Amaç: Bu çalýþmada çeþitli klinik örneklerden üretilen stafilokok izolatlarýnýn yýllara göre metisilin direncindeki deðiþim ve antibiyotiklere duyarlýlýk durumlarý incelendi.
Gereçler ve Yöntem: Hastanemiz Týbbi Mikrobiyoloji Laboratuvarý’na 2010-2015 tarihleri arasýnda servis ve polikliniklerde takip edilen hastalarýn klinik örneklerinden izole edilen toplam 21478 adet stafilokok suþu retrospektif olarak incelenmiþtir.
Bulgular: Ýncelenen suþlarýn 6317’si (%29.4) Staphylococcus aureus (S.aureus), 15161’i (%70.6) koagülaz-negatif stafilokok (KNS) olarak belirlendi. Çalýþmaya dahil edilen KNS izolatlarýnda metisilin direnci (%47.2), S. aureus izolatlarýndan (%12.4) anlamlý oranda yüksek bulunmuþtur (p<0.001). Ayaktan hasta örneklerinden izole edilen S. aureus suþlarýnýn metisilin direnç oranlarýnda yýllar içinde anlamlý bir deðiþiklik görülmezken, yatan hastalarda dikkate deðer azalma olduðu bulunmuþtur (p=0.549, p<0.001).
Ayakta tedavi edilen hastalardan izole edilen S. aureus ve KNS suþlarýnda metisilin direnci sýrasýyla %4.5 ve %32.1, genel servislerde izlenen hastalarda %14.5 ve %47.4, yoðun bakýmlarda %27.7 ve %51.8 olarak saptanmýþtýr. Hem S. aureus hem de KNS suþlarý için, yoðun bakýmlarda izlenen hastalardan izole edilen suþlarýn metisilin direnci, genel servislerde yatan hastalardan izole edilen suþlara göre daha yüksek bulunmuþtur (p<0.001, p<0.001).
Sonuç: S.aureus suþlarýnda metisilin direncinin yýllar içinde azalmasý, direnç oranlarýnda azalmada umut vaat etmekle birlikte uzun dönemde korunmasý için gerekli önlemlerin alýnmasýný gerekli kýlmaktadýr. Akýlcý antibiyotik kullanýmý ile birlikte yoðun uygulanacak enfeksiyon kontrol önlemleri sayesinde genel olarak direnç oranlarýnda düþüþün devam edebileceðini düþünmekteyiz.

Introduction: In this study, we examined the methicillin resistance and antibiotic susceptibility patterns of staphylococcus isolates from various clinical specimens.
Materials and Methods: Between 2010 and 2015 in our hospital, 21478 staphylococci strains (6317 S. aureus strains and 15161 CNS strains) isolated from various clinical specimens of patients were included in the study.
Results: In our study, 6317 (29.4%) strains were Staphylococcus aureus (S. aureus) and 15161 (70.6%) strains were coagulase-negative staphylococcus (CNS) strains. The resistance rates to methicillin was significantly higher in CNS strains than in S. aureus strains (p<0.001). A significant decrease in the methicillin resistance rates of S.aureus strains was found over the years (p<0.001).
The methicillin resistance ratios in S.aureus strains and CNS strains were 4.5% and 32.1% in outpatients, 14.5% and 47.4% in general services, 27.7% and 51.8% in intensive care units (ICU), respectively. In both S. aureus and CNS strains, methicillin resistance rate was found to be higher in strains isolated from ICU than general services (p<0.001, p<0.001).
Conclusion: The declining rates of methicillin resistance in staphylococci are encouraging, however this condition should be maintained in the longer term. We believe that we can continue to reduce in the rate of resistance by rational use of antibiotics and implementation of infection control measures.

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Manyetik rezonans (MR) defekografi ile deðerlendirilen olgularýn klinik ve radyolojik bulgularýný sunmak; pelvik taban sarkmasý (PTS) ve spastik pelvik taban sendromu (SPTS) ile yað dokusu kalýnlýklarý ve puborektal kas kalýnlýklarý arasýndaki iliþkiyi deðerlendirmek; PTS alt gruplarýnýn iliþkisini deðerlendirmek amaçlandý. Eylül 2015-Eylül 2017 tarihleri arasýnda MR defekografi ile deðerlendirilen hastalarda retrospektif olarak PTS, sarkmanýn hangi kompartmanda olduðu, sarkmanýn düzeyi (minimal, orta, ileri), rektosel, invajinasyon, enterosel ve SPTS bulgularý deðerlendirilerek suprapubik, presakral ve rektus abdominus kasý anteriorundaki yað dokusu kalýnlýklarý, saðda ve solda puborektal kas kalýnlýklarý ölçüldü. PTS alt gruplarýnýn (ön, orta, arka) birbirleri ile olan iliþkisi; PTS þiddeti ile suprapubik, presakral ve rektus abdominus kasý anteriorundaki yað dokusu kalýnlýðý arasýndaki iliþki Spearman korelasyon testi ile analiz edildi. SPTS olan ve olmayan grupta suprapubik, presakral ve rektus abdominus kasý anteriorundaki yað dokusu kalýnlýðý ve sað-sol puborektal kas kalýnlýklarý T testi ile karþýlaþtýrýldý. 63 olguda (ortalama yaþ 45; 49 kadýn, 14 erkek olgu), 62 arka, 35 orta ve 36 ön kompartman sarkmasý; 55 rektosel, 28 invajinasyon, 3 enterosel, 1 hipermobil üretra, 19 olguda SPTS izlendi. Orta kompartman ile ön kompartman sarkmasý arasýnda kuvvetli bir korelasyon bulundu. Orta kompartman ile rektus abdominus kasý anteriorundaki yað dokusu kalýnlýðý arasýnda ve ön kompartman ile rektus abdominus kasý anteriorundaki yað dokusu kalýnlýðý arasýnda istatistiksel olarak anlamlý korelasyon saptandý. Ayrýca SPTS grubunda suprapubik yað dokusu daha ince idi. Orta ve ön kompartman sarkmasý arasýndaki güçlü korelasyon, problemin orta kompartmana geçince ön kompartmaný tutmasýnýn kolay olduðunu gösteriyor olabilir. Yað dokusu kalýnlýðýnýn artýþý orta ve ön kompartman sarkmasýnda etyolojide obesitenin rol oynayabileceðini göstermekle birlikte arka kompartman sarkmasý ve SPTS’de obesitenin etkisinin belirgin olmadýðý þeklinde yorumlanabilir.

To represent the clinical and radiological findings of cases evaluated by magnetic resonance (MR) defecography; to evaluate the relationship between pelvic floor prolapses (PFP), spastic pelvic floor syndrome (SPFS) and thicknesses of fat tissue and puborectal muscles. MR defecography of patients evaluated between September 2015 and September 2017 were investigated retrospectively. PFP, involved compartment, severity (minimal, moderate, advanced), rectocele, invagination, enterocele and spastic pelvic floor syndrome; suprapubic-presacral-pre-rectus abdominus fat tissue thicknesses, right and left puborectal muscle thicknesses were measured. The association of PFP subgroups (anterior, middle, posterior) with each other; the relationship between the severity of PFP and suprapubic, presacral and pre-rectus abdominus fat tissue thickness was analyzed by Spearman’s correlation test. For the groups with and without spastic pelvic floor syndrome, suprapubic, presacral, and pre-rectus abdominus fat tissue thickness and right-left puborectal muscle thicknesses were compared by T-test. Of the 63 cases (mean age 45, 49 female, 14 male), 62 posterior, 35 middle, and 36 anterior compartment prolapsus; 55 rectocele, 28 invagination, 3 enterocele, 1 hypermobile urethra and 19 cases of SPFS were detected. There was a strong correlation between the middle and the anterior compartment prolapsus. There was a statistically significant correlation between middle compartment and rectus abdominalis anterior fat tissue thickness and between anterior compartment and rectus abdominus anterior fat tissue thickness. In addition, the suprapubic fat tissue in the SPFS group was thinner.
The strong correlation between the middle and anterior compartment prolapses can indicate that it is easy to involve the anterior compartment when middle compartment involved. The increase in fat tissue thickness may indicate that obesity may play a role in the aetiology of middle and anterior compartment prolapsus, but the effect of obesity in the posterior compartment pralapsus and SPFS may not be so significant.

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Gebelikte yapýlan ikili ve/veya üçlü tarama testleri fetal anöploidi riskini tespit açýsýndan çok önemlidir. Bu çalýþmadaki amacýmýz gebelerin bu tarama testleri hakkýnda bilgi düzeylerini deðerlendirmektir. Çalýþmanýn evrenini Gaziosmanpaþa Üniversitesi Týp Fakültesi Hastanesi Kadýn Hastalýklarý ve Doðum Polikliniklerine Ekim-Aralýk 2015 tarihleri arasýnda rutin takiplerini yaptýrmak için baþvuran 11-24 haftalýk 354 gebe oluþturdu. Araþtýrma verileri anket formu aracýlýðýyla toplandý ve istatistik hesaplamalarda ki-kare (X2) testi kullanýldý. Ýstatistiksel anlamlýlýk düzeyi p<0.05 olarak kabul edildi. Çalýþmaya katýlan gebelerin (n=354) yaþ ortalamasý 26.71±5.56 (min: 16, max: 43); ortalama gebelik haftasý 14.45±2.91 (min: 10, maks: 24)’di. Katýlýmcýlarýn tamamý (%100) tarama testlerini yaptýrdýðýný ya da yaptýracaðýný beyan etmekte iken; %58.8’i tarama testlerinin yapýlmasýnýn zorunlu olduðunu düþünmekteydi. Gebelerin tarama testleri ile ilgili verdikleri cevaplar, gebelerin eðitim ve çalýþma durumlarý açýsýndan incelendiðinde lise ve üzeri okul mezunu ve çalýþan gebelerin doðru cevap verme oranlarýnýn diðerlerine göre istatistiksel olarak anlamlý þekilde daha yüksek olduðu bulundu (p<0.05). Gebelerin eðitim düzeyleri arttýkça tarama testleri hakkýnda bilgi düzeylerinin arttýðý belirlenmiþtir. Tarama testlerinin etkin bir þekilde uygulanmasý için eðitim düzeylerinin iyileþtirilmesinin yanýnda, hekimlerin gebelere yeterli zaman ayýrarak etkili ve doðru bir bilgilendirme yapmasý da gerekmektedir.

Double and triple tests performed during pregnancy are highly important in order to determine risk of fetal aneuploidy. Our aim in this study was to evaluate the knowledge level of the pregnant women regarding these screening tests. The study population consisted of 354 pregnant patients who applied to outpatient clinic of Gynecology and Obstetrics Department between October-December 2015 within their 11. and 24. gestational weeks. Research data were collected through a questionnaire form and the chi- square test was utilized for statistical analysis. P< 0.05 was accepted as the level of significance. The mean age of the pregnant women (n=354) was 26.71±5.56 years, and the mean gestational week at admission was 14.45±2.91 weeks. All of the participants declared that they had or would undergone screening tests, while majority ( 58.8%) of the study participants thought that it was obligatory to undergo screening tests. However, patients with at least lycée education and those who worked answered the questions statistically significantly more correctly (p<0.05). It was found out that higher the educational level of the pregnant women was, higher the level of knowledge they had about the tests. In addition to increasing the educational levels of pregnant women in general, it is necessary that physicians should spare adequate time for informing pregnant women efficiently, and correctly in order to apply the screening tests effectively.

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Idiopatik Parkinson hastalýðý (IPD) ilerleyici bir hareket bozukluðu olup, nigrostriyatal dopaminerjik nöron kaybý ile iliþkilidir. Hastalýðýn kardinal klinik belirtileri; istirahat tremoru, bradikinezi, rijidite ve postural instabilitedir. IPD motor semptomlarýnýn iyi tanýmlanmýþ olmasýna karþýlýk, bu hastalýðýn motor olmayan semptomlarý yeterince tanýnmamakta ve bunun sonucunda yeterince tedavi edilememektedir.
Çalýþmamýzda Antalya Eðitim ve Araþtýrma Hastanesi Nöroloji Kliniði Parkinson Hastalýðý ve Hareket Bozukluklarý Polikliniði’nde düzenli takip edilmekte olan United Kingdom Beyin Bankasý Parkinson Hastalýðý taný kriterlerine göre Parkinson Hastalýðý tanýsý almýþ IPD hastalarý retrospektif olarak deðerlendirildi. Klinik evreleme için Birleþik Parkinson Hastalýðý Deðerlendirme Ölçeði (UPDRS) kullanýldý. Hastalarýn konstipasyon, anosmia, rapid eye movement (REM) uyku davranýþ bozukluðu (RBD) ve daha önceden taný almýþ depresyon öyküsü varlýðý, non-motor semptomlarý incelemek amacýyla sorgulandý.
Çalýþmaya alýnan 163 hastanýn 100 (61.3%)’ü erkek, 63 (38.7%)’ü kadýndý ve yaþ ortalamalarý 65,85±10,09 (min. 29-max. 87) idi. Ortalama hastalýk süreleri ise 4,93 ±0.36 yýldý. UPDRS skoru 23,87± 1.1 idi. Hastalarýn 11’i monoterapi alýrken diðer hastalar kombinasyon tedavisi almakta idi. Anosmi 52 (31.9%), konstipasyon 85 (52.1%) hastada mevcuttu. REM UDB 84 (51.5%) ve depresyon öyküsü ise 45 (27.6%) hastada mevcuttu.
Parkinson hastalarýnýn büyük çoðunluðunda rastlanabilen, hastalýðýn tüm evrelerinde görülebilen ve yaþam kalitesini olumsuz yönde etkileyen non-motor belirtilerin tanýsý esas olarak klinik özelliklere dayanýr. IPD’da non-motor belirtilerin erken tanýnmasý ve onlarýn uygun olarak tedavi edilmesi hastanýn yaþam kalitesi açýsýndan çok önemlidir. Bunun da ilk basamaðý öyküde bu belirtilerin sorgulanmasýdýr.

Idiopathic Parkinson’s Disease (IPD) is a progressive movement disorder, which is associated with nigro striatal dopaminergic neuron loss. Cardinal clinical symptoms of the disease are tremor at rest, bradykinesia, rigidity and postural instability. Although motor symptoms of IPD are well recognized, non motor symptoms of the disease are not known and hence are not treated adequately.
In our study, IPD patients diagnosed according to diagnostic criteria of United Kingdom Brain Bank and followed regularly in Antalya Research and Training Hospital Neurology Clinic Parkinson’s disease and movement disorders outpatient clinic were evaluated retrospectively for clinical evaluation, United Parkinson’s Disease Rating scale (UPDRS) was used. Constipation, anosmia, rapid eye movement (REM) sleep behavior disorder (RBD), history of depression diagnosed previously were inquired in order to investigate non motor symptoms.
This study in included 163 patients (61.3% was male and 38.7% female). Their mean age was 65,85±10,09 (min. 29-max. 87) and mean duration of disease 4,93 ±0.36 years. UPDRS score was 23,87± 1.1 while 11 patients were on monotherapy, the remaining patients received combination treatment. Anosmia was present in 52 (31.9%), patients and constipation in 85 (52.1%). RBD was present in 84 (51.5%) and history of depression in 45 (27.6%) patients.
The diagnosis of non-motor sysmptoms, that can occur in large majority of Parkinson’s disease patients at all stages of the disease and have a negative impact on quality of life are based on clinical characteristics. Early recognition and proper treatment of non-motor symptoms in IPD is important for quality of life in the patients. The first step for this is the inquiry of these symptoms.

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Amaç: Bu çalýþmanýn amacý Major Depresif Bozukluk (MDB) tanýlý hastalarda Nötrofil lenfosit oraný (NLO), platelet lenfosit oraný (PLO), kýrmýzý küre daðýlým geniþliði (RDW) ortalama trombosit hacmi (MPV) gibi hematolojik inflamatuar göstergeçlerin deðerlendirilmesidir.
Yöntem: Çalýþmaya Haziran 2016 ile Eylül 2016 tarihleri arasýnda Erzurum Bölge Eðitim ve Araþtýrma Hastanesi Psikiyatri polikliniðine baþvuran ve DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) ile ilk atak MDB tanýsý alan, herhangi bir ilaç kullanýmý olmayan, 18-75 yaþ arasý 75 hasta dahil edilmiþtir. Hastane çalýþanlarýnýn yakýnlarýndan, hasta grubuna beden kitle göstergesi ve sosyodemografik özellikler açýsýndan benzer, psikiyatrik ya da diðer týbbi hastalýk öyküsü olmayan 57 saðlýklý gönüllü kontrol grubu olarak belirlenmiþtir. Hasta grubuna DSM-IV Eksen I bozukluklarý için Yapýlandýrýlmýþ Klinik Görüþme Ölçeði (SCID-I), sosyodemografik veri formu, Hamilton Depresyon Deðerlendirme Ölçeði (HDDÖ) ve Klinik Global Ýzlem Ölçeði (CGÝ-S) uygulanmýþtýr. Kontrol grubuna ise DSM-IV Eksen I bozukluklarý için Yapýlandýrýlmýþ Klinik Görüþme Ölçeði (SCID-I), sosyodemografik veri formu uygulanmýþtýr.
Bulgular: Ýki grup arasýnda hemoglobin, hematokrit, lökosit, nötrofil, lenfosit ve trombosit sayýlarý arasýnda anlamlý bir farklýlýk tespit edilmemiþtir. Gruplar arasýnda NLO, PLO ve RDW arasýnda anlamlý bir farklýlýk tespit edilmemiþken MPV açýsýndan anlamlý bir farlýlýk saptanmýþtýr. Ayrýca hasta grubunda HDDÖ ve CGI-S ile NLO, PLO, RDW ve MPV karþýlaþtýrýldýðýnda anlamlý iliþki saptanmamýþtýr.
Sonuç: Çalýþmamýzda MDB tanýlý hastalarda MPV saðlýklý kontrol grubuna göre artmýþ olarak tespit edilmiþtir. Depresyon ve inflamatuar göstergeçler arasýndaki iliþkinin ortaya konmasý için yapýlacak yeni çalýþmalara ihtiyaç vardýr.

Objective: The aim of this study is to investigate the changes in hematologic inflammatory markers such as neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), red cell distribution width (RDW) and mean platelet volume (MPV) in patients with diagnosed Major Depresif Disorder (MDD).
Methods: Seventy-five patients between the ages of 18 and 75 who were diagnosed with first episode MDD according to DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) in the Department of Psychiatry of the Erzurum Regional Training and Research Hospital out patient clinic between June 2016 and September 2016 and who were not currently undergoing any psychiatric treatment were included. The control group was selected from relatives of the hospital employee. Fifty seven subjects with similar sociodemographic characteristics and body mass index and who don't have any psychiatric and other clinical conditions were included as a control group. Sociodemographic form, Structured Clinical Interview for DSM IV Axis I Disorders (SCID I), Hamilton Depression Rating Scale (HDRS) and Clinical Global Impression Scale (CGI-S) were applied to the patients. Sociodemographic form and SCID I were applied to control group.
Results: There was no significant difference between groups in terms of hematologic parameters like hemoglobin, hematocrit, leukocyte count, platelet count, lymphocyte count and neutrophil count. Although there was no significant difference between groups in terms of NLR, PLR and RDW, there was significant difference between groups in terms of MPV. HDRS and CGI-S were not significantly correlated with NLR, PLR, RDW and MPV.
Conclusions: We found increased MPV in MDD group compared with control group. Further studies are needed to reveal the relationship between depression and inflammatory markers.

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Bu çalýþmanýn amacý, travmatik vertebra kýrýklarýnýn demografik özelliklerine ve anatomik lokalizasyonlarýna göre daðýlýmýný araþtýrmaktýr. Çalýþma travma nedeniyle acil servisine baþvuran 351 hastayý (211 erkek ve 140 kadýn) içermektedir. 351 hastada direkt grafiler ve bilgisayarlý tomografi (BT) ile toplam 568 vertebra kýrýðý saptandý. 568 kýrýk arasýnda 87'si servikal, 221'i torakal ve 260'ý bel omurgasýnda yer almaktaydý. Kýrýklar en yaygýn olarak T12 ve L1 vertebralara lokalizeydi. Elli dört hastada vertebra dýþýndaki diðer kemiklerde de kýrýk saptandý. Travmanýn en sýk nedeni düþmeler idi, bunu sýrasýyla araç içi motorlu araç kazasý (AÝMAK) ve araç dýþý motorlu araç kazasý (ADMAK) izledi. Sonuçlarýmýza göre vertebra kýrýklarýnýn neredeyse tamamý düþme, AÝMAK ve ADMAK gibi yüksek enerjili travmalara baðlý olarak meydana gelmekteydi. Yüksek enerjili travmalar nedeniyle acil servise baþvuran hastalar aksi gösterilene kadar vertebra kýrýðý olarak düþünülmelidir. Kanýmýzca, BT tüm omurganýn birlikte deðerlendirilebilmesi ve vertebra cisim kýrýklarýnýn atlanmamasý açýsýndan iki taraflý direkt radyografiler ile birlikte kullanýlmalýdýr.

The aim of this study was to investigate the distribution of traumatic vertebral fractures according to demographic features and anatomical localizations. The study included 351 patients (211 males and 140 females) who presented to emergency service with trauma. Totally 568 vertebral fractures were detected via direct radiograms and computed tomography (CT). Among all 568 fractures, 87 were in cervical, 221 were thoracic and 260 were in lumbar spine. Fractures were most commonly localized to T12 and L1 vertebrae. Fifty-four patients had a fracture at different bones other than vertebrae. The most frequent cause of the trauma was falls, followed by intra-vehicular motor vehicle accident (IVMVA) and extra-vehicular motor vehicle accident (EVMVA). According to our results, almost all of the vertebral fractures occurred due to high energy trauma such as IVMVA, EVMVA and falls from a tall height. Patients presenting to emergency department because of high energy traumas should be regarded to have vertebral fracture until it is ruled out. In our opinion, CT should be used along with two sided direct vertebral radiograms to complete evaluation of the entire spinal area and not to miss vertebral body fractures.

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Çalýþmamýzda düzenli diyalize giren kronik böbrek yetmezliði (KBY) olan hastalar ile saðlýklý bireylerin oküler kan akýmýnýn ve koroid kalýnlýðýnýn deðerlendirilmesi amaçlanmýþtýr. Çalýþmaya KBY tanýsý olan ve düzenli olarak hemodiyalize giren 21 hasta (42 göz) ve 21 saðlýklý gönüllü birey (42 göz) kontrol grubu olarak dahil edildi. Oküler kan akýmý doppler ultrasonografi (US) ile deðerlendirildi. Koroid kalýnlýklarý ise optik koherens tomografi (OKT) ile ölçüldü. Oftalmik arter (OA) ortalama maksimum sistolik hýz (Vmax) deðerleri KBY olan hasta grubunda sol gözde 56.23 ± 19.22 cm/sn; sað gözde 61.80 ± 18.24 cm/sn; kontrol grubunda sol gözde 40.04 ± 7.90 cm/sn sað gözde 40.61 ± 8.55 cm/sn olarak ölçülmüþtür. OA’ lerdeki rezistivite indeks (RI) deðerleri sað gözde 0.77 ± 0.05 sol gözde 0.77 ± 0.03 olarak hesaplanmýþken kontrol grubunda bu deðerler sað gözde 0.65 ± 0.03 sol gözde 0.66 ± 0.02 olarak hesaplanmýþtýr. Koroid kalýnlýklarý KBY olan hasta grubunda ortalama 165.36 ± 51.29 μm, kontrol grubunda 291.79 ± 51.65 μm olarak ölçülmüþtür. KBY olan ve düzenli diyalize giren hastalarda özellikle OA’ de belirgin olmak üzere akým hýzý ve RI deðerleri yüksek olarak hesaplanmýþ ve bununla birlikte koroid kalýnlýklarýnda saðlýklý bireylere göre belirgin incelme görülmüþtür.

In our study we want to evaluate the ocular blood flow and choroidal thickness in patients with chronic renal failure (CRF) who underwent regular dialysis and healthy individuals. Twenty-one patients (42 eyes) with CRF who regularly hemodialized and 21 healthy volunteers (42 eyes) as a control group were included the study. Ocular blood flow was assessed with Doppler US and choroidal thickness were measured with optical coherence tomography (OCT). In patients with CRF; ophthalmic artery (OA) mean maximum systolic velocity (Vmax) values were 56.23 ± 19.22 cm / sec in the left eye and 61.80 ± 18.24 cm / sec in right eye; in control group, 40.04 ± 7.90 cm / sec in left eye, and 40.61 ± 8.55 cm / sec in right eye. The values of resistivity index (RI) in OA were 0.77 ± 0.05 in right eye and 0.77 ± 0.03 in left eye; in control group RI were 0.65 ± 0.03 in right eye and 0.66 ± 0.02. Mean choroidal thickness in patients was 165.36 ± 51.29 μm and 291.79 ± 51.65 μm in control group. In patients with CRF who regularly hemodialized; especially in OA, flow rate and RI values were calculated higher than control group, and there was a significant thinning of choroidal thickness compared to healthy individuals.

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Gebelik ve doðum süreci her ne kadar fizyolojik süreçler olsa da kadýn için büyük bir stres ve heyecan kaynaðýdýr. Bu çalýþmadaki amacýmýz; gebe kadýnlarýn doðum þekline karar verir iken etkilendikleri parametreleri araþtýrmaktýr. Etik kurul onayý alýndýktan sonra polikliniðe rutin gebelik takibi için gelen gebe kadýnlar çalýþma grubu olarak belirlendi. Dahil edilme kriterlerini karþýlayan gebelerin demografik verilerini de içeren anketi doldurmalarý istendi. Toplamda 410 gebenin verileri deðerlendirildi. Gebelerin yaþ ortalamasý 26,27∓5,83 ve ortalama gebelik haftasý 22,16∓9,96 idi. Toplamda 354 (%86,3) gebenin vajinal doðum yapmak istediði, 56 (%13,7) gebenin ise sezaryen doðum yapmak istediði saptandý. Kadýnlarýn doðum þekline karar vermede eþlerin tutumundan etkilenen 100 gebe (%24,4), çevresinden etkilenen 75 gebe (%18,3), doktordan etkilenen 329 gebe (%80,2) idi. Ancak bu üç etken karþýlaþtýrmasýnda 362 gebenin (%89,1) birinci sýrada doktordan, 15 gebenin (%3,2) birinci sýrada çevresinden, 33 gebenin (%7,7) birinci sýrada eþinden etkilendiðini belirtikleri saptandý. Kadýnlarýn vajinal doðum yapma nedenlerinin baþýnda vajinal doðumu daha güvenli bulmalarý geliyordu. Kadýnlarýn sezaryen doðum yapma nedenlerinin baþýnda ise vajinal doðuma karþý olan korku geliyordu. Kadýnlarýn vajinal doðumdan kaçýnmalarýnýn en önemli nedeni bilgisizlik nedeni ile doðum eyleminin kendisine olan korku olup, gebelerin doðuma hazýrlanmasý için hekimler tarafýndan verilecek eðitimin, doðum için daha saðlýklý bir alt yapý oluþturulmasý açýsýndan gerekli olduðu kanaatindeyiz.

Even though a physiological process, pregnancy and delivery are the sources of severe stress and excitement. The aim of this study is to investigate the parameters those effected women with pregnancy while choosing the delivery type. After obtaining ethics approval, women admitted to our outpatient unit for routine examination were accepted as the study group. Women with pregnancy met with the inclusion criteria were asked to complete the questionnaire including demographic data. A total of 410 records were evaluated. The mean age of the patients was 26,27∓5,83 and the mean pregnancy week was 22,16∓9,96. Since a total of 354 (%86,3) patients were wished to have vaginal delivery, 56 (%13,7) to have cesarean section. To decide the delivery type, one hundred women with pregnancy (%24,4) were affected by their husband, 75 (%18,3) by their environment, and 329 (%80,2) by their doctor. While comparing those three factors, 362 (%89,1) patients were found to be affected by their doctor in the first place, 15 (%3,2) by their environment, and 33 (%7,7) by their husband. The primary cause of vaginal delivery of women was accepting vaginal delivery safer. The primary cause of cesarean section of women was fear of vaginal delivery. The most important factor of avoiding vaginal delivery by women with pregnancy is unawareness causing fear to delivery itself, and we concluded that education is necessary to establish a stable background about delivery by physicians to prepare the women with pregnancy to the delivery.

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Akut gastroenterit, çocukluk çaðýndaki en yaygýn enfeksiyon hastalýklarýndan biridir. 5 yaþ altýndaki çocuklar arasýnda morbidite ve mortalitenin major sebeplerinden birini oluþturur. Çocuklardaki birçok akut gastroenterit vakasý kendini sýnýrlayan ve sadece destek tedavisi ile tedavi edilir olsa da klinik seyir esnasýnda vakalarda kötüleþme gözlenebilir. Gastroenteritli çocuklarda belli hiçbir kaynak olmadan inatçý ateþ ya da azalan ateþe sekonder pik, sekonder bakteriyemi þüphesini artýrmalýdýr. Bu vaka raporunda, Clostridium difficile ve rotavirüs gastroenteritine sekonder iki akut gastroenteritli enterik ateþ vakasýný gözden geçirdik.

Acute gastroenteritis is one of the most common infectious diseases in childhood. It remains one of the major causes of morbidity and mortality among children under 5 years of age. Although most cases of acute gastroenteritis in children are self-limited and treated with only supportive therapy, clinical deterioration can sometimes be observed during the clinical course. Persistence of high fever or a second peak of diminished fever with no obvious source in children with gastroenteritis should raise suspicion of secondary bacteremia. In this case report we review two acute gastroenterit cases of enteric fever secondary to Clostridium difficile and rotavirus gastroenteritis

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Giriþ: Brusellanýn, merkezi sinir sistemi, gastrointestinal sistemi, iskelet-kas sistemini ve genitoüriner sistemi tuttuðu rapor edilmiþtir. Prostatit ise brusellozun çok nadir görülen bir komplikasyonudur.
Olgu sunumu: Mesane çýkýþý darlýðý ve dizüri nedeniyle baþvuran 49 yaþýndaki erkek hasta sunulmaktadýr. Hastanýn bulgularý (yükselen PSA, anormal parmakla rektal muayene) prostat kanserini taklit etmektedir. Hastanýn Brusella aglütinasyon testi 1/640 titrede pozitif bulunmuþtur ve 6 hafta süreyle doksisiklin ve rifampin tedavisi baþlanmýþtýr. Tedavi bitiminden 1 ay sonra hastanýn prostat kanserini taklit eden bulgularý normale dönmüþ ve 12 aylýk takip sonucu relaps izlenmemiþtir.
Yorum: Brusellozis sonrasý akut prostatit geliþebiliceði unutulmamalýdýr. Dahasý, brusella prostatiti prostat kanserini taklit edebilir.

Introduction: Brucella has been reported to compromise the central nervous system, the gastrointestinal system, musculoskeletal system, and genitourinary system. Prostatitis is a very rare complication of brucellosis.
Case presentation: A case is reported of a 49-year-old man who presented bladder outlet obstruction and dysuria. The patient’s signs were mimicking the prostate cancer (such as elevated prostate specific antigen levels, abnormal digital rectal examination). The patient’s Brucella agglutination test was positive at 1/640 titer and doxycycline and rifampin was administered over 6 weeks. After 1 month of the cessation therapy, patient’s signs were normal and the patient was followed-up to 12 months and no relapse was observed.
Conclusion: Acute prostatitis should not be forgotten that prostatitis may result from brucellosis. Moreover, brucella prostatitis may mimic prostate carcinoma.

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Çölyak hastalýðý epilepsi, ataksi, nöropati, miyopati ve baþ aðrýsý gibi birçok nörolojik hastalýk ile iliþkili olup febril konvülziyon ile birlikteliði nadirdir. Bununla birlikte demir eksikliði anemisi olan olgularda febril konvülziyon ve çölyak hastalýðý sýklýðý artmýþtýr. Demir eksikliðinin katýlma nöbetinin sýklýðýný da artýrdýðý bilinmektedir. Öncesinde katýlma nöbeti ve demir eksikliði anemisi öyküsü olan 4.5 yaþýnda febril konvulziyon ile baþvuran kýz olgunun çölyak tanýsýna uzanan öyküsünü irdeledik. Çocuk hekimlerinin sýk karþýlaþtýðý çeþitli hastalýklara eþlik eden çölyak hastalýðýný, hastanýn öyküsü, muayenesi ve laboratuar test sonuçlarýný bir yap-bozun parçalarý gibi birleþtirerek nasýl ortaya çýkarýlabileceðini göstermeyi amaçladýk.

Celiac disease is related with many neurologic disorder such as epilepsy, ataxia, neuropathy, myopathy and headache. The coexistence of celiac disease and febrile convulsion is unusual. However the incidence of celiac disease has been increased in the cases with febrile convulsion and with iron deficiency anemia. Breath holding is also related with iron deficiency anemia. We’ve discussed clinical progress of A 4.5 years old female with a history of breath-holding spell and iron deficiency anemia recently suffer from febrile convulsion and is diagnosed celiac disease. We aimed to show that pediatricians could find out accompanying celiac disease with different type common disorders by the way of gathering patient’s history, findings and laboratory results as parts of a puzzle.

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Gestasyonel hidronefroz, uterusun mekanik kompresyonu ve progesteron hormonunun etkisi ile gebeliklerin % 80-90’ nýnda gözlenir (1). Gebeliðin fizyolojik hidronefrozu, üriner sistem taþlarý ve anomalileri maternal hidronefrozun sýk görülen nedenleri arasýndadýr (2). Üreter dublikasyonu sýk görülen bir anomalidir ve otopsi serilerinde 125 kiþide 1 görülmektedir (3). Dublike sistemlerin %40’ ý alt üriner sisteme ayrý ayrý baðlantýsý olan komplet üreterler þeklindedir. Kalan kýsým ise Y konfirigasyonu diye adlandýrýlan parsiyel dublike sistemlerdir. Güncel literatür tarandýðýnda bu vaka bifid Y-tip üreterin neden olduðu maternal hidronefrozun anlatýldýðý çok nadir bir olgu sunumudur.

Gestational hydronephrosis is observed in 80-90% of the pregnancy due to the dilatation effect of progesterone hormone and the secondary to mechanical compression of the uterus. (1) The common causes of the maternal hydronephrosis can be listed as physiological hydroureteronephrosis of the pregnancy, urolithiasis and genitourinary system anomalies (2). Ureteral duplication is a common anomaly, observed in approximately 1 in 125 people on autopsy series (3). Duplicated systems have 2 complete ureters with separate insertions into the lower urinary tract in 40% of the patients. The others have a partially duplicated system named as Y configuration (4). To our best knowledge, it is a very rare case presentation in the current literature about the materanal hydronephrosis which is caused by bifid Y-type ureter.

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