INTRODUCTION: Urinary tract infections are the most common healthcare-related infections, and about 60 to 80% of these infections occur related to the catheter. Precaution steps which can be taken to prevent these infections are known to reduce morbidity and mortality rates. This study aims to investigate the practices towards prevention catheter-related urinary tract infections (CRUTIs) for the nurses working in general surgery clinics.
METHODS: This study was conducted in a tertiary setting with the participation of nurses who work in general surgery clinics. The data were collected by observation form consists of 25 evidence-based practices, named "Placement of Catheter (10-practice)", "Catheter Care (7-practice)" and "Usage of Urine Bag Application (8-practice)" towards prevention of CRUTIs. The data were collected using an interactive observation method; nurses were observed three times while practicing and scored once for each practice. Then, the mean score of each practice were calculated and after evaluation, this score was found between 0-75.
RESULTS: The mean age of the nurses was 27,6±7,1(19-40) years, and 81,2% of them were females. The mean scores of the nurses for catheter placement, catheter care, and usage of urine bag were 27,2±1,4; 17.6±2.6; 19.1±2.6, respectively. In addition, the mean of total score for prevention of CRUTIs was 64,0±4,6 (range: 54 to 72).
DISCUSSION AND CONCLUSION: Although the scores of nurses were medium-good, practices towards prevention of infection should be taken as a whole. Thus, nurses should kept in mind that they are responsible from catheter placement to removal.

INTRODUCTION: Intramuscular injection is one of the fundamental duties of the nurses and midwives. Despite it was seen as a simple and basic application, many complications caused by wrong intramuscular applications were reported in the literature. This study was conducted in order to evaluate the intramuscular injections given by the nursing and midwifery students at Van Yuzuncu Yil University, Health School.
METHODS: This study is a fractional study. The participants involved in the research is made up of the nursing and midwifery students at Van Yuzuncu Yil University Health School, in 2014, spring term (n=577). 378 students who accepted to participate in the study constitute the sample of this research. In line with the literature question forms were prepared by the researchers and used for data collection. In the question form, along with the questions related to demographic characteristics, education and department information, the preparation of injection and its application were asked too.
RESULTS:
70,4% of the students stated that they preferred dorsolateral area as the injection site for adults and rektusfemoris for newborn (72%). It was determined that 95,2% of the students recommended patients to take a deep breath durig the injection and 46,6% of the students approved quick and firm injection.
DISCUSSION AND CONCLUSION: It is believed that the knowledge of nursing and midwifery students about the intramuscular injection is not at the required level. In this sense, traditional approaches should be replaced by current and evidence based knowledge.

INTRODUCTION: Headache is a common presentation in primary care. Primary headaches cause more disability and necessitate high utilisation of health care. The aim of this study was to investigate the knowledge level of family physicians about headache in primary care of Van district.
METHODS: A total of 120 family physicians completed a questionnaire relating to their knowledge, attitude and experience about diagnostic features of common primary headache syndromes and their treatment. The questionnaire was prepared according to IHS diagnostic criteria and published treatment guidelines.
RESULTS: Only 4.2% of 120 physicians had family medicine specialty, the others were general practitioners. 29.2% of the physicians thought that they have sufficient knowledge and experience for diagnosis and treatment of headache. 73.3% of the participants thought that the education they had received before the graduation related to headache was inadequate. Only 55% of physicians thought that anamnesis was the most important diagnostic tool for primary headache. Physicians responded correctly to questions of 6.7-47.5% in the management of migraine, 11.7-40.8% in tension type headache, and 16.7-37.5% in cluster type headache. 70% of physicians stated that they need for regular training programs related to headaches. The resource that physicians most needed for headaches was online source (67.5%).
DISCUSSION AND CONCLUSION: The study provides important information relating to the management of headache in primary care in Van district and highlights the need for continuing medical education.

INTRODUCTION: The purpose of this study is to determine the education and health problems of medicine school students of YYU caused by the earthquake in Van 2011.
METHODS: The type of study is descriptive. The study was conducted to 210 students were living in Van when the earthquake had happened. A questionnaire of 23 questions was applied. SPSS 22.0 was used to analysis the data, and it was considered meaningful that p value less than 0.05 and descriptive statistics, chi-square and Fisher's exact test were used in statistical analysis.
RESULTS: 70.6% of the participants were male, 29.4% were female. 50.5 % of participants stated that, the residence had little and 30.4% severely damaged. 2.8% had experienced psychological problems after the earthquake, 18.3% had any addiction and 36.5% had developed any fear. 76.9% of the students experienced disruption in their education due to the earthquake, 10.6% stopped the education, 3.8% continued their education in another medical faculty, and 27.3% stated that the school achievement was in decline. The disruption in girls' education and the decline in school achievement were significantly higher than male students (p=0.01, p=0.04, respectively). The decrease in the school achievement of the students experiencing financial distress after the earthquake was significantly higher than that of those who did not experienced financial distress(p=0.02).
DISCUSSION AND CONCLUSION: The most important result of the study was the disruption of education that the earthquake was caused. A cross-sectional study of students at the YYU campus may provide more informative information on the long-term effects of unusual circumstances.

INTRODUCTION: It is known that in cement factories health problems arise due to different kinds of risk factors such as noise, dust and temperature, which workers are exposed to in manufacturing parts of their facilities. This research was conducted to determine the reproductive health status of married men working in a cement plant.
METHODS: The ethical permit required to conduct this scientific inquiry has been obtained by the relevant institution. In this study, 70 married men working in a cement factory and 70 married men working in the office environment were categorized and tested by chi-square test. The level of significance was taken as p <0,05.
RESULTS: Regarding the reproductive health of married men working in the cement industry, statistical significance was observed in the parameters of birth congenital anomaly, maternal birth history, maternal period of pregnancy and maternal preterm birth. Statistical significance of BMI, alcohol use, smoking and chronic diseases were also examined for reproductive health-related indicators. Significance of alcohol use, as well as preterm birth, was also statistically significant
DISCUSSION AND CONCLUSION: As a result of the questionnaires and statistical studies, the reproductive health effects of men working in the cement plant were found to be significantly higher than those working in the office environment (p <0.05), depending on working conditions and demographic characteristics

INTRODUCTION: Although deep venous thrombosis (DVT) is a treatable disease, it has a strong tendency to recur leading to serious complications such as pulmonary embolism and post-thrombotic syndrome. D-dimer testing one month after the completion of anticoagulant therapy may give an idea about the risk of recurrence of disease. The aim of this study was to investigate the predictive value of D-dimer testing for recurrent events after withdrawal of coumadin therapy in patients with DVT.
METHODS: This study included 70 patients with unprovoked DVT. The diagnosis of DVT was confirmed by venous Doppler ultrasonography. All patients underwent D-dimer testing approximately one month after coumadin withdrawal and they were followed 18 months.
RESULTS: There were 36 male and 34 female patients with age range 32-76 years and mean age 54.3±13.2 years. Twenty one (30%) patients had positive D-dimer testing. While 10 (20.4%) of the 49 patients with negative D-dimer testing had residual venous obstruction (RVO), 12 (57.4%) of the 21 patients with positive D-dimer testing had RVO. In 12 patients with positive D-dimer testing and RVO, duration of coumadin therapy was prolonged for 6 months. In the remaining 58 patients, DVT recurred in 8 (%13,8) patients, of whom one was found to be homozygous FVL polymorphism.
DISCUSSION AND CONCLUSION: D-dimer testing should be useful to predict recurrent events one month after the discontinuing of coumadin therapy in patients with DVT. Resumption of anticoagulation therapy may be useful in patients with positive D-dimer testing. However, other clinical conditions affecting the D-dimer levels should be taken into consideration.

INTRODUCTION: To evaluate the effect of the leg and back pain due to lomber disc hernia on the anxiety and depression in adults.
METHODS: 60 male and 60 female patients who were diagnosed for low back pain due to lomber disc hernia admitted to algology clinic were included in this study (group 1). 30 male and 30 female healthy patients (without low backpain) were included as control group (group 2). To compare the anxiety and depression level between two groups, Beck depression scale (BDS) and Beck anxiety scale (BAS) were used. A p level of <0.05was statistically significant and Student t test was used to compare groups.
RESULTS: BDS test was 9,10±6,93 in group 2 male patients and 18,37±9,40 in group 1 male patients (p<0.05). BAS test was 9,00±6,29 in group 2 male patients and 16,92±7,96 in group 1 male patients (p<0.05). BDS and BAS tests was significantly higher in group 2 female patients than group 1 female patients (p<0.05).
DISCUSSION AND CONCLUSION: We found that there was higher anxiety and depression level in patients with low back and leg pain due to lomber disc hernia.

INTRODUCTION: The study examined the feasibility of a suturing technique involving the use of horizontal mattress sutures with gauze support, which is based on the distribution of tensile forces over a wider area and the use of mechanical creep and stress relaxation of skin, for primary or staged closure of skin defects.
METHODS: A total of 15 wounds of eight patients were included. Direct wound closure was not possible in any of these wounds and all wounds were closed using horizontal sutures supported by gauzes where a gauze was placed between suture material and skin to spread the pressure over a wider area. Defects were closed either primarily or gradually.
RESULTS: Size of the wounds ranged between 1.5 x 1.5 cm and 17 x 11cm. Successful skin edge apposition could be successfully accomplished in all fifteen wounds using the technique described herein. In one patient, skin apposition failed subsequently, and the patient was managed with skin grafting; thus, conventional methods including skin grafts/flaps or secondary healing could be avoided in the remaining patients. No scar-related complications occurred during follow-up (mean duration, 8 months) after wound healing.
DISCUSSION AND CONCLUSION: Preliminary results of this simple technique suggest that the technique has the potential to be used for the closure of primary non-closable wounds with low complication rate.

INTRODUCTION: Diabetes Mellitus is a chronic illness that cause significant morbidity and mortality in the elderly. In older diabetic patients, insulin misusage could effect the glycemic control. There is insufficient evidence that elderly diabetics benefit from insulin education.
METHODS: A total of 112 diabetic patients over 65 years of age who voluntarily participated in the study, who were taking insulin, and who applied to the outpatient clinic between July 2015 and April 2016 were included. The insulin use of the patients was assessed with 'Insulin Use Evaluation Form' and then insulin education was given. Four weeks later, patients were re-evaluated for insulin use.
RESULTS: In our study the mean age was 71,85 ± 6,36. Of the patients, 76.8% had previously been trained to use insulin. 29,1% of patients were educated in the last one year and 70,9% were educated a year ago. However, all of the patients were found to have made at least one mistake in the insulin use steps. After training, significant improvement was observed in faulty applications.
DISCUSSION AND CONCLUSION: The results of our study demonstrated that educating elderly diabetic patients about insulin treatment may remarkably decrease insulin administration errors. We recommend that this training be repeated at regular intervals so that proper insulin use is permanent. We believe that long-term laboratory data will be improved with repeated insulin training and the complication rates related to diabetes will decrease.

INTRODUCTION: It was planned as cross sectional and descriptive desing to determine the prevalence of smoking and knowing status for diseases caused by smoking among students of university.
METHODS: 602 students who volunteered to participate in the study of simple selected students, studied at Faculty of Health Sciences and Faculty of Social Sciences of a university between September 2014-June 2015. Data were collected with using a questionare of 30 questions. Percentages, frequency, mean, chi-square, standart deviation calculations are performed on collected data. Statistical significance is taken p<.05.
RESULTS: 30.7% of students were male, % 69.3 were female. Mean age of students were 20.05±1,7. Students smoking prevalence was 20.6%. In our study, it was determined that the rate of smoking was higher in men, in social sciences, and in smokers in the family. The main reasons for smoking were depending to a specific problem, curiosity, the influence of friends and affectation. 97.8% and 97.0% and 95.3% and 94.9% and 92.7% of the students knew that smoking was related with diseases of cardiovascular diseases and lung cancer and laryngeal cancer and diseases of cerebrovascular and Cronic Obstructif Pulmoner Disease.
DISCUSSION AND CONCLUSION: Smoking prevalence was less among the students at faculty of Health than at faculty of Social. Most of Students knew diseases caused smoking.

INTRODUCTION: To demonstrate the feasibility, advantages and disadvantages of Total Laparoscopic Hysterectomy (TLH) operation and to discuss the postoperative findings and complications of TLH cases in our clinic in Eastern Anatolia.
METHODS: Twenty-five patients underwent TLH surgery. LigaSure and harmonics were used as energy modalities. Mean operative time, intraoperative bleeding amount, decrease in hemoglobin concentration, major and minor postoperative complications, and laparatomy transition rates were evaluated.
RESULTS: The mean age of the patients was 52,20 ± 8,17 ± SD, the oldest patient was 73, the latest patient was 40 years old. Cervical intraepithelial lesion (CIN) was the most frequent indication for TLH with 24%. Mean operative time was 105,12 ± 26,33 ± SD, one (4%) patient had bladder injury, and 1 (4%) patient had hemorrhage requiring transfusion were seen as the major complications. Only 1 patient (4%) underwent laparotomy from the TLH due to myoma located in the lower segment and severe bowel adhesions.
DISCUSSION AND CONCLUSION: TLH is a procedure that can be safely applied. Patient selection and an experienced surgical team can help to minimize the complications that may occur during TLH.

INTRODUCTION: We aimed to determine the duration of hospitalization and the parameters affecting mortality of the patients hospitalized with upper gastrointestinal bleeding diagnosis in our service
METHODS: Archive records of 71 patients hospitalized and treated for upper gastrointestinal bleeding between 2015-2017 were retrospectively reviewed at Ordu University Medical School Training and Research Hospital Internal Medicine Service. Patients were evaluated for age, gender, presence of additional illness, history of drug use that could lead to bleeding, hemogram values at presentation, shape of bleeding, recorded endoscopic diagnosis, length of stay in hospital and blood transfusion volume
RESULTS: The most frequent endoscopic diagnoses were duodenal ulcer (%42,2), gastric ulcer in second frequency(%25,3) and acute erosive gastritis in third frequency(%15,4). Nonsteroidal analgesic drug use was used in 56 (%78.8) patients and anticoagulant drug use was used in 12 (%16.9) patients. Patients who were hospitalized for the longest time in the hospital were found to have additional comorbid diseases in the elderly (average age of 81 years and over was 5,8 ± 2,6 days).
DISCUSSION AND CONCLUSION: The most common cause of upper gastrointestinal bleeding in our patients is duodenal ulcer, the second most common gastric ulcer. Nonsteroid analgesic drug use history was found to be a significant risk factor for bleeding. We also found that patients with upper gastrointestinal bleeding were at the beginning of hospitalization and factors affecting mortality, older age and accompanying comorbid disease as a risk factor.

INTRODUCTION: To compare clinical outcomes of cataract surgeries with 2.4 mm and 2.8 mm clear corneal incisions.
METHODS: This retrospective study comprised 2 groups of cataract surgery cases with different wound lenghts of group 1; 2.4 mm and group 2; 2.8 mm. We evaluated 80 eyes of 72 patients with 3-month follow-ups. Procedures carried out using the temporal self-sealing incision technique. Measured intraoperative parameters included phacoemulsification time, mean cumulative dissipated ultrasound energy and total volume of balanced salt solution used. Keratometric data, specular microscopy and macular thickness were evaluated preoperatively, and postoperative 1 and 3 months. Vector analysis calculated the surgically induced astigmatism.
RESULTS: There were no significant differences in intraoperative ultrasound energy, total phacoemulsification time and volume of balanced salt solution analyzed between two groups (p>0.05). There were no statistically difference between two groups in macular thickness alteration and endothelial cell loss (ECL) (p>0.05). The mean surgically induced astigmatism was significantly less in group 1 in each visit (p<0.05).
DISCUSSION AND CONCLUSION: Phacoemulsification surgery through a 2.4 mm incision size appeared to be safe and less surgically induced astigmatism.

INTRODUCTION: To present our experience about Martin modification of Duhamel method which is used in Hirschsprung's Disease treatment.
METHODS: Between January 2012 and October 2017, patients which are diagnosed as Hirschsprung's Disease in our clinic were retrospectively evaluated according to age, sex, application time, symptom-signs, congenital anomalies, treatment methods, length of resected bowel, time of first post-operative defecation, duration of nasogastric decompression, first oral feeding time, postoperative complications, hospitalization time and morbidity-mortality.
RESULTS: Of the 53 patients in the study, 38 were males and 15 were females. The most common cause of appy was chronic constipation (81%). 15% of the patients had additional congenital anomalies. 24% of the patients were younger than one month old. All patients underwent definitive surgery with Duhamel-Martin method. Mean bowel resection length was 21 cm. Defecation were observed after an average of three days after surgery. Follow-up period with nasogastric was four days on average. The aganglionic bowel segment was most commonly seen in the recto-sigmoid (71%) region. The most common postoperative complication was anal zone infections (25%). One patient died because of sepsis. The average length of hospitalization time was 17 days.
DISCUSSION AND CONCLUSION: Due to the low morbidity and mortality rates in the Duhamel-Martin technique applied in the treatment of Hirschsprung's Disease, it has been a safe surgical method applied for years in our clinic.

INTRODUCTION: Aesthetic perception varies from person to person. It is accepted that personal experience and social environmental are influential on the aesthetic perception of the person. Various methods are used to apply aesthetic properties to the dentofacial structure. The most recent of these methods is the evaluation of the smile esthetic index (SEI). The purpose of this study is to evaluate the smile aesthetics of patients by using SEİ in Van Yüzüncü Yıl University.
METHODS: A total of 100 patients, 50 female and 50 male, were included in this study. The smile aesthetics were evaluated according to the criteria of SEI on the photographs taken from the patients.
RESULTS: According to the results obtained, men's SEI scores were found to be higher than women, although not statistically significant. There was no statistically significant difference between the age groups in terms of SEI score. Mean SEI score was calculated as 6.545 in this study. Factors that are most frequently encountered by the individuals participating in this study and which negatively affect aesthetics were; absence of the correct facial midline, correct toot/crown alignment, existence of visible diastema and interdental papillary loss.
DISCUSSION AND CONCLUSION: SEI is a clinically applicable index that evaluates soft and hard tissues together and most importantly reveals objective values. This is the first study in the literature SEI with clinically applied, comparing male-female and age-group assessments. It should be considered that smile aesthetics is an important factor and it is thought that further literature study is needed.

INTRODUCTION: The aim of this study is to determine the average blood pressures and pulse rates of individuals who are referred to the intended dentistry faculty.
METHODS: A total of 1598 volunteers from 18 years of age and older, who applied to the faculty of dentistry of Van Yüzüncü Yıl University between May-September 2017 were included in the study. The age, gender, occupation, height, weight, blood pressures and pulse information of the patients were recorded and the obtained data were analyzed statistically.
RESULTS: Of the 1598 individuals participating in the study, 54.7% (n=874) were female and 45.3% (n=724) were male. The ages of the individuals ranged from 18 to 91 years with an average age of 37.24 ± 13.37 years. The systolic and diastolic blood pressures of the 18-35 age group were significantly lower than those of the 36-50, 51-65 and 66 and over age groups (p<0,01). Diastolic blood pressure values of male subjects were found to be statistically higher than female (p <0,05). Pulse values of male subjects were found statistically significantly higher than female (p <0,01). Systolic and diastolic blood pressure values of individuals with normal BMI (Body Mass Index) were significantly lower than those of overweight and obese individuals (p <0,01).
DISCUSSION AND CONCLUSION: The blood pressure values of the individuals who applied to the faculty of dentistry are directly related to the age and body mass index. Male individuals have higher diastolic blood pressure and pulse rate values. Potential risks must be considered in situations requiring interventional procedures.

INTRODUCTION: Childhood diarrheas are mostly caused by viruses. Enteric viruses (particularly rotavirus and adenovirus) are the most common culprits of acute gastroenteritis.
METHODS: A total of 259 children were included in the study, and the patients were divided into two groups: patient group (n = 129) and control group (n = 130). The study group was also sub-divided in three as rotavirus positivity, adenovirus positivity, and both rotavirus + adenovirus positivity.
RESULTS: The mean age of the patient group was 21.7 ± 30.0 months, and 60.5% were males. While the presence of diarrhea (p = 0.023) and the number of diarrhea between 0 and 10 (p = 0.001) were statistically higher in the control group, the number of diarrhea between 11 and 15 was statistically higher in the patient group. Rotavirus was positive for 71.3%, adenovirus was positive for 20.2%, both rotavirus + adenovirus were positive for 8.5% in the patient group. There was a statistically strong and significant relation with white blood cell, urea, albumin and C-reactive protein (CRP) values for the patients with rotavirus positivity (p < 0.05). There was a statistically strong and significant relation with diarrhea, vomiting, abdominal pain, and lack of appetite for both three subgroups with rotavirus positivity, adenovirus positivity, and both rotavirus + adenovirus positivity (p < 0.05).
DISCUSSION AND CONCLUSION: Based on our study results, we believe that patients with viral gastroenteritis caused by rotavirus and/or adenovirus should be monitored for the development of secondary infections, considering urea, albumin levels, white blood cells, and CRP values.

INTRODUCTION: To examine the repeatability of central corneal thickness (CCT) measurements by corneal dynamic Scheimpflug analyzer Corvis ST (Corvis), RTVue anterior segment optical coherence tomography (OCT) and Sirius corneal topography (Sirius) in normal eyes and compare the agreement of devices with each other.
METHODS: Forthy right eyes of 40 patients were included in the study. Patients with active ocular pathology and a history of ocular trauma were excluded. All measurements were performed from 12: 00 to 15: 00 by the same physician.
RESULTS: The mean age of the subjects was 35,5±2,3 and 22 were males and 18 were females. Interclass correlation coefficient was 0.993 for Corvis, 0,998 for OCT and 0.990 for Sirius. CCT was 8,4u thinner in OCT compared with CORVIS and 4,0u thinner compared with Sirius. Limits of Agreement (LoA) of devices was -6,7 to 14.7u for Corvis and Sirius, -25.6u to 8.8u for Corvis and OCT, -19.9 to 13.0u for Sirius and OCT. Two devices which had the narrow LoA (which means the best agreement with each other) were Sirius and Corvis.
DISCUSSION AND CONCLUSION: It has been observed that repeatibility of all three devices were very good for CCT measurement. Agreement of Sirius and Corvis was better when compared with other devices. Thus, Corvis and Sirius can be alternatively used in clinical practice. Since measurements performed by OCT were thinner than other devices, OCT can be used in clinical practice when minor changes are critical in CCT measurement.

INTRODUCTION: We aimed to evaluate the effectiveness of ultrasound and its association with joint structure by comparing success and extravasation rates of the glenohumeral joint and the ankle joint injections.
METHODS: MR arthrography examinations of 114 glenohumeral joints and 86 tibiotalar joints were assessed in this retrospective study and, success and extravasation rates were compared statistically.
RESULTS: Extravasation rate at the injection site was significantly higher in patients with glenohumeral injection compared to tibiotalar injection (p: 0.026). There was no contrast material within the joint space along with extravasation in 6 (5.2%) patients in glenohumeral injection group whereas contrast material was seen within the joint space in all patients in tibiotalar injection group (p: 0.038).
DISCUSSION AND CONCLUSION: In intra-articular injections, the success rate of articular injection is affected by the distance of capsule to skin and capsule to cartilage. For this reason, higher extravasation rates with lower success rates were encountered in deep located joints and joints with the reduced capsule to cartilage distance.

INTRODUCTION: Nasal defects occur mostly after cancer surgery or as a result of trauma, and are of importance in reconstructions. It is highly likely that the cosmetic consequences of nasal defect reconstructions will affect the individual’s social life as the location of the nose is in the middle zone of the face.

METHODS: 40 male patients and 36 female patients who underwent operations on nasal defects for various reasons, such as trauma, cancer surgery etc. Depending on several reasons, including size, the location of the defect and surgical border. A simple, easy and reliable algorithm that could be used in nasal defects was developed
RESULTS: The youngest patient, a 3-year-old girl with xeroderma pigmentosum and she has a basal cell carcinoma in her nose and the eldest patient at the age of 92, who had basal cell carcinoma at the tip of the nose. The mean age is 57.75.
The largest defect after surgery is 10x7 cm (mass 8x5 cm). Radial forearm free flap was applied to close this defect. The smallest defect was 0.6 cm (6 mm-lesion 3 mm) and this defect was closed primarily. The diagnosis of the largest lesion was basosquamous cell carcinoma, the smallest lesion was basal cell carcinoma.

DISCUSSION AND CONCLUSION: The nose is a complex structure that is made up of such sub-units as the dorsum, lateral nasal walls, type, alar wings, soft triangle and columellate. If a reconstruction is performed after the defects in these sub-units are evaluated according to a certain algorithm, better results could be obtained.

INTRODUCTION: The purpose of this study is to evaluate the efficacy of high resolution computed tomography (HRCT) in assessing middle ear ossicular pathologies in cases with normal eardrum who underwent diagnostic tympanotomy due to conductive hearing loss.
METHODS: In this study, temporal bone HRCT images of 80 patients with normal eardrum who underwent middle ear exploration due to conductive type hearing loss were evaluated retrospectively. Pathologic findings and anatomic variations of middle ear and ossicular structures were determined. These findings were compared with the intraoperative findings of the patients.
RESULTS: The most common operative diagnosis, stapedial otosclerosis was;35 (43%), and deterioration of the integrity of the incudostapedial joint due to the incus long-arm defect was;25 (31%). As of the other pathologies, erode incus and stapes was detected in 14 patients (17%), and tympanosclerosis-related malleus incus fixation was detected in 6 patients (7%). Sensitivity for HRCT for these pathologies was determined 85% for otosclerosis, 88% for incus long-arm defect, 92% for erode-incus and stapes, and 66% for malleus incus fixation.
DISCUSSION AND CONCLUSION: Temporal bone HRCT is an effective and easily applicable imaging method with high sensitivity in detecting the cause of conductive hearing loss in patients with normal eardrums.

INTRODUCTION: The purpose of this study is to compare the reliability of two commonly used radiological techniques (Cone Beam Computerized Tomography (CBCT) and Orthopantomograme (OPT)) to prevent the occurrence of inferior alveolar nerve (IAN) injuries during routine dentoalveolar surgery.

METHODS: Among the patients admitted to our clinic, 50 random patients that have both OPG and CBCT images during their treatment were selected. The distance between the apexes of second lower premolar teeth, the mesial and distal apexes of the first lower molar teeth, the mesial and distal apexes of the second molar teeth and the inferior alveolar nerve and the distance of the third molar teeth from the mandibular canal were measured using the CBCT images eXamVisionQ program of the selected patients. Then the same measurements were repeated with an electronic caliper capable of measuring with 0.1 mm precision over these patients' OPG images. Paired Samples test was used in evaluating distance measurements taken from CBCT and OPG images and Intraclass Correlation Coefficient was used in evaluating their compliance.
RESULTS: For all the teeth, distance measurements made according to CBCT and OPG images showed a statistically significant difference. The distance measurements on the OPG images were found higher than the measurements made on the CBCT images.
DISCUSSION AND CONCLUSION: In the light of this study, it can be said that the CBCT image, according to the OPG image, will reduce the risk of IAN injuries during routine dentoalveolar surgery and allow the operation to be performed within more secure boundaries.

INTRODUCTION: The World Health Organisation defines microinvasive breast carcinoma (MIBC) as a lesion characterized by a single or multiple microscopic foci infiltrating the breast stroma, equal to 1 mm in size or smaller. The present study aims to investigate the impact of clinical and pathological parameters on the recurrence, metastasis, and prognosis in patients with the MIBC.
METHODS: A group of patients diagnosed with breast cancer from January2006 to December2014 were examined retrospectively. Patients diagnosed with the MIBC were included in the study. A histopathological examination included the type of the invasive breast carcinoma, nuclear grade, number of microinvasive foci, presence of a lymph node metastasis, and hormone receptor status, diameter and grade and hormone receptor status of insitu component. In addition, local recurrence, distant metastasis, and survival characteristics and their relationship to the histopathological parameters were evaluated
RESULTS: Twenty-seven patients with the MIBC were included in the study. All the patients were female. Median age was 56(25-78). Median follow-up duration was 51(15-130)months. Among 27cases of MIBC, clinical follow-up information was availiable in 25cases. There were only one invasive focus in 13 (48.1%) and multiple invasive focus in 14 (51.9%) patients. Five year disease free survival was 86.7% and 5year overall survival was91.4%. The number of microinvasive foci and ductal carcinoma in situ diamater and nuclear grade and hormone receptore expression were not related to recurrence and survival.

DISCUSSION AND CONCLUSION: The number of microinvasive foci and ductal carcinoma in situ diamater and nuclear grade and hormone receptore expression were not related to recurrence and survival.

Juvenile myelomonocytic leukemia (JMML) is a malignant disease characterized by excessive proliferation of monocytic and granulocytic cells resulting in clonal defect of the hematopoietic stem cell, which accounts for about 2% of pediatric leukemia in early childhood. İn nowadays; molecular pathology in 85-90% of cases can be detected. Below we present a 2.5 years old girl who was admitted to our clinic with complaints of rash on the skin and mucositis in the mouth. On the examination of the patient; hepatosplenomegaly with skin petechial rash and laboratory tests; leucocytosis, thrombocytopenia and high levels of HbF were detected. In evaluation of peripheral blood smear and bone marrow aspiration were compatible with JMML. In cytogenetic examinations; PTPN 11 mutation was detected. The natural course of case with JMML is poor.

Reno-vascular thromboembolic complications are observed more frequently in newborn period due to decreasing renal blood build-up, low natural anticoagulant levels, and increased blood viscosity and hyperosmolality. Among the thrombosis cases that are irrelevant with catheter, Renal Vein Thrombosis (RVT) has the highest prevalence with 16-20%. Perinatal asphyxia history, maternal diabetes mellitus, prematurity, dehydration, cyanotic congenital heart disease, infection and genetic defects that give rise to predisposition to thrombosis (Protein C, protein S and antithrombin deficiency, factor V Leiden mutation, prothrombin and methylene tetra hydro folate reductase gene mutations) are among the risk factors. There are anticoagulant and fibrinolytic treatments during the management. Widespread kidney dysfunction comes to the forefront among the long-term complications. In the present study, a bilateral Renal Vein Thrombosis case that is rare in the literature with the emergence time and form and relevant risk factors is presented.

Obstructive valve thrombosis after prosthetic valve replacement is a life-threatining problem.Immediate medical or surgical intervention may be life-saving in such clinical cases.In this study we presented a 55-year-old male patient who admitted to our hospital with the complaint of effort dyspnea due to thrombus on single leaflet of mechanical mitral valve. It is still a question whether surgical treatment or thrombolytic therapy should be first choice in this situation. Although serious complications of thrombolytic therapy, we suppose that in high-risk patients with isolated mechanical valve thrombus, successful results can be achieved by applying slow rate infusion of thrombolytic agents.

Mushroom poisoning has an important place in the poisonings applied to emergency department (ED). Patients may present with different toxoids according to the fungus and toxin fecalin. Pantherina syndrome is a tablature that can interfere with cerebrovascular diseases due to clinical presentation. Three patients from the same family were admitted to our ED with newly developed symptoms of confusion, aphasia and mydriasis. When the first patient was evaluated, the diagnosis of hypertensive encephalopathy was first considered with the current symptoms. However, after the application of the second and third patients with similar symptoms, the anamnesis was deepened and the story of eating a mushroom was questioned. Patients are treated in the emergency ICU. Two patients recovered within 24 hours, and the symptoms of one patient continued for up to 72 hours. Pantherina syndrome is a toxicoma characterized by early onset, confusion, neurological symptoms such as aphasia and mydriasis. Treatment is generally supportive treatment. Stomach lavage and activated charcoal will be useful in the early period. Benzodiazepines can be used in extreme agitation. Pantherina syndrome is one of the diagnoses that clinicians should actually have in patients presenting with an acute confusional condition.

Physicians encounter many patients in their daily practice often described as difficult patient. However, there is no specific consensus on the classification of these patients which physicians describe as difficult patient. However, it seems possible to describe patients as 'insistent', 'demanding' or 'persistent’ when they force the physicians or have the physicians force other medical staff to conduct some operations and investigations. Such patients decribed in this paper are listed under the heading of ‘demanding patient’. In demanding behavior, the patient's insistence, distrustful approach, and repeated requests continues despite the physician’s explanation. Demanding behavior can occur for a variety of reasons. The most significant factors in the occurrence of demanding behavior are the patient’s personality traits and ability to cope with stress. However, the physician’s appearance and behavior may also increase the patients’ demanding behavior. Another dimension of the issue is the coping ability of the physician when faced demanding patient. Physicians who try to cope with demanding patients should approach their patients by taking into account their own personality traits and the patient's biopsychosocial characteristics.

Entering high technology involves not only the recovery of the disease in progressive or terminal illness, but also the provision of postponement of death and other options for the end of life. Especially in critical care units where critical care is provided, the availability of technology leads to increased use of technological intervention methods. This situation reveals useless perception of the attempts made to the patient in terms of patients and their relatives as well as healthcare providers and the concept of futile treatment, which is an important problem in the decisions regarding the end of life. The concept of futile treatment is used for treatments that are more expensive or more risky if the patients are unlikely to be able to correct the situation or are less likely to be more beneficial than currently available treatment. While the progress of the disease progression is a reward for the nurses, it can cause the care, stress and frustration to extend the life of the patient only. Continuing the treatment that nurses think is useless can cause moral distress, compassion fatigue and burnout in nurses over time. The effect of the useless careless treatment on the nurses will be included in the literature.