<\/p>\n
COVID-19 Pn\u00f6monisinin Erken Tan\u0131s\u0131nda Akci\u011fer Ultrasonografisi: Uluslararas\u0131 \u00c7ok Merkezli Bir \u00c7al\u0131\u015fma<\/strong><\/p>\n Volpicelli G, et all. Lung ultrasound for the early diagnosis of COVID-19 pneumonia: an international multicenter study. Intensive Care Med. 2021;47(4):444-454.<\/p>\n AUS, COVID-19 pn\u00f6monisini te\u015fhis etmede, hekimler i\u00e7in etkili bir ara\u00e7t\u0131r. Ancak AUS bulgular\u0131 \u00f6zg\u00fcl de\u011fildir. Son zamanlarda, COVID-19 pn\u00f6monisi i\u00e7in farkl\u0131 olas\u0131l\u0131k derecelerine sahip modelleri temel AUS bulgular\u0131n\u0131n varl\u0131\u011f\u0131na ve da\u011f\u0131l\u0131m\u0131na g\u00f6re belirleyen basit bir yakla\u015f\u0131m \u00f6nerilmi\u015ftir. Bu yakla\u015f\u0131m, hastan\u0131n AUS bulgular\u0131 ile ba\u015fvuru s\u0131ras\u0131ndaki klinik semptomlar\u0131 ve t\u0131bbi \u00f6zge\u00e7mi\u015fi b\u00fct\u00fcnle\u015ftirir. \u0130nceleyece\u011fimiz bu \u00e7al\u0131\u015fmada; COVID-19 \u015f\u00fcphesi olan hastalarda, AUS bulgular\u0131, semptom ve klinik \u00f6zge\u00e7mi\u015fler ile birle\u015ftirilerek, tan\u0131sal yakla\u015f\u0131m analiz edilmi\u015ftir. \u00c7al\u0131\u015fman\u0131n hipotezi, COVID-19 \u015f\u00fcpheli hastalarda, standart bir AUS de\u011ferlendirmesinin uygulanabilir ve tekrarlanabilir oldu\u011fu ve RT-PCR sonu\u00e7lar\u0131n\u0131n erken tahmini i\u00e7in faydal\u0131 olabilece\u011fi y\u00f6n\u00fcndedir.<\/p>\n \u00c7al\u0131\u015fman\u0131n birincil amac\u0131<\/strong>, COVID-19 \u015f\u00fcpheli uluslararas\u0131 b\u00fcy\u00fck bir pop\u00fclasyonda RT-PCR sonu\u00e7lar\u0131n\u0131n tahmininde AUS modelleri ve klinik fenotiplerin kombinasyonunun tan\u0131sal do\u011frulu\u011funu tan\u0131mlamak, ikincil amac\u0131<\/strong> ise farkl\u0131 seviyelerde AUS becerisine sahip merkezlerde, COVID-19 i\u00e7in standart bir AUS yakla\u015f\u0131m\u0131 i\u00e7in online e\u011fitimi test etmektir.<\/p>\n Y\u00d6NTEM<\/strong><\/p>\n \u00c7ok merkezli prospektif g\u00f6zlemsel \u00e7al\u0131\u015fmaya,\u00a001.03.2020 ile 30.05.2020 aral\u0131\u011f\u0131nda, 20 hastane kat\u0131lm\u0131\u015f. Acil servise, COVID-19 \u00fcnitesine veya yo\u011fun bak\u0131m \u00fcnitesine (YB\u00dc) kabule yol a\u00e7an, klinik COVID-19 \u015f\u00fcphesi olan \u226518 ya\u015f hastalar \u00e7al\u0131\u015fmaya dahil edilmi\u015f. Klinik \u015f\u00fcphe, daha olas\u0131 alternatif tan\u0131 yoklu\u011funda en az \u00fc\u00e7 g\u00fcn s\u00fcren semptomlara g\u00f6re belirlenmi\u015f:<\/p>\n Maj\u00f6r kriterler (en az bir): <\/strong><\/p>\n Min\u00f6r kriterler (en az iki): <\/strong><\/p>\n D\u0131\u015flama kriterleri; hastalar\u0131n \u00f6nceden COVID-19 pn\u00f6monisi tan\u0131s\u0131 alm\u0131\u015f olmas\u0131 veya \u00f6zge\u00e7mi\u015fte pn\u00f6monektomi, pl\u00f6redez veya fibrotoraks \u00f6yk\u00fcs\u00fc olmas\u0131 olarak belirtilmi\u015f.<\/p>\n Hastalar, ba\u015fvuru s\u0131ras\u0131ndaki objektif veya hekime bildirilen dispne varl\u0131\u011f\u0131na g\u00f6re karakterize edilerek RT-PCR testi ve AUS ger\u00e7ekle\u015ftirilmi\u015f. Ba\u015fvuru s\u0131ras\u0131ndaki \u015fikayetler ve objektif parametrelerle \u00fc\u00e7 farkl\u0131 klinik fenotip tan\u0131mlanm\u0131\u015f:<\/p>\n \u015eiddetli fenotipten objektif desat\u00fcrasyonu olan alt grup se\u00e7ilmi\u015f ve PaO2<\/sub>\/FiO\u00a02<\/sub>\u00a0<300 veya SpO2<\/sub>\/FiO2<\/sub>\u00a0<357 olarak tan\u0131mlanm\u0131\u015f.\u00a0Kardiyopulmoner komorbiditeler, \u015fiddetli KOAH, interstisyel akci\u011fer hastal\u0131\u011f\u0131, akci\u011fer kanseri, kalp yetmezli\u011fi ve kor pulmonale dahil olmak \u00fczere kronik solunum ve\/veya kalp hastal\u0131\u011f\u0131 \u00f6yk\u00fcs\u00fc olarak tan\u0131mlanm\u0131\u015f.<\/p>\n Akci\u011fer Ultrasonografisi (AUS)<\/strong><\/p>\n Her hastanede uygulay\u0131c\u0131lar, AUS’ta daha \u00f6nce belgelenmi\u015f deneyime sahip YB\u00dc ve acil t\u0131p hekimlerinden se\u00e7ilmi\u015f.\u00a0\u00a0AUS uygulay\u0131c\u0131s\u0131, RT-PCR ve di\u011fer herhangi bir g\u00f6r\u00fcnt\u00fcleme veya kan testi sonucuna k\u00f6r tutulmu\u015f. AUS, RT-PCR sonucundan \u00f6nce, ba\u015fvuru s\u0131ras\u0131nda ger\u00e7ekle\u015ftirilmi\u015f.<\/p>\n \u00c7al\u0131\u015fmaya dahil edilen hastalara, konveks probla anterolateral ve posterior toraksta kapsaml\u0131 AUS yap\u0131lm\u0131\u015f. AUS, standartla\u015ft\u0131r\u0131larak birbirini d\u0131\u015flayan modellere g\u00f6re s\u0131n\u0131fland\u0131r\u0131lm\u0131\u015f:<\/p>\n \u015eekil 1. <\/strong>\u00a0COVID-19 pn\u00f6monisi \u015f\u00fcpheli hastalara ilk yakla\u015f\u0131mda AUS bulgular\u0131n\u0131n yorumlanmas\u0131 i\u00e7in \u00f6nerilen algoritma.<\/p>\n \u015eekil 2. <\/strong>\u00a0Semptomatik hastada COVID-19 bulgular\u0131n\u0131 g\u00f6steren, AUS modelerinin temsili g\u00f6r\u00fcnt\u00fcleri.<\/p>\n AUS yakla\u015f\u0131m\u0131n\u0131n standardizasyonu <\/strong><\/p>\n Kay\u0131t i\u015flemleri \u00f6ncesi, protokol\u00fc g\u00f6stermek ve standardizasyonu sa\u011flamak i\u00e7in toplant\u0131lar d\u00fczenlenmi\u015f.\u00a0 AUS modelleri ve bulgular\u0131n yorumlanmas\u0131nda, uygulay\u0131c\u0131 aras\u0131 de\u011fi\u015fkenli\u011fi de\u011ferlendirmek i\u00e7in, e\u011fitim verilmi\u015f ve d\u00f6rt AUS modelini tan\u0131maya y\u00f6nelik vakalar sunulmu\u015f. T\u00fcm sorumlu ara\u015ft\u0131rmac\u0131lardan anormallikleri tan\u0131malar\u0131, klinik bilgi olmaks\u0131z\u0131n AUS modeli olas\u0131l\u0131\u011f\u0131n\u0131 belirlemeleri istenmi\u015f. S\u0131n\u0131f i\u00e7i korelasyon katsay\u0131s\u0131 (ICC) >0,8 ise, uygulay\u0131c\u0131 AUS de\u011ferlendirmesinde ba\u011f\u0131ms\u0131z kabul edilmi\u015f.<\/p>\n SONU\u00c7LAR<\/strong><\/p>\n \u00c7al\u0131\u015fma s\u00fcresince 2035 hasta taranm\u0131\u015f, toplam 1462 hasta kaydedilmi\u015f. RT-PCR, hastalar\u0131n 1022\u2019sinde pozitif, 440\u2019\u0131nda negatif bulunmu\u015f. Hastalar\u0131n %74\u2019\u00fc acil servislerde, %16’s\u0131 COVID-19 \u00fcnitelerinde ve %10’u YB\u00dc\u2019de kaydedilmi\u015f. Se\u00e7ilen de\u011fi\u015fkenlerin pozitif RT-PCR’yi \u00f6ng\u00f6rmedeki ba\u011f\u0131ms\u0131z rol\u00fcn\u00fc de\u011ferlendirmek i\u00e7in \u00e7ok de\u011fi\u015fkenli lojistik regresyon analizi yap\u0131lm\u0131\u015f.<\/p>\n \u00c7al\u0131\u015fmaya dahil edilen farkl\u0131 klinik fenotiplerdeki t\u00fcm hastalarda; pozitif RT-PCR’\u0131 belirlemede; yAUS ve araAUS paternleri, %90,2 (%95 GA %88,23-91,97) duyarl\u0131l\u0131kta bulunmu\u015f. yAUS modeli, hafif klini\u011fi olan hastalarda daha y\u00fcksek \u00f6zg\u00fcll\u00fck g\u00f6stermi\u015f (%94,4 GA %90-97). \u00c7ok de\u011fi\u015fkenli analizde yAUS modeli, RT-PCR pozitifli\u011finin g\u00fc\u00e7l\u00fc ba\u011f\u0131ms\u0131z belirteci bulunmu\u015f (OR 4,2 GA 2,6-6,7 p<0,0001).<\/p>\n Hem yAUS modeli hem de \u0131\u015f\u0131k huzmesi, desat\u00fcrasyondan ba\u011f\u0131ms\u0131z RT-PCR pozitifli\u011fini \u00f6ng\u00f6rmekteyken dispne ile solunum yetmezli\u011fi aras\u0131nda ve \u0131\u015f\u0131k huzmesi ile yAUS modeli aras\u0131nda \u00e7oklu do\u011frusal ba\u011flant\u0131 bulunamam\u0131\u015f. yAUS olas\u0131l\u0131k paterni saptanan hastalarda di\u011fer AUS paternleri olan hastalara k\u0131yasla solunum yetmezli\u011fi daha yayg\u0131n bulunmu\u015f (yAUS %65,5’e kar\u015f\u0131; altAUS %50,5 araAUS %47,6 dAUS %5,8 p<0,0001).<\/p>\n \u00c7al\u0131\u015fmaya 75 sonografi uzman\u0131 kat\u0131lm\u0131\u015f ve ortalama s\u0131n\u0131f i\u00e7i korelasyon katsay\u0131s\u0131 0,980 (aral\u0131k 0,939-1,0), t\u00fcm sonografi uzmanlar\u0131 aras\u0131nda ICC >0,90 bulunmu\u015f.<\/p>\n \u015eekil 3. <\/strong>\u00a0COVID-19 \u015f\u00fcpheli hasta y\u00f6netiminde, ba\u015fvuru s\u0131ras\u0131ndaki klinik fenotip ve AUS modeline g\u00f6re olu\u015fturulan ak\u0131\u015f \u015femas\u0131.<\/p>\n \u00a0<\/strong><\/p>\n TARTI\u015eMA<\/strong><\/p>\n Bu \u00e7al\u0131\u015fma COVID-19 \u015f\u00fcpheli hastalarda h\u0131zl\u0131 karar verme ve kaynak tahsisi i\u00e7in pn\u00f6moni sonografik olas\u0131l\u0131\u011f\u0131n\u0131 klinik fenotiplerle birle\u015ftiren standart bir AUS protokol\u00fc uygulamas\u0131n\u0131 a\u00e7\u0131klayan ilk \u00e7ok merkezli b\u00fcy\u00fck \u00e7al\u0131\u015fmad\u0131r.<\/p>\n \u00c7al\u0131\u015fmadaki bulgular, daha \u00f6nceki \u00e7al\u0131\u015fmalarda kullan\u0131lmayan klinik fenotip kullan\u0131m\u0131yla AUS d\u00f6rt modelli s\u0131n\u0131fland\u0131rman\u0131n pratik avantaj\u0131n\u0131 g\u00f6stermektedir. AUS modellerini tan\u0131mlamak i\u00e7in kullan\u0131lan dil, COVID-19 BT bulgular\u0131 i\u00e7in \u00f6nerilen dile benzemektedir. BT’deki “tipik g\u00f6r\u00fcn\u00fcm” yAUS’a, “belirsiz g\u00f6r\u00fcn\u00fcm” araAUS’a, “atipik g\u00f6r\u00fcn\u00fcm” altAUS’a ve “negatif g\u00f6r\u00fcn\u00fcm” dAUS’a benzetilebilir.<\/p>\n \u00c7al\u0131\u015fmada yAUS <\/strong>modeli COVID-19 pn\u00f6monisi i\u00e7in y\u00fcksek prediktif de\u011fere sahip bulunmu\u015f, yAUS modeli ve negatif RT-PCR olan vakalar\u0131n y\u00fczdesi d\u00fc\u015f\u00fck bulunmu\u015f. Bu durum, vakalar\u0131n yanl\u0131\u015f negatif s\u00fcr\u00fcnt\u00fc testi oran\u0131yla a\u00e7\u0131klanm\u0131\u015f. Ger\u00e7ekten de ilk RT-PCR testinin duyarl\u0131l\u0131\u011f\u0131 d\u00fc\u015f\u00fckt\u00fcr ve yaln\u0131zca tekrarlanan s\u00fcr\u00fcnt\u00fcler veya baz\u0131 durumlarda bronkoalveolar lavaj, ilk s\u00fcr\u00fcnt\u00fc yanl\u0131\u015f negatif olan hastalarda tan\u0131y\u0131 do\u011fru \u015fekilde ortaya koymaktad\u0131r. Tipik klinik tablo ve BT\u2019de \u015f\u00fcpheli COVID-19 pn\u00f6monisi paterni olan ancak tekrarlayan RT-PCR negatif olan hastalar\u0131n, \u00f6zellikle COVID-19 pandemisinin pik yapt\u0131\u011f\u0131 d\u00f6nemlerde, COVID-19 pn\u00f6monisi olarak kabul edilerek tedavi edilmesi hepimizin ya\u015fad\u0131\u011f\u0131 bir deneyimdir.<\/p>\n araAUS <\/strong>modelinde negatif RT-PCR testi olan hastalar\u0131n y\u00fczdesi yAUS modelli hastalardan daha y\u00fcksek bulunmu\u015f ancak iki olas\u0131l\u0131k modeli birlikte t\u00fcm alt gruplarda en y\u00fcksek duyarl\u0131l\u0131\u011fa sahip izlenmi\u015f. Pratik bak\u0131\u015f a\u00e7\u0131s\u0131 olarak hem yAUS hem de araAUS paternlerinin yoklu\u011fu klinik durum k\u00f6t\u00fcle\u015ftik\u00e7e duyarl\u0131l\u0131\u011f\u0131 artan COVID-19 pn\u00f6monisini ekarte etti\u011fi d\u00fc\u015f\u00fcn\u00fclebilir.<\/p>\n dAUS <\/strong>modeli izlenen hastalar\u0131n %35’inde RT-PCR testleri pozitif saptanm\u0131\u015ft\u0131r. Bu fark, vir\u00fcs\u00fcn pn\u00f6moni olmayan veya AUS taraf\u0131ndan g\u00f6r\u00fclemeyen \u00e7ok hafif bir pulmoner tutulumu olan hastalarda saptanmas\u0131yla a\u00e7\u0131klanabilir.<\/p>\n altAUS <\/strong>modeli izlenen hem \u015fiddetli hem de kar\u0131\u015f\u0131k klinik fenotipe sahip hasta gruplar\u0131n\u0131n b\u00fcy\u00fck \u00e7o\u011funlu\u011funda RT-PCR negatif bulunmu\u015f. COVID-19 prevalans\u0131n\u0131n y\u00fcksek oldu\u011fu bir anda bile altAUS, \u00e7o\u011fu hastada RT-PCR’nin negatifli\u011fini do\u011fru \u015fekilde \u00f6ng\u00f6rmektedir. Bu bulgular, kronik bir hastal\u0131k alevlenmesi ile COVID-19 pn\u00f6monisi aras\u0131nda ayr\u0131m yapmaya \u00e7al\u0131\u015fan klinisyen i\u00e7in \u00f6nemlidir.<\/p>\n Karma klinik fenotipe <\/strong>sahip hasta grubunda AUS\u2019un rol\u00fc zordur. Modelleme \u00f6nceden var olan pulmoner de\u011fi\u015fikliklerin alevlenme olas\u0131l\u0131\u011f\u0131nda zorla\u015fabilir. Hem akut hem de kronik bir\u00e7ok durum, COVID-19 pn\u00f6monisi ile benzer AUS belirtilerini payla\u015fmaktad\u0131r. \u00c7al\u0131\u015fman\u0131n sonu\u00e7lar\u0131na bakacak olursak karma fenotipe sahip hastalarda yAUS paterninin tespiti, iyi \u00f6zg\u00fcll\u00fck ile pozitif RT-PCR sonucunu \u00f6ng\u00f6rm\u00fc\u015ft\u00fcr. Yine de \u00f6nceden bilinen kronik akci\u011fer hastal\u0131\u011f\u0131 olanlarda araAUS modelinin saptanmas\u0131, daha fazla test ihtiyac\u0131n\u0131 g\u00f6stermektedir.<\/p>\n K\u0131s\u0131tl\u0131l\u0131klar<\/strong><\/p>\n En b\u00fcy\u00fck k\u0131s\u0131tl\u0131l\u0131k tan\u0131da kesin bir alt\u0131n standard\u0131n olmamas\u0131d\u0131r. AUS bulgular\u0131n\u0131 do\u011frulamak i\u00e7in BT taramas\u0131 ile sistematik kar\u015f\u0131la\u015ft\u0131rma veya \u015f\u00fcpheli vakalarda COVID-19 tespiti i\u00e7in hasta takibi yap\u0131lmam\u0131\u015f. AUS uygulay\u0131c\u0131lar\u0131, RT-PCR sonu\u00e7lar\u0131na k\u00f6r iken, hastalar\u0131n klini\u011fi AUS yorumlamas\u0131nda yanl\u0131l\u0131k yaratm\u0131\u015f olabilir. Hastalar, belgelenmi\u015f AUS deneyimine sahip bir sonografi uzman\u0131 bulundu\u011funda kaydedilmi\u015f; bu durum se\u00e7im yanl\u0131l\u0131\u011f\u0131n\u0131 beraberinde getirmi\u015f olsa da \u00e7al\u0131\u015fmada se\u00e7imlerin tamamen rasgele yap\u0131ld\u0131\u011f\u0131 belirtilmi\u015f.<\/p>\n \u00a0<\/strong><\/p>\n TATDUS yazar\u0131n\u0131n \u00e7al\u0131\u015fma i\u00e7in yorumlar\u0131;<\/strong><\/p>\n \u015e\u00fcpheli vakaya ilk yakla\u015f\u0131mda bu standart olarak AUS uygulanmas\u0131 klinisyene daha h\u0131zl\u0131 ve pratik bir yol sa\u011flayarak tan\u0131da yard\u0131mc\u0131 olabilir. \u0130lk ba\u015fvuru s\u0131ras\u0131ndaki \u015fikayetler, semptomlar d\u00fc\u015f\u00fcn\u00fclerek yap\u0131lan hedefe y\u00f6nelik AUS\u2019un ana avantajlar\u0131 yatak ba\u015f\u0131 kullan\u0131m ile h\u0131zl\u0131 ve g\u00fcvenilir \u015fekilde erken tan\u0131 sa\u011flamas\u0131 ve izole hastane alanlar\u0131n\u0131n kullan\u0131m\u0131n\u0131 ile \u00e7al\u0131\u015fan maruziyetinin azalt\u0131lmas\u0131 olarak s\u0131ralanabilir. Ancak BT\u2019nin COV\u0130D-19 pn\u00f6monisi i\u00e7in AUS\u2019tan daha duyarl\u0131 oldu\u011funu d\u00fc\u015f\u00fcn\u00fcld\u00fc\u011f\u00fcnde \u00e7al\u0131\u015fmadaki en b\u00fcy\u00fck k\u0131s\u0131tl\u0131l\u0131k kar\u015f\u0131la\u015ft\u0131rma yap\u0131lmam\u0131\u015f olmas\u0131d\u0131r. AUS uygulay\u0131c\u0131lar\u0131 her ne kadar RT-PCR test sonu\u00e7lar\u0131na k\u00f6r olsa da yazar\u0131n da belirtti\u011fi gibi klinik ve semptomlar\u0131n bilinmesi yanl\u0131l\u0131k yarat\u0131r. COVID-19\u2019a klinik \u00f6zelliklerin entegre edildi\u011fi AUS modellerinin skorlama sistemleri ile kullan\u0131m\u0131n\u0131n tan\u0131 s\u00fcrecine katk\u0131y\u0131 daha iyi ortaya \u00e7\u0131karabilece\u011fi d\u00fc\u015f\u00fcncesindeyim. \u00c7al\u0131\u015fma ilk pandemi dalgas\u0131yla hastal\u0131\u011f\u0131n s\u0131k g\u00f6r\u00fcld\u00fc\u011f\u00fc d\u00f6nemde yap\u0131lm\u0131\u015f, hastal\u0131\u011f\u0131n daha d\u00fc\u015f\u00fck prevalansta oldu\u011fu d\u00f6nemde yeni \u00e7al\u0131\u015fmalarla tekrar g\u00f6zden ge\u00e7irilebilir ve biz AUS uygulay\u0131c\u0131lar\u0131 i\u00e7in k\u0131s\u0131tlamalar\u0131 ortadan kald\u0131racak \u00e7al\u0131\u015fma alanlar\u0131 a\u00e7abilir.<\/p>\n \u00a0<\/em><\/strong><\/p>\n \u00a0<\/em><\/strong><\/p>\n <\/p>\n","protected":false},"excerpt":{"rendered":" COVID-19 pandemisi ba\u015flang\u0131c\u0131ndan bu yana akci\u011fer ultrasonunun (AUS), hasta triyaj\u0131nda, kritik hasta ve tan\u0131s\u0131 net konulamayan hasta y\u00f6netiminde kullan\u0131m\u0131yla ilgili \u00e7al\u0131\u015fmalar geni\u015f…<\/p>\n","protected":false},"author":1480,"featured_media":4211,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[3,19,12,10014],"tags":[],"class_list":["post-4208","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-egitim","category-literatur-ozetleri-surekli-yayinlar","category-surekli-yayinlar","category-akademik-blog-yazisi"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts\/4208","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/users\/1480"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/comments?post=4208"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts\/4208\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/media\/4211"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/media?parent=4208"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/categories?post=4208"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/tags?post=4208"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}\n
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