Amaç: Bu çalýþma, persistan metopik sütür (PMS) ile olfaktör fossa derinliði (OFD), ve frontal sinüs volümü (FSV) arasýndaki iliþkiyi araþtýrmayý amaçlamaktadýr. Yöntemler: Yaþlarý 18-65 arasýnda deðiþen 1.603 hastanýn tomografileri PMS varlýðý açýsýndan deðerlendirildi. Yetmiþ dört PMS olgusu ve 74 kontrol çalýþmaya dahil edildi. Her bireyin frontal sinüs görünümü aplazi, hipoplazi veya normal olarak sýnýflandýrýldý. Lateral lamella uzunluðu (LLU), OFD ve FSV ölçümleri iki gözlemci tarafýndan baðýmsýz olarak yapýldý. Gözlemciler arasý uyum deðerlendirilirken, sürekli deðiþkenler için sýnýf içi korelasyon katsayýsý (ICC) ve Cohen’s kappa katsayýsý (κ) kullanýldý. Bulgular: PMS prevalansý %4,99 [güven aralýðý (GA) %95: 4,03-6,17] olarak bulundu. Hipoplazi/aplazi, PMS grubunda kontrol grubuna göre beþ kat daha fazlaydý (sýrasýyla %52,70; GA %95: 41,48-63,66 ve %10,81; GA %95: 5,58-19,91, p<0,001). Frontal sinüs görünüm sýnýflandýrmasý için gözlemciler arasýnda “mükemmel” bir uyum tespit edildi: κ=0,807, p<0,001. OFD, LLU ve FSV için ICC “mükemmel” güvenilirlik sundu: Her biri için sýrasýyla 0,956, 0,958 ve 0,981 ve p<0,001. PMS grubunda, LLU daha kýsaydý, OFD daha sýðdý ve FSV, kontrol grubuna göre daha küçüktü (her biri için p<0,001). OFD, LLU ve FSV arasýnda orta derecede pozitif korelasyon vardý (r=0,306, r=0,302). Sonuçlar: Bu çalýþmanýn sonucunda, PMS’nin frontal sinüs geliþimi ve volümü ile iliþkili olduðu bulunmuþtur. PMS varlýðýnda daha küçük bir FS, daha kýsa lateral lamella ve daha az derin olfaktör fossa beklenebilir.

Objective: This study aims to investigate the relationship of the persistence of metopic suture (PMS), frontal sinus volume (FSV), and olfactory fossa depth (OFD).
Methods: Tomography scans of 1,603 patients aged 18-65 years were evaluated for the presence of PMS. In the study, 74 PMS cases and 74 controls were included. The appearance of each individual’s frontal sinus was classified as aplasia, hypoplasia, or normal. Two observers independently measured the lateral lamella length (LLL), OFD, and FSV. Interobserver agreement was evaluated with the intraclass correlation coefficient (ICC) and Cohen’s kappa coefficient (κ).
Results: The prevalence of PMS was found to be 4.99% [95% confidence interval (CI): 4.03-6.17]. The PMS group had five times higher hypoplasia/aplasia than the controls (52.70%, 95% CI: 41.48-63.66 and 10.81%, 95% CI: 5.58-19.91, respectively; p<0.001). An “almost perfect” agreement was detected among observers for the frontal sinus appearance classification: κ=0.807, p<0.001. The ICC of continuous measurements for OFD, LLL, and FSV, respectively, presented “excellent” reliability: 0.956, 0.958, and 0.981, with p<0.001 for each. LLL was shorter, OFD was shallower, and FSV was smaller in the PMS group than the control group (p<0.001). There was a moderate positive correlation between OFD, LLL, and FSV (r=0.306, r=0.302).
Conclusions: This study interprets that the presence of PMS is related frontal sinus development and volume. With PMS, a smaller FS, shorter lateral lamella, and shallower olfactory fossa may be expected.

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Amaç: Bu çalýþmanýn amacý, farklý antropometrik ve vücut kompozisyonu ölçümlerini [aðýrlýk, vücut kitle indeksi (VKÝ), vücut yað yüzdesi (%yað), iskelet kasý indeksi (ÝKÝ), vücut þekil indeksi (VÞÝ), bel çevresi (BÇ) ve kalça çevresi (KÇ)] ölçmek ve bu ölçümlerin kemik mineral yoðunluðu ile iliþkisini araþtýrmaktýr.
Yöntemler: Bu çalýþma, 2018-2019 yýllarý arasýnda geriatri polikliniðine baþvuran 482 hastanýn dahil edildiði kesitsel bir çalýþmadýr. Hastalarýn kemik mineral yoðunluklarý dual-enerji X-ýþýný absorbsiyometri ile deðerlendirildi. Biyoimpedans analiz sistemi ile antropometrik deðerlendirmeler ve ölçümler (KÇ, BÇ, aðýrlýk, VKÝ, VÞÝ) ve vücut kompozisyon analizi (%yað, ÝKÝ) yapýldý. Hastalar aerobik egzersiz alýþkanlýklarý açýsýndan Fiziksel Etkinliklerin Hýzlý Deðerlendirilme Ölçeði aerobik bölümü ile deðerlendirildi.
Bulgular: Lomber omurga (LO) T-skoru ile ÝKÝ (r=0,36, p=0,000) arasýnda ve lomber T-skoru ile aðýrlýk (r=0,21, p=0,000), VKÝ (r=0,10, p=0,045) ve BÇ (r=0,15, p=0,001) arasýnda istatistiksel olarak anlamlý iliþki vardý. Femur boynu (FB) T-skoru ile %yað (r=0,15, p=0,001), ÝKÝ (r=0,15, p=0,010), aðýrlýk (r=0,22, p=0,000), VKÝ (r=0,20, p=0,000), BÇ (r=0,14, p=0,003) ve KÇ (r=0,17, p=0,001) arasýnda istatistiksel olarak anlamlý korelasyon vardý. Fiziksel aktivite ile LO T-skoru (n=353, r=0,08, p=0,16) ve FB T-skoru (n=360, r=0,03, p=0,53) arasýnda istatistiksel olarak anlamlý bir iliþki yoktu. Çoklu regresyon analizinde ÝKÝ, FB ve LO T-skorlarýný tahmin etmeye en çok katkýda bulunan deðiþken olarak saptandý.
Sonuçlar: Geriatrik popülasyonda antropometrik ölçümler dikkatli seçilmelidir. Ölçümler arasýnda en güçlü iliþki LO T-skoru ve ÝKÝ arasýnda saptanmýþtýr.

Objective: This study aimed to evaluate different anthropometric and body composition measurements, including weight, body mass index (BMI), body fat percentage (fat%), skeletal muscle index (SMI), a body shape index (ABSI), waist circumference (WC), and hip circumference (HC), in relation to bone mineral density.
Methods: This is a cross-sectional study of a total of 482 patients who consulted the geriatric outpatient clinic between 2018 and 2019. Patients were evaluated with dual-energy X-ray absorptiometry. Anthropometric measurements (HC, WC, weight, BMI, and ABSI), as well as body composition analysis (fat% and SMI) by bioimpedance analysis system, were performed. The patients were evaluated with the rapid Assessment of Physical Activity Index in terms of aerobic exercise habits.
Results: There was a significant correlation between lumbar spine (LS) T-score and SMI (r=0.36, p=0.000) and between LS T-score and weight (r=0.21, p=0.000), BMI (r=0.10, p=0.045) and WC (r=0.15, p=0.001). There was a statistically significant correlation between femur neck (FN) T-score and fat% (r=0.15, p=0.001), SMI (r=0.15, p=0.010), weight (r=0.22, p=0.000), BMI (r=0.20, p=0.000), WC (r=0.14, p=0.003), and HC (r=0.17, p=0.001). There was no statistically significant correlation between physical activity and LS T-score (n=353, r=0.08, p=0.16) and FN T-score (n=360, r=0.03, p=0.53). In multiple regression analysis, SMI contributes most in predicting FN and LS T-scores.
Conclusions: Anthropometric measurements should be carefully selected in the geriatric population. Among the measurements, the strongest relationship was found between LS T-score and SMI.

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Amaç: Tinnitus, herhangi bir dýþ uyaran olmaksýzýn algýlanan ses olarak tanýmlanýr ve yaygýn bir sorundur, ancak mekanizmasý tam olarak anlaþýlamamýþtýr. Bu çalýþmada tinnituslu hastalarda predispozan faktör olabilecek çocukluk çaðý travmalarý ve dissosiyatif yaþantýlarýn deðerlendirilmesi amaçlanmýþtýr.
Yöntemler: Çalýþmaya Kasým 2018-Þubat 2019 tarihleri arasýnda kulak burun boðaz polikliniðine baþvuran ve subjektif tinnitus tanýsý konulan 18 yaþ üstü 90 gönüllü (tinnituslu 45 hasta ve kontrol grubunda 45 hasta) dahil edildi. Hastalarý deðerlendirmek için kiþisel bilgi formu, çocukluk çaðý travmasý, hastane anksiyetesi ve depresyonu ve dissosiyatif yaþantýlar ölçekleri kullanýldý.
Bulgular: Katýlýmcýlarýn %55,60’ý erkek, %28,90’ý 20-30 yaþ aralýðýnda, %71,10’u evli, %40’ý ilkokul mezunu ve %68,90’ý çalýþmaktadýr. Hastalarýn %77,78’inin psikiyatriste gitmediði ve %75,56’sýnýn herhangi bir kronik hastalýðý olmadýðý belirlendi. Tinnituslu hastalarýn Çocukluk Çaðý Travma Ölçeði toplam puaný 54,37±10,17, Hastane Anksiyete ve Depresyon Ölçeði puaný 12,22±5,41, hastane anksiyete puaný 10,54±3,5 ve Dissosiyatif Yaþantýlar puaný 13,48±4,68 olduðu tespit edildi. Tinnitus olgularýnýn çocukluk çaðý travmalarý, depresif belirtileri ve dissosiyatif yaþantýlarý arasýnda pozitif yönde istatistiksel olarak anlamlý iliþki bulundu (p<0,05).
Sonuçlar: Tinnitus olgularýnýn çocukluk çaðý travmalarý ile dissosiyatif yaþantýlarý arasýnda pozitif bir iliþki bulunmuþtur ki bu durum tinnituslu hastalarda predispozan faktör olarak kabul edilebilir. Tinnituslu hastalar çocukluk çaðý travmasý açýsýndan araþtýrýlmalý ve tedaviye multidisipliner yaklaþýlmalýdýr.

Objective: Tinnitus is described as the perceived sound without any external stimulus and is a common problem, but its mechanism is not fully understood. This study aimed to evaluate childhood traumas and dissociative experiences, which may be predisposing factors in patients with tinnitus.
Methods: The study included 90 voluntary patients (45 patients with tinnitus and 45 in the control group) aged older than 18 years who applied to the otorhinolaryngology clinic between November 2018 and February 2019 and were diagnosed with subjective tinnitus. A personal information form together with childhood trauma, hospital anxiety and depression, and dissociative experiences scales were used to assess the patients.
Results: Of all participants, 55.60% were males, 28.90% were 20-30 years old, 71.10% were married, 40% were primary school graduates, and 68.90% were employed. In addition, 77.78% of patients did not visit a psychiatrist and 75.56% did not have any chronic diseases. The mean total score of Childhood Trauma Scale for the tinnitus group was 54.37±10.17, the mean total score of The Hospital Anxiety and Depression Scale for the tinnitus group in the depression subscale was 12.22±5.41 and in the anxiety subscale was 10.54±3.5, and Dissociative Experiences was 13.48±4.68. A positive significant relationship was found between the childhood traumas of the tinnitus cases in their depressive symptoms, and dissociative experiences (p<0.05).
Conclusions: The study results found a positive relationship between the childhood traumas and dissociative experiences of tinnitus cases, which can be considered as predisposing factors in patients with tinnitus who should also be investigated for childhood trauma, and the treatment approach should be multidisciplinary.

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Amaç: Çalýþmamýzda histolojik olarak düþük ve yüksek derecenin bir arada olduðu karma dereceli tümörlerin onkolojik sonuçlarýnýn saf düþük dereceli ve yüksek dereceli tümörler ile karþýlaþtýrýlmasý amaçlandý.
Yöntemler: Primer kasa invaze olmayan mesane kanserli hastalarýn týbbi kayýtlarýný geriye dönük olarak inceledik. Hastalar histolojik dereceye göre düþük, karma ve yüksek dereceli olmak üzere üç gruba ayrýldý. Üç grubun nükssüz saðkalým (NS), progresyonsuz saðkalým (PS) ve kansere özgü saðkalým (KSS) gibi onkolojik sonuçlarý ve klinikopatolojik özellikleri karþýlaþtýrýldý.
Bulgular: Ortalama 55,94±41,73 aylýk takipte toplam 369 hasta (190 düþük, 40 karma ve 139 yüksek dereceli) çalýþmamýza dahil edildi. pT1 evre hastalýk oraný; karma dereceli tümörü olan hastalarda yüksek dereceli tümörlere göre daha düþük oranda (sýrasýyla %42,5 ve %64,0) ve düþük dereceli tümörlere göre daha yüksek oranda (sýrasýyla %42,5 ve %14,7) gözlendi (p=0,001). Düþük, karma ve yüksek dereceli hastalar arasýnda NS açýsýndan istatistiksel olarak anlamlý bir fark yoktu (p=0,887). Karma dereceli tümörü olan hastalar, düþük dereceli tümörlere göre daha kötü PS ve KSS’ye sahipken (sýrasýyla PS için 199,84±23,22'ye karþý 214,94±15,92 ve KSS için 202,07±19,86’ya karþý 233,61±9,84) yüksek dereceli tümörlere göre daha iyi PS ve KSS sonuçlarýna sahipti (sýrasýyla PS için 199,84±23,22’ye karþý 163,28±16,18 ve KSS için 202,07±19,86’ya karþý 180,81±15,89). Ancak bu karþýlaþtýrmalar istatistiksel olarak anlamlý deðildi.
Sonuçlar: Karma dereceli tümörü olan hastalarda, düþük dereceli tümörlere göre daha kötü PS ve KSS saptanýrken, yüksek dereceli tümörlere göre daha iyi PS ve KSS saptandý. Ancak bu karþýlaþtýrmalar istatistiksel olarak anlamlý deðildi. Sonuçlarýmýz gelecek çalýþmalarla doðrulanmalýdýr.

Objective: This study aimed to determine the oncological outcomes of mixed-grade tumors by comparing them with pure low-grade and high-grade tumors.
Methods: We retrospectively reviewed the medical records of patients with primary non-muscle-invasive bladder cancer. Patients were categorized into three groups according to the histological grade of their tumors: low-grade, mixed-grade, and high-grade. Clinicopathological characteristics and oncological outcomes, such as recurrence-free survival (RFS), progression-free survival (PFS), and cancer-specific survival (CSS), were compared between the three groups.
Results: A total of 369 patients (190 low, 40 mixed, and 139 high-grade) were included in our study, with a mean follow-up of 55.94±41.73 months. Patients with mixed-grade tumors had lower rates of pT1 stage diseases than those with high-grade tumors (42.5% vs. 64.0%, respectively) and higher rates than those with low-grade tumors (14.7% vs. 42.5%, respectively) (p=0.001). There was no significant difference in RFS between low-, mixed-, and high-grade tumor patients (p=0.887). Patients with mixed-grade tumors had worse PFS and CSS outcomes than those with low-grade tumors (199.84±23.22 vs. 214.94±15.92 for PFS and 202.07±19.86 vs. 233.61±9.84 for CSS, respectively) and better PFS and CSS outcomes than those with highgrade tumors (199.84±23.22 vs. 163.28±16.18 for PFS and 202.07±19.86 vs. 180.81±15.89 for CSS, respectively), although these comparisons were not statistically significant.
Conclusions: Patients with mixed-grade tumors had worse PFS and CSS outcomes than patients with low-grade tumors and better PFS and CSS outcomes than patients with high-grade tumors, although these comparisons were not statistically significant. Our results should be verified by future studies.

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Amaç: Enflamasyon, kalp cerrahisi olan hastalarda postoperatif atriyal fibrilasyon (PoAF) baþlangýcýnda önemli bir rol oynadýðýndan, bu çalýþma bu tür hastalarda PoAF geliþimi için sistemik immün enflamasyon indeksinin (SII) öngörücü deðerini araþtýrmayý amaçladý.
Yöntemler: Toplamda, izole bir koroner arter baypas greft (KABG) uygulanan 391 ardýþýk hasta geriye dönük olarak analiz edildi. PoAF mevcut kýlavuza göre tanýmlanmýþtýr. SII nötrofil (N) x trombosit (T) ÷ lenfosit (L) formülü kullanýlarak belirlendi.
Bulgular: Bu çalýþmada PoAF insidansý %24’tür (n=97 olgu). Çok deðiþkenli lojistik regresyon analizi, SII’nin PoAF’nin baðýmsýz bir öngörücüsü olduðunu ortaya çýkarmýþtýr [olasýlýk oraný: %95 güven aralýðý: 1,002 (1,001- 1,002), p<0,01]. PoAF tespitinde SII’nin optimal deðeri, alýcý iþletim karakteristik eðri deðerlendirmesi ile belirlendi ve SII’nin ideal deðeri %60,8 duyarlýlýk ve %80,9 özgüllük [eðri altý alaný (EAA): 0,7107] ile 807,8’den büyük olarak belirlendi. PoAF’nin tespitinde SII’nin EAA, nötrofil/lenfosit oranýnýn (NLO) veya trombosit/lenfosit oranýnýn (TLO) (sýrasýyla EAA: 0,6740 ve EAA: 0,6426) EAA’sýndan daha yüksekti.
Sonuçlar: Bu araþtýrmada, izole KABG nedeniyle ameliyat edilen hastalarda SII’nin PoAF’nin baðýmsýz bir öngörücüsü olduðunu gösterdik. Ek olarak SII, bu olgular arasýnda NLO veya TLO’ya kýyasla PoAF için daha iyi ayýrt etme yeteneðine sahipti.

Objective: Inflammation plays an important role in the initiation of postoperative atrial fibrillation (PoAF) in individuals undergoing cardiac surgery, Thus, this study aimed to investigate the predictive value of the systemic immune inflammation index (SII) to develop PoAF in such patients.
Methods: In total, 391 consecutive patients undergoing an isolated coronary artery bypass grafting (CABG) were retrospectively analyzed. PoAF was defined according to the current guideline. The SII is determined using the following equation: neutrophil (N) × platelet (P) ÷ lymphocyte (L).
Results: The incidence of PoAF in the present study was 24% (n=97 cases). Multivariate logistic regression analysis revealed that the SII was an independent predictor of PoAF (Odds ratio: 1.002 95% confidence interval: (1.001-1.002), p<0.01). The optimal value of the SII in detecting PoAF was established by a receiver operating characteristic curve assessment, and it was >807.8 with 60.8% sensitivity and 80.9% specificity [area under the curve (AUC): 0.7107]. The AUC value of SII in detecting PoAF was much greater than the AUC values of both the neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR) (AUC: 0.6740 and AUC: 0.6426, respectively).
Conclusions: This study revealed that SII was an independent predictor of PoAF in patients who were operated on for isolated CABG. Additionally, SII had a better discriminative ability for PoAF compared to either NLR or PLR among these cases.

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Amaç: Talasemi majör (TM) tanýlý çocuklar büyüme geriliðine ve mikrobesin eksikliklerine yatkýndýrlar. Bu çalýþmada, düzenli transfüzyon uygulanan hastalarda mikro besin seviyelerini, antropometrik ölçümleri, kemik mineralizasyon defektlerini deðerlendirmeyi amaçladýk.
Yöntemler: Laboratuvar testlerini, antropometrik ölçümleri ve kemik mineral yoðunluðunu deðerlendirerek elde edilen verileri analiz ettik.
Bulgular: Çalýþmaya ortalama yaþý 12,26±4,74 yýl, ortalama transfüzyon öncesi hemoglobin 8,64±1,01 g/dL, ortalama serum ferritin 1158,6±556,8 ng/mL olan 29 hasta (%62’si erkek, %38’i kýz) alýndý. En sýk vitamin D (%72,4), selenyum (%72,4) ve folat (%37,9) eksikliði saptandý. Hastalarýn %17,2’de hipokalsemia, %3,5 hipomagnesemi, %10,3 seruloplazmin düþüklüðü saptandý. Folat 2≤ ile <6 yaþ arasýnda, seruloplazmin 6≤ ile <10 yaþ arasýnda daha yüksek saptandý (sýrasýyla p=0,028, p=0,018). Selenyum, ferritin ≥1.500 olan hastalarda anlamlý olarak yüksekti (p=0,008). Diðer mikrobesin düzeylerinde ferritin düzeyi iliþkili anlamlý farklýlýk saptanmadý (p>0,05). Hastalarýn %31’inin vücut kitle indeksi (VKÝ) 5. Persentilin (p) altýndaydý. VKÝ 95. p’nin üzerinde olan hasta saptanmadý. Hastalarýn %24,5’inin boyu, %20,7’sinin vücut aðýrlýðý 3. p’nin altýndaydý. Boy ve vücut aðýrlýðý açýsýndan 97. p’nin üzerinde olan hasta saptanmadý. Antropometrik ölçümlerin, hastalarýn kan mikrobesin ve ferritin düzeyleri ile anlamlý bir iliþkisi saptanmadý. On-18 yaþ arasýndaki hastalarýn VKÝ anlamlý olarak daha yüksek bulundu (p=0,001). Antropometrik ölçümler, ortalama ferritin ve mikrobesin düzeyleri açýsýndan anlamlý farklýlýk göstermedi. Hastalarýn %20,8’de endokrinolojik bozukluklar (hipoparatiroidi %13,8, hipotiroidi %3,5) gözlendi. Hastalarýn %14,8’inde (2 osteopenik, 2 osteoporotik) düþük kemik yoðunluðu saptandý. Kemik mineral yoðunluðunun mikrobesin ve ferritin düzeyleriyle anlamlý iliþkisi saptanmadý.
Sonuçlar: TM hastalarýnda nütrisyonel eksikliklerin önlenmesi ve beslenme desteðinin saðlanmasý kemik mineralizasyon bozukluklarý ve büyüme geriliði gibi komplikasyonlarýn geliþiminin en aza indirilmesi açýsýndan önemlidir.

Objective: Children with thalassemia major (TM) are prone to growth failure and micronutrient deficiency. Thus, this study aimed to evaluate nutritional status, anthropometrics, and bone mineralization defects in patients with regular blood transfusion.
Methods: Data obtained were analyzed by evaluating laboratory tests, anthropometric measures, and bone mineral density.
Results: This study included 29 patients (62% male and 38% female) with a mean age of 12.26±4.74 years, mean pre-transfusion hemoglobin of 8.64±1.01 g/dL, and mean serum ferritin of 1158.6±556.8 ng/ mL. Vitamin D (72.4%), selenium (72.4%), and folate (37.9%) deficiencies were most frequent. Hypocalcemia was observed in 17.2%, hypomagnesemia in 3.5%, and decreased ceruloplasmin in 10.3% of patients. Folate was higher between 2 and 6 years old (p=0.028). Ceruloplasmin was higher between 6 and 10 years old (p=0.018). Selenium was significantly higher in patients with a ferritin of ≥1,500 (p=0.008). No significant ferritin-related differences were found in other micronutrients (p>0.05). Body mass index (BMI) were <5 percentile (p) in 31% of patient, whereas none was >95 p. Height in 24.5% and weight in 20.7% of patients were <3 p, whereas none with >97 p. BMI of patients aged 10-18 years was significantly higher (p=0.001). Anthropometric percentiles did not significantly differ in the mean serum ferritin and micronutrient levels. Hypoparathyroidism was observed in 13.8% and hypothyroidism in 3.5% of patients. Low bone density was detected in 14.8% (2 osteopenic and 2 osteoporotic) of patients. Bone mineral density did not significantly differ in the ferritin and micronutrient levels.
Conclusions: Nutritional support and deficiency prevention are important to minimize the burden of complications and increase the life expectancy and quality in patients with TM.

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Afet týbbý kavramýnýn bilimsel geliþimi dünyada yaklaþýk 50 yýl önce baþlamýþtýr. Halk saðlýðý, acil saðlýk hizmetleri, afet yönetimi, acil týp ve askeri týp gibi farklý disiplinlerin afet týbbý kavramý çerçevesinde çalýþmalar yaptýðý görülmektedir. Afet týbbýnýn amacý, afet riskleri bulunan toplumun kötü saðlýk þartlarýný önlemek ve azaltmak için afet öncesi dönemde afet risk yönetimi ve afet sonrasý dönemde saðlýk hizmetleri ve tesislerini çalýþýr durumda olmasýný saðlamaktýr. Çok disiplinli yapýsý ve halen net bir þekilde alt çalýþma konularýnýn sistematize edilememesi nedeniyle bilimsel ilerlemesi oldukça yavaþ bir þekilde geliþen bir disiplindir. Ancak afet týbbý alanýna yönelik Birleþmiþ Milletler tarafýndan 2015-2030 dönemi için yayýnlanan Sendai Afet Risk Azaltýmý Çerçeve Eylem Planý’nda önemli hedefler bulunmaktadýr. Afet týbbý açýsýndan küresel hedefler arasýnda yer alan ölüm ve yaralanma sayýlarýnýn azaltýlmasý, etkilenen insan sayýsýnýn azaltýlmasý, kritik tesislerin alt yapýlarýnýn güçlendirilmesi ve afetlerde sürdürülebilir bir þekilde fonksiyonlarýna devam edebilmesi yer almaktadýr. Bu hedeflerin gerçekleþtirilebilmesi için kurumsal ve akademik olarak afet týbbýnýn hýzlý bir þekilde geliþmesi beklenmektedir. Afet týbbý disiplini klinik çalýþmalarýn ötesinde bir anlam ifade eden küresel, kitlesel, yönetimsel ve doktrinsel bir disiplindir. Özellikle 2015 yýlýnda küresel olarak belirlenen Sendai Afet Risk Azaltýmý Çerçeve Eylem Planý ile ilk defa afet týbbý eðitiminin geliþtirilmesi ve yaygýnlaþtýrýlmasý vurgulanmaktadýr. 2030 yýlýna gelindiðine afet týbbý disiplinin çok güçlü bir noktaya geleceði görülmektedir.

The scientific advancement of the disaster medicine concept started approximately five decades ago. Different disciplines, such as public health, emergency health services, emergency medicine, and military medicine, work within the disaster medicine framework. Disaster medicine aimed to ensure that health services and facilities are operational both in the pre- and post-disaster periods to prevent and reduce the negative health circumstances of the society facing disaster risks. It is a discipline with slow scientific progress due to unclearly systematized multidisciplinary structure and sub-study areas. However, important targets regarding the field of disaster medicine were indicated in the Sendai Framework for Disaster Risk Reduction 2015-2030 published by the United Nations. Among the global goals of disaster medicine, are to reduce the number of deaths and injuries, reduce the number of affected people, strengthen critical facility infrastructure, and ensure functional sustainably of these facilities during disasters. To achieve these goals, disaster medicine is expected to rapidly develop both institutionally and academically. Disaster medicine is a global, mass, administrative, and doctrinal discipline that means beyond clinical studies. Particularly, the development and dissemination of disaster medicine education were emphasized for the first time with the Sendai Framework for Disaster Risk Reduction, which was determined globally in 2015. The disaster medicine discipline is seen to reach a very strong point by 2030.

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Onkositik papiller kistadenom (OPC), tükürük bezlerinin nispeten nadir görülen iyi huylu bir tümörüdür, sýklýkla minör tükürük bezlerinde ve bazen de parotis bezi gibi majör tükürük bezlerinde görülür. Hastalar ancak þiþliðin ilerlemesiyle semptomatik hale gelir ve þiþliðin konumuna baðlý olarak obstrüktif semptomlara neden olur. Bildiðimiz kadarýyla kanamalý tümör ile baþvuru bildirilmemiþtir. Biz burada, tekrarlayan epistaksis ile baþvuran 54 yaþýndaki erkek hastadaki sað torus tubariusun OPC’sini sunduk.

Oncocytic papillary cystadenoma (OPC) is a relatively rare benign tumor of the salivary glands, frequently seen in minor salivary glands, and occasionally in major salivary glands, such as the parotid gland. Patients only become symptomatic upon progression of the swelling, causing obstructive symptoms depending on its location. To our knowledge, there are no reports of presentation with bleeding tumor. Herein, we report a case of an OPC of the right torus tubarius in a 54-year-old man who presented with recurrent epistaxis.

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Umbilikal endometriozis, genellikle umbilikus içeren laparoskopik veya cerrahi prosedürleri takip eden bir kutanöz endometriozis türüdür. Primer umbilikal endometriozis (PUE) son derece nadir bir durumdur ve PUE ile umblikal herni birlikteliði de ayný derecede nadir bir durumdur. Týp literatüründe bugüne kadar umblikal herni ile iliþkili çok az sayýda primer umblikal endometriozis vakasý bildirilmiþtir. Biz burada, umbilikal nodülün klasik semptomlarý olan ve menstrüasyona baðlý döngüsel aðrý ve kanama ile baþvuran umbilikal herni ile iliþkili bir PUE olgusunu sunuyoruz. Hastamýza, protez að kullanýlarak karýn duvarý defekt onarýmý ile omfalektomi yapýldý. Eksize edilen umblikal nodülün histopatolojik incelemesi ile taný doðrulandý. Bu olgu sunumu umbilikal nodül ile baþvuran üreme çaðýndaki kadýnlarda ayýrýcý taný olarak düþünülmesi gereken nadir bir durumu vurgulamaktadýr.

Umbilical endometriosis is a type of cutaneous endometriosis that usually follows laparoscopic or surgical procedures that involve the umbilicus. Primary umbilical endometriosis (PUE) is an extremely rare condition and its association with an umbilical hernia is an equally rare condition. To date, only very few cases of PUE with umbilical hernia association have been reported in the medical literature. Report herein is a case of PUE associated with an umbilical hernia who presented with classical umbilical nodule symptoms with cyclical pain and bleeding due to menstruation. The patient underwent omphalectomy with abdominal wall defect repair using prosthetic mesh. The diagnosis was confirmed by histopathological examination of the excised umbilical nodule. This case report highlights a rare entity that should be considered as a differential diagnosis in females of the reproductive age group that presents with the umbilical nodule.

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Hepatosit nükleer faktör 1B’yi kodlayan (HNF1B) genindeki mutasyonlar, renal malformasyonlarýn en sýk genetik nedenlerinden biridir. Bu gendeki heterozigot mutasyonlar renal kist ve diyabet sendromu ile iliþkilidir. Hastalar; farklý renal geliþimsel anomaliler ve gençlerde görülen eriþkin tip diyabet ile baþvurabilirler. Bu olgu sunumunda, yenidoðan döneminden itibaren her iki böbrekte kistlerin olmasý ve kronik böbrek hastalýðý nedeniyle takip edilen ve DNA sekanslama yöntemi ile HNF1B iliþkili glomerülokistik hastalýk tanýsý alan on yaþýnda erkek hasta anlatýlmýþtýr. Ayýrýcý tanýda yer alan otozomal dominant polikistik böbrek hastalýðý, genetik analiz ile dýþlanmýþtýr. Aile taramasýnda annenin, kýz kardeþ ve erkek kardeþin ayný mutasyona sahip olduðu gösterilmiþtir. Kistik böbrek hastalýklarýnda genetik inceleme ve danýþmanlýk, sadece erken taný ve tedavi için deðil, ayrýca ailedeki asemptomatik olgularýn da tanýsý için önemlidir.

Mutations in hepatocyte nuclear factor-1 beta (HNF1B) are the most commonly identified genetic cause of renal malformations. Heterozygous mutations are associated with renal cysts and diabetes syndrome. Various renal developmental abnormalities and maturity-onset diabetes of the young could be the presenting factors of these mutations. A 10-year-old boy who was evaluated for bilateral cystic kidneys and chronic kidney disease from the newborn period was diagnosed with HNF1B-related glomerulocystic disease by DNA sequencing. The differential diagnosis of autosomal dominant polycystic kidney disease was a diagnostic pitfall. The genetic screening of the family revealed his mother, sister, and brother to have the same mutation. Therefore, genetic diagnosis and counseling are important for cystic kidney diseases not only for formulating the diagnosis and early management plan but also for the diagnosis of potential asymptomatic cases in the family.

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