Introduction: Nasal septum deviations have been strongly associated with severity of the rhinosinusitis. However, majority of study cannot conclude the direct association between the severity of deviation and rhinosinusitis symptoms. The angulation of the deviated septum however may have a stronger association with the severity of the rhinosinusitis. This angulation is critical to be assessed during clinical examination and have important implications in the subsequent functional endoscopic sinus surgery.
Objectives: The aim of the study was to determine the association of angulation of nasal septum with the severity of rhinosinusitis as measured by symptoms score and Visual Analog Score (VAS).
Methodology: The study was a cross sectional study conducted at two different centres in Malaysia. The study protocol was approved by Ethics Committee (USM/JEPeM/140254). Ninety-eight patients who were diagnosed with rhinosinusitis and fulfilled the selection criteria were assessed for the symptoms score and VAS and the measurement of angulation of nasal septum was performed thru a coronal view of CT paranasal sinuses in bone window setting at osteomeatal complex level.
Results: The result from one-way ANOVA test revealed a significant association between category of severity of septal angulation and the symptom score of rhinosinusitis with the p-value of 0.025. In addition, the result from one-way ANOVA test also revealed a significant association between category of severity of septal angulation and the VAS of rhinosinusitis (p-value < 0.05).
Conclusion: We conclude that severity of nasal septum angulation is significantly associated with severity of rhinosinusitis based on symptoms score and VAS, and these findings could be used in tailored management of rhinosinusitis patient especially during functional endoscopic sinus surgery.

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Amaç: Çalýþmamýzda lomber disk cerrahisinde yapýlan modifiye TLIP bloðunun postoperatif analjezi ve derlenme kalitesi üzerine etkinliðini araþtýrmayý amaçladýk.
Yöntem: Lomber Disk Hernisi cerrahisi planlanan 90 hasta kontrol grubu (Grup C) ve modifiye TLIP bloðu yapýlan (Grup T) olarak iki gruba ayrýldý. Her iki gruba hasta kontrollü analjezi yapýldý. Aðrý deðerlendirilmesi 30. dk ve 1. 2. 4. 8. 12. 24. saatlerde VAS skalasýyla hastalar dinlenirken ve hareket halindeyken yapýldý. Postoperatif 24. Saatte kullanýlan fentanil kaydedildi, hastalara QoR-40 derlenme kalitesi anketi doldurtuldu.
Sonuçlar: Postoperatif 24 saatlik tüketilen fentanil Grup C’de 742.5±220.3 mcg, Grup T’de 446.0±241.98 idi. Gruplar arasýnda postoperatif tüketilen fentanil miktarý Grup T’de daha azdý ve istatistiksel olarak anlamlý fark vardý (p=0.000). QoR-40 derlenme kalitesi anketinde hastanýn aðrý, fiziki baðýmsýzlýðý, fiziksel konforu, psikolojik desteði ve emosyonel durumu karþýlaþtýrýldý. Grup T lehine istatistiksel olarak anlamlý fark vardý (sýrasýyla p=0.000, p=0.017, p=0.002, p=0.001, p=0.000). Grup C ve Grup T’de aðrý skorlarý cerrahi sonrasý 30. dk ve 1. 2. 4. 8. 12. 24. saatte statik ve dinamik olarak kaydedildi. Statik durum ortalama skorlarýnda 8 ve 12. saat haricinde Grup T lehine istatistiksel olarak anlamlý fark vardý (p<0.05). Dinamik skorlarda tüm saatlerde Grup T lehine istatistiksel olarak anlamlý fark vardý (p<0.05).
Sonuç: TLÝP blok yapýlan grupta lumbar disk cerrahisi sonrasý aðrý skorlarý, opioid tüketimi ve QoR-40 deðerleri daha etkin olarak tespit edilmiþtir Lomber spinal disk cerrahisi için modifiye TLIP bloðunun postoperatif analjezide ve hasta derlenmesinde önemli bir yöntem olabileceðini düþünüyoruz.

AIM: The purpose of this study was to investigate the effect of the modified thoracolumbar interfacial plane block(TLIP) on postoperative analgesia and quality of recovery in patients undergoing lumbar disk surgery.
Method: Ninety patients undergoing herniated lumbar disk surgery were divided into a control group(Group C) and a modified TLIP block group(Group T).Controlled analgesia was administered to both groups. Pain evaluation was performed at 30min and at 1,2,4,8,12, and 24h using a VAS scale, with patients at rest and during movement. Fentanyl use was recorded over 24h, and patients completed the QoR-40 quality of recovery inventory.
Results: Twenty-four-hour fentanyl consumption was 742.5±220.3 mcg in Group C and 446.0±241.98 in Group T. Postoperative fentanyl consumption was statistically significantly lower in Group T(p=0.000). The patient’s pain, physical independence, physical comfort, psychological support, and emotional support were evaluated with the QoR-40. Significant differences in favor of Group T were observed (p=0.000,p=0.017,p=0.002,p=0.001 and p=0.000, respectively). Static and dynamic pain scores in Group C and Group T were recorded at 30 min and at 1,2,4,8,12, and 24h. Mean static scores were statistically in favor of Group T with the exception of 8 and 12h (p<0.05).Dynamic scores were statistically significantly in favor of Group T at all time points (p<0.05).
Conclusion: Pain scores, opioid consumption and QoR-40 values after herniation of lumbar disk surgery were superior in the group undergoing TLIP. We think that the modified TLIP block may be an important method in terms of postoperative analgesia and patient recovery for lumbar spinal disk surgery.

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AMAÇ
Laparoskopik kolesistektomi (LK) operasyonlarý yaygýn olarak genel anestezi altýnda uygulanmaktadýr. Spinal anestezi ile bu operasyonlarýn yapýlýp yapýlamayacaðý konusunda daha fazla çalýþmaya ihtiyaç bulunmaktadýr. Bu çalýþmada LK geçirecek olgularda genel anestezi ile spinal anestezinin etkinlik ve komplikasyonlar açýsýndan karþýlaþtýrýlmasý ve uygulanan preemptif analjezinin omuz aðrýsý geliþimi, genel anesteziye geçiþ oraný ve postoperatif analjezi üzerine olan etkilerinin araþtýrýlmasý amaçlanmýþtýr.

YÖNTEM
Laparoskopik kolesistektomi uygulanacak 18- 65 yaþlarý arasýnda, ASA I-II risk grubunda 60 hasta, rastgele, genel anestezi (Grup GA, n = 30) ve spinal anestezi (Grup SA, n = 30) olarak iki gruba ayrýldý. Her iki grupta operasyondan önce i.v. midazolam ve fentanil ile premedikasyon yapýldý. GA grubunda propofol ile anestezi indüksiyon sonrasý sevofluran ve remifentanil ile idame saðlandý. SA grubunda hastalara L4-5 aralýðýndan girilerek 15 mg bupivakain ile spinal anestezi saðlanmasýný takiben 7-10 dakika Trendelenburg pozisyonunda tutularak blok seviyesinin T4 düzeyine çýkmasý saðlandý. Demografik veriler, hemodinamik parametreler, operasyon süresi, postoperatif 0,1,4,8,12 ve 24. saat görsel analog skala (VAS) skorlarý, hasta-cerrah memnuniyeti ve yan etkiler kaydedilerek karþýlaþtýrýldý. SA grubunda perioperatif sað omuz aðrýsý sorgulanarak kaydedildi.

BULGULAR
Grup SA'da 5 hastada hipotansiyon, 4 hastada atropin gerektiren bradikardi, 9 hastada perioperatif omuz aðrýsý gözlendi. Hiçbir hastada genel anesteziye geçilmedi. Grup GA'da 1 hastada hipotansiyon geliþti. Postoperatif VAS skorlarý 0., 1. ve 4. saatlerde Grup SA'da anlamlý olarak düþük bulundu. Hasta memnuniyet skorlarý Grup SA’da yüksek bulundu.

SONUÇ
Laparoskopik kolesistektomi geçirecek hastalarda, özellikle genel anestezi riskinin yüksek olduðu durumlarda, spinal anestezinin genel anesteziye alternatif bir yöntem olabileceði kanýsýna varýlmýþtýr.

OBJECTIVE
Spinal anesthesia (SA) in laparoscopic cholecystectomy (LC) operations still needs to be investigated since. We aimed to compare SA with general anesthesia (GA) in terms of efficacy and complications in LC operations, and to investigate the effects of preemptive analgesia on shoulder pain development, transition to general anesthesia, and postoperative analgesia.
MATERIALS and METHODS
Sixty patients in ASA I-II risk group between 18-65 years of age undergoing laparoscopic cholecystectomy were randomly divided into two groups as GA (n=30) and SA ( n=30). Patients were premedicated with i.v. midazolam and fentanyl preoperatively. Anesthesia was induced with propofol in GA group, and maintained with sevoflurane and remifentanil. In the SA group, spinal anesthesia was provided with 15 mg bupivacaine at L4-5 level, and block level was increased to T4 by keeping the patient in Trendelenburg position for 7-10 minutes. Demographic data, hemodynamic parameters, operation time, visual analog scale (VAS) scores at postoperative 0th,1st, 4th,8th,12th and 24th hour, patient-surgeon satisfaction, side effects, and occurrence of right shoulder pain in SA group were recorded.
RESULTS
Effective anesthesia was produced in both groups. The rate of hypotension and bradycardia was higher in Group SA. Nine patients developed perioperative shoulder pain, but none of them required general anesthesia. The postoperative VAS scores were significantly lower in Group SA at 0th,1st, 4th hours. Patient satisfection score was higher in Group SA.
CONCLUSION: We concluded that spinal anesthesia may be an alternative method to general anesthesia in laparoscopic cholecystectomy operations especially when the risk of general anesthesia is too high.

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Amaç
Günümüzde non-alkolik karaciðer yaðlanmasý ve steatohepatit (NASH) sýklýðý giderek artmakta olup, erken taný büyük önem taþýmaktadýr. Çalýþmamýzda karaciðer biyopsisi yapýlan NASH hastalarýnda Fibrozis-4 (FIB-4), Aspartate Aminotransferaz Trombosit Oraný (APRI) ve AST/ALT oraný skorlarýnýn karaciðer fibrozunu öngörmedeki yerini ve en uygun kestirim deðerlerini araþtýrdýk.
Metod
Karaciðer biyopsisi yapýlan NASH hastalarý çalýþmaya dahil edildi. Tüm hastalarýn biyopsi sonuçlarý histopatolojik olarak deðerlendirildi ve fibrozis dereceleri evrelendirildi. Ayný þekilde bu hastalarda FIB-4, APRI ve AST/ALT skorlarý hesaplanarak biyopsi bulgularý ile karþýlaþtýrýldý.
Bulgular
Çalýþmaya toplam 88 hasta alýndý. Bu hastalarýn 51’i (%58) kadýn olup ortalama yaþ 52.7±9.5 idi. Biyopsi sonuçlarýna göre hastalarýn 79’unda (%89.8) NASH, 9’unda ise (%10.2) NAFLD tespit edildi. Karaciðer fibrozunun ekarte edilmesinde APRI skoru için <0.47, FIB-4 skoru için ise <0.88 kestirim deðeri en yüksek prediktif deðere sahipti. Ayný þekilde ileri fibrozun öngörülmesinde ise APRI skoru için >0.68, FIB-4 skoru için ise >2.16 kestirim deðeri en yüksek prediktif deðeri gösterdi. AST/ALT oranýnýn ise tanýsal deðeri olmadýðý görüldü.
Sonuç
Nonalkolik steatohepatitis olan hastalarda fibrozun noninvazif olarak öngörülmesinde FIB-4 ve APRI skorlarýnýn önemli bir yeri vardýr, ancak AST/ALT oraný yeterli deðildir. Öte yandan her ne kadar klavuzlar bu skorlama sistemlerini taramada önerse de uygun ideal kestirim deðerleri konusunda netlik yoktur. Bu noktada FIB-4 skoru özellikle ciddi fibrozun öngörülmesinde yüksek duyarlýlýk ve özgüllük ile ön plana çýkmaktadýr.

Objective
Nowadays, the incidence of non-alcoholic fatty liver and steatohepatitis (NASH) is increasing and early diagnosis is of great importance. In this study, we investigated the optimal predictive value of Fibrosis-4 (FIB-4), Aspartate Aminotransferase to Platelet Ratio (APRI) and AST/ALT Ratio in predicting liver fibrosis in NASH patients undergoing liver biopsy.
Methods
Patients with NASH who underwent liver biopsy were included in the study. Biopsy results of all patients were evaluated histopathologically and grade of fibrosis was graded. In addition, FIB-4, APRI and AST/ALT scores were calculated and compared with biopsy findings in these patients.
Results
A total of 88 patients were included in the study. Of these patients 51 (58%) were female and the mean age was 52.7 ± 9.5. According to biopsy results, NASH was detected in 79 (89.8%) and NAFLD in 9 (10.2%) of the patients. The cut-off value less than 0.47 for APRI score and <0.88 for FIB-4 score showed the best discriminatory power in exclusion of liver fibrosis. Likewise, the cut-off value greater than 0.68 for APRI score and > 2.16 for FIB-4 score showed the highest predictive value in predicting advanced fibrosis. AST/ALT ratio had no diagnostic value.
Conclusion
FIB-4 and APRI scores play an important role in the prediction of fibrosis in NASH patients, but the AST/ALT ratio is not sufficient. On the other hand, although the guidelines recommend using these scoring systems as a screening tool, there is no clarity as to the appropriate ideal cut-off values. At this point, FIB-4 score stands out with high sensitivity and specificity especially in the prediction of severe fibrosis.

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Amaç:
Kartilaj enfeksiyon ve retraksiyona karþý oldukça dirençli ve orta kulak tarafýndan iyi tolere edilen sert bir malzemedir. Bu çalýþmanýn amacý, canal wall down (CWD) mastoidektomi sonrasý kartilaj ile mastoid kavite obliterasyon yapýlan olgularýn sonuçlarýný geriye dönük olarak gözden geçirmek ve literatürü tartýþmaktýr.
Materyal ve Metod:
Ocak 2000 - Haziran 2012 tarihleri arasýnda kronik otitis media ameliyatý geçirmiþ 983 hastadan, CWD mastoidektomi ve mastoid kavite obliterasyonu yapýlan ve düzenli aralýklarla takip edilen 54 hasta veri tabanýndan seçildi ve yeniden deðerlendirme için çaðrýldý. Tekrar inceleme için gelen tüm hastalar deðerlendirilerek verileri retrospektif olarak analiz edildi.
Bulgular:
Yeniden deðerlendirme için çaðýrýlan hastalarýn 35'i çalýþmaya dahil edildi. Çalýþmaya alýnan tüm hastalara konkal ve/veya tragal kartilaj greftler ile mastoid kavite obliterasyonu uygulandý. Takip süresi 21 ila 41 ay arasýnda deðiþmekte idi (ortalama, 27.3 ay). Rezidüel kolesteatom geliþen ve revizyon ameliyatý geçirilenlerin haricinde kuru kaviteli tüm hastalarda epitelizasyon görüldü.
Sonuç:
Bu çalýþmadan elde edilen sonuçlar, CWD mastoidektomi sonrasý mastoid kavite obliterasyonu için kartilaj tercih edilebileceðini göstermektedir.

Objective:
Cartilage is a rigid material that is highly resistant to infection and retraction and is tolerated well by the middle ear. The purpose of this study was to review retrospectively the results of cases of mastoid cavity obliteration with cartilage performed after canal wall down (CWD) mastoidectomy and to discuss the literature.
Materials and Methods:
Of 983 patients who underwent surgery for chronic otitis media between January 2000 and June 2012, 54 patients who underwent CWD mastoidectomy plus mastoid cavity obliteration with cartilage and who followed up regularly were selected from the database and invited for re-evaluation. All patients who came for a follow up after the invitation were examined and their data were evaluated retrospectively.
Results:
Thirty-five of the patients who accepted the invitation were included in the study. All of the patients in the study underwent mastoid cavity obliteration with conchal and/or tragal cartilage grafts. The duration of follow up ranged from 21 to 41 months (average, 27.3 months). Epithelization occurred in all patients with dry cavity, except one who had residual cholesteatoma and underwent revision surgery.
Conclusion:
The results of this study indicate that cartilage can be preferred for obliteration of mastoid cavity after CWD mastoidectomy.

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Amaç: Göçmen anne bebeklerinde perinatal özelliklerin ve neonatal morbiditelerin görülme sýklýðýnýn araþtýrýlmasý, Türk anne bebekleriyle karþýlaþtýrýlmasý.
Yöntem: Hastanemizde 2015-2019 yýllarý arasýnda yenidoðan yoðun bakým ünitesine yatan 89 Suriyeli anne bebekleri ile ayný dönemde ardýþýk yatan 89 Türk anne bebeklerinin verileri retrospektif ola¬rak dosya kayýtlarýndan elde edildi. Ýki grup arasýnda demografik data, perinatal ve neonatal sonuçlar karþýlaþtýrmak için istatistiksel analiz yapýldý.
Bulgular: Suriyeli annelerin yaþ ortalamasý anlamlý olarak daha düþük, adölesan gebelik oraný anlamlý olarak daha yüksekti (p<0.01). Suriyeli annelerde çoðul gebelik, akraba evliliði ve uzamýþ erken membran rüptürü görülme oraný da Türk annelere göre istatistiksel olarak anlamlý derecede daha yüksek saptandý (p<0.05). Konjenital anomaliler, respiratuvar distress sendromu, yenidoðanlarda geçici taþikne, pnömoni / bronþiolit, sepsis, sarýlýk ve beslenme problemi insidansý Suriyeli ve Türk annelerden doðan bebeklerde benzerdi. Bunun yanýnda, gestasyon haftasý, doðum aðýrlýðý, cinsiyet, doðum þekli, düþük Apgar skoru, hastanede yatýþ süresi ve mortalite görülme sýklýðý açýsýndan Suriyeli anne bebekleri ile Türk anne bebekleri arasýnda anlamlý farklýlýk görülmedi (p>0.05).
Sonuç: Göçmen statüsü perinatal ve neonatal sonuçlarý olumsuz etkileyen bir faktördür. Bununla birlikte, Suriyeli anne bebeklerinde mortalite ve neonatal morbidite görülme sýklýðý Türk anne bebeklerine göre belirgin bir farklýlýk göstermemektedir. Bu, son dönemde göçmenlerin saðlýðýnýn genel bir iyileþmesinden veya Türkiye’de yaþayan göçmen kadýnlarýn doðum öncesi ve sonrasý dönemlerinde anne-çocuk saðlýðý hizmetlerine eriþebilirliði artýran politikalarýn baþarýlý bir þekilde uygulanmasýndan kaynaklanýyor olabilir.

Objective: To investigate the incidence of perinatal features and neonatal morbidities in migrant mothers and and to compare them with native Turkish mothers.
Method: A retrospective analysis was conducted using the medical records of 89 infants born to Syrian immigrants and 89 infants born to native Turkish mothers who were consecutively admitted to the neonatal intensive care unit of our hospital between 2015 and 2019. Statistical analyses were used to compare demographic data and perinatal and neonatal outcomes between the two groups.
Results: Compared to Turkish mothers, Syrian mothers were significantly younger and included more adolescents (p <0.01). The rates of multiple pregnancy, consanguineous marriage, and prolonged premature membrane rupture were also significantly higher in Syrian mothers (p <0.05). The incidences of congenital anomalies, respiratory distress syndrome, transient tachypnea in newborns, pneumonia/bronchiolitis, sepsis, jaundice, and feeding problems were the same for infants born to Syrian and Turkish mothers (p >0.05). In addition, the two groups did not differ with respect to gestational week at birth, birth weight, sex, delivery type, Apgar score, duration of hospital stay, and infant mortality incidence (p >0.05).
Conclusion: The immigrant status negatively affects perinatal and neonatal outcomes. However, the incidences of infant mortality and neonatal morbidity did not differ between infants born to Syrian or Turkish mothers. This may be due to the recent improvements in the of overall health status of migrant women or of those migrants living in Turkey being able to have access to increased prenatal and postnatal period mother-child health services policies which have been successfully implemented.

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Amaç: Myotoni Konjenita (MK), klorür voltaj kapýlý kanal 1 (CLCN1) genindeki mutasyonun neden olduðu kalýtsal bir klorür kanalý nöromüsküler bozukluðudur. MK insidansýnýn 100.000'de 1 olduðu tahmin edilmektedir. Sol ana koroner arter yokluðu (LMCA) anomalisi nadir bir koroner anomalidir. MK varyasyonu ve kardiyovasküler risk taþýyan dört üyeli bir aileyi sunuyoruz.

Materyal ve Metodlar: Olgularýn demografik özellikleri, laboratuvar bulgularý, antropometrik ölçümleri ve kardiyolojik incelemeleri yapýldý. Ayrýca, CLCN1 geni NGS ile dizilendi ve MTHFR (A1298C), Faktör V Leiden (G1691A), Faktör II (G20210A), MTHFR (C677T), Faktör V Cambridge (G1091C), plazminojen aktivatör inhibitör 1 (PAI-1) 4G/5G APOE, APOB, ITGB, ACE (ins / del), FVHR2 ve FGB genlerindeki deðiþiklikler olasý trombofili riski açýsýndan deðerlendirildi.

Bulgular: Olgu 1'de CLCN1 geninde homozigot c.1886T> C (p.Leu629Pro) deðiþikliði ve ayrýca koroner arter hastalýðý, miyokard infarktüsü öyküsü, hiperlipidemi, primer hipertansiyon, vertigo, Lomber disk herniasyonu ve iþitme kaybý vardý. Olgu 1’de koroner anjiyografide LMCA saptanmadý. Diðer olgular (2,3 ve 4) heterozigot c.1886T> C (p.Leu629Pro) deðiþimine sahipti ancak elektrokardiyografi ve transtorasik ekokardiyografileri normaldi. Ek olarak, aile üyelerinin tümü, kardiyovasküler hastalýða yol açan ilgili genler açýsýndan artmýþ risk faktörlerine sahipti.

Sonuç: Kardiyomiyositlerdeki klorür kanallarýndaki deðiþikliklerin miyokard tutulumuna yol açabilmesi nedeniyle, MK'li olgularýn kardiyovasküler risk açýsýndan düzenli olarak incelenmesi gerektiði söylenebilir. Ayrýca, MK’li ve kardiyovasküler hastalýk için yüksek genetik risk faktörlerine sahip hastalar düzenli olarak takip edilmelidir.

Background: Myotonia Congenita (MC) is a hereditary neuromuscular disorder caused by a mutation in chloride voltage-gated channel 1 (CLCN1) gene. The incidence of MC is estimated as 1 in 100.000. The absence of left main coronary artery (LMCA) anomaly is a rare coronary anomaly. Here we present a family with four members who have MC variation carrier and cardiovascular risk.
Materials and Methods: The demographic features, laboratory findings, anthropometric measurements and cardiological examination of the cases were recorded. In addition, CLCN1 gene was sequenced by NGS and possible causes of inherited thrombophilia risk including MTHFR (A1298C), Factor V Leiden (G1691A), Factor II (G20210A), MTHFR (C677T), Factor V Cambridge (G1091C), plasminogen activator inhibitor 1 (PAI-1) 4G/5G, APOE, APOB, ITGB, ACE (ins/del), FVHR2 and FGB gene alterations were evaluated.
Results: Case 1 had homozygous c.1886T>C(p.Leu629Pro) alteration in CLCN1 gene and also coronary artery disease, myocardial infarction (MI) history, hyperlipidemia, primary hypertension, vertigo, Lomber disc herniation and hearing loss. LMCA was not detected in coronary angiography in case 1. The other cases (2, 3 and 4) have heterozygous c.1886T>C (p.Leu629Pro) alteration with normal electrocardiographic and echocardiographic findings. Additionally, all of family members had genetic risk factors for the related gene, which lead to an increased risk of cardiovascular disease.
Conclusions:
Due to alteration of chloride channels in cardiomyocytes leads to variable myocardial involvement, cases with MC should be regularly followed for cardiovascular risk. Moreover, the cases with MC and with genetic profile associated with high cardiovascular risk should also be regularly followed up by cardiologists.

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Amaç: Bu çalýþmanýn amacý, bispektral indeks kontrollü magnezyum kullanýmýnýn propofol tüketimi, periprosedürel hemodinamik cevap ve hasta konforu üzerine etkilerini araþtýrmaktýr.
Materyal ve Metod: Çalýþmaya toplam 60 hasta dahil edildi. Grup I'de (magnezyum), iþlem baþlamadan 10 dakika önce tek bir doz 50 mg / kg magnezyum sülfat (100 mL% 0.9 NaCl ile seyreltilmiþ) verildi. Ýþlem baþlangýcýnda 0.5 mg / kg propofol bolusu uygulandý. Propofolün idame dozu 60 mcg / kg / dakika idi. Ýþlem sýrasýnda propofol infüzyonu bispektral indeks (BIS) deðeri 70 olana kadar titrasyonla arttýrýldý. Grup II de (salin), iþlem baþlamadan 10 dakika önce 100 ml % 0.9 NaCl uygulandý. Propofol bolus ve idame dozlarý ve hedef BIS deðerleri Grup I deki ile aynýydý.
Bulgular: BIS deðerleri gruplar arasýnda karþýlaþtýrýldýðýnda, Magnezyum grubundaki (grup 1) ilk BIS deðerleri salin grubundan (grup 2) anlamlý derecede yüksek idi (p<0.05). BIS 70'e ulaþma süresi Magnezyum grubunda anlamlý derecede düþüktü (p <0.05). Propofol tüketimi grup 2'de grup 1'den daha fazlaydý (p <0.05). BIS 70'e ulaþma süresi Grup 1'de anlamlý derecede düþüktü (p <0.05). Gruplar arasýnda hasta ve endoskopist memnuniyeti açýsýndan anlamlý fark bulunmadý (p ˃ 0.05).
Sonuç: Propofole ilaveten magnezyum kullanýmý kolonoskopik müdahalelerde ilaç tüketimini azaltmak için etkili ve güvenilir bir seçenek olabilir.

Objective: To investigate the effects of bispectral index-controlled use of magnesium on propofol consumption, periprocedural hemodynamic response and patient comfort.
Materials and Methods: A total of 60 patients were enrolled in the study. In Group I (magnesium), a single dose 50 mg/kg magnesium sulfate (diluted with 100 mL 0.9% NaCl) was administered 10 minutes before the beginning of the procedure. Initial dose of 0.5 mg / kg propofol bolus was applied. The maintenance dose of propofol was 60 mcg / kg /min. During the procedure, the propofol infusion was increased by titration until the bispectral index (BIS) value of 70 was achieved. In Group II (saline), 100 ml 0.9% NaCl was administered 10 minutes before the beginning of the procedure. The propofol bolus and maintenance doses, and target BIS values were the same as those in Group I.
Results: When BIS values were compared between the groups, the initial BIS values in the magnesium group (Group 1) were significantly higher than those of the saline group (Group 2) (p<0.05). The time to reach BIS 70 was significantly lower in the magnesium group (p<0.05). Propofol consumption was greater in Group 2 than in Group 1 (p <0.05). The time to reach BIS 70 was significantly lower in Group 1 (p <0.05). No significant difference was found between the groups in terms of patient and endoscopist satisfaction (p ˃ 0.05).
Conclusion: The use of magnesium in addition to propofol may be an efficient and reliable option to reduce the drug consumption during colonoscopic interventions.

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The round-the-clock demands of healthcare services, coupled with the shortage of healthcare providers in many parts of the world have made shift work widespread among healthcare workers. Understanding how to mitigate adverse health effects associated with shift work is essential to health promotion, disease prevention, and quality of life. This comprehensive review aims to present evidence linking shift work with cardiovascular diseases and cancers among healthcare workers. Several studies demonstrated evidence of the association between long-term shift work exposure and the risk of cardiovascular diseases. The testimony about shift work-related adverse health effects has been on the rise among healthcare workers. Shift work disturbs circadian patterns and cardiopulmonary processes, leading to adverse health outcomes. Increasing prevalence of shift work in healthcare industries due to population expansion and public health threat of cancers call for investigation towards a better understanding of the underlying mechanism of shift work-induced diseases. Shift work period was considered in different studies using various criteria, resulting in inconsistent measurement definition leading to misclassification of the study population. There is a need for a more considerable and wholistic effort towards standardization of shift work definition, and conduct assessment to establish an actionable framework for intervention strategies.

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Rutin talasemi (hemoglobin varyant) taramasý esnasýnda tespit edilen vaka 25 yaþýnda erkek hasta ve Türk kökenlidir. Fizik muayenesinde herhangi bir anormal bulguya rastlanmadý. Laboratuvar incelemesinde anemi yönünden herhangi bir bulguya ( demir eksikliði, B12 eksikliði vs.) rastlanmadý. Ancak hemoglobin varyant raporu deðerlendirilirken, normal hemoglobin piklerinin yaný sýra daha önce tanýmlanmayan bir pik daha olduðu tespit edildi. Numune bilinmeyen bir hemoglobin varyantý þüphesi ile doðrulama yapýlmasý için genetik analize gönderildi. Genetik analiz sonucuna göre bilinmeyen hemoglobin varyantýnýn Hemoglobin Pusan (Hb Pusan) olduðu tespit edildi. Bu çalýþmanýn amacý Türk toplumunda nadir görülen bir hemoglobin varyantý hakkýnda bilgilendirme yaparak, bu hemoglobin varyantý hakkýnda farkýndalýðýný arttýrmaktýr. Ayrýca bu hastalýðýn klinik ve hematolojik bulgularý vaka raporunda tartýþýlmýþtýr.

The case, detected during routine thalassemia (hemoglobin variant) screening, was a 25-year-old male patient of Turkish origin. Physical examination revealed no abnormal findings. Laboratory findings did not reveal any signs of anemia (iron deficiency, B12 deficiency, etc.). However, when the hemoglobin variant report was being evaluated, it was found that besides the normal hemoglobin peaks, there was another peak that had not been defined before. The sample was sent to genetic analysis for verification with the suspicion of an unknown hemoglobin variant. According to the genetic analysis, the unknown hemoglobin variant was found to be Hemoglobin Pusan (Hb Pusan). The aim of this study is to give information about a hemoglobin variant which is rarely seen in Turkish population and to raise awareness about this hemoglobin variant. In addition, clinical and hematological findings of this disease are discussed in the case report.

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Oral cyst is uncommon in the neonatal period. Depending on the size and site of occurrence, the symptoms may vary. If it not diagnosed and managed expeditiously, these oral cyst may cause significant morbidity and mortality as its can be fatal. We report a successfully managed case of oral cyst in neonate that presented with huge tongue mass at birth with potential impending airway obstruction. She was referred for tracheostomy as intubation was impossible. We attempted needle aspirate and the airway successfully relieved without the need for tracheostomy.

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