Amaç: Varfarinin kendisinden kaynaklanan takip ve dozlam açýsýndan bazý zorluklarý vardýr. Bu çalýþma, varfarin tedavisinin ayný-sabit hekime karþýn farklý-deðiþken hekim tarafýndan izlenmesinin tedavi kalitesi ve klinik son noktalar üzerindeki etkisini deðerlendirmeyi amaçlamaktadýr.
Yöntemler: Çalýþmaya yedi merkezden varfarin tedavisi gerektiren toplam 625 ardýþýk hasta dahil edildi. Hastane veri tabanýna kaydedilen ve her ziyarette ölçülen INR deðerleri kaydedildi. Terapötik aralýktaki süre (TAZ), doðrusal interpolasyon yöntemi (Rosendaal'ýn yöntemi) kullanýlarak hesaplandý. Etkin varfarin tedavisi için TAZ ≥%65 olmasý kabul edildi. Bir hasta her INR ziyaretinde ayný sabit hekimle deðerlendirildiyse, sabit hekim (SH) grubuna kategorize edildi. Aksine, bir hasta her INR ziyaretinde farklý deðiþkenli doktorla deðerlendirildiyse, deðiþken hekim (DH) grubu olarak kategorize edildi.
Bulgular: Yüz elli altý hastayý (%24,9) SH grubu, 469 (%75,1) hastayý DH grubu takip etti. Deðiþken hekim grubunun medyan TAZ deðeri SH grubundan daha düþüktü (sýrasýyla % 56,2 ye % 65,1, P=0,009). Ortanca 25,5 aylýk (9-36) takip süresince DH grubunda, SH grubuna göre minör kanama, majör kanama ve serebral embolik olay oranlarý daha yüksekti (sýrasýyla P<0,001, P=0,023, P<0,001). Çok deðiþkenli analizde, DH grubu tarafýndan INR takibinin yapýlmasý kanama olaylarý (OR 2,55 % 5 CI 1,64-3,96, P<0,001) ve embolizm (OR 3,42 %95 CI 1,66- 7,04, P=0,001) için artmýþ riskin baðýmsýz bir prediktörü olduðu bulunmuþtur.
Sonuç: Ayný-sabit hekim olan polikliniklerdeki INR monitörizasyonu, takip sýrasýnda daha iyi TTR ve daha düþük advers olay oranlarý ile iliþkiliydi. Bu nedenle, en azýndan varfarin tedavisinin tek seçenek olduðu durumlarda, SH' e dayalý bir ayakta tedavi takip seklinin teþvik edilmesi önemlidir. (NCI-2021-4-32/R1)

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.

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Amaç: Serebral palside spastisite deðerlendirilmesinde sýklýkla tercih edilen klinik deðerlendirme yöntemleri, Modifiye Ashworth Skalasý, Modifiye Tardieu Skalasý ve pasif hareket aralýðýnýn ölçülmesidir. Son zamanlarda ultrasonografi, spastik kas morfolojisi ve yapýsýný incelemek amacýyla daha fazla kullanýlýr hale gelmiþtir. Bu çalýþmada serebral palsili çocuklarda spastik gastroknemius medialis ve lateralis kaslarýnýn klinik ve ultrasonografik parametreleri arasýndaki iliþkilerin ortaya konmasý amaçlanmýþtýr.
Yöntemler: Çalýþmaya 4-12 yaþ arasý, spastik serebral palsi tanýlý, son altý ay içinde botulinum nörotoksin A enjeksiyonu yapýlmamýþ ve daha önce ortopedik veya nörolojik cerrahi öyküsü olmayan 34 çocuk dahil edildi. Gastroknemius medialis ve lateralis spastisitesi ilk olarak Modifiye Ashworth Skalasý, Modifiye Tardieu Skalasý ve ayak bileði pasif hareket aralýðý ölçümü ile deðerlendirildi. Daha sonra her iki kasýn kesit alaný, kas kalýnlýðý, kalitatif ve kantitatif ekointensite deðerleri ultrasonografi görüntüleri üzerinde ölçüldü.
Bulgular: Gastroknemius medialis kesit alaný ve her iki kasýn kalitatif ekointensitesi klinik deðerlendirme yöntemleriyle hafif-orta derecede (p<0.01), gastroknemius lateralis kesit alaný ise Modifiye Ashworth Skalasý ile hafif düzeyde iliþkili olarak bulundu (p=0.009). Her iki kasýn kas kalýnlýðý ve kantitatif ekointensitesinin hiçbir klinik yöntemle iliþkisi saptanamadý (p>0.05).
Çýkarýmlar: Gastroknemius medialis ve lateralis kaslarýnýn ultrasonografik ölçümleri serebral palsili çocuklarda ayak bileði spastisitesini kýsmen yansýtmaktadýr. Ultrasonografi klinik deðerlendirmenin ideal olarak yapýlamadýðý bu hasta grubunda deðerlendirmede alternatif bir yöntem olarak kullanýlabilir. (NCI-2020-0243.R2)

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.

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Amaç: Depresyon, kýrýlgan yaþlý bireylerde oldukça yaygýndýr ve her iki klinik durum da benzer klinik ve prognostik faktörleri içerir. Bu çalýþmanýn amacý, her iki cinsiyette kýrýlganlýðýn her bir bileþenini göz önünde bulundurarak kýrýlganlýk ve depresyon arasýndaki iliþkiyi incelemektir.
Metod: Bu kesitsel çalýþmaya, üçüncü basamak bir hastanede Geriatri polikliniðine baþvuran 60 yaþ ve üstü 641 hasta dahil edildi. Kýrýlganlýðý tanýmlamak için FRIED kriterleri kullanýldý. Depresyon, Geriatrik depresyon ölçeði (GDS) ile deðerlendirildi. Fonksiyonellik, beslenme ve biliþsel durum ile ilgili deðerlendirmeler sýrasýyla Katz / Lawton ölçekleri, mini nütrisyonel beslenme deðerlendirmesi (MNA) ve mini mental durum muayenesi (MMSE) ile gerçekleþtirildi.
Sonuç: Kýrýlganlýk ve depresyon prevalansý sýrasýyla% 48.7 ve% 36.7 idi. Kýrýlganlýk ve depresyon birlikte görülme oraný% 24.0 olarak gözlendi. Hem erkeklerde (OR: 3.977, CI: 1.423-11.114, p = 0.008) hem de kadýnlarda (OR: 2.704, CI: 1.695-4.315, p <0.001), depresyon, kýrýlganlýðý etkileyen faktörler düzeltildikten sonra, baðýmsýz olarak kýrýlganlýkla iliþkili gözlendi. Tüm FRIED kriterleri, kadýnlarda daha yüksek GDS skorlarý ile korelasyon gösterdi. Fiziksel aktivite ve kuvvet ölçümleriyle ilgili iki FRIED kriteri erkeklerde depresif semptomlarla iliþkili deðildi. Eþ zamanlý kýrýlganlýk ve depresyonu olan hastalarda Lawon (p <0.001), MMSE (0.004) ve MNA skorlarý (p <0.001), ayrý ayrý olarak her iki duruma göre daha düþüktü.
Tartýþma: Depresyon, her iki cinsiyette de kýrýlganlýðýn geliþmesinde önemli bir rol oynayabilir. Her ne kadar depresif erkekler kýrýlganlýk geliþimi açýsýndan kadýnlardan daha yüksek risk altýnda görünse de, FRIED kriterlerindeki fiziksel aktivite ve güç ölçümleri, kadýnlarda depresif belirtiler için yüksek etkiye sahipti. Eþ zamanlý kýrýlganlýk ve depresyonu olan hastalar, geriatrik sendromlarla iliþkili dizabiliteler geliþtirmeye daha yatkýn gözükmektedirler. (NCI-2020-0366.R1)

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.

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Giriþ: Komorbiditeler, ilgilenilen hastalýðýn prognozunu doðrudan etkileyebilen veya dolaylý olarak tedavi seçimini etkileyebilen, ilgilenilen bir hastalýk veya bir indeks hastalýk ile birlikte var olan hastalýklardýr. Charlson komorbidite indeksi (CCI) en yaygýn olarak kullanýlan komorbidite indeksidir. Çalýþmamýzda CCI skorunun COVID-19 hastalarýn mortalitesi üzerindeki prediktif rolünü incelemek amaçlanmýþtýr.
Gereç ve Yöntemler: Çalýþmamýz Nisan 2020-Aralýk 2020 tarihleri arasýnda iki merkezde yatýrýlarak tedavi edilen COVID-19 tanýsý PCR ile doðrulanmýþ hastalar retrospektif olarak analiz edilmiþtir. Hastalarýn komorbiditesinin þiddeti CCI skoruna göre beþ grupta kategorize edildi: CCI skoru 0, CCI skoru 1-2, CCI skoru 3-4,CCI skoru 5-6,ve CCI skoru ≥7. Mortaliteyi etkileyen faktörler ve CCI tarafýndan sýnýflandýrýlan gruplar arasýndaki farklýlýklar, lojistik regresyon analizi ve tek yönlü varyans analizi (ANOVA) ile belirlendi.
Bulgular: Çalýþmaya toplam 1559 COVID-19 hastasý alýndý. Toplam 70 (%4.49) hasta öldü. 793 (%50.9) hastanýn komorbiditesi vardý. CCI skoru ölen hastalarda 3.8±2.7, yaþayan hastalarda 1.3±1.9 idi. COVID-19 hastalarýnda CCI skorlarý ile mortalite arasýnda pozitif korelasyon vardý ve CCI skorundaki her bir puanlýk artýþta ölüm riski %2.5 artmaktaydý. CCI skoru 4 ve üstünde %87.2 duyarlýlýk ve %97.9 negatif prediktif deðer (NPD) ile mortaliteyi öngördürmekte idi. CCI skorlarý 0 olan 766 hastanýn 5(%0.6)’i, CCI skorlarý 1-2 olan 439 hastanýn 16(%3.6)’sý, CCI skorlarý 3-4 olan 189 hastanýn 13(%6.9)’ü,ve CCI skoru 5-6 olan 83 hastanýn 13(%15.7)’ü, CCI skoru ≥7 olan 82 hastanýn 23(%28.0)’ü öldü.
Sonuç: Sonuç olarak, CCI komorbiditeleri sýnýflandýrmak ve COVID-19 mortalitesini tahmin etmek için basit, kolayca uygulanabilir ve geçerli bir yöntemdir. CCI skoru ile mortalitenin yakýn iliþkisi, özellikle bu grup hastalarda aþýlamanýn ne kadar önemli olduðu gerçeðini ortaya koymaktadýr.COVID-19 hastalarýnda potansiyel komorbiditeler konusunda artan farkýndalýk, hastalýða dair öngörü saðlayabilir ve hastalarý daha erken ve daha etkili bir þekilde belirleyip tedavi ederek sonuçlarý iyileþtirebilir. (NCI-2022-2-6)

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.

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Giriþ: Coronavirus hastalýðý 2019 (COVID-19) farklý kiþilerde hafif enfeksiyona, akut solunum sýkýntýsý sendromuna veya ölüme yol açabilmektedir. Bu deðiþkenliklerin temeli tam olarak aydýnlatýlamasa da bazý olasý bulgular saptanmýþtýr. Mevcut çalýþmada, enfekte hastalardan alýnan kan örneklerinden izole edilen RNA'nýn yeni nesil dizilemesi ile farklý ekspresyon profillerine sahip genleri ortaya çýkararak, farklý yanýtýn moleküler nedenlerini ortaya koymayý amaçladýk.
Gereç ve Yöntemler: Ýki saðlýklý, þiddetli akut solunum yolu sendromu koronavirüsü 2 (SARS-CoV-2) negatif kontrol bireyi (NKB), hafif enfeksiyonu (HE) olan iki SARS-CoV-2 pozitif hasta ve kritik enfeksiyonu (KE) olan iki hasta çalýþmaya dahil edildi. Total RNA, kan örneklerinden ekstrakte edildi ve dizilendi. Ham RNA-seq verileri, farklý þekilde eksprese edilen genlerin ve bunlarýn yolak katýlýmlarýnýn tanýmlanmasý için Galaxy platformunda analiz edildi.
Sonuçlar: COVID-19 pozitif KE hastalarýnýn tam kanýnda sýrasýyla NKB ve HE hastalarýna kýyasla 199 ve 521 genin down regüle olduðu bulundu. Hem NKB hem de HE ile karþýlaþtýrýldýðýnda KE hastalarýnda yaygýn olarak down regüle olmuþ, çoðunlukla doðuþtan gelen ve adaptif immün yanýtlarla iliþkili 21 gen ontolojisi (GO) yolaðý belirlendi. Sýrasýyla NKB ve HE ile karþýlaþtýrýldýðýnda 354 ve 600 genin upregüle olduðu bulundu. Upregule olan altý yol, inflamatuar yanýtta ve inflamatuar sitokin salýnýmýnda iþlev gören genleri içeriyordu.
Tartýþma: KE hastalarýnýn genlerindeki transkripsiyonel profil, HE hastalarýnýnkinden ifade edilen genlerin sayýsýna göre daha farklýdýr. Gen ekspresyon profilindeki bu farklýlýklarýn genetik altyapý ile iliþkili olmasý mümkün olup, genotipik farklýlýklar SARS-CoV2 enfeksiyonunda görülen enflamatuar ve immün yanýtýn þiddetindeki deðiþiklikleri açýklayabilir. Bu nedenle, genotip – gen ekspresyon profili iliþkilerinin dinamiklerini belirlemek için diferansiyel ekspresyon analizi ile birleþtirilmiþ tüm genom analizini içeren ileri çalýþmalara ihtiyaç vardýr. (NCI-2021-12-7/R1)

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.

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Giriþ ve Amaç: COVID-19 hastalarýnda ortaya çýkan sitokin fýrtýnasýnýn akciðer hasarý ve ARDS’ nin geliþmesinde önemli rol oynadýðý kabul edilmektedir. Bu tabloyu kontrol altýna almak için steroidler gibi immünomodülatörler daha fazla kullanýlmaya baþlandý. Bizim bu çalýþmadaki amacýmýz COVID-19 hastalarýnda kullanýlan steroidlerin etkinliði, sekonder enfeksiyonlara olan etkisi ve bu enfeksiyonlarýn morbidite ve mortalite üzerine olan etkilerini araþtýrmak.
Gereç ve Yöntem: Hastanemiz yoðun bakým kliniðine 1. 2. ve 3. dalgalarda yatan steroid alan ve almayan hastalarýn dosyalarý retrospektif bir þekilde taranarak veriler kaydedildi.
Bulgular: Steroid ve non-steroid grubu karþýlaþtýrýldýðýnda aralarýnda üreme oranlarý açýsýndan istatistiksel olarak anlamlý bir fark görülmemekle birlikte sýrasýyla %49,7 ye %43,2 olacak þekilde steroid grubunda biraz daha yüksek olarak tespit edilmiþtir Steroid tipleri arasýnda üreme görülme oranlarý açýsýndan Metilprednisolon grubunda25(%56,8), Dexametazon+ Metilprednisolon grubunda 18 (%69,2) ile en yüksek ve Dexametazon grubunda 54 (%43,2) ile en düþük olarak tespit edilmiþ olup aralarýnda istatistiksel olarak anlamlý bir fark tespit edilmiþtir. Yine steroid tedavi süresinin üremeler üzerine etkili olduðunu tespit ettik. Özellikle invaziv iþlem yapýlan (trakeal entübasyon, santral venöz kateter vb) hastalarda steroidler daha fazla enfeksiyona neden olmaktadýr. Trakeal aspirat gönderilen steroid alan ve almayan gruplarda üremeleri sýrasýyla 71 (%76,3), 32 (%54,2) olacak þekilde steroid grubunda anlamlý olarak yüksek tespit ettik. Steroid ve non-steroid grublar arasýnda mortalite açýsýndan bir fark yoktu.
Sonuç: COVID-19 hastalarýnda geliþen sitokin fýrtýnasýnýn akciðerlerdeki hasarlanma ve ARDS’ nin geliþmesinde önemli bir rol oynadýðý kabul edilmektedir. Steroidler bu hiperinflamatuar tablonun kontrol altýna alýnmasýnda faydalý olabilir. Ancak steroidlerin önemli bir yan etkisi olan sekonder enfeksiyonlardaki artýþ mortaliteyi yükseltmektedir. Steroidler özellikle invaziv mekanik ventilasyon ve santral venöz kateter uygulamasý gibi invaziv iþlemlerin uygulandýðý hastalarda bu enfeksiyonlara daha fazla neden olmaktadýr. Bu hastalarda steroid tedavisi uygulanacaðý zaman enfeksiyon kontrol önlemlerine sýký uyumun saðlanmasý bu riski azaltacaktýr. Sonuçta steroidler bir taraftan hiperinflamatuvar tablonun kontrol altýna alýnmasýndaki olumlu etkileri ile mortaliteyi azaltýrken diðer taraftan sekonder enfeksiyonlardaki artýþ ile mortaliteyi arttýrmaktadýr. Sonuç; enfeksiyonlarý önlersek steroidlerle daha baþarýlý olabiliriz. (NCI-2021-10-5/R1)

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.

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Giriþ: Türk popülasyonundaki gebelerde oral glukoz tolerans testinin (OGTT) kabul edilme sýklýðý ile ilgili yeterli veri olmadýðý düþünülmektedir. Bu çalýþmanýn amacý, üçüncü basamak merkezimizde katýlýmcýlar arasýnda OGTT’nin kabul edilme sýklýðýný araþtýrmaktýr.
Yöntem: Eylül 2016-Eylül 2017 tarihleri arasýnda hastanemizin Kadýn Hastalýklarý Kliniðinde görülen diyabetik olmayan 344 gebenin verileri hastane kayýtlarýndan elde edildi. Gebelik boyunca düzenli takibi olmayanlar çalýþma dýþý býrakýldý. Gestasyonel diyabet (GDM) tanýsýnda hastayý takip eden doktorun tercihine göre iki veya tek aþamalý yaklaþýmlardan biri kullanýldý.
Bulgular: Çalýþma için uygun olan 223 olgu vardý. Yüz yetmiþ yedi gebe kadýn (%79.4) OGTT yaptýrmayý kabul etti. Bu kohorttaki 46 kadýnýn (% 20.6) en az bir OGTT’yi tamamlamadýðýný belirledik, bunlarýn % 74’ü (n=34) önerilen tarama testini hiçbir zaman tamamlamadý. GDM sýklýðý yaklaþýk % 15.2 idi (n=34). Üniversite mezunu gebe kadýnlar arasýnda OGTT kabul edilebilirliði daha yüksekti (p=0.02). Olumsuz gebelik sonuçlarý kabul ve red eden grublar arasýnda benzerdi. OGTT rededilme nedenleri arasýnda medya önemli bir etkiye sahipti (n=35).
Tartýþma: Sonuçlarýmýz hastalarýn önemli bir yüzdesinin OGTT yaptýrmayý reddettiðini göstermektedir. Bu nedenle GDM' li gebe kadýnlarýn gerçek sýklýðý belirlenemedi. Uyumluluðu artýrmanýn bir yolu OGTT' nin reddedilme oranýnýn yüksek olduðu ülkelerdeki gebeler için sadece tek aþamalý test önermek olabilir. (NCI-2021-2-12/R1)

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.

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Amaç: Sinüs ve Burun Yaþam Kalitesi Anketi (SN-5) pediatrik gruptaki sinonazal þikayetlere ve hastalýklara baðlý oluþan yaþam kalitesini deðerlendirmek için kullanýlan bir testtir. Bu çalýþmanýn amacý bu testin Türkçe’ye çevrilmesi validasyonu ve adaptasyonudur.

Method: Bu prospektif çalýþmaya 1 aydan uzun süren sinonazal þikayetleri olan 2-12 yaþ arasýnda 50 hasta ve kontrol grubu olarak herhangi bir sinonazal þikayeti olmayan; yine 2-12 yaþ arasýnda 50 hasta katýlmýþtýr. Hasta grubuna ilk karþýlaþmada ve 4 hafta sonra yeniden olmak üzere iki kere; kontrol grubuna da ilk karþýlaþma ve 1 hafta sonra olmak üzere iki kere anket doldurulmuþtur. Türkçeye çevrilmiþ olan testin; uygun istatistiksel analizler ile iç tutarlýlýðý, test-yeniden test güvenirliði ve sensitivitesi deðerlendirilmiþtir.
Bulgular: Hasta grubu ve kontrol grubunun tedavi öncesi testlerinin ortanca deðeri sýrasýyla 25 (23-28) ve 14,25 (12-16) idi. Gruplar arasýnda istatistiksel olarak anlamlý fark bulundu (p <0,001). Alýcý çalýþma karakteristikleri (ROC) eðrisi (Aroc) deðeri altýndaki alan, güçlü tanýsal doðruluðu ifade eden 0,992 olarak hesaplandý ve kesme noktasý 16,5 olarak tanýmlandý. Cronbach alfa deðeri 0,75 bulundu. Spearman’in korelasyon katsayýsý deðeri (Spearman’s rho) 0,946 olarak hesaplandý.
Sonuç: SN-5'in Türkçe çevirisi, Türkçe konuþan popülasyonu içeren çalýþmalarda kullanýlabilecek, yüksek duyarlýlýk ve özgüllük ile tutarlý ve geçerli bir testtir. (NCI-2020-0409)

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.

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Amaç: Fizik tedavi (FT) alan ve FT almayan Down sendromlu (DS) çocuklarýn hareket geliþimlerini karþýlaþtýrmak ve 1 yaþ öncesi baþlanan FT programlarýnýn hareket geliþimine etkisini göstermektir.
Metod: Çalýþmaya, 6-42 ay arasýnda 58 DS' lu çocuk dahil edildi. DS' lu çocuklar; FT alanlar ve almayanlar olarak 2 gruba ayrýldý. FT alan DS' lu çocuklar FT'ye baþlama yaþýna göre 1 yaþýndan önce ve sonra olmak üzere iki gruba ayrýldý. Olgularýn kaba hareket ve ince hareket alaný geliþimleri Bayley Bebek ve Çocuk Geliþimi Ölçeði III ile deðerlendirildi.
Sonuçlar: FT alanlarýn, FT almayan gruba göre kaba hareket skalasý skoru (GM-SS: 3.88 ±3.46-1.67 ±1.23), ince hareket skalasý skoru (FM-SS: 4.29 ±3.24-1.79 ± 0.93) ve komposit puaný (64.4±19.5-50.38±5.38) istatistiksel olarak anlamlý olarak daha yüksekti (p< 0.05). Ayrýca 1 yaþ öncesi FT baþlananlarýn, 1 yaþ sonrasý FT baþlananlara göre GM-SS; (5.22±4.23-2.38±1.20), FM-SS; (5.61±3.85-2.81±1,37) ve komposit puanlarý (72.33 ±23.85-55.56±5.7) istatistiksel olarak anlamlý olarak daha yüksekti (p<0.05).
Tartýþma: Sonuçlarýmýz, özellikle erken çocukluk döneminde baþlanan FT'nin, DS'lu çocuklarda kaba ve ince motor geliþimini olumlu yönde etkilediðini desteklemekte olup DS'lu çocuklarý bir yaþýndan önce FT programlarýna yönlendirmek için bilimsel bir dayanak saðlamaktadýr. Klinisyenler; DS'lu çocuklar için FT’yi erken dönemde önermelidir. (NCI-2020-0280.R1)

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.

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Amaç: Alt solunum yolu enfeksiyonlarý (ASYE), çocukluk çaðýnýn en önemli morbidite ve mortalite nedenleri arasýndadýr. ASYE'lerin yaklaþýk %50-70'inden viral etkenler sorumludur. Gerçek zamanlý multipleks polimeraz zincir reaksiyonu (RT-MPCR) tabanlý testler, bazý bakteriyel patojenler ile birlikte birçok farklý virüsün daha hýzlý ve daha güvenilir þekilde eþzamanlý tespit edilmesine olanak saðlar. Bu çalýþmada, üçüncü basamak saðlýk merkezinde ASYE nedeniyle yatýrýlan ve RT-MPCR solunum patojen paneli kullanýlarak hastalýk etiyolojisi tespit edilen beþ yaþ altý çocuk hastalarýn klinik, laboratuvar ve radyolojik özelliklerini tanýmlamayý ve hastalýk etiyolojisinin tedavi ve sonuç üzerine etkilerini deðerlendirmeyi amaçladýk.
Yöntem: Bu retrospektif çalýþmada, Ocak 2019 ile Þubat 2020 tarihleri arasýnda pediatri servislerinde ve pediatrik yoðun bakým ünitesinde (YBÜ) ASYE nedeniyle yatan ve RT-MPCR analizi yapýlmýþ beþ yaþ altý tüm hastalar dahil edilmiþtir. Nazofarengeal sürüntü örneklerinin RT-MPCR analizleri ardýþýk olarak deðerlendirilmiþtir.
Bulgular: ASYE ile hastaneye yatýrýlan ve solunum yolu virüsleri açýsýndan taranan beþ yaþýn altýndaki hastalardan toplam 65 örnek alýnmýþtýr. Bu örneklerin %81,5’i pediatri servislerinden, %18,5’i pediatrik YBÜ’den toplanmýþtýr. Tüm örneklerin %89,2’inde (58/65) solunum virüsleri saptanmýþtýr. Kýrk hastada (%61,5) tek bir patojen, on beþ hastada (%23,6) iki ve üç hastada (%4,6) ise üç patojen birlikteliði görülmüþtür. En sýk olarak respiratuvar sinsityal virüs (RSV) (%32,3), ikinci sýklýk olarak insan rinovirüsü (HRV) (%30,8) saptanmýþtýr. HRV-pozitif hastalarda, eozinofil sayýsý Ýnfluenza A/B- ve Ýnsan metapneumovirus-pozitif hastalara göre daha yüksek saptanmýþtýr (sýrasýyla p: 0,014, p: 0,005). RSV pozitif hastalarda hastanede kalýþ süresi ile nötrofil, lenfosit, C-reaktif protein düzeyleri arasýnda orta derecede korelasyon gösterilmiþtir (sýrasýyla; r: 0.587; p: 0.005, r: -0.436; p: 0.038, r: 0.498; p: 0.022).
Sonuç: Tek bir merkezden sýnýrlý sayýda hastayý kapsamasýna raðmen, çalýþmamýzda geniþ bir yelpazede ASYE'nin yaygýn etkenleri tespit edilebilmiþtir. ASYE'lerde hastalýk etiyolojisini açýklamak için, RT-MPCR solunum patojen paneli kullanýlarak yapýlan tahliller, etiyolojinin saptanmasýna ve tedavinin düzenlenmesine fayda saðlayacaktýr. (NCI-2021-5-32/R1)

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.

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Amaç: Bu çalýþmanýn amacý baskýn hemorajik tip yaþa baðlý makula dejenerasyonuna (YBMD) olan hastalarda intravitreal ranibizumab tedavisinin etkinliðini deðerlendirmektir.
Materyal-Metod: En az üç intravitreal ranibizumab enjeksiyonu olan ve en az 12 ay izlenen baskýn hemorajik tip YBMD olan 25 hasta çalýþmaya dahil edildi. Optik koherens tomografide santral makula kalýnlýk (SMK) deðiþimi, ETDRS ile görme keskinliði (GK) ve fundus floresein anjiyografide lezyon boyutu deðerlendirildi.
Bulgular: Hastalarýn ortalama yaþý 68.1 ± 5.7 (63-82) yýl, ortalama takip süresi 19.9 ± 14.5 (12-67) ay ve ortalama enjeksiyon sayýsý 4.0±1.4 (3-15) idi. Baþlangýç GK 39,3 ± 17,9 (1-65) harf, SMK 272,7 ± 104 (164-587) μm ve baþlangýç lezyon geniþliði 11,4 ± 10,5 (1,3-45,7) mm2 idi. GK 6 ayda 41,4 ± 20,1 (5-75), 12. Ayda 36,9 ± 21,8 (4-80) harf (p = 0,150), MMK 6. ayda 270,7 ± 110 (159-570), 12. ayda 230,4 ± 108 (109-667) μm (p = 0,009) ve lezyon geniþliði altýncý ayda 10,9 ± 11,5 (1,1-39,7) ve 12. ayda 10,4 ± 11,6 (1,2-44,3) mm2 idi. Sonuç SMK ile iliþkili hiçbir faktör bulunamadý.
Sonuç: Sonuç görme keskinliði hastalýðýn ilerlemesi ile sýnýrlý olmasýna raðmen, ranibizumab ile tedavi edilen hemorajik lezyonlar stabil anatomik sonuca sahiptir. (NCI-2021-3-33/R2)

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.

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Meckel divertikülü genellikle asemptomatiktir, ancak çeþitli nedenlerden dolayý semptomatik hale gelebilir ve akut karýn sendromunun etyolojisinde yer alabilir. Bezoarlar, gastrointestinal sistemdeki sindirilemeyen maddelerin kombinasyonu ile oluþur ve baðýrsak týkanýklýðýnýn nadir nedenleri arasýnda yer alýrlar. Meckel divertikülünde bezoar oluþumu ve býndan kaynaklanan baðýrsak týkanýklýðý nadir görülen bir durumdur. Bu makalede, Meckel divertikülünde bezoar nedeniyle baðýrsak týkanýklýðý geliþen iki olgu ve cerrahi tedavisi sunulmuþtur. (NCI-2020-0051.R2)

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.

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AMAÇ: Türkiye'nin web tabanlý ve mobil bir hizmeti olan Korona Önlem Uygulamasý, 19 Mart 2020 tarihinden itibaren Türkiye Cumhuriyeti vatandaþlarý ve Türkiye'ye gelen yabancýlar tarafýndan aktif olarak kullanýlmaktadýr. Bu makale, Korona Önlem Uygulamasýný kullanýcýlar arasýnda riskli ve pozitif vakalarý tespit etme baþarýsý açýsýndan incelemektedir.
YÖNTEM: T.C. Saðlýk Bakanlýðý verileri ýþýðýnda yapýlan bu bilgilendirici süreç analizi çalýþmasýnda Korona Önlem Uygulamasýnýn etkinliði Mart 2020 – Aðustos 2020 arasýnda belirli illlerdeki kullaným sayýlarýyla ölçülmüþ ve uygulamanýn etkisi ortaya konmuþtur.
BULGULAR: Uygulama mobil ve web ortamýnda toplamda 2.159.903 kiþi tarafýndan kullanýlmýþ olup bu sayýda risk deðerlendirmesi yapýlmýþtýr. Sonuç olarak, yüksek risk tespit edilen 135.277 kiþi saðlýk kuruluþlarýna yönlendirilmiþ, 12.067 kiþi de PCR testi sonucunda COVID-19 pozitif sonucuyla hastaneye yatýrýlmýþ veya evde karantinaya alýnmýþtýr.
SONUÇ: Kümülatif olarak deðerlendirildiðinde, Korona Önlem Uygulamasýnýn COVID-19’la mücadelede saðlýk sistemi içerisinde verimli bir araç olarak kullanýldýðý söylenebilir. Uygulamayla hastane ziyareti tavsiye edilen 12.067 kiþinin COVID-19 pozitif olduðu görülmüþtür, bu yüzden uygulama hastalýðýn yayýlýmýný kontrol etmede en önemli enstrümanlardan biridir. (NCI-2022-2-3)

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.

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Bilimsel literatür miktarýnýn fazla oluþu, konuyu derin çalýþmak isteyen kiþileri zorlamaktadýr. Genellikle mevcut makale sayýlarý binleri aþmaktadýr. Hem mevcut kavrama hâkim olmak hem de kavramý besleyen geliþmeler arasýndaki iliþkileri görmek zorlayýcý hale gelmiþtir. Bibliyometrik verilere dayalý görselleþtirme teknikleri, karmaþýk araþtýrma konularýna iliþkin literatüre genel bir bakýþ elde etmede yardýmcý olmaktadýr. Bu çalýþmanýn amacý hasta güvenliði (HG) konusunu bibliyometrik analiz programý ile incelemektir. Web of Science (WOS) veri tabanýndan elde edilen 8372 makaleye ait veriler, SciMAT2 yazýlýmý ile incelenmiþtir. Analizden önce ham veriye yönelik genel bulgular ön plana çýkartýlmýþtýr. Stratejik diyagram ve Tematik geliþim haritasý son 30 yýlý kapsayacak þekilde 10’ar yýllýk dönem açýsýndan analiz edilmiþtir. 1990-1999 yýllarýnda beþ motor tema (“contrast agent”, “adverse events”, “program”, “safety”, “prostatectomy”), 2000-2009 yýllarýnda dört motor tema (“infection control”, “hospital acquired infections”, “adverse drug events”, “culture”) ve 2010-2019 yýllarýnda ise dokuz motor tema (“patient safety”, “education”, “climate”, “system”, “mortality”, “operating room”, “validity”, “burnout”, “primary care”) tespit edilmiþtir. Dönem içinde motor temalarýn sayýsý artmýþ ve ilk dönemlerin hareketli konularý olan advers olaylar, yerini yeni kavramlara (climate, primary care ve burn out gibi) zamanla býrakmýþtýr. Bibliyometrik görselleþtirme araçlarý, çok sayýda makaleden oluþan literatürün analiz edilmesini mümkün kýlmaktadýr. Bu yaklaþým, bir kiþinin HG gibi karmaþýk bir araþtýrma konusunu anlamasýný kolaylaþtýrmakta ve yeni araþtýrma yönleri veya alternatif araþtýrma önceliklerinden haberdar olmasýný saðlamaktadýr. (NCI-2021-3-27)

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.

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NCI-2022-3-5

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