Amaç: SARS-CoV-2’ye karþý IgG antikorunun zamansal seyrini ve ABO kan grubuna göre düzeyinin deðiþip deðiþmediðini belirlemeye çalýþtýk.
Yöntem: Türk Kýzýlay’ýn 12315 konvalesan plazma (KP) baðýþçýsýnýn 36003 KP baðýþýný inceledik. KP baðýþçýlarýnýn ABO kan grubu, Gel Centrifugation yoluyla belirlendi. IgG, Euroimmun anti-SARS-CoV-2 ELISA kullanýlarak ölçüldü. Ortalama IgG oran daðýlýmýndaki farklýlýklar, One Way ANOVA ve Independent Sample T testleri kullanýlarak ABO kan grubuna göre incelendi.
Bulgular: KP baðýþçýlarýnýn %98,4’ü erkeklerden oluþmaktadýr. KP baðýþçýlarýnda SARS-CoV-2’ye antikor yanýtýnýn -birkaç kiþiyle sýnýrlý olmakla birlikte- yaklaþýk 244. günde görüldüðünü saptadýk. ABO kan gruplarý ile ortalama IgG oranlarý arasýnda anlamlý bir iliþki saptadýk (p: 0.001). En yüksek antikor seviyesi (mean±SD) AB kan grubunda gözlenirken (39,5±15,7), onu B kan grubu (37,9±11,5), sonra A kan grubu (36,6±10,7) izlerken, en düþük O kan grubunda (34,4±11,5) idi. Yine ikili grup karþýlaþtýrmasýnda da tüm ikili gruplar arasýnda anlamlý farklýlýklar vardý. Rh (-) kan grubunda (37,4±13,6); Rh (+) kan grubuna (36,3±11,2) göre anlamlý düzeyde daha yüksek antikor seviyesi mevcuttu (p: 0,005).
Sonuç: SARS-CoV-2’ye antikor yanýtýnýn yaklaþýk 244. günde görüldüðünü saptadýk. Kan grubu AB olan KP baðýþçýlarýnda ortalama IgG oranlarý daha yüksek iken; O grubunda daha düþüktü. Klinik olarak ilgili kan grubuna sahip COVID-19 hastalarýnýn tedavisinde kullanýlacak olan KP tedavisinin etkinliðinde bu sonuçlar deðerli olabilir.

Objective: The present study investigates the seroconversion time course of the IgG antibody against SARS-CoV-2 and ascertains whether its levels change according to the patient’s ABO blood group.
Method: A total of 36,003-convalescent plasma (CP) donations of 12,315 Turkish Red Crescent CP donors were analyzed. The ABO blood group of the CP donors was determined by Gel Centrifugation; and IgG was measured using the Euroimmun anti-SARS-CoV-2 ELISA. The differences in the distributions of mean IgG ratios among the different ABO blood groups were analyzed with One-Way ANOVA and Independent Samples T-test.
Results: Among the CP donors, 98.4% were male. An antibody response to SARS-CoV-2 was noted-although in a few CP donors- on the 244th day, and a significant association between the ABO blood groups and the mean IgG ratios was noted (p: 0.001). The highest (mean±SD) antibody level was observed in the AB blood group (39.5±15.7), followed by the B (37.9±11.5) and the A blood groups (36.6±10.7), while the lowest value was recorded in the O blood group (34.4±11.5). Significant differences between all paired groups were noted in pairwise comparisons. The Rh (-) blood group (37.4±13.6) had a significantly higher antibody level than the Rh (+) blood group (36.3±11.2) (p: 0.005).
Conclusion: An antibody response to SARS-CoV-2 was noted in a CP donor on the 244th day. The average IgG ratios were higher in the CP donors with the AB blood group, but lower in the O blood group. These results may be considered a valuable indication of the effectiveness of CP therapy used for the treatment of COVID-19 patients with clinically relevant blood types.

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Amaç: Yenidoðanýn persistan pulmoner hipertansiyonu (PPHN) olan yenidoðanlarda akut böbrek hasarý (ABH) insidansýný ve risk faktörlerini belirlemek, ve yenidoðan sonuçlarý ile iliþkisini deðerlendirmek.
Yöntem: 2016-2020 yýllarý arasýnda bir üniversite hastanesinin yenidoðan yoðun bakým ünitesine yatýrýlan doðrulanmýþ PPHN’si olan 78 yenidoðan retrospektif olarak incelendi. ABH tanýsý, modifiye neonatal Kidney Disease: Improving Global Outcomes (KDIGO) kriterlerine göre konuldu.
Bulgular: 78 PPHN bebeðinin %29.5’inde (23/78) ABH saptandý. Çok deðiþkenli analiz, erkek cinsiyetin (OR 3,43 %95 CI 1,03-11,48, p=0,04) ve þiddetli PPHN’nin (OR 5,67 %95 CI 1,55- 20,68, p<0,01) baðýmsýz olarak ABH riskinde artýþ ile iliþkili olduðunu gösterdi. ABH olan bebeklerde ölüm oraný ABH olmayanlara göre anlamlý olarak daha yüksekti (%43,5’e karþý %9,1, p<0,01). Evre 1, Evre 2 ve Evre 3 ABH’deki ölüm oranlarý benzerdi (sýrasýyla, %36,4, %57,1 ve %40, p=0,68). Hayatta kalanlar arasýnda, ABH olan bebeklerin mekanik ventilator ve hastanede yatýþ süreleri, ABH olmayan bebeklere göre daha uzun idi.
Sonuç: PPHN’li bebeklerde ABH yaygýn bir komplikasyondur ve artan mortalite, daha uzun mekanik ventilasyon ve hastanede kalýþ süresi ile iliþkilidir. PPHN’li bebeklerde, özellikle erkeklerde ve þiddetli PPHN’si olanlarda böbrek fonksiyonunun dikkatli bir þekilde izlenmesi hasta sonuçlarýný iyileþtirmeye yardýmcý olabilir.

Objective: To identify the incidence of and risk factors for acute kidney injury (AKI) in neonates with persistent pulmonary hypertension of the newborn (PPHN) and to evaluate its association with neonatal outcomes.
Method: A total of 78 newborns with confirmed PPHN admitted to the neonatal intensive care unit of a university hospital between 2016 and 2020 were retrospectively analyzed. AKI was defined according to the modified neonatal Kidney Disease: Improving Global Outcomes criteria. Results: Of 78 PPHN infants, AKI was found in 29.5% (23/78). Multivariate analysis indicated that male sex (OR 3.43 95% CI 1.03-11.48, p=0.04) and severe PPHN (OR 5.67 95% CI 1.55- 20.68, p<0.01) were independently associated with increased risk for AKI. Infants with AKI had significantly higher mortality rate than infants without AKI (43.5% vs. 9.1%, p<0.01). Mortality rates in stage 1, stage 2 and stage 3 AKI were similar (36.4%, 57.1%, and 40%, respectively, p=0.68). Among survivors, AKI infants had significantly longer mechanical ventilation and lenght of stay than infants without AKI.
Conclusion: In infants with PPHN, AKI is a common complication and is associated with increased mortality, and longer mechanical ventilation and lenght of stay. Careful monitoring of kidney function in infants with PPHN, especially in males and those who had severe PPHN can help to improve patient outcomes.

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Amaç: Kronik hepatit B (KHB) hastalarýnda siroz ve hepatoselüler karsinom geliþimini önlemek için nukleos(t)id analog (NUK) tedavilerinin etkinliði ve süresine iliþkin veriler az ve heterojendir. Bu çalýþma, oral antiviral tedaviyi býrakan KHB enfeksiyonlu hastalarýn klinik ve laboratuvar sonuçlarýný özetlemeyi amaçlamaktadýr.
Yöntem: KHB enfeksiyonlu hastalarda tek merkezli bir kohort çalýþmasý yapýlmýþtýr. En az iki yýldýr viral baskýlama altýnda olan ve 18 aydan beri saptanamayan HBV DNA düzeyleri olan hastalarda NUK’lar kesilmiþtir. Klinik relaps (KR) için risk faktörleri deðerlendirilmiþtir.
Bulgular: Çalýþmaya toplam 77 hasta alýndý. HBeAg durumu, hastalarýn% 9.4’ünün NUK’larla HBeAg serokonversiyonu geçirdiðini gösterdi. Bu hastalarýn dördünde (%31) HBeAg reversiyonu kaydedildi. Antiviral tedavisi yeniden baþlandýktan sonra düzelen þiddetli hepatit, 77 hastanýn 2’sinde (%4) bildirilmiþtir. KR’li hiçbir hastada klinik veya biyolojik hepatik dekompansasyon belirtisi görülmemiþtir veya çalýþma süresi boyunca ölmemiþtir.
Sonuç: Baþlangýçta þiddetli fibrotik HBV enfeksiyonu olan hastalarda viral baskýlamadan sonra antiviral tedavinin kesilmesinin herhangi bir faydasý bulamadýk. Hafif ile orta þiddette fibrozlu hastalarda, antiviral kesilme, olumsuz sonuçla iliþkili deðildir.

Objective: Data on the efficacy and duration of nucleos(t)ide analogue (NUC) therapies to prevent the development of cirrhosis and hepatocellular carcinoma in chronic hepatitis B (CHB) patients are scarce and heterogeneous. This study aimed to summarize the clinical and laboratory results of the patients with CHB infection who discontinued oral antiviral therapy.
Methods: A single-centered cohort study was conducted with CHB infection. NUCs were discontinued in patients who were under viral suppression for at least two years with undetectable HBV DNA levels for 18 months. Risk factors for clinical relapse (CR) were evaluated.
Results: A total of 77 patients were recruited. HBeAg status showed that 9.4% of the patients underwent HBeAg seroconversion with NUCs. HBeAg reversion was noted in four (31%) of these patients. Severe hepatitis, which resolved after antiviral therapy was restored, was reported in two out of 77 patients (4%). None of the patients with CR had clinical or biological signs of hepatic decompensation or died during the study period.
Conclusions: We found no benefits of the discontinuation of antiviral therapy after viral suppression in patients with initially severe fibrotic HBV infection. In patients with mild to moderate fibrosis, cessation of antiviral treatment is not associated with adverse outcomes.

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Amaç: Tip II diyabetin neden olduðu böbrek hasarý böbrek elastisitesini bozabilir. Erken evre böbrek hasarýnýn böbrek dokusunda sertleþmeye neden olup olmadýðý konusunda sýnýrlý veri bulunmaktadýr. Bu karþýlaþtýrmalý çalýþmada; ultrason temelli 2B Shear wave hýzlarý (2B-SWH) ile, orta derecede albüminürisi olan ve olmayan diyabetiklerin böbrek elastisitesini deðerlendirmeyi amaçladýk.
Yöntem: Bu tek merkezli, prospektif çalýþmaya toplam 57 olgu (evre 1 veya 2 kronik böbrek hastalýðý olan DM-II tanýlý 40 hasta ile yaþ ve cinsiyet uyumlu 17 saðlýklý kontrol) dahil edildi. Tip II diyabetlilerin oluþturduðu grup kendi içinde albüminürisi olan (n=22) ve albüminürisi olmayanlar (n=18) olmak üzere iki alt grup oluþturdu. Her iki taraf böbrek parankim 2B-SWH deðerleri üst, orta ve alt kesimlerden ayrý ayrý ölçülmüþtür. Gruplar uygunluðuna göre T testi ve Mann-Whitney U testi ile karþýlaþtýrýlmýþtýr. Okuyucular arasý uyum sýnýf içi korelasyon katsayýsý ile deðerlendirildi.
Bulgular: Ortanca yaþ [sýrasýyla 55,5 (50-62) ve 55 (48,5-59,5) yýl, p=0,48] ve cinsiyet daðýlýmý [sýrasýyla 18 (45%) erkek ve 10 (58,8%) kadýn p=0,34] diyabetliler ve kontrol grubu için farklýlýk göstermemekteydi. Ortalama ve baðýmsýz 2B-SWH deðerleri de benzerdi (Hepsi için p>0,05). Ortalama 2B-SWH deðerleri albüminürisi olan ve olmayan grup için de benzerdi. Gözlemciler arasý uyum iyiydi (ICC: 0.66, 95% CI: 0.19-0.88, p=0.006).
Sonuç: Böbrek elastisitesinin eGFR’si korunmuþ, orta derecede albüminürisi olan ya da olmayan diyabetik hastalarda bozulmadýðý görülmüþtür.

Objective: Kidney damage caused by type 2 diabetes mellitus (T2DM) can reduce renal elasticity. Limited number of data exist indicating whether early kidney damage causes stiffening of renal tissue. This comparative study aims to assess kidney elasticity in T2DM patients with or without moderate albuminuria, using ultrasound-based two-dimensional shear wave velocity (2D-SWV) measurements.
Methods: Fifty-seven cases (40 T2D patients with stage 1 or 2 chronic kidney disease and 17 age- and sex-matched healthy controls) were included in this single-center prospective study. The T2DM patients were divided into those with moderate albuminuria (n=22) and those without albuminuria (n=18). Bilateral renal parenchymal 2D-SWV values were measured (separately) in the upper, middle, and lower kidney regions. Group data were compared using the t-test or Mann-Whitney-U test (whichever appropriate). Inter-observer agreement was assessed by deriving the intra-class correlation coefficient.
Results: There was no difference between the T2DM and control groups in terms of the median age [55.5 (50-62) vs. 55 (48.5-59.5) years, p=0.48] and sex ratio [18 (45%) males vs. 10 (58.8%) females, p=0.34]. The average regional 2D-SWV values were all similar between the groups (all p>0.05). The average 2D-SWV values were similar between the subgroups with and without albuminuria. The inter-observer agreement was good (intra-class correlation coefficient=0.66, 95% CI 0.19-0.88, p=0.006).
Conclusion: Kidney elasticity does not seem to be compromised in patients with diabetes and preserved estimated glomerular filtration rate with or without moderate albuminuria

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Amaç: Ýdrar yolu enfeksiyonu (ÝYE) ile iliþkili bakteriyel patojenlere karþý antibiyotik direnci, tüm dünyada her geçen gün artmaktadýr. Bu çalýþmada amacýmýz hastanemizde ÝYE tanýsý konulan 17 yaþ altý çocuklarda etken mikroorganizmalarýn belirlenmesi ve bu etkenlerin antibiyotik direnç oranlarýnýn saptanmasýdýr.
Yöntem: Ocak 2018-Temmuz 2019 tarihleri arasýnda hastanemize baþvuran ve ÝYE ön tanýsýyla idrar kültürü tetkiki istenen ve kültürde bakteri izole edilen 17 yaþ altý çocuklara ait 4801 örnek retrospektif olarak incelenmiþtir. Ýzole edilen bakteriler ve antibiyotik direnç profilleri istatiksel olarak analiz edilmiþtir.
Bulgular: Çalýþmaya dahil edilen 2592 hastanýn 2001 (%77,2)’i kýz ve yaþ ortalamalarý median IQR 55 (12-98) ay idi. Yenidoðan dönemi hariç diðer tüm yaþ gruplarýnda en sýk kýz cinsiyetin hakim olduðu görüldü (p<0,0001). En sýk izole edilen bakteri türleri sýrasýyla, Escherichia coli (%67,7), Klebsiella spp. (%10,7), Enterococcus spp. (%8,8) idi. En dirençli ve en az dirençli antibiyotikler Escherichia coli için sýrasýyla ampisilin (%66,6), meropenem (%0,3) idi. Enterococcus fecalis’in ampisilin ve siprofloksasine direnç durumu çok düþük olmasýna raðmen Enterococcus faecium’un bu antibiyotiklere çok daha dirençli olduðu görülmüþtür (p<0,0001).
Sonuç: Her merkezin kendi direnç oranlarýný belirlemesi ampirik tedaviye yol gösterici olmasý bakýmýndan önemlidir. Ampirik baþlanan her antibiyotiðin kültür ve duyarlýlýk sonucuna göre yeniden deðerlendirilmesinin ve uygun bir antibiyotiðe geçilmesinin direnç oranlarýný azaltmada oldukça etkili olacaðý göz önünde bulundurulmalýdýr.

Objective: Antibiotic resistance against bacterial pathogens associated with urinary tract infections (UTI) is rapidly increasing worldwide. In this study, we aimed at determining the causative microorganisms in children under 17 years of age diagnosed with UTI in our hospital and the antibiotic resistance rates of these causes.
Methods: We isolated and retrospectively analyzed 4801 urine samples of children under 17 years old who presented with bacterial growth in their urine cultures. The isolated bacteria and their antibiotic resistance profiles were statistically analyzed.
Results: Most (2001/77.2%) of 2592 patients included in the study were female and the mean age and median interquartile range (IQR) was 55 (12-98) months. Except for the neonatal period, the female gender was predominant in all age groups (p<0.0001). The most frequently isolated bacteria included Escherichia coli (67.7%), Klebsiella spp. (10.7%), and Enterococcus spp. (8.8%). The most and least resistant antibiotics were ampicillin (66.6%) and meropenem (0.3%) for E. coli, respectively. Although resistance of E. faecalis to ampicillin and ciprofloxacin is at a low level, E. faecium is much more resistant to these antibiotics (p<0.0001).
Conclusion: It is important that each center determines its own resistant antibiotics so as to guide empirical treatment. Re-evaluating each antibiotic that is started to be used empirically according to the results of culture and sensitivity in addition to switching to a suitable antibiotic would be very effective in reducing resistance rates.

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Amaç: Tükürük bezi lezyonlarý olan hastalarýn preoperatif deðerlendirilmesinde ince iðne aspirasyon sitolojisinin (ÝÝAS) rolü iyi bilinmektedir. Ancak tükürük bezi ÝÝAS için tek tip bir sistemin olmamasý etkinliðini sýnýrlamýþtýr. Son yýllarda tükürük bezi sitopatolojisini raporlamak için oluþturulan Milan sistemi (MS) dünya çapýnda kullanýlmaktadýr. Çalýþmamýzda tükürük bezi tümörlerinin MS öncesi ikili benign/malign sýnýflamasýna göre incelenen ÝÝAS sonuçlarýnýn etkinliðini ve doðruluðunu araþtýrmayý amaçladýk.
Yöntem: Ocak 2011-Aralýk 2020 tarihleri arasýnda majör tükürük bezi tümörü nedeniyle ameliyat edilen hastalar retrospektif olarak tarandý. Çalýþmaya 204 hasta dahil edildi. Preoperatif ÝÝAS sonuçlarý ve nihai histopatolojik tanýlar benign ve malign olarak gruplandýrýldý. Nihai histopatolojik tanýlar, preoperatif ÝÝAS sonuçlarý ile karþýlaþtýrýldý ve preoperatif ÝÝAS sonuçlarýnýn duyarlýlýðý, özgüllüðü, doðruluðu ve her iki test arasýndaki uyum araþtýrýldý.
Bulgular: Malignite tanýsý için preoperatif ÝÝAS’nin duyarlýlýðý %59,09, özgüllüðü %97,85, doðruluðu %93,75, pozitif prediktif deðeri %76,47 ve negatif prediktif deðeri %95,29 idi. Preoperatif ÝÝAS sonuçlarý ile nihai histopatolojik taný arasýnda orta derecede bir uyum vardý.
Sonuç: Preoperatif ÝÝAS’nin doðruluðu ve malignite riski hakkýnda verdiði bilgiler hasta yönetimi ve karar vermede en önemli kriterlerdir. Ýkili bir “evet/hayýr” sisteminden ziyade altý katmanlý bir sýnýflandýrmadan oluþan MS, ÝÝAS’nin etkinliðini ve doðruluðunu artýrarak hasta yönetimine ve karar vermeye katkýda bulunabilir.

Objective: The role of fine-needle aspiration cytology (FNAC) is well established for preoperative evaluation of patients with salivary gland lesions. However, the lack of a uniform system for salivary gland FNAC has limited its effectiveness. In recent years, the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) has been in use around the world to report the cytology results. We aimed to investigate the efficacy and accuracy of FNAC examined according to pre-MSRSGC era dichotomous benign/malignant classification in salivary gland tumors.
Methods: Patients who underwent surgery between January 2011 and December 2020 due to major salivary gland tumors were retrospectively analyzed. Two hundred and four patients were included in the analysis. Preoperative FNAC results and final histopatological diagnoses were grouped as benign or malignant. Final histopatological diagnoses were compared with the preoperative FNAC results. Also, sensitivity, specificity, and accuracy of the preoperative FNAC results, as well as the agreement between both tests were investigated.
Results: The sensitivity, specificity, accuracy, positive and negative predictive values of the preoperative FNAC for the diagnosis of malignancy were 59.09%, 97.85%, 93.75%, 76.47%, and 95.29%, respectively. There was a moderate agreement between the preoperative FNAC results and final histopatological diagnoses.
Conclusion: The accuracy of the preoperative FNAC and the information given about malignancy risk are the most important criteria for patient management and decision-making. The MSRSGC, which consists of a six-tiered classification rather than a dichotomous “yes/no” system, may contribute to patient management and decision-making by increasing the efficacy and accuracy of FNAC.

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Amaç: Bu araþtýrma, Koronavirüs hastalýðý 2019 (KOVID-19) hastalarýnda nötrofil/lenfosit ve platelet (N/LP) oranýnýn yoðun bakým ünitesine (YBÜ) kabul riskini, mekanik ventilasyon ihtiyacýný ve hastane içi mortaliteyi tahmin etmek için kullanýlýp kullanýlamayacaðýný deðerlendirmeyi amaçlamýþtýr.
Yöntem: Çalýþma, yoðun bakým ünitesine yatýrýlan 134 KOVID-19 hastasýnýn verileri üzerinden geriye dönük olarak yapýldý. N/LP oraný þu þekilde hesaplandý: nötrofil sayýsý x 100/(lenfosit sayýsý x platelet sayýsý). Araþtýrma grubunun her bir üyesi, hayatta kalma durumlarýna göre (hayatta kalan ve hayatta kalmayan gruplar) 2 gruptan 1’ine ayrýlmýþtýr.
Bulgular: Toplamda 82 (%61) hasta yoðun bakýmda kalýþ sýrasýnda öldü. Yoðun bakým ünitesinde mekanik ventilasyona ihtiyaç duyan ve ölen hastalarýn N/LP oraný, gerektirmeyen ve hayatta kalanlara göre anlamlý olarak daha yüksekti [10 (IQR=4,94-19,38) vs. 2,51 (IQR=1,67-5,49), p<0,001] ve sýrasýyla [11,27 (IQR=4,53-30.02) vs. 1.65 (IQR=1-3,24), p<0,001]. N/LP oraný, çok deðiþkenli analize göre mekanik ventilasyon gereksinimi ve hastane içi ölümle baðlantýlýydý. Alýcý iþletim karakteristik eðrisi analizinde, yoðun bakým ünitesine kabulü öngörmede N/LP’nin %61 duyarlýlýk ve %62 özgüllük ile >4,18, mekanik ventilasyon ihtiyacý için %74 duyarlýlýk ve %73 özgüllük ile >5.07, hastane içi ölümü öngörmede %81 duyarlýlýk ve %81 özgüllük ile >3,69 olduðunu bulduk.
Sonuç: Bildiðimiz kadarýyla bu, yeni ve yaygýn olarak uygulanabilir bir enflamatuvar indeks olan N/LP oranýnýn KOVID-19 hastalarýnda yoðun bakýma yatýþ, mekanik ventilasyon ve hastane içi ölüm riskini tahmin etmek için kullanýlabileceðini gösteren ilk çalýþmadýr.

Objective: This research aimed to evaluate whether the neutrophil to lymphocyte and platelet (N/LP) ratio may be used to predict the risk of admission to the intensive care unit (ICU), the need for mechanical ventilation and in-hospital mortality in Coronavirus disease 2019 (COVID-19) cases.
Methods: The study was conducted retrospectively on the data of 134 COVID-19 patients who were admitted to the ICU. The N/LP ratio was calculated as follows: neutrophil count x 100 / (lymphocyte count x platelet count). Each member of the research cohort was categorised into 1 of 2 groups based on their survival status (survivor and non-survivor groups).
Results: In total, 82 (61%) patients died during the ICU stay. Patients who required mechanical ventilation and died in the ICU stay had significantly higher N/LP ratio than those who did not require it and survived [10 (IQR=4.94-19.38) vs 2.51 (IQR=1.67-5.49), p<0.001] and [11.27 (IQR=4.53-30.02) vs 1.65 (IQR=1-3.24), p<0.001], respectively. The N/LP ratio was linked with the requirement of mechanical ventilation and in-hospital death according to multivariable analysis. In receiver operating characteristic curve analysis, we found that N/LP in predicting admission to the ICU was >4.18 with 61% sensitivity and 62% specificity, it was >5.07 with 74% sensitivity and 73% specificity for the need for mechanical ventilation, and >3.69 with 81% sensitivity and 81% specificity to predict in-hospital death.
Conclusion: To our knowledge, this is the first study showing that the N/LP ratio, which is a novel and widely applicable inflammatory index, may be used to predict the risk of ICU admission, mechanical ventilation and in-hospital death in patients with COVID-19 disease.

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Tegmen kusurlarý esas olarak kolesteatom ve iyatrojenik travmaya baðlý olarak ortaya çýkar ve ilgili kusurlara müdahale hala tartýþma konusudur. Bu çalýþmada mastoidektomi ameliyatlarý sýrasýnda ortaya çýkan tegmen defektlerinin yönetimi ile ilgili klinik deneyimimizi tartýþmayý amaçladýk.
Yöntem: Bu çalýþma retrospektif bir dosya inceleme çalýþmasý olarak tasarlandý ve 2007-2017 yýllarý arasýnda ameliyat edilen hastalar dahil edildi. Defektin nedenleri, onarým teknikleri ve uzun süreli takip sonuçlarý deðerlendirildi. Radyolojik çalýþmalardan elde edilen perioperatif ve postoperatif defekt boyutlarý incelendi.
Bulgular: Toplam tegmen defekti olan hasta sayýsý 62 olup defekt etiyolojisi sýrasýyla 31’inde (%50) kolesteatom, 29’unda (%46,7) iyatrojenik ve 2’sinde (%3,3) kronik enfeksiyon olarak izlendi. Ýntakt kanal duvarý tekniðinde tegmen defekti sayýsý daha fazlaydý. Tüm tegmen defektleri farklý materyallerle onarýldý ve herhangi bir komplikasyon tespit edilmedi. Postoperatif radyolojik görüntülerden elde edilen veriler, ilgili perioperatif defektlerin anlamlý olarak azaldýðýný ortaya koydu (p<0,001).
Sonuç: Postoperatif dönem takiplerinde perioperatif kemik defektlerinin önemli ölçüde azaldýðý izlendi. Kusurun erken tespiti ve uygun müdahaleler bu sorunun uzun vadede herhangi bir komplikasyon olmaksýzýn yönetilmesine yardýmcý olabilir.

Objective: Tegmen defects occur mainly due to cholesteatoma and iatrogenic trauma, and the intervention for the related defects is still a debate. In this study, we aimed to discuss our clinical experience on the management of the tegmen defects which were revealed during the mastoidectomy surgeries.
Methods: This study was designed as a retrospective chart review study and patients who were operated between 2007-2017 were included. The causes of the defects, repair technics, and results of the long-term follow up were evaluated. The perioperative and postoperative defect sizes which were obtained from the radiological studies were analyzed.
Results: Total number of 62 patients had tegmen defects, and their etiologic factors were cholesteatoma in 31 (50%), iatrogenic factors in 29 (46.7%), and chronic infection in 2 (3.3%) patients. The number of the tegmen defects was higher in intact canal wall technic. All of the tegmen defects were repaired with different materials, and no complication was detected. The obtained data from the postoperative radiological images revealed that the related perioperative defects were significantly decreased (p<0.001).
Conclusion: The perioperative bone defects were observedly decreased significantly in postoperative period. Early detection of the defect and appropriate interventions may help to manage this problem without any complication in the long term.

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Amaç: Bakýrlý rahim içi araç (Cu-RÝA) yerleþtirilmesi sýrasýnda oluþan aðrý korkusu, hastalarýn bu son derece etkili doðum kontrol yöntemini reddetmesine neden olabilir. Bu çalýþmanýn amacý, menstrüasyon sýrasýnda farklý zaman dilimlerinde RÝA yerleþtirme ile iliþkili aðrý skorlarýný ve iþlem kolaylýðý araþtýrmaktý.
Yöntem: Bu prospektif kohort çalýþmada, menstrüasyonun üç farklý zaman diliminde olmak üzere uygun kadýnlara RÝA yerleþtirildi. Grup I menstrüasyonun 0,5-0,69’lik zaman diliminde (n=53), Grup II menstrüasyonun 0,7 to 0,89’lik zaman diliminde (n=67) ve Grup III ise menstrüasyonun 0,9 to 1’lik (n=72) zaman diliminde RÝA yerleþtirilen katýlýmcýlardan oluþtu. Menstrüasyon sýrasýndaki zaman dilimleri her katýlýmcý için, RÝA’nýn yerleþtirildiði menses gününün toplam menses günlerine bölünmesi ile hesaplandý. Farklý RÝA yerleþtirme aþamalarýnda ve RÝA yerleþtirildikten 5 dakika sonrasýnda hissedilen aðrý skoru Wong-Baker FACES Aðrý Derecelendirme Ölçeði kullanýlarak ölçüldü. Ýþlem kolaylýðý gruplar arasýnda karþýlaþtýrýldý.
Bulgular: Yaþ (p=0,011) ve son doðum üzerinden geçen süre (p=0,017) ile iliþkili olarak gruplar arasýnda anlamlý fark saptandý. Potansiyel etki edici faktörler dýþlandýktan sonra, ortalama WBS skoru ve RÝA yerleþtirme kolaylýðý, gruplar arasýnda sýrasýyla istatistiksel olarak anlamlý farklý deðildi (p=0,664, p=0,149). En aðrýlý etabýn histerometri yerleþtirilmesi olduðu gözlendi (median, 4 [interquartile range {IQR},2]). Katýlýmcýlarýn WBS puanlarý, RÝA yerleþtirme kolaylýðý ve temel karakteristik özellikleri arasýnda anlamlý bir iliþki gözlenmedi.
Sonuç: RÝA yerleþtirme sýrasýnda en aðrýlý etabýn histerometri yerleþtirilmesi olduðu gözlendi. Menstrüasyonun ikinci yarýsýnda farklý zaman dilimlerinde RÝA yerleþtirilmesinin aðrý ve iþlem kolaylýðý bakýmýndan farklý olmadýðý görünmektedir.

Objective: Fear of pain during the copper intrauterine device (Cu-IUD) insertion may lead patients to reject this highly effective birth control method. The aim of this study was to investigate the pain scores associated with IUD insertion and the ease of procedure at different times during menstruation.
Method: In this prospective cohort trial, eligible women received IUD at three-time segments of menstruation: Group I, at 0.5 to 0.69-time segment (n=53); Group II, at 0.7 to 0.89-time segment (n=67); and Group III, at 0.9 to 1-time segment (n=72). The time segments during menstruation were calculated for each participant by dividing the menstrual cycle day of IUD insertion to total number of menses days. The score of pain experienced at different steps of IUD insertion during and five min. after the procedure measured by Wong-Baker FACES Pain Rating Scale (WBS) and the ease of insertion were compared among groups.
Results: There were significant differences in age (p=0.011) and time since the last delivery (p=0.017). After adjusting for potential confounding factors, the mean WBS score and the ease of insertion were not statistically significant among groups, respectively (p=0.664 and p=0.149). The most painful step was observed as uterine sounding (median, 4 [interquartile range {IQR}, 2]). No significant correlation was observed between WBS scores, the ease of insertion, and main characteristics of the participants.
Conclusion: The most painful step of IUD insertion was observed as uterine sounding. IUD insertion-related pain and the ease of procedure do not appear to be different at any time in the second half of menstruation.

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Alpha thalassemia (α-thalassemia) is an autosomal recessive disorder due to the reduction or absence of α globin chain production. Laboratory diagnosis of α-thalassemia requires molecular analysis for the confirmatory diagnosis. A screening test, comprising complete blood count, blood smear and hemoglobin quantification by high performance liquid chromatography and capillary electrophoresis, may not possibly detect all the thalassemia diseases. This review focused on the molecular techniques used to detect α-thalassemia, and the advantages and disadvantages of each technique were highlighted. Multiplex gap-polymerase chain reaction, single-tube multiplex polymerase chain reaction, multiplex ligation-dependent probe amplification, and loop-mediated isothermal amplification were used to detect common deletion of α-thalassemia. Furthermore, the reverse dot blot analysis and a single tube multiplex polymerase chain reaction could detect non-deletion mutation of the α-globin gene. Sanger sequencing is widely used to detect non-deletion mutations of α-thalassemia. Recently, next-generation sequencing was introduced in the diagnosis of both deletion and point mutations of α-thalassemia. Despite the advantages and disadvantages of different techniques, the routine method employed in the laboratory should be based on the facility, expertise, available equipment, and economic conditions.

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Ceruminous adenoma is described as a glandular neoplasm of ceruminous glands. It is seen for less than one percent of all external ear tumours. Ceruminous adenoma cases were reported to have recurrence and residual tumour, however there was no malignant transformation known in ceruminous adenoma up to this date. Here, we report a young adult woman with two years history of progressive reduced hearing and tinnitus of the right ear. She was proven to have right moderate conductive hearing loss with pure tone audiometry. There was a cystic mass with serous content arising from the posterior wall of the right ear canal. We proceeded with wide local excision of the mass via trans-canal approach. Ceruminous adenoma was confirmed with histopathology and immunohistochemistry of CK7 staining. The hearing impairment was resolved completely post excision and there was no recurrence of the tumour on one year follow-up. We concluded wide local excision with appropriate margin of the mass is adequate to prevent recurrence in ceruminous adenoma cases.

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Strese neden olan ya da örseleyici yaþam olaylarý duygudurum dönemlerinin ortaya çýkmasýna neden olabilir. Göç, taþýnma, yer deðiþtirme, iþini kaybetme, iflas, ekonomik kayýp, boþanma, doðal afetler, kaza sonucu yaralanma ya da yakýnýný kaybetme gibi olaylar bipolar bozukluðun ilk hastalýk dönemini tetikleyebilir. Bu tür yaþam olaylarýndan sonra genellikle depresif dönem belirtileri ortaya çýkar. Cenaze manisi ise, yakýn bir aile üyesinin ölümünü takiben kiþide mani dönemi belirtilerinin ortaya çýkmasý olarak tanýmlanmýþtýr. Sevilen kiþinin kaybýndan çok kýsa bir süre sonra ortaya çýkan cenaze manisi ile ilgili bilgiler kýsýtlýdýr. Konu ile ilgili az sayýda olgu bildirimi mevcuttur. Bu çalýþmada babasýnýn ölümü sonrasý ilk kez mani dönemi belirtileri ile baþvuran, öncesinde herhangi bir psikiyatrik hastalýk ve tedavi görme öyküsü olmayan 26 yaþýndaki kadýn hasta literatür bulgularý eþliðinde sunulmuþtur. DSM-5 taný ölçütlerine göre bipolar bozukluk (mani dönemi) tanýsý ile izlenen hastanýn duygudurum dönemi belirtileri ile babasýnýn ölümü arasýndaki zamansal yakýnlýk olmasý ve önceki örseleyici yaþam olaylarýna bu þekilde bir tepki geliþtirmemiþ olmasý dikkat çekicidir. Bu nedenle olgunun tanýsý cenaze manisi olarak deðerlendirilmiþtir. Olasý yas tepkileri arasýnda nadir de olsa mani dönemi belirtilerinin görülebileceði unutulmamalýdýr.

Stressful or traumatic life events can lead to emergence of mood episodes. Events such as migration, relocation, job loss, bankruptcy, economic loss, divorce, natural disasters, accidental injury, or the loss of a loved one can trigger the first episode of bipolar disorder. After such life events, symptoms of depressive episodes often appear. Funeral mania, on the other hand, is defined as the emergence of manic episodes following the death of a close family member. Information on funeral mania, which occurs shortly after the loss of a loved one, is limited with a few case reports. In this study, a 26-year-old female patient who presented with the symptoms of a manic episode for the first time after her father’s death and who had no previous psychiatric disease or treatment history was presented in the light of findings in the literature. It is noteworthy that the patient, who was followed up with the diagnosis of bipolar disorder (mania period) according to DSM-5 diagnostic criteria, had a temporal closeness between her mood symptoms and her father’s death, and had not developed such a reaction to previous traumatic life events. Therefore, the diagnosis was evaluated as funeral mania. It should be kept in mind that, although rare, symptoms of mania can be seen among possible grief reactions.

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IgG4-related disease (IgG4-RD) is a fibro-inflammatory condition associated with tumefactive lesions at multiple sites. IgG4-RD was initially recognized in 2001 in a case of autoimmune pancreatitis. However, the disease was not limited to the pancreas but involved other organs such as the bile ducts, lacrimal glands, lymph nodes and salivary glands. IgG4-RD is rarely seen with an estimated incidence of 0.2 to 1/100.000 as reported in Japan, but with minimal to no incidence data have been published in Western countries. We hereby report a case of an IgG4-related mass arising from the nasolacrimal duct, masquerading as a sinonasal mass.

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