E- ISSN: 2822-4051
The Journal of Tepecik Education and Research Hospital - Tepecik Eğit Hast Derg: 32 (2)
Volume: 32  Issue: 2 - 2022
1.Cover

Page I (43 accesses)

REVIEW
2.Managing Rheumatic Diseases in COVID-19
Sadettin Uslu
doi: 10.4274/terh.galenos.2020.22590  Pages 159 - 165 (76 accesses)
The outbreak of Coronavirus disease-2019 (COVID-19) infection throughout the world is a matter of global emergency. Patients with comorbidities, in their old age, and with a compromised immune system are at the highest risk of mortality. Patients with autoimmune rheumatic diseases (like rheumatoid arthritis and systemic lupus erythematosus) already have a compromised immune system which is coupled with the immunosuppressive agents they take making them more susceptible to infections. Published evidence to guide treatment decisions are lacking and doubts regarding continuation and initiation of immunosuppressants remain. Rheumatic diseases are the most common immune-mediated disorder in COVID-19 patients, and in this review, we discuss how the commonly used drugs alter the patients’ susceptibility to this infection.

CLINICAL RESEARCH
3.The Effect of Age on the Results of Tympanoplasty Operation in Pediatric Patients
Tolgahan Çatlı, Mehmet Ekrem Zorlu, Taşkın Tokat, Çağrı Çelik, Aynur Aliyeva, Levent Olgun
doi: 10.4274/terh.galenos.2020.65902  Pages 166 - 170 (82 accesses)
Amaç: Bu çalışmanın amacı, timpanoplasti yapılan pediatrik hastalarda hasta yaşının işitsel ve cerrahi sonuçlar üzerine olan etkisini değerlendirmektir.
Yöntem: Kulak Burun Boğaz kliniğinde Ocak 2013-Ocak 2016 tarihleri arasında tip 1 timpanoplasti operasyonu geçiren pediatrik yaş grubundaki hastalar retrospektif olarak incelendi. Hastaların yaşı, cinsiyeti, bilateral otoskopik muayene bulguları ile preoperatif ve postoperatif hava yolu, kemik yolu, havakemik yolu saf ses odyometri sonuçları değerlendirildi. Çalışmaya tip 1 timpanoplasti uygulanan 30 kız, 30 erkek olmak üzere 60 pediatrik hasta dahil edildi. Operasyon sonrası hastalar 1 yıl boyunca belli aralıklar ile takip edildi.
Bulgular: Hastalar; 7-13 yaş grubuna dahil olan 20 hasta (grup 1) ve 14-18 yaş grubuna dahil olan 40 hasta (grup 2) olmak üzere iki gruba ayrıldı. Hastaların yaş ortalaması 14,17±2,9 (minimum 7; maksimum 18) olarak tespit edildi. Her iki grup preoperatif ve postoperatif hava yolu ortalaması kazancı, kemik yolu ortalaması kazancı, hava-kemik yolu kazancı ve timpanik membran perforasyon başarı oranları açısından karşılaştırıldı. Grup 1’de saf ses ortalaması kazancı sınırda anlamlı bulunurken, diğer parametrelerin arasında istatistiksel olarak anlamlı fark bulunmadı.
Sonuç: Erken pediatrik yaş grubunda daha ileri pediatrik yaş grubuna oranla daha düşük cerrahi başarı oranı elde edilirken, her iki grubun işitme eşikleri değerlendirildiğinde erken pediatrik yaş grubunda daha fazla işitme kazancı elde edildi; ancak sonuçların istatistiksel olarak anlamlı olmadığı görüldü.
Objective: The aim of this study is to evaluate the effect of patient age on auditory and surgical outcomes in pediatric patients undergoing tympanoplasty.
Methods: Patients in pediatric age group who underwent type 1 tympanoplasty operation between January 2013 and January 2016 at the Ear, Nose and Throat department were retrospectively analyzed. Age, gender, bilateral otoscopic examination findings, pure tone audiometry results of preoperative and postoperative air conduction, bone conduction and air-bone gap were evaluated. 60 pediatric patients, 30 female and 30 male, underwent type 1 tympanoplasty were included in the study. Patients were observed periodically for one year after the operation.
Results: The patients were divided into two groups; 20 patients in the 7-13 age group (group 1), and 40 patients in the 14-18 age group (group 2). The mean age of the patients was 14.17±2.9 (minimum 7; maximum 18). Preoperative and postoperative mean air conduction gain, mean bone conduction gain, mean air-bone gain and tympanic membrane perforation success rates were compared between two groups. Mean air conduction gain was found to be marginally significant in group 1, while other parameters were not statistically significant.
Conclusion: Lower surgical success rate was obtained in the early pediatric age group compared to the advanced pediatric age group. When hearing thresholds of both groups were evaluated, more hearing gain was obtained in the early pediatric age group; but the results were not statistically significant.

4.The Correlation Between Hyperglycemia and Inflammatory Markers, Haemodynamic Parameters and Mortality in Diabetic and Non-diabetic Septic Patients
Tunzala Yavuz, Hüseyin Özkarakaş, Burcu Acar Çinleti, Çiler Zincircioğlu, Işıl Köse Güldoğan, Nimet Şenoğlu
doi: 10.4274/terh.galenos.2020.57873  Pages 171 - 179 (85 accesses)
Amaç: Bu çalışmada, diyabetik olan ve diyabetik olmayan sepsis tanılı hastaların kan şekeri düzeyi ile enflamatuvar belirteçler, hemodinamik veriler ve mortalite ilişkisinin araştırılması amaçlandı.
Yöntem: Çalışmaya kan şekeri düzeyi >140 mg/dL olarak ölçülen septik hastalar dahil edildi. Sepsis tanısı konulduktan sonrakı 24 saatlik takipte kan şeker ve hemodinamik verileri kayıt edilmiştir. Ayrıca kan şekeri, kan basıncı ve kalp hızı için 24 saatlik ortalama değerleri hesaplandı. Hastanede, Yoğun Bakım Ünitesinde (YBÜ) yatış gün sayı, YBÜ, 1. ve 3. ay sonundaki mortaliteler kaydedildi. Çalışmanın birinci aşamasında hastalar diyabet tanısı olan (1) ve diyabet tanısı olmayan (2) iki gruba ayrıldı, grup 1 ve grup 2 arasında enflamatuvar belirteçler, hemodinamik veriler ve mortalite karşılaştırılması yapıldı. Çalışmanın ikinci aşamasında tüm hastalar ortalama kan şeker düzeyine göre, ortalama kan şeker düzeyi 140-180 mg/dL (A) ve ortalama kan şeker düzeyi >180 mg/dL (B) iki gruba ayrıldı. A ve B grupları arasında enflamatuvar belirteçler, hemodinamik veriler ve mortalite karşılaştırılması yapıldı.
Bulgular: Diyabetik ve diyabetik olmayan hastalar arasında yaş, cinsiyet, hastanede kalış gün, YBÜ'de kalış gün, YBÜ'de mortalite, 1. ay ve 3. ay mortalite açısından anlamlı fark saptanmadı. YBÜ'de mortalite B grubunda daha yüksek saptandı (p=0,047). 1. ay mortalite açısından anlamlı fark saptanmaz iken 3. ay mortalite yine B grubunda daha yüksek saptandı (p=0,038).
Sonuç: Çalışmamızda 24 saatlik ortalama kan şeker düzeyi >180 mg/dL seyreden hastalarda YB ve 3. ay mortalite anlamlı olarak yüksek saptandı. Diyabet tanısı ile mortalite arasında anlamlı ilişki saptanmadı. Mortalitenin diyabet tanısından daha ziyade yüksek kan şeker düzeyleri ile ilişkili olduğu düşünüldü.
Objective: In this study, we aimed to evaluate the correlation between blood glucose (BG) levels with inflammatory markers, hemodynamic data and mortality in diabetic and non-diabetic septic patients.
Methods: Septic patients whose BG level was measured as >140 mg/dL were included in this study. BG monitoring and hemodynamic data were recorded at 24-hour follow-up after sepsis was diagnosed. In addition, 24-hour mean values for BG, blood pressure and heart rate were calculated. The number of days of hospitalization, intensive care unit (ICU) stay, and mortality at the end of 1st and 3rd months of ICU were recorded. The patients were first divided into two groups with (1) and without diabetes (2) and inflammatory markers, hemodynamic data and mortality rates were compared between group 1 and group 2. In the second stage, patients were divided into two groups with mean BG level 140-180 mg/dL (A) and mean BG level >180 mg/dL (B). Inflammatory markers, hemodynamic datas and mortality were compared between the group A and B.
Results: There was no significant difference between the patients with and without diabetes in terms of hospital stay day, ICU stay day, ICU mortality, 1st month and 3rd month mortality. There was no statistically significant difference between group A and B in terms of hospitalization and ICU stay. Mortality in the ICU was higher in the B group (p=0.047). There was no significant difference in terms of mortality in the first month, whereas the mortality in the third month was higher in the group B (p=0.038).
Conclusion: In our study, ICU stay and 3-month mortality were significantly higher in patients with a mean BG level >180 mg/dL for 24 hours. There was no significant relationship between the diagnosis of diabetes and mortality. Mortality was thought to be associated with high BG levels rather than diabetes.

5.The Use of the Impulse Oscillometry Method in Evaluating the Respiratory Function of Children with Asthma
Esra Toprak Kanık, Özge Yılmaz, Yurda Şimşek, Hasan Yüksel
doi: 10.4274/terh.galenos.2022.55531  Pages 180 - 185 (62 accesses)
Objective: Asthma is a chronic inflammatory lung disease. Classic spirometry is the gold standard in asthma follow-up. Howewer, the evaluation of asthma control can be difficult particularly in younger children due to limited cooperation and adaptability. Impulse oscillometry (IOS), shows the airway resistance and reactance with minimal patient cooperation and simple method of use. Our study aims to evaluate the use of IOS in monitoring asthma control.
Methods: The study included 80 newly diagnosed asthma and did not have asthma exacerbation patients between the ages of 6-17 who were asymptomatic, along with 34 healthy individuals as a control group. The sociodemographic features such as age, sex and height were noted. Classic spirometry obtained the forced expiratory volume (FEV1), FEV1/forced vital capacity (FVC), FVC, forced expiratory flow between 25-75% (FEF 25-75) and peak expiratory flow (PEF) values, whereas IOS acquired the R5, R10, R15 (resistance), X5, X10 and X15 (reactance) values.
Results: The mean age for children with asthma was 11.4±2.8 and 11.9±3.1 for the control group. When compared to the control group, the FEV1/FVC, FEF25/75 and PEF values of asthma patients were discovered to be significantly lower (p=0.040, p=0.007, p=0.02 respectively). At the same time, asthma patients R5 and R10 values reflecting the small airway resistance were found to be significantly higher compared to the control group (p=0.009, p=0.031 respectively). Moreover, the X5 value representing small airway compliance was found to be significantly smaller in asthma patients compared to the control group (p=0.014).
Conclusion: IOS is easy to use, requiring a scarce amount of patient cooperation in determining the respiratory functions in asthma patients, allowing for a safe method for monitoring asthma control at a young age.

6.Factors Predicting the Upgrading and Downgrading of Prostate Cancer from Biopsy to Radical Prostatectomy: Has What We Know Changed?
Batuhan Ergani, Mehmet Yiğit Yalçın, Mert Hamza Özbilen, Hayal Boyacıoğlu, Yusuf Özlem İlbey
doi: 10.4274/terh.galenos.2020.56578  Pages 186 - 194 (62 accesses)
Amaç: Gleason skor (GS), prostat kanserinin agresifliği ve progresyonu ile yüksek oranda ilişkilidir. Literatür verilerine göre biyopsi GS’si ile radikal prostatektomi (RP) GS’si arasındaki korelasyon ilginç bir şekilde, çok düşük olarak bildirilmiştir. Bu çalışmanın amacı, prostat kanserli hastalarda ameliyat öncesi klinik ve patolojik değişkenlerin biyopsi ve RP arasında tümör derecesi değişikliklerinin ve korelasyonunun öngörülmesindeki etkisini değerlendirmek ve eski literatür verileri ile yeni sonuçlarımızı karşılaştırmaktır.
Yöntem: Kliniğimizde Ocak 2017 ile Mart 2020 tarihleri arasında prostat biyopsisi yapılıp ardından RP uygulanan 229 hasta çalışmaya dahil edildi. Bu hastaların tıbbi kayıtları retrospektif olarak incelendi. Derece yükselmesi ve düşmesi olan gruptaki hastaların demografik verileri, derece yükselmesi ve düşmesini predikte eden preoperatif ve postoperatif değişkenler; derece yükselmesi olmayan kontrol grubunun verileri ile karşılaştırıldı.
Bulgular: Hastalarımızın 123’ünde (%53,7) prostat biyopsisi ile RP spesmen patolojileri arasında GS yönünden korelasyon saptanırken; 72 (%31,4) hastada derece yükselmesi ve 34 (%14,8) hastada ise derece düşmesi olduğu görüldü. Derece yükselmesini predikte edebilecek faktörlerden RP’deki prostat ağırlığı, cerrahi sınır pozitifliği, ekstrakapsüler yayılım ve seminal vezikül invazyonunun; derece düşmesini predikte edebilecek faktörlerden ise preoperatif total PSA değerinin istatistiksel olarak anlamlı derecede etkili olduğu sonuçlarına ulaşılmıştır.
Sonuç: Biyopsi GS’sinin gerçek hastalık derecesini tahmin etmedeki genel doğruluğu ciddi şekilde sınırlıdır. Nitekim biyopsi ile RP GS’si arasındaki uyumsuzluk nedeniyle neredeyse prostat kanserinin gerçek evresinin yarısının tahmin edilemediği bir hastalık olduğu sonucuna biz de ulaştık. Sonuçlarımızın literatürle paralel oluşu bildiklerimizin henüz değişmediğini göstermektedir. Mevcut standart klinik ve patolojik değişkenler, klinik kullanım için yeterince öngörücü olmadığından, derece yükselme ve düşmeyi daha iyi tahmin etmek için ek araçlara ihtiyaç vardır.
Objective: Gleason score (GS) is highly correlated with the aggressiveness and progression of prostate cancer. According to literature data, the correlation between biopsy GS and radical prostatectomy (RP) GS is reported to be very low interestingly. Aim of this study is to evaluate effect of preoperative clinical and pathological variables on predicting tumor grade changes and correlation between biopsy and RP in patients with prostate cancer and to compare old literature data with our new results.
Methods: Between January 2017 and March 2020; 229 patients who underwent prostate biopsy and then underwent RP were included in the study. Medical records of these patients were reviewed retrospectively. Demographic data of patients in group with upgrade and downgrade, preoperative and postoperative variables predicting upgrading and downgrading; it was compared with the data of the control group without upgrade or downgrade.
Results: In 123 of our patients (53.7%), there was a correlation between prostate biopsy and RP specimen pathologies in terms of GS; upgrading was observed in 72 (31.4%) patients and downgrading in 34 (14.8%) patients. Prostate weight in RP, positivity of surgical margins, extracapsular extension and seminal vesicle invasion were found to be among the factors that could predict the upgrading and preoperative total PSA value was found to be among the factors that could predict the downgrading with statistically significant effect.
Conclusion: Overall accuracy of biopsy GS in predicting true disease grade is severely limited. As a matter of fact, we came to the conclusion that almost half of true stage of prostate cancer is an unpredictable disease due to the incompatibility between biopsy and RP GS. Fact that our results are in line with the literature shows that what we know has not changed yet. Since current standard clinical and pathological variables are not sufficiently predictive for clinical use, additional tools are needed to better predict upgrading and downgrading.

7.Emotional Status, Stress and Insomnia in Pediatric Healthcare Workers During the COVID-19 Pandemic
Pelin Elibol, Kayı Eliaçık, Alper Çiçek, Şefika Bardak, Gülşah Demir, Emel Berksoy, Yavuz Demirçelik, Ali Kanık, Mehmet Helvacı
doi: 10.4274/terh.galenos.2020.34356  Pages 195 - 200 (66 accesses)
Amaç: Koronavirüs hastalığı-2019 (COVID-19) pandemisi sırasında, sağlık çalışanları hastaların tanı, tedavi ve bakımı ile ön sırada ilgilenmekte; bu sırada psikolojik stres ve diğer mental sağlık problemleri yaşamaktadırlar. Bu çalışmada çocuk kliniği çalışanlarının hastalığın psikolojik yükünün neresinde durduğunu tespit etmek amaçlanmıştır.
Yöntem: Sağlık Bilimleri Üniversitesi, İzmir Tepecik Eğitim ve Araştırma Hastanesi, Çocuk Sağlığı ve Hastalıkları Kliniği’nde çalışan ve 10-20 Haziran 2020 tarihleri arasında web tabanlı ankete katılmış 151 doktor ve hemşir/hemşire çalışmaya dahil edilmiştir. Sosyo-demografik sorular, Depresyon, Anksiyete ve Stres Skoru-21 (DASS-21) ve Uykusuzluk Şiddeti Ölçeği (ISI) sağlık çalışanlarının psikolojik durumunu belirleme amacıyla kullanılmıştır.
Bulgular: Katılımcıların çoğu erkek (%73,6) ve doktordu (%64,2). Çalışanların yaklaşık 2/3’ü COVID-19 ilişkili bölümlerde görev almıştı. ISI ve DASS-21 alt skorları arasında kuvvetli ilişkiler bulundu. Sosyo-demografik değişkenlere bağlı olarak ISI ve DASS-21 skorları arasında erkek veya evli olmanın istatistiksel olarak anlamlı fark oluşturduğu gözlendi. Evli olmanın psikolojik açıdan koruyucu olmadığı ve erkek olmanın daha fazla emosyonel durum değişikliğine neden olduğu saptandı.
Sonuç: Bu tip acil halk sağlığı problemleri sonrasında mental sağlık tepkilerini anlamaya çalışmak, sağlık çalışanları ve toplumda yer alan kişilerin afet durumlarına daha hazırlıklı olmasını sağlayabilir. Şimdiye kadar yapılan çalışmaların hiçbiri çocuk sağlığı kliniklerini kapsamamaktadır ve pandeminin psikolojik etkileri konusunda daha fazla çalışmaya ihtiyaç vardır.
Objective: Facing the critical situation of the pandemic, healthcare professionals are directly involved in the diagnosis, treatment, and care of patients with COVID-19 in the front line and they are at risk of developing psychological distress and other mental health symptoms. Here it is aimed to determine where the child clinic staff stand in terms of the psychological burden of the disease.
Methods: A hundred and fifty-one eligible physicians and nurses working in the Clinic of Pediatric, University of Health Sciences Turkey, İzmir Tepecik Education and Research Hospital who answered a web-based questionnaire between 10-20 June 2020 were included in the study. Socio-demographic questions, Depression, Anxiety and Stress Scale-21 (DASS-21), and Insomnia Severity Index (ISI) were used to evaluate the psychological determinants of the healthcare workers.
Results: Most of the participants were males (73.6%) and physicians (64.2%). Nearly two-thirds of the participants were employed in the COVID-19 related departments. We found strong correlations between DASS-21 subscale scores and ISI. Regarding socio-demographic variables, there were statistical differences for the results of ISI and DASS-21; such as male workers had more emotional problems and to be married had no protective effect during this pandemic.
Conclusion: Trying to understand mental health responses after this emerging public health problem, it can enable us to be prepared for the disaster for healthcare professionals and communities. None of the studies conducted does include child health and disease clinics and more research is needed about this topic.

8.Various Perspectives on Foreseeing Placental Failure
Serdar Balcı
doi: 10.4274/terh.galenos.2020.05579  Pages 201 - 207 (56 accesses)
Amaç: İlk trimester testi sırasında rutin olarak gözlemlenen düşük gebelikle ilişkili plazma protein-A (PAPP-A) değerleri, gelişimsel gecikmenin bir ön göstergesi olabilir. Düşük PAPP-A değerleri ile birlikte ikinci trimesterde yapılacak fetal Doppler akım ölçümleri ve fetal biyometrik ölçümler kötü gebelik sonuçlarını tahmin etmede faydalı olabilir.
Yöntem: Tüm gebeler doğuma kadar takip edildi. Çalışmaya katılan gebelerin ilk trimester testi sırasında ölçülen PAPP-A değerleri kaydedildi. Daha sonra gebeliğin 20.-24. ve 28.-32. haftalarında umblikal arterin renkli pulslu Doppler ultrason muayenesi yapıldı Bulgular: Bu çalışmada, gebeliğin 20.-24. haftaları arasında umblikal arter pulsatilite indeksi (PI) için kesme değeri 1,135 iken, kötü gebelik sonuçları için %70,6 duyarlılık ve %48,9 özgüllük elde ettik. Gebeliğin 28.-32. haftalarında umblikal arter PI kesme değeri 0,85 olarak alındığında, kötü gebelik sonuçları için %82,4 duyarlılık ve %22,7 özgüllük elde edilmiştir. Çalışmamızda, gebeliğin 20.-24. ve 28.-32. haftalarında yapılan fetal biyometrik ölçümlerde son adet tarihine göre hesaplanan gestasyonel yaştan 1 haftadan fazla gerisinde kalan ve HC/AC oranı 20.-24. ve 28.-32. haftalar için sırasıyla 1,15 ve 1,10’un üzerinde olan gebeler erken başlangıçlı fetal büyüme geriliği açısından riskli grup olarak kabul edildi. Riskli gebeler grubu, diğer gebe grubu ile karşılaştırıldı ve gebelik sonuçları açısından anlamlı farklılık tespit edildi.
Sonuç: Tarama testi olarak tek başına kullanılabilecek bir yöntem olmamasına rağmen, plasental yetmezliğin olumsuz maternal ve fetal sonuçlarının erken tahmin edilmesinin bazı fetal biyometrik ölçümler veya HC/AC oranının değerlendirilmesi kullanılarak mümkün olabileceğini bulduk.
Objective: Low values of pregnancy-associated plasma protein-A (PAPP-A) routinely observed during the first trimester testing may be a preliminary indicator of developmental delay. Doppler flow measurements and fetal biometric measurements (FBMs) that would be performed in the second trimester together with low PAPP-A values may be useful in predicting poor pregnancy outcomes.
Methods: The pregnant women were followed until delivery. PAPP-A values measured during the first trimester test of pregnant women participating in the study were recorded. Later on, color pulsed Doppler ultrasound examination of umblical artery was performed on the 20th-24th and 28th-32th weeks of pregnancy.
Results: In the present study, we achieved a sensitivity of 70.6% and a specificity of 48.9% for poor pregnancy outcomes, when the cut-off value for umbilical artery pulsatility index (PI) was 1.135 during the 20th-24th weeks of pregnancy. On the 28th-32nd weeks of pregnancy; when the cut-off value of umbilical artery PI was taken as 0.85, a sensitivity of 82.4% and a specificity of 22.7% were achieved for poor pregnancy outcomes. In the present study, the pregnant women of whom estimated gestational age that was calculated based on ultrasonographic. FBMs performed on the 20th-24th and 28th-32nd weeks of pregnancy was more than 1 week behind the gestational age that was calculated according to the last menstrual period and the pregnant women with head circumference/abdominal circumference (HC/AC) ratio over 1.15 and 1.10 on the 20th-24th and 28th-32nd weeks of pregnancy, respectively were considered as risky group in terms of early-onset fetal growth retardation.The group of risky pregnant women was compared with the other group of pregnant women and significant difference was determined in terms of pregnancy outcomes.
Conclusion: We found that early prediction of unfavorable maternal and fetal outcomes of placental insufficiency might be possible using some test results, such as FBMs or assessment of HC/AC ratio,even though there is no method that can be used alone as a screening test.

9.Evaluation of Turkish Validity and Reliability of the Depression Literacy Qestionnaire (D-LIT-Qestionnaire)
Saniye Göktaş, Çınar Yenilmez, Selma Metintaş
doi: 10.4274/terh.galenos.2021.26429  Pages 208 - 214 (75 accesses)
Amaç: Araştırmanın amacı, Depresyon Okuryazarlığı Ölçeği’nin (DOY-Ölçeği) Türkçe geçerlilik ve güvenilirliğinin değerlendirilmesiydi.
Yöntem: Çalışma, Eskişehir Osmangazi Üniversitesi öğrencileri ile yapılan metodolojik tipte bir araştırmadır. DOY-Ölçeği Griffiths ve ark. tarafından geliştirilmiştir. Çeviri-geri çeviri yöntemiyle DOY-Ölçeği’nin son şekli oluşturuldu. Eş değer ölçüt geçerliliği için, Türkiye Sağlık Okuryazarlığı Ölçeği-32 (TSOY-32) kullanıldı. Ölçeğin, ayırt edici geçerliliği ve test-tekrar test güvenilirliğini değerlendirmek için 40 tıp fakültesi öğrencisine iki hafta arayla anket uygulaması yapıldı. Verilerin analizinde Statistical Package for the Social Sciences (versiyon 15.0) ve Lisrel 9.3 (Student’s) kullanıldı. DOY-Ölçeği’nin geçerliliğini değerlendirmek için açımlayıcı faktör analizi (AFA), doğrulayıcı faktör analizi (DFA), Spearman korelasyon analizi yapıldı. Ölçeğin güvenilirliğini değerlendirmek için, iç tutarlılık ve test-tekrar test korelasyonu kullanıldı. İstatiksel anlamlılık düzeyi p<0,05 kabul edildi.
Bulgular: Çalışma grubundaki 204 kişinin, yaş ortalamaları 20,2±2,3 yıl idi. DOY-Ölçeği’nin Kaiser-Mayer-Olkin değeri 0,69, Barlett testi p<0,001 bulundu ve verilerin faktör analizine uygun olduğu görüldü. AFA’da faktör yüklerinin 0,30’un üstünde olduğu görüldü. DFA’da ölçeğin uyum indeksleri kabul edilebilir düzeylerde bulundu. Tıp fakültesi öğrencilerinde [15 (0-19)] puan ortancası, fen edebiyat fakültesi öğrencilerine [9 (0-16)] göre daha yüksekti (p<0,001). DOYÖlçeği ve TSOY-32’nin pozitif yönde korelasyon gösterdiği saptandı (r=0,199, p=0,046). DOY-Ölçeği’nin Cronbach’s alfası 0,71 olarak hesaplandı. DOY-Ölçeği’nin, test-tekrar test puanları arasında kuvvetli düzeyde pozitif korelasyon saptandı (r=0,720, p<0,001).
Sonuç: DOY-Ölçeği’nin 18 yaş ve üzerindeki bireylerde DOY-Ölçeği’nin geçerli ve güvenilir olduğu görülmektedir.
Objective: The aim of the study was to evaluate the validity and reliability of the Turkish version of Depression Literacy Questionnairre (D-LIT-Questionnaire).
Methods: The study is a methodological research conducted with Eskişehir Osmangazi University students. D-LIT-Questionnaire was developed by Griffiths et al. The final shape of the D-LIT-Questionnaire was created by the translation-back translation method. Turkey’s Health Literacy Scale-32 (THLS-32) was used for criterion validity. A questionnaire was applied to 40 medical faculty students in two weeks intervals to evaluate the discriminant validity and test-retest reliability of the scale. Statistical Package for the Social Sciences (version 15.0) and Lisrel 9.3 (Student’s version) were used to analyze the data. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), Spearman correlation analysis were performed to evaluate the validity of the D-LIT-Questionnaire. Internal consistency and test-retest correlation was used to evaluate the reliability of the scale. Statistical significance was accepted as p<0.05.
Results: The mean of age of 204 students in the study group was 20.2±2.3 years. The Kaiser-Mayer-Olkin value of the scale was 0.69 and the Barlett test result was p<0.001 and the data were found to be suitable for factor analysis. It was observed that factor loads in EFA were above 0.30. The fit indices of the scale in CFA were found at acceptable levels. The median score of the students of Faculty of Medicine [15 (0-19)] was higher than the students of Faculty of Arts and Sciences [9 (0-16)] (p<0.001). The D-LIT-Questionnaire and THLS-32 were found to be positively correlated (r=0.199, p=0.046). The Cronbach’s alpha of the D-LIT-Questionnaire was calculated as 0.71. There was a strong positive correlation between the test-retest scores of the D-LIT-Questionnaire (r=0.720, p<0.001).
Conclusion: It is observed that the D-LIT-Questionnaire is valid and reliable for measuring D-LIT-Questionnaire in individuals aged 18 and over.

10.Evaluation of COVID-19 Tests Laboratory Processes
Hatice Esen, Nevgün Sepin Özen, Tuğba Çalışkan, Yeşim Çekin
doi: 10.4274/terh.galenos.2021.92603  Pages 215 - 220 (64 accesses)
Amaç: Bu araştırmanın amacı; bir eğitim ve araştırma hastanesi mikrobiyoloji laboratuvarında Koronavirüs hastalığı-2019 (COVID-19) sürecinde çalışılan polimeraz zincir reaksiyonu (PCR) testlerinin preanalitik, analitik ve post analitik süreçleri incelenerek düzeltici faaliyetlerin belirlenmesidir.
Gereç ve Yöntem: 29 Mart-15 Mayıs 2020 tarihleri arasında COVID-19 şüpheli hastalardan alınan ve mikrobiyoloji laboratuvarına gelen PCR numune kayıtları incelenerek test süreçleri araştırılmıştır. Kullanılan veriler; Halk Sağlığı Yönetim Sistemi, Hastane Bilgi Yönetim Sistemi ve Laboratuvar Bilgi Sistemi’nden elde edilmiştir. Araştırma retrospektif, kesitsel ve tanımlayıcı olarak planlanmış olup, kabul edilen numunelerin test sonuç verme süreleri, numune kabul ile sonuç verme zamanı arasındaki süre ile reddedilen numune oranı kullanılarak ilgili verilerin istatistiksel analizi Statistical Package for the Social Sciences 20.0 programı aracılığı ile değerlendirilmiştir.
Bulgular: Çalışmada, mikrobiyoloji laboratuvar süreçlerinin izlenebilirliği, nedenleriyle birlikte ele alınmış ve araştırmadan elde edilen bulgulara göre PCR testlerinin ortalama 3 saatte sonuçlandığı, zamanında verilmeyen sonucun oldukça az olduğu ve numune reddinin oldukça düşük olduğu saptanmıştır.
Sonuç: Pandemi sürecinde; mikrobiyoloji laboratuvarlarının organizasyonu, kısa sürede sonuç vermesi, sağlık çalışanları ve hastadan hastaya bulaşın önlemesinde önem arz etmektedir.
Objective: It is aimed to determine the corrective actions by examining the preanalytical, analytical and postanalytical processes of the polymerase chain reaction (PCR) tests studied in the Coronavirus disease-2019 (COVID-19) process in a education and research hospital microbiology laboratory.
Methods: The test processes were investigated by examining PCR sample records taken from patients with suspected COVID-19 and sent to the microbiology laboratory between March 29 and May 15, 2020. Data used; The Public Health Management System has been obtained from the hospital information management system and the Laboratory Information System. The research was planned as retrospective, cross-sectional and descriptive, and the statistical analysis of the relevant data was evaluated using the Statistical Package for the Social Sciences 20.0 program using the test result time of the accepted samples, the time between sample acceptance and the time of giving results, and the rejected sample rate.
Results: In the study, traceability of microbiology laboratory processes was discussed together with the reasons. According to the findings obtained from the study, it was determined that the PCR tests were completed in an average of 3 hours, the results that were not given on time were very low and the sample rejection was quite low.
Conclusion: The organization of microbiology laboratories during the pandemic process is important in preventing transmission from healthcare professionals and patient to patient, giving results in a short time.

11.The Success of Directly Observed Treatment and Effecting Factors in Tuberculosis
Sami Deniz, Ahmet Emin Erbaycu
doi: 10.4274/terh.galenos.2021.48264  Pages 221 - 229 (61 accesses)
Amaç: Türkiye’de tüberkülozluların (TB) tedavi ve takibi Verem Savaş Dispanserleri (VSD) tarafından ücretsiz, doğrudan gözetimli olarak yapılmaktadır. Bu çalışmada Aydın ilindeki TB’li hastaların hastalığa özgü karakteristikleri ve doğrudan gözetimli tedavi (DGT) başarısını ortaya koymak amaçlanmıştır.
Yöntem: İldeki dört VSD’nin dört yıl boyunca takip ve tedavi ettikleri TB’li hastalar incelenmiştir. Bu döneme ait kayıtlardan 6.557 hasta bilgisine ulaşılmış, kayıtları eksiksiz ve tedavi sonuçlarını içerenler çalışmaya alınmıştır. Hastaların demografik, mikrobiyolojik, tedavi sonuçları kaydedilmiştir.
Bulgular: 1.023 erkek, 490 kadın, toplam 1.513 hasta çalışmaya dahil edildi. 1.126 (%74,4) hastaya akciğer, 387 (%25,5) hastaya akciğer dışı TB tanısı konulmuştu. Akciğer dışı TB’de en sık lenfadenit (%44,1), ikinci sıklıkta plevral TB (%41,6) saptandı. TB’nin kadınlarda daha genç yaşlarda, erkeklerde orta ve ileri yaşlarda görüldüğü tespit edildi (p=0,0001). En yüksek negatif mikroskopik inceleme sıklığı 18 yaş altında saptandı (p=0,0001). Akciğer dışı TB sıklığı kadınlarda anlamlı şekilde daha fazla ve tedaviyle kür oranı anlamlı şekilde daha düşüktü (p=0,0001). Akciğer ve akciğer dışı TB’liler karşılaştırıldığında; akciğer TB’de daha yüksek ilaç direnci ve kür oranı vardı (p=0,0001). İlaç direnci erkeklerde, 18-65 yaş aralığında ve akciğer TB’de daha sıktı.
Sonuç: VSD takibindeki TB’li hastalarda tedavi başarısı %87,5 olarak bulunmuştur. TB kadınlarda daha genç yaşlarda, erkeklerde orta ve ileri yaşlarda görülmektedir. En yüksek negatif mikroskopik inceleme sıklığı 18 yaş altı hastalardadır. Akciğer dışı TB sıklığı kadınlarda daha fazladır ve tedaviyle kür oranı düşüktür. Akciğer ve akciğer dışı TB’de DGT ülkemizde pratik ve etkin bir tedavi yöntemidir.
Objective: In Turkey, patients with tuberculosis are treated and followed by Tuberculosis Dispensaries by free directly observed method. In the study, the demography, microbiology, disease localization, drug resistance, success of treatment in tuberculosis in Aydın city were assessed.
Methods: In Turkey, patients with tuberculosis are treated and followed by Tuberculosis Dispensaries by free directly observed method. In the study, the disease characteristics and success of treatment in tuberculosis patients in Aydın city were assessed.
Results: 1.023 men and 490 women, totally 1.513 patients were included. The diagnosis was pulmonary tuberculosis in 1.126 (74.4%), extra-pulmonary tuberculosis in 387 (25.5%). In extra-pulmonary tuberculosis; lympadenitis was most frequent (44.1%), where the second was pleural tuberculosis (41.6%). Tuberculosis was diagnosed in women on earlier ages, where on middle and advanced ages in men (p=0.0001). The higher frequency of smear negativity was found in ages lower 18 years old (p=0.0001). The frequency of extra-pulmonary tuberculosis was significantly higher and cure with treatment was significantly lower in women (p=0.0001). Higher frequency of drug resistance and cure were shown in pulmonary tuberculosis (p=0.0001). Drug resistance was frequent in men, 18-65 years old and pulmonary tuberculosis.
Conclusion: Treatment success in patients followed by Tuberculosis Dispensaries were 87.5%. Tuberculosis is diagnosed at earlier ages in women, at middle and advanced ages in men. The higher microscopic negativity frequency is in ages lower than 18. Extra-pulmonary tuberculosis is frequent in women and cure after treatment is lower. Directly observed therapy in pulmonary and extra-pulmonary tuberculosis is practical and effective treatment method in our country.

12.Does Severity of Being Small for Gestational Age in Very Low Birth Weight Infants Affect Mortality?
Aybüke Yazıcı, Mehmet Büyüktiryaki, Ömer Ertekin, Fatma Nur Sarı, Şerife Suna Oğuz, Evrim Alyamaç Dizdar
doi: 10.4274/terh.galenos.2021.93753  Pages 230 - 234 (62 accesses)
Amaç: Gestasyon yaşına göre küçük (SGA) olmanın klasik tanımı, pretermlerde değişik derecelerde büyüme kısıtlılığının olması durumunda yetersiz değerlendirmeye sebep olabilir. Bu çalışmada çok düşük doğum ağırlıklı bebeklerde (ÇDDA) ılımlı ya da ciddi düzeyde SGA olmanın mortalite üzerine etkinliğinin araştırılması amaçlandı.
Yöntem: Bu retrospektif çalışmaya 2013-2017 tarihlerinde hastanemizde doğan doğum ağırlığı <1500 g olan 711 prematür bebek dahil edildi. Gestasyon haftasına göre doğum ağırlığı <10 persentil olanlar SGA, 10-19 persentil arasında olanlar ılımlı SGA (M-SGA) ve >20 persentil olanlar AGA olarak gruplandırıldı. Persentil belirlemede Fenton büyüme eğrisi kullanıldı.
Bulgular: Çalışmada SGA, M-SGA ve AGA grubuna sırası ile 34, 46 ve 631 bebek dahil edildi. Çalışmaya dahil edilen bebeklerden SGA olan grupta medyan doğum ağırlığı 660 g (560-720), M-SGA grubunda 800 g (720-870), AGA grubunda 1,080 g (920-1245) (p<0,001) idi. Mortalite oranları SGA (%44,1) ve M-SGA (%15,2) gruplarında AGA (%11,9) grubuna göre daha yüksek saptandı (p<0,001). Lojistik regresyon analizinde erken neonatal sepsis [Odds oranı (OR): 2,5, %95 güven aralığı (GA): 1,5-4,3], ciddi intraventriküler kanama (OR: 3,8, %95 GA: 2,08-6,77) ve SGA olmak (OR: 7,08, %95 GA: 2,5-14,7) mortalite için bağımsız risk faktörleri olarak bulundu. Ilımlı SGA varlığı mortalite için bağımsız risk faktörü olarak saptanmadı.
Sonuç: Prematüriteye SGA’nın eşlik ediyor olması morbidite ve mortalite açısından risk oluşturmaktadır. ÇDDA’larda ılımlı SGA varlığı da mortaliteyi arttırabilir. SGA ciddiyeti de göz önüne alınarak hazırlanmış yeni sınıflandırmalarla yapılan ileri çalışmalara ihtiyaç vardır.
Objective: The classic definition of being small for gestational age (SGA) may lead to inadequate evaluation if there are varying degrees of growth restriction in preterms. In this study, we aimed to investigate the effectiveness of moderate or severe SGA on mortality in very low birth weight infants.
Methods: In this retrospective study, 711 premature babies with birth weight <1500 g born in our hospital between 2013 and 2017 were included. According to the gestational week, with a birth weight <10 percentile were grouped as SGA, between 10-19 percentile were grouped as moderate SGA (M-SGA) and with >20 percentile were grouped as AGA. Fenton growth curve was used to determine percentile.
Results: In the study, 34, 46 and 631 babies were included in the SGA, M-SGA and AGA groups, respectively. The median birth weight was 660 g (560-720) in the SGA group, 800 g (720-870) in the M-SGA group and 1080 g (920-1245) in the AGA group (p<0.001). Mortality rates were higher in SGA (44.1%) and M-SGA (15.2%) groups than in AGA (11.9%) groups (p<0.001). In logistic regression analysis, early neonatal sepsis [Odds ratio (OR): 2.5, 95% confidence interval (CI): 1.5-4.3], severe intraventricular bleeding (OR: 3.8, 95% CI: 2.08-6.77) and being SGA (OR: 7.08, 95% CI: 2.5-14.7) are found as independent risk factors for mortality. The presence of moderate SGA was not detected as an independent risk factor for mortality.
Conclusion: SGA with accompanying prematurity involves more risk for morbidity and mortality. The presence of moderate SGA in very low birth weight infants may also increase mortality. Further studies are needed with new classifications prepared considering the severity of SGA.

13.Evaluation of Six Years of HCV Seroprevalance and Correlation with HCV RNA at a Tertiary Care Hospital
Pınar Şamlıoğlu, Yeşer Karaca Derici, Güliz Doğan, Arzu Bayram, Sebahat Taş, Nisel Yılmaz
doi: 10.4274/terh.galenos.2021.01709  Pages 235 - 239 (67 accesses)
Amaç: Hepatit C virüsü (HCV), kronik karaciğer hastalığı, siroz ve hepatoselüler karsinomaya yol açabilmesi nedeniyle dünyada ve ülkemizde önemli bir halk sağlığı problemidir. HCV enfeksiyonunun tanı ve takibinde serolojik ve moleküler yöntemler kullanılmaktadır. Bu çalışmadaki amacımız hastanemizin altı yıllık HCV seroprevalansının ve HCV RNA ile korelasyonunun değerlendirilmesidir.
Yöntem: Laboratuvarımıza 01.01.2013-31.12.2018 tarihleri arasında anti-HCV istemiyle gönderilen 193.332 örnek ve bunlardan HCV RNA isteği yapılan 8,034 örnek sonuçları retrospektif olarak incelendi. Anti-HCV seropozitiflik tarama testi olarak kemilüminesans mikropartikül immün yöntem ile çalışan Architect i2000 cihazında (Abbott, ABD) Architect anti-HCV kiti (Abbott, ABD) kullanıldı. HCV RNA polimeraz zincir reaksiyonu testi (COBAS AmpliPrep/COBAS Taqman HCV kantitatif testi v2.0 (Roche, İsviçre) ile çalışıldı.
Bulgular: Altı yıllık süre içinde çeşitli kliniklerden toplam 193.332 serum örneği gelmiştir. Bu örneklerin 124.655’i (%64) kadın, 68.677’si (%36) erkek hastalara ait idi. 9,224 (%5) hasta 18 yaş ve altı, 28.607 (%15) hasta 65 yaş ve üzeriydi. Gelen örneklerden 190.200’ü (%98,4) anti-HCV non reaktif bulunmuştur. Toplam 3,132 (%1,6) serumda anti-HCV pozitif saptanmıştır. 1,646 (%52,5) serumda anti-HCV 1,00-4,99 değeri arasında bulunmuş olup zayıf pozitif olarak, 1,486 (%44,4) serumda anti-HCV beşten büyük bulunmuş olup yüksek pozitif olarak değerlendirilmiştir. Her iki test istemi yapılan 8,034 hastanın 531’inde (%7) anti-HCV ve HCV RNA pozitif, 2,601 (%32) örnekte anti-HCV pozitif HCV RNA negatif saptanmıştır. 4,902 (%61) serumda anti-HCV ve HCV RNA negatif bulunmuştur.
Sonuç: Anti-HCV araştırılması tüm laboratuvarlarda kolaylıkla uygulanabilir bir yöntemdir. Özellikle düşük titrelerde anti-HCV pozitifliği olan hastalarda HCV RNA test edilerek gerçek pozitiflikler ortaya konulmalıdır.
Objective: Hepatitis C virus (HCV) is an important public health problem due to chronic liver disease, cirrhosis and hepatocellular carcinoma. Serological and molecular methods are used in the diagnosis and follow-up of HCV infection. Our aim in this study is to evaluate the six-year HCV seroprevalence of our hospital and its correlation with HCV RNA.
Methods: The results of 193.332 samples sent to the our laboratory 01.01.2013-31.12.2018 with anti-HCV request and 8034 sample results from which HCV RNA requests were made were analyzed retrospectively. Anti-HCV was studied by chemiluminescance microparticle immunoassay (Abbott, US) at Architect i2000 immunoanalyzer (Abbott, US). The HCV RNA polymerase chain reaction test was studied by Roche COBAS AmpliPrep/COBAS Taqman HCV quantitative test v2.0 (Roche, Swiss).
Results: A total of 193.332 serum samples from various clinics during a six years period were included in the study. 124.655 (64%) of these samples belonged to female patients and 68.677 (36%) belonged to male patients. 9.224 (5%) patients were 18 years and under, 28607 (15%) patients were 65 years and over. Of all incoming samples, 190.200 (98.4%) serum samples were found to be non-reactive. Anti-HCV reactive in total 3.132 (1.6%) serum samples. In 1.646 (52.5%) serum samples anti-HCV was found between 1.00-4.99 and weakly reactive, 1.486 (44.4%) serum samples were found to be higher than five and anti-HCV was evaluated as high reactive. HCV RNA was positive in 531 (7%) of anti-HCV reactive serum. 2.601 (32%) of the HCV RNA samples were negative. Anti-HCV non reactive and HCV RNA negative were found in 4.902 (61%) serum.
Conclusion: Anti-HCV is an easily applicable method in all laboratories. Confirmation should be demonstrated by testing HCV RNA, especially in patients with anti-HCV positivity at low titers.

14.Current Status of Oocyte Cryopreservation in Assisted Reproductive Technologies and Evaluation of Oocyte Freezing Cycles Performed in Our Clinic
Volkan Emirdar, Funda Göde, Volkan Karataşlı, Gülin Okay, İbrahim Pala, Zerrin Sertkaya
doi: 10.4274/terh.galenos.2021.06926  Pages 240 - 244 (78 accesses)
Amaç: Çeşitli endikasyonlar ile kliniğimizde uygulanan oosit dondurma hastaları ve sonuçlarının değerlendirilmesidir.
Yöntem: Bu retrospektif araştırmaya üçüncü basamak bir hastanenin tüp bebek merkezine 2015-2020 yılları arasında başvuran, gonadotoksik tedaviler öncesi fertilite prezervasyonu uygulanan; düşük over rezervi saptanan evli olmayan kadın hastalar ve azospermi nedeniyle işlem günü eşlerinden sperm elde edilemeyen veya oosit sayısının az olması nedeniyle mikroenjeksiyon için oosit havuzlaması yapılan 18-48 yaş arası kadın hastaların oosit dondurma siklusları ve sonuçları değerlendirildi.
Bulgular: Farklı endikasyonlar ile başvuran 224 kadın hastanın yapılan kontrollü ovaryen stimülasyon sonrası oosit dondurma sikluslarından elde edilen verilere göre oosit canlılık oranı %92,68, çözme siklusu başına gebelik oranı %8,66, çözme siklusu başına canlı doğum oranı ise %4,66 olarak bulundu.
Sonuç: Klinik uygulamalarda yerini almış olan oosit kriyoprezervasyon sikluslarında dondurma-çözme sonrası oosit sağkalım oranları vitrifikasyon ile oldukça yüksek saptanmış olup; bu oositler ile elde edilen gebelik ve canlı doğum oranları, embriyo dondurma-çözme oranlarına yakın bulunmuştur. Vitrifikasyon tekniklerindeki gelişmeler ile yüksek canlılık ve başarı oranları yakalanan oosit dondurma-çözme uygulamalarının endikasyonlar dahilinde yardımcı üreme tekniklerinde daha güçlü bir yer alacağı düşünülmektedir.
Objective: Evaluation of oocyte cryopreservation cycles and results that we perform for various indications in our clinic.
Methods: The patients aged between 18-48 years and subjected oocyte cryopreservation for various indications between 2015 and 2020 in tertiary referral center hospital in vitro fertilization clinic were investigated in this retrospective study. The groups are established as single women for fertility preservation before gonadotoxic treatments, single women with diminished ovarian reserve, whose sperm could not be obtained on the day of oocyte retrieval or oocyte pooling due to microinjection application on the same day for the whole oocytes.
Results: According to the data obtained from oocyte freezing after controlled ovarian hyperstimulation cycles of 224 patients for various indications; oocyte survival rate was 92.68%, pregnancy rate was 8.66% and live birth rate was 4.66% per oocyte thaw cycle.
Conclusion: In oocyte cryopreservation cycles that have taken their place in clinical practice, oocyte survival rates after freeze-thaw were found quite high with vitrification method; pregnancy rates and live birth rates obtained with these oocytes were found similar to embryo freeze-thaw rates. By the developments in vitrification techniques, it is thought that oocyte freeze-thaw cycles which have high survival and success rates will have stronger place in the field of assisted repruductive treatments.

15.Retrospective Analysis of Fetal Central Nervous System Anomalies Diagnosed Prenatally in a Tertiary Center
İbrahim Ömeroğlu, Hakan Gölbaşı, Elif Uçar, Barış Sever, Halil Gürsoy Pala
doi: 10.4274/terh.galenos.2021.65872  Pages 245 - 250 (68 accesses)
Objective: In our study, we aimed to emphasize the prevalence and characteristics of central nervous system (CNS) anomalies detected by fetal ultrasonography in normal and high-risk pregnant women admitted to our clinic.
Methods: In this retrospective analysis, cases who applied to University of Health Sciences Turkey, İzmir Tepecik Education and Research Hospital Perinatology Clinic between January 1, 2017 and January 1, 2021 and who were found to have CNS anomaly were included. The data of 81,163 pregnant women were analyzed. CNS anomaly was detected in 712 pregnant women.
Results: When all cases included in our study were examined, the median maternal age was calculated as 27.4 and the median of gestational weeks as 21.9. The median gravidas of the pregnant women were 2.4, and the median of the parities was 1.1. When all diagnoses were examined, ventriculomegaly (n=217, 30%) was the most common anomaly among the CNS anomalies. The second most common anomaly we detected was the cases of neural tube defect (n=95, 13.17%).
Conclusion: Termination option could not be offered to families for anomalies incompatible with life in pregnant women whose gestational weeks are more than 24 weeks. Some of the families who were offered the termination option did not accept the termination option due to cultural reasons and religious beliefs. For this reason, early diagnosis becomes important in the perinatal period in order to present this option to the family.

16.Management of Granulosa Cell Ovarian Tumors: 10-Year Experience in a Tertiary Center
Sema Karakaş, Ayşe Büşra Önder, Gökhan Demirayak, Cihan Comba, Selim Avşar, Burcu Akay, Sema Süzen Çaypınar, Aykut Özdemir
doi: 10.4274/terh.galenos.2021.77150  Pages 251 - 256 (60 accesses)
Amaç: Granüloza hücreli tümörler (GCT) yumurtalıkların mezenkimal hücrelerinden ve cinsiyet kordonlarından ortaya çıkar ve her yaş grubundaki kadınlarda görülebilir. Bu çalışma, GCT olgularının klinik seyri ve sonuçları hakkında 10 yıllık jinekoloji onkoloji deneyimimizi sunmayı amaçladı.
Yöntem: Ocak 2011-Ocak 2018 tarihleri arasında hastanemizde şüpheli adneksiyal kitle nedeniyle ameliyat edilen ve son patoloji raporu GHT tanısı ile doğrulanan 31 hasta çalışmaya dahil edildi. Hastaların verileri değerlendirildi. Preoperatif ultrason bulguları ve serum tümör belirteç sonuçları not edildi.
Bulgular: Yirmi dokuz (%94) hastaya AGCS tanısı kondu ve sadece iki (%6) hastaya JGCS tanısı kondu. Çalışma popülasyonunun ortalama yaşı 47,74 14,47 yıl ve ortalama vücut kitle indeksi: 32,51 7,1 idi. Hastaların çoğu ağır adet kanaması (%29) ile başvurdu. Hastaların %48,4’üne bilateral salpingo-ooferektomi ve tam lenf nodu diseksiyonu ile histerektomi, %22,6’sına bilateral salpingo-ooferektomi ile histerektomi, %29’una sadece ooferektomi yapıldı. Üç hastada (%9,3) hastalık nüksü vardı. Genel sağkalım 54,4 29,3 aydı ve hastalıksız sağkalım 49,6 24,2 aydı.
Sonuç: GCT’li hastalar arasında sağkalımın en önemli prediktörü, ilk tanı anındaki hastalık evresidir. Tümör belirteçlerinin rutin klinik takibi ve değerlendirmesini içeren uzun vadeli sürveyans zorunludur.
Objective: Granulosa cell tumors (GCT) arise from the mesenchymal cells and sex cords of the ovaries and can be observed in women of all age groups. This study presented our 10 year-long gynecology oncology experience on the clinical course and outcome of GCT cases.
Methods: Thirty-one patients who were operated due to suspicious adnexal masses in our hospital between January 2011 and January 2018 and whose final pathology report confirmed the diagnosis of GCT was included in the study. The data of the patients were evaluated. Preoperative ultrasound findings and serum tumor marker results are noted.
Results: Twenty-nine (94%) patients were diagnosed with AGCS and only two (6%) patients were diagnosed with JGCS. The mean age of the study population was 47.74 14.47 years and the mean body mass index was 32.51 7.1. Most patients presented with heavy menstrual bleeding (29%). 48.4% of the patients underwent hysterectomy with bilateral salpingo-oophorectomy, and complete lymph-node dissection, whereas 22.6% of them had hysterectomy with bilateral salpingo-oophorectomy, and 29% of them had oophorectomy only. Three patients (9.3%) had a disease recurrence. The overall survival was 54.4 29.3 months and disease free survival was 49.6 24.2 months.
Conclusion: The most important predictor of survival among patients with GCT is a disease stage at the time of initial diagnosis. Long-term surveillance, including routine clinical follow-up and evaluation of tumor markers is mandatory.

17.Factors Affecting the Morbidity and Mortality of Gastric Cancer Surgery
Sevinç Dağıstanlı
doi: 10.4274/terh.galenos.2021.32815  Pages 257 - 261 (55 accesses)
Objective: 60-65% of all gastric cancers detected in the Western world are locally advanced at the time of diagnosis. Since curative surgery is a factor affecting survival, extended resections applied to these patients may increase the risk of complications. The aim this study was to determine the post-surgical mortality and morbidity rates in locally advanced gastric cancers.
Methods: One hundred-eighteen patients with non-metastatic, locally advanced gastric cancer who underwent surgery at Ankara Oncology Education and Research Hospital between January 2002 and September 2004 were retrospectively analyzed.
Results: Additional organ resection was performed in 65 (55.08%) patients due to adjacent organ invasion. The morbidity and mortality rates of the total series were 21.7% and 4.5%, respectively. In multivariate analyses, the morbidity-increasing parameter was found to be more than two additional organ resections (p=0.001), while the factors-increasing mortality were two or more additional organ resections (p=0.001), cardiovascular and respiratory comorbidities (p=0.002).
Conclusion: Additional organ resection rates are high in patients with locally advanced gastric cancer who do not receive neo-adjuvant therapy, which increases morbidity and mortality rates.

18.Is it Really Clean? Investigation of a “No-Touch Button” for Bacterial Contamination by a Different Technique
Aybüke Akaslan Kara, İlker Devrim, Nevbahar Demiray, Yeliz Oruç, İlknur Çağlar, Elif Böncüoğlu, Elif Kıymet, İlker Yavuz, Özlem Gamze Gülfidan, Fahri Yüce Ayhan, Tanju Çelik, Nuri Bayram
doi: 10.4274/terh.galenos.2022.79477  Pages 262 - 267 (69 accesses)
Objective: No-touch buttons are generally used by patients, patients care givers and healthcare workers. Principal mechanism is based on opening the doors without touching the surface and is supposed to be clean. The objective of this study was to determine the contamination load of no- touch buttons with adenosine triphosphate (ATP) measurement method and to identify microorganisms using microbiological methods in a tertiary pediatric research hospital.
Methods: A total of 65 samples were collected from the surfaces of buttons located the inside and outside of the units and analyzed to assess ATP levels and mircoorganim colony count.
Results: Among the samples taken from the surface of buttons, 53 (81.5%) of the surfaces had microorganism isolation. The relative light unit (RLU) values ranging from 35 to 2048/100 cm2 were determined by the ATP bioluminescence assay. The median RLU value was 217/100 cm2 and 41.5% of the values (27 samples) were equal to or higher than 250/100 cm2. A significant correlation was found between the luminometric and microbiological data obtained for the same surfaces (p<0.05). No significant differences in colonization prevalence were clear concerning the location of the buttons (p>0.05).
Conclusion: Although not an alternative to cultural methods, the ATP-bioluminescence-assay can be a useful tool for measuring the efficiency of cleaning also in environments. Our data suggest that microbial contamination of no-touch buttons is prevalent. Regarding these results, strict hand hygiene is important since even no-touch buttons might serve as reservoirs for microorganisms.

19.The Effect of COVID-19 Pandemic Thoracic Trauma Patients with on Transferred to the Emergency Service
Şükrü Yorulmaz, Anıl Gökçe
doi: 10.4274/terh.galenos.2022.33339  Pages 268 - 272 (66 accesses)
Objective: On March 11 2020, World Health Organization declared Coronavirus disease-2019 (COVID-19) a pandemic. Trauma, and particularly thoracic trauma, may not be prominent with the coronavirus, but there is a serious risk to the patient's life and needs to be planned. Our study aims to reveal the effects of the current pandemic on the distribution of patients with thoracic trauma transferred to the emergency service.
Methods: In this study, patients with thoracic trauma who were transferred to the emergency services by ambulance between March 2019 and March 2021 were examined. The study group was divided into two as pre-pandemic and post-pandemic periods. Data such as trauma type, gender, age, type of thoracic injury area were included in the study.
Results: The total number of patients referred to the emergency department in the pre-pandemic period was 267,897. During the pandemic period, there were 167,729 patients. In the pre-pandemic period, traffic accidents were in the first place, with 72,293 patients. In the pandemic period, falls were in the first place with 37,256 patients. When the study data were examined, there was a significant difference in terms of the total number of patients in the pre-pandemic and post-pandemic periods (p=0.021). Both groups were evaluated in terms of the type of trauma, there was a significant difference (p=0.017).
Conclusion: The implementation of various preventions in the COVID-19 pandemic and the reduction of human movements decreased the number of patients with thoracic trauma. Along with the decrease in the number of patients, the COVID-19 pandemic has also created differences in the etiology of trauma.

20.Evaluation of Risk Factors Affecting Metabolic Alkalosis in Infantile Hypertrophic Pyloric Stenosis
Oktay Ulusoy, Efil Aydın, Ayşe Guneş Karakurt
doi: 10.4274/terh.galenos.2022.68335  Pages 273 - 278 (59 accesses)
Objective: The cardinal sign of infantile hypertrophic pyloric stenosis (IHPS) is projectile non-bilious vomiting, which may lead to severe dehydration, electrolyte imbalance, acid-base balance disorder as metabolic alkalosis, malnutrition, growth delay and retardation. We investigated the risk factors for developing metabolic alkalosis and the effectiveness of the operative procedures, i.e., open vs. laparoscopic pyloromyotomy.
Methods: The data of 30 infants with IHPS who were treated with Ramstedt’s and laparoscopic pyloromyotomy between January 2014 and March 2022 were reviewed retrospectively. Demographic characteristics, blood chemistry, pyloric muscle thickness and length measurements by ultrasonography were recorded.
Results: Metabolic alkalosis was present in the first blood gas analysis in 20 (66.7%) of the cases. When the patients were evaluated in terms of metabolic alkalosis, no statistical difference was found regarding prenatal age, body weight, and length of stay. In patients with metabolic alkalosis, duration of symptoms was significantly long (p<0.001), serum lactate level (p=0.016) and chlorine level (p=0.006) were significantly high. Pyloric muscle thickness (p=0.019) and pyloric muscle length (p=0.004) measured using ultrasonography were significantly increased in the metabolic alkalosis group.
Conclusion: Metabolic alkalosis is an important parameter in determining the severity of the disease in IHPS. In the present study, it has been shown that length of symptom duration, increase in pyloric muscle thickness and muscle length, increase in serum lactate levels and low serum chloride levels are risk factors for developing metabolic alkalosis.

21.Evaluation of Anti-HCV Positivity in Patients Receiving Inpatient Treatment in a Mental Health Hospital in Turkey
Melis Demirci, Cem Çınar, Aslıhan Eslek, Mustafa Orhan, Şebnem Şenol Akar
doi: 10.4274/terh.galenos.2022.96992  Pages 279 - 282 (56 accesses)
Objective: Chronic hepatitis is the first cause of cirrhosis and liver carcinoma in developed countries, and it is the second cause of these conditions in Turkey. When the epidemiology of hepatitis is examined, its prevalence is 1.5 to 3.5% globally, and only about 1% in Turkey varies according to different geographical regions. We evaluated the prevalence of chronic hepatitis C infection in the psychiatric patient’s group based on sociodemographic data (age, gender, and place of residence).
Methods: We retrospectively analyzed hospitalized patients between January 2016 and January 2018 at the Manisa Psychiatric Hospital, a regional hospital in Turkey. The serological results were analyzed by the ELISA method.
Results: The number of patients included in the study was 10,944. Over the two years, 109 of the hospitalized patients were found to have anti-HCV positivity. The anti-HCV positivity ratio was 0.99%. Of these patients, 87 were men, with anti-HCV positivity of 0.97%. The mean age of anti-HCV-positive patients was 30.17 years (lowest 15, highest 91). And, the highest number of cases was found in 20-to 30-year age group. 58% of patients with anti-HCV positivity resided in the city center and districts. Almost half the patients were in the alcohol and substance addiction treatment.
Conclusion: In psychiatric patients considered a risk group for chronic hepatitis C, routine anti-HCV screening can increase the awareness and diagnostic rates of the disease. Although the prevalence of chronic hepatitis C is similar to that of psychiatric patients and the general population, more comprehensive studies are needed in these patients.

22.Evaluation of Kidney Transplant Patients Infected with COVID-19 in Turkey
Himmet Durgut, Yusuf Yavuz
doi: 10.4274/terh.galenos.2022.57614  Pages 283 - 288 (75 accesses)
Objectives: Determining the clinical course of Coronavirus disease-2019 (COVID-19) infection in terms of mortality and morbidity in patients with kidney transplantation is of scientific importance in our country and in the world. Our aim in this study was to examine the epidemiological incidence and results of kidney transplant patients registered in the data system of the “Directorate of Tissue, Organ Transplantation and Dialysis Services” in Turkey after COVID-19 infection.
Methods: In this study, which was designed as a non-interventional, retrospective, and observational study; demographic information of patients, clinical and radiological parameters, life expectancy, hospital service and intensive care requirements and length of stay were analyzed in the information systems of the Ministry of Health. In the study, a total of 12,360 people with kidney transplants in Turkey were examined between March 2020 and March 2021 with suspected COVID-19.
Results: Between March 2020 and March 2021, 12,360 patients who received Kidney Transplants were examined in Turkey with COVID-19 symptoms. The rate of patients diagnosed with COVID-19 infection was 34.5% (4266) and their average age was 49.3 years. The number of patients who died from COVID-19 in patients with kidney transplantation was 288 (6.8%) and their average age was 60.7 years. In the intensive care unit, 446 patients (10.45%) were followed and 149 (3.5%) were intubated patients.
Conclusion: COVID-19 diagnosis, pneumonia cases and mortality rates were found to be higher in patients with kidney transplantation than in the general population. However, when many publications originating from abroad are examined, it is determined that we are well below the world average in the incidence of COVID-19 infection, hospitalization, intensive care hospitalization and mortality rates in those who have kidney transplants in our country.

23.Is There a Relationship Between the National Institutes of Health Stroke Scale Scores and Magnetic Resonance Volumetric Measurements in Acute Stroke?
Alpay Tuncar, Başar Cander
doi: 10.4274/terh.galenos.2022.25349  Pages 289 - 295 (73 accesses)
Objective: In this study, we determined the relationship between the volumetric measurement value detected in the acute infarct area by diffusion magnetic resonance imaging (MRI) and the National Institutes of Health Stroke Scale (NIHSS).
Methods: This is a cohort study comparing the relationship between volumetric volume measured by diffusion MRI and NIHSS in patients with a definite diagnosis of stroke. Between February 2014 and February 2015, 99 patients over the age 18 and 57 healthy controls who applied within the first 72 h after the onset of acute stroke symptoms were included. Inclusion criteria of the patients; patients with ischemic stroke admitted to the hospital within 72 h of symptom onset, patients with MRI (including DWI) within 72 h of symptom onset are patients with an NIHSS score obtained just before MRI. DWI lesion volumes were measured on the image of the maximum contrast (ie, the DWI with the highest b-value) between the lesion and normal brain regions.
Results: The results of the volumetric measurement values determined in the patient group; left MCA 40.6%, right MCA 31.7%, left ACA 2%, right ACA 2%, left PCA 9.9%, right PCA 8.9%, left cerebellar 7.9%, right cerebellar 6%, 9, left PICA 5%, right PICA 5%, thalamooperferator 2%, AICA 2%, lacunar 2%. A statistically significant correlation was found between the NIHSS score and volumetric measurements (p<0.005).
Conclusion: Segmenting penumbra and infarct core regions based on PWI and DWI, and making volumetric measurements are important in determining immediate and future risks in acute stroke patients.

24.Effects of Working Conditions of the Operating Room Personnel on Their Quality of Life
Nevin Esra Gümüş, Tuba Kuvvet Yoldaş
doi: 10.4274/terh.galenos.2022.09735  Pages 296 - 304 (55 accesses)
Objective: The concerns of healthcare workers about their working conditions and working environment affect their Quality of Life (QOL). Operating room environment requires working attentively and at a high pace. Our objective in this study was to examine the effects of working conditions of an operating room on the QoL of the operating room personnel.
Methods: Healthcare workers working in the operating room of Samsun Education and Research Hospital were included in the study. The “Quality of Work-Life Scale” developed by Aydın et al., was used to determine the level of work-life quality of healthcare workers. A 21-question survey evaluating the demographic and occupational characteristics of the employees was also administered.
Results: One hundred and two personnel in the operating room were included in our study. Total mean score of the “QoL Scale” of healthcare workers was 76.63±10.55. A negative relationship was found between the age of healthcare workers and job stress and time pressure. Working time in the operating room was negatively associated with job discrimination and social integration into the organization. The risk of occupational accidents and diseases was positively associated with physical conditions in the workplace, work stress and time pressure. Discrimination in the workplace and social integration into the organization displayed a positive association with work stress and time pressure.
Conclusion: Increasing work experience along with increasing age of the healthcare workers were considered to reduce work stress and time pressure. It was also found that the time spent in the operating room-mitigated workplace discrimination and improved social integration into the organization. As a result, as the factors involved in the evaluation of quality of work-life, which are multidimensionally interrelated, the situations complicating the work conditions physically and psychologically increase work stress further and negatively influence the QoL at work.

25.OCT Findings and Ocular Changes in Subclinical Hypothyroidism
Esin Tunca Kırıkkaya, Hamiyet Yılmaz Yaşar
doi: 10.4274/terh.galenos.2022.93206  Pages 305 - 313 (59 accesses)
Objective: To evaluate the changes in intraocular pressure (IOP), central corneal thickness (CCT), retinal nerve fiber layer thickness (RNFLT), foveal thickness (FT) and choroid thickness (ChT) in patients with subclinical hypothyroidism.
Methods: Sixty eyes of 30 patients with subclinical hypothyroidism (study group) and 60 eyes of 30 healthy subjects (control group) were included in the study. A complete ocular examination including best corrected visual acuity (BCVA), IOP, anterior and posterior segment examination together with CCT, RNFLT, FT and ChT measurements were performed in each group. p<0.05 was accepted statistically significant.
Results: Global (G) RNFLT, nasal (N) RNFLT, nasal inferior (NI) RNFLT and ChT (p=0.008, p=0.006, p=0.046 and p=<0.001 respectively) values of the study group were statistically higher than the control group. There was a weak negative correlation between ChT and RNFLT temporal inferior (TI) and nasal (N) and global (G) quadrants in the study group (r=-0.426; p=0.024, r=-0.403; p=0.034 & r=-0.410; p=0.030 respectively). FT values of the control group were statistically higher than the study group (p=0.026).
Conclusions: Glucosaminoglycan accumulation in subclinical hypothyroid group may cause increase in RNFLT(G) and ChT. According to the SD-OCT (Spectral Domain - Optical Coherence Tomography) measurements of subclinical hypothyroid patients, negative correlation between ChT and RNFLT may be a guide in terms of progression to glaucoma. Besides, FT measurement follow-up, which may be inversely proportional with the level of hypothyroidism, may lead off about the level of visual acuity (VA). In addition to all these, the ChT may be a guide in following the treatment process. The results of our study should be supported by further studies.

26.The Protection Scale of Healthcare Professionals and Their Families in Pandemia: A Scale Development Study Specific to COVID-19
Kürşat Yurdakoş, Demet Ünalan
doi: 10.4274/terh.galenos.2021.83604  Pages 314 - 322 (64 accesses)
Objective: In this study, “The Protection Scale of Healthcare Professionals and Their Families in Pandemia” (SHPFP) was developed specifically to the Coronavirus disease-2019 (COVID-19) pandemic to determine the protection levels and efficiencies of the measures taken in healthcare institutions.
Methods: This study is of a methodological type. In scale studies, it is recommended to reach the number of participants 5-10 times more than the number of items in the item pool. The scale included 22 items and was applied to 220 participants. Therefore, 35 physicians, 148 nurses and 37 health technicians, were determined as the sample using a stratified random sampling method. The predictive factors for SHPFP were developed between the dates of June- September 2020. The internal consistency of the tool was examined using Cronbach’s alpha, and factor structure and discriminant validity by exploratory and confirmatory factor analyses. The test-retest reliability was measured by intraclass correlation coefficient.
Results: The KMO sample suitability coefficient of the scale was found as 0.876, and Barlett’s Sphericity test as χ2=2715,998 (df=231). The tool having 22 items at first was reduced to 21 items in 5 factors describing 66.78% of the total variance. These five factors, of which the scree plot eigenvalue of 1.0 and above, are “business processes”, “participation in decisions”, “work environment”, “informing and isolation” and “psychological support”.
Conclusion: SHPFP, developed in this study, can be used in healthcare institutions to determine the protection levels and efficiencies of the measures taken due to the pandemic to protect healthcare staff and their families.

27.Effect of HALP Rate to Pathological Stage with Bladder Tumor Patients
Mehmet Yoldaş, Burak Karabacakoğlu, Cem Yücel, Erdem Kısa, Gökhan Koç, Hakan Üçok, Tufan Süelözgen, Mehmet Zeynel Keskin
doi: 10.4274/terh.galenos.2022.34437  Pages 323 - 327 (75 accesses)
Objective: In this study, to investigate the effect of preoperative hemoglobin, albumin, lymphocyte and platelet (HALP) ratio on the pathological stage in patients with bladder tumors larger than 3 cm.
Methods: In the study, 310 patients who met the inclusion criteria were evaluated who underwent transurethral resection of bladder tumors operation for the first time due to bladder tumor between 2010 and 2020 and whose data were fully collected were evaluated. The patients were divided into two groups as muscle invasive (MIBC) and non-muscle invasive bladder tumor (NMIBC) according to the pathology report. The difference between HALP values and ratios was evaluated for both groups.
Results: In the study, 310 patients included in the study with complete data, 227 (73.2%) had NMIBC and 83 (26.8%) had MIBC pathology results. Of the NMIBC patients, 157 (69%) had high-grade papillary urethelial carcinoma and 70 (31%) had low-grade papillary urethelial carcinoma. The mean HALP value for NMIBC is 28.36±2.83, the mean HALP value for MIBC is 21.45±3.14. According to the univariate analysis, it was concluded that high stage was associated with hypoalbuminemia, anemia and low HALP.
Conclusion: In this study, it was concluded that calculating the HALP rate, which is cheap, easy to apply and gives rapid results, may be a significant predictor of the pathological stages of the patients and indirectly in estimating the survival of the disease.

28.Histopathological and Immunohistochemical Parameters (TGF-β1, FSP1-S100A4, α-Straight Muscle Actin, Collagen Type 1 and E-Cadherin) Conclusion of the Fibrogenesis Process in Chronic Liver Disease
Tuğba Karadeniz, Semin Ayhan, Ali Rıza Kandiloğlu, Aydın İşisağ
doi: 10.4274/terh.galenos.2022.71084  Pages 328 - 335 (59 accesses)
Objective: In any toxic or inflammatory damage to the liver, the function of transforming growth factor-beta (TGF-ß), a fibrogenic cytokine, is to secrete collagen type 1 through hepatic stellate cells (HSCs) and to ensure the restructuring of extracellular matrix. Recently, it has been thought that not only HSCs but also epithelial to mesenchymal transition (EMT)-showing cells secrete extracellular matrix proteins in the pathogenesis of fibrosis. The aim of this study was to show the relationship of activated HSCs and TGF-ß, with the changing stages of fibrosis and the presence of epithelial mesenchymal-transforming cells.
Methods: A total of 70 liver needle biopsy materials, including chronic viral hepatitis with different fibrosis scores evaluated in our department, and 20 control biopsies have been submitted to immunohistochemical (IHC) staining with IHC markers TGF-ß1, FSP1/S100A4, alpha (α)-smooth muscle actin, collagen-type 1, and E-cadherin.
Results: With an increased degree of fibrosis and inflammation TGF-β1, FSP1/S100A4, α-smooth muscle actin and E-cadherin and collagen type 1 expression have increased. This finding suggests that these molecules play a role in the process of fibrogenesis. A positive correlation was found between the expression of TGF-β1, α-smooth muscle actin, and E-cadherin, and collagen-type 1 relative to hepatitis B in chronic hepatitis cases, especially those associated with hepatitis C. It has been concluded that FSP1/S100A4 is not specific because it also marks other inflammatory cells besides fibroblasts. Hepatocytes, which show epithelial and mesenchymal transition, were detected in the liver by the dual IHC staining method.
Conclusion: Our findings support the idea that a mechanism of fibrogenesis in the liver occurs due to an increase in α-smooth muscle actin via fibrogenicacting TGF-ß. Additionally, although only one study on IHC is not enough, the appearance of hepatocytes showing EMT suggests that this mechanism also contributes to the development of fibrosis.

29.Is Bladder Outlet Obstruction Diagnosis with Uroflow Parameters Without Urodynamics?
Mehmet Yoldaş, Mehmet Zeynel Keskin
doi: 10.4274/terh.galenos.2022.72593  Pages 336 - 341 (69 accesses)
Objective: We have tried to define bladder outlet obstruction without urodynamics, by examining the uroflowmetry parameter (time to start voiding after the command, time between start voiding and maximum flow, maximum urinary flow, mean urinary flow, voiding time, voiding volume, postvoid residual urine volume).
Methods: In our study, group 1 patients who were diagnosed with bladder outlet obstruction and received surgical or medical treatment, and group 2 patients with an underactive bladder, which was the cause of surgical treatment failure, were compared in terms of uroflow parameters. Results: Ninety-nine patients in group 1, 105 patients in groups 2. Mean and maximum flow value are similer between the two groups (p=0.091 p=0.387 repectively) however, total voiding time, time to reach the maximum urinary flow rate and voided volume showed statistically significant difference between the two groups (p<0.001). Bladder outlate ostrction patients can be diagnosed with at least 95% sensitivity and 88% specificity.
Conclusion: Bladder outlet obstruction can be diagnosed without urodynamics by uroflowmetry parameters.

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