GÝRÝÞ ve AMAÇ: Ýlaç aþýrý kullanýmý baþ aðrýsý (ÝAKB), migren ve gerilim tipi baþ aðrýlarýný izleyerek en sýk 3. baþ aðrýsý tipi olmasý ve iyatrojenik kökeni önemlidir. Amacýmýz, baþ aðrýsý ile baþvuran hastalar içerisinde ÝAKB sýklýðý, aðrý þiddeti ve eþlik eden psikiyatrik bozukluklarla iliþkisini deðerlendirmektir.
YÖNTEM ve GEREÇLER: Ýlaç aþýrý kullanýmý baþ aðrýsý olanlar ve ÝAKB olmayan olarak 2 hasta grubu oluþturuldu. Hastalarýn cinsiyeti, yaþý, baþ aðrýsý süresi, aylýk baþ aðrýsý atak sýklýðý, aylýk analjezik kullanýmý ve tipi, anksiyete ve depresyon varlýðý ve aðrý þiddeti açýsýndan deðerlendirildi.
BULGULAR: Ýlaç aþýrý kullanýmý baþ aðrýsý hastalarýnýn 38’sinde (%69,10) migren, 17’sinde (%30,90) gerilim tipi baþ aðrýsý hikayesi vardý. Hastalarda en sýk kullanýlan analjezik olarak 37 hastada (%67,28) olmak üzere parastemol + non-steroid antiinflamatuar saptandý. Ýlaç aþýrý kullanýmý baþ aðrýsý olan hastalarýn 33’ünde depresyon (%60) 12 ‘sinde (%21,82) anksiyete gözlendi. Ýlaç aþýrý kullanýmý olmayan 164 hastanýn 30’unda (%18,29) depresyon ve 42’sinde (%25,60) anksiyete gözlendi. Yaþ, cinsiyet, baþ aðrýsý süresi ve tipi her iki grup arasýnda anlamlý bir farklýlýk görülmedi. Baþ aðrýsý atak sýklýðý (aylýk), depresyon varlýðý ve aðrý þiddeti ÝAKB grubunda anlamlý olarak daha fazla idi.
TARTIÞMA ve SONUÇ: Bu hastalýðýn bilinmesi, öncelikle geliþmesinin önlenmesi açýsýndan, eðer geliþti ise de erkenden tanýnarak tedavisinin yapýlmasý açýsýndan önem taþýmaktadýr. Özellikle birinci basamak poliklinikleri baþvuran hastalarýn aþýrý analjezik kullanýmý açýsýndan farkýndalýðýnýn saðlanmasýnýn, ÝAKB görülme sýklýðýný azaltacaðýný düþünmekteyiz.

INTRODUCTION: Medication overuse headache (MOH) is the third most common type of headache following migraine and tension-type headaches, and its iatrogenic origin is important. Our aim is to evaluate the frequency of MOH, the severity of pain and its relation with comorbid psychiatric disorders among patients presenting with headaches.
METHODS: Two patient groups were formed: those with MOH and those without MOH. Patients' gender, age, headache duration, monthly headache attack frequency, monthly analgesic use and type, presence of anxiety and depression, and pain severity were evaluated.
RESULTS: 38 (69.10%) of the MOH patients had a history of migraine, and 17 (30.90%) of them had a tension headache. Paracetamol + non-steroidal anti-inflammatory was the most commonly used analgesic in 37 patients (67.28%). Depression was observed in 33 (60%) of the patients with MOH, and anxiety was observed in 12 (21.82%). Depression was observed in 30 (18.29%) and anxiety in 42 (25.60%) of the 164 patients who did not use medication excessively. There was no significant difference in age, gender, headache duration and type between the two groups. The frequency of attacks (monthly), presence of depression and pain severity were significantly higher in the MOH group.
DISCUSSION AND CONCLUSION: Knowing this disease is important primarily in terms of preventing its development and if it has developed, early diagnosis and treatment. We think that raising awareness of patients who apply to primary care polyclinics in terms of excessive analgesic use will decrease the incidence of MOH.

GÝRÝÞ ve AMAÇ: Bu çalýþmada RT-PCR testi sonucu negatif ancak toraks bilgisayarlý tomografi (BT) bulgularý COVID-19 ile uyumlu olan hastalarýn test sonuçlarýný ve bulaþtýrýcýlýk durumlarýný deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Çalýþma kesitsel, tanýmlayýcý bir araþtýrma olarak tasarlandý. Birinci grupta toraks BT COVID-19 pnömonisi ile uyumlu ve RT-PCR testi sonucu negatif olan hastalar ikinci grupta toraks BT COVID-19 pnömonisi ile uyumlu ve RT-PCR testi sonucu pozitif olan hastalar bulunmaktadýr. Toplanan veriler SPSS 21.0 yazýlým programý ile deðerlendirildi. Anlamlýlýk deðeri %5 olarak kabul edildi.
BULGULAR: Katýlýmcýlarýn %54,41'u erkek, %45,59'u kadýndý. Ýki grup arasýnda temas ortamý, saðlýk çalýþaný olma ve exitus olma açýsýndan anlamlý bir fark yoktu. Temas sayýsý açýsýndan birinci ve ikinci grup arasýnda fark yoktu. Ýkinci grupta örnek toplama oraný daha yüksekti. Hastalarla temaslý olan ve RT-PCR testi sonucu pozitif olanlarýn sayýsý birinci grupta daha yüksekti.
TARTIÞMA ve SONUÇ: Hastalar, COVID-19 için negatif RT-PCR test sonuçlarýna sahip olsalar bile bulaþtýrýcýdýrlar.

INTRODUCTION: This study aimed to evaluate the test results of patients whose RT-PCR test result was negative, but thorax CT findings were compatible with COVID-19 and their infectiousness in terms of contacts.
METHODS: The study was designed as cross-sectional, descriptive research. In the first group, thorax CT revealed findings compatible with COVID-19 pneumonia, and the RT-PCR test result was negative. In the second group, thorax CT revealed findings compatible with COVID-19 pneumonia, and the RT-PCR test result was positive. Data collected were assessed with SPSS 21.0 software program. The significance level was accepted as 5%.
RESULTS: Of the participants, 54.41% were male, and 45.59% were female. There was no significant difference between the two groups in terms of contact environment and status of being a healthcare worker and exitus. There was no difference between the first and second groups in terms of the number of contacts. The rate of sample collection was higher in the second group. The number of people who had contact with the patients and positive RT-PCR test results was higher in the first group.
DISCUSSION AND CONCLUSION: Even if patients have negative RT-PCR test results for COVID-19, they are still infectious.

GÝRÝÞ ve AMAÇ: Astým, yaþam kalitesini etkileyen, hava yolu aþýrý duyarlýlýðýyla iliþkili kronik hava yolu inflamasyonu ile karakterize bir hastalýktýr. Astým tedavisinde dünya genelinde kabul görmüþ tedavi kýlavuzlarý olmasýna raðmen çoðu hasta, hem tedavi sýrasýnda yaþanan sýkýntýlar ve yan etki korkularý hem de uzun süreli ilaç kullanma gibi nedenlere baðlý olarak Tamamlayýcý ve Alternatif Týp (TAT) yöntemlerini tercih edebilmektedir. Bu çalýþmada astým tanýsý ile takip edilen çocuklarda tamamlayýcý alternatif týp kullanýmýnýn ve ailelerin tutumlarýnýn belirlenmesi amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Tanýmlayýcý nitelikteki araþtýrma 3-17 yaþ arasýndaki astým tanýlý çocuklarda gerçekleþtirilmiþtir. Hasta yakýnlarýna, kullandýklarý TAT yöntemlerini belirlemek amacýyla anket formu uygulanmýþtýr. Ailelerinin tutumlarýný tespit edebilmek için Bütüncül Tamamlayýcý ve Alternatif Týbba Karþý Tutum Ölçeði uygulanmýþtýr.
BULGULAR: Aileler tarafýndan TAT yöntemlerinin en sýk “Hastalýk ile savaþmak için mümkün olan her þeyi yapmak” (%46,46) amaçlý tercih edildiði ve bu bilgiyi “aile üyeleri/ arkadaþ/komþu/yakýnlarýn” önerisi (%56,30) ile uyguladýklarý belirlendi. TAT yöntemlerini %66,53 oranýnda 1-6 ay arasýnda kullandýklarý ve bu yöntemin kullanýmýnýn %53,94 oranýnda tedavide baþarý saðladýðýný düþündükleri bulundu. Medikal tedaviden memnuniyetsizlik ve ümitsizlik yaþayan ailelerin ortanca 25 (20-39) puan ile tamamlayýcý ve alternatif týbba karþý pozitif tutumlarýnýn arttýðý ve istatistiksel olarak anlamlý olduðu belirlendi (p=0,035).
TARTIÞMA ve SONUÇ: Çocuklarýnda astým hastalýðý olan ailelerin TAT kullaným oranlarýnýn yüksek olduðu ve TAT kullanýmýna yönelik pozitif tutum sergiledikleri bulunmuþtur. Giderek artan oranlarda TAT kullanýmý, saðlýk çalýþanlarýnýn da bu konuda bilgi sahibi olma ihtiyacýný ortaya koymaktadýr.

INTRODUCTION: Asthma is a disease that affects the quality of life and is characterized by chronic airway inflammation associated with airway hypersensitivity. Although there are worldwide accepted treatment guidelines in the treatment of asthma, most patients use Complementary and Alternative Medicine (CAM) methods for many reasons, such as both insufficiencies in treatment and fears of side effects and long-term medication. This study aimed to determine the use of complementary & alternative medicine and the attitudes of families in children followed with the diagnosis of asthma.
METHODS: This descriptive study was carried out in children diagnosed with asthma between the ages of 3-17. A questionnaire was applied to the patients' relatives to determine CAM methods. The Holistic CAM Questionnaire was applied to determine the attitudes of their families.
RESULTS: It was determined by families that they prefer using CAM to “Do everything possible to fight the disease” (46.46%) and use this information with the recommendation “Family members/friends/neighbors/relatives” (56.30%). It was found that they used CAM methods 66.53% between 1-6 months, and they thought that the use of the CAM method achieved 53,94% success in treatment. It was determined that families with dissatisfaction and hopelessness from medical treatment had a positive attitude of 25 (20-39) with complementary and alternative medicine and were statistically significant(p=0.035).
DISCUSSION AND CONCLUSION: It was found that the use of CAM is high in families with asthma in their children and that they have a positive attitude towards CAM use. The increasing use of CAM shows the need for healthcare professionals to be informed about this issue.

GÝRÝÞ ve AMAÇ: Bel aðrýsý sýk görülen, kostalarýn alt sýnýrýyla aþaðý gluteal kývrýmlar arasýnda lokalize olabilen ve bacaklara da yansýyabilen sakatlýðýn önemli nedenlerinden biridir. Kayropraksi bel aðrýsýnda kullanýlan non invaziv ve ucuz bir tedavi metodudur. Çalýþmamýzýn amacý bel aðrýsýnda kayropraksi ve izometrik egzersizin aðrý ve fonksiyonellik üzerine etkisini deðerlendirmektir.
YÖNTEM ve GEREÇLER: Poliklinikte bel aðrýsý tanýsý almýþ hastalar çalýþmaya alýndý. 30 kadýn ve 30 erkekten oluþan 60 hasta randomize olarak iki gruba ayrýldý. Birinci gruba bel bölgesine kayropraksi uygulamasý ve bel izometrik egzersiz, ikinci gruba bel izometrik egzersiz programý oluþturuldu. Egzersiz programý her iki gruba da 4 hafta boyunca haftada 5 gün fizyoterapist tarafýndan yaptýrýldý. Kayropraksi tedavisi 4 hafta boyunca haftada 2 gün ayný doktor tarafýndan uygulandý. Uygulama sýrasýnda kayroprakside yüksek hýzlý düþük amplitüdlü manipülasyon tekniði kullanýldý. Tedavi öncesi ve sonrasý aðrýyý deðerlendirmek için VAS (Vizüel Aðrý Skalasý), fonksiyonel durumu deðerlendirmek için de Oswestry özürlülük indeksi uygulandý. Eklem hareket açýklýðý gonyometre ölçümü ile deðerlendirildi.
BULGULAR: Tedavi öncesi ve tedavi sonrasý VAS ve Oswestry deðerleri her iki grupta tedavi ile istatistiksel olarak anlamlý þekilde azalýrken beldeki eklem hareket açýklýðý deðerleri belirgin þekilde artmýþtý. Egzersiz ve kayropraksi alan hastalarda sadece egzersiz alan hastalara göre VAS istirahat, VAS hareket ve Oswestry deðerlerinin istatistiksel olarak anlamlý derecede daha düþük düzeylerde ve eklem hareket açýklýðýndaki artýþýn ise daha yüksek düzeylerde olduðu saptandý. Tedavi sýrasýnda herhangi bir yan etkiye rastlanmadý.
TARTIÞMA ve SONUÇ: Kayropraksi ve egzersizin bel aðrýsýnda aðrý ve fonksiyonellik üzerine etkili olduðunu ve birlikte uygulandýðýnda daha etkili olduðunu düþünmekteyiz.

INTRODUCTION: Low back pain that is localized between the inferior costal margin and inferior gluteal folds and that can reflect legs is a common health problem and a leading cause of disability. Chiropractic is a non-invasive and inexpensive treatment method used for low back pain. The aim of our study was to evaluate the effects of chiropractic and isometric exercises on pain and functionality related to low back pain.
METHODS: Patients diagnosed with low back pain in the policlinic examination were taken in the study. Sixty patients consisting of 30 females and 30 males were randomly divided into two groups. Chiropractic application and lumbar isometric exercise were created for the first group, and a lumbar isometric exercise program was created for the second group. The exercise program was applied to both groups five days a week for four weeks by a physiotherapist. Chiropractic treatment was applied by the same doctor two days a week for four weeks. During the application, a high-speed, low amplitude manipulation technique was used in chiropractic. Visual Analog Scale (VAS) was used to score pain, and Oswestry Disability Index (ODI) was used to evaluate functionality before and after treatment. The range of motion was evaluated by goniometer measurement.
RESULTS: VAS and ODI scores decreased statistically significantly with treatment in both groups, while the range of motion in the lumbar spine increased significantly before and after treatment. VAS rest, VAS motion, and ODI scores were statistically significantly lower, and the increase in range of motion was higher in patients who received exercise and chiropractic compared to patients who only received exercise. Any adverse effect did not appear in both groups during the treatment.
DISCUSSION AND CONCLUSION: We think that chiropractic and exercise are effective on pain and functionality in low back pain, and they are more effective when applied together.

GÝRÝÞ ve AMAÇ: Bu çalýþmada hipotiroidi nedeniyle levotiroksin alan hastalarda ilaç kullaným þeklinin, ilaca uyumun ve ilaç uyumunu etkileyen faktörlerin deðerlendirilmesi amaçlanmýþtýr.


YÖNTEM ve GEREÇLER: Primer hipotiroidi nedeniyle levotiroksin kullanan 18 yaþýn üzerindeki hastalar çalýþmaya dahil edilmiþtir. Hastalarýn demografik ve klinik özellikleri, levotiroksin kullanma alýþkanlýklarý anket yoluyla deðerlendirilmiþtir. Ýlaç uyumu, ilacý kullanmama/atlama sýklýðý sorusuna asla/nadiren cevabý verenlerde yüksek, ara sýra cevabý verenlerde orta, sýklýkla/çoðu zaman cevabý verenlerde düþük olarak tanýmlanmýþtýr.
BULGULAR: Çalýþmaya 282’si (%84,18) kadýn, 53’ü (%15,82) erkek toplam 335 hasta alýndý. Yaþ ortalamasý 47,36±12,50 idi. Hastalarýn 330’u (%98,50) levotiroksini sabah, 332’si (%99,10) aç karnýna alýyordu. 8 (%2,41) hasta ilacý yemekten hemen önce alýyordu, 66 (%19,88) hastada ilaçla yemek arasýndaki süre 15 dk. idi. Levotiroksin emilimini etkileyebilecek ilaç kullanan 145 (%45,03) hastadan %66,66’sý ilaç-levotiroksin arasýnda 2 saatten az süre býrakýyordu. Ýlaç uyumu 218 (%65,08) hastada yüksek, 98 (%29,25) hastada orta, 19 (%5,67) hastada düþüktü. Ýlaç uyumu ile demografik özellikler, hipotiroidi nedenleri, hastalýk süresi, kronik hastalýk varlýðý ve tiroid hormonlarý arasýnda iliþki saptanmadý. Ýleri eðitim düzeyi ve ailede tiroid hastalýðý varlýðý yüksek ilaç uyumu ile iliþkiliydi (sýrasýyla p=0,008 ve p=0,013).

TARTIÞMA ve SONUÇ: Bu çalýþmada hipotiroidi hastalarýnýn %34,92’sinin ilaç uyumunun düþük-orta düzeyde olduðu görülmüþtür. Hastalarýn %22,29’unun ilaçla yemek arasýnda yeterli süre býrakmadýðý, levotiroksin emilimini etkileyebilecek ilaç kullananlarýn da önemli bir kýsmýnýn iki ilaç arasýnda yeterli süre beklemediði saptanmýþtýr. Hipotiroidinin etkin tedavi edilmesi için hastalarýn hipotiroidi ve ilaç kullanýmý hakkýnda bilgilendirilmesi ve ilaç uyumunun arttýrýlmasý önemlidir.

INTRODUCTION: We aimed to evaluate adherence and determine the factors that are related to adherence in patients on levothyroxine therapy.
METHODS: Patients older than 18 years old and using levothyroxine for primary hypothyroidism were recruited. Demographical and clinical features, practices of using levothyroxine, and compliance were evaluated through a questionnaire. Those who answered the frequency of not using/skipping the drug as never/rarely, sometimes, and frequently/often were grouped as high, medium, and low adherence, respectively.
RESULTS: Data of 335 patients -282(84.18%) female and 53(15.82%)- male, with a mean age of 47.36±12.50 were analyzed. 330 (98.50%) patients were taking levothyroxine in the morning, and 332 (99.10%) were taking fast. 8(%2.41) patients were taking the drug just before the meal, and 66(19.88%) were taking it in 15 minutes. 66.66% of 145 patients using a medication that interferes with the absorption of levothyroxine were using it less than 2 hours of levothyroxine. There were 218 (65.08%) high, 98 (29.25%) medium and 19 (5.67%) low adherence patients. Drug adherence was not associated with demographical features, the cause and duration of hypothyroidism, the presence of comorbid disease, and thyroid hormones. Higher education level and familial thyroid disease were associated with high adherence (p=0.008 and p=0.013, respectively).
DISCUSSION AND CONCLUSION: Drug adherence was medium/ low in 34.92% of hypothyroid patients. A considerable amount of patients did not leave enough time between levothyroxine and meal or other medications. For effective treatment of hypothyroidism, it is important to inform patients about hypothyroidism and levothyroxine use and increase drug compliance.

GÝRÝÞ ve AMAÇ: Bu çalýþmada Ankara Ýl Saðlýk Müdürlüðü Saðlýk Hizmetleri Baþkanlýðý'nda saðlýk hizmeti sunan personelin COVID-19 hakkýndaki bilgi, tutum ve davranýþlarýný deðerlendirmek amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Kesitsel tipte olan çalýþmamýzýn verileri 26 Ekim-30 Kasým 2020 tarihleri arasýnda toplanmýþ ve evrenin %85’ine ulaþýlmýþtýr. Ýstatistiksel deðerlendirme sayý ve yüzde daðýlýmlarý ve ki-kare testi ile yapýlmýþtýr.
BULGULAR: Personelin bilgi puan ortalamasý ise 9,35±1,02 olarak bulunmuþtur. 10 bilgi sorusundan 7’si %91’in üzerinde doðru yanýtlanmýþtýr. Katýlýmcýlarýn %60,6’sý bilgi sorularýnýn tamamýný doðru cevaplamýþlardýr. Bilgi düzeyinde mesleðe göre ve öðrenim seviyesine göre istatistiksel anlamlý fark bulunmuþtur (p<0,001). Katýlýmcýlarýn %47,6'sý ise tam doðru davranýþ sergilemiþtir ve davranýþ düzeyinde mesleðe, cinsiyete ve eðitim düzeyine göre istatistiksel olarak anlamlý fark bulunmuþtur (p<0,05).
TARTIÞMA ve SONUÇ: Saðlýk dýþý meslek gruplarýnýn bilgi ve davranýþ düzeylerinin daha düþük olmasý göz önünde bulundurularak saðlýk alanýnda çalýþanlara yönelik kapsamlý hizmet içi eðitimler planlanarak pandemi ile mücadeleye katký saðlanmalýdýr.

INTRODUCTION: In this study, it was aimed to evaluate the knowledge, attitude, and practices of the personnel providing health services in the Department of Health Services in Ankara Provincial Health Directorate about COVID-19.
METHODS: The data of our cross-sectional type of study was collected between the dates of 26 October-November 30, 2020, and 85% percent of the pre-defined population was reached. Statistical evaluation was performed with number and percentage distributions and chi-square test.
RESULTS: The average knowledge score of the personnel was found to be 9.35±1.02. Out of 10 knowledge questions, 7 were answered correctly over 91%. 60.6% of respondents answered all knowledge questions correctly. A statistically significant difference was found in the level of knowledge according to profession and level of education (p<0.001). 47.6% of participants exhibited exactly the right practice, and a statistically significant difference was found in the level of practice by profession, gender and education level (p<0.05).


DISCUSSION AND CONCLUSION: Considering the lower level of knowledge and practice of non-health professional groups, comprehensive in-service training for health professionals should further contribute to the fight against the pandemic.

Dünya genelinde yaþam süresinin uzamasý nedeniyle evde bakým ve palyatif bakým ihtiyacý bulunan birey sayýsý artmaktadýr. Palyatif bakým sürecinde, hasta ve bakým verenlerin yaþam kalitesini etkileyen ve günlük yaþam aktivitelerine katkýda bulunabilecek ihtiyaçlarý tespit edilmelidir. Tüm dünyada hýzla yayýlan COVID-19 salgýný ve bu salgýnýn sosyal hayat üzerinde yaptýðý deðiþiklikler, kronik hastalýða sahip bireyleri ve/veya uzun dönem bakým hastalarýný etkilemiþtir. Palyatif bakým hastalarýnýn ve ailelerinin yaþadýklarý süreçler içerisinde gereksinimleri ve hizmet talepleri deðiþkenlik gösterebilir. Salgýn, toplumda saðlýk hizmet talebini arttýrmakta, saðlýk sistemleri üzerinde zorlayýcý etki oluþturmaktadýr. Bu durumda hastalarýn týbbi bakým izlemlerini gerçekleþtirebilmek için uzaktan eriþimli yardýmcý destek hizmetleri gündeme gelebilmektedir. Teletýp/Telesaðlýk uygulamalarý, týbbi hizmet sunumu açýsýndan hekim ile hastanýn yüz yüze görüþmesinin yerini tutmasa da kýrýlgan hasta gruplarýný özellikle bulaþ riskinden korumak ve bakým hizmetlerinin devamlýlýðýný saðlamak için bu uygulamalara ilgi gün geçtikçe artmaktadýr. Bu derlemede, pandemi sürecinde palyatif bakým ve evde bakýma ihtiyacý olan hastalarýn deðiþen bakým ihtiyaçlarýnýn tartýþýlmasý ve saðlýk taleplerinin daha az risk içerecek þekilde karþýlanabilmesine yönelik yeni araçlarýn kullanýmý gözden geçirilecektir.

Due to the prolonged life expectancy worldwide, the number of individuals in need of home care and palliative care is increasing. In the process of palliative care, the needs of patients and caregivers that affect the quality of life and can contribute to daily life activities should be identified. The COVID-19 pandemic, which is spreading rapidly all over the world, and the changes it has made to social life have affected individuals with chronic diseases and/or long-term care patients. The needs and service demands of palliative care patients and their families may vary during their processes. The epidemic increases the demand for health services in society and has a compelling effect on health systems. In this case, remote access auxiliary support services may be raised in order to carry out medical care monitoring of patients. Although tele-medicial/tele-health applications are not a substitute for a face-to-face meeting between physician and patient in terms of medical service delivery, interest in these applications is increasing day by day to protect vulnerable patient groups from the risk of transmission and to ensure the continuity of care services. In this review, the discussion of the changing care needs of patients in need of palliative care and home care during the pandemic process and the use of new tools to meet health demands in a way that includes less risk will be reviewed.

Osteoartrit (OA), eklemlerin tamamýnda tutuluma neden olabilen, eklem kýkýrdaðýnda ve subkondral kemikte harabiyete yol açan kronik ve dejeneratif bir kas iskelet sistemi hastalýðýdýr. OA daha çok diz ve kalça eklemi gibi büyük eklemleri etkilemekle birlikte, en sýk diz eklemini tutar. Prevalansý yaþla birlikte artmakta olup, en sýk 65 yaþ üstü hastalarda görülmektedir. OA etiyolojisi multifaktöriyel olup yapýsal ve mekanik nedenleri içermektedir. Tutulan eklemde aðrý, hareket kýsýtlýlýðý ve sonuç olarak fonksiyon kaybýna neden olduðu için çok sayýda hasta bu þikayetlerle hekime baþvurmaktadýr. OA tedavisinde amaç hastanýn þikayetlerini gidermektir. Güncel literatürde hasta bilgilendirilmesi ve eðitimi, diyet, analjezikler, nonsteroidal anti inflamatuvar ilaçlar (NSAID), fizik tedavi uygulamalarý, intra-artiküler enjeksiyonlar gibi konservatif tedaviler önerilmektedir. Bu gibi koruyucu tedaviler yeterli olmadýðýnda cerrahi tedavi düþünülebilir. OA, aile hekimlerine yaþam kalitesinde azalma ve aðrý þikayeti ile oldukça sýk baþvurulmaktadýr. Bizde güncel kýlavuzlar eþliðinde hasta eðitimi ile yaþam tarzý deðiþiklikleri oluþturabilecek danýþmanlýk hizmetleri vermeliyiz. Bu derlemede, birinci basamak saðlýk kuruluþuna baþvuran diz OA’lý hastalara yaklaþým, güncel tedavi rehberleri eþliðinde anlatýlmýþtýr.

Osteoarthritis (OA) is a chronic and degenerative musculoskeletal disease that causes involvement in all joints and destroys the articular cartilage and subchondral bone. Although OA mostly affects large joints such as the knee and hip joints, it most commonly affects the knee joint. Its prevalence increases with age, and it is most common in patients over 65 years of age. OA etiology is multifactorial. It includes structural and mechanical reasons. A large number of patients apply to the physician with these complaints because of the pain in the affected joint causes limitation of movement and consequently loss of function. The aim of OA treatment is to relieve the patient's complaints. Conservative treatments such as patient information and education, diet, analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, intra-articular injections are recommended in the current literature. When such conservative treatments are not sufficient, surgical treatment may be considered. OA is one of the major diseases that cause a decrease in the quality of life in primary care, and family physicians should focus on counseling in order to create patient education and lifestyle changes. In this review, the approach to patients with knee OA who applied to the Primary Healthcare Institution is explained in the light of current treatment guidelines.

Genç yaþ inme insidansýnýn artmýþ olmasý ilerde acilde genç yaþ iskemik inme geçiren hasta grubu ile sýk karþýlaþacaðýmýz anlamýna geliyor. Nörolojik bulgularý açýklayacak olasý hastalýklar dýþlanmadan konversiyon bozukluðu tanýsý koymak hastalarýn morbidite ve mortalite açýsýndan tehlikeli bir durum teþkil etmektedir. Burada akut stres ataðý sonrasý oluþan sol ektremitede kas gücü kaybý ile gelen 30 yaþýnda kadýn bir hasta sunulmuþtur. Erken taný ile giriþimsel iþleme alýnmýþ olup dramatik bir iyileþme saðlanmýþtýr. Bu yazýda, tanýda ayrýntýlý fizik ve nörolojik muayenenin hýzlý bir þekilde yapýlmasý ve tanýsal görüntülemenin erken yapýlmasýnýn önemi vurgulanmýþtýr.

Increased incidence of strokes in young adults could result in more emergency department visits for ischemic stroke evaluation. Diagnosing a young patient with neurological symptoms as conversation disorder without exploring other potential diagnoses can be detrimental and at times result in mortality. In our case, we present a 30-year-old female who develops left extremities weakness after a stressful event. In this case, early diagnosis and intervention provided a dramatic improvement in patients' health status and prognosis. This case emphasizes the importance of early neurological exams and imaging studies in the diagnosis of stroke.

Hastalarýn saðlýk hizmetlerine ulaþýmda zorluk yaþama sebeplerinden biri olan pandemi dönemlerinde, Diabetes Mellitus gibi prevalansý yüksek ve taný koyulmasý günümüzde kolay olan hastalýklarda dahi hastalarýn taný almasýnda gecikmeler yaþanabilmektedir. Ayný þekilde bu hastalarýn takiplerinde de pandemi dönemi kýsýtlamalarý nedeniyle zorluklar yaþanabilmektedir. Bu yazýda COVID-19 pandemi döneminde taný almada gecikmiþ 1 diabetes mellitus hastasý ve pandemi kýsýtlamalarý nedeniyle takiplerde zorluklar yaþamýþ olan 2 diabetes mellitus hastasýný birlikte sunduk.

Pandemic periods are one of the reasons patients have difficulty accessing healthcare services. Even diseases such as diabetes mellitus with a high prevalence and easy to diagnose today may delay the diagnosis of patients. Likewise, difficulties may be experienced in the follow-up of these patients due to pandemic period restrictions. We presented 1 diabetes mellitus patient delayed in diagnosis during the COVID-19 pandemic period and 2 diabetes mellitus patients who had difficulties in follow-up due to pandemic restrictions in this case reports.