Rates of emergency room visits and hospitalizations among refugee and resident children in a tertiary hospital in Turkey.

Evaluation of emergency department (ED) presentation by Syrian refugee children might provide important information about their health care needs. For this purpose, we compared ED presentation of refugee and resident children in a tertiary university hospital in Istanbul, Turkey.Electronic medical records of Syrian refugee children ≤ 18 years old presenting to the ED between January 2013 and July 2019 were retrospectively reviewed and compared with resident children.The study population consisted of 7299 refugees and 690,127 resident children admitted to the ED. High-acuity cases were more frequent in Syrian refugees (2.2% vs 1% p < 0.001). One-third of Syrian children were under 12 months of age (31% vs 17%, p < 0.001). Syrian children were more commonly hospitalized (7.9% vs 3.1% p < 0.001). The median age (and interquartile range - IQR) was lower in hospitalized refugee than in resident children [12 (0-83) months vs 41 (8-111) months, p < 0.001]. Rate of intensive care unit hospitalization (13% vs 9.4%, p = 0.001) and neonatal hospitalization was higher in Syrians compared to resident children (29% vs 12%, p < 0.001). The median NICU stay was longer in refugees [6 (IQR 4-17) days vs 3 (IQR 1-9) days, p < 0.001]. CONCLUSION: Refugee children, as compared to resident children, are more likely to present to the ED with high acuity conditions and at a younger age resulting in higher rates of inpatient admissions. Strategies to increase access to preventive health care services for young refugee children should be explored to decrease ED and hospital services and improve health outcomes. WHAT IS KNOWN: • Children are the most affected victims of armed conflicts in terms of health outcomes. • Refugees prefer to access healthcare through the emergency department. WHAT IS NEW: • Refugee children were more likely to present as urgent when compared to resident children. • Admission to neonatal and intensive care units was more frequent among refugee than resident children.

Evaluation of the Relationship Between Environmental Factors, Nutrition, and Metabolic Changes in Children Diagnosed With Autism in North Cyprus: A Case-Control Study.

Introduction Autism spectrum disorder (ASD) is a set of neurodevelopmental disorders characterized by deficits in social behaviors and nonverbal interactions. The disorder is believed to be multifactorial regarding etiopathology. This study aimed to investigate the possible risk factors associated with the development of autism in the prenatal and postnatal periods. Methods We conducted an unmatched case-control study composed of 56 autistic cases and 85 control children in North Cyprus. Cases recruited were previously diagnosed by a pediatric psychiatrist as being on the autistic spectrum. Parental questionnaires were distributed, and the collected data were analysed using Statistical Package for the Social Sciences (SPSS) version 24 (IBM Corp, Armonk, NY). Binary logistic regression was used to compute the adjusted odds ratios (aOR), adjusted for possible confounders. Results Our results showed increased odds of developing ASD in mothers with mental disorders such as depression and anxiety (aOR 6.99; 95% CI 1.94 - 25.24), mothers with medical conditions such as Hashimoto's thyroiditis (aOR 2.68; 95% CI 1.06 - 6.78), mothers using aluminum-containing anti-acids (aOR 2.34; 95% CI 1.012 - 5.39), mothers exposed to loud noises during pregnancy (aOR 2.66; 95% CI 1.005 - 7.034), mothers with ≥ two previous miscarriages (aOR 4.19; 95% CI 1.17 -14.97), neonates with birth weight <2500 grams (aOR 4.19; 95% CI 1.16 - 14.84), male gender neonates (aOR 3.26; 95% CI 1.31 - 8.90), and neonates exposed to MRI or CT scan during the first year of life (aOR 6.94; 95% CI 1.15 - 42.07). Decreased odds of ASD development were observed in mothers using multivitamins during pregnancy (aOR 0.35; 95% CI 0.13 - 0.97), mothers consuming slight amounts of baking powder during pregnancy (aOR 0.235; 95% CI 0.09 - 0.60), mothers with threatened abortion (aOR 0.35; 95% CI 0.12 - 0.98), and neonates taking iron supplementation during the first six months of life (aOR 0.38; 95% 0.16 - 0.91). Conclusion There were various maternal and neonatal factors associated with ASD development in North Cyprus. Although there is some evidence to suggest that exposure to specific factors during prenatal or postnatal periods may increase the risk of ASD, there is insufficient evidence that implicates a specific factor for autism etiology. Future studies are recommended to be performed on larger scales to support further the factors associated with ASD development.

The differences in perinatal outcomes between refugee and resident mother-infant dyads: A retrospective study in Turkey between 2013 and 2018.

In this study, we aimed to examine and compare the perinatal outcomes between refugee and resident mother-infant dyads. Data of refugee women who had given birth in a university hospital (n = 924) and matched resident mother-infant dyads (n = 957) were included. Analysis revealed higher adolescent pregnancy rates and lower rates of antenatal care attendance among refugee mothers compared to residents. No significant differences in neonatal outcomes were found, except for a significantly higher number of preterm births among refugee infants. Interventions should be made to ensure antenatal care for all pregnant women, which can also prevent preterm birth.

Clinical utility of noninvasive scores in assessing advanced hepatic fibrosis in patients with type 2 diabetes mellitus: a study in biopsy-proven non-alcoholic fatty liver disease.

BACKGROUND/AIM: Simple noninvasive fibrosis scores based on routine blood tests have been increasingly investigated as screening tools in different clinical settings. Here, we sought to examine whether the Fibrosis-4 Index (FIB-4) and the non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS) could perform differently in diabetic versus non-diabetic patients with biopsy-proven NAFLD. METHODS: We examined 349 patients with biopsy-proven NAFLD (166 with type 2 diabetes and 183 without). Patients with FIB-4 scores < 1.3 and > 2.67 or NFS scores < - 1.455 and > 0.676 were considered at low and high risk of advanced fibrosis, respectively. RESULTS: A FIB-4 cutoff value of 1.3-which denotes a low risk of advanced fibrosis-had a specificity of 67% in patients with diabetes and 69% in those without. Conversely, a FIB-4 cutoff value of 2.67-which denotes a high risk of advanced fibrosis-had a sensitivity of 22% in patients with diabetes and 0% in those without. NFS performed similar to FIB-4. CONCLUSION: Both FIB-4 and NFS scores have an acceptable clinical utility in the exclusion of advanced fibrosis in patients with NAFLD, regardless of the presence of type 2 diabetes. However, their usefulness in identifying advanced fibrosis is limited-especially in the absence of diabetes.

Growing burden of nonalcoholic fatty liver disease in Turkey: A single-center experience.

BACKGROUND/AIMS: Nonalcoholic fatty liver disease (NAFLD), which consists of nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH), is a growing epidemic in Turkey, considering the recent alarming prevalence of 48.3%. Patients with NASH and/or liver fibrosis are more likely to progress to advanced liver disease. In this single-center study, we sought to describe the clinical and histological characteristics of a sample of Turkish patients with biopsy-proven NAFLD, who were enrolled over a 4-year period. MATERIALS AND METHODS: This is a retrospective analysis of prospectively collected data from a total of 468 patients (224 males, 244 females; median age, 47 [18-71]. The study cohort consisted of patients with biopsy-proven NAFLD who were followed up at our outpatient clinic from 2009 to 2010 and from 2017 to 2018. Histological classification of the biopsies was performed according to the Steatosis, Activity and Fibrosis (SAF) scoring allowing the use of Fatty Liver Inhibition of Progression (FLIP) algorithm and the NAFLD Activity Score (NAS) scoring system. RESULTS: Based on the SAF scoring, most patients (90.4%) had biopsy-proven NASH, whereas the NAFL was much rarer (9.6%). The prevalence of significant fibrosis (≥F2), advanced fibrosis (≥F3), and cirrhosis (F=4) was 35.0%, 17.5%, and 3.8%, respectively. The percentage of lean, overweight, and obese patients with NAFLD was 6.4%, 32.6%, and 61%, respectively. Metabolic syndrome was prevalent in 63% of the patients and Type 2 diabetes mellitus in 33.5%. CONCLUSION: The growing burden of NAFLD as a public health problem in Turkey is underscored by its marked histological severity in terms of NASH and fibrosis. Well-conducted clinical trials will be essential for slowing down the NASH progression.