Patient Blood Management (PBM) is a concept that includes all practices to prevent unnecessary transfusions, to minimize the possibility of the patient getting transfusion and to optimize his own blood reserves. It is most effective in elective surgery patients and it has been shown that it is very effective in providing a significant reduction in the amount of transfusions, financial savings and better medical outcomes for the patient. This paper summarizes the key points of the PBM, which the World Health Organization has declared that it should be an integral part of health practices.

INTRODUCTION: The objective of our study was to investigate the physical examination and laboratory findings in obese children with or without primary headaches.
METHODS: A total of 161 children, aged 8-18, with obesity (90 female and 71 male) and primary headache, admitted to pediatric endocrinology and pediatric neurology department between 2013 and 2018 were evaluated retrospectively. Participants were divided into subgroups as with tension headache and migraine headache. Obese children without primary headache were included in the control group. Laboratory and oxologic data were compared between the groups.
RESULTS: Twenty-nine obese children had migraine and 35 had tension type headache. There was no statistically significant difference between the groups with respect to gender, age, body mass index, Body mass index standard deviation score, waist circumference and hip circumference. Low density lipoprotein-cholesterol and total cholesterol levels were significantly higher in obese children with migraine headache compared to group without primary headache. There was no difference between the groups in terms of other biochemical parameters.
DISCUSSION AND CONCLUSION: There is a probable relationship between cholesterol elevation and migraine headache in obese children. For that reason, blood lipids should be followed carefully in obese children with migraine headache.

INTRODUCTION: Critical diseases such as sepsis have been shown to suppress thyroid hormone secretion. The relationship between hypothyroidism and the frequency of sepsis and causative bacteria is not known especially in premature infants. In this study, we aimed to investigate the relationship between congenital hypothyroidism (CH) and late onset sepsis (LOS) in premature infants.
METHODS: The study was carried out between January 2013 and December 2016, and the data of VLBW infants were retrospectively recorded from hospital medical records. Thyroid stimulating hormone (TSH) and free thyroxine (sT4) levels were measured on postnatal day 5. The data were recorded in terms of gestational age, birth weight, gender, LOS (clinically or culture proven), number of LOS episodes and meningitis. Comparisons were implemented in terms of LOS, number of LOS episodes, meningitis and demographic characteristics between the groups with and without CH.
RESULTS: In our study, KH was found in 26 out of 581 VLBW infants (4.4%). No significant differences were found between two groups in terms of LOS (clinically) (66,7% vs 57,4%), LOS (culture proven) (34,6% vs 23,9%), number of LOS episodes (1,37 ± 0, 76 vs 1,41 ± 0,66) and meningitis (3.8% vs 4,3%) (p> 0,05).
DISCUSSION AND CONCLUSION: In our study, we found that hypothyroidism did not cause any risk of sepsis and meningitis in VLBW preterm infants. This issue needs to be investigated further in the newborns.

INTRODUCTION: House dust mite (HDM) specific sublingual immunotherapy (SLIT) has longterm effects contrary to pharmacotherapy in children with asthma. We aimed to study the longterm effects of SLIT on inhaled corticosteroid usage.
METHODS: Fifty-four asthmatic children received HDM specific SLIT for at least 3 years and followed up minimum 5 years after cessation of SLIT in addition to pharmacotherapy and 23 received only pharmacotherapy in the same time period were admitted to study. SLIT and pharmacotherapy groups were evaluated retrospectively from the medical records in regard to their inhaled corticosteroid (ICS) dose (μg/day) and duration (month(s)/year) of ICS, pulmonary function test (PFT) parameters. All patients were evaluated for ICS dose (μg/day) and duration (month(s)/year) of ICS, PFT and evaluated by visual analogue scores and symptom scores with daily cards given to them for at least 6 months. According to the diary card records, ICS need and FEV1%, patients were grouped as 37 SLIT-responder, 17 SLIT-nonresponder, 15 PT-responder, 8 PT-nonresponders.
RESULTS: Reduction in ICS dose was significantly higher for SLIT (407 ± 252 μg) in comparison to pharmacotherapy group (224 ±174 μg) (p=0.009). Duration of ICS usage reduced in a percentage of %63 (p=0,001) in SLIT-nonresponder group, but in pharmacotherapy-nonresponder group duration of ICS usage was only %11 (p=0,108).
DISCUSSION AND CONCLUSION: SLIT is effective in reducing ICS dose. Duration of ICS treatment did not decrease in the course of time in PT-nonresponder group while decreased in SLIT-nonresponder group.

INTRODUCTION: Amyloidosis is a systemic disease that occurs when abnormally folded amyloid fibrils accumulates in the extracellular area in various organs and tissues of the body. Amyloidosis is definitively diagnosed by demonstration of abnormal amyloid deposition in the tissues. Biopsies are taken from various tissues when considering amyloidosis clinically. In this study, we wanted to investigate the distribution of underlying diseases in AA amyloidosis in our country.
METHODS: In this study, we retrospectively evaluated the data of 63 patients with AA amyloidosis and tried to determine the primary underlying diseases.
RESULTS: The most common primary etiologic cause was Familial Mediterranean Fever (FMF) (57%). In addition, rheumatoid arthritis, chronic bronchitis, tuberculosis, crohn’s disease, sarcoidosis, ankylosing spondylitis and bronchiectasis were other etiologic causes. The most commonly used biopsy for diagnosis in this study was renal biopsy (63%).
DISCUSSION AND CONCLUSION: Further studies with large sample size are needed to confirm these results and determine etiology of AA amyloidosis.

INTRODUCTION: Endoscopic endonasal transsphenoidal surgery (EETS) is used mainly in pituitary adenomas, other tumors of the sellar and parasellar region, rhinorrhea surgery and optic nerve surgery. The results of 200 patients who underwent EETS in our clinic were evaluated.
METHODS: 200 patients who underwent EETS at Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological Disorders Education and Research Hospital Neurosurgery Clinic in 2014-2017 were retrospectively evaluated. Follow-up period was 3-43 (mean 15) months. 108 patients were female (54%), 92 male (46%) and mean age was 47.5 (15-79).
RESULTS: Pathology results showed 119 of the patients had secretory pituitary adenomas (23 cushing, 15 prolactinoma, 37 acromegaly, 12 mixed type, 3 TSH, 29 gonadotropinoma), 47 had non- secretary adenoma. 5 meningioma, 5 craniopharyngiomas, 6 cordoma, 2 neuroendocrine tumor, 1 germinoma, 6 rathe cleft cyst, 1 ossifying fibroma, 7 spontaneous rhinorrhea, 1 abscess diagnosis were made. Epistaxis was found in 15, transient diabetes insipidus (DI) in 14, CSF leakage in 23, permanent anosmia in 5, temporary visual loss in 1, and late period sinusitis in 7. No major vascular injury was found. 2 patients died due to meningitis and its complications.
DISCUSSION AND CONCLUSION: In EETS, the rates of CSF fistula were 0.5-15%, epistaxis 0.6%, transient DI 11.99%, permanent DI 3.41%, and remission and total resection rate 60-80%. Epistaxis incidence rate was higher than the literature. Temporary DI, remission and total resection incidences were consistent with the literature; permanent DI was lower. We believe EETS is an effective and reliable surgical method.

INTRODUCTION: Tube thoracostomy is a surgical procedure, which is performed from the chest wall toward the pleural space, frequently to evacuate air or fluid and provide pulmonary expansion. This procedure is a variable procedure, with efficacy and complication rates being applied by many specialties such as emergency physicians. We aimed to retrospectively evaluate patients who underwent tube thoracostomy during the 1-year period in our emergency department.
METHODS: In this study, patients who were performed tube thoracostomy between January 1st, 2017 and January 1st, 2018 in our emergency medical department were evaluated retrospectively. NCSS 2007 (Kaysville, Utah, USA) program was used for statistical analysis. Significance was at least p <0,05.
RESULTS: Of the 42 cases screened in the study, 9.5% (n=4) were female and 90.5% (n=38) were male. The mean age was 36.19 ± 20.19 years and the average emergency service cost was 711.21 ± 446.34 Turkish Lira. There was statistically significant difference in complication status according to tube cause (p = 0.012; p <0.05). Complication rate in pneumothorax (PNX) group was significantly higher than haemothorax (HTX) and HTX + PNX group. Emergency service cost of cases with HTX + PNX was found statistically significantly higher than PNX patients (p = 0.023, p <0.05).
DISCUSSION AND CONCLUSION: Tube thoracostomy is a life-saving interventional procedure in emergency situations. A lack of implementation the procedure can cause significant morbidity and mortality. For this reason, we believe that the tube thoracostomy procedure should be known and practiced by every emergency medicine specialist.

INTRODUCTION: In this study, it was aimed to investigate the types and causes of foreign bodies and their complications according to the demographic characteristics of patients who were brought to the external ear canal by foreign body complaints.
METHODS: The pediatric patients that were given medical treatment in EEC between 2014 and 2016 were retrospectively analyzed in age, gender, kind of foreign body, symptoms of complaints, treatment and complications.
RESULTS: From 93 pediatric patients, it was identified that the youngest patient was 3, the eldest one was 11, the age range 4± 2.1, 55 of them were girls and 38 of them were boys. It is observed that there were mostly beads in the external ear canal. The parents mostly came by finding or seeing a foreign body and the most seen symptom was earache. A foreign body was identified in right ear of 51 and left ear of 41 patients and also both ears of 1 patient. It was identified that there were more than one foreign body in the same ear at 5 patients. The foreign body removal was occurred in 51 patients at polyclinic and 42 patients at operation room under general anesthesia.
DISCUSSION AND CONCLUSION: The external ear canal can lead to complications when approaching foreign bodies, the age of the child, the type of foreign body being decisive and can not be intervened properly.

INTRODUCTION: Oral anticoagulant agents are used to be protected from thromboembolic diseases. The present study was conducted to review types of oral anticoagulants (OAC) used for the patients who are at risk of thromboembolic diseases by initiation of direct oral anticoagulants (DOACs) and emergency room admissions of these patients.
METHODS: In the present study, a retrospective analysis was performed on cause of referral, oral anticoagulant indication, electrocardiography (ECG) rhythms and period of drug use on all patients who use oral anticoagulants and referred Emergency Department of Kanuni Sultan Suleyman Education and Research Hospital between July 2017 and January 2018 through hospital information system and patient files.
RESULTS: Totally 46 patients on OAC were included into the study. Among the participants, 28.2% (n=13) of the patients were male and 71.8% (n=33) of them were female; the age average was 73.28±13.35. The analysis on OAC type revealed use of varfarine by 39.1% (n=18), dabigatran by 23,9%(n=11), apixaban by 13,1% (n=6) and rivaroxaban by 23.9% (n=11). There was not any statistically significant association between OAC type and cause of referral (p>0.05). The ECG rhythm of the patients was detected as normal sinus rhythm in 37.2% (n=16), atrial fibrillation (AF) in 55.8%, supraventricular tachycardia in 2.3% (n=1) and other rhythms (pace and bigemine rhythm) in 4.7% (n=2).
DISCUSSION AND CONCLUSION: We believe that increase of the studies conducted on use of DOACs, we would have more information on safety and efficacy of these drugs; indications for use may increase of DOACs; therefore comprehensive and multi-centered studies are needed.

INTRODUCTION: Acute Respiratory Stress Syndrome (ARDS) is form of acute inflammatory lung injury caused by systemic damage and inflammation. Berlin Criteria are presented in 2011. Berlin Criteria included, onset-time, degree of hypoxemia, cause of edema, radiological appearances. In this study, we aimed to retrospectively investigate ARDS patients in terms of morbidity, mortality, 6-month survival and Berlin Criteria.
METHODS: Between January2016-January2017 at the ICU of our hospital, age, gender, mortality, APACHE II score, length of hospital, procalcitonin-CRP, leukocyte counts, accompanying diseases and the Berlin Criteria of ARDS cases were analyzed retrospectively.

RESULTS: A total of 52 ARDS patient files were included in the study. Mortality was observed in 15 patients(28%). Hypertension(55.8%) was detected in 29 of the patients. Diabetes mellitus was present in 16 patients(30.8%), asthma in 38 patients(38.5%), chronic renal failure in 3 patients(5.8%), chronic heart failure in 19 patients (36.5%). Alcohol use was seen in 6 patients(11.5%) and smoking was seen in 21 patients(40.4%). In terms of Berlin Criteria; Within 7 days, the development of ARDS was detected in 45 patients(86.5%). There were 38(73.1%) ARDS developments on chest X-ray. Pulmonary edema was seen in 32 patients(61.5%). Mild oxygenation was detected in 19 patients(36.5%), moderate oxygenation in 18(34.6%) patients, severe oxygen deficiency in 15(28.8%) patients. There were no mortality determined looking at 6-month mortality.
DISCUSSION AND CONCLUSION: According to Berlin criteria, adequate oxygenation and mechanical ventilation therapy in ARDS patients increases survive and reduces mortality and morbidity. In this study we demonstrated that ARDS patients’s findings are compatible with Berlin criteria.

INTRODUCTION: To investigate choroidal thickness change in patients with diastolic dysfunction secondary to hypertrophic cardiomyopathy (HCM)
METHODS: Sixty five eyes of HCM diagnosed 33 patients and 65 eyes of 33 healthy subjects were included in the cross-sectional, case-controlled, prospective study. The retina nerve fiber layer (RNFL) thickness, macular thickness, macular volume, ganglion cell thickness, subfoveal choroidal thickness (SFCT), choroidal thickness of 1 mm nasal side of fovea (NCT), choroidal thickness of 1 mm temporal side of fovea (TCT) were compared between the two groups with Zeiss Cirrus device.
RESULTS: In the HCM group, 11 of 33 patients were female and 22 were male. In the control group, 10 of the 33 patients were female and 23 were male. There was no difference between the two groups in the values of age, body mass index, spherical equivalent, axial length, and intraocular pressure that might affect choroidal thickness. SFCT were detected 266.3± 50.1 µm in the HCM group and 273.6±56.8 µm in the control group. NCT were detected 262±55.9 µm in the HCM group and 261.2±41.4 µm in the control group. TCT were detected 270.5±57.5 µm in the HCM group and 259.4±52.7 µm in the control group. RNFL, macular thickness, macular volume, SFCT, NCT, TCT values were not statistically different between the two groups.
DISCUSSION AND CONCLUSION: No change in choroidal thickness in patients with diastolic dysfunction suggesting that there is no significant decrease in blood flow in the posterior ciliary arteries in diastolic heart dysfunction.

INTRODUCTION: Our open-label clinical trial; to investigate the effect of dry needling on sleep problems in fibromyalgia patients with trigger points.
METHODS: Informed consent was obtained from a total of 100 patients with trigger points in the upper trapezius and rhomboid muscles under regular medical treatment followed by a diagnosis of fibromyalgia for at least six months in the outpatient clinic. All patients were evaluated with FEA (Fibromyalgia Impact Questionnaire), BDI (Beck Depression Scale), PUKI (Pittsburg Sleep Quality Index) and VAS (Visuel Pain Scale). The patients were divided into two groups by computer-assisted simple randomization. In the study group, 50 fibromyalgia patients with trigger points were given a total of three dry needle injections to the upper trapezius and rhomboid muscles three times a total of three weeks a week. 50 fibromyalgia patients with trigger points in the control group were not given any needling. One month after the first evaluation questionnaires of all patients (all of the study and control groups), the FEA, BDI, PUKI scores were checked again and the patients were questioned by VAS (Visuel Pain Scale).
RESULTS: There was a statistically significant difference in FEA, PUKI and VAS scores when the groups were compared in terms of change amounts (respectively; p<0.001, p=0.007 ve p=0.035).
DISCUSSION AND CONCLUSION: In our study, it was observed that dry nails applied to trigger points of fibromyalgia patients had a statistically significant contribution to patients in terms of FEA, PUKI and VAS values.

INTRODUCTION: Preeclampsia is a multisystemic gestational syndrome characterized by hypertension, proteinuria, often occurring after 20 weeks of gestation.
Eclampsia is assessed if seizure not due to other causes is added to the disease.
Magnesium is effective in the prevention and control of convulsions. Magnesium increases the effect of nondepolarizing muscle relaxants. TOF monitoring can be used when the degree of nondepolarizing nerve-muscle block or suspicion of residual block. Our aim was to determine the effect of magnesium on the neuromuscular range by measuring the effect of magnesium during intubation.

METHODS: Sixty obese, preeclamptic patients with cesarean-section between December2016-June2017 were retrospectively reviewed. Age, ASA, accompanying disease, gestational week, time of intensive care stay and hospitalization, VKI, MgSO4 doses, preoperative MgSO4-levels, proteinuria, 24hour urine, intraoperative TOF, blood pressure, pulse, SPO2 for induction and infant output were recorded for study.
RESULTS: When the demographic data were compared, there was no significant difference between patient and control groups in terms of age, BMI, hospital stay. The weekly average of the babies in the control group was higher than the weekly average of the babies in the patient group and statistically significant. When the TOF reached 0 in the cesarean section before the intubation operation, the TOF reached 0 in the patient group was statistically significant.
DISCUSSION AND CONCLUSION: Magnesium significantly shortens the duration of intubation and enhances the effect of nondepolarizing muscle relaxants. We think that dose of nondepolarizing muscle relaxants should be lower than usual in patients receiving magnesium treatment for this reason.