INTRODUCTION: Our purpose was to review our experience with the fetuses diagnosed prenatally with congenital pulmonary malformations (CPM).
METHODS: Retrospective study of fetuses prenatally diagnosed with congenital pulmonary airway malformation (CPAM), bronchopulmonary sequestration (BPS), bronchogenic cyst (BC) by ultrasonography between September 2020 and December 2022.
RESULTS: Sample analysis was based on 34 pregnancies with CPMs. On the basis of prenatal sonographic appearance, CPAM, BPS and BC were identified antenatally in 79.4% (27/34), 14.7% (5/34) and 5.8% (2/34), respectively. Most (76.5%) were isolated, all cases were unilateral (100%) and majority (64.7%) were regressed late antenatally or postnatally with expectant management. Of the 27 fetuses presented with CPAM, postsurgical resection was necessary for 5 cases (18.5%). There was only one case with hydrops and a CPAM volume ratio >1.6 and was managed with thoraco-amniotic shunt prenatally and right lower lobe resection postnatally. Of the 5 fetuses presented with BPS, thoracoscopic excision was necessary for 2 cases. Of the 2 fetuses presented with BC, cyst excision was performed or planned to cases.


DISCUSSION AND CONCLUSION: The results from our center in last two years reflect overall favorable outcomes for all CPMs. The role of ultrasound is cost-effective during perinatal period rather than fetal MRI.

INTRODUCTION: The aim of this study is to compare the treatment costs, hospitality costs and total costs of the patients who were hospitalized for chronic decompensated heart failure and monitored by the Palliative Care Center and Cardiology Clinic during a one-time hospitalization.
METHODS: A two-center retrospective study was performed. A total of 92 patients were included in this study. Thirty-eight out of the 92 were inpatients with chronic decompensated heart failure, and were monitored in the Palliative Care Center, and the other 54 were dealing with chronic decompensated heart failure and were treated at the Cardiology Clinic.
RESULTS: At the end of the day, 42.10% of the patients hospitalized in the Palliative Care Center and 37.03% of the patients hospitalized in the Cardiology Clinic were women. The mean age of the patients hospitalized in the Palliative Care Center was 76.71 ± 11.34 years; the mean age of the patients hospitalized in the Cardiology Clinic was 74.09 ± 11.16 years. There was no statistical difference between the two groups.
The duration of hospitalization for patients in the Palliative Care Center was longer than patients in the Cardiology Clinic.
The cost to the patient was greater in the palliative care center in terms of the average cost of treatment per patient, average cost of hospitality management and average total cost per patient, which was statistically important (p <0.05). The mortality rate that was observed during hospitalization was lower in the Cardiology Clinic by a statistically important margin (p <0.05).

DISCUSSION AND CONCLUSION: The cost of treatment, the cost of hospitality and the total cost of hospitalization for chronic decompensated heart failure patients were higher in the Palliative Care Center than in the Cardiology Clinic. However, it was observed that the rate of mortalityand higer co-morbidities in the Palliative Care Center was higher than the Cardiology Clinic.

INTRODUCTION: We aimed to compare the postoperative continence rates in prostate cancer patients who had robot-assisted radical prostatectomy (RARP) when bladder necks were “unpreserved”, “preserved” and “extremely preserved”.
METHODS: In this study, the data of 184 patients who underwent RARP for localized prostate cancer in our clinic between August 2019 and January 2023 were analyzed. The patients were divided into three groups as the bladder neck was not preserved (Group 1), the bladder neck was preserved (Group 2), and the bladder neck was extremely preserved (Group 3). Incontinence status was evaluated with the 24-hour pad test postoperatively at the 1st, 3rd, 6th month and 12th months.
RESULTS: One month after surgery, the rate of fully continent patients was higher in Group 3 (39.1%) than Groups 1 and 2 (27.5% and 32.7%, respectively), however the difference was not statistically significant (p=0.483). At the postoperative 3rd month, the rate of fully continent patients was 56.5% in Group 3, 51.9% in Group 2 and 43.1% in Group 1 (p=0.361). The rate of patients with moderate incontinence was higher in Group 1 compared to other study groups (p=0.019). The rate of fully continent patients was 82.6% in Group 3, 73.1% in Group 2 and 61.5% in Group 1 at 6th postoperative month (p=0.079). At postoperative 6 month a significant difference was observed for moderate incontinence rates (15.6%, 5.8% and 0 for Groups 1, 2 and 3, respectively) (p=0.034). At the postoperative 12th month, the rate of fully continent patients was 91.3% in Group 3, 80.8% in Group 2 and 72.5% in Group 1 (p=0.118).
DISCUSSION AND CONCLUSION: Our results indicated that the approaches for preserving the bladder neck during RARP did not have a statistically significant effect on the prevalence of incontinence, however reduced the severity of incontinence.

INTRODUCTION: Non-immune hydrops fetalis (NIHF) can occur at different gestational ages and with different etiologies. The aim of this study was to investigate the association of gestational age at diagnosis and a novel clinical scoring system with survival in NIHF cases
METHODS: This retrospective study was conducted between January 2020 and January 2023 in the perinatology clinic of a tertiary care center. Maternal characteristics, causes of NIHF, and survival rate were analyzed. The hydrops score was calculated and compared for those less than and greater than 20 weeks.
RESULTS: Of 41 NIHF, etiology was determined in 76% (87% <20 weeks vs. 70% ≥20 weeks), including cardiovascular malformations (27%), cystic hygromas (17%), and chromosomal defects (12%). Cystic hygromas were more common before 20 weeks. Cardiac malformations were the most common cause after 20 weeks. There was a negative correlation between live birth and hydrops score. The overall survival was 7.3%. The most favorable overall survival is in NIHF cases associated with fetal arrhythmias and placental pathology for the second and third trimesters, respectively.
DISCUSSION AND CONCLUSION: Earlier gestational age at diagnosis and higher hydrops score are associated with lower survival rates in NIHF cases. Determining the cause, accompanying structural abnormalities, and the week NIHF is diagnosed will help predict prognosis and apply treatments earlier to improve care for these fetuses and newborns

INTRODUCTION: Isolated gestational proteinuria (IGP) is new onset gestational proteinuria after 20 weeks of gestation in which the pregnancy is to be completed with normal maternal blood pressure and no signs of preeclampsia with no history of hypertension, diabetes, malignancy, autoimmune or kidney disease. IGP can be the first symptom of preeclampsia, however there is no consensus on whether IGP is a mild form of preeclampsia, in which immunologic factors and inflammation take role in pathogenesis. Platelet and inflammatory indices are changed under inflammation as under systemic inflammation neutrophilia, lymphopenia and thrombocytosis and platelet activation occur. Platelet indices are mean platelet volume (MPV) and platelet volume distribution width (PDW). Inflammatory indices include neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio(PLR). This study compared the platelet and inflammatory indices between IGP and healthy pregnancies.
METHODS: Thirty-two IGP and 60 healthy term pregnancies were recruited. Proteinuria was detected in 24-hours urine sample if proteinuria exceeded 300 mg/day. Platelet and inflammatory indices were obtained and calculated from complete blood count test. The groups were compared with respect to participant characteristics, MPV, PDW, NLR and PLR. p<0.05 was considered statistically significant.
RESULTS: There was no significant difference among the two groups in terms of participant characteristics, pregnancy outcomes. The platelet and inflammatory indices were not significantly different between the groups.
DISCUSSION AND CONCLUSION: Mean platelet volume, PDW, NLR and PLR were not significantly different between healthy and IGP pregnancies. The pathophysiology of IGP is still controversial in the literature, but this study showed that inflammatory status was not different in IGP pregnancies than healthy pregnancies.

INTRODUCTION: Necrosis due to ischemia at the distal end of a flap is an important problem encountered during flap operations. Several procedures and drugs including delayed procedures, leeches, and anticoagulants, can be used to maintain flap viability.
METHODS: Sixteen rats were randomly divided into two groups of eight: the ticagrelor and the control groups. Rats in the ticagrelor group were administered ticagrelor diluted with 0.3 mL of saline at a dose of 10 mg/kg twice a day for 7 days, starting at 2 h preoperatively and 10 h postoperatively, by oral gavage. Similar stress in the control group was induced orally with saline solution at the same time. The results were statistically analyzed for both clinical and histopathological evaluations.
RESULTS: During the clinical examination, the area of necrosis and the entire flap area were measured using transparent acetate paper (grid method). In the histopathological examination, tissue samples were taken from the transition zone between necrotic tissue and intact tissue in the flaps of rats sacrificed on the 7th day. There were significant differences in clinical evaluation. (p<0,05) The mean and SD of necrosis were 15,65±1,84 cm2 in the control group and 8,59±3,75 cm2 in ticagrelor group. There were no significant differences (p>0,05) in the histopathological examinations; however, compared with the control group, fewer inflammatory cells and necrosis were observed in the ticagrelor group.
DISCUSSION AND CONCLUSION: We found a statistically significant difference in clinical outcomes with the use of ticagrelor. However, no significant differences were found in the histopathological observations. Our results suggest that ticagrelor is effective on survival of skin flaps of rats in clinical evaluation.

INTRODUCTION: Our aim in this study is to show how various aspects of the psychosocial health status and demographic features relate to the development and severity of hyperemesis gravidarum (HG).

METHODS: A total of 100 women before 20 weeks of pregnancy were enrolled in a study. The pregnant women were divided into three groups, hospitalized hyperemesis gravidarum patients, HG outpatients, and control group respectively. Pregnant women were questioned by scales after written consent. These scales were Rosenberg’s self-esteem scale and multidimensional perceived social support scale and The Dyadic Adjustment Scale. SPSS 20.0 software (SPSS Inc., Chicago, USA) was used for analyses. Statistical significance was set at p< 0.05.
RESULTS: Results: Duration of marriage significantly differs between hospitalized HG group and the control group (p=0.045), and between the HG group and the control group (p=0.006). Parity significantly differs for nulliparity between hospitalized HG and nonhospitalized HG groups with the control group. According to our data among all parameters, some (age, educational status of women and husband, types of family, economic status, previous history of depression, planned pregnancy, feeling of anxiety caused by pregnancy, having health insurance, working status, anxiety, and depression) were found not to be related

DISCUSSION AND CONCLUSION: Conclusion: Our study provides powerful scientific evidence of a psychogenic etiology by putting forth that psychological factors have no effect on the risk of HG.

INTRODUCTION: The aim of this study is to evaluate 112 emergency ambulance calls made from primary healthcare institutions and to determine the reasons for patient referrals,the most frequent (pre)diagnoses they received according to age groups, and the frequency of encounters with these patients.Additionally, the study aims to identify which topics should carry more weight in family medicine specialty education and in-service training for individuals working in family health centers.
METHODS: Our study is a retrospective cross-sectional and descriptive study. Between November 2018 and November 2019, we retrospectively reviewed 112 emergency ambulance requests from family health centers in Ankara using the 112 command and control center archive records of the relevant patients. A total of 1829 calls were evaluated. Various parameters such as age, gender, vital signs, urban/rural case status, reason for the call, type of call termination, the ICD-10 diagnostic code, and ambulance type were analyzed.
RESULTS: Among the patients, 45.54% were female. The mean patient age was 47.31±24.62 years. The most frequent triage code assigned to patients was code yellow, accounting for 46.36% of cases. While 33.95% of patients were referred due to cardiovascular diseases, 12.52% for trauma, 7.22% for gastrointestinal diseases, and 6.62% for pulmonary diseases. Trauma and fever were more prominent in pediatric cases. Among diagnoses in the geriatric age group, vertigo was identified as one of the top five diagnoses.
DISCUSSION AND CONCLUSION: Medical reasons constituted the most common causes for 112 emergency ambulance requests, and the primary method of resolution by 112 teams was hospital transfer. Through this study, we identified the primary care physician's most frequent involvement in emergency case management and areas where they require assistance. A majority of the relevant cases were assigned code yellow, indicating that reinforcing family health centers could provide a solution to alleviate unnecessary patient overcrowding in emergency departments.

INTRODUCTION: This study aimed to determine the prevalence of chromosomal anomalies in fetuses with isolated and non-isolated aberrant right subclavian artery (ARSA) and to evaluate its association with other congenital anomalies.
METHODS: From 1 June 2021 to 1 June 2023, 47 ARSA cases were diagnosed by prenatal ultrasound in our hospital. The fetuses were divided into isolated ARSA group and non-isolated ARSA group. Among the 47 fetuses, 15 were characterized in the isolated group and 32 with combined other ultrasonic abnormalities in the non-isolated group. General information, ultrasound presentation, chromosomal findings, and birth and pregnancy outcomes were reviewed retrospectively.
RESULTS: In the non-isolated ARSA group, 17 cases (53,1%, 17/32) were associated with congenital heart defects, and 8 cases (25 %, 8/32) were associated with extracardiac abnormalities. Chromosome karyotype analysis was performed successfully with all 23 samples, and a total of 8 abnormalities (17 %, 8/47) were detected, including 7 cases of trisomy 21, and 1 case of trisomy 18. Single-nucleotide polymorphism array was performed in these 5 cases. Microdeletion was detected in four cases, but one of the arrays was reported normal. Using SNP-array and karyotype analysis in fetuses with ARSA, the total chromosomal anomaly detection rate was found 25.5 % (12/47).
DISCUSSION AND CONCLUSION: The most common malformation accompanying ARSA is cardiac abnormality. Isolated ARSA has a low risk of chromosomal abnormalities, so invasive chromosomal testing is not recommended. Non-isolated ARSA has a high incidence of chromosomal abnormalities, so early karyotyping should be recommended.

INTRODUCTION: Pregnancy is a physiological process in which the need for iron increases. We aimed to compare the effectiveness and side effects of different oral iron supplements on pregnant women.
METHODS: 100 pregnant women between the ages of 18-45 who used Fe+2 (ferrous sulfate) valent iron supplementation during their pregnancy were included in the study as group 1. 100 pregnant women in the same age range who used Fe+3 (iron polymaltose complex) valent iron supplementation during their pregnancy were determined as group 2. Response to anemia treatment was evaluated with the results of laboratory parameters (Hgb, Hct). The side effects of the preparations used in oral iron replacement were questioned retrospectively with a questionnaire applied to the patients.
RESULTS: 16 of 100 patients (16%) had side effects with oral iron polymaltose complex supplementation. 43 of 100 patients (43%) had side effects with oral ferrous sulfate supplementation. The overall side effect was higher in those taking oral ferrous sulfate supplementation (p<0.001). Hb and Hct values measured at 3-month periods were found to be similar between the groups (p>0.05). The most common side effect was nausea and vomiting with 12%.
DISCUSSION AND CONCLUSION: Both oral ferrous sulfate and iron polymaltose complex supplementation have similar effects on hemoglobin and hematocrit levels in pregnant women without iron deficiency anemia. However, oral ferrous sulfate supplementation causes more side effects compared to iron polymaltose complex.

INTRODUCTION: Traumatic facial nerve injuries present a unique challenge to clinicians and surgeons because of the intricate facial nerve anatomy and profound impact on the psychological well-being and social interactions of patients. In this study, we aimed to shed light on the multifaceted nature of non-iatrogenic traumatic facial nerve injuries through an in-depth analysis of 12 distinctive cases.
METHODS: Between March 2019 and June 2022, at Ankara City Hospital and Akdeniz University Hospital, we conducted a retrospective analysis of 12 patients who presented with traumatic facial nerve injuries without surgery-related complications. To better understand the particularities of traumatic injuries to the facial nerve outside the context of surgical interventions, all cases selected for this study were of nonsurgical origin.
RESULTS: Twelve patients (eight males and four females) were included in the study. The average age of the patients was 29 years (range, 5–53 years). The causes of injury varied from dog bites in one patient, work-related injuries with a jigsaw in one patient, traffic accidents in two patients, sharp penetrating injuries in four patients, and temporal bone trauma in four patients. Five patients underwent a direct nerve repair. Three patients had nerve grafting. Three patients underwent reconstruction using a free functional gracilis flap. One patient underwent masseter nerve transfer. Considering the diverse treatment modalities applied and the subsequent outcomes observed, an algorithm was formulated.
DISCUSSION AND CONCLUSION: By sharing these experiences, we aspire to contribute a nuanced perspective to the existing body of knowledge on traumatic facial nerve injuries, further supporting clinical decision-making in such rare and challenging scenarios.

INTRODUCTION: Depression is the most common psychiatric disorder in the general population and is the most common mental health condition in primary care patients. Although theories involving biological, psychological, and environmental factors have been put forth, the underlying pathophysiology of depression is unknown, as several different mechanisms are likely involved. Identification of vitamin D receptors in brain regions active in depression has strengthened the link between vitamin D and depression. The aim of this study was to examine the relationship of depression with vitamin D and certain biochemical parameters.
METHODS: Patients who were admitted to Şanlıurfa Mehmet Akif İnan Training and Research Hospital Internal Medicine outpatient clinic who had no chronic diseases and whose vitamin D, ferritin, hemoglobin (Hb), thyroid stimulant hormone (Tsh), free thyroxine (T4), folate, magnesium and B12 levels were recorded were included in the study. Beck's Depression Inventory was presented to the patients to examine the relationship of depression with the selected parameters.
RESULTS: A total of 352 cases were included in the study. Of the cases, 246 (69.9%) were female and 106 (30.1%) were male. There was no significant correlation between Beck's Depression Inventory scores and magnesium, hemoglobin, ferritin, B12, Tsh and T4 levels (p>0.05). A significant correlation was found only between folate levels and Beck's Depression Inventory scores (p=0.046). There was not a significant correlation between vitamin D levels and Beck's Depression Inventory scores (p=0.727), although a weak negative correlation was discovered between them (r= -0.019). There was no significant correlation between vitamin D levels and depression severity (p=0.650). None of the patients who had normal vitamin D levels were found to have severe depression.
DISCUSSION AND CONCLUSION: Depression is a common psychiatric disease and its pathophysiology has not been fully elucidated. Further studies are need to better understand the relationship between biochemical parameters and depression. The evidence-based results of these studies should be used to prevent and treat depression, which is an important health problem.

INTRODUCTION:
Primary immunodeficiency diseases (PIDD) cause increased sensitivity against infections. The main treatment of PIDD is regular immunoglobulin (Ig) replacement therapy. IgG replacement therapy can be administered intravenously (IVIG) or subcutaneously (SCIG). SCIG and IVIG treatments are similarly effective in preventing infections in PIDD

METHODS: This retrospective study was conducted in tertiary pediatric immunology department during the 3 years. We compared the cost-effectiveness, adverse reactions, serum IgG trough levels, infection rates, antibiotic usage, infection-related hospitalization, effectiveness, safety and tolerability of SCIG and IVIG in PIDD.
RESULTS: We enrolled 51 patients and the median ages were 10.3 and 17.5 years of IVIG and SCIG groups (p<0.001). The patients who received SCIG treatment were significantly older and the duration of treatment was longer than the IVIG group (p=0.003 and p=0.004,respectively). There was no significant difference in the frequency of hospitalization between the two groups (in IVIG and SCIG groups, 26.4% vs 5.8%,respectively) (p=0.08). The annual median number of infections in patients requiring outpatient treatment were 6.0 and 4.0 in the IVIG and SCIG groups (p<0.001). Although, the incidence of systemic side effects was statistically significantly higher in the IVIG group(p=0.002), local side effects were significantly more frequent in the SCIG (35.9% vs. 5.9%,respectively)(p=0.012). The total average costs incurred were statistically significantly higher in the group receiving IVIG in all three years compared to those receiving SCIG (p<0.001).
DISCUSSION AND CONCLUSION:
SCIG treatment had more lower systemic adverse effects, cost, infection rates, antibiotic usage and duration of hospitalization than IVIG treatment in PIDD.

INTRODUCTION: The COVID-19 pandemic has affected millions of people worldwide. Some patients with COVID-19 pneumonia have residual Computed Tomography (CT) findings in the lungs due to lingering symptoms for weeks after infection. Given the widespread impact of the COVID-19 pandemic, it is crucial to recognize and classify these findings. The aims of study is to identify and classify patients post COVID-19 chest CT findings according to a pattern.
METHODS: We examined 74 patients over the age of 18 who tested positive for COVID-19 using Polymerase Chain Reaction (PCR) and underwent multiple chest CT scans at intervals after their first diagnosis. Patients were classified as having non-specific interstitial pneumonia (NSIP), possible usual interstitial pneumonia (UIP), organizing pneumonia (OP), or no distinctive pattern. We also evaluated demographic data of the patients.
RESULTS: A total of 74 patients were included in the study, with 57 (77%) males and 17 (23%) females. The median age of the participants was 64 years. Of these, 47 (63.5%) had NSIP, 6 (8.1%) had possible UIP, 3 (4.1%) had OP pattern, and 18 (24.3%) patients had no distinctive pattern.
DISCUSSION AND CONCLUSION: Studies using control chest CT examinations 3-12 months after COVID-19 infection have shown residual lung findings at varying rates. In our study, most patients exhibited NSIP pattern, with fewer OP and possible UIP pattern findings. One fourth of the patients had no distinctive pattern.

INTRODUCTION: In the management of abdominal aortic aneurysm (AAA), endovascular aneurysm repair (EVAR) presents as a superior alternative to conventional surgery, especially for elderly patients with elevated surgical risks and accompanying comorbidities. This study aimed to examine the early outcomes of AAA patients who underwent EVAR.
METHODS: A total of 33 patients diagnosed with AAA who underwent EVAR were evaluated retrospectively. In every patient, the indication for the EVAR procedure was an abdominal aorta diameter exceeding 5.5 cm or over 5 cm when accompanied by additional comorbid factors. During the 1-year follow-up period for the patients, data on early-phase outcomes, lengths of stays in ICU and the hospital, and post-procedure complications were collected.
RESULTS: In 5 of the patients who underwent EVAR, both iliac artery aneurysm and AAA were present, while in 28, only AAA existed. The median length of ICU stay was 13 hr, and the median length of hospital stay was 3 days. In 12% of the patients, Type I-III endoleak was detected. In the follow-ups examinations, two patients without detected endoleaks manifested lower extremity ischemia or rupture. The total complication rate was 21.2%. There were no mortality cases during the early follow-up period.
DISCUSSION AND CONCLUSION: EVAR, in older patients with coexisting comorbidities, offers advantages in diminishing durations in intensive care and hospital stays, potentially boosting early survival outcomes. However, the results from our single-center study indicated that a substantial fraction of patients are susceptible to complications during the early postoperative period.

In February 2023, two major earthquakes with magnitudes of 7.6 and 7.8 occurred in Kahramanmaraş, Turkey. Major burns are traumas that involve a multisystemic organ response. Gastrointestinal complications, including stress ulcers and acute mesenteric ischemia-related conditions, are commonly seen in patients with major burns. While crush syndrome and extremity injuries are typically observed in earthquake survivors, burn cases have also been reported. However, hollow organ perforation due to blunt trauma from being trapped under the rubble is not commonly observed. In this case report, a patient who developed a scald burn during the earthquake, trapped under the rubble, and developed silent pneumoperitoneum on the 10th day after the earthquake is presented.