GÝRÝÞ ve AMAÇ: 31 Aralýk 2019' da DSÖ Çin'in Wuhan þehrinde etiyolojisi bilinmeyen pnömoni vakalarý bildirmiþ ve 7 Ocak 2020’de etken yeni bir coronavirüs olarak tanýmlanmýþtýr. Hastalýk pandemi haline gelmiþtir. Salgýnda en önde çalýþan saðlýk personeli doktorlardýr. Bu çalýþma, birinci, ikinci ve üçüncü basamak hastanelerde çalýþan hekimlerin COVID-19 salgýný hakkýnda bilgi ve farkýndalýk düzeylerini belirlemek amacýyla yapýlmýþtýr.
YÖNTEM ve GEREÇLER: Kesitsel ve tanýmlayýcý bir araþtýrma olarak tasarlanan bu çalýþmaya Kayseri’de kamu hastanelerinde görev yapan tabip ve uzman tabipler dâhil edildi. 378 hekim ile elektronik ortamda anket çalýþmasý yapýldý. Hekimlerin sosyo-demografik özellikleri, meslek bilgileri, görev süreleri, COVID-19 salgýný ile ilgili bir eðitim alýp almadýklarý, virüsün mikrobiyolojik özellikleri ile ilgili sorular soruldu. Sonuçlarýn deðerlendirilmesi için istatistik anlamlýlýk düzeyi %5 olarak alýndý ve hesaplamalar için TURCOSA programý kullanýldý.
BULGULAR: Çalýþmaya katýlan 378 hekimin % 57,70’i erkek, % 42,30’u kadýndý. Hekimlerin medyan yaþý 35 (24-64) yýldý. Uzman hekimlerin pratisyenlere göre yaþlarý daha büyük ve görev süreleri daha uzundu.
Anketin yapýldýðý zamanda hekimlerin %47,80’i eðitim almýþ, %52,20’si eðitim almamýþtý.
Pratisyen hekimlerin bilgi düzeyi skoru medyaný 11 (7-17), uzman hekimlerin bilgi düzeyi skor medyaný ise 11 (5-16) olarak tespit edilmiþ olup, uzman ve pratisyen hekimler arasýnda bilgi düzeyi skoru açýsýndan anlamlý farklýlýk yoktu. Eðitim alanlar ile almayanlar arasýnda bilgi düzeyi skoru açýsýndan anlamlý bir farklýlýk vardý.
TARTIÞMA ve SONUÇ: Katýlan hekimlerin uzmanlýk alanlarýnýn COVID-19 hakkýnda farkýndalýk, üzerinde etkili olmadýðý asýl etkenin hekimlere verilen eðitimin olduðu görülmüþtür.

INTRODUCTION: On December 31, 2019, the WHO reported pneumonia cases of unknown etiology in China and on January 7, 2020, the causative agent was identified as a new coronavirus. The disease has become a pandemic. Physicians are the leading medical staff in the epidemic. This study was conducted to determine the knowledge and awareness levels of the physicians working in primary, secondary and tertiary hospitals about the COVID-19 outbreak.
METHODS: This study, was designed as a cross-sectional and descriptive study. A survey was conducted electronically to 378 physicians. Questions were asked about the physicians' demographic characteristics, occupational information, duration of employment, whether they got education on the COVID-19 outbreak and the microbiological characteristics of the virus. Statistical significance level was taken as 5% to evaluate the results and TURCOSA program was used for calculations.
RESULTS: Of the 378 physicians participating in the study, 57.70% were male and 42.30% were female. The median age of physicians was 35 (24-64) years. At the time of the survey, 47.80% of the physicians were trained and 52.20% were not trained. The median level of knowledge score of the general practitioners was 11 (7-17), and the median level of knowledge score of specialists was 11 (5-16), and there was no significant. There was a significant difference between the trained and non-trained physicians in terms of knowledge level score.
DISCUSSION AND CONCLUSION: We found that, attending physician’s speciality was not important on awareness about COVID-19. The most important factor was training on pandemic given to physicians.

GÝRÝÞ ve AMAÇ: Mevsimsel özellik gösteren ve yaygýn ve önemli bir saðlýk sorunu olan mantar zehirlenmelerinde erken (30dk-6 saat) baþlayan semptomlarda iyi sonlaným beklenirken; geç semptomlarda (6 saat sonrasý) ciddi komplikasyonlar için yüksek risk söz konusudur Amacýmýz 10 yýllýk süreçte acil servisimize baþvuran mantar zehirlenmelerinin epidemiyolojik olarak deðerlendirilmesi ve erken ve geç zehirlenmelerin farkýnýn araþtýrýlmasý, mortalite ve morbiditeye yol açan faktörlerin deðerlendirilmesidir.
YÖNTEM ve GEREÇLER: Haziran 2011-Haziran 2020 arasýnda acil servise mantar zehirlenmesi ile baþvuran 18 yaþ ve üstü hastalarýn verileri hastane bilgi yönetim sisteminden geriye dönük olarak tarandý. Tüm hastalarýn demografik bilgileri, laboratuvar bulgularý ve acil servis sonuçlanmasý deðerlendirildi.
BULGULAR: Çalýþmaya dahil edilen 163 hastanýn 90’ý (%55,20) erkekti. Hastalarýn yaþ ortancasý 46,00 (33,00-58,00) olarak belirlendi. Hastalarýn acil servise en çok geldiði ay Haziran’dý. 16 hastanýn baþ dönmesi, 14 hastanýn bilinç durum deðiþikliði semptomlarý vardý. Hastalarýn 87’sinin (%53,40) erken zehirlenmesi vardý. Erken zehirlenmeler ilkbahar, geç zehirlenmeler sonbahar mevsiminde daha çok baþvurmuþtur. Laboratuvar parametrelerinde geç zehirlenme grubunda ALT daha yüksek olarak belirlenmiþtir (p=0.003). Geç zehirlenmelerin %61,80’i, erken zehirlenmelerin %35,60’ý hastaneye yatýrýldý (p=0.005). Geç zehirlenmelerin 3’ünde böbrek yetersizliði, 1’inde dirençli enfektif tablo geliþmesine raðmen, hastalarýn taburcu olabildiði gözlendi.
TARTIÞMA ve SONUÇ: Erken dönemde taný konmasý, hastaneye ulaþýmýn kolay olmasý, tedavide yaþanan geliþmeler sayesinde mortalitenin azaldýðý düþünülmektedir. Mantar zehirlenmeleri çok sýk görülmese de önemli sonuçlarý nedeniyle acil serviste dikkat edilmesi gereken bir klinik tablodur. Bulantý, terleme, bilinç durum deðiþikliði gibi nonspesifik semptomlarla baþvuran hastalarda mantar yeme kesinlikle sorgulanmalýdýr.

INTRODUCTION: Mushroom poisoning has seasonal characteristics and is an important health problem. A good outcome is expected in the early period(30min-6 hours). There is a high risk of serious complications in late symptoms (after 6 hours). We aim to evaluate the epidemiological evaluation of fungal poisoning in 10 years period and to investigate the difference between early and late poisonings and the factors that cause mortality and morbidity.
METHODS: The data of patients aged 18 years and older who applied to the emergency department with mushroom poisoning between June 2011 and June 2020 were retrospectively evaluated.
RESULTS: We evaluated 163 patients, and 90 (55.20%) patient were male. The median age of the patients was determined as 46.00 (33.00-58.00). Patients most often applied in June. 16 patients had dizziness, 14 had altered mental status. 58 (53.40%) of the patients had early poisoning. Early poisonings were mostly applied in spring, late poisonings in the autumn season. ALT was determined to be higher in the late poisoning group (p = 0.003). 61.80% of late poisonings and 35.60% of early poisonings were hospitalized (p = 0.005). Patients could be discharged, although 3 of late poisonings developed kidney failure and 1 had a resistant infective picture.
DISCUSSION AND CONCLUSION: It is thought that mortality is reduced thanks to early diagnosis, easy access to the hospital, and improvements in treatment. In cases with nonspecific symptoms (such as nausea, sweating, change of consciousness), mushroom poisoning should be questioned.

GÝRÝÞ ve AMAÇ: Doðum eylemi, ciddi aðrýya yol açtýðý bilinen, bu sebeple belirgin stres, anksiyete ve hatta depresyona yol açabilen bir durumdur. Bu çalýþmamýzda doðumun ikinci evresinin aktif fazý sonu ile baþlayan ve epizyotomi onarýmýnýn tamamlanmasýna kadar geçen sürede, müzik dinletisinin, epizyotomi onarýmý sýrasýndaki aðrý ile anksiyete, stres ve depresyon düzeylerine olan etkisini araþtýrdýk.
YÖNTEM ve GEREÇLER: Çalýþmaya 2017-2019 yýllarý arasýnda vajinal doðum yapmasý planlanan 90 gebe hasta dahil edildi. Doðum eyleminin 1. evresinin aktif fazýnýn sonundan, restriktif mediolateral epizyotomi onarýmýnýn tamamlanmasýna kadar müzik çalýndý. Hastalar dinlenen müzik türüne göre rastgele üç gruba ayrýldý: Klasik müzik (n = 30), Türk pop müziði (n = 30) ve kontrol grubu (n = 30). Kontrol grubuna yalnýzca gürültüyü azaltan bir kulaklýk verildi. Stres, anksiyete ve depresyonu deðerlendirmek için DASS-42 ve aðrýyý deðerlendirmek için Görsel Analog Aðrý Ölçeði (VAS) kullanýlarak üç grubun sonuçlarý karþýlaþtýrýldý.
BULGULAR: Yapýlan deðerlendirmeler sonucunda gruplar arasýnda anksiyete ve depresyon skorlarýnda belirgin bir farklýlýk elde edilemese de; stres skorunun ikinci grupta anlamlý olarak düþtüðü görüldü. Fakat bu düþüþün aðýrlýklý olarak çalýþan ve çalýþmayan hastalar arasýndaki farktan kaynaklandýðý görüldü. Aðrý skorlarý arasýnda da anlamlý fark elde edilemedi.
TARTIÞMA ve SONUÇ: Stres skorlarýndaki iyileþme, hastalarýn anadillerinde çalýnan bir müziði dinlediklerinde daha dikkat çekici þekilde belirgindir. Müzik dinletisinin, epizyotomiye baðlý ortaya çýkan aðrýnýn dindirilmesinde ise beklendiði kadar etkin olmadýðý görülmüþtür.

INTRODUCTION: Labor is known to cause severe pain; therefore, it can lead to significant stress, anxiety, and even depression. We investigated the effect of listening to music from the end of the active stage of labor until the completion of episiotomy repair on pain, anxiety, stress, and depression levels.
METHODS: The study includes 90 pregnant patients that were planned to have vaginal delivery between 2017 and 2019. We played music starting from the end of the active phase of the 1sth stage of labor until the completion of the repair of restrictive mediolateral episiotomy. The subjects were randomly divided into three groups: classical music (n = 30), Turkish pop music (n = 30), and control group (n = 30). The control group was only provided with a headset that would reduce noise. We used DASS-42 to evaluate stress, anxiety and depression, and the Visual Analogue Scale for Pain (VAS) to evaluate pain. We compared the results of the three groups.
RESULTS: The anxiety and depression scores of the three groups were not significantly different; however, stress findings were significantly lower in the Turkish pop music group. We observed that this result was majorly associated to the working status of the mother. The pain results of the three groups were not significantly different.
DISCUSSION AND CONCLUSION: Music should be noted that this effect is especially prominent when the music is in the patient’s native tongue. Also, we conclude that playing music is not as effective as expected in relieving pain caused by episiotomy.

GÝRÝÞ ve AMAÇ: Kas-iskelet sistemi hastalýklarý, eklemleri, kemikleri ve kaslarý etkileyen ve uzun süreli dizabiliteye neden olan bir hastalýk grubudur. Bu çalýþmada kas iskelet sistemi aðrýsýnda bitkisel ürünlerin kullanýmýnýn incelenmesi amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Tanýmlayýcý kesitsel tipteki çalýþmaya Kasým 2019- Ocak 2020 tarihleri arasýnda polikliniðe kronik kas iskelet sistemi aðrýsý nedeniyle baþvuran 18 yaþ ve üzeri, bir haftadan uzun süre bitkisel ürün kullanýmý bildiren ve çalýþmaya katýlmayý kabul eden 98 birey dahil edildi. Bireylere sosyodemografik özellikler ve bitkisel ürün kullaným durumlarýnýn sorgulandýðý araþtýrmacýlar tarafýndan oluþturulan 26 maddelik soru formu uygulandý.
BULGULAR: Çalýþmada kas iskelet sistemi aðrýsý olan bireylerin bitkisel ürün kullaným sýklýðý %7,09 olarak bulundu. Bireylerin en sýk kullandýðý 6 ürün sýrasýyla; %19,38 at kestanesi jeli, %15,30 zeytin yaðý, %13,26 bamya tohumu, %10,20 çýnar yapraðý, %8,16 ardýç yaðý ve %7,14 çörekotu yaðý þeklinde tespit edildi. Bireylerin %57,14’ünün (n=56) bitkisel ürün kullanýmý sýrasýnda doktoru bilgilendirmeye gerek duymadýðý saptandý.
TARTIÞMA ve SONUÇ: Hastalarýn kas-iskelet sistemi aðrýlarýnda bitkisel ürün kullanýmýna baþvurduklarý açýktýr. Tedavi de kullanýlacak bitkilerden iyi sonuç elde edebilmek için ürünün uygun doz ve sürelerde, doðru endikasyonlarda, doðru zamanda kullanýmý, yan etkileri, ilaç etkileþimleri ile ilgili hastalar bilgilendirilmelidir. Doktor ve saðlýk personeline bitkisel ürün kullanýmý hakkýnda bilgi vermeleri konusunda hastalar cesaretlendirilmelidir.

INTRODUCTION: Musculoskeletal disorders are a group of disorders that affect the joints, bones, and muscles, causing long-term disability. The aim of the present study was to examine the usefulness of herbal products in musculoskeletal system pain.
METHODS: This descriptive sectional study included 98 individuals who applied to Outpatient Clinic with chronic musculoskeletal system pain, who were 18 years old and over, who had reported using herbal products for more than a week and who were willing to participate in the study. The individuals were subjected to a 26-item questionnaire form which was prepared by the authors and which questioned sociodemographic characteristics of the participants and their use of herbal products.
RESULTS: It was found that 7.09% of the individuals with musculoskeletal system pain used herbal products. The most common six products used by the individuals in decreasing order were horse chestnut gel (19.38%), olive oil (15.30%), okra seed (13.26%), plane tree leaves (10.20%), juniper oil (8.16%) and black cumin oil (7.14%). Of all individuals, 57.14% of them (n = 56) reported that they did not need to notify physicians about their herbal product use.
DISCUSSION AND CONCLUSION: It is clear that patients resort to the use of herbal products in musculoskeletal system pain. In order to have better outcomes with the herbal products used in therapy, patients should be informed about the proper dose, duration, indication and time, and side effects and drug interactions of herbal products. Patients should be encouraged about informing their physicians and healthcare providers about their use of herbal products.

GÝRÝÞ ve AMAÇ: Prematür yenidoðanlar, yaþayabilirlik sýnýrý olan 22 hafta üzerinde ve 37 hafta altýndaki bebekler olarak tanýmlanýr. Çalýþmada prematür bebeklerin ikinci ve üçüncü yaþtaki büyüme özelikleri incelenerek çocukluk çaðý obezitesine neden olabilecek etkenlerin deðerlendirilmesi ve böylece yetiþkin çaðda ortaya çýkabilecek metabolik hastalýklarýn erken dönemde önlenmesi amaçlandý.
YÖNTEM ve GEREÇLER: Araþtýrmanýn yapýsý retrospektif kohort çalýþmasý niteliðindedir. Çalýþma Mayýs 2018 - Ekim 2018 tarihleri arasýnda Rize ili Merkez ilçesine baðlý 18 farklý Aile Hekimliði Polikliniði’nde yürütülmüþtür. 3 yaþýný doldurmuþ ve bu yaþa kadar tüm izlemleri ayný aile hekimi tarafýndan yapýlmýþ 253 tane çocuk izlem kartý taranmýþtýr.
BULGULAR: Çalýþmaya alýnan bebeklerin ortalama doðum aðýrlýðý 2574,49±638,79 gr, ortalama boyu 46,20±4,12cm idi ve bebeklerin 123’ü (%54, 66) erkek, 102’si (%45,33) kýzdý. VKÝ (Vücut Kitle Ýndeksi) deðerlendirmelerine göre 2.yaþta 43 bebek (%19,11) fazla kilolu, 36 bebek (%16) obezdi. 3.yaþta ise 45 bebek (%20) fazla kilolu, 30 bebek (%13,33) obezdi. 2. yaþta obeziteyi etkileyen faktörler açýsýndan deðerlendirildiðinde, 2.yaþta obez olarak belirlenen bebeklerin anne hemoglobin deðerleri, diðerlerine göre anlamlý olarak daha düþüktü (p<0,001).
TARTIÞMA ve SONUÇ: DSÖ (Dünya Saðlýk Örgütü)’nün verilerine göre 2010 yýlýnda çocukluk çaðýnda fazla kilolu olma ve obezite sýklýðý %6,70 idi ve bu oranýn 2020 yýlýnda %9,10 olmasý beklenmektedir. Çalýþmamýzda beklenenin çok üzerinde olan fazla kilolu olma ve obezite sýklýðýnýn nedenleri araþtýrýldýðýnda beslenme durumlarý ve maternal faktörler açýsýndan anlamlý fark saptanmadý. 2.yaþta fazla kilolu olma ve obezite ile maternal anemi arasýnda anlamlý iliþki saptandý.

INTRODUCTION: Premature newborns are defined as babies born before 37 weeks of pregnancy and after 22 weeks of pregnancy as a viability limit. Aim of this study was to analyze growth characteristics at the age of second and third age and prevention of metabolic diseases that may occur in adult age at an early phase.
METHODS: This study was conducted as a retrospective cohort study between May 2018 and October 2018 in 18 different Family Medicine Outpatient Clinics in Rize, Central district. All participants were at least 3 years old and their follow-up visits made by the same family physicians for 3 years.
RESULTS: It was found that 54.66% of babies were males(n=123), 45.33% of them were females(n=102). According to BMI (Body Mass Ýndex) evaluations, 19.11% of babies were overweight(n=43), 16% of them were obese(n=36) at the age of two and 20% of them were overweight (n=45), 13.33% of them were obese(n=30) at the age of three. The mean Hb levels of the mothers whom children were obese at the age of two were statistically lower than the others (p<0.001).
DISCUSSION AND CONCLUSION: According to WHO, worldwide prevalance of childhood overweight and obesity was 6.70% in 2010 and it is expected to reach 9.10% in 2020. When we searched reasons of high overweight and obesity prevalance, there wasn't significant difference related with maternal factors and feeding patterns. We found significant relationship between maternal anemia and being overweight and obesity at the age of two.

GÝRÝÞ ve AMAÇ: Geriatrik popülasyonda yaþ ile deðiþen fizyoloji ile birlikte travmaya verilen vücut yanýtý da deðiþmektedir. Skorlama sistemleri birçok hasta grubu ve hastalýk üzerinde hastane yatýþý gerekliliði ve prognoz tahmini açýsýndan çalýþýlmaktadýr. Bu çalýþmada acil servise travma ile baþvuran 65 yaþ üstü hastalarýn demografik özelliklerinin belirlenmesini ve travmanýn oluþ þekli ile birlikte Revize Travma Skoru (RTS) deðerlendirilmesini amaçladýk.
YÖNTEM ve GEREÇLER: Çalýþma prospektif, kesitsel bir çalýþmadýr. 01/12/2017- 31/05/2018 tarihleri arasýnda bir üniversite hastanesi acil servisine baþvuran 65 yaþ ve üzeri travma hastalarý çalýþmaya dahil edildi. Hastalarýn demografik verileri, vital bulgularý, fizik muayene bulgularý, görüntüleme, laboratuvar sonuçlarý, eritrosit süspansiyonu (ES) ihtiyacý, hasta sonlanýmlarý ve hastane içi ve 28 günlük mortaliteleri kayýt edildi. Tüm hastalarýn RTS skorlarý hesaplandý.
BULGULAR: Çalýþma dönemi boyunca acil servise 4898 geriatrik hasta baþvurdu. Çalýþmaya alýnma kriterlerine sahip 229 hasta çalýþmamýza dahil edildi. Çalýþma hastalarýnýn 153’ ü (%66.81) kadýn olup yaþ ortancasý 79 (IQR 72-86) bulundu. Hastalarda en sýk komorbid hastalýk hipertansiyondu (n=109, %47.59). En sýk baþvuru þikâyeti düþmeydi. Hastalarýn RTS ortancasý 12 olarak bulundu. Hastalara ait son tanýlara bakýldýðýnda en sýk yumuþak doku travmasý (YDT) (31.87%) ve ikinci sýrada femur/kalça kýrýðý (23.58%) yer aldýðý görüldü. Hastalar RTS skorlarýna göre normal ve düþük olanlar karþýlaþtýrýldýðýnda düþük olan grupta Alzheimer/demans, geçirilmiþ inme varlýðý, eritrosit süspansiyonu ihtiyacýnýn ve mortalite oranýnýn daha fazla olduðu görüldü (sýrasýyla, p<0.001, p=0.002, p<0.001, p=0.002).
TARTIÞMA ve SONUÇ: Yaþam standartlarýnýn geliþmesiyle ülkemizde de yaþlý popülasyon giderek artmaktadýr. Buna baðlý olarak yaþlý popülasyonun travmaya maruz kalma olasýlýðý da yükselmektedir. Çalýþmamýzda hastalarýn en sýk mekanik veya non mekanik düþme nedeniyle acil servise baþvurduðu en sýk gözlenen yaralanma bölgesinin ekstremite/pelvis olduðunu ve RTS skoru düþük olan grupta Alzheimer/demans ve geçirilmiþ inme varlýðý, ES ihtiyacýnýn ve mortalite oranýnýn daha fazla olduðu gösterdik.

INTRODUCTION: In the geriatric population, body response to trauma changes with age-varying physiology. Scoring systems are studied in many patient groups and diseases in terms of hospitalization requirement and prognosis prediction. In this study, we aimed to determine the demographic characteristics of patients over 65 years of age who applied to the emergency department with trauma, and to evaluate the RTS score together with the form of trauma.
METHODS: The study is a prospective, cross-sectional study. Trauma patients aged 65 and over who applied to a university hospital emergency room between 01/12 / 2017- 31/05/2018 were included in the study. Demographic data, vital signs, physical examination findings, imaging, laboratory results, erythrocyte suspension (ES) requirement, patient outcomes, and in-hospital and 28-day mortality were recorded. RTS scores of all patients were calculated.
RESULTS: During the study period, 4898 geriatric patients applied to the emergency department. 229 patients with the inclusion criteria were included in our study. 153 (66.81%) of the study patients were women and the median age was 79 (IQR 72-86). The most common comorbid disease in patients was hypertension (n = 109, 47.59%). The most common complaint was to drop. The median RTS of the patients was found to be 12. When the last diagnoses of the patients were analyzed, it was seen that soft tissue trauma (YDT) (31.87%) and femur / hip fracture (23.58%) were the most common. Compared to normal and low patients according to RTS scores, it was observed that the group with low Alzheimer / dementia, presence of previous stroke, erythrocyte suspension requirement and mortality rate were higher (p <0.001, p = 0.002, p <0.001, p = 0.002, respectively).
DISCUSSION AND CONCLUSION: With the development of living standards, the elderly population is increasing in our country. Accordingly, the probability of the elderly population exposed to trauma also increases. In our study, we showed that the patients were admitted to the emergency room most frequently due to mechanical or non-mechanical fall, the most common injury area was extremity / pelvis, and the presence of Alzheimer's / dementia and previous stroke, ES requirement and mortality rate were higher in the group with low RTS score.

GÝRÝÞ ve AMAÇ: Saðlam çocuk takibi ülkemizde daha çok birinci basamakta görev yapan aile hekimleri ile bu çocuklarýn ebeveynleri tarafýndan yürütülmektedir. Çalýþmamýzýn amacý ailelerin saðlam çocuk takibi konusundaki sorumluluklarýna dikkat çekmek, farkýndalýðý arttýrmak ve saðlýk okuryazarlýk durumlarýyla iliþkisini tespit etmektir.
YÖNTEM ve GEREÇLER: Araþtýrma, kesitsel tanýmlayýcý ve gözlemsel bir anket çalýþmasýdýr. Ankara ilindeki bir Aile Saðlýðý Merkezinde(ASM), saðlam çocuk takibinin en sýk olarak yapýldýðý 0-5 yaþ arasý çocuðu olan ebeveynler üzerinde bu çalýþma yapýlmýþtýr. Çalýþmamýzýn evrenini oluþturan 648 aile çalýþmaya davet edilmiþtir.Veri toplama aracý olarak çalýþmaya özgün yapýlandýrýlmýþ bir anket formuyla ebeveynlerin saðlýk okuryazarlýðýný ölçmek amacýyla Türkiye Saðlýk Okur Yazarlýk Ölçeði(TSOY-32) kullanýlmýþtýr. Gerekli izinler alýndýktan sonra anket formu yüz yüze anket uygulama yöntemiyle doldurulmuþtur.
BULGULAR: Araþtýrmaya katýlmayý kabul eden 269 aileden birer ebeveyn çalýþmaya dâhil edildi.Tüm katýlýmcýlarýn TSOY-32 toplam puaný ortancasý 32,3 olarak hesaplandý ve “sýnýrlý-sorunlu” saðlýk okuryazarlýk grubuna dâhil olduðu görüldü. Saðlýk okuryazarlýk puanlarýnýn eðitim düzeyi yüksek, gelir düzeyi iyi ve çalýþan ebeveynlerde anlamlý derecede daha fazla olduðu saptandý. Çocuðunun takip ve izlemlerini “düzenli olarak kendi yaptýran” ebeveynlerin, "doktor çaðýrýnca izlemlerini yaptýran” ebeveynlerden daha yüksek saðlýk okuryazarlýk toplam ve bileþen puanlarýna sahip olduðu tespit edildi.
TARTIÞMA ve SONUÇ: Ailelerin saðlýk okuryazarlýk bilgi düzey puanlarý beklenenden düþük saptandý. Bu çalýþma saðlýklý bir toplum inþasý için saðlýk okuryazarlýðýnýn saðlýk ile ilgili sorumluluk bilinci ile iliþkili bir faktör olduðunu gösterdi. Ayrýca ASM’lerde saðlam çocuk takibi konusunda yapýlmasý gerekenler açýsýndan ailelerde farkýndalýk oluþturmuþ olup tespit edilen eksik konularda daha dikkatli, saðlýklý ve bilinçli bir takip yapýlmasýna dair literatüre katký sunmuþtur.

INTRODUCTION: Healthy child follow-up is mostly carried out by family physicians working in primary care and their parents.The aim of our study is to draw attention to the responsibilities of families in healthy child follow-up, to raise awareness and to determine their relationship with health literacy situations.
METHODS: The study was planned as an observational and cross-sectional survey.It was carried out on parents with children between the ages of 0-5 years followed up in a family health center in Ankara.648 families were invited to study.We developed a structured questionnaire and used Turkey Health Literacy Scale(TSOY-32) in order to measure the parents' health literacy.After obtaining the necessary permissions, the questionnaire was filled through the face-to-face questionnaire application method.
RESULTS: 269 families agreed to participate in the study.The median score of total TSOY-32 was calculated as 32.3 and it was included in the “limited-problematic” health literacy group.It was determined that the TSOY-32 scores were significantly higher in high education and good income levels and among working parents.It was determined that the parents who “regularly make their children’s follow-ups by themselves” have higher health literacy total and component scores than the parents who “follow-up by their doctor’s calling”.
DISCUSSION AND CONCLUSION: Health literacy knowledge level scores of the families were lower than expected.Health literacy is an important factor in raising awareness of health-related responsibilities for building a healthy society.This study has made awareness among families in terms of what to do about child follow-up,and contributed to the literature on a more careful,healthy and conscious follow-up on the identified issues.

GÝRÝÞ ve AMAÇ: Toplumda sýk görülen tiroid nodüllerinin deðerlendirilmesinde aþýrý taný kapsamýnda deðerlendirilebilecek tetkikler istenebilmektedir. Serum kalsitonin düzeyi aslýnda medüller tiroid kanseri (MTK) tanýsý için duyarlý ve özgül bir yöntemdir. Bethesda kategori III (önemi belirsiz atipi-ÖBA) sitolojisi olan hastalar klinik ve sonografik olarak yüksek riskli ise tiroidektomi açýsýndan deðerlendirilebilir. Bu çalýþmamýzda Tiroid Ýnce Ýðne Aspirasyon sitolojisi Bethesda I ve III kategorisinde olan hastalarýmýzda retrospektif deðerlendirme ile serum kalsitonin ile taramanýn deðerini irdelemeyi amaçladýk.
YÖNTEM ve GEREÇLER: Kliniðimizde 2007-2018 tarihleri arasýnda tiroidektomi yapýlan hastalar arasýndan preoperatif serum kalsitonin düzeyi bakýlan hastalarýn sitoloji ve histopatoloji sonuçlarý retrospektif olarak deðerlendirildi.
BULGULAR: Opere olan 6905 hasta içinde serum kalsitonin bakýlan hasta sayýsý 881 olarak saptandý. Kalsitonin deðerleri <2, 2-10 ve >10 pg/mL olarak 3 ayrý grupta (sýrasýyla; Grup 1,2 ve 3) sýnýflandýrýldý. Bu hastalarýn 217’si (%24,6) tanýsal olmayan (TO), 275’i (%31,2) ÖBA idi. TO ve ÖBAlý hastalarda cinsiyet daðýlýmý benzerdi (p=0,7). TO hastalarýnýn % 84,8’inde kalsitonin düzeyleri 1. grupta, %14,3’ünde 2. grupta ve %0,9’u 3. grupta yer alýrken, ÖBA’lý hastalarýn %82,9’u 1. grupta, %15,6’sý 2. grupta ve %1,5’i 3. grupta yer alýyordu (p=0,786). ÖBA olan hastalarýn %30’unda histopatolojide malignite saptanýrken, ND grubundaki hastalarýn %11,6’sýnda malignite saptandý (p=0,006). Histopatolojide malign saptanan hastalarda kalsitonin deðerlerinin %82,9’u 1. grupta, %15,4’ü 2. grupta ve %1,7’si 3. grupta iken benign saptanan hastalarla kýyaslandýðýnda bu oranlar benzerdi (p=0,16). Çalýþmada 2 kadýn hastanýn kalsitonin düzeyleri çok yüksekti (144 pg/mL ve 655 pg/mL). Ýki hastanýn da preoperatif sitolojisi ÖBA ve histopatolojisi maligndi.
TARTIÞMA ve SONUÇ: Özellikle Bethesda Kategori III tiroid nodüllerinde cerrahi kararý verirken hem tiroidektominin tipini belirlemek hem de takip seçeneði tercih edildiðinde serum kalsitonin düzeyini bilmenin faydalý olabileceðini düþünmekteyiz.

INTRODUCTION: The overdiagnostic analyses can be performed for evaluation of thyroid nodules which are commonly seen pathology in the population. Diagnostic tests in the evaluation of thyroid nodules, commonly-seen pathology in the population, mostly cause overdiagnosis. In fact, serum calcitonin(SC) measurement is a sensitive and specific method in the diagnosis of medullary thyroid cancer(MTC). If the patients with Bethesda Category III(atypia of undetermined significance -AUS) cytologies have also high risk clinical and ultrasonographical features, they can be evaluated for thyroidectomy. In this study, we aimed to evaluate the value of screening with serum calcitonin in patients with cytologies of Bethesda I and III categories.
METHODS: The medical records of patients who had thyroidectomy between 2007-2018 were screened retrospectively. The patients with preoperative calcitonin, cytology results and postoperative histopathology reports were included in the study.
RESULTS: Of the 6905 thyroidectomized patients, 881 had SC values. SC levels were evaluated as <2, 2-10 and >10pg/mL and classified as Group 1, 2, and 3; respectively. 217 patients(24.6%) had nondiagnostic(ND) and 275(31.2%) had AUS cytologies. The gender distribution was similar between ND and AUS groups(p=0.7). However, SC levels of group 1, 2, and 3 were found in 84.8%, 14.3%, and 0.9% of patients with ND, it was found in 82.9%, 15.6%, and 1.5% in patients with AUS cytologies, respectively(p=0.786). In histopathology, malignancy was detected in 30% of patients with AUS and 11.6% patients with ND(p=0.006). Calcitonin levels of patients with malignant histopathology were evaluated in 82.9%, 15.4%, and 1.7% of patients as Group 1, 2, and 3, respectively. This was similar compared to patients with benign histopathology (p=0.16). In the present study, 2 female patients had high calcitonin levels(144pg/mL and 655pg/mL). Both patients had preoperative AUS cytologies and final malignant histopathologies.
DISCUSSION AND CONCLUSION: We think that preoperative assessment of serum calcitonin levels can be useful in treatment decision of patients especially with Bethesda Category III thyroid nodules such as in follow-up and extent of surgery for cases planning surgery.

GÝRÝÞ ve AMAÇ: Her gün hasta-hastalýk kavramlarý ile yüzleþen týp öðrencilerinin saðlýk algýsý ve kaygýsýnýn bilinmesi önemlidir. Çünkü hekimlerin saðlýk algýlarý kendileri için saðlýklý yaþam davranýþlarý oluþturma, hastalarýný anlama ve yardým etme süreçlerini etkilemektedir. Bu çalýþmanýn amacý týp fakültesi ile sosyoloji ilk üç sýnýf öðrencilerinin saðlýk algýsý ve saðlýk kaygýsý düzeylerini iki üniversite örneðinde belirleyip karþýlaþtýrmaktýr.
YÖNTEM ve GEREÇLER: Kesitsel, tanýmlayýcý çalýþmada Edebiyat Fakültesi Sosyoloji Bölümü ile Meram Týp Fakültesi öðrencilerine gönüllülük temelinde demografik sorular, Saðlýk Algýsý Ölçeði (SAÖ) ile Saðlýk Kaygýsý Ölçeðini (SKÖ) içeren bir anket formu uygulandý. Verilerin analizinde frekans, yüzde, ortalama, baðýmsýz t testi, One way Anova ve korelasyon testleri kullanýldý. p<0,05 anlamlý kabul edildi.
BULGULAR: Çalýþmada eksiksiz doldurulmuþ 345 anket formu deðerlendirildi. Yaþ ortalamasý 19,84 ±1,69 yýl olan grubun 107’si (%31) sosyal alanlarda okuyan öðrenci, 235’i (%68) kadýn, 87’si (%25) kýrsal kökenli, 259 (%75,7) orta gelir düzeyine sahipti. Tüm öðrencilerin ortalama SAÖ puaný 50,17±5,66, ortalama SKÖ puaný 17,59±5,78 puandý. Týp fakültesi öðrencilerinin SAÖ puaný 49,41±5,62 ve sosyoloji öðrencilerinin 51,86±5,41 olan puanýndan anlamlý düzeyde düþüktü (p=0,000). Ortalama SKÖ puaný sýrasýyla týp ve sosyoloji öðrencileri için 17,97±5,63 ve 16,74±6,05 puan ile týp öðrencilerinde yüksek ancak fark anlamlý deðildi (p=0,068). Benzer þekilde cinsiyetler arasýnda ortalama SAÖ puanlarý anlamlý farklý olmasýna karþýn (p=0,019)ortalama SKÖ puanlarý açýsýndan fark yoktu (p=0,206).
TARTIÞMA ve SONUÇ: Týp fakültesinde okuyan öðrencilerin saðlýk algýsýnýn anlamlý olarak daha düþük, saðlýk kaygýlarýnýnsa anlamlý olmasa da daha yüksek olmasý önemli ve ileri araþtýrma gereken bir sonuçtur.

INTRODUCTION: It is important to know medical students' perception and anxiety who confronts patient-disease concepts every day. Because, physicians' health perceptions are creating healthy living behaviors for them, affecting the process of helping and understanding their patients. This study aimed to compare first three grade students of the faculty of medicine and sociology thus determining the health perception and health anxiety levels in two university examples.
METHODS: In this cross-sectional, descriptive study, Faculty of Letters, Department of Sociology and Faculty of Medicine's volunteer students took a questionnaire including demographic questions, Health Perception Scale (HPS) and Health Anxiety Scale (HAS). For statistics frequency, percentage, mean, independent t-test, One-way Anova and correlation tests were used. p<0.05 was considered significant.
RESULTS: In the study, 345 questionnaire forms were evaluated. The mean age was 19,84±1,69, which included 107(%31)sociology students, 235(%68)women, 87(%25) of rural origin, and 259(%75,70) of middle income. Mean HAS and HPS scores were 50.17 ± 5.66 and 17.59 ± 5.78. Medical students HAS score (49.41 ± 5.62) was significantly lower than sociology students' score (51.86 ± 5.41) (p= 0.000). The mean HPS for medical and sociology students were 17.97 ± 5.63 and 16.74 ± 6.05, respectively. High in medical students but not significant (p=0.068). Although mean HAS scores differ significantly between genders (p=0.019), HPS scores doesn’t (p=0.206).
DISCUSSION AND CONCLUSION: Significantly lower perception of health of students studying in medical school, health anxiety, though not significant, is important, and further research is required.

GÝRÝÞ ve AMAÇ: Ülkemizde birinci basamak saðlýk hizmetleri yürütümünde önemli bir yere sahip olan aile hekimlerinin ve hastalarýnýn saðlýkta iletiþim yetkinlikleri, koruyucu ve tedavi edici saðlýk hizmeti uygulamalarýnda hem zamandan hem de ekonomiden kazanç saðlayacaktýr. Ancak ülkemizde bu yetkinliði deðerlendirecek bir ölçek kullanýlmamaktadýr. Bu nedenle araþtýrmamýzda “Saðlýk Ýletiþiminde Yetkinlik Ölçeði”nin Türkçe geçerlilik ve güvenilirliðinin uygulanmasý amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Toplam 253 hasta ve 253 aile hekiminin anketi analize alýnmýþtýr. Açýmlayýcý Faktör Analizi uygulamasý için örneklem büyüklüðünün yeterliliðini ölçmek için Kaiser-Meyer-Olkin (KMO) istatistiði uygulanmýþtýr. Güvenilirlik analizi için elde edilen faktörlerin “Cronbach alfa” deðerleri hesaplanmýþtýr.
BULGULAR: Saðlýk Ýletiþiminde Yetkinlik Ölçeði temel birleþenler analizi adýna hekimlerin öz yetkinliklerine ait üzere 1,00’den büyük özdeðere sahip iki faktör, hekimlerin hastalarýn yetkinliklerini deðerlendirmelerine ait iki faktör, hastalarýn öz yetkinliklerine ait üç faktör, hastalarýn hekimlerin yetkinliklerini deðerlendirmelerine ait üç faktör elde edilmiþtir.
TARTIÞMA ve SONUÇ: Hekimlerin saðlýk iletiþiminde yetkinlik ölçeðinin özyetkinlik-faktör 1 ifadelerinin Cronbach alfa deðeri 0,95; özyetkinlik-faktör 2 ifadelerinin Cronbach alfa deðeri 0,97; diðer yetkinlik faktör 1 ifadelerininki 0,94; diðer yetkinlik faktör 2 ifadelerininki ise 0,95 olmak üzere oldukça yüksek bulunmuþtur. Hastalarýn saðlýk iletiþiminde yetkinlik ölçeðinde de benzer þekilde yüksek Cronbach alfa deðerleri bulunmuþtur.

INTRODUCTION: Health communication competencies of the family physicians and patients in our country, who have an important role in the execution of primary health care services, will yield time efficiency and economic benefits in the implementation of preventive and curative health services. However, there is no scale to assess that competency in our country. Therefore, validity and reliability of the “health communication competency scale” in Turkey is to be applied in this research.
METHODS: The questionnaire of 253 patients and 253 family physicians were analyzed. Kaiser-Meyer-Olkin (KMO) statistics were used to measure the adequacy of the sample size for the Exploratory Factor Analysis application. “Cronbach alpha” values of the factors obtained for reliability analysis were calculated.
RESULTS: Health Communication Competence Scale has yielded (a) two factors in terms of analysis of basic components related to the self competencies of the physicians with Eigen value bigger than 1, (b) two factors in terms of the of the physicians’ evaluation of the patients’ competences, (c) three factors in terms of the self competences of the patients, (d) three factors in terms of patients’ evaluation of the physicians’ competences.
DISCUSSION AND CONCLUSION: Cronbach's alpha value for physicians’ competence in health communication is found quite high in self competence factor 1: 0.95, self competence factor 2: 0,97, other competence factor 1: 0,94, other competence factor 2: 0,95. Cronbach's alpha value for patients’ competence in health communication is found quite high like physicians’.

GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý, Ankara Ýli Eðitim ve Araþtýrma Hastanelerinde aile hekimliði asistanlarý dýþýnda eðitim gören asistan doktorlarýn akýlcý ilaç kullanýmý ile ilgili bilgi, davranýþ ve tutumlarýný belirlemektir.
YÖNTEM ve GEREÇLER: Çalýþmada, Ankara'da Eðitim ve Araþtýrma Hastanelerinde aile hekimliði asistaný olmayan 180 araþtýrma görevlisi yer aldý. Akýlcý ilaç kullanýmýnýn bilgi ve tutum düzeyini deðerlendirmek için hekimlere 27 soruluk bir anket verildi.
BULGULAR: laç reçete ederken, doktorlarýn % 65,6'sý (n = 118) hastanýn tedaviye cevabýnýn nasýl ve hangi þekilde olabileceðini açýklamaktadýr. Hekimlerin % 41,7'si (n = 75) hastalarýný muayene etmeden asla reçete yazmamaktadýr. Hekimlerin ilaçlar hakkýndaki bilgi düzeyini deðerlendiren sorular arasýnda, hekimlerin kendilerini en yeterli bulduklarý ilaçlarla ilgili (% 18,9, n = 31) ve günlük dozla ilgili (% 18,3, N = 30) sorular, hekimlerin en az yeterli bulduklarý sorular ise ilaç fiyatýna iliþkin sorulardý (% 10,4, n = 17). En sýk reçete edilen 3 ilaç grubu; % 35,3 oranýnda antibiyotik, % 18,7 oranýnda analjezik ve % 12,8 oranýnda PPI idi. Hekimlerin % 2,2'si (n = 4) akýlcý ilaç kullanýmý açýsýndan çok yeterli olduðunu düþünürken, % 35,8'i (n = 64) yeterli olduðunu, % 54,2'si (n = 97) orta düzeyde yetkinliðe sahip olduðunu ve % 7,8 (n = 14) akýlcý ilaç kullanýmýnda yetersiz olduklarýný düþünmektedir.
TARTIÞMA ve SONUÇ: Akýlcý ilaç kullanýmý bilincini artýrmak için örgün ve yaygýn eðitim yöntemlerinin uygulanmasýna devam edilmeli ve geliþtirilmelidir. Eðitime ek olarak, öðrenilmiþ tutum ve davranýþlarý korumak ve desteklemek için gerekli idari düzenlemeler yapýlmasý gerektiði düþüncesindeyiz.

INTRODUCTION: The aim of this study was to determine the knowledge, behavior and attitudes of resident doctors training in the Research and Training hospitals of Ankara Province, except Family Medicine Residents.
METHODS: The study included 180 research assistants, a 27-question questionnaire was given to the physicians to evaluate the level of knowledge and attitudes about rational drug use.
RESULTS: While prescribing drugs, 65.6% of the physicians (n = 118) described how and which way the patients’ response to treatment can be. 41.7% (n = 75) of the physicians never prescribed their patients without examination. Among the questions that assess knowledge level of physicians on drugs, the questions with which physicians found themselves most sufficient were related to drug indication (%18,9, n=31) and daily dose (%18.3, N=30); on the other hand the questions with which physicians found themselves least sufficient were related drug prices (%10,4, n=17). Of the physicians, 2.2% (n = 4) thought that they were very sufficient in terms of rational drug use, whereas 35.8% (n = 64) thought that they were sufficient, 54.2% (n = 97) thought that they had moderate competence and 7.8% (n = 14) thought that they were insufficient in rational drug use.
DISCUSSION AND CONCLUSION: In addition to education in rational drug use, the necessary administrative arrangements should be made to protect and support learned attitudes and behaviors. Therefore, in order for physicians to reach objective information, pre- and post-graduate education in our country should be reviewed.

GÝRÝÞ ve AMAÇ: Ortalama trombosit hacmi (OTH), kýrmýzý kan hücresi daðýlým geniþliði (KKDG), nötrofil-lenfosit oraný (NLO) ve lenfosit-monosit oranýnýn (LMO) arteryel istenmeyen olaylar için öngördürücü olduðu bilinmesine raðmen derin ven trombozu (DVT) tanýsýnda yerinin olup olmadýðý net deðildir. Bu çalýþmanýn amacý bunu deðerlendirmektir. Bu amaçla OTH, KKDG, NLO ve LMO normal saðlýklý populasyonda ve DVT tanýsý almýþ hastalarda ölçülerek karþýlaþtýrýlmýþtýr.
YÖNTEM ve GEREÇLER: Çalýþma geriye dönük planlandý. Akut DVT tanýsý konulmuþ 77 hasta ve 67 saðlýklý gönüllünün OTH, KKDG, NLO ve LMO deðerleri kaydedildi ve arada istatistiksel anlamlý fark olup olmadýðý deðerlendirildi. Ek olarak hasta grubunda bu hematolojik parametreler ile baþvuru anýndaki D-dimer deðerleri arasýnda korelasyon olup olmadýðý araþtýrýldý.
BULGULAR: Hasta grubunda OTH, KKDG ve NLO deðerleri kontrol grubuna göre istatistiksel anlamlý olarak daha yüksekti (9,68±1,89 vs. 8,9±1,01, p=0,003, 12,77±3,67 vs. 11,15±2,16, p=0,002 ve 1,91±0,84 vs. 1,51±0,54, p=0,001, sýrasýyla). Lenfosit-monosit oraný ise hasta grubunda daha düþük bulundu (6,27±3,14 vs. 8,85±3,92, p<0,001). D-dimer ile OTH, KKDG ve NLO arasýnda pozitif, LMO ile ise negatif yönlü korelasyon bulundu (r=0,693, p<0,001, r=0,896, p<0,001, r=0,798, p<0,001 ve r= -0,287, p=0,011, sýrasýyla)
TARTIÞMA ve SONUÇ: Akut DVT hastalarýnda OTH, KKDG, NLO saðlýklý populasyona göre artmýþ, LMO ise azalmýþtý. Bu bulgular bize bu belirteçlerin akut DVT tanýsýnda yardýmcý olabileceðini düþündürebilir.

INTRODUCTION: Although it is known that mean platelet volume (MPV), red blood cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) are predictive for arterial trombosis and adverse events, it is not clear whether they help in the diagnosis of deep vein thrombosis. The aim of the study was to evaluate it. For this purpose MPV, RDW, NLR and LMR were measured and compared between in patients with DVT and control groups.
METHODS: In a retrospective study, a total of 144 subjects (77 patients with DVT, 67 control) were examined. Mean platelet volume, RDW, NLR and LMR were calculated and compared between the groups. It was investigated whether there was a correlation between D-dimer values and MPV, RDW, NLR, LMR.
RESULTS: Mean platelet volume, RDW and NLR values were significantly higher in the patient group than in the control group (9.68±1.89 vs. 8.9±1.01, p=0.003, 12.77±3.67 vs. 11.15±2.16, p=0.002 and 1.91±0.84 vs. 1.51±0.54, p=0.001, respectively). On the other hand LMR was lower in the patient group (6.27±3.14 vs. 8.85±3.92, p<0.001). There was a positive correlation between D-dimer and MPV, RDW, NLR while there was a negative correlation between D-dimer and LMR (r=0.693, p<0.001, r=0.896, p<0.001, r=0.798, p<0.001 and r = -0.287, p=0.011, respectively).
DISCUSSION AND CONCLUSION: Mean platelet volume, RDW and NLR increase but LMR decrease in patients with DVT. These results suggesting that these markers may help in the diagnosis of acute DVT.

GÝRÝÞ ve AMAÇ: Ortalama trombosit hacmi (MPV) trombosit aktivasyonunun bir indeksidir. Bu çalýþmada, göðüs hastalýklarý bölümüne baþvuran KOAH ve kardiyovasküler hastalýk olan hastalar ile MPV arasýndaki iliþkiyi deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Sigara içen 535 (%71.80 ve sigara içmeyen, 210 (%28.20) hasta MPV ve diðer parametrelerle karþýlaþtýrýldý.
BULGULAR: Sigara içenlerde beyaz kan hücrelerinin (Wbc), hemoglobin (Hgb) ve Hematokrit (Htc) düzeyleri sigara içmeyenlere gore istatistiksel olarak anlamlý derecede yüksekti (p<0.001).
Sigara içenlerde MPV düzeyleri, sigara içmeyenlere gore istatistiksel olarak yüksekti [MPV seviyeleri, 10.10 (8-14.20), 9.60 (6.40-11.80), sýrasýyla p<0.001]. Sigara içenlerde 106 KOAH hastasý vardý. KOAH hastalarý ve KOAH’lý olmayan ve sigara içmeyen hastalar arasýnda trombosit ve MPV düzeyindeki farklýlýklar istatistiksel olarak anlamlýydý [10.20 (8.30-14), 9.60 (6.40-11.80), sýrasýyla p=0.001]. Ayrýca, kardiyovasküler komorbiditeleri (CVC) olan KOAH hastalarýnýn MPV seviyeleri, CVC’siz hastalardan daha yüksekti.
TARTIÞMA ve SONUÇ: Bu çalýþmada sigara içenlerde ve KOAH hastalarýnda sigara içmeyenlere gore daha yüksek MPV ve daha yüksek trombosit deðerleri gösterilmiþtir. Sonuç olarak yüksek MPV düzeylerinin KOAH’lý hastalarda tromboza eðilimi artýrabileceði düþünülmüþtür. Bununla birlikte, KOAH’ýn MPV ve CVC ile iliþkisi hakkýnda daha fazla araþtýrma yapýlmasý gerekmektedir.

INTRODUCTION: Mean platelet volume (MPV) is an index of platelet activation. In this study, we aimed to evaluate the relationship between in patients with COPD and cardiovasculary disease who present to chest diseases department and MPV.
METHODS: : Smoker 535 (71.80%) and non-smoker, 210 (28.20%) subjects were compared for MPV and other parameters. Accordingly, patients with and without COPD were compared in terms of MPV and other parameters.
RESULTS: The levels of white blood cells (Wbc), hemoglobin (Hgb) and hematocrit (Htc) in smokers were statistically significantly higher than non-smokers (p<0.001). The level of MPV in smokers was statistically higher than non-smokers [the levels of MPV were, 10.10 (8-14.20), 9.60 (6.40-11.80),respectively p<0.001]. There were 106 cases of COPD among smokers. The differences in levels of platelets and MPV between patients with COPD and nonsmoker patients without COPD were [10.20 (8.30-14), 9.60 (6.40-11.80), respectively p=0.001] statistically significant. Also, MPV levels of COPD patients with cardiovascular comorbidities (CVC) were higher than that of the patients without CVC.
DISCUSSION AND CONCLUSION: In this study, higher MPV and higher platelet values have been shown in smokers and COPD patients compared with non- smokers. As a result, consider that high MPV levels may increase the tendency to thrombosis, with COPD. However, further larger studies are warranted about the relationship of COPD with MPV and CVC.

GÝRÝÞ ve AMAÇ: Bu çalýþma, kendi kendine aðýz muayenesi formunu Türk diline uyarlayarak geçerliliðini ve güvenilirliðini test etmek amacýyla yapýlmýþtýr.
YÖNTEM ve GEREÇLER: Metodolojik araþtýrma Aralýk 2019-Ocak 2020 tarihleri arasýnda Ýzmir ilinde yürütülmüþtür. Araþtýrmada, Müller& Hein (2013) tarafýndan Kanada’da geliþtirilen kendi kendine aðýz muayenesi adýmlarý Türkçe ’ye uyarlanmýþtýr. Kendi kendine aðýz muayenesi basit sekiz adým içermektedir. Formun dil uyarlamasý, kapsam geçerlik indeksi, Kendall W uyumluluk düzeyi, faktör analizi, Kuder Richardson 21 ve pilot uygulama çalýþmalarý yürütülmüþtür.
BULGULAR: Kapsam geçerlik indeksi 0,97 bulunmuþtur. Kendall W kat sayýsý 0,88 olarak elde edilmiþtir (p= 0,519). Tek faktör tarafýndan açýklanan toplam varyans %71,24’tür. Formun Kuder Richardson 21 deðeri 0,94 olarak hesaplanmýþtýr.
TARTIÞMA ve SONUÇ: Aðýz kanserinin erken tanýsý için Türk diline uyarlanan kendi kendine aðýz muayenesi formu geçerli ve güvenilir bir araçtýr. Form tek boyut ve sekiz adýmdan oluþmaktadýr.

INTRODUCTION: The aim of this study was to test the validity and reliability of oral self-examination form according to adaptation it Turkish.
METHODS: Methodological research was conducted in December 2019-January 2020 in Izmir. Steps of oral self-examination developed by Müller &Heller (2013) were adapted to Turkish. Oral self-examination includes simple eight steps. Language adaption, content validity index, factor analysis, Kendall's W coefficient of concordance test, Kuder Richardson 21 and pilot study were carried out.
RESULTS: The content validity index was found 0,97. After the analysis, Kendall W was found 0,88 (p = 0,519). The total variance explained by the single factor is 71.24%. Kuder Richardson 21 value of the form was calculated as 0.94.
DISCUSSION AND CONCLUSION: Oral self-examination form is an early diagnostic tool for early diagnosis of oral cancer, valid and reliable tool. The form consists of one dimension and eight steps.

GÝRÝÞ ve AMAÇ: Çalýþmamýzýn amacý yaþam tarzý deðiþiklikleri ile kilo veren hastalarda obezitenin inflamasyon belirteci olan Nötrofil/ Lenfosit Oranýndaki (NLO) deðiþimi belirlemektir.
YÖNTEM ve GEREÇLER: Çalýþmamýz obezite polikliniðimizde izlenen ve 6 ay süreli yaþam tarzý deðiþiklikleri ile anlamlý kilo veren 74 obez kadýn hasta ile yapýldý. Akut ya da kronik inflamatuar hastalýðý ve diyabeti olan hastalar çalýþmaya alýnmadý. Hastalarýn boy, kilo, beden kütle indeksi (BKI), total vücut yað kilosu, gövde yað kilosu, baþlangýç ve 6 ay kilolarý ve kilo verme oranlarý gibi klinik verileri ile CRP, hemogram, nötrofil lenfosit oraný (NLO), C peptid ve HOMA-IR gibi laboratuvar sonuçlarý obezite kliniðimiz dosyalarýndan retrospektif olarak alýndý.
BULGULAR: Yaþ ortalamasý 49.24±9.89 yýl olan hastalarýn çalýþma baþlangýcýnda kilo ve BKI deðerleri sýrasý ile 95.44 ±15.60 kg ve 37.75±5.74 kg/m² iken altýncý ayýn sonunda 87.99±15.70 kg ve 34.78±5.78 kg/m² olarak saptandý. Hastalarýn çalýþma baþlangýcýnda açlýk plazma insülin ortalama deðeri 12.96 uU/ml iken altýncý ayda 9.19 uU/ml düzeyine(p=0.015), açlýk plazma c peptid düzeyleri 2.74 ng/ml iken altýncý ayda 2.29 ng/ml deðerine(p=0,021) ve HOMA-IR ortalama düzeyleri 3.31 iken altýncý ayda 2.03 deðerine gerilemiþti. Hastalarýn baþlangýç ve altýncý aydaki NLO deðerleri sýrasý ile 1.79±0.79 ve 1.53±0.53 mm³ bulundu (p=0.004). Baþlangýç ve altýncý ay CRP deðerleri arasýnda ise anlamlý fark bulunmadý(p=0.586).
TARTIÞMA ve SONUÇ: Sonuç olarak çalýþmamýzda obez kadýnlarda yaþam tarzý deðiþiklikleri ile kilo kaybý saðlandýðýnda insülin direncinde azalmayla birlikte NLO deðerinde anlamlý düþme olduðu saptanmýþtýr.

INTRODUCTION: The aim of our study is to determine the change in the neutrophil / lymphocyte ratio (NLR), which is an inflammatory marker of obesity in patients who lose weight with lifestyle changes.
METHODS: Our study was conducted with 74 obese female patients who significantly lost weight with six-month lifestyle changes in the obesity outpatient clinic. Patients with acute or chronic inflammatory disease and diabetes were excluded from the study. Clinical data, anthropometric measurements and laboratory results were collected from the patients' files retrospectively.
RESULTS: The mean age of the patients was 49.24±9.89 years. Weight and BMI values of the patients at the beginning of the study were 95.44 ±15.60 kg and 37.75±5.74 kg/m² and at the end of the sixth month 87.99±15.70 kg and 34.78±5.78 kg / m² respectively. The fasting plasma insulin, C peptide levels and HOMA of the patients the beginning and at the sixth month of the study were 12.96 uU/ml and 9.19 uU/ml (p = 0.015) and 2.74 ng/ml to 2.29 ng/ml and 3.31 to 2.03 respectively (p = 0.021). The NLR values of the patients who lost weight decreased significantly compared to baseline values (p = 0.004). There was no significant difference between baseline and sixth month CRP values (p = 0.586).
DISCUSSION AND CONCLUSION: As a result, it was found that there was a significant decrease in NLR value together with a decrease in insulin resistance when weight loss was achieved with lifestyle changes in obese women.

GÝRÝÞ ve AMAÇ: Bu çalýþmada obezite polikliniðinde takip edilen hastalarýn yaþam tarzý müdahalesi ile bir yýllýk kilo takip sonuçlarýný deðerlendirmek, obezite takip ve tedavisinin daha etkin olmasýný saðlamak için yýllýk kilo kaybý oraný ile vizit sayýsý arasýndaki iliþkiyi deðerlendirmek amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Bu retrospektif çalýþmaya Ýstanbul Medeniyet Üniversitesi Göztepe Eðitim Araþtýrma Hastanesi Obezite Polikliniðinde en az bir yýl süreyle takip edilen, kiloya etki edecek ek metabolik hastalýk veya ilaç kullaným öyküsü bulunmayan (istisna olarak, tiroid hormon seviyeleri normal sýnýrlarda seyreden tiroid hastalarý ve HbA1c deðeri ≤%7 olan, sadece metformin kullanan diyabet hastalarý dahil), Beden Kütle Ýndeksi (BKÝ) ≥30 mg/m2 olan 18 yaþ üstü hastalar dahil edildi.

BULGULAR: 243 hastada yýllýk ortalama kilo kaybý 6,9±5,9 kg, yýllýk ortalama kilo kaybý oraný %7,12±5,75 olup; 1 yýllýk takip sonunda yaþam tarzý müdahalesi ile hastalarýn %63,4’ü en az %5 kilo vermiþtir. En az %5 kilo kaybý saðlayan vizit sayýsý için anlamlýlýk gösteren cut off deðeri 11 olarak bulundu. Yýllýk kilo kaybý oraný ile vizit sayýsý arasýnda pozitif yönde ve istatistiksel olarak anlamlý iliþki gözlendi.
TARTIÞMA ve SONUÇ: Yaþam tarzý müdahalesi obezite tedavisinde oldukça etkin ve uygulanabilir bir yöntemdir. Bu tedavi þeklinin birinci basamakta uygulanabilir bir yöntem olmasý, vizit sayýsý arttýkça tedavi baþarýsýnýn artmasý nedeniyle birinci basamaðý içine alacak stratejiler belirlenmeli, aile hekimleri obezite yönetimi konusunda eðitilmeli, hastalarýna gerekli vakti ayýrabilmeleri saðlanmalýdýr.

INTRODUCTION: The aim of this study was to evaluate the annual weight loss rate and the number of visits to obesity follow-up and to provide more effective follow-up of the patients with obesity follow-up.
METHODS: In this retrospective study, there is no history of additional metabolic disease or drug use in obesity followed by at least one year in Obesity Outpatient Clinic of Istanbul Medeniyet University, Göztepe Training and Research Hospital. Patients over 18 years of age with a body mass index (BMI) of ≥30 mg/m2 were included in the study. The annual weight loss rates were calculated by calculating the results of an annual weight gain.
RESULTS: The average annual weight loss in 243 patients was 6.9 ± 5.9 kg, and the average annual weight loss rate was 7.12 ± 5.75%. At the end of a year follow-up, 63.4% of the patients lost 5% weight with lifestyle intervention. A cut off value of 11 was found to be significant for the number of visits with a 5% weight loss. There was a statistically significant relationship between the annual weight loss rate and the number of visits.
DISCUSSION AND CONCLUSION: Lifestyle intervention is a very effective and applicable method in the treatment of obesity. Since this treatment is a feasible method in the primary care unit, as the number of visits increases, the success rate of treatment increases and the strategies to be included in the first step should be determined.

GÝRÝÞ ve AMAÇ: Hemoptizi hayatý tehdit eden ve hýzlý taný konulup tedavi edilmesi gereken bir durumdur. Bizim bu çalýþmadaki amacýmýz merkezimizin masif hemoptizi vakalarýnda uyguladýðý süperselektif arteriyel embolizasyonun baþarýsýný deðerlendirmek, bu tür hastalarýn demografik ve klinik özelliklerini belirlemek, yapýlan iþlemin etkinliðini ve komplikasyonlarýný belgelemektir
YÖNTEM ve GEREÇLER: Çalýþmaya merkezimizin acil servis veya göðüs hastalýklarý bölümüne hemoptizi ile baþvuran ve endovasküler tedavi yapýlmýþ olan 72 hasta dahil edilmiþtir. Bu hastalarýn demografik, klinik ve radyolojik verileri retrospektif olarak analiz edilmiþtir
BULGULAR: Hastalarýn ortanca yaþý 55’ti (min-maks; 22-78). Hastalarýn 25’i (%34.70) kadýn 47’si erkekti (%65.30). Hastalardan 16’sýnýn iþlem öncesi tanýsý akciðer kanseri, 7’sinin alveolar hemoraji, 1’nin malign melanoma baðlý akciðer metastazý,2’nin histopatolojisi belirsiz hiler ve mediastinal kitle, 4’nün tüberküloz, 4 ‘nün pulmoner tromboemboli, 1’nin sarkoidoz, 2’nin pnömoni,1’nin siroza baðlý hepatopulmoner sendrom ve 34’ninki bronþiektaziydi. Embolize edilen damar 32 vakada sað bronþiyal arter, 9 vakada sol bronþiyal arter, 15 vakada bilateral bronþiyal arter, 10 vakada kostobronþiyal arter ve 6 vakada bronþiyal dýþý arterdi. En sýk saptanan üç anjiyografik görünüm vasküler hipertrofi, vasküler iregülerite ve kontrast madde akümülasyonu idi. Kýsa vadeli klinik baþarý oraný %100’dü.12 vakada ilk bir ay içinde tekrar kanama izlendi. En sýk görülen komplikasyon geçici göðüs aðrýsýydý.
TARTIÞMA ve SONUÇ: Deneyimli ellerde masif hemoptizin en iyi minimal invaziv tedavi yöntemi selektif arteriyel embolizasyondur. Çalýþmamýz bu yöntemin etkinliðini ve güvenilirliðini doðrulamýþtýr

INTRODUCTION: Hemoptysis is a life-threatening condition and requires immediate diagnosis and treatment. Herein this study, our aim was demonstrate our single center experience of super selective arterial embolization in cases of massive hemoptysis, to describe the demographic and clinical data of those patients, to evaluate the success rate of the intervention and to document the complications.
METHODS: In this study, total of 72 patients who admitted to our tertiary center’s emergency service or chest diseases department and underwent endovascular treatment were enrolled. The demographic and clinical data were analyzed retrospectively.
RESULTS: The median age was 55 years (min-max; 22-78). 25 patients (34.70%) were female whereas 47 (65.30%) were male. 16 patients was diagnosed with lung cancer (squamous cell / adeno cancer), 7 alveolar hemorrhage, 1 pulmonary metastasis of malign melanoma, 2 mediastinal and hilar mass of unknown origin, 4 tuberculosis, 4 pulmonary thromboembolism, 1 sarcoidosis, 2 pneumonia, 1 cirrhosis and hepatopulmonary syndrome and 34 patients with bronchiectasis. The embolized vessel was right bronchial in 32 cases, left bronchial in 9, bilateral in 15, costobronchial trunk in 10 and non-bronchial in 6 patients. The most common angiographic pattern was vascular hypertrophy followed by vascular irregularity and blush. The immediate clinical success was 100%. Rebleeding occurred in 12 patients due to recanalization of the vessel. The most common complication was chest pain.
DISCUSSION AND CONCLUSION: In experienced hands, arterial embolization is the most effective and minimally invasive procedure for treat­ing massive and recurrent hemoptysis.This study confirms the efficacy and safety of the intervention

GÝRÝÞ ve AMAÇ: Doðum sonrasý göbek kordonu klempleme zamanýnýn post partum depresyon üzerindeki etkileri deðerlendirmek

YÖNTEM ve GEREÇLER: Çalýþmaya kliniðimizde 24 Ocak 2020 - 01 Nisan 2020 tarihleri arasýnda 36 hafta sonra doðum yapan gebeler dahil edildi. Daha önce depresyon öyküsü olanlar, kronik hastalýðý olanlar, çoðul gebelikler, doðum sonrasý hemodinamisi bozulmuþ lohusa dönemindeki kadýnlar ve doðumdan sonra Apgar skoru düþük olan veya resüsitasyon gerektiren yenidoðanlar dahil edilmedi. Postpartum göbek kordonu klempleme süresi Dünya Saðlýk Örgütü'ne göre 1 dakika geç veya daha fazla ve 1 dakikadan erken olarak sýnýflandýrýldý. Hastalar bu gruplamaya göre iki grupta deðerlendirildi. Postpartum 1. ayda yapýlan takip muayenesinde poliklinikte hastalara verilen Edinburgh Doðum Sonrasý Depresyon Ölçeði ile postpartum depresyon açýsýndan riskler deðerlendirildi.
BULGULAR: 36 hafta üstünde olan 176 normal doðum yapan gebe çalýþmaya dahil edildi. Her iki grupta sosyodemografýk özellikler, obstetrik öykü ve doðum bilgileri açýsýndan fark görülmedi. Her iki grupta ortalama EDSDÖ puan ortalamalarý geç klemplenen grupta 11,07±1,97; erken klemplenen grupta 13,23±1,61 olarak tesbit edilmiþ olup istatistiki olarak anlamlý olarak bulunmuþtur (OR=6,36; p<0,001).
TARTIÞMA ve SONUÇ: Çalýþmamýz sonucunda göbek kordonu geç klemplenen gebelerde postpartum depresyon riskinin daha az olduðunu saptadýk.

INTRODUCTION: To assess the effects of umbilical cord clamping time on risk of postpartum depression.
METHODS: The study included pregnant cases giving birth after 36 weeks from 24 January 2020 to 01 April 2020 in our clinic. Those with previous depression history, chronic disease, multiple pregnancy, puerperant women with impaired hemodynamics after birth, and neonates with poor Apgar score after birth or who required resuscitation were not included. The postpartum umbilical cord clamping time was classified according to the World Health Organization as late 1 minute or more and early under 1 minute. Patients were evaluated in two groups according to this grouping. During the follow-up examination performed in the postpartum 1 month, the risks in terms of postpartum depression were evaluated with the Edinburgh Postpartum Depression Scale given to the patients in the outpatient clinic.
RESULTS: The study included 176 pregnant cases with birth after 36 weeks. Both groups were not observed to be different in terms of sociodemographic characteristics, obstetric history and birth information (p≥0,05). In both groups, mean EPDS points were identified as 11.07±1.97 in the late clamping group and 13.23±1.61 in the early clamping group and this was statistically significant (OR=6.36; p<0.001).
DISCUSSION AND CONCLUSION: With our study results, we identified that cases with late clamping of the umbilical cord had lower risk of postpartum depression

GÝRÝÞ ve AMAÇ: Tekrarlayan gebelik kaybý olan hasta grubu ile tekrarlayan gebelik kaybý öyküsü olmayan hasta grubu arasýnda serum signal peptid C1r/C1s, Uegf, ve Bmp1 (CUB) epidermal growth factor-like domain-containing protein-1 (SCUBE-1) düzeyinin ve karotis intima media kalýnlýðýnýn deðerlendirilmesi
YÖNTEM ve GEREÇLER: Prospektif ve tek merkezli çalýþmaya 20-40 yaþ arasýnda 30 tekrarlayan gebelik kaybý öyküsü olan, 30 tekrarlayan gebelik kaybý öyküsü olmayan hasta olgusu alýnmýþtýr. Tekrarlayan gebelik kaybý olanlarda ve kontrol grubunda anatomik, kalýtýmsal, endokrin, trombofilik defekti olanlar çalýþma kapsamýna alýnmamýþtýr.Hasta grubu ile kontrol grubu arasýnda SCUBE-1 düzeyinde ve ölçülen karotis intima media kalýnlýðý arasýnda istatistiksel fark olup olmadýðý araþtýrýlmýþtýr.
BULGULAR: Demografik özellikler açýsýndan hastalar ve kontrol gruplarý arasýnda gravite, parite ve düþükler dýþýnda istatistiksel olarak anlamlý fark bulunmamýþtýr.Tekrarlayan gebelik kaybý olan hastalarýn ortalama SCUBE1 düzeyleri (16,44±5,43) kontrol grubunun ortalama SCUBE1 düzeylerinden (10,17±5,19) istatistiksel olarak anlamlý þekilde yüksektir (p=0,001). TGK kaybý olan hastalarýn ortalama CIMT düzeyleri (0,60±0,09) kontrol grubunun ortalama CIMT düzeylerinden (0,44±0,07) istatistiksel olarak anlamlý þekilde yüksektir (p=0,001).
TARTIÞMA ve SONUÇ: TGK olan grupta yüksek serum SCUBE-1 ve CIMT seviyeleri, iskemi ve endotel disfonksiyonunun TGK etiyolojisinde rol oynayabileceðini düþündürebilir. Gelecekteki çalýþmalar TGK'nýn taný, tedavi ve yönetimine ýþýk tutabilir.

INTRODUCTION: Evaluation of the signal peptide complement C1r/C1s, Uegf, and Bmp1 (CUB), and epidermal growth factor-like domain-containing protein-1 (SCUBE-1) levels and carotid intima media thickness (CIMT) between the group of patients with and without recurrent pregnancy loss (RPL).
METHODS: This prospective and single-center study included 20-40-year-old 30 patients with and 30 patients without a history of RPL. No patients with any anatomical, hereditary, or endocrinological thrombophilic defects were included. Comparison of SCUBE-1 levels and CIMT were made between the patient and control groups.
RESULTS: There were no statistically significant differences between patients and control groups in terms of demographic characteristics except for gravidity, parity and miscarriages.The mean SCUBE-1 level in the RPL group was statistically significantly higher compared to the control group (16.44±5.43 vs.10.17±5.19, respectively, p=0.001). The mean CIMT value in RPL patients was statistically significantly higher than that of the control group (0.60±0.09 vs.0.44±0.07, respectively, p=0.001).
DISCUSSION AND CONCLUSION: High levels of serum SCUBE-1 and CIMT in RPL may suggest that ischemia and endothelial dysfunction may be involved in the etiology of RPL. Future studies may shed light on the diagnosis, treatment, and management of RPL.

Birinci basamaða senkop ile baþvuru sýklýðý oldukça fazladýr. Özellikle tekrarlayan senkop ataklarý varlýðýnda, iyileþme süreci hýzlý olsa dahi etyoloji araþtýrýlmalý, ayýrýcý tanýya gidilmesi için gerekli araþtýrma ve klinik testler yapýlmalýdýr. Olgumuzda, Aile Hekimliði Polikliniðimize senkop sebebi ile baþvuran ve perikardiyal efüzyona baðlý kardiyovasküler senkop tanýsý alan olguyu sunduk.

Frequency of application to primary health care servces with syncope is quite high. Especially in the presence of recurren syncope attacks, even if the healing process is fast, the etiology should be investigated, and the necessary research and clinical tests should be done to make a differential diagnosis. In our case, we presented a patient who was admitted to our Family Medicine Outpatient Clinic due to syncope and was diagnosed with cardiovascular syncope due to pericardial effusion.

Birinci basamak saðlýk hizmeti, kiþilerin çeþitli nedenlerle baþvurduðu, toplumun büyük bir kýsmýnýn tedavi edildiði, gerekli noktalarda ikinci ve üçüncü basamaða sevk edildiði ve koruyucu saðlýk hizmeti sunumunun yapýldýðý saðlýk kurumlarýnda üretilen saðlýk hizmetidir. Topluma en yakýn ve en ulaþýlabilir konumda yer alan aile hekimleri, muayene için baþvuran bireylere gerekli inceleme ve tetkiklerden sonra farklý týp dallarýný ilgilendiren tanýlar koymaktadýrlar. Birinci basamakta ayrýþmamýþ semptomlarla baþvuran hastalardaki bulantý ve kusma, santral sinir sistemi, vestibüler sistem, gastrointestinal sistemle ilgili hastalýklara veya psikolojik rahatsýzlýklara eþlik edebilir. Bu olgu, bulantý ve kusma semptomunun birinci basamaktaki önemini ve ayýrýcý tanýda pek çok sisteme ait olabilecek hastalýklarýn göz önünde bulundurulmasý gerektiðini vurgulamak amacý ile sunulmuþtur.

Primary health care is a health service produced by health institutions where people apply for a variety of reasons, where a large part of the society is treated and referred to the second and third levels when it’s necessary and where preventive medicine practice is provided. Family physicians, who are located in the closest and most accessible position to the society, make the diagnoses related to different medical branches after the necessary examinations. Nausea and vomiting in patients presenting with undifferentiated symptoms in primary care, may accompany central nervous system, vestibular system, gastrointestinal system or psychological diseases. This case is presented to emphasize the importance of nausea and vomiting in primary care and that many systemic diseases should be considered in differential diagnosis.

Yýllardýr astým tedavisi kullanan ancak tedaviden fayda görmeyen yetiþkin bir kadýnda spirometrik deðerlendirmenin inspiratuar ve ekspiratuar eðrilerinde düzleþme not edildi. Ýleri incelemelerde sabit üst hava yolu týkanýklýðýnýn altýnda yatan patoloji olarak subglottik stenoz varlýðý tespit edildi.

In an adult female who has been using asthma treatment for years but has not benefited from the treatment, flattening was noted in the inspiratory and expiratory curves of spirometric evaluation. Subsequent examination revealed the presence of subglottic stenosis as the underlying pathology of fixed upper airway obstruction.

Pestisitler yaþamýn pek çok alanýnda yaygýn kullanýlan kimyasal maddelerdir. Tarým çalýþanlarýnýn pestisit kullanýmý konusunda yeterli bilgi ve donaným yoksa ve koruyucu önleyici yaklaþýmlar yetersizse toksisite riski söz konusudur. Literatürde pestisitlerin akut toksik etkilerinin yaný sýra, kanser, diyabet, hipertansiyon, kardiyovasküler hastalýklar, nörolojik hastalýklar gibi kronik etkilerden de bahsedilmektedir. Bu kronik etkilere ek olarak son yirmi yýldýr; tarým çalýþanlarýnda görülen, son dönem böbrek hastalýðýna ilerleyen, erken baþlangýçlý ve hýzlý geliþen kronik bir böbrek hastalýðý da bildirilmektedir. Bu hastalarda yapýlan çalýþmalar da böbrek biyopsilerinde kronik tubulointerstisyel deðiþiklikler gözlenmiþtir. Tarým çalýþanlarýnda görülen bu hastalýk, etiyolojisi bilinmeyen kronik böbrek hastalýðý anlamýnda “Chronic Kidney Disease of unknown cause (CKDu)” veya ilk tanýmlandýðý bölgeye atfen; “Mesoamerikan nefropatisi” olarak adlandýrýlmýþtýr. Etiyolojisinde ýsý stresi ve pestisit kullanýmýnýn etkin rol oynadýðý tartýþýlmaktadýr. Bu açýdan açýdan deðerlendirildiðinde pestisit kullanýmý yüksek olan ve iklim deðiþikliðinden etkilenen ülkeler “risk grubundaki ülkeler” olarak tanýmlanmaktadýr. Türkiye de pestisit kullanýmý konusunda artan bir seyir izlemektedir ve küresel ýsýnmanýn neden olduðu iklim deðiþikliklerinden olumsuz etkilenmektedir. Özellikle sera çalýþanlarýnda, çalýþtýklarý ortamýn kapalý olmasý nedeniyle ýsý stresi ve pestisit maruz kalýmý yoðunluðunun artmasý riski artýrmaktadýr. Bundan dolayý söz konusu bölgelerdeki koruyucu-önleyici yaklaþýmlar ve farkýndalýk, bu hastalýðýn belirti vermeden ilerleyici nitelikte olmasý nedeniyle özellikle önem taþýmaktadýr.

Pesticides are chemicals that are widely used in many areas of life, especially in agriculture. There is always a risk of toxicity if agricultural workers do not have sufficient knowledge and experience about the use of pesticides and preventive measures are inadequate. In the literature, there are references to acute toxic effects of pesticides as well as their chronic effects, such as cancer, diabetes, high blood pressure, cardiovascular diseases, and neurological disorders. In addition to these chronic effects, early-onset and rapidly developing chronic kidney disease has been reported in agricultural workers over the past two decades, which progresses to end-stage renal disease. The renal biopsies that have been performed on these patients showed chronic tubulointerstitial changes. This disease, observed in agricultural workers, is either referred to as “Chronic Kidney Disease of unknown cause (CKDu)” or "Mesoamerican nephropathy," in reference to the region where it was first identified. It is argued that heat stress and pesticides play an active role in its etiology. From this point of view, countries with high pesticide use that are affected by climate change are referred to as "countries in the risk group". The use of pesticides is increasing in Turkey, which is also adversely affected by climate change caused by global warming. Greenhouse workers in particular are more exposed to heat stress and pesticides, since they work in a closed environment. Therefore, preventive measures and awareness are particularly important in these regions, as the disease progresses without symptoms.