Amaç: Periampuller tümörler için Whipple prosedürünün önemli riskleri ve komplikasyonlarý vardýr. Gecikmiþ mide boþalmasý en yüksek orana sahiptir. Uluslararasý Pankreas Cerrahisi Çalýþma Grubu (ISGPS) bunu tanýmlasa da, otörler arasýnda çok sayýda taným hala mevcuttur. Bu çalýþma tanýmý revize etmeyi amaçlamaktadýr.
Yöntem: 73 ardýþýk hasta, özellikle gecikmiþ mide boþalmasý olmak üzere komplikasyonlar açýsýndan analiz edildi. Tüm hastalara standart bir ameliyat uygulandý. Total pankreatektomili ve benign hastalýklarýn olduðu prosedürler hariç tutuldu.
Bulgular: Toplam 73 hasta çalýþmaya dahil edildi. 15 (%20,6) hastada intraabdominal komplikasyon görüldü. Sadece bir (%1,4) hastada Grade C gecikmiþ mide boþalmasý gözlendi. Grade A ve B ise üç (%4,1) hastada gözlendi, bu hastalar konzervatif yöntemlere iyi yanýt verdiler ve ekstra morbidite görülmedi.
Sonuç: Grade A ve B gecikmiþ mide boþalmasý herhangi bir gastrointestinal cerrahi sonrasý görülebilmektedir. Bu hastalar nazogastrik tüp yerleþtirilmesi ile basit konzervatif yöntemlere iyi yanýt verir. Karýn içi koleksiyonun drenajý, varsa boþalma sorununu çözer. Diðer intraabdominal komplikasyonlar olmaksýzýn sadece grade C bu prosedürün bir komplikasyonu olarak kabul edilebilir. ISGPS tanýmý nedeni içermiyor. Dolayýsýyla taným ve derecelendirme revize edilebilir.

Objective: Whipple’s procedure for periampullary tumors has significant risks and complications. Delayed gastric emptying has the highest rate. Although the International Study Group of Pancreatic Surgery defined (ISGPS) this entity, multiple definitions still exist among authors. This study aims to revise the definition.
Method: Seventy-three consecutive patients were analyzed for complications, particularly delayed gastric emptying. All patients underwent a standardized surgery. Procedures used for total pancreatectomies and benign diseases were excluded.
Results: A total of 73 patients were included in the study. Intra-abdominal complications were observed in 15 (20.6%) patients. Grade C delayed gastric emptying was observed in only one (1.4%) patient. Grade A and B disease were observed in three (4.1%) patients. However, they responded well to conservative methods, causing no extra morbidity.
Conclusion: Grade A and B delayed gastric emptying can be observed after any gastrointestinal surgery. These patients respond well to simple conservative methods with nasogastric intubation. Drainage of the intra-abdominal collection resolves the emptying problem (if any). Only grade C disease without other intra-abdominal complications can be accepted as a complication of this procedure. ISGPS definition does not include the cause. Thus, the definition and grading can be revised.

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Objective: Healthcare professionals with an advanced level of knowledge and skills on diabetic wound care management are needed to effectively manage complex wounds. This study aimed to determine the effects of an educational intervention to enhance the management of wound care among healthcare professionals.
Method: This study was part of a quasi-experimental pre-post research design where 82 healthcare professionals were recruited and assigned to intervention and control groups. The participants in the intervention group attended two days of educational intervention training on diabetic wound care management, while there was no intervention in the control group. A questionnaire on knowledge, attitude, and practice was applied before and one-month post-intervention to both groups.
Results: Pre-test resulted in a low level of knowledge 72.1% and 74.4%, negative level of attitude 67.4% and 66.7%, and a moderate level of practice 79.1% and 76.9% in both intervention and control groups respectively. Post-test resulted in increasing levels of knowledge (76.7%), positive attitude (100%), and practice (76.7%) in the intervention group. At the same time, there was no significant change in the control group. Repeated Measure ANOVA for within-subject and between-subject effects resulted in a statistically significant p-value of 0.001 for knowledge, attitude, and practice after the educational intervention.
Conclusion: Health professionals have only a moderate level of knowledge on diabetic wound care management. It is important to improve this level by specific trainings and by using a good training module.

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Objective: To determine the levels of thyroid-stimulating hormone (TSH), thyroxin (T4), triiodothyronine (T3), anti-thyroid peroxidase (anti-TPO), anti-thyroglobulin (anti-TG) and renal iodine excretion (RIE) in the first trimester of the pregnancy and to estimate the risk of developing GDM in these patients.
Method: The levels of TSH, T3, T4, anti-TPO, anti-TG, and RIE were retrospectively evaluated. A total of 312 pregnant women were included in the study (GDM (-) group n=240, GDM (+) group n=62). Diagnosis of GDM was made according to the recommendation of American Diabetes Organization (ADA). The association between thyroid dysfunction and GDM was evaluated.
Results: Our study included a total of 302 women. Sixty-two of these women were diagnosed as GDM (62/302=20.5%). When compared with the GDM (-) group the mean TSH level (2.02 vs 4.13 p=0.019), anti-TPO positivity (8.3% vs 30.64% p=0.044), anti-TG positivity (8.3% vs 19.4% p=0.019) and RIE (156 vs 178 p=0.017) were significantly higher in the GDM (+) group. TSH levels were statistically significantly higher in patients with positive anti-TPO levels (P=0.045).
Conclusion: Elevated TSH levels, TPO and TG antibody positivity rates were more frequent among the patients with GDM. These results may be a guide to perform routine thyroid function tests for patients with increased risk of GDM, on the other hand, they will alert the physicians for GDM progression and ensure taking preventive attempts for the patients who have thyroid disorder, especially those with positive thyroid antibodies in the first trimester of the pregnancy.

Objective: To determine the levels of thyroid-stimulating hormone (TSH), thyroxin (T4), triiodothyronine (T3), anti-thyroid peroxidase (anti-TPO), anti-thyroglobulin (anti-TG) and renal iodine excretion (RIE) in the first trimester of the pregnancy and to estimate the risk of developing GDM in these patients.
Method: The levels of TSH, T3, T4, anti-TPO, anti-TG, and RIE were retrospectively evaluated. A total of 312 pregnant women were included in the study (GDM (-) group n=240, GDM (+) group n=62). Diagnosis of GDM was made according to the recommendation of American Diabetes Organization (ADA). The association between thyroid dysfunction and GDM was evaluated.
Results: Our study included a total of 302 women. Sixty-two of these women were diagnosed as GDM (62/302=20.5%). When compared with the GDM (-) group the mean TSH level (2.02 vs 4.13 p=0.019), anti-TPO positivity (8.3% vs 30.64% p=0.044), anti-TG positivity (8.3% vs 19.4% p=0.019) and RIE (156 vs 178 p=0.017) were significantly higher in the GDM (+) group. TSH levels were statistically significantly higher in patients with positive anti-TPO levels (P=0.045).
Conclusion: Elevated TSH levels, TPO and TG antibody positivity rates were more frequent among the patients with GDM. These results may be a guide to perform routine thyroid function tests for patients with increased risk of GDM, on the other hand, they will alert the physicians for GDM progression and ensure taking preventive attempts for the patients who have thyroid disorder, especially those with positive thyroid antibodies in the first trimester of the pregnancy.

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Amaç: Bu çalýþmanýn amacý, aðýrlýklý olarak platine dirençli hastalardan oluþan epitelyal over kanserli ve endometriyal kanserli hastalarda sitoredüktif cerrahi (SRC) esnasýnda yapýlan HÝPEK iþleminin sonuçlarýný ortaya koymaktýr.
Yöntem: Mayýs 2015-0cak 2020 arasýnda SRC sonrasý HÝPEK uygulanan hastalarýn bilgileri retrospektif olarak deðerlendirildi. Cerrahi komplikasyonlar, Clavien-Dindo sýnýflamasýna göre sýnýflandýrýldý.
Bulgular: 32 hastaya SRC+HÝPEK uygulandý. Tedavinin uygulandýðý hastalardan 2 tanesi endometriyum kanseriydi. Epitelyal over kanseri olan 30 hastanýn 5 tanesine interval SRC+HÝPEK yapýldý. Nüks epitelyal over kanseri olan 25 hastaya ise sekonder SRC+HÝPEK uygulandý. Nüks epitelyal over kanserli 18 hasta platine dirençliydi. Retrospektif olarak operasyona baðlý mortalite %3 ve ciddi morbidite %12 olarak saptandý Epitelyal over kanseri olan 30 hastanýn ortance takip süresi 15 ay idi. Kaplan-Meier saðkalým l istatistik testine göre 1 yýllýk toplam saðkalým %69 ve hastalýksýz saðkalým %30.3 olarak hesaplandý.
Sonuç: SRC+HÝPEK prosedürünün kabul edilebilir ciddi morbidite ve mortalite oranlarý vardýr. Öte yandan, tam sitoredüktif cerrahi geçiren nüks epitelyal over kanserli hastalarýn genel saðkalýmlarýnýn sayýsal olarak daha uzun olduðu ancak bunun istatistiksel olarak anlamlý olmadýðý görülmüþtür. SRC esnasýnda HÝPEK uygulamasý, platine dirençli epitelyal over kanseri kohortunda olumsuz sonuçlarla iliþkili bulunmamýþtýr. Mevcut çalýþmanýn kýsa dönem sonuçlarý umut vericidir.

Objective: The aim of this study was to reveal the results of hyperthermic intraperitoneal chemotherapy (HIPEC procedure) performed during cytoreductive surgery (CRS) in patients with endometrial cancer and epithelial ovarian cancer which included mainly platinum-resistant patients.
Method: Patients who underwent CRS+HIPEC between May 2015 and January 2020 were evaluated retrospectively. Surgical complications were graded according to the Clavien-Dindo classification.
Results: A total of 33 CRS+HIPEC procedures were performed in 32 patients, two of whom had recurrent endometrial cancer. Of the 30 patients with epithelial ovarian cancer (EOC), five underwent interval CRS+HIPEC, and remaining 25 patients underwent secondary CRS+HIPEC treatment due to relapsed disease. Eighteen of the patients with relapsed disease were platinum-resistant. The overall operative mortality and severe morbidity rates were %3 and 12%, respectively. For 30 patients with EOC, during a median follow-up period of 15 months, Kaplan-Meier survival analysis revealed a 1-year OS and PFS rates of 69.7% and 30.3%, respectively. Moreover, in the subgroup analysis of the platinum-resistant cohort, median OS and PFS were 14 and five months, respectively.
Conclusion: CRS+HIPEC procedures had acceptable severe morbidity and mortality rates. In addition, patients with recurrent EOC and without a visible residual disease at the end of cytoreductive surgery had, though not statistically significant, longer OS. HIPEC administration during CRS was not associated with adverse outcomes in the platinum-resistant EOC cohort. The short-term results of the current study are promising.

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Objective: Multiple sclerosis (MS) is a neurodegenerative disorder with various clinical types. Glial fibrillary acidic protein (GFAP) is significantly elevated in the cerebrospinal fluid (CSF) of MS patients compared with that of healthy controls. The aim of this study is to evaluate serum levels of GFAP in relation to disease activity in relapsing-remitting MS patients and to compare them with those of healthy controls.
Method: This study involved 58 MS patients of relapsing-remitting MS (RRMS) type, 22 in an active stage of the disease and 36 in remission, and 50 healthy individuals as age- and sex-matched controls. Blood samples were taken from the patients at the MS Clinic of the Baghdad Teaching Hospital, and the serum levels of GFAP were determined using the enzyme-linked immunosorbent assay (ELISA) technique.
Results: Mean GFAP serum levels in 22 patients presenting in the active state of the disease (6.47±3.39 ng/ml) and 36 cases in remission were (5.33±2.82 ng/ml) (p=0.074) were determined as indicated. When RRMS patients (n=58) were compared with the healthy controls (n=50, 1.89±1.21), the difference in serum levels of GFAP was statistically significant (p<0.001). The area under the curve of the serum measures of GFAP obtained through the receiver operating characteristics was 0.903, which was also statistically significant (p<0.001).
Conclusion: GFAP biomarker is an indicator of disease activity in RRMS patients, and its serum level may correlate with the state of remission or exacerbation.

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Amaç: Bu çalýþmada amacýmýz göç almasýndan dolayý bütün ülke genelini yansýtan karýþýk insan populasyonuna sahip Ýstanbul’da Bazal Hücreli Karsinom (BHK) vakalarýnýn histopatolojik alt tiplerinin, vücutta daðýlým bölgelerinin, tek ve multiple görülme oranlarýnýn belirlenmesidir.
Yöntem: 2014-2018 yýllarý arasýnda 896 BHK vakasý ile ilgili verileri retrospektif olarak analiz ettik. Hastalarýn yaþý, cinsiyeti, tümör çapý, tümör lokalizasyonu, histolojik tip, ülserasyon, lenfovasküler/perinöral invazyon ve multiple tümör varlýðý hastanenin ve patoloji kliniðinin arþiv kayýtlarýndan elde edildi.
Bulgular: Tek deðiþkenli analizde yaþ, tümör boyutu ve multiple tümör varlýðý cinsiyet ile anlamlý olarak iliþkili bulunmuþtur (sýrasýyla p=0,011, p=0,001 ve p=0,021). Ayrýca, yaþ, erkek cinsiyet ve tümör boyutu multiple tümör varlýðýyla anlamlý olarak iliþkiliydi (sýrasýyla p=0,003, p=0,021 ve p=0,001). BHK erkeklerde daha yaygýn ve BHK çaplarýnýn da erkek hastalarda daha büyük olduðu gözlendi. Multiple tümörler, yaþlý ve erkek hastalarda daha sýk görüldü. Bu tümörler yine bu gruplarda daha büyük çaplara sahipti. Nodüler BHK tipi tüm yaþ gruplarýnda en sýk görülen tip olarak bulundu.
Sonuç: Çalýþmamýz, Türkiye’de en fazla vakaya sahip olan ilk BHK çalýþmasý olmasý ve Ýstanbul, Türkiye’nin nüfusunu yansýtýyor olmasýndan dolayý, Türkiye’deki BHK vakalarýnýn verileri için önemlidir.

Objective: Our aim in this study is to define the histopathological subtypes, body site distribution, and incidence rates of single or multiple of BCCs. The study is conducted on patients from a single institution in Istanbul which has a migrant-receiving population reflecting that of the country overall.
Method: We retrospectively analyzed data concerning 896 cases of BCC seen between 2014 and 2018. Data about patient demographics (age and sex), tumor diameter,its anatomic localization, histological type, presence of ulceration, lymphovascular/perineural invasion, and single or multiple tumor formations were retrieved from both the hospital’s automated system and archived records of the pathology clinic.
Results: Our univariate analysis showed that the patients’ age, tumor size, and tumor multicentricity were all significantly related to their gender (p=0.011, p=0.001, and p=0.021, respectively). Further, age, male gender, and tumor size were all significantly related to tumor (p=0.003, p=0.021, and p=0.001, respectively). BCC was most commonly found in male, and the diameters of the BCC tumors were also larger in male patients. Multiple BCC was more frequently seen in older and male patients, and the tumors had larger diameters in these groups. The nodular type of BCC was the most frequently seen type in all age groups.
Conclusion: As our study is the first BCC study that has the greatest number of cases in Turkey and as Istanbul reflects the population of Turkey, it is important for the data of BCC cases in Turkey.

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Amaç: Ýnfertil kadýnlarda anksiyete bozukluklarý ve depresyon riskinin arttýðý ve yaþam kalitesinin bozulduðu bilinmektedir. Mizaç özellikleri ise duygudurum bozukluklarýnýn öngörücüsü olarak kabul edilmektedir. Bu çalýþmanýn amacý infertil kadýnlardaki mizaç özelliklerini ve depresyon, anksiyete düzeyi ile yaþam kalitesi üzerine etkilerini inceleyerek, saðlýklý kadýnlara göre farklarýnýn ve iliþki düzeyinin ortaya koyulmasýdýr.
Yöntem: Çalýþmaya primer infertilite tanýsý almýþ 44 kadýn hasta ve 30 saðlýklý kadýn kontrol dahil edildi. Katýlýmcýlarýn mizaç özellikleri, Memphis, Pisa, Paris ve San Diego Mizaç Deðerlendirme Anketi (TEMPS-A) ile deðerlendirildi. Depresyon ve anksiyete þiddeti Beck Depresyon Envanteri (BDE) ve Beck Anksiyete Envanteri (BAE) ile deðerlendirildi. Ayrýca yaþam kalitesini deðerlendirmek için Kýsa Form 36 (SF-36) yaþam kalitesi ölçeði uygulandý.
Bulgular: Ýnfertil kadýnlarda hipertimik mizaç özellikleri kontrol grubuna göre daha yüksekti (p=0,001). BDE puanlarý depresif ve siklotimik mizaç puanlarý ile pozitif, BAE puanlarý ise depresif ve anksiyöz mizaç puanlarý ile pozitif korelasyon gösterdi. Hipertimik mizaç ile BAE ve BDE puanlarý arasýnda negatif korelasyon bulundu. Hipertimik mizaç puanlarý, yaþam kalitesi ölçeðinin hem fiziksel hem de zihinsel alt boyut puanlarý ile pozitif korelasyon gösterdiði saptandý.
Sonuç: Bu çalýþmada infertil kadýnlarda hipertimik mizaçýn anksiyete ve depresyondan koruyucu olduðu; yaþam kalitesini arttýrdýðý gösterilmiþtir. Hipertimik mizaç ile ovaryan hormonlar ya da biyolojik parametreler arasýndaki iliþkinin aydýnlatýlmasý için ek çalýþmalara ihtiyaç vardýr.masý için ek çalýþmalara ihtiyaç vardýr.

Objective: It is known that the risk of anxiety disorders and depression in infertile women increases and their quality of life deteriorates. Temperamental characteristics are considered as predictors of mood disorders. The aim of this study was to investigate temperamental characteristics in infertile women and their effects on depression and anxiety levels, and the quality of life, and to reveal the differences and level of relationship compared to healthy women.
Method: Fourty-four female patients with primary infertility and 30 healthy female controls were included in this study. Temperamental characteristics of the participants were assessed with Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire version (TEMPS-A). Depression and anxiety severity were evaluated with Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). To evaluate the quality of life, Short Form 36 (SF-36) health survey questionnaire was also applied.
Results: Hyperthymic temperament scores were higher in infertile women than the control group (p=0.001). BDI scores were positively correlated with depressive and cyclothymic temperament scores, and BAI scores were positively correlated with depressive and anxious scores. A negative correlation was found between hyperthymic temperament and BAI and BDI scores. Hyperthymic temperament scores were positively correlated with both physical and mental subdimension scores of the quality of life scale.
Conclusion: In this study, hyperthymic temperament in infertile women was shown to be protective against anxiety and depression and it also improves the quality of life. Additional studies are needed to clarify the relationship between hyperthymic temperament and ovarian hormones or other biological parameters.

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Amaç: Günümüzde özellikle geliþmiþ ülkelerde çocuk yaþlardaki þiþmanlýk önemli bir saðlýk problemi olarak ele alýnmaktadýr. Bu çalýþma, çocuklarda obezite sýklýðýný belirleyebilmeyi ve çocuklarda televizyon izleme alýþkanlýðýnýn, bilgisayar kullanýmýnýn ve sosyoekonomik durumun obezite ile iliþkisini ortaya koymayý amaçlamaktadýr.
Materyal ve metod: Ýstanbul’da tesadüfi örnekleme ile seçilen 11 tane devlete ait ilköðretim okulunda kesitsel bir araþtýrma yapýldý. Araþtýrmaya 767 erkek (% 51.9), 712 kýz (% 48.1) olmak üzere toplam1479 öðrenci katýldý. Yaþlarý 10-15 arasýnda deðiþmekte olup, ortalama yaþ kýzlarda 11.95±1.36 yýl, erkeklerde 12.06±1.39 yýldý. Yapýlandýrýlmýþ anket formu ile demografik özellikler ve obezitede etkili olan faktörler sorgulandý. Öðrencilerin boy ve kilolarý ölçüldü ve beden kitle indeksi (BMI) hesaplandý. BMI 95. persantilin üzerinde olanlar þiþman olarak, 85-95 persantilleri arasý hafif þiþman (overweight) olarak kabul edildi.
Sonuçlar: Araþtýrma grubunda obezite oraný %5.3, hafif þiþman oraný %14.9 olarak saptandý. Obez ve hafif þiþman toplam sýklýðý %20.2 bulundu. Sosyoekonomik düzeyin yüksek olduðu grupta obezite sýklýðý kýz ve erkek cinste de anlamlý yüksek olarak belirlendi. (p< 0.01) Obezite risk faktörlerinde ana belirleyici olarak sosyoekonomik durum saptandý.
Ortalama televizyon izleme ve bilgisayar kullanma süresi 3.74±1.58 saatti. Bu sürenin 5 saatin üzerinde olduðunda obezite riskinin 3 kat arttýðý saptandý. Lojistik regresyon analizinde sosyoekonomik düzey ana belirleyici olarak saptanýrken, televizyon izleme ve bilgisayar kullaným süresinin obeziteye etkisi sýnýrda anlamlý olarak bulundu. (p<0.045)
Tartýþma: Yüksek sosyoekonomik duruma sahip ailelerin yaþam tarzý adölesanlarda obezite için ana belirleyicidir. Daha yüksek kalorili gýdalar ile beslenme, daha çok media kullanýmý ve bunun getirdiði daha sedanter yaþam yüksek sosyoekonomik durumun oluþturduðu obesojenik bir çevredir. Obezite için çevresel risk faktörleri belirlenmelidir.

Objective: The objective of this study is to determine the frequency of obesity among students between 10-15 years of age and to evaluate the relationships between daily screen time and socioeconomic level and obesity in children.
Methods: A cross-sectional study was performed in 11 state schools selected with random sampling in Istanbul. Demographic characteristics and factors affecting obesity were inquired with the structured questionnaire form and Body Mass Indexes were calculated.
Results: A total of 1479 students (767males (51.9%)) were included in the study. The total prevalence of overweight and obese children was 20.2%. The frequency of obesity in the high socioeconomic level group was significantly higher than low one (p< 0.01).
The average daily screen time was 3.74±1.58 hours. The obesity risk is found to increase 3 times when this period exceeded 5 hours. In the logistic regression analysis, while high socioeconomic level was found as the main determinant among the risk factors for obesity, the effects of daily screen time were found to be marginally significant (p<0.045).
Conclusion: Lifestyles of families with high socioeconomic status are the main determinant of obesity in adolescents. Environmental risk factors for obesity should be assessed taking national characteristics into account.

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COVID-19, tüm yaþ gruplarýný etkiler ancak çocuklarda aðýr vakalar genellikle azdýr ve mortalite çok düþüktür. Birçok durumda çocuklar hastalýðý ebeveynlerinden veya yakýn çevresinden alýrlar. Çocuklarda hastalýðýn neden hafif geçtiði tam olarak bilinmemektedir ancak ACE2 reseptörlerinin fazla oluþu, immün sistemlerinin tam olarak geliþmemiþ olmasý, sýk görülen diðer viral ajanlarla çapraz reaksiyon olmasý, fetal hemoglobinin koruyucu olmasý, ev dýþýnda daha az zaman geçirmeleri ve daha az seyahat etmeleri, sigara ve hava kirliliðine maruz kalmamalarý etkili olabilir. Birçok vaka asemptomatik olmasýna raðmen virusü etrafa bulaþtýrabilirler. Anneden fetusa vertikal geçiþ gösterilememiþtir. Semptomatik hastalarda ateþ ve solunum sistemi bulgularýný ishal ve kusma izler. COVID-19 ile Kawasaki hastalýðý arasýnda iliþki olabileceðini gösteren bulgular vardýr. Yenidoðanlardaki bulgular ve tanýsal testler büyük çocuklardakine benzerdir. Çocuklardaki esas tedavi þekli destek tedavisidir ve birçok hastada antiviral tedaviye gerek yoktur. Sitokin fýrtýnasýnýn geliþtiði durumlarda anti-inflamatuar tedaviler yapýlabilir. Anne sütünde virus gösterilememiþtir, bu yüzden anneler tüm önlemleri aldýktan sonra bebeklerini emzirmelidir. Bu dönemde çocuklarýn rutin aþýlanmasý ihmal edilmemelidir. Evde kalmak zorunda kalan çocuklara ve saðlýk personeline psikolojik destek yapýlmalýdýr.

COVID-19 disease affects all ages, but severe cases of the disease and mortality are very rarely seen among children. In most cases, they acquire the virus from their parents or from an another infected person. The exact reasons why the disease has a milder course in children is unknown but high numbers of Angiotensin Converting Enzyme-2 (ACE2) receptors, underdeveloped immune responses, cross-reaction with other viruses, protective effect of fetal hemoglobin and fewer outdoor activities as well as journeys, and nonexposure to air pollution, and smoking. Although many cases are asymptomatic, they can still shed the virus. Materno-fetal vertical transmission has not been shown so far. In symptomatic cases, clinical findings include fever and respiratory symptoms, followed by diarrhea and vomiting. There are signs indicating a possible association between Kawasaki disease and COVID-19. Clinical findings and diagnostic procedures in newborns, and older children are similar. Supportive therapy is essential and antiviral agents are not required in most cases. During cytokine storm, anti-inflammatory treatments may be tried. There is no evidence for transmission through breastmilk; therefore infected mothers should breastfeed their infants by taking all precautions. Routine immunizations of children should not be deferred during COVID-19 outbreak period. Psychological support for children who need to stay at home and for healthcare personnel should be provided.

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Coronaviridae familyasý içerisinde sýnýflandýrýlan koronavirüsler (CoVs) oldukça geniþ bir omurgalý grubu enfekte etmektedir. Ýnsanlarda hastalýk oluþturan yedi tip koronavirüsten HCoV-229E ve NL63 alfa, MERS-CoV, SARS-CoV, HCoV-OC43, HCoV-HKU1, SARS-CoV-2 ise beta cinsinde yer almaktadýr. SARS-CoV-2, yeni bir koronavirüs hastalýðýna (Coronavirus disease 2019; COVID-19) yol açan zarflý, pozitif-polariteli, tek sarmallý bir RNA virüsüdür. SARS-CoV-2’nin mutasyon kabiliyeti viral evrimi ve genom deðiþkenliðini yönlendirir. Böylece virüslerin konakçý baðýþýklýðýndan kaçmasýna ve ilaç direnci geliþtirmesine olanak tanýr. Ayrýca viral mutasyonlarýn izlenmesi yeni aþýlar, anti-viral ilaçlar ve taný sistemlerinin geliþtirilmesi için de önemlidir. Konak hücrede replikasyon esnasýnda virüste mutasyon oluþmakta ve bu mutasyonlar yeni soylara aktarýlmaktadýr. Bu nedenle SARS-CoV-2 genomundaki mutasyonlarýn sistematik bir biçimde izlenmesi virüsün ulusal ve uluslararasý moleküler epidemiyolojisinin gözlenmesine olanak saðlamaktadýr. SARS-CoV-2’nin spike (S) proteini virüsün konak hücre reseptörü olan anjiyotensin dönüþtürücü enzim 2’ye (ACE2) baðlanmasý, membrana füzyonu, aþý çalýþmalarý ve oluþacak baðýþýk yanýtta hayati öneme sahiptir. Bu nedenle S glikoproteinini kodlayan gendeki mutasyonlar ve özellikle virüsün ACE-2 reseptörüne baðlanma bölgesindeki (RBD olasý varyasyonlarýn irdelenmesi, üzerinde durulmasý gereken önemli konulardandýr. Bu yazýda SARS-CoV-2 S glikoproteininde saptanmýþ olan mutasyonlar ve olasý etkileri hakkýnda bilgi sunulmuþtur.

Coronaviruses (CoVs) classified in the Coronaviridae family infect a very large spectrum of vertebrate group. Seven CoVs that cause human disease consist of Alpha-CoVs, which are HCoV-229E, and NL63 and beta-CoVs, which are MERS-CoV, SARS-CoV, HCoV-OC43, HCoV-HKU1, and SARS-CoV-2. SARS-CoV-2 is an enveloped, positive-polarity, single-stranded RNA virus responsible for a new Coronavirus disease 2019 (COVID-19). The mutagenic ability of the SARS-CoV-2 directs its evolution and genome variability, thus allowing viruses to escape from host immunity and develop drug resistance. Tracing viral mutations is also important for the development of new vaccines, antiviral drugs, and diagnostic systems. During replication in the host cell, genomic mutations occur in the virus and these mutations are transferred to new generations. For this reason, systematic monitoring of mutations in the SARS-CoV-2 genome allows observation of the national and international molecular epidemiology of the virus. SARS-CoV-2 spike (S) glycoprotein is vital in the binding of the virus to the host cell receptor that is angiotensin converting-enzyme 2 (ACE2), membrane fusion, vaccine studies and immune response to the virus. Therefore, mutations in the gene encoding the S glycoprotein and especially the possible variations in the receptor binding domain (RBD) in S gene are important issues to be emphasized. In this article, information about the mutations observed in the SARS-CoV-2 S glycoprotein and their possible effects are presented.

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Doðumsal özofagus darlýðý (DED) tek baþýna görülen veya özofagus atrezisine (ÖA) eþlik eden nadir bir doðumsal hastalýktýr. DED özofagus boþalmasýnda týkanýklýk ile seyreder. Özofagusun epifirenik divertikülleri (ED) ise diyafram üstü seviyede oluþan özofagus çýkýntýlarýdýr. Altta yatan özofagus motor hastalýklarý zemininde geliþirler. ÖA ameliyatý sonrasýna rutin takip sýrasýnda DED tanýsý konan bir hasta sunulmuþtur. Hastaya DED tedavisi amacýyla çeþitli kereler balon dilatasyon uygulanmýþ ve semptomlarýnda kýsmi düzelme saðlanmýþtýr. Bu tedavi esnasýnda yapýlan ileri tetkiklerle hastada ED geliþtiði tespit edilmiþtir. Cerrahi rezeksiyon ile baþarýlý sonuç elde edilmiþtir. DED nedeniyle geliþen ED daha önce bildirilmemiþtir. Bu iki nadir duruma iliþkin uygulanan tanýsal yöntemler, tedavi seçenekleri ve klinik izlem bulgularý vurgulanmýþtýr.

Congenital esophageal stenosis (CES) is a rare congenital disorder which may be isolated or associated with esophageal atresia (EA). It courses with esophageal outflow tract obstruction. Esophageal epiphrenic diverticulae are esophageal outpouchings above diaphragm which develop because of an underlying esophageal motor disorder. We present an infant who had CES associated with EA detected during the course of routine follow-up. She underwent several sessions of esophageal balloon dilatations for CES with some symptomatic improvement. However, an epiphrenic diverticulum (ED) developed during the course of treatment which was detected by further investigations. A surgical excision was performed with a successful outcome. An ED developed secondary to CES has not been previously reported. We have highlighted the diagnostic modalities employed, treatment options, and clinical follow-up for these two rare conditions in children.

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Takotsubo syndrome is a rare disease and remained ambiguous with its etiology. The disease manifests in various clinical characteristics and even mimicking acute coronary syndrome. We are reporting a case of an elderly lady who manifested by unsteady gaits and recurrent falls. Subacute infarct of the right corona radiata was observed on the brain CT. In addition, coronary angiography and ventriculogram were performed because of dynamic ECG changes and elevated troponin I levels. The angiogram was normal while ventriculogram showed apical ballooning. She was diagnosed and treated as Takotsubo syndrome.

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Adult type of extracardiac rhabdomyoma is a benign tumour of mature striated muscle histopathologically. It is a slow growing tumour with predilection to occur in head and neck region. It appeared mainly to be a solitary lesion with 15% can occurred multicentric. A 56 year-old gentleman presented to us with floor of mouth swelling for 1 year and right neck swelling for 3 years mimicking a plunging ranula. Radiological imaging revealed enhancing mass at the floor of mouth and submandibular region. The mass represent a non vascular benign tumour. Subsequently, the patient underwent combine approached excision of the mass via transcervical and transoral method. Histopathological examination revealed adult type of extracardiac rhabomyoma. Adult type of extracardiac rhabdomyoma should be considered in the differential diagnosis in the head and neck masses. A complete excision will reduce the risk of recurrence.

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Nodular fasciitis (NF) is an uncommon and benign tumour-like fibroblastic proliferation that is difficult to distinguish from sarcoma both clinically and histologically. In addition, it is a type of lesion characterised by having a potential for spontaneous regression. NF is frequently misdiagnosed due to its rapid growth, rich cellularity, and mitotic figure. Although NF is only rarely diagnosed in children, the head and neck represent the most common locations for NF among this population. The cause of NF remains unknown, however trauma is believed to be an important triggering factor. We describe an unusual case of NF in the posterior ethmoid sinus in a six-year-old boy with no history of trauma. The NF was incidentally noted on a computed tomography scan after the patient complained of a squint. The diagnosis of NF was also supported by histopathology and specific immunohistological staining. A surgical biopsy was performed, and no recurrence was observed after one year.

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