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Volume : 51 Issue : 1 Year : 2022

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ZEYNEP KAMIL MEDICAL JOURNAL - Zeynep Kamil Med J: 51 (1)
Volume: 51  Issue: 1 - 2020
ORIGINAL RESEARCH
1.A Retrospective Analysis of Gestational Trophoblastic Diseases: Our Midterm Results
Gülten Özgen, Gültekin Adanas
doi: 10.16948/zktipb.656568  Pages 1 - 4
GİRİŞ ve AMAÇ: Bu çalışmanın amacı, gestasyonel trofoblastik hastalığın (GTH) sıklığını ve tiplerini belirlemek ve klinik parametreler ile olan ilişkisini değerlendirmektedir.
YÖNTEM ve GEREÇLER: Çalışmamıza hastanemiz kadın hastalıkları ve doğum kliniğine Ocak 2016 ile Haziran 2019 tarihleri arasında yatırılarak tedavi edilen ve GTH tanısı alan 90 hasta dahil edildi.Hasta bilgileri hasta dosyaları ve bilgisayar kayıtları kullanılarak, retrospektif olarak değerlendirildi. Hastaların sosyodemografik ve klinik özellikleri, vakum küretaj öncesi ve sonrası laboratuvar test sonuçları ve patoloji sonuçları kaydedildi.
BULGULAR: Çalışma süresince gerçekleşen toplam doğum sayısı 45,000 idi. Gestasyonel trofoblastik hastalık insidansı 2/1000 doğum olarak tespit edildi. Doksan hastanın 69’unda parsiyel (%76,7) ve 21’inde (%23,3) komplet mol ve 1 hastada (%1,1) parsiyel mol sonrası koryokarsinom gelişti.Klinik tanı hastaların %36’sında (n=32) mol ve %1,1’inde (n=1) fetal anomali olarak değerlendirildi. Laboratuvar ve klinik bulgular açısından parsiyel ve komplet mol gebelik geçiren hastalar arasında anlamlı bir farklılık olmadığı görüldü. Ancak komplet mol gebeliklerde küretaj öncesi ortalama β-hCG değeri istatistiksel olarak yüksek saptandı(p=0,088). Parsiyel molde en yüksek ortalama β-hCGdeğeri 46014,66mIU/mL iken,komplet molde bu değer 76292,26 mIU/mL olarak bulundu. Hastalarda en küçük gebelik yaşı 14 yıl, en yüksek gebelik yaşı ise 47 yıl olarak saptandı.
TARTIŞMA ve SONUÇ: Çalışma sonuçlarımıza göre, nadir olsa da,malign olma ihtimalini taşıyan GTH tanısı olan hastalar küretaj sonrasında β-hCG takiplerinin yapılması hususunda bilgilendirilmeli ve herhangi bir takip yapılmaması halinde hayati tehlike oluşturabileceği açıklanmalıdır.
INTRODUCTION: In this study, we aimed to investigate the frequency and type of gestational trophoblastic disease (GTD) and to evaluate clinical parameters associated with GTD.
METHODS: Between January 2016 and June 2019, a total of 90 patients who were diagnosed with GTH and treated in the inpatient setting were included. Patient data were retrospectively analyzed using medical records and database. Sociodemographic and clinical characteristics of the patients, laboratory test results before and after vacuum curettage, and pathology results were recorded.
RESULTS: Throughout the study, the number of deliveries was 45,000. The incidence of GTD was 2/1000 live births. Of 90 patients, 69 (76,7%) had partial, 21 (23,3%) had complete, and 1 (%1,1) had choriocarcinoma after partial molar pregnancy. Clinical diagnoses were molar pregnancy in 36% (n=32) and fetal anomaly in 1,1% (n=1) of the patients. There was no significant difference in the laboratory and clinical characteristics between the patients with partial and complete molar pregnancy. However, the mean β-hCG level was statistically significantly higher in complete molar pregnancies before curettage (p=0,088). The highest mean β-hCG level was 46014,66mIU/ mL in partial mole and 76292,26 mIU/mL in complete mole. The youngest maternal age was 14 years and the oldest maternal age was 47 years.
DISCUSSION AND CONCLUSION: Our study results suggest that, although rare, patients with GTD must be informed about the β-hCG measurements on a regular basis following curettage, as the disease has the potential of malignant transformation, and be enlightened about life-threatening potential of GTD in the absence of regular follow-up.

2.First Trimester Intracranial Translucency Nomogram in Singleton Pregnancies
Fatih Şanlıkan, Resul Arısoy, Koray Özbay, Altuğ Semiz
doi: 10.16948/zktipb.685282  Pages 5 - 8
GİRİŞ ve AMAÇ: 11-14. gebelik haftaları için intrakranial translusensi (IT) nomogramı oluşturulması ve IT ölçümlerinin gebelik günleri, baş popo mesafesi ve bipariyatel çap ile olan ilişkisinin değerlendirilmesi.
YÖNTEM ve GEREÇLER: Kliniğimize başvuran birinci trimester’deki 119 tekiz gebe çalışmaya dâhil edildi, bu gebelerde fetüslerin IT genişliği değerlendirilip gebelik günü, baş popo mesafesi (CRL) ve bipariyatel çap (BPD)ile olan ilişkisi araştırıldı. Yapısal veya kromozomal anomali saptanan fetüsler ve çoğul gebelikler çalışma dışı bırakıldı.
BULGULAR: Çalışmamızda ortalama gebelik günü 86,6 ± 4,9, CRL 61,6 ± 7,2 mm, BPD 20,7 ± 2,3 mm, IT genişliği 1,7 ± 0,3 mm olarak tespit edildi. 11-14. gebelik haftaları için gebelik günlerine göre IT nomogramı oluşturuldu. Lineer regresyon analizinde IT ile gebelik günü, CRL ve BPD arasında zayıf pozitif korelasyon saptandı (sırasıyla r=0.30, r2=0,0899, r2 =0,0815). IT genişliğinin 50.persentil değeri 11 hafta 0-6 gün, 12 hafta 0-6 gün ve 13 hafta 0-6 gün için sırasıyla 1,5 mm, 1,7 mm ve 1,8 mm olarak saptandı.
TARTIŞMA ve SONUÇ: Birinci trimesterde nuchal tranlusensi ölçümleri yapılırken eş zamanlı olarak kolaylıkla ölçülebilen IT, santral sinir sistemi anomalilerinin saptanmasında faydalı olabilen bir ölçümdür. Çalışmamızın sonuçları literatürü destekleyecek şekilde, IT’nin ilerleyen gebelik haftalarıyla beraber lineer olarak arttığını ve gebelik günleri, CRL ve BPD ile korele olduğunu göstermiştir. Elde ettiğimiz IT nomogramı kendi popülasyonumuzun değerlendirilmesinde faydalı olabilir.
INTRODUCTION: Our aim was to create an intracranial translucency (IT) nomogram for the 11-14 weeks of gestation and to evaluate the relationships between IT measurements and gestational days, crown rump length and biparietal diameter
METHODS: 119 singleton pregnant women who applied to our clinic in the first trimester were included in the study. The IT of the fetuses were evaluated and the relationship between IT measurements and gestational day, crown rump length (CRL) and biparietal diameter (BPD) was investigated.
RESULTS: We determined the mean values for gestational day, CRL, BPD and IT as 86.6 ± 4.9 days, 61.6 ± 7.2 mm, 20.7 ± 2.3 mm1.7 ± 0.3 mm, respectively. After then an IT nomogram was formed according to pregnancy days for the11-14gestational weeks. Linear regression analysis revealed a weak positive correlation between IT and gestational day, CRL and BPD (r= 0.30, r2= 0.0899, r2= 0.0815, respectively).The 50th percentile value of IT was determined as 1.5 mm, 1.7 mm and 1.8 mm for 11 weeks 0-6 days, 12 weeks 0-6 days and 13 weeks 0-6 days, respectively.
DISCUSSION AND CONCLUSION: IT can be easily measured simultaneously while performing nuchal translucency measurements in the first trimester, which can be useful in detecting central nervous system anomalies. The results of our study showed that IT increased linearly with advancing gestational weeks and correlated with gestational days, CRL and BPD, in accordance with the literature. The IT nomogram we obtained can be useful in evaluating our own population.

3.Evaluation of Risk Factors Associated with Red Blood Cell Transfusion in Preterm Infants
Didem Arman, Uzman Nursu Kara
doi: 10.16948/zktipb.672462  Pages 9 - 13
GİRİŞ ve AMAÇ: Preterm bebeklere yenidoğan ünitesinde (YYBÜ) yatışları esnasında çoğu kez eritrosit süspansiyonu (ES) transfüzyonu (TF) yapılması gerekmektedir. Çok düşük doğum ağırlıklı (ÇDDA) bebeklerin %90 kadarına yaşamın ilk haftalarında bir veya daha fazla ES transfüzyonu yapılmaktadır.Çalışmamızda 34 gestasyonel haftanın (GH) altında doğan pretermlerde ES transfüzyonu ile ilişkili olabilecek risk faktörlerini değerlendirmeyi amaçladık.
YÖNTEM ve GEREÇLER: Çalışmamıza YYBܒde takip edilen 34 GH altında doğan 68 bebeğin tıbbi kayıtları retrospektif olarak incelendi. Bebeklerin demografik verileri ve klinik verileri ile doğum sonrası alınan tüm kan örneklerinin sayısı kaydedildi. Bebekler TF yapılan ve yapılmayan grup olarak ikiye ayrılarak, istatistiksel olarak morbiditelerin oluşumu ve mortalite açısından kıyaslandı.
BULGULAR: Çalışmaya dahil edilen 68 olgunun 35‘ı kız (%51.4), 33’ü (%48.5) erkekti. Transfüzyon alan ve almayan olguların ortalama doğum
tartıları ve gestasyon haftaları sırasıyla 1301 ± 402.8 g ile 1425 ± 462.3 g. (p>0.05) ve 30.0 ± 2.64 ile 30.8 ± 2.04 hafta idi (p>0.05). Olguların 25’ine (%36.7) çoklu TF tedavisi uygulanmıştı. TF olan grupta birinci, ikinci ve 3. TF günleri sırasıyla postnatal 21.4 ±10.9, 29.6±11.6 ve 32.83±8.9 gün idi. TF almayan ve alan grup kıyaslandığında doğum tartısı, gestasyon haftası, ventilatörde kalma süresi, hastanede yatış süresi, sepsis ve inotrop ihtiyacı açısından istatistiksel anlamlı fark bulundu (p<0.05). TF yapılan grupta kümülatif kan kaybı 7-14.gün arası anlamlı olarak yüksek saptandı (p<0.05). 14-28.gün arasında kümülatif kan kaybı açısından fark saptanmadı (p=0.009). Çoklu TF alan bebek grubunun ortalama tartı ve gestasyon haftasının sırasıyla 1041±205 gr ve 28.7±1.2 hafta olduğu görüldü. Çoklu TF alan gruptaki bebeklerin ventilatörde kalış süreleri de istatistiksel olarak yüksekti (p<0.05). PN 7.,14. ve 28. günlerde TF alan gruptaki bebeklerin tartı alımlarının daha az olduğu tespit edildi (p<0.05). TF alan grupta BPD görülme sıklığı anlamlı biçimde yüksekti. TF alan grupta ROP sıklığı daha yüksek saptansa da istatistiksel olarak anlamlı fark saptanmadı (p>0.05).
TARTIŞMA ve SONUÇ: Çalışmamızda TF alan bebeklerin doğum tartısı ve gestasyon haftasının daha düşük, ventilatörde kalma süresi,hastanede yatış süresi, sepsis görülme ve inotrop ihtiyacı sıklığının daha yüksek olduğunu saptadık.Özellikle ilk iki haftada alınan kan örnek sayısının fazla olması TF ihtiyacını arttırmakta idi. Pretermlerde ES TF ihtiyacının azaltılması için kan örneği alım sayısının azaltılması, mümkünse mikro yöntemlerin kullanılması ve invaziv olmayan monitörizasyon yöntemlerinin kullanılması gerekmektedir.
INTRODUCTION: Blood products,in particular red blood cell (RBC) transfusions (TF), are frequently administered in preterm neonates during their stay in neonatal intensive care unit (NICU). Up to 90% of very low birth weight preterm neonates receive one or more transfusions in the first few weeks of life.In our study,we aimed to evaluate the risks associated with ES transfusion in preterms born <34GW.
METHODS: 68 infants born under 34 GW were included in the study. The medical records of these infants were retrospectively reviewed.Demographic information and clinical findings of the babies were evaluated in the first week, 7-14. days and 14-21 days.The number of blood samples taken between the days were recorded.The infants were divided into two groups as transfused and non-transfused infants.Clinical outcomes were compared.
RESULTS: Of the 68 cases included in the study, 35(51.4%) were female and 33(48.5%)were male.Mean birth weight of TF and non-TF group were 1301±402.8 g and 1425±462.3 (p>0.05) and mean gestational age was 30.0±2.64 and 30.8±2.04 weeks (p>0.05) respectively.Twenty-five (36.7%) of patients had multiple TF treatment.The mean weight and gestational week of the group with multiple TF was 1041±205 g and 28.7±1.2 weeks, respectively.In the TF group, the first, second and third TF days were postnatal 21.4±10.9, 29.6±11.6 and 32.83±8.9 days, respectively. There was a significant difference in terms of duration of ventilator stay, hospitalization time, sepsis and inotropic requirement when comparing TF group and non-TF group(p <0.05). Cumulative blood loss between 7-14 days were significantly higher in TF group(p <0.05). There was no difference regarding cumulative blood loss between 14th and 28th days(p=0.009). The duration of ventilator stay of the babies in the multiple TF group was also statistically higher (p <0.05). At postnatal 7 th,14 th,28th day, it was seen that the transfused group gained less weight.Bronchopulmonary dysplasia was
found to be increased in TF group than non-TF group.When the groups were compared in terms of ROP, the rate was found
similar in both groups (p>0.05).
DISCUSSION AND CONCLUSION: In our study, we found that babies receiving TF had longer duration of ventilator stay, hospitalization, sepsis and inotropic requirement.The number of blood samples taken in the first two weeks increased the need for TF.In order to reduce the need for TF in preterms, it is necessary to reduce the number of blood samples taken by using micro methods and non-invasive monitoring.

4.To Evaluate the Level of Knowledge of the Pediatricians About the Drugs Used in the Treatment of Asthma
Fatih Çiçek, Mahmut Doğru, Rabia Gönül Sezer, Burçin Çiçek, Tarık Kırkgöz, Abdulkadir Bozaykut
doi: 10.16948/zktipb.522255  Pages 14 - 18
GİRİŞ ve AMAÇ: Astım, öksürük, hışıltı, nefes darlığı ve göğüste sıkışma hissi gibi tekrarlayıcı solunum semptomları ile seyreden çocukluk çağının en sık rastlanan akut ve kronik enflamatuar solunum yolu hastalığıdır.Genel pediatri uzmanlığında çocukluk çağı astımı ve tedavisi konusunda yeterli bilgi düzeyi etkin kontrol için gereklidir. Bu çalışmada, pediatristlerin çocukluk çağı astımında kullanılan ilaçlar konusunda bilgi ve uygulamalarının değerlendirilmesi amaçlanmıştır.
YÖNTEM ve GEREÇLER: Çalışmamıza 200 çocuk sağlığı ve hastalıkları uzmanı veya asistan hekimi katıldı. Astım tedavisinde kullanılan ilaçlar ilgili toplam 40 soruluk anket hekimlere uygulandı.
BULGULAR: Uzman hekimlerin ve hekimlik süresi 5 yıldan fazla olanların anket sorularına verdikleri doğru cevap sayıları, asistan hekimlerin ve hekimlik süresi 5 yıldan daha az olanların verdikleri doğru cevap sayısından anlamlı olarak daha yüksekti (p: 0.001). Cinsiyetin teste doğru cevap verme açısından anlamlı bir farklılık oluşturmadığı görüldü (p: 0,881).
TARTIŞMA ve SONUÇ: Astım kılavuzları ve pratik yaklaşımda bir kısım farklılıklar olsa da çocuk hekimlerinin çoğu yaklaşımları kılavuzlara uygunluk göstermektedir. Hekimlik süresi ve uzman veya asistan olmak anlamlı olarak fark yaratmışken, cinsiyetin anlamlı farklılık yaratmadığı görülmüştür. Ancak astımlı çocuklara daha etkin ve standartize tedavi verilebilmesi için mezuniyet sonrası düzenli aralıklarla eğitimin gerekli olduğu düşünülmektedir.
INTRODUCTION: Asthma is the most common acute and chronic inflammatory airway disease of childhood with recurrent respiratory symptoms such as shortness of breath, wheezing, chest tightness and cough. Adequate knowledge about childhood asthma and treatment in general pediatric expertise is essential for effective control of the disease. The aim of this study was to evaluate the knowledge and practices of pediatricians on drugs used in childhood asthma.
METHODS: 200 children health and disease specialists or assistant physicians participated in our study. A total of 40 questions about the drugs used in the treatment of asthma were applied to physicians.
RESULTS: The number of correct answers given to the test by the specialists and the physicians more than 5 years was significantly higher than the number of correct answers given by the asistant physicians and the physicians with less than 5 years (p: 0.001). Gender showed no significant difference in terms of responding to the test (p: 0,881).
DISCUSSION AND CONCLUSION: Although there are some differences in asthma guidelines and practical approach, most of the pediatricians comply with the guidelines. The duration of the job and being an expert or assistant make a significant difference, gender showed no significant difference in terms of responding to the test. It is believed that education is necessary at regular intervals after graduation in order to provide more effective and standardized treatment for children with asthma.

5.To Compare Pregnancy Results of Patients with Or Without PcosWho Are Included Gnrh Agonist Long Protocol Treatment
Alper Seyhan, Kenan Sofuoğlu, Merve Begüm Osmanlıoğlu
doi: 10.16948/zktipb.616816  Pages 19 - 22
GİRİŞ ve AMAÇ: Kadın infertilitesinin en sık nedeni ovulasyon bozukluklarıdır. Anovulatuar infertilitenin en temel nedeni Polikistik Over Sendromudur. Polikistik Over Sendromu fertil çağdaki kadınlarda görülen en sık endokrin bozukluktur. Polikistik Over Sendromlu infertil kişide ilk tercih ovulasyon indüksiyon ajanı Klomifen Sitrat’tır. Klomifen Sitrat’a yanıtsız olgularda eksojen gonadotropinler kullanılmaktadır. Çalışmamızda, GnRH Agonist Uzun Protokol uygulanan PKOS olan ve olmayan hastalarda gebelik sonuçları ve yanısıra kullanılan gonadotropin dozları, bazal FSH, E2, prolaktin değerleri, elde edilen matur oosit sayıları gibi parametreleri retrospektif olarak karşılaştırmayı hedefledik.
YÖNTEM ve GEREÇLER:
BULGULAR:
TARTIŞMA ve SONUÇ:
INTRODUCTION: Ovulation defects are the most common cause of woman infertility. Polycystic Ovary Syndrome is main cause of anovulatory infertility and most commonly seen endocrine pathology in fertile period of women. In infertile patients with PCOS, first choice of induction agent is Klomifen Citrate. Patients who do not response to Klomifen Citrate, exogen gonadotropines are used for induction. In our study we aimed to evaluate gonadotrophine doses, basaline FSH, E2, prolactine levels, mature oocyte number and pregnancy rates in GnRH Agonist Long Protocol treatment in patients who have PCOS or not.
METHODS:
RESULTS:
DISCUSSION AND CONCLUSION:

6.Early Evaluation of Cardiac Functions by Conventional Echocardiography in Children and Adolescents with Type 1 Diabetes
Nilüfer Çetiner, Semih Bolu, Habip Almış, Fatih Işleyen, Mehmet Turgut
doi: 10.16948/zktipb.631740  Pages 23 - 25
GİRİŞ ve AMAÇ: Kardiyak disfonksiyonun tip 1 diyabetin ciddi ve sık görülen komplikasyonlarından biri olduğu bilinmektedir. Bu çalışmanın amacı, tip 1 diyabet tanılı çocuk ve adolesanların kardiyak etkilenmenin konvansiyonel ekokardiyografi ile erken dönemde değerlendirilmesiydi.
YÖNTEM ve GEREÇLER: Çalışmada 53 tip 1 Diyabet tanılı çocuk ve adolesan ile benzer yaş ve cinsiyette 55 sağlıklı çocuk ve adolesan yer almaktadır. Katılımcıların, boy, kilo, vücut kitle indeksi ve kan basıncı değerleri kaydedildi. Tip 1 diyabetli hasta grubunda glisemik kontrol için glikolize hemoglobin ölçümü yapıldı. Tüm katılımcıların miyokardiyal sistolik ve diyastolik fonksiyonları konvansiyonel ekokardiyografi yöntemi ile değerlendirildi.
BULGULAR: Tip 1 diyabetli 53 hastada kontrol grubuna göre triküspid kapağın A dalga akım hızı anlamlı yüksek (p=0,04) ve triküspid E/A oranı ise anlamlı düşük (p=0,02) bulundu. Sol ventrikül fraksiyonel kısalma ve ejeksiyon fraksiyonu hasta grubunda kontrole göre daha düşük bulundu, ancak istatiksel olarak anlamlı değildi (p değerleri sırasıyla 0,675, 0,933). Hasta grubunda glikolize hemoglobin düzeyi ile sol ventrikül sistolik fonksiyonu arasında ise istatiksel olarak anlamlı negatif korelasyon bulundu (p= 0,049, r= -0,669).
TARTIŞMA ve SONUÇ: Tip 1 diyabet tanısı olan çocuk ve adolesanlarda erken dönemde bile ekokardiyografik olarak sağ ventrikülde diyastolik disfonksiyon ve glikolize hemoglobin düzeyi ile sol ventrikül ejeksiyon fraksiyonu arasında negatif korelasyonun gösterilmesi, kötü glisemik kontrollü diyabetik hastaların peryodik olarak kardiyak değerlendirmelerinin noninvazif tanı yöntemi olan ekokardiyografi ile yapılmasının gerekli olduğunu düşündürmektedir.
INTRODUCTION: It is known that cardiac dysfunction is one of the serious and common complications of type 1 diabetes. The aim of this study was to evaluation early cardiac functions of children and adolescents with type 1 diabetes by conventional echocardiography.
METHODS: This study included 53 children and adolescents with type 1 diabetes and 55 age-sex matched healty children and adolescents. The values of height, weight, body-mass index and blood pressure of the all participants were recorded. Glycated hemoglobin measuring was performed for glycemic control in patients with type 1 diabetes. Myocardial systolic and diastolic functions of all paticipants were assessed by conventional echocardiography.
RESULTS: A wave velocity of tricuspid valve was significantly higher (p=0,04) and tricuspid E/A rate was significantly less (p=0,02) in patients with type 1 diabetes than controls. Fractional shortening and ejection fraction of left ventricular revealed less in the patient groups than controls, but they were no statistically significant differences (p values 0,675,0,933 respectively). Statistically significant negative correlation was noted between level of glycated hemoglobin and ejection fraction of left ventricular in patients group (p=0,049, r= -0,669).
DISCUSSION AND CONCLUSION: Determination of right ventricular diastolic dysfunction and negative corrrelation between level of glycated hemoglobin and left ventricular ejection fraction in children and adolescents with type 1 diabetes suggest, that cardiac evaluation of poor glycemic controlled diabetic patients is necessary periodically performing by echocardiography, which is noninvasive diagnostic method.

7.Subtype Distribution and Frequency of Uveitis in Southeastern Anatolian Children with Juvenile Idiopathic Arthritis
Mustafa Çakan, Kübra Öztürk
doi: 10.16948/zktipb.590889  Pages 27 - 30
GİRİŞ ve AMAÇ: Juvenil idiyopatik artrit (JİA) tüm dünyada en sık gözlenen çocukluk çağı romatizmal hastalığıdır. Tek bir hastalık olmayıp alt gruplardan oluşmaktadır. Kas iskelet sistemi dışında üveit şeklinde göz tutulumu önemli bir morbidite nedenidir. Çalışmamızın amacı kliniklerimizde takip edilen JİA hastaların alt tip dağılımını ve üveit sıklığını saptamaktır.
YÖNTEM ve GEREÇLER: Kliniklerimizde JİA tanısı ile takip ve tedavi edilen tüm hastaların dosyaları geriye dönük olarak taranmıştır.
BULGULAR: Çalışmamıza 264 JİA hastası dahil edilmiştir. Hastaların %54.9’u kız iken %45.1’i erkek idi ve ortalama takip süresi 13.8 ± 5.8 ay idi. JİA alt tip dağılımına bakıldığında en sık oligoartiküler JİA (%42.4) gözlenmekte idi. Entezit ilişkili artrit (%21.6) ikinci sırada iken diğer JİA alt tip dağılımı şu şekilde idi; sistemik JİA (%13.6), romatoid faktör (RF) negatif poliartiküler JİA (%10.2), RF pozitif poliartiküler JİA (%9.5), psoriatik artrit (%1.9) ve sınıflandırılamayan artrit (%0.8). Üveit toplam 23 hastada (%8.7) gözlenmiş olup üveit hastalarının
%91.3’ü oligoartiküler JİA grubunda idi. Sistemik JİA hastalarının %13.8’inde makrofaj aktivasyon sendromu gözlendi. Son kontroldeki hastalık aktivitesine bakıldığında hastaların %18.6’sı aktif iken %81.4’ü remisyonda takip edilmekteydi.
TARTIŞMA ve SONUÇ: Ülkemizde en sık gözlenen JİA alt tipi diğer ülkelerde olduğu gibi oligoartiküler JİA’dır. Ancak batı ülkelerinden farklı olarak ikinci en sık gözlenen alt tip entezit ilişkili artrittir. Ülkemiz JİA hastalarının diğer bir farkı da, JİA ilişkili üveitin daha az gözlenmesidir. Oligoartiküler JİA üveitin en sık gözlendiği alt gruptur. Güncel tedavi seçeneklerinin artması ile hastaların büyük çoğunluğunda hastalık remisyonu sağlanabilmektedir.
INTRODUCTION: Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood in the world. It is not a single disease rather composed of distinct subtypes. Apart from musculoskeletal complications, uveitis is one of the major causes of morbidity in JIA. The aim of this study was to demonstrate subtype distribution and frequency of uveitis in JIA.
METHODS: The study was conducted in two pediatric rheumatology centers of Southeastern part of Turkey.
RESULTS: The cohort consisted of 264 children with slightly female predominance (females: 54.9%, males: 45.1%). Mean duration of follow-up was 13.8 ± 5.8 months. The most common subtype was oligoarticular JIA (42.4%) followed by enthesitis related arthritis (21.6%). The distribution of other subtypes were as follows; systemic JIA (13.6%), rheumatoid factor (RF) negative polyarticular JIA (10.2%), RF positive polyarticular JIA (9.5%), psoriatic arthritis (1.9%) and unclassified arthritis (0.8%). The frequency of uveitis was 8.7% and 91.3% of the patients with uveitis had oligoarticular JIA. Macrophage activation syndrome was observed in 13.8% of systemic JIA
patients. While 18.6% of the patients had active disease at the time of enrollment, 81.4% had remission.
DISCUSSION AND CONCLUSION: As in other parts of the world, oligoarticular JIA is the most common subtype in our country. But, in contrast to western countries, enthesitis related arthritis is the second most common subtype in Turkey. The frequency of uveitis is low in Turkish JIA children that is another major difference from the western countries and oligoarticular JIA is the most common subtype associated with uveitis. With the introduction of newer treatment modalities, remission is an achievable goal in most of the JIA patients.

8.Clinical Experience in Peripartum and Postpartum Blood Transfusion Patients
Elçin Işlek Seçen, Mehmet Akif Sargın, Esra Çamurşen, Idris Yetimoğlu, Özge Kaymaz Yılmaz, Niyazi Tuğ
doi: 10.16948/zktipb.500935  Pages 31 - 34
INTRODUCTION: We aimed to discuss the indications of blood and blood products transfusion in prepartum, peripartum and postpartum period who delivered in our obstetric clinic.
METHODS: A retrospective, observational study was performed of the patients who were delivered and received blood transfusion, at the Department of Obstetrics and Gynecology of Sancaktepe Training and Research Hospital between 01 February 2018 - 31 October 2018. Data abstracted included demographic features, birth records, time of blood transfusions, indications and results.
RESULTS: During the study period, the records of 3575 patients who delivered in our clinic, were examined. Blood transfusion was performed in 2,65% (n: 95) of the patients. Blood transfusion was performed in 5,41% of deliveries by cesarean section and 1,56% in vaginal deliveries. No specific indications for transfusion were identified in 26,3% (n: 25) of the patients and 30,5% patients (n: 29) had no risk factors except chronic anemia. The most common obstetric indication was uterine atony 18,9% (n: 18) of the patients. The red blood cells ratio used in the transfused patients was 2,09 ± 1,18 (0-7) units, the fresh frozen plasma ratio was 1,49 ± 1,05 (0-4) units.
DISCUSSION AND CONCLUSION: Blood and blood products transfusions are life- saving therapies, but they can also cause undesirable complications. We believe that transfusion rates can be reduced by preventing the anemia in pregnancy with appropriate iron and multivitamin supplements by ensuring the regular follow-up of pregnant patients.

9.Evaluation of Occupational Safety in Health Institutions
Asiye Gül, Şenay Özalp, Işıl Işık Andsoy
doi: 10.16948/zktipb.411568  Pages 35 - 39
INTRODUCTION: The aim of the descriptive, cross sectional study is to assess whether the occupational safety of the health personnel working at the hospital is provided and the activities carried out in this regard are evaluated.
METHODS: The study was conducted between 01 June and 31 July 2017. The data were obtained using the Likert- type "Occupational Safety Scale", which was developed by Öztürk and Babacan in 2012. Taking a high score in the scale indicates that occupational safety is provided in the hospitals, and low scores indicate that occupational safety is not provided. In the analysis of the data, number, percentage, mean, Mann Whitney U and Kruskall Wallis test were used. The results were evaluated with a 95% confidence interval and p value less than 0.05 was considered statistically significant.
RESULTS: The mean age of the participants was 38.34 ± 4.96, 76.1% of them reported that they read a notification on patient and employees safety in health institutions and 82.6% reported that they participated in an education on the subject. The mean total score of the scale was determined as 153.64±25.83 (min=107, max= 239). The lowest score in the scale subscores; occupational illnesses and complaints (1.98 ± 0.84), managerial support and approaches (2.77 ± 1.08), and the highest score was taken from the health screening and registration system (4.99 ± 0.84).
DISCUSSION AND CONCLUSION: Measures and practices in the provision of occupational health and safety in hospitals will also increase the safety of patient and employee health. More efforts are needed to ensure occupational safety.

10.The Effect of Awareness Studies Rational Drug Use on The Primary Health Care Institutions
Abdullah Emre Güner, Esra Şahin, Saadet Peksu
doi: 10.16948/zktipb.689416  Pages 40 - 45
INTRODUCTION: Rational Drug Use is a serious problem affecting public health when applied wrongly and unnecessarily in our country as well as in the whole world. These effects include increased morbidity and mortality rates, increased risk of side effects of drugs, reductions in accessibility to essential drugs, even by misuse of resources, based on resistance that can develop against emergency and basic drugs, increased economic and social costs of treatment. For these worldwide, accounting media works was started. In Turkey, 1/3 of Health Services is provided by Primary Health Care Institutions. Health workers working in primary health care institutions have a great effect on Rational Drug use. Family Health Centers are the most important of these institutions. Therefore Public works, public
information, posters and brochures, public trainings, trainings for health workers and the use of rapid antigen kits have been
made. In this study, the effects of awareness studies on the use of Rational Drug in Istanbul were evaluated.
METHODS: The research was conducted in Istanbul between 2014-2015- 2016 and 2017, It is a cross-sectional study which is done by comparing the data obtained from the Prescription Information System which contains the prescription information written in Family Health Centers. In this study, personal information of patients and physicians were not included, only prescription numbers and rates were used.
RESULTS: Application rate 31.5% of the Primary Health Care Instıtutıons in 2017. Application rate 68.5% of the hospitals, Application rate 95.16% of the Family Health Centers. 60.53% of the medical examinations in Family Health Centers in 2014, 57.12% in 2015, 56.89%in 2016, in 2017, 50. 53% of them were prescribed. Antibiotics were prescribed to 31.57% in 2014, 30.92%in 2015, 30.09% in 2016 and 25. 65 % in 2017. Prescribing antibiotics prescription rate is 29.2% average in Turkey in 2017.
DISCUSSION AND CONCLUSION: Prescription and antibiotic prescriptions in Family Health Centers in Istanbul in 2017 are lower compared to 2014, 2015, 2016. Rational Drug Use awareness studies have had a positive effect on prescription and antibiotic prescription rates in Family Health Centers in Istanbul. In 2017, the rate of antibiotic prescribing in Family Health Centers in Istanbul was 25.65% and Turkey is below the average. The impact of awareness studies is great. It is important that studies continue.

CASE REPORT
11.Early Onset Hellp Syndrome with Systemic Lupus Erytematosus and Acute Cholecystitis Attack at 17th Week of Gestation
Gamze Nur Cimilli Şenocak
doi: 10.16948/zktipb.492975  Pages 46 - 48
Hellp syndrome is an atypic, severe and life threatening form of preeclapmsia, which is usually associated with hemolysis, elevated liver enzymes and low platelet count. Also it is very important because it causes significantly maternal and perinatal mortality. It is known that hellp syndrome almost always occurs after 20 weeks of gestation. But in the presence of some accompanying diseases, hellp syndrome or severe preeclampsia can occur at earlier gestational weeks. This may also lead to diagnostic difficulties.In this case, we described the diagnosis and recovery period of a systemic lupus erytematosus (SLE) patient who developed hellp syndrome at 17 weeks of gestation. Our experience takes attention that detection of hellp syndome accompanying diseases like systemic lupus erytematosus or acute cholecystitis can be difficult
and it can occur distinctly at earlier weeks of gestation. Also the differential diagnosis is very important in such cases, because many diseases can mimic hellp syndrome.

REVIEW ARTICLE
12.Aromatherapy in Pregnancy: A Complementary Approach to Care
Gazme Teskereci, Ilkay Boz
doi: 10.16948/zktipb.431968  Pages 49 - 52
Structural and functional changes that occur in pregnancy can affect women’s physically and psychologically health and quality of life negatively. In this article, it is aimed to review the evidence-based studies carried out aiming at preventing, reducing or improving the symptoms in pregnant process using aromatherapy. When the literature is examined, studies investigating the effect of aromatherapy on nausea and vomiting, fatigue, energy level, anxiety, anger, parasympathetic nerve activity, stria gravidarum, pruritus, backpain in pregnancies have been reached. It shows that there is a need for high quality randomised control trials related to the effect of aromatherapy on symtoms in pregnancy.

13.Precocious Puberty and Role of Pediatric Nurse
Selen Özakar Akca, Ahu Pınar Turan, Havva Nur Peltek Kendirci
doi: 10.16948/zktipb.423576  Pages 53 - 58
Precocious puberty (PP) is the physical and hormonal manifestations of early pubertal development occurring at an earlier age than the normally accepted limit. With this present article it is aimed to increase the awareness of pediatric nurses about PP. In this literatüre review, the definition of PP pathophysiology, etiology, epidemiology, clinic, diagnosis, treatment, nursing initiatives and definitive diagnosis. The early onset of puberty can lead to early growth of the mammals, premature menstruation, growth in the penis and testes in boys, early onset of sperm production and increased libido, due to early closure of the epiphyses in children and short stature in the adult years. Emotional stress or behavioral problems cause psychosocial problems due to incompatibility of physical, hormonal and psychological development. Pediatric nurses have important responsibilities in the early diagnosis of PP children, in the orientation to appropriate centers, in the implementation of school-family cooperation as well as of the application of nursing approaches to the necessary precautions.

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