GÝRÝÞ ve AMAÇ: Akut pulmoner embolide mortalite tahmininde Pulmoner Emboli Þiddet Ýndeksi (PESI) ve basitleþtirilmiþ Pulmoner Emboli Þiddet Ýndeksi (sPESI) gibi prognostik deðerlendirme araçlarý kullanýlmaktadýr. Bu çalýþmanýn amacý, COVID-19 hastalarýnýn prognozunda PESI ve sPESI skorlarýnýn uygunluðunu deðerlendirmek ve orijinal ile basitleþtirilmiþ PESI'lerin prognostik deðerliliklerini karþýlaþtýrmaktýr.
YÖNTEM ve GEREÇLER: Retrospektif, tek merkezli kohort çalýþmasý olarak tasarlanan çalýþmada PESI ve sPESI'yi hesaplamak için hastane yatýþýnda elde edilen týbbi veriler kullanýldý. Hastalar PESI ve sPESI kullanýlarak düþük risk ve yüksek risk gruplarýna ayrýldý. Primer sonlaným noktasý hastane mortalitesi olarak belirlendi. Düþük ve yüksek riskli hastalarda skorlarýn spesifite, prediktif deðerleri ve sensitiviteleri ölçülerek doðruluklarý deðerlendirildi. Modellerin ayýrt edici güçlerini karþýlaþtýrmak için de ROC eðrisi altýndaki alan hesaplandý.
BULGULAR: PESI ve sPESI, mortaliteyi öngörmek için benzer duyarlýlýklara (%82,1'e %84,6) ve negatif prediktif deðerlere (%96,7'ye %97) sahipti. Mortaliteyi öngörmek için ROC eðrisi altýnda kalan alan PESI için 0,82 (p<0,001) ve sPESI için 0,72 (p<0,001) saptandý. Hastane mortalitesini tahmin etme güçleri PESI ve sPESI için benzer saptandý.
TARTIÞMA ve SONUÇ: COVID-19 hastalarýnda PESI ve sPESI skorlarý ile hastane mortalitesi tahmin edilebilir ve risk sýnýflandýrmasý kolaylaþtýrýlabilir.

INTRODUCTION: The prognostic assessment tools such as pulmonary embolism severity ýndex (PESI) and simplified PESI (sPESI) are used to predict the mortality in patients with acute pulmonary embolism. The aim of this study is to assess PESI and sPESI accuracy for the prediction of the prognostic outcomes in coronavirus disease (COVID).
METHODS: This retrospective single-center was done as a cohort study. Data on hospital admission obtained from medical records were used to calculate PESI and sPESI. All the consecutive patients were assigned to low risk and high-risk groups using of PESI and sPESI. The primary outcome was hospital mortality. Accuracy of the models was assessed to predict mortality by calculating specificity, predictive values, and sensitivity of the patients at low to high risk. The area under receiver operating characteristic (ROC) was calculated to compare the discriminative power of the models.
RESULTS: The PESI and sPESI had similar sensitivities (82.1% vs. 84.6%), negative predictive values (96.7% vs. 97%) for predicting mortality. The area under the ROC curve for predicting mortality was 0.82 (p<0.001) for PESI and 0.72 (p<0.001) for sPESI. PESI and sPESI had a similar discriminatory to predict hospital mortality.
DISCUSSION AND CONCLUSION: Hospital mortality could be predicted, and risk stratification can be facilitated in COVID-19 patients based on PESI and sPESI Scores.

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GÝRÝÞ ve AMAÇ: Ýnsomni yaygýn uyku bozukluklarýndan biridir. Yararý olmayan biliþsel süreçler ve kiþilerarasý faktörler uykusuzlukta rol oynar. Bu çalýþmanýn amacý kronik insomni tanýsý alan bireylerin baðlanma stillerini, algýlanan stres düzeylerini, stresle baþa çýkma tarzlarýný incelemek ve bu parametreler arasýndaki iliþkiyi araþtýrmaktýr.
YÖNTEM ve GEREÇLER: Çalýþmaya ICSD-3'e (International Classification of Sleep Disorders) göre Kronik Ýnsomni tanýsý alan 40 hasta ve 40 saðlýklý kontrol dahil edildi. Hastalara Sosyodemografik Veri Formu, Uykusuzluk Þiddeti Ýndeksi (ISI), Pittsburgh Uyku Kalitesi Ýndeksi (PUKÝ), Algýlanan Stres Ölçeði (ASÖ), Stresle Baþa Çýkma Tarzlarý Ölçeði, Yakýn Ýliþkilerde Yaþantýlar Envanteri 2 (YÝYE 2) uygulandý.
BULGULAR: Hastalarýn ortalama ISI puaný 19.5±5.5, ortalama toplam PUKÝ puaný 14.3±3.7 idi. Hasta grubunda orta-lama ASÖ skoru 31.0±8.9 idi ve anlamlý olarak yüksekti (p<0.001). Stresle baþ etme tarzlarý incelendiðinde hasta grubunda çaresiz yaklaþým anlamlý derecede daha fazlayken (p=0.002), kendine güvenli yaklaþým ve iyimser yak-laþým kontrol grubunda anlamlý olarak daha yüksekti (p=0.036, p=0.001). Baðlanma stillerine bakýldýðýnda kronik insomni hastalarýnda kaygýlý baðlanma kontrol grubuna göre anlamlý olarak daha yüksekti (p=0.022). ISI skoru ile kaygýlý baðlanma, ASÖ skoru, kendine güvenli yaklaþým, çaresiz yaklaþým ve optimistik yaklaþým arasýnda anlamlý korelasyon saptandý (r=0.266, p=0.017; r=0.607, p=0.001; r=-0.254, p=0.023; r=0.278, p=0.012; r=-0.380, p=0.001).
TARTIÞMA ve SONUÇ: Kronik insomniye zemin hazýrlayan, tetikleyen ve sürdüren faktörler arasýnda biliþsel süreçler ve kiþilerarasý faktörler önemlidir. Uykusuzluk, stres, baþa çýkma ve baðlanma biçimleri arasýndaki iliþkiyi anlamak hem hastalýk sürecinin anlaþýlmasýný saðlayacak hem de tedaviye yön verecektir.

INTRODUCTION: Insomnia is one of the most frequent sleep disorders. Unhelpful cognitive processes and interpersonal factors play a role in insomnia. The aim of the present study is to investigate the perceived stress levels, attachment, and coping styles of individuals diagnosed with chronic insomnia and the relationship between these parameters.
METHODS: The study group consisted of 40 patients diagnosed with insomnia according to International Classification of Sleep Disorders and 40 healthy controls. The sociodemographic data form, insomnia severity index (ISI), Pittsburgh sleep quality index (PSQI), perceived stress questionnaire (PSQ), coping with stress scale, and inventory of close relationship experiences 2 were applied.
RESULTS: The mean ISI score of the patients was 19.5±5.5, and the mean total PSQI score was 14.3±3.7. The mean PSQ score in the patient group was 31.0±8.9 and was significantly higher than controls (p<0.001). When the coping styles were examined, the helpless style was higher in the patient group (p=0.002), while the self-confident and optimistic style were significantly higher in the control group (p=0.036, p=0.001). Looking at the attachment styles, the anxious attachment was significantly higher in chronic insomnia patients than in the control group (p=0.022). Significant correlations were found between ISI score and anxious attachment, PSQ score, self-confident, helpless, and optimistic styles (r=0.266, p=0.017; r=0.607, p=0.001; r=–0.254, p=0.023; r=0.278, p=0.012; and r=–0.380, p=0.001).
DISCUSSION AND CONCLUSION: Cognitive processes and interpersonal factors are important factors that predispose, trigger, and maintain chronic insomnia. Understanding the relationship between insomnia, stress, coping, and attachment styles will both provide an understanding of the disease process and will guide the treatment.

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GÝRÝÞ ve AMAÇ: Huzursuz Bacak Sendromu (HBS) patofizyolojisinde demir eksikliði ve dopamin disfonksiyonu en iyi bilinen mekanizmalardýr. Enflamasyonun rol oynadýðýna dair yeni bir bakýþ açýsý ortaya çýkmasýna raðmen kanýtlar sýnýrlýdýr. Bu çalýþmada, sistemik inflamatuar belirteçlerin hastalýktaki potansiyel rollerini araþtýrmayý hedefledik.
YÖNTEM ve GEREÇLER: Bu kesitsel çalýþma 70 hasta ve 50 saðlýklý kontrol içermektedir. Hastalarýn demografik verileri dosyalanmýþ arþivlerinden kaydedildi. HBS, Uluslararasý Uyku Bozukluklarý Taný Kriterleri Sýnýflandýrmasý (ICSD-3) ile teþhis edildi ve þiddeti Uluslararasý Huzursuz Bacak Sendromu Çalýþma Grubu Derecelendirme Ölçeði (IRLSSG) ile deðerlendirildi. Hastalar "hafif (1-10)", "orta (11-20)", "þiddetli (21-30)" ve "çok þiddetli (31-40)" olmak üzere dört alt gruba ayrýldý. 8 saatlik açlýðý takiben medial kübital venden kan örnekleri alýndý. Kýrmýzý hücre daðýlým geniþliði (RDW), trombosit-lenfosit (PLR), nötrofil-lenfosit (NLR) ve C-reaktif-protein-albümin (CAR) oranlarý hesaplandý ve kontrol grubu verileri ile karþýlaþtýrýldý.
BULGULAR: Gruplar arasýnda cinsiyet ve yaþ açýsýndan fark tespit edilmedi. Hastalarda ortalama NLR 3.42±2.2 ve kontrollerde 1.44±0.64 (p=0.001), PLR hastalarda 200.54±180.67 ve kontrollerde 63.39±13.76 (p=0.001) ve RDW hastalarda 50.06±4.27 ve kontrol grubunda 45.43±4.28 saptandý (p=0.001). Tüm belirteçler hasta grubunda istatistiksel olarak daha yüksekti. RDW, %85.7 duyarlýlýk ve %40.0 özgüllük ile 37.4'te öngörücüydü. NLR %58.57 duyarlýlýk ve %96 ile 2.33'te, PLR %65.71 duyarlýlýk ve %98 özgüllük ile 95.34'te öngörücüydü.
TARTIÞMA ve SONUÇ: PLR, NLR ve RDW'nin hastalarda istatistiksel olarak daha yüksek olmasý, periferik inflamasyon ile HBS arasýnda bir iliþki olduðu hipotezini desteklemektedir. Ayrýca, PLR, NLR ve RDW, hastalýðý öngörmek için biyobelirteçler olarak kullanýlabilir. Hastalýðýn doðasýný anlamak için ek araþtýrmalara ihtiyaç vardýr.

INTRODUCTION: Iron depletion and dopamine dysfunction are the best-recognized mechanisms in the pathophysiology of restless leg syndrome (RLS). A novel perspective has risen that inflammation plays a part; however, the evidences remain limited. We investigated the potential roles of systemic inflammatory markers in the disease.
METHODS: This cross-sectional study contains 70 patients and 50 healthy controls. We recorded the demographic data from patients’ filed archives. RLS was diagnosed by the International Classification of Sleep Disorders Diagnostic Criteria, The severity of disease was evaluated by the International RLS Study Group Rating Scale and patients were divided into four subgroups as “mild (1–10),” “moderate (11–20),” “severe (21–30)” and “very severe (31–40)” We obtained the blood samples from the medial cubital vein regarding an 8-h of fasting. Red cell distribution width (RDW), platelet-to-lymphocyte (PLR), neutrophil-to-lymphocyte (NLR), and C-reactive-protein-to-albumin (CAR) ratios were estimated and compared with controls.
RESULTS: We detected no difference in gender and age among the groups. The mean NLR was 3.42±2.2 in patients and 1.44±0.64 in controls (p=0.001), PLR was 200.54±180.67 in patients and 63.39±13.76 in controls (p=0.001), and RDW was 50.06±4.27 in patients and 45.43±4.28 in controls (p=0.001). All of them were are statistically higher in patients. RDW was predictive at 37.4 with a 85.7% sensitivity and 40.0% specificity. NLR was at 2.33 with a 58.57% sensitivity and 96%, PLR was predictive at 95.34 with a 65.71% sensitivity and 98% specificity.
DISCUSSION AND CONCLUSION: PLR, NLR, and RDW are statistically higher in patients, which supports the hypothesis that there is a relationship between peripheral inflammation and RLS. Moreover, PLR, NLR, and RDW may be used as biomarkers to predict the disease. Additional investigations are needed to understand the nature of the disease.

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GÝRÝÞ ve AMAÇ: Çalýþmanýn amacý, glisemik kontrolün iyi olmadýðýnýn göstergesi olarak HbA1c kan düzeyi yüksek diyabet hastalarýnda glisemik kontrol sonrasý meydana gelen multifokal elektroretinografi deðiþikliklerinin incelenmesidir.
YÖNTEM ve GEREÇLER: Bu çalýþmada, diyabetik retinopati tespit edilmeyen, HbA1c düzeyi 8’in üzerinde olan 40 diyabet hastasý glisemik kontrol için diyabet merkezine yönlendirilmiþtir. Üç ayda bir bakýlan HbA1c deðerleri sonunda baþlangýca göre 1 birim HbA1c düþüþü saðlanan hastalar çalýþma grubunu oluþtururken (n=24), yeterli düþüþ saðlanamayan hastalar kontrol grubunu oluþturmuþ (n=16) ve çalýþma grubunu oluþturulan hastalarýn HbA1c düþüþü saðlandýktan sonra (ortalama 13,5 ay), kontrol grubunun ise birinci yýl kontrolünde tekrar multifokal elektroretinografi kayýtlarý alýnmýþtýr.
BULGULAR: Baþlangýç HbA1c deðeri çalýþma grubunda 8,7±0,6, kontrol grubunda 8,4±0,5 iken glisemik kontrol son-rasý çalýþma grubunda 7,5±0,5, kontrol grubunda 8,35±0,4 olarak ölçülmüþtür. Çalýþma grubundaki HbA1c deðerindeki bu düþüþ istatistiksel olarak anlamlý iken (p=0,01), kontrol grubundaki deðiþiklik istatistiksel olarak anlamlý bulunmamýþtýr (p=0,275). Hastalarýn kadran ve halka analizleri sonucunda; multifokal elektroretinografi p1 ve n1 dalga amplitüd ve implisit zamanlarýnda baþlangýca göre glisemik kontrolü iyi olan çalýþma grubunda istatistiksel olarak anlamlý bir deðiþiklik tespit edilmezken; glisemik kontrolü iyi olmayan kontrol grubunda da istatistiksel olarak anlamlý bir deðiþiklik tespit edilmemiþtir.
TARTIÞMA ve SONUÇ: Çalýþmada hem glisemik kontrol ile HbA1c düþüþü saðlanan hem de glisemik kontrol saðlanamayan hasta grubunda multifokal elektroretinografide yaklaþýk bir yýllýk takip sürecinin sonunda anlamlý bir deðiþiklik saptan-mamýþtýr. Bunun nedeni glisemik kontrol saðlanmasýna raðmen diyabet hastalarýnda retinopatinin ilerlemesi olabileceði gibi birinci kernel yanýtlarýnýn iç retina katlarýnýn fonksiyonlarýný yeteri kadar göstermemesi nedeniyle de olabileceði, bu nedenle çalýþmanýn ikinci kernel yanýtlarýnýn deðerlendirildiði baþka bir çalýþma ile desteklenmesi gerektiði düþünülmektedir.

INTRODUCTION: We aimed to demonstrate probable neuronal benefits derived from glycemic control in diabetic patients without diabetic retinopathy (DRP) by using multifocal electroretinography (mfERG).
METHODS: Forty patients with HbA1c level >8% were included in this study. Baseline mfERG measurement (first kernel order) of patients were done. The study group consisted of patients existed 1 unit decrease in HbA1c relative to baseline and the control group consisted of patients with an insufficient decrease (n=16). The control mfERG measurements of the study group were done after HbA1c decrease is obtained (mean 13.6 months) and in the first year follow-up in the control group.
RESULTS: Baseline HbA1c level was 8.7±0.6 in the study group and 8.4±0.5 in the control group and the levels were 7.5±0.5 and 8.35±0.4 respectively after glycemic control. Decrease of HbA1c levels in the study group was significant. Comparing baseline and follow up measurements the difference between P1 and N1 wave amplitude and implicit time values weren’t statistically significant in the study group in which glycemic control was good relative to baseline.
DISCUSSION AND CONCLUSION: We have determined no significant changes in mfERG parameters after approximately 1 year follow up in both good and insufficient glycemic control groups. The reasons for this could be the progression of retinopathy in diabetic patients despite glycemic control or inadequacy of first kernel orders in revealing functions of inner retina layers.

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GÝRÝÞ ve AMAÇ: Rektal prolapsus hala etyolojisi belli olmayan sosyal problemlere sebep olan bir hastalýktýr. Çalýþmamýzda kliniðimizde uyguladýðýmýz presakral mesh uygulamasý ve perineal cerrahi prosedürlerinin sonuçlarýný karþýlaþtýrýp yöntemlerin etkinliðini tesbit etmeyi hedefledik.
YÖNTEM ve GEREÇLER: 2014-2020 tarihleri arasýnda sadece rektal prolapsusu olan hastalarda komorbiditesi yüksek olanlara peri-neal cerrahi, komorbiditesi düþük olanlara ise rezeksiyonsuz presakral mesh uygulamasý yapýldý. Ameliyat öncesi ve sonrasý takiplerinde hastalarýn semptomlarý Roma II ve Boutsis Ellis kriterlerine göre standartize edilip karþýlaþtýrýldý.
BULGULAR: Rektal prolapsus nedeniyle abdominal (n=15) ve perineal prosedür uygulanan (n=5) toplam 20 hastanýn sonuçlarý retrospektif olarak deðerlendirildi. Ýki grup arasýnda yaþ (p=0,041), ASA (American Society of Anesthesiology) skoru (p=0,000), uygulanan anestezi tipi (p=0,016) arasýnda istatistiksel olarak anlamlý fark mevcuttu. Abdominal grupta kabýzlýk þikayeti ameliyat öncesi ve sonrasý yapýlan deðerlendirmede istatistiksel olarak anlamlý farklý bulundu (p=0,000). Perineal grupta ise anlamlý fark saptanmadý (p=0,151). Ýnkontinans þikayeti ise abdominal grupta ameliyat sonrasý istatistiksel olarak anlamlý ölçüde azalýrken (p=0,000), perineal grupta semptomlarýn evrelerinde azalma olmasýna raðmen semptomu devam eden hasta sayýsýnda anlamlý fark görülmedi (p=0,07).
TARTIÞMA ve SONUÇ: Sadece presakral mesh uygulamasý rektal prolapsuslu hastalarda düþük komplikasyon riskiyle uygulanabilecek etkili bir minimal invaziv yöntemdir.

INTRODUCTION: Rectal prolapse is still a disease that causes social problems with an unknown etiology. In our study, we aimed to compare the results of the presacral mesh application and perineal surgical procedures performed in our clinic and to determine the effectiveness of the methods.
METHODS: Between 2014 and 2020, perineal surgery was performed only in patients with rectal prolapse with high comorbidity, and presacral mesh without resection was applied to those with low comorbidity. In the preoperative and postoperative follow-up, the symptoms of the patients were standardized and compared according to Rome II and Boutsis Ellis criteria.
RESULTS: The results of 20 patients who underwent abdominal (n=15) and perineal procedures (n=5) due to rectal prolapse were retrospectively evaluated. There was a statistically significant difference between the two groups between age (p=0.041), American Society of Anesthesiology score (p=0.000), and type of anesthesia applied (p=0.016). In the abdominal group, the complaint of constipation was found to be statistically significantly different in the preoperative and postoperative evaluations (p=0.000). There was no significant difference in the perineal group (p=0.151). Incontinence complaints were significantly decreased postoperatively in the abdominal group (p= 0.000), while there was no significant difference in the number of patients whose symptoms continued in the perineal group despite the decrease in the stages of symptoms (p=0.07).
DISCUSSION AND CONCLUSION: Presacral mesh application alone is an effective minimally invasive method that can be applied with a low risk of complications in patients with rectal prolapse.

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GÝRÝÞ ve AMAÇ: Penoskrotal web peniste þekil bozukluðuna neden olan ve eriþkinlikte cinsel iliþki sýrasýnda sorunlara yol açabilen skrotum cildinden penis ventral derisine uzanan deri uzantýsýdýr. Penoskrotal web onarýmý için V-Y plasti, ikili Z plasti, V plasti ve ikili V plasti teknikleri tanýmlanmýþtýr. Biz de çalýþmamýzda ikili V plasti tekniði ile penoskrotal web onarýmý yaptýðýmýz hastalarýn sonuçlarýný paylaþmayý amaçladýk.
YÖNTEM ve GEREÇLER: Kliniðimizde sünnet öncesi deðerlendirme sýrasýnda penoskrotal web saptanan ve sünnet ile beraber web ona-rýmý yapýlan 30 hastanýn verileri retrospektif olarak incelendi. Tüm hastalara ikili V tekniði ile web onarýmý yapýldýktan son-ra sleeve tekniði ile sünnet yapýldý. Operasyondan 1 ay sonra kontrol edilen olgularýn kozmetik sonuçlarý deðerlendirildi.
BULGULAR: Kliniðimizde 2017–2019 arasýnda 30 hastaya sleeve tekniði ile sünnet ile beraber ikili V plasti ile penos-krotal web onarýmý yapýldý. Hastalarýn yaþ ortalamasý 3,70±3,68 yýl idi. Genel anestezi altýnda opere edilen olgular ayný gün sorunsuz olarak taburcu edildi. Operasyondan 1 ay sonra kontrole çaðrýlan hastalarýn kozmetik sonuçlarý deðerlendirildi. Tüm hastalarýn weblerinin ortadan kalktýðý görüldü. Sirkumsizyon insizyonunun ve penoskrotal bölgedeki yara yerlerinin sorunsuz iyileþtiði tespit edildi.
TARTIÞMA ve SONUÇ: Penoskrotal web onarýmýnda literatürde birçok farklý teknikler tarif edilmiþtir. Biz de kliniðimizde ikili V plasti tekniðini baþarý ile uygulamaktayýz. Literatürde az sayýda çalýþma bulunan penoskrotal web onarýmý sonuçlarýmýzý ortaya koyarak literatüre katký saðlayacaðýný düþünmekteyiz.

INTRODUCTION: Penoscrotal web is the extension of skin from scrotum skin to ventral skin of the penis that causes malformation of the penis and may lead to problems during sexual intercourse in adulthood. V-Y plasty, double Z plasty, V plasty, and double V plasty techniques have been described for penoscrotal web repair. In our study, we aimed to share the outcomes of patients who underwent penoscrotal web repair with the double V plasty technique.
METHODS: The data of 30 patients who were observed to have penoscrotal web during the pre-circumcision examination in our clinic and underwent web repair along with circumcision were retrospectively analyzed. After all patients underwent web repair using the double V technique, circumcision was performed with the sleeve technique. The cosmetic outcomes of the patients who were checked in the post-operative 1st month were evaluated.
RESULTS: Thirty patients underwent penoscrotal web repair with double V plasty together with circumcision with the sleeve technique in our clinic between 2017 and 2019. The average age of the patients was 3.70±3.68. The patients who were operated under general anesthesia were discharged on the same day without any problem. The cosmetic outcomes of the patients who were called for control 1 month after the operation were evaluated. It was observed that the webs of all patients disappeared. It was determined that the circumcision incision and wounds in the penoscrotal region were healed smoothly.
DISCUSSION AND CONCLUSION: In the literature, many different techniques have been described on penoscrotal web repair. We also successfully apply the double V plasty technique in our clinic. We consider that our results related to penoscrotal web repair, on which there are few studies in the literature, will contribute to the literature by revealing them.

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GÝRÝÞ ve AMAÇ: Bu çalýþmadaki amacýmýz 25 OH Vitamin D’nin, vitiligo tipi ve klinik özellikleriyle iliþkisi bulunup bulunmadýðýný ortaya koymak.
YÖNTEM ve GEREÇLER: Çalýþmamýza 60 vitiligo hastasý ve 60 saðlýklý gönüllü dahil edildi. Hastalar 4 gruba ayrýldý; kýþ dönemi yeni vitiligo tanýsý alanlar (K-VH), kýþ dönemi saðlýklý katýlýmcýlar (K-SG), yaz dönemi yeni vitiligo tanýsý alanlar (Y-VH) ve Y-SG yaz dönemi saðlýklý gönüllüler (Y-SG). Katýlýmcýlarýn yaþ cinsiyet, kendisinde veya ailesinde otoimmün hastalýk varlýðý, vitiligonun klinik tipi (lokalize (fokal, segmental, mukozal), yaygýn (akrofasiyal, vulgaris, karýþýk tip) ve üniversal) ve 25 (OH) Vitamin D düzeyleri bakýldý.
BULGULAR: Çalýþmada 62 (%51,7) erkek, 58 (%48,3)kadýn katýlýmcý vardý. Vitiligo hastalarýnýn yaþ ortalamalarý 42.2±13.29, kontrol grubunun yaþ ortalamalarý ise 30.5±12.6’ydý.. Gruplarýn yaþ ve cinsiyet bakýmýndan benzer olduðu görüldü (p>0,05). Vitiligonun klinik tipleri ve otoimmun hastalýklarla arasýnda istatistiksel açýdan anlamlý bir fark tespit edimedi (p>0, 05). K-VH ve Y-VH hastalarýn 25 (OH) Vitamin D düzeyleri, K-SG ve Y-SG göre isttiksel olarak düþüktü (p < 0,05). K-VH ile Y-VH arasýnda ve K-SG ile Y-SG arasýnda 25 (OH) Vitamin D düzeyleri açýsýndan istatistiksel fark saptanmadý (p>0,05) K-VH ve Y-VH’deki otoimmun hastalýðý bulunan olgularýn 25 (OH) Vitamin D düzeylerinin ile klinik tipine göre 25 (OH) Vitamin D düzeylerinin arasýnda istatistiksel olarak anlamlý fark saptanmadý (p>0,05).
TARTIÞMA ve SONUÇ: Vitiligo hastalarýnda ve vitiligoya eþlik eden baþka otoimmun hastalýk varlýðýnda, normal populasyona göre plazma 25 (OH) vitamin D seviyesi daha düþük düzeyde bulunmaktadýr. Vitiligo aktivasyonunun kontrolü ve ikincil otoimmun hastalýklarýn önlenmesinde, vitamin D desteðini etkili olabilir.

INTRODUCTION: Vitiligo is an acquired skin disease characterized by depigmentation and characterized by loss of epidermal melanocytes in the skin. The low levels of Vitamin D have been observed in vitiligo patients and with other autoimmune diseases. This study aimed to investigate whether 25(OH) Vitamin D levels are associated with clinical types and features of vitiligo.
METHODS: A total of 60 patients with vitiligo and 60 healthy volunteers were included in our study. The patients were divided into four groups; patients newly diagnosed with vitiligo in the winter season (W-VP), participants who visited the clinic in the winter season and were found to be healthy (W-HP), patients newly diagnosed with vitiligo in the summer season (S-VP), and participants who visited the clinic in the summer season and were found to be healthy (S-HP). Participants’ age, sex, incidence of other autoimmune diseases among participants and their families, clinical type of vitiligo (localized (focal, segmental, or mucosal), common (acrofacial, vulgaris, or mixed), or universal), and 25(OH) Vitamin D levels were evaluated.
RESULTS: Twenty-five (41.7%) of the patients and 33 (55%) of the control group were women. The mean age of vitiligo group was 42.2±13.29 years and the mean age of control group was 30.5±12.6 years. The groups were similar in terms of age and sex (p>0.05). About 45% of the patients were localized, 53.32% were widespread, and 1.6% were universal type vitiligo. Another autoimmune disease was accompanying in 55%. No significant difference was found between the W-VP and S-VP groups in terms of vitiligo types (p>0.05). The incidences of other autoimmune diseases among the families of patients with vitiligo did not differ between both the sexes (p>0.05). There was no statistically significant difference between the clinical types of vitiligo and incidence of autoimmune diseases (p>0.05). The 25(OH) Vitamin D levels of participants in the W-VP and S-VP groups were statistically lower than those of participants in the W-HP and S-HP groups (p<0.05). Comparison of the 25(OH) Vitamin D levels of the W-VH with S-VP groups and the W-HP with S-HP groups did not show any statistically significant difference (p>0.05). There was no statistically significant difference between patients with autoimmune disease in the W-VH and S-VP groups in terms of clinical type of vitiligo and 25(OH) Vitamin D levels (p>0.05).
DISCUSSION AND CONCLUSION: Plasma 25 (OH) Vitamin D level is lower in vitiligo patients compared to the normal population. Vitamin D supplementation can be effective in the treatment and control of vitiligo.

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GÝRÝÞ ve AMAÇ: Adolesanlarda lomber disk hernisiyle (LDH) birlikte olan ve olmayan bel aðrýsýnýn multifidus (MF), erektör spina (ES) ve psoas major (PM) kas volumleri üzerine etkisi olup olmadýðýný araþtýrmak.
YÖNTEM ve GEREÇLER: 205 bel aðrýlý adolesan hasta LDH olan (grup A) ve olmayan (grup B) olmak üzere iki gruba ayrýldý. MF, ES ve PM volümleri, L4-5 ve L5-S1 intervertebral disk seviyesinden aksiyel T2 aðýrlýklý görüntüler kullanýlarak ölçüldü.
BULGULAR: Ýki grup arasýnda L4-5 ve L5-S1 seviyelerinde bilateral MF, ES ve PM volumlerinde anlamlý fark yoktu. Grup A’da L4-5 seviyesinde sað taraf ES volumleri soldan (sað/sol p=0.000/p<0.05), L5-S1 seviyesinde sað MF ve ES volümleri soldakilerden anlamlý düzeyde düþüktü (MF p=0.008/p<0.05; ES p=0.000/p<0.05). Grup B’de L4-5 seviyesinde sað MF ve ES volumleri soldakilerden (MF right/left p=0.001/p<0.05; ES p=0.000/p<0.05), L5-S1 seviyesinde sað MF, ES ve PM volümleri soldakilerden anlamlý düzeyde düþüktü (MF p=0.001/p<0.05; ES p=0.000/p<0.05; PM p=0.024/p<0.05).
TARTIÞMA ve SONUÇ: Paraspinal kas volüm kaybý eriþkinlerde olduðu gibi adolesan yaþ grubunda da bel aðrýsýnýn bir sonucu olarak görülebilir. LDH’nin bu yaþ grubunda sýklýkla santral yerleþimli olmasý nedeniyle paraspinal kas volum kaybýna etkisi olmadýðý düþünülebilir.

INTRODUCTION: The objective of the study was to investigate whether low back pain (LBP) with or without lumbar disc herniation (LDH) would affect paraspinal muscle volumes in adolescents.
METHODS: A total of 205 adolescent patients were distributed into two groups – LBP with LDH (Group A) and LBP without LDH (Group B). Multifidus (MF), erector spinae (ES), and psoas major (PM) volumes at the L4–5 and L5-S1 intervertebral disc levels were measured.
RESULTS: No statistically significant difference in bilateral MF, ES, and PM volumes was observed between the groups at the L4–5 and L5-S1 levels. The right side ES volumes at the L4–5 were lower than the left volumes in Group A (p=0.000/p<0.05). At the L5-S1, the right MF and ES volumes were lower than those on the left (MF p=0.008/p<0.05; ES p=0.000/p<0.05). In Group B, the right MF and ES volumes were lower than those on the left (MF p=0.001/p<0.05 and ES p=0.000/p<0.05) at the L4–5 level. At the L5-S1, the right MF, ES, and PM volumes were lower than those on the left (MF p=0.001/p<0.05; ES p=0.000/p<0.05; and PM p=0.024/p<0.05).
DISCUSSION AND CONCLUSION: Paraspinal muscle volume loss can be seen as a result of LBP in adolescents like in adults. Since LDH more commonly occurs as the central type in the pediatric age, perhaps it may not contribute to volume changes of paraspinal muscle.

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GÝRÝÞ ve AMAÇ: Omuz eklem hareket açýklýðýný (EHA) ölçmek için kullanýlabilecek düþük maliyetli bir alternatif, iPhone® (Apple, Cupertino, CA, ABD) ve çeþitli akýllý telefonlarda bulunan açýölçer uygulamalarýdýr. Bu çalýþmada omuz aðrýsý olan hastalarda akýllý telefon ile omuzun aktif iç rotasyon EHA ölçümünün geçerliliði ve güvenilirliði araþtýrýldý.
YÖNTEM ve GEREÇLER: Fiziksel Týp ve Rehabilitasyon, omuz yan dal polikliniðine baþvuran omuz aðrýsý olan 18 hasta ve daha önce omuz aðrýsý yaþamamýþ 18 gönüllü çalýþmaya dahil edildi. Omuz iç rotasyon hareket açýklýðý ölçümleri hem standart gonyometre hem de iHandy uygulamasý ile her katýlýmcý için ayrý ayrý 1 fizik tedavi uzmaný ve 1 fizyoterapist tarafýndan yapýldý.
BULGULAR: Uygulayýcýlar arasýnda ICC deðerlerinin büyük oranda 0,99'dan büyük olduðu ve tutarlýlýðýn çok güçlü olduðu görülmektedir. Hem gonyometre ölçümü hem de uygulama ölçümü için, gözlemciler arasýndaki uyumluluk 0,92'nin üzerinde bulundu.
TARTIÞMA ve SONUÇ: Bu çalýþma, iPhone uygulamasý ile omuz iç rotasyon hareketini ölçmenin güvenilir ve geçerli bir yöntem olduðunu göstermektedir.

INTRODUCTION: A low-cost alternative that can be used to measure shoulder range of motion (ROM) is the goniometer applications available on the iPhone®(Apple, Cupertino, CA, USA) and various smartphones. The validity and reliability of active internal rotation ROM measurement of shoulder with smartphone in patients with shoulder pain were investigated.
METHODS: Eighteen patients with shoulder pain who applied to the physical medicine and rehabilitation, shoulder subspecialty outpatient clinic, and 18 volunteers who had not experienced shoulder pain before enrolled in the study. Shoulder internal rotation ROM measurements were conducted with both standard goniometer and iHandy application separately without seeing each other for each participant by one physiatrist and one physiotherapist.
RESULTS: It is observed that the intraclass correlation coefficient values of Observer B, except from goniometric measurements, are >0.99 and consistency is very strong among practitioners. For both goniometer measurement and app measurement, the compatibility between the observers was found to be above 0.92.
DISCUSSION AND CONCLUSION: This study shows that it is a reliable and valid method to measure shoulder internal rotation movement with the iPhone application.

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Anjiomiksoma özellikle doðurganlýk çaðýndaki kadýnlarda nadir görülen bir yumuþak doku lezyonudur. Çoðunlukla perine, pelvis, gluteal bölgede ortaya çýkar. Yüksek oranda rekürrens göstermesi nedeniyle cerrahisi önem taþýmaktadýr. Olgumuzda perineal hemanjiyom ön tanýsýyla opere edilen, patolojik deðerlendirmesi anjiyomiksoma olarak rapor edilen 39 yaþýndaki kadýn hasta sunulmuþtur.

Angiomyxoma is a soft-tissue lesion found particularly in women who are of childbearing age. It is mostly encountered in perineal, pelvic, and gluteal area. Due to its recurring nature, surgical intervention is necessary. In our case, a 39-year-old female patient who was operated with the perianal hemangioma pre-diagnosis and whose patholog-ic evaluation was reported as angiomyxoma was presented.

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Kronik böbrek yetmezliði ile birliktelik gösteren büyük taþlý böbrekler ülkemiz gibi taþ hastalýðýnýn endemik olduðu bölgelerde nadir deðildir. Bu hastalarýn yüksek oranda ek vasküler hastalýklara sahip olmasý ve artmýþ kanama eðilimleri taný ve tedavide çeþitli zorluklar çýkarabilir. Günümüz ürolojisinde sýklýkla ve güvenle uygulanan perkütan nefrolitotomi gerek kanama gerekse nefron kaybý endiþesi ile bu olgular için tartýþýlabilir hale gelebilir. Biz bu gibi durumlarda laparoskopik piyelolitotominin güvenle uygulanabileceðini düþünüyoruz.

Kidneys with large stones associated with chronic renal failure are not rare in areas where stone disease is endemic, such as our country. The high rate of these patients having additional vascular diseases and increased bleeding tendencies can present various difficulties in diagnosis and treatment. Frequent and safe percutaneous nephrolithotomy in contemporary urology may become debatable because of bleeding or nephron loss concerns. We think that laparoscopic pyelolithotomy can be performed safely in such cases.

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Koruma amacýyla özgürlüðün kýsýtlanmasý kurumu uygulamada istemsiz/zorunlu yatýþ ve tedavi kavramýný ele almakta ve uzun yýllardýr sosyal, psikolojik ve etik yönleriyle tartýþýlmaktadýr. Türk Medeni Kanunu’nun 432. maddesinde kapsamý açýklanan istemsiz yatýþ ve tedavinin asýl eleþtirilen tarafý, karar ve denetleme mekanizmalarýnýn yetersiz olmasýdýr. Bu yazýda, bir olgudan yola çýkýlarak istemsiz yatýþ ve tedavi uygulamalarýnýn ortaya çýkarabildiði maðduriyetin literatür eþliðinde tartýþmasý amaçlanmýþtýr. Sonuç olarak, daha týbbi, etik ve insani bir düzenlemeye acilen ihtiyaç duyulduðu önerilmektedir.

The restriction of freedom for the purposes of protection deals with the concept of involuntary/compulsory hospitalization and treatment in practice and has been discussed for many years in social, psychological and ethical aspects. The main criticism of involuntary hospitalization and treatment, the scope of which is explained in article 432 of the Turkish Civil Code, is the insufficient decision and supervision mechanisms. In this article, we aimed to discuss the victimization that involuntary hospitalization and treatment practices can occur in the light of the literature based on a case. We suggest that a more medical, ethical and humanitarian regulation is urgently needed.

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