INTRODUCTION: Bezoar is the accumulation of indigestible food or material in the gastrointestinal system. Bezoars have different names according to the accumulated material. Phytobezoar is the accumulation of indigestible food, fruit fibers and seeds. Most common cause of phytobezoar is the persimmon fruit. Small bowel obstructions caused by bezoars may account for 0.4-4%of total cases. The aim of this study is to evaluate the patients who were diagnosed and operated with small bowel obstruction duo to the phytobezoar.
METHODS: In this study, data of 20 patients have been evaluated retrospectively who were operated with small bowel obstructions associated with phytobezoars in between December2014 and January 2019.
RESULTS: Median age of patients who were enrolled in the study was 61.3. Oldest patient was 77 years old whereas youngest was 35. Out of 20 patients, 11 were male and 9 were female. 17 of the patients were admitted during winter and all had a history of eating excess amount of persimmon fruit. Half of the patients had a history of gastric surgery. Of these 20 patients diagnosed with phytobezoar in their small bowels, 11 had phytobezoar also in their stomach. 9 of the patients were detected phytobezoar only in their small bowels.Milking was the common technique for small intestinal phytobezoars and done to the 14 patients.
DISCUSSION AND CONCLUSION: Phytobezoar might be the reason of obstruction in patients who had small intestine obstruction; either with a history of previous gastric surgery or not, especially in regions where persimmon fruit is grown and consumed frequently

INTRODUCTION: Idiopathic premature ventricular contractions (PVCs) are the most prevalant ventricular arrhythmias. Vitamin Dand intact parathyroid hormone (iPTH) play role in cardiovascular system, but their affect on premature ventricular complex (PVC) triggering is still uncertain. We investigated the effect of serum 25-hydroxyvitamin D (25[OH]D) and iPTH on PVC burden in our patients.
METHODS: In this study, a total of 128 patients, who underwent electrocardiography (ECG), 24-hour Holter recordings and transthoracic echocardiographic examination as a study protocol were enrolled. In addition, serum 25(OH)D, iPTH levels were measured. The patients were divided into two groups as 64 of them with PVC and 64 of them as normal healthy controls
RESULTS: A 64 patients with frequent PVCs (median age 41 [16-84], male 33/64) and Sixty-four controls (median age 38 [19-72], male 34/64), were included in the study. Parathyroid hormone levels were higher (51.70 [18.35-139.30] vs 73.60 [40.40-139.30], p<0.001) and 25(OH)D levels were lower (27.84±6.79 vs. 17.08±6.36, p<0.001) in patients compared to controls. There were no significant differences between the study groups in terms of phosphorus and other blood chemistry parameters, whereas serum calcium levels were lower in the PVC group.
DISCUSSION AND CONCLUSION: High iPTH levels or lower 25-hydroxyvitamin D levels that might be implicated in the pathophysiology of PVC occurrence; even at the normally accepted reference range, may affect ventricular arrhythmias.

INTRODUCTION: We aimed to evaluate the clinical and radiological signs and side effects of patients with pulmonary tuberculosis treated between years 2005 and 2011 in Kocaeli Tuberculosis Dispansary, Turkey.
METHODS: We retrospectively reviewed medical charts of patients with pulmonary tuberculosis who were treated between years 2005 and 2011 in Kocaeli Tuberculosis Dispansary, Turkey. Exclusion critera were as follows: patients who transferred out, younger than 15 years, treated with second-line drugs and whose medical charts could not be obtained.
RESULTS: Of 818 patients, 285 were females (34.8%), and 533 were males (65.2%), the mean age was 36.9±14.6 years. Of the cases, 81 received previous treatment. The most common symptom was cough and was present in 555 (67.8%) patients, systemic findings were present in 264 patients. 508 of patients (62.1%) had single zone, 90 (11%) had multizone abnormality in the same lung and 220 (26.9%) had bilateral radiologic abnormality. In 84 patients, isolated lower lobe involvement was present. During antituberculosis therapy 73 patients (8.9%) had side effects, most of those patients had liver related side effects (74%). In 76 (9.3%) patients, tuberculosis was diagnosed through radiographic screening. Expansive radiologic abnormality was related with old age and comorbidity (p<0.001; p=0.029, respectively). Isolated lower lobe abnormality was related with older age, women gender and comorbidity (p= 0.005; 0.001; 0.014, respectively). Adverse effects weren’t found related with age gender, comorbidity and to be retreatment.
DISCUSSION AND CONCLUSION: Lung specific symptoms were most common symptoms of pulmonary tuberculosis. Systemic symptoms are related with expansive chest radiologic abnormality. Advanced age and comorbidity were related with expansive radiologic signs and lower lobe abnormality. Hepatotoxicity was the most common adverse effect of treatment and it was considered routine biochemical examination is necessary for all patients. Tuberculosis screening can be useful in some work places which have unsuitable conditions.

Fetus in fetu (FIF) is a rare anomaly resulting from abnormal embryogenesis. Patients often present with an abdominal mass. We report a case of FIF initially diagnosed as a lymphocyst in fetal ultrasonography (USG) during prenatal screening.

INTRODUCTION: Eating disorders are common in university students. We aimed to determine the relationship between perceived stress level and eating awareness of university students.
METHODS: This research is a descriptive type of study and performed with Health Management, Nutrition and Dietetics, Sports Teaching departments’ students. Sociodemographic questions, Mindfull Eating Questionnaire (MEQ), Perceived Stress Scale (PSS) and 6 questions of Eating-Exercise Habits Scale (EEHS) were asked. Sample size was calculated as 384, assuming that the rate of eating awareness in students as 50%, the confidence level as 95%, and the margin of error as 5%. Class based stratified sampling method was used and 64 pupils from first and fourth grade students of each department were randomly selected from the school lists.
RESULTS: This study was conducted with 263 participants with the acceptance rate of 68,5%. Among 263 participants, 76,4% (n= 201) were women. Of the students 44,1% (n=116) were at the department of nutrition and dietetics, 31,2% (n=82) at health management, 24,7% (n=65) at sports teaching. Of the participants 51,0% (n=134) were 1st grade. Of the participants 77,1% (n=202) had high eating awareness. A statistically significant differece was found between the percentages of students with high eating awareness and the departments (p=0,007). Negative correlation was found between PSS scores and EEHS and MEQ scores (respectively r=-0,209,p=0,001; r=-0,224, p<0,001).
DISCUSSION AND CONCLUSION: Mindfulness-based interventions can reduce stress and increase eating awareness. Similar to literature knowledge, eating awareness falls as the stress level rises in this study population. Activities for university students may be planned to improve eating awareness.

INTRODUCTION: The aim of this study was to determine the extent of influenza vaccination coverage among pregnants during the 2019-2020 season, as well as their knowledge, attitudes and behaviors towards vaccination.
METHODS: Pregnant patients who applied to an obstetrics outpatient clinic between June and July 2020 were included in the report. The convenience sampling method was used for sample selection in the study. Descriptive and categorical statistics were used for the study. Nominal data are given as numbers and percentages. Categorical variables were compared using the Chi-square test. Results were considered statistically significant when p < 0.05.
RESULTS: A total of 402 patients accepted participation in the study. The rate of participation in the study was 80.4%. Of the participants, 56 (13.9%) were vaccinated before pregnancy and 346 (86%) were never vaccinated. Only five cases (1.2%) were vaccinated during pregnancy. A statistical comparison was made between the pregnant groups that had received at least one influenza vaccine and the group that never received one. There was a significant difference between the two groups in terms of sources of information. The reason for rejection of vaccine in both groups was safety concerns.
DISCUSSION AND CONCLUSION: In this study, 13.9 % of patient had a previous history of vaccinations against influenza but only 1.2% were vaccinated during pregnancy. The reason for this low rate might be that the vaccine is not routinely recommended by the obstetrician or family physician. It is necessary to develop primary health care services for vaccines in our country.

INTRODUCTION: Sepsis is a rare but life-threatening complication following transrectal ultrasound (TRUS)-guided needle prostate biopsy. Despite technological and pharmacological developments, the problem of bacterial urosepsis after prostate biopsy continues. There is no strategy for the prevention of urosepsis following TRUS prostate biopsy in areas with a high prevalence of resistant strains or in patients with risk factors.
METHODS: 500 patients who underwent ultrasound-guided transrectal prostate biopsy in our clinic between 2015 and 2020 were included in the study. Patient data were searched retrospectively from the TRUSG-Bx database. The patients were divided into two groups as those with and without systemic infection after biopsy. The clinical status of the patients and the lymphocyte, neutrophil, thrombocyte counts in the hemogram parameters, CRP values and PSA were evaluated.
RESULTS: SIRS developed after biopsy in 13 of 498 patients included in the study. When 13 patients who developed SIRS and 485 patients who did not develop SIRS were compared, no statistically significant difference was found between the two groups in terms of age, tPSA, fPSA, PSA density, Qmax and prostate volume. In the univariate analysis, the N/L ratio was
3.85 (1.96-7.21) in the SIRS group, while it was 2.12 (1.56-2.90) in the 2nd group (p=0.005). The P/L ratio was found to be
112.78 (86.50-145.60) in Group 1 and 138.57 (114.76 - 168.18) in Group 2 (p=0.037), but these differences were not statistically significant in multivariate analyzes.

DISCUSSION AND CONCLUSION: In recent years, blood parameters, which are easily accessible and low-cost tests, are frequently used to predict infection and cancer diagnosis or progression. These tests, which have low sensitivity and specificity, have a limited effect in predicting infection after prostate biopsy.

Coronavirus disease 19 (COVID- 19) is a life threatening contagious infection caused by coronavirus 2 (SARS- CoV-2). Hypertrombotic state and endotheliopathy occurring in COVID-19 infection may affect numerous organs as well as influence renal tubular and endothelial cells, causing ARI that is a rarely seen condition. This reveals the significant extent of microvascular and endothelial damage caused by the virus. Similarly to the above mentioned definition, cases of ARI induced by COVID-19 in elderly and/or patients with comorbidity prone to thrombosis have been reported in the literature. Herein, we present a case of ARI secondary to COVID-19 that was developed in a patient without typical COVID-19 symptoms and comorbidity.

New antifibrotic agents (nintedanib, pirfenidone) have been approved for the treatment of idiopathic pulmonary fibrosis. However, the roles of these drugs on acute respiratory deteriorations are not clear. The aim of this review was to investigate possible preventive effects of the drugs. There were 101 clinical trials or randomized controlled trials in Pubmed using keyword “nintedanib”. Sixty of them were oncological papers. All trials about the effect of nintedanib on interstitial lung diseases were funded or derived industry-sponsored studies such as INPULSIS, INSTAGE, and TOMORROW. Previous immunosuppressive therapy such as steroids increases the risk of acute exacerbations in idiopathic pulmonary fibrosis. There is not a significant difference between placebo and pirfenidone, and between pirfenidone and nintedanib on the exacerbations. Adjudication of acute exacerbations is essential to an accurate categorization of serious adverse events. The exclusion of severe patients from the clinical trials may result in selection bias. In conclusion, we think that no significant impact of nintedanib treatment on the incidence of acute exacerbations.

INTRODUCTION: Ventricular septal defect (VSD) is a congenital cardiac disease which is characterized by abnormal connection between left and right ventricle through interventricular septum. Untreated VSD patients may have experience complications such as heart failure, cardiac arrhythmia, infective endocarditis, and pulmonary hypertension. So, hemodynamical significant and symptomatic all VSDs should be closed in patients who are suitable for closure percutaneous. In this study, we aimed to evaluate the short-term results of patients who underwent percutaneous VSD closure.
METHODS: Twenty-nine patients with VSD who underwent percutaneous closure in our hospital between September 2011 and January 2021 were retrospectively evaluated. Procedural success, device embolism, arrhythmia and residual shunt were assessed.
RESULTS: The mean age was 28.79 ± 12.16 years and 17 (58.62%) of them were female. Twenty-six patients had perimembranous VSD. Successful percutaneous closure was achieved in 86.21% of the patients. Device embolism was observed during the procedure in one patient and the VSD closure device was successfully retrieved using with a snare system from the iliac artery. In one patient complete AV block developed and improved within 24 hours. In four patients, there was residual shunt in defects edges and three of them closed in one month follow-up.
DISCUSSION AND CONCLUSION: Percutaneous closure of perimembranous and muscular VSD is a safe, effective treatment method and should be performed in experienced centers by cardiologists specialized in the treatment of structural heart diseases.

INTRODUCTION: Functional studies have shown that cancer cells inactivate CD40-CD40L costimulators, which contribute to immune escape by inhibiting CD40L expression. CD40 -1C>T (rs1883832) is a 5′ UTR variant and may cause changes in protein level or function in the posttranslational process. In this article, we aimed to determine the importance of CD40 -1C>T variant in terms of histopathological criteria and its effect on sCD40 levels in patients with CRC (colorectal cancer).
METHODS: In peripheral blood samples of ninety-three CRC and one hundred sixty-three controls, sCD40 level was detected by ELISA, and CD40-1C>T variant was detected by PCR-RFLP.
RESULTS: 1.48 times higher sCD40 level was found in CRC with CT compared to those with CC (p=0.007). The frequency of CT and TT genotypes was found to be higher in early tumor stage than in advanced tumor stage (p=0.041). It was observed that the frequency of CT genotype was higher in patients with distant organ metastases compared to those without. (p=0.02).
DISCUSSION AND CONCLUSION: We do not think that the CD40-1C>T variant is an important part of CRC initiation. On the other hand, our findings in favor of metastasis suggest that CD40 is a factor that may be effective in the progression stages.

INTRODUCTION: Carotid artery stenting (CAS) is a recommended technique for extracranial carotid artery stenosis. CAS is prefered more than carotid endarterectomy because of more non-invasive technique, decrased recovery period, decresed patient discomfort. In this study, we evaluated the datas of patients treated with CAS in Kocaeli Derince Training and Research Hospital.
METHODS: We retrospectively evaluated the datas of patients who were treated with CAS in Kocaeli Training and Research hospital Neurology Department between 2018 and 2020 were included to our study. Demographic datas, angiographic findings, periprocedural processes and complications, ischemic stroke, acute myocardial infarction (MI) and death rates in 1 year follow- up were evaluated.
RESULTS: Seventy-one patients were treated with CAS. Fifty-nine (83.1%) patients were male. Mean age was found as 67,4±8,7 years. CAS was applied to only right carotid artery in 32(45.1%) patients, only lef t carotid artery in 36(50.7%) patients and bilateral carotid arteries in 3(4.2%) patients. Open-cell stents were placed to 39 (54.9%) patients. Hemodynamic depression occured in 21(29.5%) patients. Hemodynamic depression was associated with open-cell stents (p=0.005) and coronary artery disease in medical history (p=0.030). Only 2(2.8%) patients had acute ischemic stroke in 1 year follow-up. Acute MI and death didn’t occur in our patients.
DISCUSSION AND CONCLUSION: CAS is a safe and effective method in treatment of extracranial carotid artery stenosis. Open-cell stents may increase the risk of hemodynamic depression, but mechanism is unclear.

INTRODUCTION: Complete blood count (CBC) is the most commonly used laboratory test in the clinic. The number and distribution of neutrophils, lymphocytes and monocytes are tests that reflect the inflammatory response and the general immune status of the body. In other types of cancer, the status of the peripheral blood prognostic inflammatory markers; neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), platelet-lymphocyte ratio (PLR), and red cell distribution width (RDW), which were determined to be associated with prognosis and treatment, is still unclear in patients with EGFR mutation-positive lung cancer. This study aims to investigate the prognostic value of NLR, LMR, PLR, and RDW in terms of PFS and OS in EGFR positive adenocarcinoma cases.
METHODS: Among the patients with EGFR sensitizing mutations, those who were older than 18 years of age, who were treated with EGFR-TKI in primary care or the secondary care after series 1 chemotherapy, those with pre-treatment complete blood count (CBC) and those who were evaluated by computed tomography every three months were included in the study.
RESULTS: We found that only the high-PLR parameter was a significant independent negative prognostic factor for the OS in EGFR-positive NSCLC patients treated with EGFR TKI (HR 2.18, 95% CI 1.17-4.07, p=0.014).
DISCUSSION AND CONCLUSION: In our cohort of patients with EGFR-positive NSCLC treated with EGFR TKIs, a high PLR level (>322) was detected as an independent, poor prognostic factor for OS. However, new and multi-center studies are needed to define the precise prognostic role of other parameters and PLR in this group of patients.

INTRODUCTION: The aim of the study was to determine the presence of CD1a positive dendritic cells (DCs) in primary breast carcinomas and to analyze their relationship with other parameters of prognostic importance in breast carcinomas.
METHODS: 66 primary breast carcinoma cases were included in the study. Age, tumor size, histological grade, lymph node involvement, lymphovascular invasion, estrogen receptor, progesterone receptor status, and presence of in situ component were taken into account when the patients were examined. From the blocks suitable for immunohistochemical staining, 3-4 μm sections were taken and CD1a expression was investigated.
RESULTS: All 66 patients included in the study were women. The average age is 54±11,07. While 54.55% of the cases had an in situ component, 45.45% had no in situ component. Two of the tumors were grade 1, 31 of the tumors were grade 2, and 33 of the tumors were grade 3.Tumor diameters varied between 0,6 cm and 13 cm. Lymph node metastasis was observed in 51,52% of the patients, and lymphovascular invasion was observed in 81,82%. In the study, no statistically significant relationship was found between CD1a staining intensity, patient age, tumor diameter, histological grade, lymph node metastasis, lymphovascular invasion and receptor status among invasive and in situ tumors.
DISCUSSION AND CONCLUSION: Although no relationship was found between CD1a + dendritic cells and prognostic factors in breast carcinomas in our study, our demonstration of the presence of immature dendritic cells in tumor areas may contribute to the development of new treatment methods.

INTRODUCTION: During the current pandemic, a great effort is being made to understand COVID-19 and find an effective treatment. Still, there is no specific drug that has been approved by the FDA for the prevention or treatment of COVID-19. This study aims to evaluate the effect of hydroxychloroquine (HCQ) treatment in COVID-19 patients.
METHODS: We retrospectively analyzed the clinical and radiological findings of COVID-19 patients that were treated between March 11-May 15 2020. Confirmation of a COVID-19 diagnosis was made according to a positive Real Time -Reverse Transcriptase Polimerase Chain Reaction (RT-PCR) result and/or with a consistent high-resolution computerized tomography (HRCT) findings. Following treatment, the clinical and radiological response, mortality and overall survival rates were evaluated.
RESULTS: 469 patients were included in the study. 58.8% of these patients were male and 41.2% of were female. 36 patients (7.7%) did not receive HCQ and 433 patients (92.3%) received HCQ. The groups who received and did not receive HCQ were at similar ages, had a similar gender distribution and smoking habits. There is no statistically significant difference for comorbidities between these two groups. No significant difference was found when the radiological regression times of the patients were compared. Mortality rates of the non-HCQ group and HCQ group were comparable (11% vs. 11% respectively). There is no statistical difference in overall survival (OS).
DISCUSSION AND CONCLUSION: In this retrospective study, it was observed that the use of HCQ does not contribute to mortality and life expectancy in patients with Covid-19.

INTRODUCTION: The aim of this study is to investigate the relationship between living donor renal artery diameter(RAD), donor renal parenchymal volume(RPV) and post-transplant recipient graft function.
METHODS: We retrospectively collected data of patients with living kidney donor-recipients. 63 living donors and recipients who met the criteria for kidney donor were included in the study. Abdomen CT protocol was performed for all living renal donors. Data of age, gender, BMI, number of rhe renal artery, renal parenchymal volume (RPV),renal cortical volume(RCV), renal artery diameter (RAD) of the donors were recorded.
RESULTS: A statistically significant positive correlation was found between RAD and RPV (r = 0.493). It was found that the cut- off value of RAD for eGFR >60 (ml/min/1.73 m2) was 6,65 (sensitivity 68%, specificity 62%) with ROC (Receiver Operating Characteristic) curve analysis according to the Youden index. In the multivariate logistic regression analysis, RAD above 6,65 mm (OR=5,533, 95% GA = 1,193 - 25,655, p =,029) was found to be associated with 6 months eGFR.
DISCUSSION AND CONCLUSION: Renal artery diameter, which can be measured more easily than renal volume in CT routinely used before transplantation, may apply for the prediction of graft function.

INTRODUCTION: The aim of this study was to determine the safety and efficacy of porous polyethylene sheet implants in the reconstruction of blow-out fracture without any fixation procedure.
METHODS: Patients who underwent orbita reconstruction using porous polyethylene sheets for the repair of orbital floor fracture were included in the study group. Indication for surgery were patients with enophthalmos, dystopia, limited ocular motility or diplopia on physical examination, fracture of the orbital floor, orbital entrapment or prolapse during computed tomography. Patients were retrospectively analyzed in terms of gender, age, mechanism of injury, concomitant fractures, surgical approach, follow-up period, time of surgery and complications such as diplopia, enophthalmos, dystopia, limitation of ocular motility and infra-orbital hypoesthesia. All statistical analyses were performed using IBM SPSS for Windows version 20.0 (IBM Corp., Armonk, NY, USA). Continuous variables were expressed as median(25.th-75.th percentiles) and standard deviation. Categorical variables were expressed as counts (percentages).
RESULTS: The study group consisted of 101 patients. The mean follow-up period was 8.6 ±3.8 months. Postoperative complications were: enophthalmos, 4 patients (preoperative 20 patients); diplopia, 2 patients (preoperative 17 patients); dystopia, 1 patient (preoperative 13 patients); limitation of ocular motility, 3 patients (preoperative 21 patients), and infraorbital nerve hypoesthesia, 8 patients (preoperative 56 patients). None of the patients developed infection, implant exposure or migration, worsening diplopia, or loss of vision during the follow-up period.
DISCUSSION AND CONCLUSION: The study demonstrated that porous polyethylene implants in the repair of blow-out without any fixation procedure had relatively good results with few complications.

INTRODUCTION: Granulomatosis with polyangiitis (GPA) is a kind of small blood vessel vasculitis that is characterized by lung and renal involvement with a high mortality rate. This study was aimed to investigate the association of baseline laboratory, demographic, clinical parameters between renal and overall survival in patients with GPA.
METHODS: Twenty-four patients diagnosed with GPA between 2010 and 2020 from a tertiary hospital were analyzed retrospectively. Baseline hematological and biochemical parameters, C reactive protein (CRP), and antineutrophil cytoplasmic antibodies (ANCA) were also recorded. History of plasmapheresis and acute dialysis were recorded. Primary endpoints were defined as the diagnosis of end-stage kidney disease and mortality.
RESULTS: Mean age of patients were 53,00±13,78. Ten (41,7%) of 24 patients were male. Median estimated glomerular filtration (eGFR) rate was 62 ml/min/1,73m2 (22,50-88,75).C-ANCA was positive in 15 (65%) patients. Median proteinuria level was 1,30 gr/day (0,80-2,05). Median CRP level was 14,00 g/dl at baseline (4,58-96,80). Cox regression analysis with the adjusted model by age and gender showed that platelet count, eGFR, proteinuria, and CRP levels were significantly associated with renal survival and hemoglobin levels were also associated with overall survival. Platelet count below 150 103/µL and hemoglobin levels below 12 g/dL showed the worst prognosis in terms of renal and overall survival.
DISCUSSION AND CONCLUSION: The platelet count and hemoglobin level could be useful in predicting renal and overall survival at the baseline assessment of patients with granulomatosis polyangiitis.

INTRODUCTION: Appendicitis is one of the most common causes of acute abdomen in General Surgery practice. Although ultrasonography and abdominal tomography have high sensitivity and specificity for Appendicitis, their use may not be appropriate in all cases. Neutrophil/lymphocyte ratio and platelet/lymphocyte ratio can be used to predict Appendicitis. This study aims to compare the less studied novel Systemic immune-inflammatory index’s success in predicting Appendicitis with the neutrophil/lymphocyte and Platelet/lymphocyte ratios.
METHODS: The data of patients who were operated on for Appendicitis in our clinic between 2005-2021 were reviewed retrospectively. We divided the patients into two groups regarding the histopathologic examinations as those with Appendicitis or not. Neutrophil/lymphocyte, Platelet/lymphocyte ratio, Systemic inflammatory index were calculated for each patient. Receiver operator characteristic curve analysis was used to assess the performances of the test scores for Appendicitis.
RESULTS: A total of 205 patients were included in the study. There were 105 patients in the appendicitis group and 100 patients in the non-appendicitis group. SII (AUC: 0.713) and NLR (AUC: 0.764) were found to be valuable for predicting Appendicitis, but PLR (AUC: 0.442) was not.
DISCUSSION AND CONCLUSION: NLR and SII are valuable markers that can assist physical examination in predicting Appendicitis in cases where imaging methods cannot be used.

INTRODUCTION: Clinicians use several cardiac risk scoring systems in daily clinical practice. The most powerful cardiac risk scoring system in predicting the 10-year cardiovascular disease (CVD) risk in patients newly diagnosed with essential hypertension in Turkey has not yet been established. We aimed to compare the role of cardiac risk scoring systems to predict the 10-year CVD risk and to identify the most powerful cardiac risk scoring system in predicting CVD in asymptomatic patients with hypertension in the Turkish population.
METHODS: A total of one hundred patients who applied to the cardiology outpatient clinic with essential hypertension were included in the study. The 10-year cardiovascular risk probability of the patients was calculated according to four commonly used cardiac risk scoring systems. The 10-year CVD prediction and major adverse cardiovascular events were compared.
RESULTS: After a median follow-up period of 11±0.5 years, CAD developed in 40%,CVD in 52% and all-events in 65% of the patients. The study population was stratified as low-, intermediate- and high-risk according to FRS, SCORE, PROCAM and TEKHARF risk scores. The rate of CAD, CVD and all-events was significantly higher in the high-risk group of the SCORE scale compared to the low risk groups (chi square test, p <0.05). In FRS, the incidence of CVD and all events and in PROCAM, the incidence of all events in the low risk group were found to be high and statistically significant (p <0.05). In the ROC analysis for the prediction of CAD, CVD and all events, AUC for the SCORE scale were significantly higher than that for the other three scales (AUC: 0.774 P: 0.049).
DISCUSSION AND CONCLUSION: In conclusion, this study showed that the SCORE scoring system is the most appropriate scale to be used in predicting cardiovascular disease in the Turkish population compared to FRS, PROCAM and TEKHARF.

INTRODUCTION: Botulinum toxin A (BTX-A) is a powerful and long-acting inhibitor of muscle contractions in both striated and smooth muscles.BTX-A inhibits peristalsis by reducing the release of acetylcholine, which is responsible for gastric motility. Thus, it causes delay in gastric emptying, early satiety and weight loss.The aim of this study is to observe the effects of endoscopic intragastric injection of BTX-A in obese patients.
METHODS: Intragastric botox injection was applied to 67 patients.The average age of these patients is 38 and the average body mass index is 32 kg / m2 (28-36).Firstly, patients underwent endoscopy with sedation. The three vials botulinium toxinA were diluted withserum sale. Endoscopically, a total of 300 units of botox were injected into the stomach. 200 ünits were injected into the gastric antrum in four rows in circular fashion and 100 units in to the fundus.The patients were followed up for 1 year. Patients were recorded prospectively body weight and early satiety. A toxic effect of BTX-A was observed in one patient.
RESULTS: As a result of one-year follow-up, it was observed that the patients lost an average of 16kg (6-28). 85% of patients reported early satiety. Botulinium toxinA intoxication was considered in one patient.
DISCUSSION AND CONCLUSION: Endoscopic stomach botox injection can be applied to people who cannot have bariatric surgery or before bariatric surgery.We think that prospective randomized studies should be conducted in larger case series to evaluate statistically.

INTRODUCTION: Chordomas are rare, locally aggressive low-grade malignancies that develop from notochordal embryonic residues. They show a dual epithelial-mesenchymal differentiation. Chordomas preferentially occur in the sacrum. The head and neck localization is uncommon. Here we report chordomas of spheno-occipital, and cervical region diagnosed in our department and summarize clinicopathological characteristics of these cases.
METHODS: Retrospectively, the cases diagnosed as “chordoma” were reviewed from 2002 to 2021. Clinicopathological features of cases with a tumor at spheno-occipital, and cervical region were assessed.
RESULTS: Of 9 cases (4 males, 5 females) with a mean age of 53,4 (13–88 years), eight cases were diagnosed as conventional chordoma and one case as chondroid chordoma. Mean follow-up was 37 months (3-167 months). Recurrence was detected in 2 cases and distant metastasis was determined in one case.
DISCUSSION AND CONCLUSION: Chordomas are resistant to chemotherapy and radiotherapy. Given the location and invasive nature of these tumors, complete resection is difficult. In the head and neck region, chordomas should be included in the differential diagnosis of tumors especially with myxoid characteristics.

INTRODUCTION: The effects of cardiopulmonary bypass(CPB) on visual functions was sought by comparison of visual examinations in the preoperative and early postoperative periods of isolated coronary artery bypass grafting(CABG) operations with CPB.
METHODS: Twenty consequent patients (16 males, 4 females; average age 58.75±7.88 years; range 45-69 years) operated for isolated CABG with CPB at the same centre by the same team were enrolled. All patient data were recorded prospectively. The patients were compared regarding vision defects, retinal vascular and other structural changes by examination of vision, fundus examination for retinal pathologies and retinal photography to verify retinal structural changes in preoperative and postoperative periods. The findings on the last preoperative and seventh postoperative days were analyzed.
RESULTS: Between the preoperative and postoperative examinations, visual acuity of the left eye (p=0.042), intraocular pressure of the right eye (p=0.008) and intraocular pressure of the left eye (p=0.004) were found statistically significantly higher. Intraocular pressure showed correlation with aortic cross clamp and intubation duration, which was not accepted as clinically significant. No structural defects were detected by biomicroscope. The findings of direct examination of fundus photographed preoperatively, remained unchanged postoperatively. No differences could be detected regarding arterial and venous structures, optic papilla, macula, and peripheral retinal structure between the preoperative and postoperative periods.
DISCUSSION AND CONCLUSION: Maintaining careful cannulation and proper management of CPB in coordination with anaesthesiologist, CABG operations can be performed safely with CPB, since no undesired effects on preoperative and postoperative direct fundus examinations, retinal morphology, visual functions and consequently on cerebral functions in part were detected.

INTRODUCTION: The 2019 coronavirus disease (Covid-19) outbreak is a public health emergency of international concern and poses a resilience challenge. Research data are needed to develop evidence-based strategies to reduce adverse psychological effects and psychiatric symptoms during the epidemic. This study aims to determine the relationship between nurses’ stigma and personal well-being in the first stage of the Covid-19 epidemic in Turkey. It is thought that the results obtained will contribute to the correct management of human behavior in current and future epidemics and will guide policymakers.
METHODS: A total of 301 nurses working in the surgical clinics and operating rooms of two separate public hospitals operating in Istanbul between 1 -15 May 2020. It was aimed to reach the whole population by not choosing a sample. However, 82 nurses were excluded due to the shift work system, being on leave, and not participating in the study. The research was carried out with 219 participating nurses. Data were collected with the Individual Information Form, which included demographic questions created by the researchers, and the Stigma in Pandemics scale. SPPS 25.0 statistical package program was used to evaluate the data.
RESULTS: The mean score of the Stigma Scale in Pandemics of the nurses was X̄ = 3.38±0.8, and the mean score of the Personal Well-Being Scale was X̄ = 68.75±5.5 “as moderate. In addition, it was determined that nurses’ fear of contagion or contagion and social isolation sub-dimensions scores were high, and the scores of being exposed to written and verbal attacks were low.According to the results of the correlation analysis, the relationship between the stigma of nurses and their well-being in the Covid-19 pandemic is negative and at a low level.
DISCUSSION AND CONCLUSION: Nurses feel moderately stigmatized by the society in the Covid-19 pandemic, which negatively affects their subjective well-being.

INTRODUCTION: This study is a qualitative study in which interpretive phenomenological analysis is used to determine the difficulties experienced by cancer patients in the Covid-19 pandemic process.
METHODS: Using maximum diversity sampling, 16 cancer patients were interviewed between 20 December 2020 and 25 February 2021. The data were collected using the online interview technique by making one-to-one interviews with semi-structured interview forms.
RESULTS: The difficulties of the patients related to the Covid 19 pandemic were grouped under three themes. These themes are “emotional problems, economic problems and behavioral responses associated with Covid-19”.
DISCUSSION AND CONCLUSION: Cancer patients fear from transmission of Covid 19 virus; experienced a sense of longing due to the quarantine process; faced with economic difficulties; the cleaning habits of the patients who applied to traditional complementary methods for protection from the virus have changed.

The anomalies of the branchial apart, which are responsible for the development of the head and neck structures, usually appear as a mass, sinus, or fistula in the neck. Although it can occur anywhere between the clavicle and the tragus in the neck, it should be kept in mind that it can also appear in atypical localizations. Treatment of branchial cleft cysts, which usually become symptomatic after an upper respiratory infection, is excision. We present a case of branchial cyst in the vallecula, the area where no case sample has been previously presented.

INTRODUCTION: In this study, it is aimed to evaluate the effective communication skills of university students who receive education in the field of health.
METHODS: This descriptive study was conducted with 465 students who receive health education at three schools of Kocaeli between March and June 2018. The data were collected with the student information form and the Effective Communication Skills Scale (ECSS). Comparisons between groups were made with Mann-Whitney U and Kruskal Wallis tests. Spearman correlation analysis was used for the relationships between the variables.
RESULTS: The mean age of the students participating in the study was 20.5±1.9, and 79.8% of them were women. 29% of the students were in the nursing department, 30.5% were third class students. The students stated that they had problems in communicating with the lecturers mostly, while the patient or the patient’s companion the least. It was determined that the students scored above the average in the ECSS sub-dimensions, and their communication skills differed according to gender, number of siblings, what number child, income level and the department of education (p<0.05). The ECSS scores of the students did not differ according to the class of education (p>0.05).
DISCUSSION AND CONCLUSION: In the research; it was concluded that the students had good-level effective communication skills and that these skills did not change during their education. Studies should be conducted on the reasons why the occupational education curriculum cannot develop students’ effective communication skills.

INTRODUCTION: The goal of this study was to compare changes in subfoveal choroidal thickness (CT) using spectral-domain optical coherence tomography (SD-OCT) after using the N95 mask and the surgical mask.
METHODS: The study included 32 health workers between the ages of 20-50, 14 men and 18 women, with best corrected visual acuity (BCVA) ≥ 10/10, spherical or cylindrical refractive error of less than 2 diopters, axial length (AL) of 22-25 mm, and normal intraocular pressure (IOP). The choroidal thickness was evaluated with enhanced depth imaging (EDI) using SD-OCT. Measurements for the N95 mask and surgical mask were obtained on two consecutive days at the same time after at least 2 hours without removing the mask and 15 minutes after removing it.
RESULTS: The mean subfoveal CT after using the N95 mask and surgical mask for 2 hours without removing them are 383.34±103.30 (min: 171, max: 545) and 347.78±94.85 (min: 170, max: 539), respectively. The mean subfoveal CT was 339.53±93.91 (min: 160, max: 479), and 346.22±98.37 (min: 172, max: 545) after the masks were removed. The subfoveal CT assessed after two hours of N95 mask usage and 15 minutes after mask removal (p 0.05) showed a statistically significant difference. There was no statistically significant difference in subfoveal after two hours of surgical mask usage and 15 minutes after mask removal (p > 0.05). Furthermore, subfoveal CT was significantly different after 2 hours of N95 mask usage and surgical mask use (p 0.001).
DISCUSSION AND CONCLUSION: The tight bands of the N95 mask cause a decrease in venous return owing to compression of the veins on the face and a temporary increase in CT, whereas the use of a surgical mask has no effect on CT.

Sporadic Creutzfeldt-Jacobs Disease (CJH) is spongioform encephalopathy caused by prion that should be considered in cases of dementia. It starts with dementia and neuropsychiatric findings in the middle age. Disease symptoms are not characteristic and can be confused with neurological and psychiatric diseases. A 49-year-old male patient was brought to the emergency room with complaints of not speaking, inability to move, memory loss and hearing loss, gait difficulty, intermittent agitated behavior, cold sweating, and vomiting. Her skin looked pale and cold. His temperature was 35 ° C. He had anxiety. The disease is diagnosed by clinical, laboratory, radiological examination, and EEG. Protein 14.3.3, a protease inhibitor protein released from neurons into the cerebrospinal fluid, is a biochemical marker with high sensitivity and specificity used in diagnosis. In radiological imaging, enlargement of the sulci, cerebral and cerebellar atrophy are helpful in the diagnosis of magnetic resonance imaging (MRI). In this study, we examined a rare, rapid and progressive, mortal, neurodegenerative prion disease, a sporadic case of Creutzfeldt-Jakob disease (CJD).