GÝRÝÞ ve AMAÇ: Kabin memuru, pilot ve diðer uçuþ ekibi personelinde sigara ile ilgili çalýþmalar sýnýrlýdýr. Uçuþ sýrasýnda sigara içmek yasaktýr. Bu araþtýrmada, özellikle uzun uçuþlarda sigara içen ve içip býrakan uçuþ personelinin sigarayla iliþkili alýþkanlýklarýný ve uçuþ sýrasýnda nikotin eksikliðine baðlý en sýk hangi semptomlarý yaþadýklarýný, bu durumla nasýl baþa çýkmaya çalýþtýklarýný yaptýðýmýz anketle deðerlendirmek istedik.
YÖNTEM ve GEREÇLER: Bu çalýþmada, ülkemizde Mayýs ile Temmuz 2019 tarihleri arasýnda farklý havayollarýnda yurtiçi ve yurtdýþýna uçuþ yapan, kabin memuru, pilot ve diðer uçuþ ekibine, yaklaþýk üç aylýk sürede, birden fazla þýklý anket yapýldý. Anket, mail ayný zamanda Ýstanbul Havalimaný ve Sabiha Gökçen Havalimaný ile Ýzmir Adnan Menderes havalimanlarýnda basýlý evrak þeklinde onaylarý alýndýktan sonra gönüllülük esasýna göre yapýldý. Sigara kullanma kriteri olarak günde en az bir sigara içiyor ya da içmiþ olmak; býrakmýþ olma kriteri olarak da bir yýl süreyle hiç sigara içmemiþ olmak kabul edildi.
BULGULAR: Çalýþma toplam 263 katýlýmcý ile gerçekleþtirilmiþtir. Katýlýmcýlarýn %18.3’ü uçuþ esnasýnda nikotin eksikliði hissetmekte, %9.9’u nikotin eksikliðini sýklýkla hissetmekte, %47.5’i ise bazen hissetmekte, %24.3’ü ise nikotin eksikliði hissetmemekteydi. Uçuþ esnasýnda nikotin eksikliðini hissetmeye en fazla etki %36.9 oran ile çay kahve vb sigarayý hatýrlatan ritüeller idi. Bunu %34.6 oraný ile uzun uçuþ süresi takip etmekteydi. Katýlýmcýlarýn %52.1’i nikotin eksikliði ile yeme-içme atýþtýrma yaparak baþa çýkmakta, %35’i baskýlayarak, %9.1’i nikotin bandý takarak baþa çýkmaya ça-lýþmaktadýr.Nikotin eksikliðine baðlý davranýþ þekli olarak, en sýk yeme arzusu gözlenirken bunu sýra-sýyla huzursuzluk ve konsantrasyon eksikliði takip ediyordu.

TARTIÞMA ve SONUÇ: Uçuþ personelinde sigara baðýmlýlýðý önemli bir sorun olup çalýþanlarý gerek verimlilik gerekse psikolojik olarak zorlayabilir. Bu tanýmlý özel grup içinde yaptýðýmýz araþtýrma tütün baðýmlýlýðý ile baþ etme yöntemlerini incelemeyi amaçlamýþ olup benzer spesifik gruplar için baþarýlý tütün kontrol ve terk yöntemlerinin geliþtirilmesi amacýyla araþtýrmalara ihtiyaç vardýr.

INTRODUCTION: Smoking is an addictive habit used by many people of all ages and occupations. Smoking adversely affects users physically, spiritually, socially and economically. Airline companies implement policies to ban smoking. Flight performance may be reduced in flight personnel, especially in pilots who smoke. Studies on smoking are limited in cabin crew, pilot and other flight crew personnel. Smoking is prohibited during the flight. In this study, we aimed to evaluate the smoking-related habits of active smokers and quitted flight personnel, especially on long flights dealing with what symptoms they experienced most frequently due to nicotine deficiency during the flight and how they tried to cope with this situation.
METHODS: In this study, a questionnaire was applied between May and July 2019 to cabin crew, pilot and other flight crews who fly in Turkey and abroad. The surveys were conducted on a voluntary basis after obtaining the written document approvals at Istanbul Airport, Sabiha Gökçen Airport and Ýzmir Adnan Menderes Airports at the same time. The criterion of quitting was accepted as no smoking for a year, and as a criterion for smoking, at least one smoking per day was accepted.
RESULTS: This study was conducted with a total of 263 participants. All of the participants were flight personnel and worked as cabin crew, pilot, dispatcher, technician, loadmaster and so on. Nicotine deficiency during the flight was felt in 18.3% of the participants, while 9.9% often felt nicotine deficiency, 47.5% sometimes felt, and 24.3% did not feel nicotine deficiency. The most common factor aggregating the sense of nicotine deficiency during the flight was rituals, including tea and coffee, with a rate of 36.9%. This was followed by long flight times with a rate of 34.6%. Among study participants, 52.1% cope with nicotine deficiency by eating-drinking snack, 35% by suppressing, 9.1% trying to cope by wearing a nicotine band. The most common desire to eat was followed by restlessness and lack of concentration, respectively.
DISCUSSION AND CONCLUSION: Cigarette addiction is an important problem in flight personnel and may force employees psychologically and diminish their productivity. This research we conducted in this special group aimed to examine the methods of coping with tobacco addiction, and there is a need for research to develop successful tobacco control and quitting methods for similar specific groups.

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GÝRÝÞ ve AMAÇ: Travma, baþlýca çocukluk çaðý saðlýk problemlerindendir ve çoðunluðu önlenebilir özelliktedir. Travma olgularýnda, mortalite ve morbiditeye belirgin bir þekilde etki eden çeþitli etiyolojik faktör sayýlabilir. Travma hastalarýný deðerlendirmek için birçok skor sistemi geliþtirilmiþtir. Bu çalýþmanýn amacý, pediatrik travma hastalarýnda kullanýlan skor sistemlerinin birbirlerine üstünlüðünü incelemektir.
YÖNTEM ve GEREÇLER: Bu retrospektif çalýþma, Acil Servis baþvuru sayýsý yýllýk 200.000 hastanýn üzerinde olan bir özel hastanede yapýlmýþtýr. Bu çalýþmada, iki yýl boyunca, 0-18 yaþ arasý travma ile acil servise baþvuran 20314 hasta tarandý ve hastaneye yatýrýlan 251 tanesi retrospektif olarak incelendi. Demografik, etiyolojik ve klinik özellikler ile birlikte beþ travma skor sistemi (Yaralanma Ciddiyeti Skoru, Revize Travma Skoru, Travma Revize Yaralanma Ciddiyeti Skoru, Pediatrik Glasgow Koma Skoru, Pediatrik Travma Skoru) analiz edildi.
BULGULAR: Olgularýn yaþ ortalamasý 6.8±5.4 yaþ idi. Olgularýn 86.9%’u künt travma, 46.9%’u izole kafa travmasý idi. En sýk görülen travma tipi, yüksekten düþme (57.3%) idi. Bunu 25.8% ile trafik kazalarý takip ediyordu. Hastalarýn ortalama Pediatrik Travma Skoru 9.41±1.32, ortalama Glascow Koma Skoru 14.79±0.88, ortalama Yaralanma Ciddiyeti Skoru 7.74±8.44, ortalama Revize Travma Skoru 7.84±0, ortalama Travma Revize Yaralanma Skoru (Künt) 98.45±7.71 ve ortalama Travma Revize Yaralanma Skoru (Penetran) 98.61±6.90 olarak bulundu. Yoðun Bakým ve Acil Servis Gözlem yatýþ süreleri sýrasý ile ortalama 2.6±3.1 ve 1.9±2 gün, toplam hospitalizasyon süre ortalamasý ise 2.2±2.7 gün idi. Hastaneye yatýþ süreleri, travma skorlarý ve pozitif görüntüleme bulgularý ile korelasyon göstermekteydi.
TARTIÞMA ve SONUÇ: Acil serviste yatan hastalarýn ilk deðerlendirmesi sýrasýnda klinik ciddiyeti ve gerekli tedaviyi öngörmede travma skorlarýnýn olumlu rolü tespit edildi. Yaralanma Ciddiyeti Skoru ve Travma Revize Yaralan ma Ciddiyeti Skoru'nun hastalarýn hastanede kalma süresini saptamakta diðer skor sistemlerine göre üstün olduðu tespit edildi.

INTRODUCTION: Trauma is a major health problem in the pediatric age group. Various etiological factors can be accounted for the traumas, and they cause significant mortality and morbidity in children. Multiple scoring systems have been developed for evaluating trauma patients. The present study aims to investigate to find out which trauma scoring system used in pediatric trauma is superior to others.
METHODS: This retrospective study was conducted in the Emergency Department of a private university hospital that accepts over 200.000 patients annually. Records of all 20314 trauma cases between 0 and 18 years of age, who were referred to ED of a private university hospital in two years, were searched, and 251 of them who were hospitalized evaluated retrospectively. Demographical, etiological, and clinical characteristics, including scores of five trauma scoring systems, were analyzed.
RESULTS: The mean age of the cases was 6.8±5.4 years, 86.9% of the cases had blunt trauma, and 46.9% had isolated head trauma. The most frequent trauma type was falling from a height (57.3%), followed by traffic accidents (25.8%). Mean pediatric trauma score of the patients was 9.41±1.32, mean Glasgow Coma Score was 14.79±0.88, mean Injury Severity Score was 7.74±8.44, mean Revised Trauma Score was 7.84±0, mean Trauma Revised Injury Severity Score blunt was 98.45±7.71 and mean Trauma Revised Injury Severity Score penetrating was 98.61±6.90. The mean duration of the Intensive Care Unit and ward stay was 2.6±3.1 and 1.9±2 days, respectively, and the total duration of hospitalization was 2.2±2.7 days.
DISCUSSION AND CONCLUSION: The trauma scores provide predictive value for clinical severity and treatment in the initial evaluation of cases at admission to the Emergency Department. In this study, we found that Injury Severity Score and Trauma Revised Injury Severity Score are more valuable than the other scoring systems for determining the patient's length of stay in the hospital.

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GÝRÝÞ ve AMAÇ: Bu çalýþmada akut iskemik inme (AÝÝ) olgularýnda risk faktörü olarak mikroalbumin (MA) deðerlerinin incelenmesi amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: AÝÝ inme tanýsý ile hastaneye yatýrýlan ve yaþ ortalamasý 69.42±11.9 olan 30 hasta (19 kadýn, 11 erkek) çalýþmaya alýndý. Hastalarda 24 saatlik MA düzeyi bakýldý. Mikroalbumin deðerleri 30 mg/gün’den daha düþük ise normal, 30-300 mg/gün arasýnda ise yüksek olarak kabul edildi. Bulgular yaþ ortalamasý 64.92±14.2 olan 30 saðlýklý kiþi (16 kadýn, 14 erkek) ile karþýlaþtýrýldý.
BULGULAR: Hasta ve kontrol grubunda yaþ ortalamasý ve cinsiyet daðýlýmý yönünden anlamlý fark saptanmadý. Mikroalbumin düzeyi yönünden hasta grubunda anlamlý bir yükseklik vardý. AÝÝ olgularýnda mikroalbuminüri 23 olguda (%76.6) mevcuttu. Hipertansiyon 16 (%53.3), diyabet 9 (%30.1), eski iskemik inme 5 (%16.6), hiperkolesterolemi 18 (%60.2), alkol kullanýmý 10 (%33.3) ve sigara öyküsü 12 olguda (%40.7) saptandý. Hipertansiyon, diyabet, eski iskemik inme, ve sigara kullanýmý olan olgularda mikroalbüminüri görülme oraný istatistiksel olarak anlamlý derecede yüksek bulundu. Kontrol grubunda sadece 2 olguda (%6.3) mikroalbuminüri düzeyi üst sýnýrýn hafif üstünde saptandý.
TARTIÞMA ve SONUÇ: Elde edilen bulgular AÝÝ’de mikroalbuminüri varlýðýnýn bir risk faktörü olduðunu desteklemektedir.

INTRODUCTION: This study aims to investigate the presence of microalbuminuria (MAU) as a risk factor in patients with acute ischemic stroke (AIS).
METHODS: Thirty patients (19 female and 11 male; mean age 69.4±11.9 years) hospitalized with the diagnosis of acute ischemic stroke were enrolled in this study. Microalbuminuria was assessed from the urine samples of patients obtained within 24 hours after the onset of ischemic stroke. Microalbuminuria was accepted as normal if the level was less than 30 mg/day and as high if the level was between 30-300 mg/day. Data obtained were compared with the data of the controls (16 female, 14 male; meanage 64.9±14.2).
RESULTS: A significant difference was not detected between the patients and the control groups for gender and mean ages. When data of the cases with AIS and data of the control group were compared, the mean microalbuminuria level of the AIS group was significantly higher than the control group. Microalbuminuria was present in 23 (76.6%) cases with AIS. Hypertension, diabetes mellitus, recent ischemic stroke, hypercholesterolemia, alcohol and smoking were found in 16 (53.3%), 9 (30.1%), 5 (16.6%), 18 (60.2%), 10 (33.3%), 12 (40.7%) cases with AIS, respectively. The incidence of microalbuminuria in cases with hypertension, diabetes, recent ischemic stroke, and cigarette smoking was significantly higher. Microalbuminuria was found in two (6.3%) cases of the control group.
DISCUSSION AND CONCLUSION: Our findings support the hypothesis that microalbuminuria may be a risk factor of ischemic stroke.

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GÝRÝÞ ve AMAÇ: Hepatit B ve Hepatit C enfeksiyonlarý kronik karaciðer hastalýðýna baðlý ölümlerin majör nedenleridir. Uzun dönem sirozu ve hepatoselüler karsinomu azaltmada tedavi çok önemlidir. Biz bu çalýþmamýzda hepatit B ve C tedavisi verdiðimiz hastalarýmýzdaki gerçek yaþam verilerini saptamayý amaçladýk.
YÖNTEM ve GEREÇLER: Ýzmir’de bir eðitim ve araþtýrma hastanesi enfeksiyon hastalýklarý ve klinik mikrobiyoloji polikliniðinde Mayýs 2007 ile Aralýk 2008 tarihleri arasýnda tedavisine baþlanan 30 kronik hepatit B (KHB), 21 kronik hepatit C (KHC) hastasý retrospektif olarak incelendi.
BULGULAR: Kronik hepatit B hastalarýmýzda 48 haftalýk pegileinterferon tedavisine virolojik yanýt oraný %57 olarak saptandý. Ancak tedavi sonu virolojik yanýt geliþen hastalarýn %85’inde 1 yýl içerisinde biyokimyasal ve virolojik alevlenme nedeniyle oral antiviral tedavilere geçildi. Pegileinterferon tedavisi alan 14 hastadan 2’sinde HBeAg serokonversiyonu geliþirken, 11’inde oral antivirallere geçildi. Bir hastada ise virolojik ve biyokimyasal süpresyon saðlandý. Entekavir ve tenofovir tedavisi alan hastalarda ise tedavinin 48. haftasýnda virolojik yanýt oranlarý sýrasýyla %91, %100 olarak saptandý. Pegile interferon ve ribavirin tedavisi alan 21 kronik hepatit C hastasýnda hýzlý virolojik cevap oraný %71, erken virolojik cevap oraný %100 iken kalýcý virolojik yanýt %100 olarak saptandý.
TARTIÞMA ve SONUÇ: Kronik hepatit B hastalarýnda pegile interferon tedavisinin, sadece HbeAg (+), düþük viral yük ve yüksek ALT düzeylerine sahip seçilmiþ hasta gruplarýna, yüksek yan etki potansiyeli düþük tedavi yanýtý nedeniyle verilmesi gerektiðini düþünüyoruz. KHC’li hastalarda günümüzde direk etkili antiviraller (DAA) yüksek kalýcý virolojik yanýtlar ve yan etkilerin çok daha az olmasý nedeniyle önerilen tedaviler olmakla birlikte; özellikle geliþmekte ve geri kalmýþ ülkelerde DAA ilaçlarýn yüksek maliyeti nedeniyle seçilmiþ hastalarda ribavirinle kombine pegileinterferon alfa 2a veya 2b tedavisi alternatif olarak düþünülmelidir.

INTRODUCTION: Hepatitis B and hepatitis C infections are the major causes of death due to chronic liver disease. Treatment is very important in reducing long-term cirrhosis and hepatocellular carcinoma. In this study, we aimed to determine the real-life data of patients treated with hepatitis B and C.
METHODS: Thirty patients with chronic hepatitis B and 21 patients with chronic hepatitis C who were treated in an Infectious Diseases and Clinical Microbiology outpatient clinic in a training and research hospital in Izmir between May 2007 and December 2008 were retrospectively evaluated in this study.
RESULTS: In chronic hepatitis B patients, the virological response rate to 48 weeks of pegylated interferon treatment was 57%. However, in 85% of the patients who developed virological response at the end of the treatment, we started oral antiviral treatments within a year due to biochemical and virological exacerbations. HBeAg seroconversion developed in two of the 14 patients receiving pegylated interferon treatment, while 11 of 14 patients were switched to oral antivirals. Virological and biochemical suppression was achieved in one patient. In patients who received entecavir and tenofovir treatment, virological response rates were 91% and 100% at 48 weeks of treatment, respectively. The rate of sustained virologic response was 100% in patients treated with ribavirin plus pegylated interferon treatments in 21 hepatitis C patients.
DISCUSSION AND CONCLUSION: We think pegylated interferon treatment should be given only to selected chronic hepatitis B patient groups with HBeAg (+), low viral load and high ALT levels because of the low treatment response to a high potential for side effects. Although direct-acting antivirals (DAA) are recommended treatments for patients with Chronic hepatitis C due to their high persistent virological responses and much fewer side effects, especially in developing and undeveloped countries, because of the high cost of DAA drugs, pegylated interferon alfa 2a or 2b treatment combined with ribavirin should be considered as an alternative.

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Kardiyak tümörlerin çoðunun iyi huylu olmasý nedenli, malign tümorler gözden kaçabilmektedir. Bu yazýda, dispne yakýnmasý ile, sol atriyumda düzgün þekilli kitle tanýsý olan, bir bayan hastanýn sunumu yapýlmýþtýr. Cerrahi eksizyondan sonra, frozen-kesit bakýda, ön taný olarak hemanjiyoendotelyoma tanýsý alan hastanýn, operasyonu mitral kapak replasmasný ile sonlandýrýlmýþtýr. Takibinde patolojik taný olarak immunohistokimyasal baký sonrasý düþük-grade fibromiksoyid sarkom, operasyondan üç ay sonra tekrar dispne ile hospitalize edilmiþtir. Ekokardiyografide ayný bölgede, tüm atriyumu dolduran, 45 x 24 mm boyutlu dev kitle saptanmýþtýr. Hasta takibinde hemaodinamik kolabs ile kaybedilmiþtir. Kardiyak tümörlerin daha sýk iyi huylu olduðu fikri, malign kitlelerin gözden kaçmasýna neden olabilir. Vakaya bir dahiliye uzmanýnýn bakýþ açýsýyla, her kalp tümörünün - benign-malign olma lehineözellikleri, kalp ameliyatýndan önce hem klinik hem de görüntüleme yöntemleri ile deðerlendirilmesi bu sorunu engelleyebilir.

As the majority of cardiac tumors are benign, malignant tumors may be easily missed. The case presented here was a female with complaints of dyspnea who was diagnosed with a left atrial mass of regular shape. After surgical excision with a pre-diagnosis of hemangioendothelioma in the frozen-section, the operation finished with mitral valve replacement. The pathological diagnosis from the immunohistochemical examination was of low-grade fibromyxoid-sarcoma. At three months postoperatively, the patient was re-hospitalized with dyspnea. Echocardiography detected a giant mass in the left atrium, 45 x 24 mm in size. The hemodynamic collapse resulted in mortality. The idea that cardiac tumors are more frequently benign causes malignant masses to be overlooked. With the perspective of an internal medicine specialist, the characteristics of each cardiac tumor should be evaluated with both clinical and imaging methods before the cardiac surgery.

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Rektum kanseri nedeniyle yapýlan abdomnoperianal rezeksiyon sonrasý nüksler en sýk pelviste görülmektedir. Bu hasta grubunda parastomal herni geliþme ihtimali yüksektir. Parastomal herni tamirinde bazen rezeksiyon ihtiyacý olup çýkarýlan kolon segmenti ise patologlar tarafýndan incelenmektedir. Literatürde nadir rastlanan parastomal herni pyesinde tesadüfen saptanan nüks olgusunu paylaþmak istedik.

Recurrences after abdomnoperianal resection for rectal cancer are most commonly seen in the pelvis. In this patient group, the possibility of developing a parastomal hernia is high. In the repair of parastomal hernia, sometimes resection is needed and the removed colon segment is examined by the pathologist. We want to share a rare case of recurrent parastomal hernia in the literature.

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Anti tümör nekrosis faktör (TNF) tedavi baþlandýktan sonra görülen yeni baþlangýçlý psoriyatik cilt lezyonlarýna veya mevcut psoriyazis varlýðýnda psoriyatik cilt lezyonlarýnda kötüleþmeye paradoksal psoriyazis (PPs) denir. Anti-TNF tedavi alan hastalarýn %2-5’inde görülür (1). Anti-TNF’lerin ortak bir yan etkisidir ve anti-TNF ajanlarýn endike olduðu tüm hastalýklarda ortaya çýkabilir (2). Tedavi baþlangýcýndan birkaç gün ya da yýllar sonra görülebilir. Anti-TNF tedavinin kesilmesi, biyolojik ajanýn deðiþtirilmesi veya devam edilerek adjuvan tedavi eklenmesi tedavi seçenekleri arasýndadýr. Ýnterlökin-17 inhibisyonu ile PPs'de ve romatolojik hastalýk aktivitesinde azalma saðlanabilmektedir. Bu yazýda PPs geliþen üç olgunun tedavi süreçlerini ve secukinumab tedavisi ile saðlanan remisyonu tartýþmayý amaçladýk.

Paradoxical psoriasis (PPs) is new-onset psoriatic skin lesions or worsening of the existing psoriatic skin lesions during anti-TNF therapy. PPs occurs in 2-5% of patients using anti TNF drugs (1). It is a class effect of anti-TNF agents rather than a drug effect and has been observed with all diseases for which TNF-a inhibitors are indicated (2). The time between the starting treatment and the appearance of lesions can range from a few days to years. Discontinuation of anti-TNF therapy, replacement of biological agents, or continued adjuvant therapy are among the treatment options. Inhibition of IL17 can lead to a decrease in PPs and rheumatic disease activity. We aimed to discuss the treatment process and secukinumab in three cases in PPs and to discuss the remission with IL-17 inhibition.

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