Amaç: Çalýþmanýn amacý, idiyopatik rekürren pediatrik epistaksis hastalarýnda topikal týbbi tedavinin etkinliðini ve güvenliðini hem antimikrobiyal hem de nemlendirici bir ajanýn intranazal uygulanmasýnýn birinci basamak tedavi yöntemi olarak incelemektir.
Materyal ve Metod: Ýzlemin hasta kayýtlarýnýn gözden geçirilmesiyle seçilen idiyopatik tekrarlayan burun kanamasý olan 326 pediatrik hastanýn 67'si çalýþmaya dahil edildi. Çalýþma iki grubun analizi olarak tasarlanmýþtýr: bir grupta hiperemik burun mukozasýna sahip 35 pediatrik hasta (toplam kohortun % 52.2'si) ve ikinci grupta hipervasküler burun mukozasýna sahip 32 pediatrik hasta (toplam kohortun % 47.8'i) tedaviden önce fizik muayeneleri yapýlmýþ uygun hastalar olarak seçilmiþtir.
Bulgular: Çalýþma 36 erkek (toplam kohortun % 53.7'si) ve 31 kadýn (toplam kohortun % 46.3'ü) olmak üzere toplam 67 çocuk hasta (3-17 yaþ arasý) ile gerçekleþtirildi. Yaþ ortalamasý 9.78 ± 4.09 idi. Gruplar arasýnda yaþ, takip süresi ve burun kanamasý nüks süresi açýsýndan istatistiksel olarak anlamlý fark yoktu (p> 0.05). Hiperemik nazal mukoza grubunun % 22.9'unda (8/35) ve hipervasküler nazal mukoza grubunun % 34.4'ünde (11/32) burun kanamasý nüksü görüldü (p> 0.05).
Sonuç: Daha invaziv epistaksis kontrol yöntemlerinden önce, idiyopatik tekrarlayan epistaksisi olan pediatrik hastalar için hem intranazal antimikrobiyal merhem hem de mukozal nemlendirici jelin birlikte kullanýmýnýn etkili, invaziv olmayan ve kolayca uygulanabilir bir týbbi tedavi seçeneði olarak kullanýlmasýný öneriyoruz.

Objectives: The goal of the study was to verify the efficacy and safety of topical medical management in idiopathic recurrent pediatric epistaxis patients by usage of both an antimicrobial and a moisturizing agent intranasally as a first-step management modality.
Materials and Methods: Sixty-seven out of 326 pediatric patients with idiopathic recurrent epistaxis selected on a chart review of follow-up were enrolled in the study. The study was designed as an analysis of two groups: one group included 35 individuals (52.2% of the total cohort) having a hyperemic nasal mucosa and the second group included 32 individuals (47.8% of the total cohort) having a hypervascular nasal mucosa on physical examination before treatment.
Results: The study was performed with a total of 67 children (age range 3-17 years) including 36 males (53.7% of total cohort) and 31 females (46.3%of total cohort). The mean age was 9.78±4.09. There was no statistically significant difference between the groups in terms of age, follow-up duration and recurrence time of epistaxis (p>0.05). Recurrence of epistaxis was seen in 22.9% (8/35) of hyperemic nasal mucosa group and in 34.4% (11/32) of hypervascular nasal mucosa group, there was no statistically significant difference between them (p>0.05).
Conclusion: We advise the use of both an intranasal antimicrobial ointment and a mucosal moisturizing gel as an effective, noninvasive and easily applicable medical treatment option for pediatric patients with idiopathic recurrent epistaxis before more invasive methods of epistaxis control.

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Amaç: Hastaneye yatarak tedavi gerektiren hiperemezis gravidarum (HG) ile komplike gebelikler ile hiperemezis gravidarum görülmeyen gebeliklerin maternal ve fetal sonuçlarýný karþýlaþtýrmak.
Yöntem: Tek merkezde yapýlan bu retrospektif çalýþmaya 2015 Mart ile 2018 Ocak arasýnda tekil doðum yapan 386 kadýn dahil edildi. 386 kadýnýn 186’sý (ortalama ± SD yaþ: 30.7 ± 5.9 yýl) gebeliðin ilk 20 haftasýnda hiperemezis gravidarum nedeniyle hastaneye yatýrýlan kadýnlardan oluþurken hiperemezis gravidarum görülmeyen 200 kadýn kontrol grubu olarak oluþturdu.
Bulgular: HG ve kontrol gruplarý arasýnda maternal özellikler, ve sýrasýyla gebelik yaþý (ortalama 38.6 ve 39.0 hafta), doðum þekli (normal spontan doðum, % 78.0 ve% 80.0), fetal cinsiyet (kýz, % 53.2 ve % 48.5), doðum aðýrlýðý (ortalama 3250 g ve 3275 g) ve 5 dakikalýk APGAR skorlarý (≥7, % 97.3 ve % 97.5) farklýlýk görülmedi. Olumsuz gebelik sonuçlarý olarak deðerlendirilen preterm doðum (%8.1 ve %11.0), SGA (%5.9 ve %9.5), hipertansif hastalýklar (%5.4 ve %7.5), dekolman plasenta (%1.1 ve %0.5) ve GDM (%3.8 ve %2.5) görülme oranlarý da benzer bulundu. Gebelik sýrasýnda kilo kaybý hiperemezis gravidarum grubundaki kadýnlarýn% 91.3'ünde görülürken, kontrol grubundaki kadýnlarýn hiçbirinde gebelik sýrasýnda kilo kaybý görülmedi (p <0.001).
Sonuç: Bu çalýþmanýn bulgularý, geniþ ölçekli baþka çalýþmalarla doðrulanmak üzere, hiperemezis gravidarumun olumsuz fetal ve maternal komplikasyonlarla iliþkili olmayabileceðine iþaret etmektedir.

Objective: To compare maternal and fetal outcomes of pregnancies complicated and not complicated with hyperemesis gravidarum (HG) necessitating hospitalization.
Method: A total of 386 women with singleton deliveries between March 2015 and January 2018 were included in this retrospective single-center study. Of 386 women, 186 women (mean±SD age: 30.7±5.9 years) who were hospitalized with HG within the first 20 weeks of gestation comprised the hyperemetic pregnancy group, while 200 women without HG during pregnancy served as a control group.
Results: No significant difference was noted between the HG and control groups in terms of maternal characteristics, gestational age (median 38.6 and 39.0 weeks, respectively), type of delivery (normal spontaneous delivery in 78.0% and 80.0%, respectively), fetal gender (female: 53.2% and 48.5%, respectively), birthweight (median 3250 g and 3275 g, respectively) and 5-min APGAR scores (≥7 in 97.3% and 97.5%, respectively). Adverse pregnancy outcomes were also similar between groups including preterm birth (8.1% and 11.0%, respectively), SGA (5.9% and 9.5%, respectively), hypertensive disorder (5.4% and 7.5%, respectively), placental abruption (1.1% and 0.5%, respectively), stillbirth (0.0% and 0.5%, respectively) and GDM (3.8% and 2.5%, respectively). Weight loss during pregnancy was evident in 91.3% of women in the HG group, while none of women in the control group had weight loss during pregnancy (p<0.001).
Conclusions: The findings of this study seem to indicate that HG may not be related with adverse fetal and prenatal outcome and this conclusion needs to be clarified with large scaled investigations.

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Amaç: Bu çalýþmada, Acil Týp ile Ýç Hastalýklarý bölümlerinde çalýþan hekimlerin psikolojik iyilik halleri ile stres düzeylerinin incelenerek karþýlaþtýrýlmasý amaçlanmýþtýr.
Metot: Bu araþtýrma, bir eðitim ve araþtýrma hastanesinde yapýlan kesitsel bir çalýþmadýr. Çalýþmaya 39 hekim katýldý. Ölçeklendirmelerden Profesyonel Yaþam Stres Ölçeði (PYSÖ), Beck Anksiyete Envanteri (BAE), Beck Depresyon Envanteri (BDE) ve Kabul Eylem Formu-II (KEF-II) kullanýldý.
Bulgular: Analize dahil edilen 39 hekimden (%56,4’ü kadýn, ortalama yaþ: 32,6 ± 6,8) 19’u (%48,7) acil ve 20’si (%51,3) iç hastalýklarý branþýndaydý. Katýlýmcýlarýn %66,7’sýnda (N=26) PYSÖ 16-30 puan aralýðýnda hesaplanmýþtýr ki bu deðer aralýðý meslek yaþamlarýnda orta düzeyde streste olduklarýný göstermektedir. BAE ve BDE skorlarý sýrasýyla 0 - 36 (ortalama, 8,4±8,9) ve 0 - 29 (ortalama, 7,6±5,9) arasýnda deðiþmekteydi. Ortalama puanlar üzerinden baktýðýmýzda bu deðerler katýlýmcýlarýn anksiyete ve depresif semptomlar açýsýndan psikopatolojik sýnýrýn altýnda olduklarýný iþaret etmektedir. Acil uzmanlarýnda KEF-II skorlarýnýn anlamlý olarak düþük bulunmasý (p=0,049) yaþantýsal kaçýnmanýn sadece bu grupta düþük olduðunu göstermektedir. Ayrýca çocuk sahibi olanlarýn KEF-II skorlarýnýn düþük olduðu saptanmýþtýr (p=0,028).
Sonuç: Uzun süreli acilde çalýþmak, stresle baþa çýkma yeteneðini arttýrýrken, daha yüksek stres seviyelerine neden olmaktadýr. Çalýþmamýzda çocuk sahibi olmanýn yaþantýsal kaçýnmada azalma ve psikolojik esneklikte artma ile birlikte olduðu görülmüþtür. Bununla birlikte, gruplar arasýnda PYSÖ, BAE ve BDE skorlarý açýsýndan anlamlý bir fark bulunmamýþtýr.

Objective: This study aimed to examine and compare the stress levels working in Emergency Medicine (EM) and Internal Medicine (IM) Departments. In addition, the factors affecting stress levels were assessed.
Methods: This is a cross-sectional study performed in a research and training hospital. The population of the study was consisted of 39 doctors. Professional Life Stress Scale (PLSS), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) and Acceptance and Action Questionnaire-II (AAQ-II) were used.
Results: 39 doctors (female 56.4%; mean age 32.6±6.8) included in analysis, 19 (48.7%) were from EM, 20 (51.3%) were from IM. Twenty-six (66.7%) of the participants had a score of 16-30 points indicates a moderate range of stress in their professional life. The BAI and BDI scores of the participants ranged from 0 to 36 (mean, 8.4±8.9) and 0 to 29 (mean, 7.6±5.9), respectively, which indicates the participants were below the psychopathological limits in terms of anxiety and depressive symptoms. AAQ-II scores were found significantly lower in emergency physicians (p=0.049) that indicates that they had a lower level of experiential avoidance than others. Also, AAQ-II scores were found significantly lower in those who had children (p=0.028).
Conclusion: Working in EM departments in long-term period cause more higher stress levels while increase the ability to cope with stress. Our study shows that having children is related with decrease in experiential avoidance, hence higher levels of psychological flexibility. No significant differences had been found between the groups in terms of PLSS, BAI and BDI scores.

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Amaç: Bu çalýþmada amaç, yaþlý bireylerde kemik saðlýðýný belirleyen faktörleri saptamaktýr.
Metod: 65 yaþ ve üzeri 313 birey (ort. yaþ 74.2±6.4 yýl, %70.6 kadýn) çalýþmaya dahil edildi. Demografik veriler, yürüyüþ hýzý, kavrama kuvveti, fiziksel aktivite düzeyi (Fiziksel Etkinliðin Hýzlý Deðerlendirilmesi- FEHD kullanýlarak) ve vitamin D seviyeleri, femur boyun (FN) ve lumbal omurgaya (LS) ait T skorlarý kaydedildi.
Bulgular: FN' e göre katýlýmcýlarýn %40,7' si normal T skoru düzeylerine sahipken; %46,2'si osteopenik ve %13,1'i osteoporotikti. FN, yaþ (r: -0.184, p<0.001), VKÝ (r: 0.269, p<0.001) ve kavrama kuvvetine (r: 0.149, p: 0.009) ek olarak FEHD'nin aerobik alt skalasý (FEHD-aerobik) (r: -0.133, p: 0.02) ile iliþkiliydi. Benzer þekilde LS, kadýn cinsiyet (r: -0.207, p<0.001), yaþ (r: 0.136, p: 0.016), vücut kitle indeksi (VKÝ) (r: 0.246, p<0.001) ve kavrama kuvveti (r: 0.217, p<0.001) ile iliþkiliydi. Kemik saðlýðýnýn belirleyicileri çoklu lojistik regresyon analizi kullanýlarak kararlaþtýrýldý. Belirleyici model içerisinde yaþ, cinsiyet, VKÝ, boy, kilo, kavrama kuvveti, yürüyüþ hýzý, FEHD-aerobik ve vitamin D yer aldý. LS baðýmsýz deðiþkeni için, model anlamlýydý (F: 10.149, p<0.001); ancak, modelde yer alan deðiþkenlerden yalnýzca kilo (β: 0.389, p<0.001) ve kavrama kuvveti (β: 0.186, p<0.001) anlamlý belirleyiciydi. Benzer þekilde FN baðýmsýz deðiþkeni için, model anlamlýydý (F: 6.525, p<0.001) ve yalnýzca iki deðiþken anlamlý belirleyiciydi: kilo (β: 0.371, p<0.001) ve FEHD-aerobik (β: 0.148, p: 0.009).
Sonuç: Düþük vücut aðýrlýðý, aerobik aktivite katýlým düzeyi ve kavrama kuvveti gibi faktörler yaþlý bireylerde kemik saðlýðýnýn bozulmasý açýsýndan risk faktörü olabilir.

Objective: The objective of this study was to determine the predictors of bone health in older adults.
Methods: 313 subjects older than 65 years (mean age 74.2±6.4 years, 70.6% female) were included in the study. The demographic and clinical characteristics of participants such as gait speed, handgrip strength, level of physical activity (using Rapid Assessment of Physical Activity-RAPA), vitamin D levels, T scores of femur neck (FN) and lumbar spine (LS) were collected.
Results: Based on FN, 40.7% of participants had normal bone health whereas 46.2% and 13.1% were osteopenic and osteoporotic, respectively. It was found that the FN was correlated with age (r: -0.184, p<0.001), BMI (r: 0.269, p<0.001), and handgrip strength (r: 0.149, p: 0.009) in addition to the aerobic subscale of RAPA (RAPA-aerobic) (r: -0.133, p: 0.02). Similarly, the LS was correlated with female gender (r: -0.207, p<0.001), age (r: 0.136, p: 0.016), body-mass index (BMI) (r: 0.246, p<0.001) and handgrip strength (r: 0.217, p<0.001). The predictors of bone health were analyzed with multiple logistic regression analysis. The predictor model consisted of age, gender, BMI, height, weight, handgrip strength, gait speed, RAPA-aerobic and vitamin D. For LS dependent variable, the overall model was significant (F: 10.149, p<0.001). However, only two variables were significant predictors in the model: weight (β: 0.389, p<0.001) and handgrip strength (β=0.186, p<0.001). Similarly for FN dependent variable, the overall model was significant (F: 6.525, p<0.001) and only two variables were significant predictors: weight (β: 0.371, p<0.001) and RAPA-Aerobic (β: 0.148, p: 0.009).
Conclusion: Lower levels of body weight, aerobic activity participation and handgrip strength might be risk factors for deterioration of bone health in older adults.

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Amaç: Bu çalýþmada, neonatal indirekt hiperbilirubinemi dýþýnda baþka sorunu olmayan term yenidoðanlarda, hiperbilirubineminin nörolojik geliþim ve iþitme fonksiyonu üzerinde uzun dönem etkilerinin araþtýrýlmasý amaçlanmýþtýr.
Yöntemler: Bu çalýþma, indirekt hiperbilirubinemi nedeniyle yatýrýlarak tedavi edilen 41 term yenidoðanda ileriye dönük olarak gerçekleþtirilmiþtir. Hemoliz bulgusu saptanmayan hastalar sTB <20 mg/dl, 20-24.9 mg/dl, =>25 mg/dl olarak 3 gruba ayrýlmýþtýr. Hemolitik hastalýk saptanan ve sTB =>20 mg/dl olan hastalar 4. grup olarak belirlenmiþtir. Maksimum sTB düzeyi, sTB >20 mg/dl üzerinde kalma süresi ve sarýlýk etyolojisi ile nörolojik ve iþitsel fonksiyonlar arasýndaki iliþki incelenmiþtir. Tüm olgulara 18-24. aylar arasýnda ayrýntýlý nörolojik muayene, Denver II geliþimsel tarama testi ve iþitme testleri (otoakustik emisyon, OAE ve iþitsel beyin sapý cevaplarý, ABR) incelemesi yapýlmýþtýr.
Bulgular: Hastalarýn 5’inde (%12,2) nörolojik geliþim bozukluðu saptanmýþ olup, bu hastalarýn sadece ikisinde hemolitik hastalýk mevcuttu. Hastalarýn 4’ünde (%9,8) iþitme kaybý tespit edilmiþtir. Bu hastalarýn ikisi iþitsel nöropati spektrum bozukluðu, diðer ikisi ise koklea kaynaklý sensorinöral iþitme kaybý olarak deðerlendirilmiþtir. Nörolojik ya da iþitsel bozukluk saptanan hastalarýn hepsinde maksimum sTB düzeyi 25 mg/dl’nin üzerinde bulunmuþtur. Maksimum sTB düzeyi 25 mg/dl’nin altýndaki hastalarýn hiçbirinde nörolojik ya da iþitsel bozukluk saptanmamýþtýr. Nörolojik disfonksiyon ve ABR patolojisi saptanan olgularýn 20 mg/dl’nin üzerinde sTB düzeylerine maruz kalma süresi, diðer hastalardan anlamlý uzun bulunmuþtur (sýrasýyla p: 0,007, p: 0,007; p<0,05).
Sonuç: Bu çalýþma, ciddi hiperbilirubinemisi (sTB>25 mg/dl) olan, ancak belirgin hemoliz bulgusu olmayan term bebeklerde de kernikterus geliþebileceðini; bilirubin nörotoksisitesi geliþmesinde sadece bilirubin düzeyinin deðil, yüksek bilirubin düzeylerine maruz kalma süresinin de etkili olabileceðini göstermektedir. Hastalarýmýzda saptanan yüksek iþitme kaybý oraný, ciddi hiperbilirubinemisi olan term yenidoðanlarýn olasý iþitme kayýplarýnýn erken tanýsý için kapsamlý iþitme taramasý yapýlmasýnýn önemini vurgulamaktadýr.

Objective: The aim of this study was to investigate the long-term effects of hyperbilirubinemia on neurological and hearing function in term newborns.
Methods: This study was performed prospectively in 41 term newborns hospitalized for indirect hyperbilirubinemia. Patients with no signs of hemolysis were grouped as sTB <20 mg/dl, 20-24.9 mg/dl, and =>25 mg/dl. Patients with total bilirubin level =>20 mg/dl and hemolytic disease were classified as the fourth group. The relationship between maximum sTB level, duration of exposure to sTB levels >20 mg/dl and jaundice etiology with neurological and auditory functions were investigated. Detailed neurological examination, Denver II developmental screening test and hearing tests (otoacoustic emmissions, OAE and auditory brainstem responses, ABR) were performed to all patients at 18-24 months of age.
Results: Neurological dysfunction was found in 5 (12.2%). Hemolytic disease was detected in two of these patients. Hearing loss was found in 4 (9.8%) of the patients. Two of these patients had auditory neuropathy spectrum disorder and the other two had cochlear hearing loss. sTB levels of all these patients were above 25 mg/dl. No neurological disorder or hearing loss was found in the patients had a sTB<25 mg/dl. Exposure time to sTB levels above 20 mg/dl was significantly longer the patients with neurological dysfunction and pathologic ABR results (p: 0.007, p: 0.007; p<0.05).
Conclusion: This study demonstrates that kernicterus may develop in term newborns with severe hyperbilirubinemia (sTB>25 mg/dl) without any finding of significant hemolysis. Not only the bilirubin level but also the duration of exposure to high bilirubin levels may be effective in the development of bilirubin neurotoxicity. The high rate of hearing loss in our patients emphasizes the importance of screening for infants with severe hyperbilirubinemia using comprehensive auditory evaluation for early diagnosis of possible hearing loss.

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Objective: Antrochoanal polyp (ACP) is a benign soft tissue lesion arising from the inner wall of the maxillary sinus that extends into the nasal cavity and choanae. Although it was first explained by Killian in 1906, the underlying pathogenesis has not yet been fully understood. Neurotrophins were demonstrated to have a possible role in the pathogenesis of allergic rhinitis, idiopathic rhinitis and nasal polyps. To date there is no study that investigates the function of neuronal inflammation and neurotrophins in ACP development. The objective of this study was to investigate the possible effect of Neurotrophin-3 (NT-3) in ACP pathogenesis. Material and Methods: Twenty adult patients with ACPs who were undergone endoscopic sinus surgery in our department were taken as a study group. The control group included 15 patients with concha bullosa of middle concha who were undergone lateral removal operation. Nasal tissue NT-3 staining scores of study and control groups were determined by using immunohistochemistry. Blood NT-3 levels of both groups were detected by enzyme-linked immunosorbent assay. Results: There were no statistically significant differences between these two groups regarding tissue NT-3 staining scores (p=0.843) and blood NT-3 levels (p=0.463). In addition, no statistically significant correlation has been observed between tissue NT-3 staining scores and blood NT-3 levels in both ACP (p=0.578) and control (p=0.359) group patients. Conclusion: NT-3 related neuronal inflammation does not seem to have any role in ACP pathogenesis.

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Geriatrik Beslenme Ýndeksinin Perkütan Koroner Giriþim Uygulanmýþ ST Segment Yükselmesiz Miyokard Ýnfarktüslü Hastalarda Geliþen Kontrast Kaynaklý Nefropati Üzerine Olan Etkisi
Amaç: Geriatrik beslenme indeksi (GBÝ) hastalarýn beslenme durumunu belirlemek için kullanýlan yararlý bir araçtýr. GBÝ’ nin perkütan koroner giriþimler (PKG) sonrasýnda geliþen kontrast kaynaklý nefropati (KKN) geliþimi ile iliþkisini deðerlendiren bir çalýþma yoktur. Biz bu çalýþmamýzda GBÝ’nin PKG sonrasý geliþen KKN’nin öngördürücüsü olup olmadýðýný deðerlendirmeyi amaçladýk.
Yöntem: Merkezimizde ST segment yüksekliði olmayan miyokard infarktüsü tanýsý almýþ ve PKG uygulanmýþ 1116 hasta çalýþmaya dahil edildi. GBÝ hastane kayýtlarýndaki veriler kullanýlarak 14.89 × serum albumin (g/dL) + 41.7 × güncel vücut aðýrlýðý (kg) / ideal vücut aðýrlýðý (kg) formülü ile hesaplandý. KKN, PKG iþleminden sonraki 72 saat içinde serum kreatinin seviyesinin ≥0,5 mg / dL veya baþlangýþ düzeyinden ≥%25 oranýnda artmasý olarak tanýmlandý. Hastalar KKN geliþenler (KKN (+)) ve KKN geliþmeyenler (KKN (-) ) olarak iki gruba ayrýldýlar.
Bulgular: KKN (+) grubunun yaþ ortalamasý KKN (-) grubundan anlamlý olarak yüksekti (64.8 ± 10.67 ve 60.5 ± 10.61; p <0.001). Ortalama boy, kilo ve vücut kitle indeksi (VKÝ) deðerleri KKN (+) grubunda KKN (-) grubuna göre anlamlý olarak daha düþüktü (hepsi için p <0.001). GBÝ ortalamasý KKN (+) grubunda KKN (-) grubundan anlamlý olarak daha düþüktü (101.4 ± 8.7 vs. 112.1 ± 12.9; p <0.001). KKN (+) grubunda serum albümin düzeyi anlamlý olarak daha düþüktü (3.71 ± 0.52 g / dL ve 3.94 ± 0.53 g / dL; p <0.001). Sol ventrikül ejeksiyon fraksiyonu (SVEF) KKN (+) grubunda anlamlý derece de düþüktü (% 50.7 ± 9.07 ve% 54.3 ± 7.20; p <0.001).
Sonuç: Bu çalýþmada, GBÝ, serum albumin seviyesi, VKÝ ve SVEF KKN'in baðýmsýz belirleyicileri olarak tespit edildi. Dahasý, GBÝ KKN geliþimini öngördürmede hem serum albümin seviyesinden hem de VKÝ'den daha iyi bulundu.

Impact of Geriatric Nutritional Index in Contrast Induced Nephropathy in Non-ST Segment Elevated Myocardial Infarction Patients Performed Percutaneous Coronary Intervention
Objective: Geriatric nutritional index (GNRI) is a useful tool to determine the nutritional status of patients. There were no studies that evaluated the impact of GNRI in development of contrast induced nephropathy (CIN) after percutaneous coronary intervention ( PCI). We aimed to evaluate whether GNRI could predict CIN after PCI.
Method: 1116 patients with non-ST elevation myocardial infarction (non-STEMI) that performed PCI were enrolled to the present study. The GNRI was calculated using a previously reported method: GNRI = 14.89 × albumin (g/dL) + 41.7 × body weight (kg)/ideal body weight (kg). CIN was defined as an increase in serum creatinine level of ≥0.5 mg/dL or ≥25% above baseline within 72 hours after the PCI procedure. The patients were categorized into two groups: CIN (+) and CIN (–).
Results: The mean age of the CIN (+) group was significantly higher than the CIN (–) group (64.8 ± 10.67 vs. 60.5 ± 10.61; p<0.001). The mean values of height, weight, and body mass index were significanlty lower in CIN (+) group than CIN (–) group (p<0.001, for all). The mean of GNRI was significantly lower in the CIN (+) group than the CIN (–) group (101.4 ± 8.7 vs. 112.1 ± 12.9; p<0.001). Serum albumin level was significantly lower in the CIN (+) group (3.71 ± 0.52 g/dL vs. 3.94 ± 0.53 g/dL; p<0.001). Left ventricular ejection fraction (LVEF) was significantly lower in the CIN (+) group (50.7% ± 9.07 vs. 54.3% ± 7.20; p<0.001).
Conclusion: In this study, GNRI, serum albumin level, BMI, and LVEF were independent predictors of CIN. Moreover, GNRI was better than both serum albumin level and BMI in predicting CIN development.

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Hamilelikte bitkisel ürün kullanýmýn prevalansý coðrafya ve sosyo-kültürel faktörlere baðlý olarak, deðiþmektedir. “Doðal olan güvenlidir” inancýyla, bitkiler ve bitkisel ürünlerinin kullanýmý dünya genelinde popüler hale gelmiþtir ve hamilelik dönemi dahil sýklýkla kullanýlmaktadýr. Herhangi bir maddenin özellikle de hamilelik döneminde olasý istenmeyen etkileri önemlidir, çünkü hýzlý büyüyen fetüsün hücresel geliþimi ve hücre bölünmesi etkilenmeye açýktýr. Bir bitkisel ürünün yanýt oluþturabilmesi için, bir ilacýn yanýt oluþturmasý gibi, ürünün organizmanýn bir bileþeni ile moleküler seviyede etkileþime girmesi gereklidir. Hamilelikte en sýk kullanýlan bitkisel preparatlar, genellikle en düþük konsantrasyonlara sahip olan ve en az miktarda bileþik içeren çaylar veya infüzyonlardýr (kurutulmuþ otlarýn sýcak su özleri). Bu derlemenin amacý, hamilelikte en sýk kullanýlan, bitkisel çay olarak tüketilen bitkilerin olasý toksik etkilerini özetleyerek kullanýmýnda dikkatli olunmasý gerektiðinin önemini vurgulamaktýr.

The prevalence of herbal medicine use during pregnancy is varying, depending upon the geographical location and socio-cultural factors. In a belief of “being natural is safe”, use of herbs and herbal products became popular worldwide and used more frequently including pregnancy period. The potential unwanted effects of any substance is more important during pregnancy period, because the rapidly growing fetus is vulnerable to be affected in growth and division at cellular level. As with medicines, herbal products must at least interact with a component of the organism at the molecular level in order to exert a response. Herbal preparations most commonly used during pregnancy were teas or infusions (hot-water extracts of dried herbs) which usually have the lowest concentrations and contain the least amount of compounds. The purpose of this review is to summarize the herbs that are most commonly used as "herbal teas" during pregnancy and their potential toxic effects to highlight the importance of caution.

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Otoimmün pankreatit çocuklarda sýk görülmese de, kronik pankreatit etiyolojileri içinde yer almaktadýr.
Dört ay önce kronik pankreatit tanýsý alan 16 yaþýndaki kýz olgu, karýn aðrýsý ve kanlý dýþkýlama nedeniyle polikliniðe baþvurdu. Fizik bakýsýnda epigastrik bölgede ve sol alt kadranda hassasiyeti vardý. Laboratuvar tetkiklerinde amilaz: 109 U/L, lipaz: 196 U/L, Ig G: 13.70 g/L, IgG4: 2.117 g/L, fekal kalprotektin 573 µg/g saptandý. MRCP incelemesinde pankreas heterojen görünümde ve boyutu artmýþ, ana pankreatik kanal geniþlemiþ idi. Kolonoskopik inceleme ve histopatojik bulgular inflamatuvar baðýrsak hastalýðý ile uyumlu idi. Olguya otoimmun pankreatitle birlikte seyreden Crohn hastalýðý tanýsý konuldu. Steroid tedavisi sonrasý klinik ve laboratuvar bulgularý geriledi.
Otoimmun pankreatit çocuklarda nadir görülmesi ve az sýklýkta da olsa Crohn hastalýðý ile birliktelik göstermesi nedeniyle önemlidir. Otoimmun pankreatit takibinde inflamatuvar baðýrsak hastalýðý geliþebileceði ve kronik pankreatit etiyolojilerinde otoimmun pankreatit de olabileceði unutulmamalýdýr.

Although autoimmune pancreatitis is not seen in children frequently, it is included in the etiology of chronic pancreatitis.
A 16-year-old girl who was diagnosed with chronic pancreatitis presented with abdominal pain (epigastric region, left lower quadrant) and bloody defecation. Laboratory analysis were amylase: 109 U/L, lipase: 196 U/L, Ig G: 13.70 g/L, IgG4: 2.117 g/L, fecal calprotectin 573 µg/g. In the MRCP examination, the pancreas had a heterogeneous appearance, showed an increase in size, and the main pancreatic duct was enlarged. Colonoscopic and histopathological findings were consistent with inflammatory bowel disease. The case was diagnosed as Crohn's disease with autoimmune pancreatitis. Clinical and laboratory findings regressed after steroid treatment.
Autoimmune pancreatitis is rare in children and is associated with Crohn's disease rarely. It should be kept in mind that inflammatory bowel disease may develop in the follow-up of autoimmune pancreatitis and autoimmune pancreatitis may be present in the etiology of chronic pancreatitis.

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Vallecular lymphoma is an extremely rare tumour of oropharynx. We report a case of 61-year-old gentleman presented with severe dysphagia and globus sensation for two months. Patient underwent endoscopic transoral tumour debulking for diagnostic and therapeutic purpose. Histopathologically, patient was diagnosed with mantle cell lymphoma (MCL). Atypical presentation of the disease, histopathological features and its current treatments are discussed.

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Plasmablastic lymphoma (PBL) is a rare and aggressive variant of diffuse large B-cell lymphoma predominantly in oral cavity of human immunodeficiency virus (HIV)-positive male patients or immunosuppressive hosts. HIV-negative PBL in immunocompetent patients has not been extensively reported. We reported an unusual case of sinonasal PBL which occurs in an HIV-negative and immunocompetent female patient. She underwent endoscopic removal of the tumor and completed 6 cycles of chemotherapy (hyperfractionated-CVAD). Positron-emission tomography scan (PET-scan) 18 months post treatment showed no evidence of tumour recurrence.

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Bu yazýda negatif basýnçlý akciðer ödemi (NPLE) olan iki olgu tanýmlanmýþtýr. Týkalý bir hava yoluna karþý, aþýrý negatif hava yolu basýncýnýn alveollere ve akciðer ödemine neden olduðu bildirilmiþtir. Hastalar genellikle genç ve saðlýklý yetiþkinlerdir ayrýca herhangi bir týbbi problemi yoktur. Bu durum, her iki akciðerin santral interstisyel bölgesini içerir. Noninvaziv mekanik ventilasyon ve kortikosteroidlerle tedavi edilir.

In this paper we describe two cases with negative pressure lung edema (NPLE). Excessive negative airway pressures against an obstructed airway have been reported to cause fluid filtration to alveoli and lung edema. The patients are generally young and healthy adults without any medical problems. The condition involves central interstitial area of both lungs and is treated by non-invasive mechanic ventilation and corticosteroids.

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