Predictors of missed injuries in hospitalized trauma patients in the emergency department.

AIM: To determine the extent of missed injuries in patients hospitalized with major trauma in a Turkish Level 1 emergency department. We also tried to identify the primary factors contributing to each missed injury and to determine their subsequent adverse short-term clinical outcomes. METHODS: This is a retrospective analysis of prospectively collected data on a cohort of trauma patients. Trauma patients were divided into two groups: patients with missed injury and others. Logistic regression was used to define factors affecting "missed injury". RESULTS: A total of 670 hospitalized trauma patients were included. The incidence of missed injuries in the patients and the rate of missed injury per patient were 13.3% (95% CI 6-20) and 1.64, respectively. The most frequently missed diagnosis was injuries of the musculoskeletal system (38%; 95% CI 30-46). It was "clavicle fracture and/or dislocation" (35%; 95% CI 16-53) when the rate of missed diagnosis according to the frequency of the specific injury was calculated. A multiple logistic regression analysis showed that the predictors of missed injuries were patient's age (OR 0.74, 95% CI 0.63-0.87), total number of injuries (OR 1.74, 95% CI 1.38-2.20), and ISS (OR 1.10, 95% CI 1.03-1.18). Radiological errors were prominent in almost 90% (95% CI 85-95). Missed injury caused additional hospital stay (30%; 95% CI 21-40) and additional surgery was required (15%; 95% CI 8-23). CONCLUSION: The study highlights the need for a trauma team approach and the need for support of radiological report in the ED.

Tuberculosis in Turkey: high altitude and other socio-economic risk factors.

BACKGROUND: In Turkey, there are insufficient data regarding the relation between altitude and the incidence of tuberculosis (TB). OBJECTIVES: This study aimed to investigate the effect of high altitude and socio-economic conditions on the incidence of TB in Turkey. METHODS: The mean incidence of TB in 56 Turkish cities was measured as n/100,000 population between 1999 and 2005. The mean altitude of each city was recorded in metres. RESULTS: The incidence of TB was lower in cities located at high altitude (P=0.000) and higher in cities with a high population density (P=0.000). Multivariate analysis showed that the incidence of TB in low altitude cities was 3.28-fold higher than in high altitude cities (P=0.000). In cities with a population density >80 people/km(2), the incidence of TB was 4.18-fold higher than in cities with a lower population density (P=0.000) Other factors found to affect the incidence of TB were having a social insurance card and a low annual income. CONCLUSIONS: There was a strong negative correlation between altitude and the incidence of TB, and population density was significantly associated with the incidence of TB. Possession of a social insurance card and fertility rate were also risk factors for TB. The authors believe that altitude has a stronger influence on the incidence of TB than the other factors. The effect of altitude on TB may reveal new data, but further studies need to be undertaken to assess the effects of potential factors on the incidence of TB.

Thalassaemia screening in a non-prevalent region of a prevalent country (Turkey): is it necessary?

OBJECTIVES: Haemoglobinopathies are the most widespread inherited disorders in the world, and are also common in Turkey. Haemoglobinopathies are preventable with control programmes. Therefore, the Ministry of Health initiated a control and prevention programme in 33 provinces in Turkey. The aim of this study was to determine the frequency of haemoglobinopathies in Erzurum as part of the programme mentioned above, and to discuss the need for premarital screening in a non-prevalent region (Erzurum) of a prevalent country (Turkey) as part of a national control programme. STUDY DESIGN: Epidemiological and descriptive survey. METHODS: This study was conducted between May 2005 and February 2006 in Erzurum. Subjects were couples who attended for premarital screening. All blood samples were measured by high-performance liquid chromatography (HPLC) to determine haemoglobinopathies. RESULTS: In total, 1610 individuals were screened. The frequency of beta-thalassaemia trait was 0.68%. Haemoglobin D was the most common (0.12%) abnormal haemoglobin. Haemoglobins S, C and E were not detected. The frequency of beta-thalassaemia trait and other haemoglobinopathies in Erzurum was quite low compared with other provinces in Turkey. CONCLUSIONS: Premarital haemoglobinopathy screening should not be mandatory in a non-prevalent region of a prevalent country as part of a national control programme. If screening is mandatory, it should be performed by total blood count or enzyme-linked immunosorbent assay, which are simple, rapid and less expensive than HPLC.

Risk factors for typhoid fever among adult patients in Diyarbakir, Turkey.

We conducted a case-control study to assess risk factors for typhoid fever in Diyarbakir, Turkey, a region where transmission of Salmonella typhi is endemic. We prospectively identified febrile patients from Diyarbakir and the surrounding area who were admitted to hospital. Cases were defined as patients who had S. typhi isolated from at least one blood culture. Sixty-four cases with blood culture-confirmed S. typhi were identified between May 2001 and May 2003. In total, 128 age- and sex-matched controls selected from neighbourhoods as cases were enrolled. We hypothesized that consumption of raw vegetables contaminated with sewage would be associated with an increased risk of typhoid fever. Conditional logistic regression modelling revealed that living in a crowded household (OR 3.31, 95% CI 1.58-6.92, P=0.002), eating cig kofte (a traditional raw food) (OR 5.29, 95% CI 2.20-12.69, P=0.000) and lettuce salad (OR 3.55, 95% CI 1.52-8.28, P=0.003) in the 15 days prior to symptoms onset was independently associated with typhoid fever. We conclude that living in a crowded household and consumption of raw vegetables outside the home increase the risk of typhoid fever in this region.

Vaccination coverage in the South-East Anatolian Project (SEAP) region and factors influencing low coverage.

OBJECTIVES: To determine the vaccination coverage of children living in the South-east Anatolian Project (SEAP) region; whether the vaccination coverage was similar to formal reports, other studies and other countries; and which factors influence vaccination, in order to indicate how vaccination coverage can be improved. STUDY DESIGN: A descriptive cross-sectional study conducted in nine provinces of the SEAP region in order to determine public health problems and their causes. METHODS: A population-based sample of 1150 houses was selected from rural and urban areas of the SEAP region and visited by the researchers. Questionnaires were applied in 2001 and 2002. RESULTS: In the SEAP region, only 30% of children had received a complete set of vaccines. The vaccination coverage was 76.7% for Bacille Calmette-Guérin; 62.0% for the third doses of diphtheria, tetanus toxoid, pertussis and polio vaccine; 62.7% for measles; 44% for the third dose of hepatitis B vaccine in children aged 12-23 months; and 13.3% for the second dose of tetanus toxoid in women who gave birth in the last 5 years. In logistic regression analysis, residence type, number of siblings, birth interval, follow-up visits of midwives, and maternal level of education were found to influence whether children were completely vaccinated. CONCLUSIONS: The findings of this study indicate that vaccination coverage is not acceptable in the SEAP region. Efforts must focus on family planning services, education of women, follow-up visits and strengthening health facilities, especially in rural regions, to improve vaccination.

Penetrating eye injuries from southeastern Anatolia region of Turkey.

OBJECTIVES: This study analysed 420 patients with penetrating eye injuries who presented for treatment at the Eye Clinic of Dicle University Hospital in Turkey. The aim of the study was to identify preventable risk factors. METHODS: A retrospective evaluation of patients who presented between January 1995 and December 2000 was undertaken. Cases were examined with regard to age, sex, profession, which eye was traumatized, reason for the trauma, nature of the trauma, time between injury and operation, and accompanying pathologies. RESULTS: This study found that most penetrating eye injuries occurred in children aged 0-15 years, and these were mainly caused by accidents during play. For patients aged 16-60 years, penetrating eye injuries were mainly caused by work-related accidents. CONCLUSION: Most penetrating eye injuries were caused by preventable accidents. Many accidents and their resulting injuries could have been prevented by education, greater intensive care and workplace safety.

Family planning in the Southeast Anatolian Project Region.

OBJECTIVES: The aim of this study was to evaluate contraceptive use by women of reproductive age in the Southeast Anatolian Project Region and the promotion of the use of family planning services. METHODS: An optimum sample size to represent the rural and urban area of the region was determined and the sample was chosen by sampling method proportional to the size. A total of 1126 houses were visited and questions about reproductive health were asked of 1019 ever-married (currently married, widows and divorced) women. RESULTS: The study showed that 48.2% of the ever-married women of reproductive age had never used any method of family planning; 37.4% were currently using a family planning method, and 14.4% had used a family planning method in the past. Of the women who were currently using a family planning method, 73.1% were using an effective method. The result of the logistic regression analysis showed that educational level, knowledge of Turkish, type of residence, and total number of living children were the main variables that affected the use of family planning methods. CONCLUSIONS: Use of family planning methods in the region was not at the expected level. In order to decrease the barriers to family planning in developing countries, we must provide obtainable, acceptable, integrated health services.

Prevention of spinal epidural fibrosis by recombinant tissue plasminogen activator in rats.

STUDY DESIGN: A randomized-controlled experimental study was conducted to investigate the effectiveness of recombinant tissue plasminogen activator (rt-PA) on postlaminectomy epidural fibrosis in rats. SETTING: Diyarbakir, Turkey. METHODS: In a rat model, allowing objective histopathological quantification, the postoperative epidural scar formation was investigated and the potential of local rt-PA in preventing the production of epidural fibrosis was assessed. Rats were randomly allocated to local rt-PA (12 rats) or control (12 rats). RESULTS: Findings suggest a beneficial effect of rt-PA in decreasing the epidural fibrosis following laminectomy when compared with control groups for all investigated parameters such as intermuscular scar (P=0.04), middle scar (P=0.001), deep scar (P=0.001) and dural adhesion (P=0.01) except new bone formation. The presence of arachnoiditis was less in treatment group (P=0.01). CONCLUSION: In rats, the topical thrombolysis with rt-PA is safe and efficacious in preventing postlaminectomy epidural fibrosis. This Thrombolytic therapy with rt-PA after spine surgery may come to play an important role in the prevention of epidural fibrosis and arachnoiditis.