OBJECTIVE: Warfarin therapy has some difficulties in terms of close monitoring and dosage. This study aims to evaluate the effect of same-fixed versus different-variable physician-based monitoring of warfarin therapy on treatment quality and clinical end-points.
METHODS: A total of 625 consecutive patients requiring warfarin treatment were enrolled at seven centers. INR values of the patients measured at each visit and registered to hospital database were recorded. Time in therapeutic range (TTR) was calculated using linear interpolation method (Rosendaal’s method). A TTR value of ≥65% was considered as effective warfarin treatment. If a patient was evaluated by the same-fixed physician at each INR visit, was categorized into the same-physician (SP) group. In contrast, if a patient was evaluated by different-variable physicians at each INR visit, was categorized into variable physician (VP) group. Enrolled patients were followed up for bleeding and embolic events.
RESULTS: One hundred and fifty-six patients (24.9%) were followed by SP group, 469 (75.1%) patients were followed by VP group. Median TTR value of the VP group was lower than that of SP group (56.2% vs. 65.1%, respectively, p=0.009). During median 25.5 months (9–36) of follow-up, minor bleeding, major bleeding and cerebral embolic event rates were higher in VP group compared to SP group (p<0.001, p=0.023, p<0.001, respectively). In multivariate analysis, INR monitoring by VP group was found to be an independent predictor of increased risk of bleeding events (OR 2.55, 95% CI 1.64–3.96, p<0.001) and embolism (OR 3.42, 95% CI 1.66–7.04, p=0.001).
CONCLUSION: INR monitoring by same physician was associated with better TTR and lower rates of adverse events during follow-up. Hence, it is worth encouraging an SP-based outpatient follow-up system at least for where warfarin therapy is the only choice.

OBJECTIVE: The Modified Ashworth Scale, the Modified Tardieu Scale, and measuring the passive range of motion is commonly preferred examination tools for spasticity in cerebral palsy (CP). Ultrasonography has become increasingly used to provide relevant insight into spastic muscle morphology and structure recently. It was aimed to reveal associations between the clinical and ultrasonographic parameters of gastrocnemius medialis (GM) and lateralis muscles in this population.
METHODS: Thirty-four children with spastic CP aged between 4 and 12 years who did not have botulinum neurotoxin A intervention within 6 months or had no previous history of any orthopedic or neurological surgery were included. The spasticity of GM and lateralis was evaluated firstly by the Modified Ashworth Scale, Modified Tardieu Scale, and ankle passive range of motion. Then, the cross-sectional area (CSA), muscle thickness (MT), qualitative and quantitative echo intensity (EI) values of both muscles were measured from their ultrasonographic images.
RESULTS: The CSA of GM, and qualitative EI of both muscles were found to be mild-to-moderately correlated to all clinical examination tools (p<0.01), whereas the CSA of gastrocnemius lateralis was mildly related to Modified Ashworth Scale (p=0.009). The MT and quantitative EI of both muscles were not associated with any of the clinical tools (p>0.05).
CONCLUSION: Ultrasonographic measurements of GM and lateralis partially reflect ankle spasticity in children with CP. Ultrasonography can be used as an alternative tool in this patient population where the clinical evaluation can not perform ideally.

OBJECTIVE: Depression is highly prevalent in frail older adults and both clinical situations share similar clinical and prognostic factors. The aim of this study was to investigate the relationship between frailty and depression by considering each component of frailty, in both genders.
METHODS: Six hundred and forty-one patients aged 60 years and older, admitted to a Geriatrics outpatient clinic in a tertiary hospital, were included in this cross-sectional study. FRIED criteria were used for defining frailty. Depression was assessed by the Geriatric depression scale (GDS). Evaluations related to disability, nutrition, and cognition were performed by the Katz/Lawton scales, mini nutritional assessment (MNA), and the mini mental state examination (MMSE), respectively.
RESULTS: Prevalence of frailty and depression was 48.7% and 36.7%, respectively. Co-occurrence of frailty and depression was observed as 24.0%. Both in men (OR: 3.977, CI: 1.423–11.114, p=0.008) and in women (OR: 2.704, CI: 1.695–4.315, p<0.001), depression was independently associated with frailty, after adjusting with confounders regarding frailty. All FRIED criteria were significantly correlated with the higher GDS scores in women. Two FRIED criteria regarding physical activity and strength measures were not related to depressive symptoms in men. Lawon (p<0.001), MMSE (p=0.004), and MNA scores (p<0.001) were lower in patients with co-occurring frailty and depression, than both as separate conditions.
CONCLUSION: Depression may play a key role in the development of frailty in both genders. Albeit, depressed men seem to be at a higher risk than women for development of frailty are, physical activity and strength measures in the FRIED criteria had a high impact in women for depressive symptoms. Patients with co-occurring frailty and depression are more prone to develop geriatric syndrome related disabilities.

OBJECTIVE: Comorbidities are diseases that coexist with a disease of interest or an index disease, which can directly affect the prognosis of the disease of interest or indirectly affect the choice of treatment. The Charlson comorbidity index (CCI) is the most widely used comorbidity index. In this study, it was aimed to examine the predictive role of the CCI score on the mortality of patients with COVID-19.
METHODS: We have retrospectively analyzed COVID-19 patients whose diagnosis was confirmed by PCR and who were hospitalized in two centers between April 2020 and December 2020. The severity of comorbidity of the patients was categorized into five groups according to the CCI score: CCI score 0, CCI score 1–2, CCI score 3–4, CCI score 5–6, and CCI score ≥7. Factors affecting mortality and differences between groups classified by CCI were determined by logistic regression analysis and one-way analysis of variance.
RESULTS: A total of 1,559 COVID-19 patients were included in the study and 70 (4.49%) patients had deceased. Half of the study population (n=793, 50.9%) had different comorbidities. The CCI score was 3.8±2.7 in deceased patients and 1.3±1.9 in surviving individuals. There was a positive correlation between CCI scores and mortality in COVID-19 patients, with each point increase in the CCI score increasing the risk of death by 2.5%. CCI score of 4 and above predicted mortality with 87.2% sensitivity and 97.9% negative predictive value. Five (0.6%) of 766 patients with CCI scores of 0, 16 (3.6%) of 439 patients with CCI scores of 1–2, 13 (6.9%) of 189 patients with CCI scores of 3–4, and a CCI score of 5, 13 (15.7%) of 83 patients with -6 and 23 (28.0%) of 82 patients with a CCI score of ≥7 died.
CONCLUSION: CCI is a simple, easily applicable, and valid method for classifying comorbidities and estimating COVID-19 mortality. The close relationship between the CCI score and mortality reveals the reality of how important vaccination is, especially in this group of patients. Increasing awareness of potential comorbidities in COVID-19 patients can provide insight into the disease and to improve outcomes by identifying and treating patients earlier and more effectively.

OBJECTIVE: Coronavirus disease 2019 (COVID-19), leading to mild infection (MI), acute respiratory distress syndrome or death in different persons. Although the basis of these variabilities has not been fully elucidated, some possible findings have been encountered. In the present study, we aimed to reveal genes with different expression profiles by next-generation sequencing of RNA isolated from blood taken from infected patients to reveal molecular causes of different response.
METHODS: Two healthy, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-negative control individuals (NCI), two SARS-CoV-2-positive patients who have MI, and two patients who have critical infection (CI) were included in the study. Total RNA was extracted from blood samples and sequenced. Raw RNA-Seq data were analyzed on Galaxy platform for the identification of differentially expressed genes and their pathway involvements.
RESULTS: We found that 199 and 521 genes were downregulated in whole blood of COVID-19-positive CI patients compared to NCI and MI patients, respectively. We identified 21 gene ontology pathways commonly downregulated in CI patients compared to both NCI and MI, mostly associated with innate and adaptive immune responses. Three hundred and fifty-four and 600 genes were found to be upregulated compared to NCI and MI, respectively. Upregulated six pathways included genes that function in inflammatory response and inflammatory cytokine release.
CONCLUSION: The transcriptional profile of CI patients deviates more significantly from that of MI in terms of the number of differentially expressed genes, implying that genotypic differences may account for the severity of SARS-CoV-2 infection and inflammatory responses through differential regulation of gene expression. Therefore, further studies that involve whole genome analysis coupled with differential expression analysis are required in order to determine the dynamics of genotype – gene expression profile associations.

OBJECTIVE: Cytokine storm in coronavirus disease 2019 (COVID-19) patients causes lung damage and acute respiratory distress syndrome (ARDS). Immunomodulators such as steroids are widely used to control this situation. This study investigates the effectiveness of steroids used in COVID-19 patients, and their effects on secondary infections, morbidity, and mortality.
METHODS: Data were obtained by retrospectively scanning the files of patients in our hospital’s intensive care unit clinic during the three peak periods.
RESULTS: Between the steroid and non-steroid groups, there was no statistically significant difference in reproductive rates. These rates were 49.7% and 43.2%, respectively. Reproductive rates among steroid types were determined as 25 (56.8%) in the Methylprednisolone group, 18 (69.2%) (Highest) in the Dexamethasone + Methylprednisolone group, and 54 (43.2%) (Lowest) in the Dexamethasone group. Steroid treatment duration was effective on reproduction. Steroids cause more infections, especially after invasive procedures (Tracheal intubation, central venous catheter, etc.). In the groups with and without tracheal aspirate steroids, the growth rates were 71 (76.3%) and 32 (54.2%) respectively. There was no difference in mortality between the groups.
CONCLUSION: Cytokine storm causes lung damage and ARDS. Steroids can be useful in controlling this hyper-inflammatory situation. However, increased secondary infections, an important side effect of steroids, increase mortality. Steroids more often cause these infections, especially in patients undergoing invasive Strict adherence to infection control measures during steroid treatment will reduce this risk. In conclusion, while steroids reduce mortality by controlling the hyper-inflammatory picture, they also increase mortality with increased secondary infections. Preventing infections enables success with steroids.

OBJECTIVE: It is thought that there is not enough data about the frequency of acceptance of oral glucose tolerance test (OGTT) in Turkish pregnant women. The aim of this study was to investigate the frequency of acceptance of OGTT among participants in our single tertiary center.
METHODS: The data of non-diabetic 344 pregnant women seen at the Obstetrics Clinic of our hospital between September 2016 and September 2017 were obtained from the hospital records. Women who did not have regular follow-up during pregnancy were excluded. One of the two or one-step approaches was used in the diagnosis of gestational diabetes mellitus (GDM) depending on the choice of the physician following the patient.
RESULTS: There were 223 subjects eligible for the study. One hundred seventy-seven pregnant women (79.4%) accepted to do OGTT. We determined that 46 women (20.6%) did not complete at least one OGTT, of whom 74% (n=34) never completed the recommended screening test in this cohort. The overall frequency of GDM was approximately 15.2% (n=34). OGTT acceptability was higher among pregnant women with university graduates (p=0.02). Adverse pregnancy outcomes were similar between the accepted and rejected groups. Among the reasons for OGTT rejection, the media had a significant influence (n=35).
CONCLUSION: Our results show that a significant percentage of patients refused to do OGTT. Therefore the actual frequency of pregnant women with GDM could not be determined. One way to increase compliance may be recommending only the one-step test for pregnant women in countries with a high rejection rate of OGTT.

OBJECTIVE: The Sinus and Nasal Quality of Life (QoL) Survey (SN-5) is a valid questionnaire that evaluates the QoL of the pediatric population associated with sinonasal diseases and symptoms. The aims of this study were to translate the SN-5 test to Turkish language (SN-5t), evaluate the internal consistency of the test and test-retest reliability and validate the translation for further use in studies in Turkish language.
METHODS: In this prospective study, 50 healthy subjects and 50 patients, age between 2 and 12, with sinonasal symptoms prolonged over 1 month were included to the study. Families of healthy subjects were asked to fill the SN-5t twice with 1-week interval. The patient group completed test once prior the treatment and once 4 weeks after the treatment. Cronbach’s test was performed to test internal consistency and Spearman’s test was performed to evaluate test-retest validity.
RESULTS: The median value of the pre-treatment tests of the patient group and control group was 25 (23–28) and 14.25 (12–16), respectively. A statistically significant difference was found between groups (p<0.001). Area under the receiver operating characteristics (ROC) curve (Aroc) value was calculated as 0.992 which stated the strong diagnostic accuracy, and the cutoff point was defined as 16.5. Cronbach’s alpha value of 0.75 was found. The Spearman’s rank correlation coefficient value (Spearman’s rho) was calculated as 0.946.
CONCLUSION: The Turkish translation of the SN-5 is a consistent and valid test with high sensitivity and specificity that can be used in studies including Turkish speaking population.

OBJECTIVE: The objective of the study was to compare the motor development of children with Down syndrome (DS) who received physical therapy (PT) and did not receive PT, and to show the effect of PT programs started before the age of one on movement development.
METHODS: The study included aged between 6 and 42 months, 58 children with DS. Children with DS were divided into two groups as receiving PT and non-receiving PT. Children with DS who received PT were further divided into two groups according to the age of starting PT as before and after 1 year of age. Gross motor and fine motor development of the cases were evaluated with Bayley Scales of Infant and Toddler Development III.
RESULTS: Gross motor scaled scores (GM-SS: 3.88±3.46–1.67±1.23), fine motor scaled scores (FM-SS: 4.29±3.24–1.79±0.93), and composite scores (64.4±19.5–50.38±5.38) of PT group were statistically higher than the non-PT group (p<0.05). In addition, GM-SS (5.22±4.23–2.38±1.20), FM-SS; (5.61±3.85–2.81±1.37), and composite scores (72.33±23.85–55.56±5.7) of the cases who started PT before the age of one were statistically higher than those who started after the age of one (p<0.05).
CONCLUSION: Our results revealed that PT especially when started early childhood under had a positive effect on the development of gross and fine motor in children with DS and provided a scientific basis for referring children with DS to PT programs before the age of one. Clinicians should recommend PT for children with DS in the early period.

OBJECTIVE: Lower respiratory tract infections (LRTIs) are responsible for significant morbidity and mortality in children. Viral pathogens are responsible for 50–70% of LRTIs. The real-time multiplex polymerase chain reaction (RT-MPCR) tests allow the simultaneous detection of several different viruses along with some bacterial pathogens and give faster and more reliable results than viral culture. We aimed to describe the disease etiology and the clinical, laboratory, and radiological characteristics of children aged under 5 years who were hospitalized in a tertiary care medical center with LRTIs assayed using an RT-MPCR respiratory pathogen panel, and evaluate the effects of the detection of etiology on treatment and outcome.
METHODS: This retrospective study was conducted in the tertiary medical health center. The study group comprised all pediatric cases aged under five who were hospitalized due to LRTIs in the pediatric wards and pediatric intensive care unit (ICU) and undergone RT-MPCR analyses between January 2019 and February 2020. RT-MPCR analyses of samples from nasopharyngeal swabs were consecutively evaluated.
RESULTS: A total of 65 samples were collected from aged under 5 years who were hospitalized with LRTIs and screened for respiratory viruses. Specimens were collected from pediatric ICU (18.5%) and pediatric wards (81.5%). The overall positive rate was 89.2% (58/65). Forty of the patients (61.5%) were positive for a single pathogen, 15 (23.6%) for two, and three (4.6%) for three pathogens. The most common virus was respiratory syncytial virus (RSV) (32.3%), followed by human rhinovirus (HRV) (30.8%). In HRV-positive patients, eosinophil count was higher than that in Influenza A/B- and Human metapneumovirus-positive patients (respectively p=0.014, 0.005). In RSV-positive patients, hospitalization duration and neutrophil, lymphocyte, C-reactive protein level had moderate correlation (respectively; r=0.587; p=0.005, r=–0.436; p=0.038, r=0.498; p=0.022).
CONCLUSION: Despite the limited number of participants from a single center, a wide range of causative pathogens were detected in our study. In addition, we found that viral pathogens are common etiologies of LRTIs. To describe the disease etiology in LRTIs, assays using an RT-MPCR respiratory pathogen panel, would be beneficial to the detection of etiology and treatment.

OBJECTIVE: Predominantly hemorrhage represents one of the possible manifestations of choroidal neovascularisation (CNV) in eyes with age-related macular degeneration (AMD). The purpose of this study is to evaluate the effecte of ranibizumab treatment in patients with predominantly hemorrhagic CNV secondary to AMD.
METHODS: Twenty-five patients with predominantly hemorrhagic choroidal neovascularization due to AMD with at least three ranibizumab injections and followed up for at least 12 months were included in the study. The months of follow-up were recorded (baseline, 3rd, 6th, and 12th months). The change in central macular thickness (CMT) on optical coherence tomography, visual acuity (VA) in ETDRS letters, and lesion size on fundus fluorescein angiography were evaluated.
RESULTS: The mean age of the patients was 68.1±5.7 (range: 63–82) years, the mean follow-up was 19.9±14.5 (range: 12–67) months, and the mean number of injections was 4.0±1.4 (range: 3–15). The initial VA was 39.3±17.9 (range: 1–65) letters, CMT was 272.7±104 (range: 164–587) μm, and the initial lesion width was 11.4±10.5 (range: 1.3–45.7) mm2. The VA was 41.4±20.1 (range: 5–75) and 36.9±21.8 (range: 4–80) letters (p=0.150), CMT was 270.7±110 (range: 159–570) and 230.4±108 (range: 109–667) μm (p=0.009) and the lesion width was 10.9±11.5 (range: 1.1–39.7) and 10.4±11.6 (range: 1.2–44.3) mm2 at 6th and 12th month, respectively. No factor was found to be associated with final CMT.
CONCLUSION: Although the final visual outcome is limited by the progression of the disease, hemorrhagic lesions treated with ranibizumab have stable anatomical outcome.

Meckel’s diverticulum is generally asymptomatic, but it may become symptomatic due to various reasons and maybe the etiology of the acute abdominal syndrome. Bezoars are formed by the combination of non-digestible substances in the gastrointestinal tract, and which are among the rare causes of intestinal obstruction. The formation of bezoars in Meckel’s diverticulum and subsequent intestinal obstruction is a rare condition. In this article, two cases with intestinal obstruction due to bezoar in Meckel’s diverticulum and their surgical treatment had presented.

Turkey’s Corona Precaution Application, a web-based and mobile service, has been actively used by the citizens of the Republic of Turkey and foreigners coming to Turkey since March 19, 2020. This article examines the Corona Precaution Application in terms of its success in detecting risky and positive cases among users. In this informative process analysis study, which is conducted in the lights of Ministry of Health of Turkey data, the efficiency of Corona Precaution Application in March 2020-August 2020 has been measured through the usage statistics from specific provinces and the effect of the application has been proved. The application was used by a total of 2.159.903 people on mobile and web platforms and risk assessments were made. As a result, 135.277 people who were scored as high risk were referred to health-care facilities, and 12.067 people were hospitalized with a positive diagnosis of COVID-19 in PCR tests or isolated at home. When evaluated cumulatively, Corona Precaution Application is used as an effective tool of the health system in the fight against COVID-19. 12.067 people were found to be positive with the referrals to the healthcare facility made through the application; thus, it has been one of the most effective tools in controlling the spread of the disease.

A large amount of scientific literature is forcing those who want to study the subject deeply. In general, the number of articles available exceeds thousands. It has become challenging both to dominate the current concept and to see the relationships between the developments that feed the concept. Visualization techniques based on bibliometric data help to gain an overview of the literature on complex research topics. The aim of this study is to examine the topic of “patient safety” with a bibliometric analysis program. The data of 8372 articles obtained from the Web of Science database were analyzed with SciMAT2 software. Before the analysis, general findings regarding the raw data were brought to the fore. The strategic diagram and thematic development map have been analyzed in terms of 10-year periods covering the past 30 years. Five motor themes (“contrast agent,” “adverse events,” “program,” “safety,” “prostatectomy”) were identified in 1990-1999, four motor themes (“infection control,” “hospital-acquired infections,” “adverse drug events,” “culture”) in 2000-2009 and nine motor themes (“patient safety,” “education,” “climate,” “system,” “mortality,” “operating room,” “validity,” “burnout,” “primary care”) in 2010-2019. The number of motor themes increased during the period and adverse events, which were the active subjects of the early periods, were replaced by new concepts (such as climate, primary care, and burnout) over time. Bibliometric visualization tools make it possible to analyze the literature consisting of a large number of articles. This approach facilitates a person’’s understanding of a complex research topic such as patient safety and ensures that they are aware of new research directions or alternative research priorities.

NCI-2022-3-5