ü kronik bir hastalığının olduğunu % 10,8’i sigara kullandığını, % 4,8’i sürekli kullandığı ilaçlar olduğunu, % 3,6’sı reçetesiz ilaç kullandığını bildirdi. Gebelerin % 5,2’sinin erken doğum, % 2,4’ünün üçten fazla düşük, % 3,2’sinin önceki gebeliklerinde gebeliğini tehlikeye sokacak hastalık öyküsü bulunmaktaydı. Gebelerin %10,8’sinin gebeliği planlı değildi ve % 8,9’unun gebelik aralığı 24 aydan kısa, % 27,4’ünün gebelik aralığı 60 aydan uzundu. Gebe kalmadan önce danışmanlık hizmeti aldığını belirten gebelerden; %35,4’ü aile hekiminden, %29,5’i kadın doğum uzmanından, % 27,5’i ebeden/ hemşireden, % 7,6’sı da diğer sağlık çalışanlarından danışmanlık aldığını belirtmişti. Danışmanlık alınan konular sırasıyla beslenme (%22,0), vitamin kullanımı (%20), ilaç kullanımı (%13,4), aşılama (%12,6), egzersiz (%9,5), akraba evliliği (%6,3), sigara, alkol, madde kullanımı (%6), kronik hastalıklar ((%5,6), genetik hastalıklar (%2,4), diğer (%2,2) şeklinde belirlenmiştir. Sonuç: Katılımcıların yaş, obstetrik öykü, kronik hastalık, ilaç kullanımı gibi konularda riskleri bulunmakla birlikte sadece onda birinin gebeliği planlı değildir. Çoğu, gebelik öncesinde aile hekimlerinden, kadın doğum uzmanlarından ve ebe/hemşirelerden farklı konularda danışmanlık almışlardır., Aim: The aim of this study was to evaluate the preconception care related to risk screening and counseling for the pregnant women registered to the family physicians in Adana. Method: The study sample consisted of 250 pregnant women who were registered to 48 family physicians at 20 randomly selected family health centers in the central districts of the province of Adana and agreed to participate in the study. A questionnaire form created by the authors was used to evaluate sociodemographic data and preconceptional status. Results: The mean age of the pregnant women was 27.8 ±5.6 years. The participants who were 18 or younger (2.8%) and those who were 35 or older (12.8%) were considered as the risk group. Of the participants, 6.8% declared that they had close-kin marriage, 8.4% had a chronic disease, 10.8% smoked, 4.8% had prescription medication, and 3.6% used non-prescription medication. Of the pregnant women, 5.2% had a history of preterm birth, 2.4% had more than three miscarriages, and 3.2% had a history of a disease that could endanger pregnancy in previous pregnancies. Pregnancy was not planned for 10.8% of the pregnant women; the inter-pregnancy interval was shorter than 24 months in 8.9% and longed than 60 months in 27.4%. Of those who indicated that they had received counseling services before getting pregnant, 35.4% were counseled by a family physician, 29.5% by an obstetrician/gynecologist, 27.5% by a nurse/midwife, 7.6% by other healthcare personnel. The subjects about which they had received counseling were nutrition (22.0%), vitamin use (20%), medication use (13.4%), vaccination (12.6%), exercise (9.5%), consanguineous marriage (6.3%), smoking, alcohol, or substance use (6%), chronic diseases (5.6%), genetic diseases (2.4%), and other issues (2.2%). Conclusion: Only one-tenth of pregnancies were not planned even though participating pregnant women had risk factors such as age, obstetric history, chronic disease, and medication use. Most of them had received counselling on different topics from a family physician, obstetrician/gynecologist, or nurse/midwife before pregnancy.

A 62-year-old man with high fever, general fatigue, and history of transient ischemic attack was transferred to our cardiology clinic with high clinic suspicious of endocarditis. He had a history of mitral ring annuloplasty and coronary artery bypass grafting operation before many years ago and reoperation for aortic dissection as Bentall procedure about 3 months ago. Blood tests showed leukocytosis with massive elevation of C-reactive protein, modest elevation of troponin, marked elevation of International Normalized Ratio, mild anemia, and hypoalbuminemia. Transesophageal echocardiogram (TEE) revealed a 4-mm × 15-mm round mobile mass originating from the anterior part of the mitral annular ring. In addition, there were a sac surrounding aortic graft and surrounding aneurismal aorta suggests a separation of graft because of possible aortic perivalvular abscess. There was blood flow into the sac and extensive thrombus with mobile component was seen in it. Blood cultures were positive for Streptococcus pneumoniae . Vancomycin, gentamicin, and rifampicin were chosen as antibiotic regimen. Early surgery planned for endocarditis and drained abscess cavity. However, the patient was persistently refused the third heart surgery operation. Repeat TEE showed the absence of vegetation on mitral valve and evident shrinkage of thrombus. Chest X-ray showed large left pleural effusion. Computed tomography with contrast enhancement confirmed this finding and revealed that contrast leak to the periaortic area and spreading a path under pulmonary artery to adjacent of the anterior wall of left ventricle. Thoracentesis was performed. Fistula to left pleura was suspected but not clearly confirmed. At 6 weeks of hospitalization, he clinically deteriorated. Due to confusional state, informed consent was obtained from attending relatives. The patient was transferred to the operating room. Cardiopulmonary resuscitation was initiated and thoracotomy was performed. Dehiscence of the aortic valve was seen. Infected tissues were extracted and repair with new prosthesis aortic valve was performed. Despite all resuscitation efforts, the patient died.

Giriş: Obezite, Dünya Sağlık Örgütü ve diğer bir çok uzmanlık alanı tarafından “sağlık için risk oluşturacak şekilde anormal ya daaşırı yağ birikimi” olarak tanımlanmaktadır. Obezitenin etiyolojisinde birçok kompleks mekanizma yer almaktadır. Obezite,etiyolojisine benzer biçimde biyopsikososyal kültürel ve varoluşsal çok çeşitli rahatsızlıklara yol açmaktadır. Hem etiyolojisinde hemde sonuçlarındaki bu karmaşık yapı nedeniyle obezitenin tedavisi bireye özgü olmalıdır. Ancak birinci basamaktaki günlük hastabaşvurularındaki yoğunluk nedeniyle bu pek mümkün olamamaktadır. Bu çalışmada, birinci basamakta obezite yönetimi içinkullanılmış olan grup görüşmeleri (GG) yönteminin incelenmesi amaçlanmıştır. Yöntem: Çalışma niceliksel ve niteliksel araştırmayöntemlerinin bir arada kullanıldığı bir çalışma olarak planlandı. Araştırmanın nicel bölümünde araştırmacılar tarafından oluşturulan11 soruluk değerlendirme formu kullanıldı. Beşli Likert puanları ortalama ve standart sapma olarak hesaplandı. Nicel verilerindeğerlendirilmesinin ardından GG’leri daha detaylı incelemek ve ortaya çıkan neden-nasıl sorularına yanıt aramak amacıyla yarıyapılandırılmış derinlemesine görüşmeler yapıldı. Nitel çalışmanın yapılandırılması ve raporlanması aşamasında ise NitelikselAraştırmayı Raporlamak için Konsolide Kriterler Kılavuzu (COREQ-Consolidated Criteria for Reporting Qualitative Research)kullanıldı. Bulgular: Çalışmanın nicel kısmında yaş ortalaması 37,6±10,3 bulundu. Bu yanıtlar arasında en yüksek puanı (iyi/çok iyiderece) alan maddeler, katılımcıların beslenme ve egzersizin önemini kavramaya yönelik yanıtlarına aitti. Nitel kısmında; 1) olumluetkiler 2) olumsuz etkiler 3) sürdürülebilen sağlıklı yaşam tarzı değişiklikleri 4) motivasyonları 5) GG ile ilgili önerileri, olmak üzerebeş temaya ulaşıldı. Sonuç: GG, obezitenin yönetiminde, aile hekimliği disiplinin ilkeleri doğrultusunda uygulanabilir ve buçalışmada belirlenen iyileştirmelerle daha etkili hale getirilebilir., Introduction: Obesity is defined as abnormal or excessive fat accumulation, which poses a risk to health by the World HealthOrganization and many other areas of expertise. There are many complex mechanisms in the etiology of obesity. Obesity, like itsetiology, causes diverse biopsychosocial cultural and existential disorders. Because of this complexity in both the etiology and theoutcomes, the treatment of obesity should be customized. However, this is not possible due to the high number of daily patient log inthe primary care. The aim of this study was to investigate the group visits (GV) used for obesity management in primary care.Method: The study was planned as a combination of quantitative and qualitative research methods. In the quantitative part of thestudy, an 11-item evaluation form was used. The five-point Likert scores were calculated as mean and standard deviation. Followingthe evaluation of quantitative data, semi-structured in-depth interviews were conducted in order to examine the GV in more detail andto find answers to the why and how questions. COREQ-Consolidated Criteria for Reporting Qualitative Research was used in thestructuring and reporting phase of the qualitative study. Results: The mean age of the study was 37.6 ± 10.3 years. Among theseresponses, items with the highest score (good / very good) were the participants' responses to understanding the importance ofnutrition and exercise. In the qualitative part; 1) positive effects 2) negative effects 3) sustained healthy lifestyle changes 4)motivations 5) suggestions for GV, five themes were reached. Conclusion: GV can be applied in the management of obesity in linewith the principles of family medicine discipline and can be made more effective with the improvements determined in this study.