INTRODUCTION: n this study, we aimed to examine the clinical and sociodemographic characteristics and treatment characteristics of the patients who are currently receiving service from Community Mental Health Center(CMHC) in Rize.
METHODS: In this study, 1119 patients aged 18 and over who were enrolled in Rize State Hospital TRSM between March 2012 and December 2018 were included. The sociodemographic and clinical characteristics data form created by the researchers was applied to the cases. The information obtained from the hospital records of the cases and interviews with families were analyzed retrospectively.
RESULTS: In our study, 41.5%(n=464) of the patients were female and 58.5%(n=655) of the patients were male. The average age of 1119 people was found to be 45.92(±12.781). 335(29.9%) patients had Bipolar Disorder, 538(48.1%) patients had schizophrenia, 96(8.6%) patients had schizoaffective disorder, and 150(13.4%) patients had other diagnoses. Most of the patients were found to be single with a rate of 47.8%(n=535). It was determined that they were primary school graduates with the highest rate of 43.9%(n=489) and the majority of the patients were unemployed with 56.8%(n=635). It was observed that 72.9(n=814) patients received regular treatment, 50.5%(n=560) patients smoked, 62.3%(n=696) patients had at least one previous hospitalization, 46.6%(n=521) patients had a family history of psychiatric illness and 39.2%(n=438) patients had comorbid medical illnesses.
DISCUSSION AND CONCLUSION: Our study is the first to report the current CMHC status with a high number of cases. We think that it will reflect the situation in the geographic region of affiliation and will make significant contributions to the literature.

INTRODUCTION: In general surgery training, the use of multimedia-based training is limited. Most surgeons use different platforms to watch or broadcast surgical videos for their ongoing training, particularly after surgical residency. This survey study is planned to examine the habits of using online resources (like video platforms) among general surgeons.
METHODS: Twenty-eight questions prepared with the Google survey were sent to general surgeons through the Turkish Surgical Society's mail system and announcement system. Demographic features, surgical video and educational perspectives, video viewing platforms, ideal video features were questioned.
RESULTS: Two hundred twelve surgeons answered the questions. The majority were men. About half of them employed in an academic center. Current publications and textbooks are the two main reliable resources for learning.The Websurg is the number one resource for web-based learning, followed by the YouTube and Turkish Surgical Society website.
DISCUSSION AND CONCLUSION: As a result, the vast majority of participants follow a video platform. However, they especially monitor current publications to learn new information or techniques. Recording and watching videos have gained importance. By creating understandable and reliable video resources, an effective asset can be created in surgeons' ongoing training in the post-residency process.

Granular cell tumors (GCT) are often benign, very rare soft tissue neoplasms originating from neural / schwanian cells, most often located from the skin and head and neck region. These tumors, which are classified as benign, atypical and malignant according to Fanburg-Smith criteria, are generally asymptomatic and usually form solitary, well-demarcated masses below 3 cm. Numerous tumors and reactive conditions need to be considered in differential diagnosis. Here, we presented the differential diagnosis and histopathological features of a benign granular cell tumor localized subcutaneous in the lumbosacral region, which was observed in a 48-year-old female patient.

INTRODUCTION: Hemophilia-specific quality of life index (Haemo-QoL) is a questionnaire designed for patients with hemophilia. It is a valuable tool to evaluate standards of care and to understand patient's and parent's feelings and challenges. This study aims to evaluate the quality of life in hemophiliac patients.
METHODS: Hemophilia patients 4-25-year-old and having factor level ≤1 were enrolled during their outpatient visits. Turkish version of Haemo-QoL for children and proxy and adults was applied. (www.haemoqol.de) Patients were also screened for hepatitis virus and human immune deficiency virus serology.
RESULTS: Forty-three patients with hemophilia A and hemophilia B were enrolled. The study group was 74.1% of the patients carrying enrolment criteria. The median age of diagnosis was 11.5 (5.5-25.5) months for the 4-16 age group and 12.0(6.0-27.0) months for the 17-25-year-old group. Sixty percent of the patients (26/43) could perform the home treatment. Patients on primary prophylaxis and secondary prophylaxis were18.60% and 69.76% of the study group, respectively. Two patients in the>16 age group were hepatitis B carriers. Factor injection was the most impaired score in the 4-16-year-old group. In the 4-7-year-old group, relations with family and treatment dimensions were poorly impaired. In the 8-12 age group perceived support and in the 13-16 age group, sports and leisure scores were poor. In 4-16-year-old groups total haemo-QoL score range was 29.9-34.4. There was no patient with severe arthropathy
DISCUSSION AND CONCLUSION: Quality of life of children and young adults with hemophilia is acceptable in this study. Training of the patients and families should continue for more compliance to prophylaxis.

Chloralhydrate is a drug that is used as sedative - hypnotic drug for imaging methods where analgesia is not required and sedation is sufficient in children. It is widely used because of its wide therapeutic index, relatively low respiratory depression, ease of administration and less frequent side effects. Although delirium was mentioned as the side effect of chloral hydrate in many places, no case report could be detected. In this case report, a child who developed delirium after the therapeutic use of chloralhydrate was mentioned.

INTRODUCTION: The aim of the present study was to evaluate the effectiveness of the three different algorithms on pregnant women who had adnexal mass, and also, to compare the sensitivity and specificity of these algorithms in pregnancy.
METHODS: Our retrospective study evaluated the women who had a suspicious adnexal mass during pregnancy consulted to the Division of Gynecologic Oncology and underwent surgery at the Department of Obstetrics and Gynecology, Istanbul University from December 1999 to December 2019.
RESULTS: There were forty pregnant women with adnexal mass. Eleven (30%) has benign, six (15%) had borderline, and twenty-three (55%) had malign lesions. The RMI4 algorithm had a sensitivity of 0.21, a specificity of 0.91, at a cut-off point ≥ 450. At a cut-off>%10, the LR2 and ADNEX algorithms both had a sensitivity of 1.00, however, LR2 algorithm had a specificity of 0.55; ADNEX algorithm had a specificity of 0.82. Positive predictive values (PPV) were 0.86 for RMI4, 0.85 for LR2 and 0.94 for ADNEX algorithm, and negative predictive values (NPV) were 0.30 for RMI4, 1.00 for LR2 and ADNEX algorithms. The difference between RMI4 and both LR2 and ADNEX algorithm was statistically significant (p <0.001 for all). However, the difference between the LR2 and ADNEX algorithm was not significant (p=0.25).
DISCUSSION AND CONCLUSION: The ADNEX and LR2 algorithms had high sensitivity in differentiating malignant tumors from benign lesions on pregnant women with adnexal mass. In addition, ADNEX had the highest specificity of all. However, RMI4 algorithm had the poorest performance on pregnant women with adnexal mass.

INTRODUCTION: Laparascopic hernia repairs have become popular nowadays. The aim of this study is to evaluate the intraoperative and postoperative outcomes of patients who underwent laparoscopic total extraperitoneal (TEP) inguinal hernia repair and to emphasize the importance of learning curve.
METHODS: Patients who underwent laparoscopic TEP inguinal hernia repair in our hospital between 2012-2019 were retrospectively analyzed. Age, gender, intraoperative and postoperative complications, duration of operation, postop hospital stay,time to return to work/ daily activity, pain and recurrence parameters were evaluated.
RESULTS: The study has been conducted on the results of 184 procedure repairs applied to 140 hernia patients, 96 of them unilateral and 44 bilateral. The average age is 50.55±15.01years, 126 patients are men and 14 patients are women. While 98 of the patients are under 65 years old, 42 of them are over 65 years old. The average duration of activity/return to work is 4.88±1.57 days and the average duration of operation is 59.53±21.21 minutes. Duration of staying in hospital is 1.02±0.14 days. %9,3 Intraoperative complication, %5,7 postop pain, %5 seroma were observed among cases. At the 3rd month checkup 6 patients experienced moderate pain, recurrence was observed in 5 patients at the 1st year checkup.
DISCUSSION AND CONCLUSION: Laparascopic TEP inguinal hernia repair is a safe surgical procedure in terms of less postoperative pain, shorter hospital stay,shorter time return to daily activity, similar complication rates compared to laparoscopic and open repairs in literature.

INTRODUCTION: Early or late complications of bilioenteric anastomoses may bring other problems that are difficult to tackle. We aimed to evaluate the effect of anastomosis technique on the formation of bile fistula seen in this spectrum of complications starting from wound infection to liver failure.
METHODS: Patients who underwent hepaticojejunostomy anastomosis due to periampullary region masses, stomach tumor, biliary tract injury between 2013-2019 were grouped according to the preferred anastomosis method.The interrupted suturing technique was preferred in the main bile duct less than 5mm and morbidly obese patients with a diameter of 5 to 7 mm, whereas in other patients, the continuous anastomosis technique was preferred. In patients using continuous technique, basic sutures were added to the area with bile leakage in anastomosis and included in the combined method group. Postoperative leak rates of patients were compared.
RESULTS: 130 patients underwent hepaticojejunostomy anastomosis. The mean age of the patients was 62, of which 54 were men and 76 were women. According to the anastomosis technique applied, the patients were divided into 3 groups with the names of continuous, interrupted suturing and combined method groups. Bile leakage was observed in 5 of 130 patients. In 4 of these patients, continuous suturing method was used in 1. One patient's bile leak could not be brought under control and he needed surgery again.
DISCUSSION AND CONCLUSION: In the evaluation of our study, there are advantages of continuous hepaticojejunostomy anastomosis in patients with a main bile duct larger than 7 mm, and there was no significant difference between early complications..

INTRODUCTION: This study was carried out to evaluate the satisfaction levels of patient relatives and the way they deal with stress in intensive care units (ICU).
METHODS: This descriptive and cross-sectional study was 3rd in a State Hospital between 10 February 2020 and 30 September 2020. The step was carried out with 245 relatives of patients lying in intensive care units. The research data were collected with the Personal Information Form, Family Satisfaction in the Intensive Care Unit (FS-ICU-24) and Ways of Coping with Stress Inventory (WCSI).
RESULTS: The average age of the participants was 33.29±12.75% and 52.7% were male, 53.9% were single, 26.1% were secondary school graduates, 24.1% were civil servants, 61.2% described the income status as moderate. 57.1% of the participants know the diagnosis of their patient and 58.4% get daily information about the patient. Participants FS-ICU-24 score average was 60.75±18.98, Self-confident approach subscale mean score of the participants was 22.89 ± 3.47, the optimistic approach was found to be 16.13±2.67. The helpless approach sub-dimension mean score was 22.36 ± 5.92, the sub-dimension mean score was 16.59 ± 4.83 and the social support sub-dimension mean score was 12.56 ± 2.1. A positively significant relationship was found between FS-ICU-24 and sub-dimensions and WCSI and its sub-dimensions.
DISCUSSION AND CONCLUSION: The satisfaction of the patient's relatives is moderate and they have been found to deal effectively with stress. The satisfaction of the patient's relatives has now been seen to be able to effectively cope with stress.

INTRODUCTION: Glanzmann thrombasthenia (GT) is a rare thrombocyte aggregation defect and there are no guidelines for supporting surgical hemostasis in patients with GT. The aim of the present study is to share the experiences in bleeding control of surgical interventions of patients with GT.
METHODS: In this retrospective study, patients with a diagnosis of GT, followed-up between 1999 and 2000 and underwent surgical procedure were analyzed. Patients’ age at diagnosis, bleeding characteristics, surgical procedures, hemostatic treatments, and bleeding complications of surgery were analyzed.
RESULTS: Twenty-three surgical procedures were performed in 13 patients. Thirteen (56.5%) of these procedures were tooth extractions. Thrombocyte concentrate, and oral tranexamic acid were started before tooth extractions and oral treatment was continued for 5 days but in three of these procedures bleeding control was poor after the procedure. In two of these procedures, bleeding was controlled with recombinant factor VIIa (rFVIIa). In bronchoscopy, varicocele, circumcision, thyroglosal cyst operations and molar tooth extractions, rFVIIa was used alone or in addition and bleeding control was achieved. In four patients with history of surgical interventions performed before GT diagnosis, bleeding complications were reported whereas bleeding control was good in a cesarean operation performed without any hemostatic agent.
DISCUSSION AND CONCLUSION: Patients with suspected bleeding defect or with bleeding defect must be referred to the hematologist. Abnormal platelet clumping in peripheral smear performed from the fingertip, prolonged bleeding time suggest GT. Surgical procedures in patients with GT can be safely performed with collaboration of a hematologist by administering tranexamic acid, thrombocyte suspension and rVIIa.

INTRODUCTION: Cardiopulmonary stress test (CPT) plays important role in management of adult congenital heart disease (ACHD). Our aim in the current study is to investigate the role of a novel CPT parameter, O2-pulse-Heart rate inclination angle difference (IAD), that integrates chronotropic and inotropic responses to exercise, in the assessment of ACHD.
METHODS: ACHD patients and healthy controls were enrolled prospectively for this observational study. Participants underwent transthoracic echocardiography and CPT on a bicycle ergometer with a ramp protocol, respectively. IAD was calculated in addition to standard CPT parameters in each patient.
RESULTS: Twenty-one patients with ACHD (mean age: 28 ± 12 years, 14 male, 66 %) and 79 healthy controls (mean age: 34 ± 6, male 100 %) were included in the study. Patients had significantly lower systemic ventricle ejection fraction (60±8% versus 69±4%, p <.001) and higher systolic pulmonary artery pressure (33±13 versus 21±5 mmHg, p<.001). Execise duration (7.4±4 versus 10.1±2.3 minutes, p=.007), maximal oxygen consumption (VO2max) (1524±614 versus 2398±391, p<.001) and IAD (-5.9±13.7 versus 1.2±13.1°) were lower while VE/VCO2 was higher (31±5.1 versus 28.8±3.3,p=.030) in ACHD patients. In univariate analysis, age (r=0.236,p=.18), diagnosis of ACHD (r=-0.205,p=.41), NT-proBNP (r=-0.870,p=.002), VO2max (r=0.334,p=.001) and VE/VCO2 (r=-0.273, p=.006) were associated with IAD. IAD was independently associated with VE/VCO2 when adjusted by age, diagnosis of ACHD, LVEF and VO2max (β=-1.2, CI -1.892--0.508, R2=0.242)
DISCUSSION AND CONCLUSION: In this study, we demonstrated that the novel CPT parameter IAD might have a potential role in assessing cardiovascular function in patients with ACHD. This role should be further investigated in larger cohorts.

INTRODUCTION: This study is carried out to determine the health literacy and healthy lifestyle behaviors of university students studying in health-related departments.
METHODS: The descriptive and cross-sectional study was carried out between February and May 2020. The research was completed with 1086 students studying and accepting to participate the research in health-related departments at three different state universities. During collecting the data, “Questionnaire Form”, Health Literacy Scale” and “The Healthy Lifestyle Behaviors Scale II” are used.
RESULTS: The average score of the students from Turkish Health Literacy Scale was 36.2 ± 8.3 and 41.3% of them have sufficient health literacy. The students' “Healthy Lifestyle Behaviors Scale II” mean score is 125,3 ± 24,0 and is at an intermediate level. It was observed that some characteristics such as gender, income level, perception of health, education status of parents, the faculty and department of education were effective on the scores obtained by the students from the scales. It has been determined that individuals with high health literacy scores have more healthy lifestyle behaviors.
DISCUSSION AND CONCLUSION: It is of great importance to increase the level of health literacy in students studying health sciences in order to develop and maintain healthy lifestyle behaviors.

INTRODUCTION: Several techniques have been described for the Recurrent Laryngeal Nerve (RLN) identification. The aim of the present study is to evaluate the effect of the RLN identification technique at the level of the Berry’s Ligament on permanent RLN injury rate in Thyroid Surgery.
METHODS: 803 cases with benign thyroid diseases, those underwent surgical therapy with at least lobectomy, and total or near total thyroidectomy during the last 13 years evaluated retrospectively. Hospital records of the patients were evaluated according to the age, sex, indications for the surgical therapy and postoperative complications.
RESULTS: In our study, 656 (81.69%) of the cases were female and 147 (18.31%) were male. The ratio of the women to men was 4.4/1, A total of 1474 RLN dissection/identification were performed. RLN was able to be visualized in all cases. Indirect laryngoscopy was performed on patients with voice / speech disorders after 6 months. Unilateral vocal cord paralysis was detected in nine (0.61%) patients. These cases were accepted as permanent RLN paralysis. No bilateral permanent RLN paralysis was encountered in our series.
DISCUSSION AND CONCLUSION: As a result it can be said that, in it’s course during the travelling in the neck RLN shows different variations. But at the level of the cricothroid articulation, where it enters the larynx, beyond the Berry’s Ligament, the position of the nerve is more constant than elsewhere. So identification of the nerve at this point may lead to low ratio of permanent RLN palsy..

INTRODUCTION: Critically ill patients have life-threatening injuries or illnesses that might require transportation for adequate care. However, transport of these patients poses additional risks for these patients. Therefore, prehospital management of these patients is crucial. The study aimed to compare the knowledge level of the emergency medicine residents and specialists on aeromedical patient transfer and to determine the effects of previous experience and previous education in aeromedical transfer on the knowledge level of the participants.
METHODS: This was a prospective web-based survey study conducted between February 2021 to March 2021. The survey consisted of three parts. The first part was for the written informed consent, the second part included age, sex, the academic degree of the physician, previous education on aeromedical patient transfer, and previous experience of aeromedical patient transfer. The third part was dedicated understanding the knowledge level of the participants on aeromedical patient transfer.
RESULTS: Seventy-seven emergency physicians participated in the study. Thirty-eight (49.4%) of them were residents and 39 (50.6%) of them were specialists. The right answer rates of the endotracheal cuff pressure was significantly different between the residents and specialists [3/38 (7.9%), 14/39 (35.9%), respectively] (p<0.05) while other topics had not significant difference between participants.
DISCUSSION AND CONCLUSION: Education and training of the physicians on this highly specific medical specialty is not sufficient in our findings. Further randomized controlled simulation studies should investigate the knowledge level of the physicians on aeromedical patient transfer.

INTRODUCTION: Gastric perforation is a serious and life-threatening problem seen mostly in premature newborns in the neonatal period.Various causes play a role in the etiology.This retrospective study aimed to determine the etiology, basic risk factors, clinical features, prognosis, and mortality in newborns diagnosed with gastric perforation in our neonatal intensive care unit.
METHODS: Newborns diagnosed with gastric perforation between 2002 and 2015 were included in this study.Data including birth weight, gestational age,sex,risk factors,gastric perforation time,perforation location, and prognosis were recorded.
RESULTS: A total of eleven newborns diagnosed with gastric perforation were included in the study.The median gestational birth weight of the newborns was 2.014 g. Two of the newborns were term, and nine were preterm.Three of the newborns were female, and eight were male.The main clinical finding was abdominal distention, and pneumoperitoneum was detected in all newborns.The average age at diagnosis was 5.6 days.Spontaneous gastric perforation was detected in 6 newborns, and secondary gastric perforation was found in 5 newborns.Recurrent gastric perforation was detected in two newborns.The gastric perforation size was between 0.5 and 2.5 cm, and it was primarily detected in the greater curvature of the stomach.The absence of ýnterstitial cells of Cajal (ICC) was shown in a gastric muscle biopsy taken from a newborn.The mortality rate was 45%.
DISCUSSION AND CONCLUSION: Gastric perforation is an emergency that threatens the life of newborns.It can often develop due to distal obstruction or the absence of ICC cells.It is essential to look for ICC cells in the stomach muscle biopsy material to monitor for recurrent gastric perforation.

INTRODUCTION: The prevalence of thyroid nodules has been increased as a result of the high life expectancy of individuals. By the way, the rate of thyroidectomy also increased in the elderly. However, thyroidectomy in the elderly has a higher risk when compared to young patients. This study aimed to evaluate the efficacy of two energy-based devices in thyroidectomy in elder patients.
METHODS: Patients who had undergone thyroidectomy between January 2013 and October 2017 were retrospectively analyzed. The patient’s demographic, surgical, and clinical data were evaluated from the hospital database. Transient or permanent hypocalcemia, vocal cord paralysis, bleeding, duration of hospitalization, and reoperation rates were analyzed.
RESULTS: Thirty-six out of 224 patients were 65 years or older and the remaining were young. Five patients were male (13.9 %), 31 patients were female (86.1%). The mean age of the patients was 67.5 years. There was no significant difference among the groups in terms of operative time, postoperative hematoma/seroma after the drainage tube was removed, rate of vocal cord paralysis, and postoperative hypocalcemia, postoperative parathyroid hormone levels, and rate of reoperation (p>0.05). Long-term hospitalization and inability to the withdrawal of drainage tubes within one day were significantly higher in elderly patients (p<0.05).
DISCUSSION AND CONCLUSION: Advanced technologies reduce morbidity and mortality during surgery in elderly patients. Our results showed that energy-based devices provide safe thyroidectomy in elderly patients.

The novel coronavirus (COVID-19) continues to be a global health crisis all around the world. Although the respiratory system plays a major role in the person-to-person transmission, unknowns about this virus gradually increase due to Covid-19 patients represented with unusual symptoms. It’s still not known exactly whether or not it is a blood-borne pathogen, so, this brings along the discussions about blood safety in the future. In this report, it’s aimed to represent a case received a blood transfusion from an asymptomatic COVID-19 donor and review the literature about blood safety during pandemic.

Henoch-Schonlein purpura (HSP) is the most common vasculitis of childhood. It is less common in adulthood. Charactarized by the storage of immunglobulin A (IgA), and its also called IgA vasculitis (IgAV). In this article, adult age case diagnosed as IgAV, with proteinuria at nephrotic level unresponsive to steroid treatment, is presented. The patient, who presented with typical rash, gastrointestinal and renal involvement, was administered monthly cyclophosphamide infusion due to increasing proteinuria despite steroid and azathioprine treatment. After the third cycle, the patients proteinuria significantly regressed and her treatment was continued with methylprednisolone and azathioprine. HSP, has no accepted treatment approach in adults. Renal involvement is more common in older children and adults, and it's the most important determinant of morbidity and mortality. In this article, we aimed to share our approach to a patient who presented with renal involvement at an adult age.

INTRODUCTION: We aimed to reveal the clinical and laboratory features of pregnant women with permanent hypoparathyroidism.
METHODS: We retrospectively analyzed the pregnant women with permanent hypoparathyroidism and without any comorbid illness. Age, gravida, parity, etiology and duration of hypoparathyroidism, medications, and laboratory tests, history of previous hypoparathyroid pregnancy, gestational diabetes mellitus, hospitalization due to hypocalcemia, regular follow-up (presence of clinical controls or not), severe hypocalcemia at least once in pregnancy (corrected Ca(CCa)<7.5 mg/dL) were analyzed.
RESULTS: Mean age of the patients (n=20) was 35.10 (±4.83). Mean duration of hypoparathyroidism was 74.55 months. Only 1 patient had idiopathic hypoparathyroidism. Severe hypocalcemia was detected in 55% (n=11) in total, and in only 25% (n=1) of 4 patients who did not use calcitriol in pregnancy. In pregnancy, 80% (n=16) of the patients used calcitriol, 40% (n=8) cholecalciferol, 65% (n=13) calcium carbonate, and 20% (n=4) magnesium. Two patients left off calcitriol and used only CaCO3 when became pregnant. Calcitriol dosage was higher in 3rd trimester of pregnancy comparing to pregestational period (p=0.001), but no change was found in CaCO3 dosage, CCa or phosphorus level.
DISCUSSION AND CONCLUSION: To our knowledge, our study is the first to analyze such a high number of pregnant women with hypoparathyroidism. We recommend delicate dose adjustment based on the clinical background.

INTRODUCTION: In this study, fasting and postprandial cholesterol levels were investigated in patients diagnosed with subclinical hypothyroidism (SH), and it was investigated whether thyroxine treatment had an effect on these cholesterol levels.
METHODS: Newly diagnosed 50 SH and 25 euthyroid patients were included in the study. The first 25 patients with SH were the treatment group (group I) and the second 25 patients with SH were the control group without treatment (group II).
RESULTS: At the first admission, fasting and postprandial glucose, fasting fT4 and fT3 levels were significantly lower in patients with subclinical hypothyroidism compared to euthyroid patients, while fasting TSH levels were higher. There was no significant difference in other parameters. According to these results, it was observed that whether the patients had SH or not did not affect the fasting or postprandial cholesterol levels of the patients. At the end of the third month, basal and postprandial values were compared between the groups that received treatment with subclinical hypothyroidism (group 1) and those who did not receive treatment (Group 2). While fasting and postprandial total cholesterol and TSH values were statistically significantly higher in the untreated group, fT4 and fT3 values were significantly lower. However, the amount of change in cholesterol levels (delta 0-3 months) was evaluated and no statistical difference was observed.
DISCUSSION AND CONCLUSION: No difference was found in terms of cholesterol profile in both fasting and postprandial periods in patients with SH compared to euthyroid control group. There was no improvement in fasting or postprandial cholesterol levels with thyroxine treatment.

INTRODUCTION: In this study,we aimed to investigate the most optimal removal time for the implants placed during internal fixation in the practice of hand surgery.
METHODS: Of a total of 241 patients who underwent surgery in the Orthopedics and Traumatology,Hand Surgery Unit between January 2019 and February 2021, six (2.4%) whose implants were removed were retrospectively analyzed.There were seven implants in six patients (4 males, 2 females).Time from surgery for fractures and/or malunion to the implant removal was evaluated.Indications for implant removal, the removal sites, post-procedural complications, and patient satisfaction were assessed.Statistical analysis was performed using the SPSS software. Correlation analysis was carried out using the Friedman correlation analysis. A p value of <0.05 was considered statistically significant.
RESULTS: The median age was 31 (range, 11 to 62) years.Of the patients, two (33.3%) were females and four (66.7%) were males.The median follow-up was 11.5 (range, 8 to 18) months.The implants were removed due to patient preference in three patients (50%) and limited range of motion in three patients (50%).All patients were satisfied with the implant removal procedure.No complication was observed in any of the patients.There was a significant correlation between the implant removal due to the limited range of motion and postoperative patient satisfaction (p=0.003).
DISCUSSION AND CONCLUSION: Implant removal surgery is one of the most frequent operations in the practice of orthopedics with a special care to avoid complications.It can be effectively used to ameliorate limitations in the range of motion of the hand joints which occur following hand surgeries.

INTRODUCTION: COVID-19, the cause of which is SARS-CoV-2, continues to be a global epidemic for which there is still no effective treatment and vaccine. During the pandemic period, various measures have been taken in Turkey as well as in the whole world. While taking these measures, it has been an important question how to manage the diagnosis and treatment possibilities of other diseases in the COVID-19 epidemic. In this article, the studies carried out in our Kocaeli University Faculty of Medicine General Surgery Clinic in terms of diagnosis, treatment and prevention are explained, as well as explaining how the health practices in the clinic follow in this process, it is tried to shed light on the clinical management during the pandemic periods.
METHODS: From 10 March 2020, when the first COVID-19 case was reported in Turkey, to 1 June 2020, when the normalization period began, the data of all patients receiving health care in our clinic were collected. The number of patients examined in the outpatient clinic, the number of patients admitted to the ward, the number of surgeries performed, the nature of the surgeries, the period, the urgency, the surgical plan, the outcome of the patients who underwent surgery, the number and outcome of patients hospitalized for treatment, the number of PCR tests performed from inpatients, the PCR positive Parameters such as number of negative / negative were obtained from retrospective files and hospital records.
RESULTS: In our study, patient data and demographic information in our clinic during the active period of COVID-19 in Kocaeli University Faculty of Medicine, Department of General Surgery, clinical physician operating data in this period, and COVID-19 conditions in our clinic during this period were evaluated on the basis of patient groups. All three data groups were examined in themselves as two active periods of COVID-19.
DISCUSSION AND CONCLUSION: General surgery clinical management in the COVID-19 period is difficult and requires planning. In terms of both patients and working physicians, it is necessary to carry out work without being infected. With this study, we tried to guide the management of general surgery clinics in similar pandemic periods by evaluating the management of our clinic during the COVID-19 period.

INTRODUCTION: It can be difficult to determine the transection line in total laparoscopic surgery of gastric cancer. This retrospective study aims to evaluate the clinical significance of intraoperative gastroscopy in determining the resection margin in total laparoscopic gastrectomy.
METHODS: 55 patients who underwent intraoperative gastroscopy to determine the resection margin during total laparoscopic gastrectomy between March 2017 and January 2021 were included in the study. After the lesion location was determined in endoscopic imaging, transection was performed by determining the resection margin with light transillumination.
RESULTS: Of 55 patients who underwent total laparoscopic gastrectomy with intraoperative gastroscopy, 28 (50.9%) were male, 27 (49.1%) were female, and the mean age was 59.89±11.18 years. Tumor was located in 1/3 proximal in 25 patients (45.4%), 1/3 medial in 9 patients (16.4%) and 1/3 distal in 21 patients (38.2%). Of the patients who underwent intraoperative gastroscopy and completed total laparoscopic surgery, subtotal gastrectomy was performed in 19 (34.5%) patients, vertical gastrectomy was performed in 10 (18.2%) patients, and total gastrectomy was performed in 26 (47.3%) patients. No complications related to intraoperative gastroscopy were observed in the patients. Resection margins of all cases were shown to be within safe limits by histopathological analysis.
DISCUSSION AND CONCLUSION: Intraoperative gastroscopy is a reliable procedure in total laparoscopic gastrectomy in tumor localization and to ensure resection margin safety.

INTRODUCTION: Although discrimination against older people is a condition carried out by individuals of all ages, it is more common among young people who are far from old age. It is thought that emphatic tendencies of students are effective on discrimination against older people. This study was conducted to investigate university students’ emphatic tendencies and attitudes relating discrimination against older people.

METHODS: This cross-sectional descriptive study was conducted on 483 students in a foundation university who accepted to participate in the study in January 2020. Personal Information Form, Emphatic Tendency Scale and Ageism Attitude Scale were used to collect the data. Descriptive statistics, Mann-Whitney U Test, Kruskall Wallis test and Spearman’s correlation analysis were used to evaluate the data.
RESULTS: Average age of the students was 20.76±2.40; 49.3% were female and 78.5% were Turkish citizens. Emphatic Tendency Scale score was 66.58±8.2; Age Discrimination Attitude Scale score was 80.84±10.33 and Ageism Attitude Scale subscale scores were 34.43±5.64 for restricting life of the elderly, 28.81±5.94 for positive ageism and 17.6±3.54 for negative ageism. Positive significant correlation was found between Emphatic Tendency Scale and Ageism Attitude Scale, restricting life of the elderly and positive ageism.
DISCUSSION AND CONCLUSION: University students were found to have positive attitude toward elderly and moderate level of emphatic tendency. As the emphatic tendency of students increase, they show positive attitude towards elderly.

INTRODUCTION: Due to the surge of coronavirus disease 2019 (COVID-19) in spring 2020, a 75-day lockdown began. All non-emergent operations, were postponed. With signs of resolution of the pandemic, all elective cases resumed. This represented a unique experience for health care providers to deal with at the beginning of the post-pandemic era, i.e., the “new normal.”
METHODS: Patient characteristics, operations performed and diagnostic tools to prevent COVID-19 in our cardiovascular surgery clinic between June 1 and November 2, 2020 (the “new normal” period) were evaluated and compared with the results from the same period in 2017–2019.
RESULTS: Overall, emergency operations (p = 0.042) increased. Vascular surgery emergency operations (p = 0.029), unplanned admissions (p = 0.017), and the patients’ American Society of Anesthesiologists (ASA) score (p = 0.022) increased. The cardiac risk score (p =.040), ASA score (p <.001), and off-pump coronary artery bypass grafting (CABG) procedures increased (p <.001), while the postoperative hospital stays decreased (p =.025) in the “new normal” period. In the first half of the “new normal” period, significantly more emergency heart surgical and vascular surgical procedures (p =.042, p =.004, respectively) were performed compared with the second half. The use of computed tomography and detected pneumonia increased more than twofold compared to previous years. In relation to COVÝD-19, 1.74% of the admitted patients had a positive polymerase chain reaction test.
DISCUSSION AND CONCLUSION: An increase in patient risks and admission of more urgent cases was observed after the lockdown period,especially in the first weeks.

INTRODUCTION: Nasal polyposis (NP) is a benign chronic disease characterised by mucosal inflammation. In this study, to investigate the relationship between -746 C/T, -174 G/C and -607 C/A single nucleotide polymorphisms (SNPs) which are Interleukin (IL) 5, IL6 and IL18 gene promoter and NP
METHODS: A total 163 patients of 87 with NP and 76 controls were included in the study, and genotyped with Snap-Shot. SNPStats, a logistic regression model, MDR.
RESULTS: In our study, the presence of IL5 and IL18SNPs, the frequency of major alleles CC genotypes were significantly higher in the patient group (respectively P< 0.001ve P< 0.001; P< 0.001 ve P< 0.001; P= 0.023 ve P= 0.006). In addition, IL18SNP was observed more frequently in patients with NP with aspirin intolerance and asthma (P= 0.013, P= 0.045). However, the frequency of IL5-IL6-IL18 CGC haplotype was high in the patient group with NP (P< 0.0001). According to the best single-locus model detected by MDR analysis, IL18 CC genotype was found to be associated with increased-NP risk of IL-5_IL18 containing major alleles according to the two-locus model (P= 0.006, P< 0.0001). IL5 genotypes and IL5_IL6 diplotypes were observed to be linked to the genotype of IL18, risk pattern in NP (P< 0.0001). It was also observed that individuals with NP-positive family history had a 16-fold increased risk of NP (P= 0.0004). However, a synergistic interaction was observed between IL18 genotypes and the clinical variable aspirin intolerance (P< 0.0001).
DISCUSSION AND CONCLUSION: The polymorphisms IL5 (-746) and IL18 (-607) may be predisposing factors for nasal polyposis.

INTRODUCTION: Health status perception affects to health behaviors and to responsibility for health. Perceived health status is used to determine general state of health in recent years. Aim of this study is to determine perceived health status and related factors of people aged 15 years and older in a district.
METHODS: The study carried out in Aðaçören district of Aksaray is cross-sectional. The developed questionnaire was applied to peoplr face-to-face by visiting their houses. Questions about general health perception were evaluated on a five-point Likert scale. Within the scope of the research, 418 people were reached. Participation rate was 95.9%.
RESULTS: 40.2% of the respondents stated it was intermediate, bad or very bad for their health in general. 28.9% said their health was worse than a year ago. There is a significant difference in general health status according to gender, age, marital status, educational status, employment status, monthly income, chronic illness and smoking (p <0.05).
DISCUSSION AND CONCLUSION: Increasing socioeconomic levels of individuals is one of the most important factors that will recover the negative situation in general health perceptions. In addition, it may be beneficial to increase awareness about healthy lifestyle in order to perceive health conditions more positively.

INTRODUCTION: Pathophysiological changes after surgical interventions and anesthesia facilitate the development of postoperative pulmonary complications (PPCs). The purpose of this study was evaluation of pulmonary complications showing radiological findings after abdominal surgery.
METHODS: This was a retrospective study of pulmonology consultations requested for 619 patients who had undergone abdominal surgery under general anesthesia between January 2010 and November 2014. We included only patients in whom there was radiological evidence of PPCs.
RESULTS: Radiological findings were detected in 128 (20.7%) of the patients whom postoperative chest diseases consultation was requested. The mean age of the patients was 57.28 ± 11.2 years. Of the 128 patients evaluated, 81 (63.2%) had undergone upper abdominal surgery, the remaining 47 (36.7%) having undergone lower abdominal surgery. Of the patients who had undergone upper abdominal surgery, 51 (62.9%) were ≥ 60 years of age. The most common PPCs were pleural effusion (in 32.8% of the cases), pneumonia (in 26.5%), and atelectasis (in 17.9%). Among the patients who had undergone upper abdominal surgery, the most common PPCs were atelectasis and pleural effusion (seen in 69.5% and 66.0%, respectively), pneumonia was the most common PPC among (seen in 76.0% of) those who had undergone lower abdominal surgery.
DISCUSSION AND CONCLUSION: Pleural effusion, pneumonia, and atelectasis were the most common PPCs for which there was radiological evidence. In particular, atelectasis and pleural effusion were the most common PPCs after upper abdominal surgery, whereas pneumonia was more common after lower abdominal surgery. However, none of the risk factors evaluated correlated significantly with any such complications.

INTRODUCTION: Preventive behaviors of breast cancer have a significant impact on women's health. The aim of this study was to validity and reliability of the Turkish version by adapting to Turkish "The Scale to Determine Factors Affecting Women’s Breast Cancer Prevention Behaviors” developed by Maryam Khazaee-Pool et al. in 2016.
METHODS: This study, which is a methodological type was conducted in Adýyaman between July 1 and December 31, 2018. The population of the study consisted of 4550 women registered in Family Health Center No 7 and the sample included 190 women aged 30 and over, who agreed to participate in the study, could be contacted, were at least literate, and had no history of breast cancer. For the validity and reliability of the Scale to Determine Factors Affecting Women's Breast Cancer Prevention Behaviors, explanatory factor analysis, confirmatory factor analysis, reliability and normality analysis were performed.
RESULTS: Cronbach alphas of each factor of the scale were calculated separatelly. It was determined that the Cronbach alpha coefficient of the scale was 0.76 and its sub-dimensions ranged between 0.70’ and 0.77’. Another method used in the reliability analysis of its scale was the split-half method. The relationship between the scores obtained from the two halves of the scale was calculated by the halving method and there was no statistically significant difference between the two halves (p>0.05).
DISCUSSION AND CONCLUSION: The results showed that this scale is a valid and reliable tool for evaluating the factors affecting women's breast cancer prevention behaviors both in practice and in future studies.

The every surgery requires positioning the patient, and there is a risk of injury for the patient in all surgical positions. The purpose of surgical positioning is to provide the optimum surgical field opening for the surgical team members by giving the appropriate position for the type of surgery and to prevent negative patient outcomes. Multidisciplinary teamwork, assessment of risk factors and planning process are among the important components of a safe surgical position. The positioning is as important as patient safety for the safety of the surgical team. Respiratory and cardiovascular problems, musculoskeletal problems, neuromuscular injuries, skin and tissue injuries that can cause permanent damage are among the complications that may develop in the patient due to the surgical position. In this article, evaluation and planning of surgical positioning, nursing practices to prevent surgical position-related injuries, the effects of surgical positions on systems and nursing practices were included.