Amaç: Çocuklarda immatür kemik iliði sinyali nedeniyle sakroiliak eklemin deðerlendirilmesi eriþkinlere göre daha zordur. Bu çalýþmanýn amacý, sakroiliak eklem manyetik rezonans görüntüleme (MRG)' de difüzyon aðýrlýklý görüntülemenin (DAG) etkinliðini deðerlendirmektir.
Gereç ve Yöntemler: Difüzyon aðýrlýklý incelemeleri içeren sakroiliak eklem MRG sakroiliit tanýlý 54 hasta ve 85 tamamen normal control grubunda iki pediatrik radyolog tarafýndan deðerlendirildi. MRG deðerlendirmesinde subkondral kemik iliði ödemi ve sakroiliak eklemlerde kontrast tutulumu aktif sakroiliit olarak kabul edildi. Her sakroiliak eklemden altý alanda görünür difüzyon katsayýsý (ADC) ölçümleri yapýldý. Toplam 1668 alan, tanýlarý bilinmeden geriye dönük olarak deðerlendirildi.
Sonuçlar: Kontrast sonrasý T1A serileri referans alýndýðýnda, sakroiliit tanýsýnda short time imversion recovery (STIR) sekans görüntülerinin duyarlýlýðý, özgüllüðü, pozitif prediktif deðeri ve negatif prediktif deðeri kontrasta kýyasla sýrasýyla %88, %92, %83 ve %94 bulundu. STIR görüntülerinde yanlýþ pozitif sonuçlarýn olgunlaþmamýþ kemik iliðindeki parlamaya sekonder olduðu tespit edildi. Difüzyon aðýrlýklý görüntülerden elde edilen ADC ölçümleri tüm hastalarda ve saðlýklý gruplarda kaydedildi. ADC deðerleri sýrasýyla sakroiliit alanlarýnda 1.35 x10-3 mm2/s (SD: 0.21), normal kemik iliðinde 0.44x10-3 mm2/s (SD: 0.71) ve immatür kemik iliði alanlarýnda. 0.72x10-3 mm2/s (SD: 0,76) olarak bulundu.
Sonuç: STIR sakroiliit tanýsýnda etkili bir MRG sekansý olmasýna raðmen, deneyimsiz ellerde çocuklarda immatür kemik iliðinde yanlýþ pozitif sonuçlara neden olmaktadýr. DAG, immatür iskelette ADC ölçümleri ile sakroiliit tanýsýnda hatalarý önleyen objektif bir yöntemdir. Ayrýca çocuklarda kontrastlý tetkiklere ihtiyaç duymadan tanýya önemli katkýlar saðlayan kýsa ve etkili bir MRG sekansýdýr. (NCI-2022-8-20/R2)

OBJECTIVE: Because of the immature bone marrow signal in children, assessment of the sacroiliac joint is more difficult than in adults. Aim of this study is to evaluate the efficacy of diffusion-weighted imaging (DWI) in sacroiliac joint magnetic resonance imaging (MRI).
METHODS: Sacroiliac joint MRI, including DWI sequences, were evaluated by two pediatric radiologists in 54 patients with sacroiliitis and 85 completely normal controls. In MRI evaluation, subchondral bone marrow edema and contrast enhancement in the sacroiliac joints were considered as active sacroiliitis. Apparent diffusion coefficient (ADC) measurements were made in six areas from each sacroiliac joint. A total of 1668 fields were evaluated retrospectively without their diagnosis being known.
RESULTS: When the postcontrast T1W series were referenced, the sensitivity, specificity, positive predictive value, and negative predictive value of short time inversion recovery (STIR) images in the diagnosis of sacroiliitis were 88%, 92%, 83% and 94% respectively, compared to contrast-enhanced images. False positive results in STIR images were observed secondary to the flaring signal in the immature bone marrow. ADC measurements obtained from diffusion-weighted images were recorded in all patients and healthy groups. The ADC values were 1.35x10-3 mm2/s (SD: 0.21) in the areas of sacroiliitis, 0.44x10-3 mm2/s (SD: 0.71) in the normal bone marrow and 0.72x10-3 mm2/s (SD: 0.76) in the immature bone marrow areas.
CONCLUSION: Although STIR studies are an effective sequence in the diagnosis of sacroiliitis, they cause false positive results in immature bone marrow in children in inexperienced hands. DWI is an objective method that prevents errors in the assessment of sacroiliitis by means of ADC measurements in the immature skeleton. In addition, it is a short and effective MRI series that makes important contributions to the diagnosis without the need for contrast-enhanced examinations in children.

Amaç: Akut iskemik inme, geliþmekte olan ülkelerde uzun süreli özürlülüðün en sýk nedenlerinden olup doku plazminojen aktivatörü (DPA) klinik düzelmeyi saðlayan en etkili medikal tedavi yöntemidir. Bu çalýþmadaki amacýmýz, bir yýl içinde hastanemizde akut iskemik inme tanýsý alarak DPA tedavisi uyguladýðýmýz hastalarýmýzýn klinik verilerinin serum inflamatuar parametrelerindeki deðiþikliklerle iliþkisini incelemek; tedavinin yaygýnlýðýnýn ikinci basamak hastanelerde artmasýna yardýmcý olmaktýr.
Gereç ve Yöntem: Akut iskemik inme tanýsý ile DPA verilen hastalarýn retrospektif incelenmesi için çalýþmaya Nisan 2019 – Nisan 2020 tarihleri arasýnda Siirt Eðt. ve Arþt. Hastanesi’nde DPA tedavisi alan 49 hasta dahil edildi. Hastalarýn demografik, klinik, serum platelet/lenfosit oraný (PLO), nötrofil/lenfosit oraný (NLO) ve CRP/albümin oraný (CAO), radyolojik verileri, semptom-kapý-iðne zamanlarý, trombektomi, mortalite, komplikasyon geliþme yüzdeleri, tedavi öncesi ve tedaviden sonraki 7.gün National Institutes Of Health Stroke Scale Scores (NIHSS) ile birinci ve üçüncü ay modifiye Rankin Skoru (mRS)’nun serum inflamatuar parametrelerindeki deðiþikliklerle iliþkileri incelendi.
Bulgular: Hastalarýn ortalama yaþý 71.2±13.7 idi. Kadýn/erkek oraný yaklaþýk 1 saptandý. Tedavi sonrasý NIHSS skorlarýnda bazal skorlara göre istatistiksel olarak anlamlý bir azalma gözlendi (p<0.001). Üçüncü ay mRS skorlarý, birinci aya göre anlamlý olarak azalmýþ bulundu (p=0.002). Hastalarýn giriþ ve çýkýþ NLO ve CAO deðerlerinde anlamlý artýþ gözlendi (p=0.012, p=0.009). korelasyon analizinde tedavi sonrasý NIHSS skorlarý ve CAO, NLO, PLO deðerleri arasýnda pozitif korelasyon gözlendi. NLO ve PLO deðerleri, üçüncü ay mRS ile korele saptandý (p<0.001, p=0.011). Semptom-kapý zamaný, kapý-iðne zamaný ve semptom-iðne zamanlarý NIHSS ve mRS ile korelasyon gözlenmedi.
Sonuç: Giriþim zamanýnýn kýsalmasý için tanýnýn erken dönemde konulmasý hastalarýn tedaviden faydalanma imkanýný arttýrmaktadýr. Bu nedenle ikinci basamak saðlýk merkezlerinde erken dönemde müdahale prognoz açýsýndan önem taþýmaktadýr. Erken müdahale klinik iyileþmeyi hýzlandýrdýðý gibi komplikasyon oranlarýný da azaltmaktadýr. NLO, PLO ve CAO düzeylerindeki deðiþikliklerin klinik yansýmalarýnýn daha iyi anlaþýlmasý için daha fazla sayýda çalýþmalara ihtiyaç vardýr. (NCI-2021-3-17/R1)

OBJECTIVE: Acute ischemic stroke is a cause of long-term disability in developing countries. Intravenous tissue plasminogen activator (iv-tPA) is the most effective medical treatment shown to provide clinical improvement. Our aim in this study is to investigate the relationship between the clinical data of our patients treated with iv-tPA and the changes in serum inflammatory parameters; and to help increase the prevalence of treatment in secondary hospitals.
METHODS: Forty-nine patients diagnosed as acute ischemic stroke and treated with iv-tPA at Siirt Research and Training Hospital between April 2019 and June 2020 were included in this study. Demographic and clinical findings, serum platelet/lymphocyte ratio (PLR), neutrophyle/ lymphocyte ratio (NLR) and CRP/albumin ratio (CAR), radiological data, symptom-door-needle times, trombectomy, complication and mortality rates, pre and post treatment 7th day of National Institutes of Health Stroke Scale Scores (NIHSS) and first and third-month of modified Rankin Scale (mRS) scores, and prognosis were evaluated.
RESULTS: The mean age was 71.2±13.7 years. Female-to-male ratio was almost 1. Decreases in the post-treatment NIHSS scores were statistically significant compared with the baseline (p<0.001). First month’s mRS score was statistically decreased in the third month follow up significantly (p=0.002). There were significant differences between the baseline and post-treatment laboratory values. Significant increases in the values of NLR, and CAR were detected (p=0.012, p=0.009). Correlation analysis revealed significant positive correlations between post-treatment NIHSS and CAR, PLR, NLR. PLR and NLR were significantly correlated with the third month mRS score (p<0.001, p=0.011). Symptom-to-door time, door-to-needle time, and symptom-to-needle time were not correlated with the NIHSS and mRS scores.
CONCLUSION: It would be beneficial to treat the patients with iv-tPA in secondary-staged hospitals and should be widespread. Rapid treatment is sufficient and can reduce complications and poor outcomes. Elevated levels of NLR, PLR, and CAR predict modest consequences.

Giriþ: 2011 yýlýnda Suriye'de baþlayan iç savaþ, 3,7 milyon Suriyelinin Türkiye'ye göç etmesine neden olmuþtur. Özellikle savunmasýz konumda olan kadýn sýðýnmacýlar, saðlýk hizmetlerine eriþimde sorunlar yaþayabilmektedir. Bu çalýþma, Ankara'daki sýðýnmacýlarýn saðlýk sorunlarýný, saðlýk hizmetlerine eriþimlerini ve bu hizmetleri kullanma þekillerini belirlemeyi amaçlamaktadýr.
Yöntem: Sýðýnmacý annelerin saðlýk durumlarý ve aldýklarý saðlýk hizmetlerini belirlemek için anket düzenlenmiþtir. Çalýþma 15 Eylül 2017-15 Aralýk 2018 tarihleri arasýnda Mülteci Saðlýk Merkezine baþvuran 310 sýðýnmacý annenin katýlýmýyla gerçekleþtirilmiþtir.
Bulgular: Katýlýmcýlarýn %28, 4’ü 15-18 yaþ arasý adolesan yaþ grubudur. Annelerin yaþ ortalamasý 31.18 ± 13.84 yýl, babalarýn yaþ ortalamasý 32.37 ± 10.76 yýl olarak tespit edilmiþtir. Katýlýmcýlar Ankara'da ikamet ettikleri süre boyunca saðlýk hizmetleri için Göçmen Saðlýk Merkezlerini (%94) ve Devlet Hastanelerini (%83) tercih etmiþlerdir. Katýlýmcýlarýn %42,1’i bir veya daha fazla aile üyesinin saðlýk sorunlarý olduðunu ve bu nedenle düzenli hastane ziyaretlerini gerektirdiðini belirtmiþtir. Bu çalýþmada katýlýmcýlarýn %95,2’si aldýklarý saðlýk hizmetlerinden memnun olduklarýný göstermiþtir.
Sonuç: Sýðýnmacýlar, saðlýk sorunlarý için sýklýkla Göçmen Saðlýk Merkezlerine tercih etmekle birlikte devlet hastanelerine de baþvurmuþlardýr. Ancak Göçmen Saðlýk Merkezleri dýþýnda diðer saðlýk kuruluþlarýna eriþimde dil bariyeri sýðýnmacýlar için büyük bir engel oluþturmaktadýr. Mültecilerin baþlýca saðlýk sorunlarý arasýnda yüksek oranda adolesan gebelik, engellilik ve kronik hastalýk olduðu tespit edilmiþtir. Kadýn sýðýnmacýlar eðitim, dil, gelir ve istihdam açýsýndan dezavantajlý konumdadýr. (NCI-2022-7-14/R1)

OBJECTIVE: The civil war that broke out in Syria in 2011 caused 3.7 million Syrians to migrate to Turkiye. Being particularly vulnerable women refugees may experience problems with access to healthcare services. This study aimed to determine the health problems of refugees in Ankara, their access to and use of these services.
METHODS: Healthcare-related levels of refugee mothers were assessed using a questionnaire and the study was conducted with the participation of 310 refugee mothers who presented to the Refugee Health Center, between 15 September 2017 and 15 December 2018.
RESULTS: Among the participants, 28.4% were minors who were between the ages of 15 and 18 years. The mean age of the mothers was 31.18±13.84 years, while the mean age of the fathers was 32.37±10.76 years. During their residence in Ankara, the participants preferred Refugee Health Centers (94%) and State Hospitals (83%) for healthcare. Of the participants, 42.1% stated that one or more family members had health problems, which necessitated regular hospital visits. In this study, 95.2% of participants stated that they were satisfied with the healthcare services they were receiving.
CONCLUSION: Although state hospitals were frequently used, refugees were also able to find solutions to their health problems through Refugee Health Centers. Nevertheless, while using other healthcare institutions, the biggest issue for the refugees was the language barrier. The high rates of adolescent pregnancy, disabilities, and chronic diseases were found to be among the main health problems of refugees. Women refugees seemed disadvantaged in education, language, income and employment.

Amaç: Göz kaymasý olarak tanýmlanan þaþýlýk, genellikle çocukluk döneminde taný konulan ve sýk rastlanan bir göz bozukluðudur. Þaþýlýk çocuklar üzerinde hem fonksiyonel hem de psikososyal etkilere neden olan önemli bir saðlýk problemidir. Bu çalýþmada kliniðimizde taný ve takip edilen þaþýlýk hastalarýnýn klinik özelliklerini ve risk faktörlerini belirlemeyi amaçladýk.
Yöntemler: Þubat 2016 ile Eylül 2022 tarihleri arasýnda þaþýlýk kliniðimizde takip edilen pediatrik yaþ grubu hastalarýnýn verileri geriye dönük olarak incelendi. Hastalarýn detaylý oftalmolojik ve þaþýlýk muayene bulgularý ve þaþýlýk etiyolojisine yönelik anemnez bulgularý kaydedildi.
Bulgular: Bu çalýþmaya toplam 391 hasta kayýt edildi. Hastalarýn ortalama yaþ aralýðý ise 8.66±4,7 idi. Bu hastalarýn 207’si esotropya (%52.9), 172’si ekzotropya (%43.99) ve 12’si vertikal deviasyon (%3.07) mevcuttu. Esotropya hastalarýnýn ortalama yaþ 7.27±4,1, ekzotropya hastalarýnda 10.45±4,8 ve vertikal deviasyon olanlarda ise 7.16±4,7 idi. Ambliyopi ise 207 esotropya olgusunun 54’ünde (%26.09), 172 ekzotropya olgusunun 27’sinde (%15.70) görüldü. Çalýþmamýzda ezotropyanýn ambliyopi ile iliþkili olma olasýlýðý ekzotropyadan daha fazla olduðunu tespit ettik. Hastalarýn 97 (%24.81)’unda birinci derece ailesinde þaþýlýk öyküsü, 38 (%9.7)’unda erken doðum öyküsü, 39 (% 10)’unda yenidoðan bakým ünitesinde kalma öyküsü, 38 (%9.7)’sýnda epilepsi, 4 (%1)’inde travma öyküsü ve 14 (%3.6)’ünde ek göz hastalýðý mevcuttu.
Sonuçlar: Þaþýlýkla iliþkili olabilecek aile öyküsü, erken doðum, yenidoðan bakým ünitesinde kalýþ süresi ve epilepsi gibi risk faktörlerinin saptanmasý, erken taný ve tedavi için yüksek riskli çocuklarýn belirlenmesine yardýmcý olabilir. (NCI-2022-12-9)

OBJECTIVE: Strabismus, defined as the misalignment of the eyes, is a common disorder that is usually diagnosed in childhood. Strabismus is an important health problem with both functional and psychosocial effects on children. In this study, we aimed to determine the clinical features and risk factors of patients diagnosed with strabismus and followed up in our clinic.
METHODS: The data of pediatric patients who were followed up in our strabismus clinic between February 2016 and September 2022 were retrospectively reviewed. The patients’ detailed ophthalmological and strabismus examination findings and anamnesis findings concerning the etiology of strabismus were recorded.
RESULTS: A total of 391 patients were enrolled in the study. The mean age of the patients was 8.66±4.7 years. Of the patients, 207 (52.9%) had esotropia, 172 (43.99%) had exotropia, and 12 (3.07%) had vertical deviation, with the mean ages of these groups being calculated as (7.27±4.1), (10.45±4.8), and (7.16±4.7) years, respectively. Amblyopia was present in 54 (26.09%) of the 207 esotropia cases, 27 (15.70%) of the 172 exotropia cases. Esotropia is more likely than exotropia to be related to amblyopia, according to our research. Of all the patients, 97 (24.81%) had a family history of strabismus, 38 (9.7%) had a history of preterm birth, 39 (10.0%) had a history of neonatal care unit stay, 38 (9.7%) had epilepsy, 4 (1%) had a history of trauma, and 14 (3.6%) had an additional eye disease.
CONCLUSION: Detection of risk factors such as family history, preterm birth, length of stay in the neonatal care unit and epilepsy that may be associated with strabismus can help identify high-risk children for early diagnosis and treatment.

AMAÇ: Kronik ruhsal bozukluklarda tedavi ve yönetimin temel amacý yaþam kalitesini iyileþtirmektir. Umutsuzluk, intihar riskiyle iliþkili önemli bir biliþsel incinebilirliði gösterir. Klinisyenlerin hastalarýnýn yaþam doyumu ve maneviyatý hakkýnda bilgi sahibi olmalarý önemlidir. Bu çalýþma, bir toplum ruh saðlýðý merkezinden hizmet alan hastalarda umutsuzluk ve yaþam doyumunu belirlemek amacýyla yapýldý.
GEREÇ VE YÖNTEM: Kesitsel türde olan araþtýrma, Türkiye'nin doðusunda bulunan bir hastanenin bünyesinde hizmet veren toplum ruh saðlýðý merkezinde DSM-5 ölçütlerine göre psikoz (n=66) ve bipolar bozukluk (n=24) tanýsý alan hastalar ile yürütüldü. Veriler Ocak-Mayýs 2019 tarihleri arasýnda bir psikiyatri uzmaný tarafýndan soru formu, Beck Umutsuzluk Ölçeði (BUÖ) ve Yaþam Doyumu Ölçeði (YDÖ) kullanýlarak yüz yüze görüþme yöntemi ile toplandý.
BULGULAR: Çalýþmada Hastalarýn BUÖ ve YDÖ puan ortalamasýnýn taný gruplarý arasýnda anlamlý fark oluþturmadýðý bulundu (p>0.05). Hastalarýn BUÖ ve YDÖ puan ortalamasý arasýnda negatif yönde orta düzeyde iliþki bulundu (rs= -0.450, p<0.001). Ayrýca ortaokul mezunu olanlarýn umutsuzluk düzeyinin düþük olduðu (p<0.05), hastalarýn yaþý ve taný süresi arttýkça BUÖ puan ortalamasýnýn arttýðý (p<0.001), taný süresi ile YDÖ puan ortalamasý arasýnda ise negatif yönde düþük düzeyde bir iliþki olduðu belirlendi (rs: -0.208; p<0.05).
SONUÇ: Bu çalýþmada hastalarýn umutsuzluk düzeyinin düþük, yaþam doyumlarýnýn orta düzeyde olduðu, umutsuzluk düzeyi arttýkça yaþam doyumlarýnýn azaldýðý bulundu. Ayrýca taný gruplarýna göre hastalarýn umutsuzluk ve yaþam doyumu düzeylerinin farklýlaþmadýðý belirlendi. Ruh saðlýðý profesyonelleri hastalarýn iyileþmesinde temel olan umut ve yaþam doyumu gibi hususlarý dikkate almalarý son derece önemlidir. (NCI-2022-6-22)

OBJECTIVE: The main purpose of treatment and management in chronic mental disorders is to improve the quality of life (QOL). Hopelessness indicates a significant cognitive vulnerability that is associated with suicide risk. It is important for clinicians to have information about their patients’ life satisfaction and spirituality. This study was conducted to determine hopelessness and life satisfaction in patients who received service from a community mental health center (CMHC).
METHODS: This cross-sectional study was conducted with patients diagnosed with psychosis (n=66) and bipolar disorder (n=24) according to Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) criteria, at a community mental health center serving in a hospital located in eastern Turkiye. Data was collected by a psychiatrist between January and May 2019 with face-to-face interviews, using a questionnaire, Beck Hopelessness Scale (BHS) and Satisfaction with Life Scale (SWLS).
RESULTS: In the study, it was found that the mean BHS and SWLS scores of the patients did not differ significantly between the diagnosis groups (p>0.05). A moderately negative correlation was found between the patients’ mean BHS and SWLS scores (rs=-0.450, p<0.001). In addition, it was determined that the hopelessness level of the secondary school graduates was low (p<0.05), the mean BHS score increased as the age and time from diagnosis of the patients increased (p<0.001), and there was a low negative correlation between the time from diagnosis and the mean SWLS score (rs: -0.208; p<0.05).
CONCLUSION: In this study, it was found that the hopelessness level of the patients was low, their life satisfaction was moderate, and as the hopelessness level increased, their life satisfaction decreased. In addition, it was determined that the hopelessness and life satisfaction levels of the patients did not differ by to the diagnosis groups. It is extremely important for mental health professionals to consider aspects such as hope and life satisfaction, which are key in the recovery of patients.

Amaç: Malign plevral mezotelyoma (MPM) hastalarýnda, helikal tomoterapi (HTT) ile uygulanan hemitorasik radyoterapinin etkinlik ve toleransýný belirlemek amaçlandý.
Yöntem: Ekim 2018- Aralýk 2020 tarihleri arasýnda akciðer koruyucu cerrahi (plörektomi-dekortikasyon, P/D), kemoterapi ve HTT'yi içeren trimodalite tedavinin uygulandýðý 11 MPM hastasýna ait veriler retrospektif olarak incelendi. Tüm hastalara P/D'den sonra adjuvan kemoterapi (sisplatin+pemetreksed, 3-6 kür) ve ardýndan radyoterapi uygulandý. Radyoterapi, HTT cihazýyla günlük 1,8-2 Gy’lik dozlarla toplam 30 Gy-50- 54 Gy, R2 hastalýða 59,4-60 Gy uygulandý. Tanýmlayýcý veriler medyan±StdD (minimum-maksimum) olarak belirtildi. Saðkalým verileri Kaplan-Meier yöntemi ile hesaplandý. Toksisite geliþen hastalarda risk organ dozlarý Mann Whithey U testi ile karþýlaþtýrýldý.
Bulgular: Medyan takip süresi 20,5 (12-30) ay, iki yýllýk lokal kontrol, hastalýksýz ve genel saðkalým sýrasýyla %48,5, %49 ve %77,9 bulundu. Planlanan hedef hacime (PTV) medyan 50,4±8,7 (30-60) Gy uygulandý. Total akciðer ortalama dozu (Dmean) 19,9±6 (10.4-26) Gy; ipsilateral ve kontralateral akciðerlerin V20 (%) deðerleri sýrasýyla 89,4±11,2 (62,7-100) ve 0,7±2,1 (0-5,9) bulundu. Özofagus Dmean ve maksimum dozlarý (Dmaks) sýrasýyla 21,7±8,4 (7,5-34) ve 53,1±10,4 (25,4-64,4); kalbin V30 (%) ve Dmean deðerleri sýrasýyla 22,3±13,4 (3,9-47), 21±5,7 (10,8-29,3) Gy bulundu. Medulla spinalis (MS) Dmax dozu 38,6± 1,3 (13,7-48) Gy saptandý. Grad 1-2 toksisite olarak 4 (%36,4) hastada, radyasyon pnömonisi (RP), 2 (%18,2) hastada özofajit geliþti. RP, MS ve özofagus dozlarý ile iliþkili bulundu (p<0.05). Bir hastada (%9,1) miyelit geliþti (MS Dmax: 29 Gy).
Sonuç: Hemitorasik HTT, kabul edilebilir toksisite oranlarýyla MPM hastalarýnýn trimodalite tedavisinin bir parçasý olarak uygulanabilir. Radyasyon pnömonitis riski için MS ve özofagus dozlarý da göz önünde bulundurulmalý ve bu organlar özellikle de MS için yeni doz limitleri tanýmlanmalýdýr. (NCI-2023-2-2)

OBJECTIVE: The purpose of this study was to determine the efficacy and tolerability of hemithoracic radiotherapy implemented with helical tomotherapy (HTT) in malignant pleural mesothelioma (MPM) patients.
METHODS: Between October 2018 and December 2020, data from 11 MPM patients who received trimodality therapy, including lung-sparing surgery (pleurectomy-decortication, P/D), adjuvant chemotherapy (cisplatin+ pemetrexed), and radiotherapy, were retrospectively reviewed. HTT was used to deliver a total of 30 Gy, 50–54 Gy or 59.4–60 Gy to R2 disease with 1.8–2 Gy daily doses. Descriptive data are presented in number (percentage) or median (minimum– maximum). The Kaplan-Meier method was used to calculate survival data. In patients with toxicities, the risk organ doses were compared using the Mann-Whitney U test.
RESULTS: The median follow-up was 20.5 (12–30) months. Two-year local control, disease-free, and overall survival rates were 48.5%, 49%, and 77.9%, respectively. The median prescribed dose for planning target volume (PTV) was 50.4±8.7 (30–60) Gy. Mean dose (Dmean) of total lung was 19.9±6 (10.4–26) Gy; the V20 (%) of ipsilateral and contralateral lungs were 89.±11.2 (62.7–100) and 0.7±2.1 (0.49–5.9), respectively. Esophageal Dmean and maximum doses (Dmax) were found as 21.7±8.4 (7.4–34) and 53.1±10.4 (25.4–64.4) Gy, respectively. V30 (%) and Dmean of heart were 22.3%±13.4% (3.9–47) and 21±5.7 (10.8–29.3) Gy, respectively. Dmax of medulla spinalis (MS) was 38.6± 1.3 (13.7–48) Gy. Grade 1–2 radiation pneumonitis (RP) developed in 4 (36.4%) and esophagitis in 2 (18.2%) patients. RP was found to be associated with MS and esophageal doses (p<0.05). Myelitis was diagnosed in 1 (9.1%) patient (MS Dmax: 29 Gy).
CONCLUSION: HTT can be used as part of trimodality therapy for MPM patients with acceptable toxicities. MS and esophageal doses should be considered for radiation pneumonitis risk, and new dose constraints for these organs should be defined.

Amaç: Bu çalýþmanýn amacý peripartum depresyon ile sosyal destek, evlilik doyumu ve benlik farklýlaþmasý arasýndaki iliþkiyi incelemektir.
Yöntemler: Bu kesitsel çalýþma, 28 Aralýk 2021 ve 31 Mart 2022 tarihleri arasýnda doðum yapmýþ kadýnlar üzerinde yapýlmýþtýr. Doðum yapmýþ kadýnlar, sosyodemografik özellikleri, obstetrik öykü ve psikometrik araçlarý deðerlendiren bölümlerden oluþan bir anket kullanýlarak deðerlendirildi: Edinburgh Postpartum Depresyon Ölçeði (EPDS), Evlilik Hoþnutsuzluðu Ölçeði (MDS), Çok Boyutlu Algýlanan Sosyal Destek Ölçeði (MSPSS) ve Benliðin Farklýlaþmasý Envanteri (DSI).
Bulgular: Çalýþmaya toplam 425 anne dahil edildi. Bunlardan 140 (%32,9) anne EPDS'den ≥13 puan ve 285 (%67,1) anne ≤12 puan almýþtýr. EPDS'de ≥13 puan alan annelerin evlilik doyumsuzluðu puanlarýnýn anlamlý derecede yüksek olduðu bulundu. EPDS'den ≤12 puan alan annelerde aile desteði, arkadaþ desteði, duygusal kesme, baþkalarýyla kaynaþma ve benliði farklýlaþtýrma toplam puanlarý daha yüksekti. Baþkalarýyla anlamlýlýk, duygusal tepkisellik ve ben pozisyonu açýsýndan iki grup arasýnda anlamlý bir fark yoktu.
Sonuç: Bu çalýþma, evlilik doyumunun hem doðrudan hem de aile desteði ve duygusal kesinti yoluyla perinatal depresyon geliþiminde önemli olduðunu bulmuþtur. Bununla birlikte aile desteði, arkadaþ desteði ve benlik farklýlaþmasý olan annelerin EPDS puanlarý nispeten daha düþükken, evlilikten memnuniyetsizliði olan annelerin EPDS puanlarý daha yüksek olarak bulunmuþtur. (NCI-2022-12-26)

OBJECTIVE: The aim of the study was to investigate the relationship between peripartum depression and social support, marital satisfaction, and self-differentiation.
METHODS: This cross-sectional study was conducted on postpartum women from December 28, 2021, and March 31, 2022. Postpartum women were evaluated using a questionnaire consisting of sections assessing sociodemographic characteristics, obstetric history, and psychometric instruments: Edinburgh Postpartum Depression Scale (EPDS), Marital Disaffection Scale (MDS), Multidimensional Scale of Perceived Social Support (MSPSS), and Differentiation of Self Inventory (DSI).
RESULTS: A total of 425 mothers were included in the study. Of those, 140 (32.9%) mothers scored ≥13 points on EPDS, and 285 (67.1%) mothers scored ≤12 points. Mothers who scored ≥13 on the EPDS were found to have significantly higher scores for marital dissatisfaction. Total scores of family support, friend support, emotional cutoff, fusion with others, and differentiation of self were higher in mothers who scored ≤12 points on the EPDS. There was no significant difference between the two groups in terms of significance with others, emotional reactivity and I position.
CONCLUSION: This study found that marital satisfaction is important in the development of perinatal depression both directly and through family support and emotional cuttoff. In addition, mothers with family support, friend support, and self-differentiation had comparatively lower EPDS scores, while mothers with marital dissatisfaction had higher EPDS scores.

AMAÇ: Covid-19 enfeksiyonu sýrasýnda geliþen sitokin fýrtýnasý olarak tanýmlanan hiperinflamatuar durumu kontrol altýna almak için bazý anti-sitokin tedaviler test edilmektedir. Bu çalýþmada, IL-1 antagonisti anakinranýn hastanede yatan Covid-19 enfeksiyonu olan hastalarýn klinik durumlarý ve laboratuvar deðerleri üzerindeki etkilerini araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Bu çalýþma retrospektif bir çalýþma olup çalýþmaya dahil edilen Kasým 2020-Ocak 2021 tarihleri arasýnda Covid-19 enfeksiyonu nedeniyle anakinra tedavisi alan toplam 66 hastasýnýn yaþý, cinsiyeti ve mevcut komorbiditeleri analiz edildi. Oksijen gereksinimi miktarý (L/sn), oksijenin veriliþ þekli, oksijen satürasyonu, radyolojik görüntüler, lökosit (WBC) sayýsý, lenfosit sayýsý, nötrofil sayýsý, C-reaktif protein (CRP), laktat dehidrogenaz (LDH), ferritin, fibrinojen, D-dimer sonuçlarý deðerlendirildi (anakinra tedavisi öncesi ve sonrasý). Hastalarýn hastanede yatýþ süreleri, oksijen ihtiyacý ve taburculuk þekli deðerlendirildi. Erken anakinra tedavisinin (semptom baþlangýcýndan itibaren dokuzuncu gün öncesi ve sonrasý) prognoz üzerindeki etkileri deðerlendirildi. Ýstatistiksel analiz için ABD’nin Chicago þehrindeki IBM Firmasý tarafýndan üretilen SPSS 21.0 sürümü kullanýldý ve p <0.05 anlamlý kabul edildi.
BULGULAR: 66 hastanýn prognozunda anlamlý cinsiyet farký saptanmadý. Komorbiditeli hastalarda istatistiksel olarak anlamlý fark saptandý (p=0.004). Anakinra tedavisine daha erken baþlayan hastalarýn yoðun bakýma daha az ihtiyacý oldu ve mortalite oranlarý düþüktü (p=0.019). Anakinra tedavisi uygulandýktan sonra WBC (p=0,045), nötrofil (p=0,016), lenfosit (p=0,001), LDH (p=0,005), ferritin (p=0,02) ve fibrinojen (p=0,01) düzeylerinde anlamlý düzelme saptandý.
SONUÇ: Sonuç olarak, makrofaj aktivasyon sendromu bulgularý gösteren Covid-19 hastalarýnda anakinra tedavisinin erken ve uygun kullanýmýnýn, hastalarda oksijen desteði ihtiyacýný azalttýðýný, laboratuvar deðerlerinde iyileþmeye ve radyolojik iyileþmeye katkýda bulunduðunu ve en önemlisi yoðun bakým ihtiyacýný azalttýðýný tespit ettik. (NCI-2022-8-5)

OBJECTIVE: Some anti-cytokine treatments are being used to control the hyperinflammatory condition defined as cytokine storm that develops during COVID-19 infection. In this study, we aim to investigate the effects of anakinra, an IL-1 antagonist, on the clinical status and laboratory values of hospitalized patients with the COVID-19 infection. The aim of the study was to investigate the effects of anakinra, an IL-1 antagonist, on the clinical and laboratory results of hospitalized patients with COVID-19 infection.
METHODS: This study was planned as a retrospective study. The age, gender, and current comorbidities of a total of 66 patients who were treated with anakinra for COVID-19 infection from November 2020 to January 2021 were analyzed. The amount of oxygen demand (L/s), the type of oxygen supplementation, oxygen saturation, radiological findings, WBC count, lymphocyte count, neutrophil count, C-reactive protein, LDH, ferritin, fibrinogen, D-dimer levels were monitored before the treatment, and after the anakinra treatment, newly gathered results were compared. Patients’ hospitalization period, oxygen need, and their clinical status at discharge were evaluated. The effects of early anakinra treatment (9 days before and after the onset of symptoms) on the prognosis were evaluated. SPSS version 21.0 provided by IBM Company in the USA, Chicago, IL was used for statistical analysis and p<0.05 was considered significant.
RESULTS: Sixty-six patients were included in the study. There was no significant gender difference in the prognosis of the patients. There was a significant difference in the statistical deterioration in patients with comorbidities (p=0.004). Patients who started the anakinra treatment at an early stage developed less need for intensive care and low mortality ratios (p=0.019). There were significant improvements on the levels of WBC (p=0.045), neutrophils (p=0.016), lymphocyte (p=0.001), LDH (p=0.005), ferritin (p=0.02), and fibrinogen (p=0.01) after the administration of anakinra therapy.
CONCLUSION: We found that earlier and appropriate use of anakinra therapy in COVID-19 patients with the signs of macrophage activation syndrome reduces the need for oxygen support in patients and contributes to improvement in laboratory results and radiological findings, and most importantly reduces the need for intensive care.

Giriþ: Bu çalýþmada, online eðitim sýnýflarýnda Dikkat Eksikliði / Hiperaktivite Bozukluðu (DEHB) olan Türk çocuk ve ergenlerinin dikkat düzeylerinin saðlýklý kontrollerle karþýlaþtýrýlmasý amaçlanmýþtýr.
Yöntem: Bu çalýþma, sekiz merkezden DEHB tanýsý alan ve tedavi ve saðlýklý kontrolleri alan 6-18 yaþ arasý hastalarý içeren, kesitsel, internet tabanlý, vaka-kontrol çalýþmasýdýr. Çalýþmada kullanýlan ölçümler google anketinde hazýrlanmýþ ve Whatsapp uygulamasý üzerinden katýlýmcýlara ulaþtýrýlmýþtýr.
Bulgular: Çalýþma dönemi içerisinde 510 DEHB'li çocuk ve 893 kontrol alýnmýþtýr. COVID-19 salgýný nedeniyle online eðitim dersleri sýrasýnda her iki grupta ebeveynlerin deðerlendirdiði dikkat düzeyleri önemli ölçüde azalmýþtýr (p <0.001; her biri için). Ebeveyn raporlarýna göre DEHB olan çocuk ve ergenlerde kontrol çocuklarýna göre uyku zamaný direnci anlamlý olarak artmýþ, aile iþlevsellik güçlüðü sorunlarý vardý (sýrasýyla p = 0,003; p <0,001). Ayrýca, yatma zamaný direnci ve komorbidite, online eðitimde dikkat düzeylerini anlamlý þekilde yordamýþtýr.
Sonuç: Bulgularýmýz, hem dikkat problemi olmayan hem de DEHB olan çocuklar için online eðitime öðrenci katýlýmýný artýrma ihtiyacýnýn altýný çizebilir. Çocuklarda uyku güçlüklerinin yönetiminde etkili olduðu gösterilen müdahaleler ile ebeveyn yönetimi müdahaleleri çevrimiçi eðitim süresince devam etmelidir. (NCI-2021-2-34/R2)

OBJECTIVE: This study aimed to compare the attention levels, of Turkish children and adolescents with Attention Deficit/Hyperactivity Disorder (ADHD) in on-line education classes with healthy controls.
METHODS: This study is a cross-sectional, internet-based, case-control study that recruited 6–18 years old patients diagnosed with ADHD and receving treatment and healthy controls from eight centers. The measurements used in the study were prepared in the google survey and delivered to the participants via Whatsapp application.
RESULTS: Within the study period, 510 children with ADHD and 893 controls were enrolled. Parent- rated attention decreased significantly in both groups during on-line education classes due to COVID-19 outbreak (p<0.001; for each). Children and adolescents with ADHD had significantly elevated bedtime resistance, problems in family functioning difficulties than control children according to parental reports (p=0.003; p<0.001; p<0.001, respectively). Furthermore, bedtime resistance and comorbidity significantly predicted attention levels in on-line education.
CONCLUSION: Our findings may underline the need to augment student engagement in on-line education both for children without attention problems and those with ADHD. Interventions shown to be effective in the management of sleep difficulties in children as well as parent management interventions should continue during on-line education.

Giriþ: Bu çalýþmada, mitral kapak prolapsus (MVP) Sendromu olan ve olmayan olgularda ventriküler ve supraventriküler aritmi insidansýný karþýlaþtýrmak ve mitral kapak prolapsus sendromlu hastalarda ventriküler aritmiler ile repolarizasyon parametreleri arasýnda bir iliþki olup olmadýðýný araþtýrmak amaçlanmýþtýr.
Yöntem: Bu kesitsel çalýþmaya MVP Sendromlu 41 hasta ve çarpýntýsý olan ancak MVP'si olmayan 41 kiþi (kontrol grubu) alýndý. Repolarizasyon anormalliklerini, yapýsal anormallikleri ve supraventriküler ve ventriküler aritmileri tanýmlamak için tüm hastalara 12-lead elektrokardiyogram, transtorasik ekokardiyografi ve 24 saatlik Holter monitörizasyonu yapýldý. QRS geniþliði, QTc aralýðý ve Tpeak - Tend aralýklarý her hasta için ölçüldü.
Bulgular: PVC, couplet ve NSVT yaþayan hasta sayýsý, MVP grubunda kontrol grubuna kýyasla anlamlý olarak daha yüksekti. Sol ventrikül sistol sonu ve diyastol sonu çapý ve sol atriyal çap da MVP grubunda kontrol grubuna göre anlamlý olarak daha yüksekti. QRS geniþliði ve Tpeak-Tend interval aralýðý da MVP'li hastalarda kontrol grubuna göre anlamlý olarak daha yüksek izlendi. Korelasyon analizi, Mitral yetersizliði (MY) ciddiyetinin PVC ve couplet sayýsý ile pozitif korelasyon gösterdiðini ortaya çýkarmýþtýr; LA çapý, PVC'lerin ve NSVT'lerin sayýsý ile önemli ölçüde korelasyon gösterdi.
Sonuç: MVP Sendromlu kiþilerde, MVP'si olmayanlara göre PVC'ler, coupletler ve NSVT'ler dahil olmak üzere ventriküler aritmiler daha sýk görülmektedir. LVESD, LVEDD, LA çapý, QRS geniþliði ve Tpeak-Tend aralýðý MVP'si olmayanlara göre MVP hastalarýnda artmýþtýr. MY ve LA çapýnýn ciddiyeti, PVC'lerin, coupletlerin veya NSVT'lerin sýklýðý ile iliþkilidir. (NCI-2021-1-47/R1)

OBJECTIVE: The aim of present study is to compare ventricular and supraventricular arrhythmia incidences in subjects with and without mitral valve prolapse (MVP) syndrome and to examine if an association exists between ventricular arrhythmias and repolarization parameters in patients with MVP syndrome.
METHODS: This cross-sectional study involved 41 subjects with MVP Syndrome and 41 subjects with palpitation but without MVP (control group). All subjects were subjected to lead-electrocardiogram, transthoracic echocardiography, and 24-h Holter monitoring to identify repolarization abnormalities, structural abnormalities, and supraventricular and ventricular arrhythmias. The QRS width, QTC interval, and Tpeak-Tend intervals were measured for each participant.
RESULTS: The number of subjects who had premature ventricular contractions (PVCs), couplets, and non-sustained ventricular tachycardia (NSVTs) was significantly higher in the MVP group compared to the control group. Left ventricular endsystolic diameter (LVESD) and left ventricular end-diastolic diameter (LVEDD) and left atrial diameter were also significantly higher in the MVP group than the control group. QRS width and Tpeak-Tend interval were also significantly higher in subjects with MVP than the controls. Correlation analysis showed a positive correlation between the severity of mitral regurgitation (MR) and the number of PVCs and couplets, while there was a significant correlation between left atrium (LA) diameter and the number of the PVCs and NSVTs.
CONCLUSION: Subjects with MVP experience ventricular arrhythmias more often including PVCs, couplets, and NSVTs compared to subjects without MVP. LVESD, LVEDD, LA diameter, QRS width, and Tpeak-Tend interval were increased in MVP subjects than those without MVP. There is an association between the severity of the MR and the frequency of the PVCs, couplets, or NSVTs.

Giriþ: 4. National Audit Project’te ciddi havayolu komplikasyonu insidansý 1/22.000 olarak bildirilmektedir. Zor havayolu rehberlerinde zor entübasyon durumunda çeþitli kurtarýcý yöntemler önerilmektedir. Bu çalýþmamýzda baþarýsýz direkt laringoskopi sonrasý kurtarýcý tekniklerin baþarýsýný ve zor havayolu durumunda potansiyel komplikasyonlarýný analiz etmeyi amaçladýk.
Materyal ve metot: Çalýþma çok merkezli, prospektif, gözlemsel bir çalýþma olarak planlandý. Çalýþmaya günlük ameliyathane rutininde fiberoptik bronkosopi ve videolaringoskopi kullanan dört üniversite hastanesi dahil edildi. Genel anestezi altýnda operasyona alýnan hastalardan, beklenen ya da beklenmeyen zor entübasyon olgularý çalýþmaya dahil edildi. Tercih edilen kurtarýcý teknikler, direkt ve indirekt laringoskopi giriþimleri kayýt altýna alýndý.
Bulgular: Ortalama yaþý 46.58 ± 21.19 olan 92 hasta çalýþmaya dahil edildi. En yaygýn kullanýlan kurtarýcý yöntem videolaringoskopi, ve en çok tercih edilen videolaringoskop glidescope olarak tespit edildi. Tüm merkezlerde ilk laringoskopi giriþimi asistanlar tarafýndan ve ikinci giriþim anestezi uzmanlarý tarafýndan uygulandý. Öngörülen zor entübasyon grubunda, ilk direkt laringoskopiyi uygulayan asistanlarýn kýdemi, istatistiksel olarak anlamlý derecede yüksekti(4.0 ± 5.5 years) (p=0.045). Ýlk kurtarýcý teknik için giriþim sayýsý, öngörülemeyen zor entübasyon grubunda ve öngörülen zor entübasyon grubunda sýrasýyla 2.0 ± 2.0 ve 1.0 ± 1.0 olarak tespit edildi. (p=0.004).
Tartýþma: Videolaringoskopun öngörülen ve öngörülemeyen zor entübasyon olgularýnda en yaygýn tercih edilen kurtarýcý teknik olmuþtur. Glidescope ise hem öngörülen hem öngörülemeyen zor entübasyon olgularýnda yüksek baþarý oraný ile en çok tercih edilen videolaringoskop olmuþtur. (NCI-2021-5-9/R1)

OBJECTIVE: The Fourth National Audit Project revealed that severe airway complications occur in the frequency of 1/22,000. Various rescue techniques were recommended in difficult airway guidelines. This study aims to evaluate the rescue techniques following failed direct laryngoscopy and analyze the success rates and potential complications during difficult airway management.
METHODS: This was a multicenter and prospective observational study carried out in four referral centers. Four academic university hospitals using fiberoptic bronchoscopy and videolaryngoscopy in their daily practice were included in the study. Patients undergoing general anesthesia with anticipated or unanticipated difficult intubation were enrolled. The preferred rescue technique and the attempts for both direct and indirect laryngoscopies were recorded.
RESULTS: At the mean age of 46.58±21.19 years, 92 patients were analyzed. The most common rescue technique was videolaryngoscopy following failed direct laryngoscopy. Glidescope was the most preferred videolaryngoscope. Anesthesia residents performed most of the first tracheal intubation attempts, whereas anesthesia specialists performed the second attempts at all centers. The experience of the first performer as a resident was significantly higher in the anticipated difficult airway group (4.0±5.5 years) (p=0.045). The number of attempts with the first rescue technique was 2.0±2.0 and 1.0±1.0 in the unanticipated difficult airway and anticipated difficult airway groups, respectively (p=0.004).
CONCLUSION: Videolaryngoscopy was a more commonly preferred technique for both anticipated and unanticipated difficult intubations. Glidescope was the most used rescue device in difficult intubations after failed direct laryngoscopy, with a high success rate.

AMAÇ: Bu çalýþmanýn amacý, gebelikte hipertansif bozukluðu olan, ve sezaryen sonrasý tromboemboli profilaksisi yapýlan yadsa yapýlmayan hastalarda tromboembolik olay oluþma insidansýnýn karþýlaþtýrýlmasýdýr.
METOD: Gebelikte hipertansiyon tanýsý olan ve 2012-2018 yýllarý arasýnda sezaryene alýnmýþ 386 hasta dahil edilmiþtir. Hastalar gebeliðin hipertansif bozukluðu çeþidine göre ve tromboemboli profilaksisi yapýlýp yapýlmamasýna göre gruplara ayrýlýp, tromboembolik olay ve diðer gebelik sonuçlarý açýsýndan karþýlaþtýrýlmýþtýr.
BULGULAR: Gruplar arasý sonuçlar karþýlaþtýrýldýðýnda 210 tromboprofilaksi yapýlmamýþ hastada 11 tromboembolik olay (%5) izlenirken, tromboprofilaksi yapýlmýþ 176 hastada sadece 2 hastada (%1) tromboembolik olay saptanmýþtýr (p<0.05).
SONUÇ: Gebelikte tromboemboliye yatkýnlýk artmýþtýr. Gebeliðe eþlik eden hipertansiyon varlýðýnda insidans artmaktadýr. Çalýþmamýzda gebeliðe eþlik eden hipertansif bozukluklarda tromboemboli için yapýlan profilaksinin önemi vurgulanmýþtýr. (NCI-2021-4-30/R1)

OBJECTIVE: This study aims to compare the effect of thromboembolic prophylaxis in patients diagnosed with hypertensive disorders of pregnancy undergoing cesarean section.
METHODS: Three hundred and eighty-six patients were included in the study. The patients were divided into groups according to the type of hypertensive disorders of pregnancy and whether thromboembolism prophylaxis was applied or not. The thromboembolic event incidence and other pregnancy outcomes were compared.
RESULTS: Nonadministration of thromboprophylaxis was recorded in 210 patients. Eleven patients had thromboembolic events (5%). Among 176 patients who received thromboprophylaxis, only two patients (1%) had a thromboembolic event (p<0.05).
CONCLUSION: There is an increased tendency to thromboembolism in pregnancy. The incidence increases in the presence of hypertension accompanying pregnancy. In our study, the importance of thromboembolism prophylaxis on peri-postnatal complications in patients with hypertensive disorders of pregnancy was emphasized.

Amaç: Çocuklarda romatizmal hastalýklar, kronik multisistemik hastalýklardýr. Bu çalýþmada otoimmün veya otoinflamatuvar romatizmal hastalýðý olan çocuklarda gastrointestinal endoskopik bulgularýn deðerlendirilmesi amaçlandý.
Yöntem: Çocuk Romatoloji Bölümü tarafýndan takip edilen ve gastrointestinal þikayetleri nedeniyle Çocuk Gastroenteroloji Bölümü'ne konsülte edilen hastalar çalýþmaya dahil edildi. Hastalarýn dosya kayýtlarý geriye dönük olarak incelendi.
Bulgular: Çalýþmaya toplam 28 hasta dahil edildi. Hastalarýn on ikisinde otoimmün hastalýk (juvenil idiopatik artrit, sistemik lupus eritematozis, Sjögren sendromu, skleroderma) ve diðer 16'sýnda otoinflamatuvar hastalýk (ailevi Akdeniz ateþi, hiper IgD sendromu, tanýmlanmamýþ sistemik otoinflamatuvar hastalýk, sistemik juvenil idiopatik artrit) vardý. Ailevi Akdeniz ateþli hastalarýn dördü ayrýca juvenil idiopatik artrit tanýsý aldý. Hastalarýn ortalama yaþý 11.7 + 3.5 yýl idi. Hem otoimmün hem de otoinflamatuvar hastalýðý olan hastalarýn baþlýca gastrointestinal þikayetleri karýn aðrýsý ve ishaldi. Endoskopik deðerlendirme yapýlan hastalardan otoimmün hastalýðý olanlarýn %33'ünde ve otoinflamatuvar hastalýðý olanlarýn % 56'sýnda inflamatuvar barsak hastalýðý saptandý. Gastrointestinal þikayetlerle baþvuran otoinflamatuvar hastalýklý hastalarýn % 62'sinde M694V mutasyonu vardý.
Sonuç: Hem otoimmun hem de otoinflamatuvar romatizmal hastalýklar gastrointestinal þikayetlere neden olabilir ve erken taný için bir çocuk gastroenterolojisi uzmanýna sevk edilmelidir. (NCI-2021-3-47/R2)

OBJECTIVE: Rheumatic diseases in children are chronic and multisystemic diseases. In this study, it was aimed to evaluate gastrointestinal endoscopic findings in children diagnosed as autoimmune or autoinflammatory rheumatic diseases consulted with pediatric gastroenterology for gastrointestinal complaints.
METHODS: The patients followed up by the Pediatric Rheumatology Department and consulted to the Pediatric Gastroenterology Department due to gastrointestinal complaints were included in the study. File records of the patients were analyzed retrospectively.
RESULTS: A total of 28 patients were included in the study. Twelve of the patients had autoimmune disease (Juvenile idiopathic arthritis [JIA], systemic lupus erythematosus, Sjögren’s syndrome, and scleroderma) and the other 16 had autoinflammatory disease (familial Mediterrnean fever, hyper Immunoglobulin D syndrome, undifferantiated systemic autoinflammatory disease, and systemic JIA). Four of the patients with familial Mediterrnean fever also diagnosed as JIA. The mean age of the patients was 11.7±3.5 years. The main gastrointestinal complaints of patients with both autoimmune and autoinflammatory diseases were abdominal pain and diarrhea. Inflammatory bowel disease was found in 33% of those with autoimmune disease and 56% of those with autoinflammatory disease in patients underwent endoscopic evaluation. M694V mutation was present in 62% of the patients with autoinflammatory disease presented with gastrointestinal complaints.
CONCLUSION: Both autoimmune and autoinflammatory rheumatic diseases can cause gastrointestinal complaints and should be referred to a pediatric gastroenterologist for early diagnosis.

Amaç: Kliniðimizde akut romatizmal ateþ (ARA) tanýsý ile izlenen olgularýn demografik ve klinik bulgularý, ekokardiyografinin tanýdaki önemi, tedaviye yanýtlarý ve prognozlarýnýn deðerlendirilmesi amaçlandý.
Yöntemler: Ocak 2010- Ocak 2017 tarihleri arasýnda çocuk kardiyoloji kliniðinde 1992,2003 ve 2015 Jones ölçütlerine göre ARA tanýlý 6-17 yaþ arasý (ortalama 11.7±2.3yýl, K/E: 88/72) 160 takipli hasta geriye dönük deðerlendirildi.
Bulgular: Romatizmal kalp hastalýðý (RKH) olan 104 hastanýn %.29.4’ünde (n=47) subklinik kardit saptandý. Subklinik kardit en sýk poliartraljili hastalarda (% 52,2) görülürken, klinik kardit en sýk kore (% 39) ve poliartrit (% 37,1) ile birlikte görüldü. Romatizmal ateþ hastalarýn %60’nýn (n=96) 10-13 yaþ arasýnda olduðu ve %31.3’nün (n=50) kýþ aylarýnda en sýk artralji ( %71.9), artrit (%53.1) ve istem dýþý hareketler (%25) baþvurduðu saptandý. Major bulgularýn birlikte görülme daðýlýmýna bakýldýðýnda; %35’inde (n=56) kardit+artrit ve %19.4’ünde (n=31) kardit+kore birlikteliði idi. Karditli olgularda en sýk tutulan kapak mitral (%63.8) ve aort kapak (%50.6) idi. Hastalarýn %44.4’ünde aort ve mitral yetmezlik birlikte tutulumu ve %18.8’inde izole mitral yetmezlik mevcuttu. Monoartrit ve poliartralji olgularýnda 2015 ve sonrasýnda anlamlý artma (p<0.05) ve bunlarýn da sýrasýyla %29.4 ve %52.2’sinde subklinik kardit görüldü. Karditli hastalarýn %70.4’ünde ilk 1 yýl içerisinde kapak bulgularýnda gerileme gözlenirken, yaklaþýk 7 yýllýk izlemde bu oranýn %4.2 düþtüðü saptandý. Kardite eþlik eden artrit veya korea varlýðýnda izlemde RKH anlamlý yüksek kaydedildi. Hastalarýn %30’unda (n=48) tekrarlayan atak ilk bir yýl içinde gözlenirken, klinik ve subklinik sýklýðý açýsýndan anlamlý fark yoktu. Ýlk ataðýnda kardit olmayan olgularda, rekürrens oraný %18.2 saptanýrken; bu oran hafif karditte %18.2, orta karditte %36.4 ve aðýr karditte %27.2 idi. Klinik karditli ve proflaksiye uyumlu astalarda; subklinik kardit ve proflaksiye uyumsuz hastalara göre kapak bulgularýnda gerileme oraný anlamlý düþüktü.
Sonuç: Çalýþmamýzda ekokardiyografinin ARA’lý hastalarda taný ölçütleri içinde yer almasýný, özelliklede subklinik karditin kalýcý RKH riski taþýdýðý saptanmýþtýr. Sekonder proflaksi uyumsuzluðunun rekürren ARA geliþiminde önemli belirleyici faktör olduðu ve proflaksinin eriþkin yaþtaki RKH olan birey sayýsýnýn ve olasý komplikasyonlarýn azalmasýna katký saðlanabilir. (NCI-2021-3-48/R2)

OBJECTIVE: This study aims to evaluate the demographic and clinical findings of acute rheumatic fever (ARF) patients followed up in our clinic, their responses to treatment, and prognoses and to determine the clinical utility of echocardiography (ECHO) in the diagnosis of ARF.
METHODS: We retrospectively evaluated the data of 160 patients with ARF (6–17, mean 11.7±2.3 years, F/M: 88/72) that was diagnosed according to the Jones criteria and followed up in the pediatric cardiology clinic between January 2010 and January 2017.
RESULTS: About 29.4% (n=47) of 104 patients with rheumatic heart disease (RHD) had subclinical carditis. It was observed that subclinical carditis was most common in patients with polyarthralgia (52.2%); in contrast, clinical carditis was most commonly observed together with chorea (39%) and polyarthritis (37.1%). It was found that 60% (n=96) of the patients with rheumatic fever were between the ages of 10–13 and 31.3% (n=50) presented arthralgia most frequently in the winter months. The most common concomitant major symptoms were carditis + arthritis (35%) and carditis + chorea (19.4%). In patients with carditis, the most affected valves were mitral (63.8%) and aortic (50.6%) valves, respectively. The prevalence of monoarthritis, polyarthralgia, and subclinical carditis increased in cases diagnosed during and after 2015. The cardiac valve involvement findings of 71 of 104 patients (68.2%) with carditis improved during the approximately 7 years of follow-up. The regression of heart valve symptoms was significantly higher in patients with clinical carditis and those that complied with prophylaxis compared to patients with subclinical carditis and those that did not comply with prophylaxis.
CONCLUSION: We conclude that ECHO results should be included in the diagnostic criteria of ARF, and that subclinical carditis is associated with a risk of developing permanent RHD. Secondary prophylaxis non-compliance is significantly associated with recurrent ARF, and early prophylaxis can reduce the prevalence of RHD in adults and potential associated complications.

Giriþ: Kronik hastalýðý olan bireylerin zaman perspektifi çok az çalýþýlmýþ bir parametredir. Amacýmýz, multipl skleroz (MS) hastalarýnýn zaman perspektifini ve zaman perspektifini etkileyebilecek faktörleri incelemek ve geçmiþ, þimdiki ve gelecek perspektiflerinin korelasyonunu araþtýrmaktýr.
Yöntem: Hastaarýn demografik özellikler, Zimbardo Zaman Perspektif Envanteri (ZTPI) puaný ve Geniþletilmiþ Engellilik Durum Ölçeði (EDSS) puaný kaydedildi. Çalýþmaya toplamda 50 MS'li birey dahil edildi.
Bulgular: Hastalarýn Þimdiki-Kaderci (x = 3.18) ve Þimdiki-Hedonistik deðerleri (x = 3.49), (p =0.017) arasýnda anlamlý bir fark olduðunu bulduk; ayrýca Þimdiki-Kaderci (x = 3.18) ve gelecek (x = 3.57) arasýnda da (p = 0.011) anlamlý fark olduðunu tespit ettik. Cinsiyet, ikamet yeri, medeni durum, atak sayýsý ve eðitim düzeyinin ZTPI puanlarýnda anlamlý farklýlýk yoktu.
Sonuç: MS’li hastalar kaderci olmaktan ziyade hayatýn daha çok haz boyutuna odaklanmaktadýr. MS hastalarýnýn çoðunlukla geleceðe odaklandýðý sonucuna vardýk. Hastalarýmýzýn Þimdiki-Fatalistik puanlarýnýn en düþük ve Gelecek puanýnýn en yüksek zaman perspektifi boyutuna sahip olduðunu bulduk. (NCI-2021-1-38/R1)

OBJECTIVE: The time perspective of individuals with chronic disease is a little-studied parameter. Our aim is to examine multiple sclerosis (MS) patients’ time perspective and factors that may affect time perspective and to research the correlation of past, present, and future perspectives.
METHODS: Demographic characteristics, the Zimbardo Time Perspective Inventory (ZTPI) score, and the expanded disability status scale score were recorded. Overall, 50 with MS were included in the study.
RESULTS: We found that there was a significant difference between present-fatalistic (x=3.18), and present-hedonistic (x=3.49), (p=0.017); also between present-fatalistic (x=3.18), and future (x=3.57), (p=0.011). There was no significant difference in ZTPI scores between gender, place of residence, marital status, number of attacks, or education level.
CONCLUSION: MS patients focus mostly on the hedonistic dimension of the life than the fatalistic one in present time. We concluded that patients with MS focused mostly on the future. We found that our patients’ present-fatalistic scores were lower, and the future was higher time perspective dimension.

Giriþ: Pediatrik suprakondiler humerus kýrýklarý yönetimi zor, komplikasyon geliþme riski yüksek olan ve pediatrik dönemde yüksek oranda görülen kýrýk tiplerinden biridir. Kapalý redüksiyon ve perkütan pinleme, cerrahi tedavisinde en sýk kullanýlan yöntem olmakla birlikte, bazý durumlarda açýk redüksiyon uygulanmasý gerekebilmektedir. Bu çalýþmanýn amacý, açýk redüksiyonla tedavi edilen hastalarda lateral, medial ve posterior yaklaþýmýn fonksiyonel ve radyolojik sonuçlarýn karþýlaþtýrýlmasýdýr.
Metot: Toplam 86 hasta çalýþmaya dahil edildi. Lateral yaklaþým uygulanan 30 hasta grup 1, medial yaklaþým uygulanan 29 hasta grup 2 ve posterior yaklaþým uygulanan 27 hasta grup 3 olarak gruplandýrýldý. Açýk redüksiyon ve internal fiksasyon kullanýlarak yapýlan tedavinin klinik ve radyografik sonuçlarý deðerlendirildi. Kozmetik ve klinik sonuçlarýn deðerlendirilmesinde Flynn kriterleri kullanýldý. Bununla birlikte Baumann açýsý, lateral kapitellohumeral açý ve postoperatif komplikasyonlar açýsýndan gruplar arasýnda karþýlaþtýrma yapýldý.
Bulgular: Deðerlendirmeye alýnan komplikasyonlardan hiç birinde üç grup arasýnda istatistiksel olarak anlamlý bir fark olmayýp, en yüksek frekansta saptanan komplikasyon kübitus valgustur. Flynn kriterleri ile cerrahi yaklaþýmlar arasýnda istatistiksel açýdan anlamlý bir iliþki yoktur (p>0,05). Tüm cerrahi yaklaþýmlarda çok yüksek kozmetik ve fonksiyonel sonuçlar elde edilmiþtir. Postoperatif eklem hareket açýklýðý ile cerrahi yaklaþým arasýndaki iliþki deðerlendirildiðinde, hastalarýn hiç birinde ekstansiyon kusuru saptanmamýþtýr. Fleksiyon kusuruna sahip hasta sayýsý 7 kiþi olup, ortalama 8° kýsýtlýlýk saptandý. Yapýlan istatistiksel analizde postoperatif fleksiyon hareket açýklýðý ile cerrahi yaklaþým arasýndaki anlamlý iliþki saptanmýþtýr (p: 0,011).
Sonuç: Pediatrik suprakondiler humerus kýrýðý vakalarýnda kapalý redüksiyon ve perkütan çivileme tercih edilir. Ancak bu yöntem uygulanamadýðýnda, lateral ve medial ve posterior yaklaþým güvenle tercih edilebilecek açýk redüksiyon yöntemleridir. (NCI-2021-6-9/R1)

OBJECTIVE: The aim of this study was to compare the functional and radiological results of lateral, medial, and posterior surgical approaches in pediatric patients undergoing open reduction and internal fixation for supracondylar humerus fractures.
METHODS: A total of 86 patients were included in the study. The clinical and radiographic results of the treatment in patients who underwent open reduction and internal fixation with lateral, medial, and posterior approaches were evaluated. Flynn’s criteria were used in the evaluation of cosmetic and clinical results. Comparisons were made between the groups in terms of Baumann angle, lateral capitellohumeral angle, and post-operative complications.
RESULTS: There was no statistically significant difference between the three groups in terms of complications. No statistically significant relationship was observed between Flynn’s criteria and surgical approaches. When the relationship among post-operative range of motion (ROM) and surgical approach was evaluated, no extension defect was found in any of the patients, but a significant relationship was found between post-operative flexion ROM and surgical approach (p=0.011).
CONCLUSION: Closed reduction and percutaneous pinning are preferred in cases of pediatric supracondylar humerus fractures. However, when this method cannot be applied, lateral, medial, and posterior approaches are the possible open reduction methods, that can be safely preferred.

Amaç: Türkiye’deki majör torasik arter damar sistemi için normatif referans deðerleri belirlemek, yaþ ve cinsiyete göre damar çaplarýndaki farklýlýklarý deðerlendirmek.
Yöntemler: Mart-Haziran 2020 tarihleri arasýnda COVID-19 ön tanýsý nedeniyle çekilen düþük doz kontrastsýz toraks bilgisayarlý tomografi (BT) görüntüleri retrospektif olarak deðerlendirildi. Bilinen kronik akciðer parankim hastalýðý, plevral efüzyon, pnömotoraks, diyabet, hipertansiyon, obezite, kronik kalp hastalýklarý (koroner arter hastalýðý, ateroskleroz, konjestif kalp yetmezliði, kapak replasmaný, aritmi) gibi kronik hastalýklarý olan hastalar çalýþma dýþý býrakýldý. Çýkan aort çapý (ÇAÇ), inen aort çapý (ÝAÇ), aortik ark çapý (AAÇ), ana pulmoner arter çapý (APAÇ), sað pulmoner arter çapý (SaPAÇ), ve sol pulmoner arter çapý (SoPAÇ) standart yöntemlerle ayný kesitlerde ölçüldü. Parametrelerin yaþa (<40 yaþ; ≥40 yaþ) ve cinsiyete (kadýn;erkek) göre deðiþkenliði istatistiksel yöntemlerle deðerlendirildi. Normal daðýlýma uygun nicel verilen yaþ ve cinsiyete göre karþýlaþtýrýlmasý için Student-t test kullanýlýrken, normal daðýlýma uymayan veriler Mann Whitney U test ile karþýlaþtýrýldý. Verilerin normal daðýlýma uygunluklarý Kolmogorov-Smirnov, Shapiro-Wilk testi ve grafiksel incelemeler ile sýnandý.
Bulgular: Çalýþmaya dahil edilen 777 olgunun % 52,8'i (s: 410) erkek, % 47,2'si (s: 367) kadýndý. Çalýþma grubu 18-96 yaþ aralýðýnda olup genel ortalama yaþý 43.80 ± 15.98 idi. Ortalama çaplar ÇAÇ için 28.52 ± 5.13 mm, AAÇ için 30.83 ± 5.25 mm, ÝAÇ için 21.27 ± 3.57 mm; APAÇ için 23,27 ± 4,03 mm, SaPAÇ için 17,27 ± 3,19 mm ve SoPAÇ için 17,62 ± 3,06 mm idi. 40 yaþ üstü olgular için tüm damar çaplarýnda istatistiksel olarak anlamlý derecede daha yüksek deðerler elde edildi. Benzer þekilde erkeklerde tüm damar çaplarýnda kadýnlara göre daha yüksek deðerler elde edildi.
Sonuç: Tüm torasik ana vasküler yapýlarýn çaplarý erkeklerde kadýnlara göre daha büyüktür ve yaþla birlikte damar çaðlarý geniþlemektedir. (NCI-2021-5-3/R1)

OBJECTIVE: The aim of this study was to determine normative reference values for major thoracic arterial vasculature in Turkiye and to evaluate differences according to age and gender.
METHODS: Low-dose unenhanced chest computerized tomography images acquired with pre-diagnosis of COVID-19 between March and June 2020 were evaluated retrospectively. Patients with known chronic lung parenchymal disease, pleural effusion, pneumothorax, chronic diseases such as diabetes, hypertension, obesity, and chronic heart diseases (coronary artery disease, atherosclerosis, congestive heart failure, valve replacement, and arrhythmia) were excluded from the study. The ascending aorta diameter (AAD), descending aorta diameter (DAD), aortic arch diameter (ARCAD), main pulmonary artery diameter (MPAD), right pulmonary artery diameter (RPAD), and the left pulmonary artery diameter (LPAD) were measured in the same sections by standardized methods. The variability of parameters according to age (<40 years; ≥40 years) and gender (male to female) was evaluated by statistical methods. The Student’s t test was used to compare the normal distribution according to the given quantitative age and gender, while the data that did not fit the normal distribution were compared with the Mann-Whitney U test. The conformity of the data to the normal distribution was tested with the Kolmogorov-Smirnov, Shapiro-Wilk test, and graphical examinations.
RESULTS: Totally 777 cases between the ages of 18–96 (43.80±15.98) were included in the study. Among these, 52.8% (n=410) were male and 47.2% (n=367) were female. Mean diameters were 28.52±5.13 mm (12–48 mm in range) for AAD, 30.83±5.25 mm (12–52 mm in range) for ARCAD, DAD 21.27±3.57 mm (11–38 mm in range) for DAD; 23.27±4.03 mm (14–40 mm in range) for MPAD, 17.27±3.19 mm (10–30 mm in range) for RPAD, and 17.62±3.06 mm (10–37 mm in range) for LPAD. Statistically significantly higher values were obtained in all diameters for cases over 40 years of age. Similarly, higher values were obtained in all diameters for males compared to females.
CONCLUSION: The diameters of all thoracic main vascular structures are larger in men than in women and increase with age.

Giriþ: Seboreik dermatit (SD), klinik olarak kepekli yamalarla karakterize kronik, tekrarlayan enflamatuvar bir deri hastalýðýdýr. Kronik enflamasyonlu deri hastalýklarýnýn metabolik sendrom, obezite, kardiyovasküler hastalýklar (KVH) ve diyabet gibi komorbid durumlarla iliþkili olduðu bilinmektedir. Son yýllarda SD'in metabolik sendrom, hipertansiyon, obezite ve beslenme faktörleri ile iliþkisini araþtýran çalýþmalar bulunmaktadýr. Ancak SD hastalarýnda vücut kompozisyonu parametrelerini deðerlendiren bir çalýþma bulunmamaktadýr. Bu bilgiler ýþýðýnda SD ile vücut kompozisyon parametreleri arasýndaki iliþkinin deðerlendirilmesi amaçlanmýþtýr.
Yöntem: Araþtýrma, Üniversite Týp Fakültesi Dermatoloji polikliniðine baþvuran 18 yaþ üstü 39 SD hastasý ve 39 yaþ ve cinsiyet uyumlu kontrol hastasý olmak üzere toplam 78 katýlýmcý üzerinde gerçekleþtirildi. Tanita MC 580 Body Analyzer ile her katýlýmcý için vücut kompozisyon parametreleri ölçüldü. Ayrýca SD hasta grubunda Seboreik Dermatit Alan Þiddet Ýndeksi (SDASI) hesaplandý. Bu parametreler vaka ve kontrol gruplarý arasýnda karþýlaþtýrýldý.
Bulgular: Hasta ve kontrol gruplarý arasýnda boy (p=0,208), aðýrlýk (p=0,309), vücut kitle indeksi (p=0,762), yað kütlesi (p=0,092), metabolik yaþ (p=0,916), vücut yoðunluðu (p=0,180), mineral (p=0,699), viseral yaðlanma (p=0,401), protein (p=0,665) ve diðer vücut kompozisyon parametreleri açýsýndan anlamlý fark yoktu. Sadece SDASI ile boy (p=0,026) ve protein (p=0,016) deðerleri arasýnda pozitif bir korelasyon vardý.
Sonuç: SD, obezite, metabolik sendrom, insülin direnci ve KVH ile iliþkili olabilir, ancak sonuçlar net deðildir ve daha ileri çalýþmalara ihtiyaç vardýr. (NCI-2021-12-3/R1)

OBJECTIVE: Seborrheic dermatitis (SD) is a chronic, recurrent inflammatory skin disease characterized by clinically scaly patches. It is known that skin diseases with chronic inflammation are associated with comorbid conditions such as metabolic syndrome, obesity, cardiovascular diseases (CVD) and diabetes. In recent years, there are studies investigating the relationship of SD with metabolic syndrome, hypertension, obesity and nutritional factors. However, there is no study evaluating body composition parameters in SD patients. In the light of this information, it was aimed to evaluate the relationship between SD and body composition parameters.
METHODS: The study was conducted on a total of 78 participants, including 39 SD patients over the age of 18 and 39 age- and gender-matched control patients, who applied to the University Faculty of Medicine Dermatology outpatient clinic. Body composition parameters were measured for each participant with the Tanita MC 580 Body Analyzer. In addition, SD area severity ýndex (SDASI) was calculated in the SD patient group. These parameters were compared between the case and control groups.
RESULTS: There was no significant difference concerning height (p=0.208), weight (p=0.309), body mass index (p=0.762), fat mass (p=0.092), metabolic age (p=0.916), body density (p=0.180), mineral (p=0.699), visceral adiposity (p=0.401), protein (p=0.665), and other body composition parameters, between the case and control groups. There was only positive correlation between SDASI and height (p=0.026) and protein (0.016) value.
CONCLUSION: SD may be associated with obesity, metabolic syndrome, insulin resistance, and CVD, but the results are unclear and further studies are needed.

Cryptococcal endocarditis is an exceedingly rare entity associated with high mortality and morbidity. Hereby, we present a 37-year-old patient with underlying systemic lupus erythematosus and end-stage renal disease who was diagnosed with cryptococcal endocarditis involving native mitral valve. Her blood culture grew Cryptococcus neoformans. Echocardiography confirmed presence of vegetations and patient underwent mitral valve replacement and received appropriate anti-fungal treatment. Her course was further complicated by sternal wound dehiscence and infection of hemodialysis site as well as atrial flutter. Unfortunately, patient passed 2 weeks after discharge from hospital. C. neoformans is typically known to cause serious central nervous system. However, this pathogen can rarely cause serious infective endocarditis case particularly in immune compromised patients or those with prosthetic valves. Fungal endocarditis is usually treated with a combination of
surgery and anti-fungal medications. (NCI-2022-6-7)