Prevalence and incidence of multiple sclerosis in Turkey: A nationwide epidemiologic study.

BACKGROUND: Many studies on multiple sclerosis (MS) reveal different prevalence and epidemiologic results. OBJECTIVES: In this study, we aimed to determine the epidemiologic profile of MS using official health records in Turkey. METHODS: Patients diagnosed with MS from the official health data of the Ministry of Health, representing the entire population of Turkey, were included in the study. Prevalence and incidence calculations were performed using the data on gender, age, year of birth, city of residence, and year of diagnosis. RESULTS: As a result of the study, the number of patients with the ICD code G35 was determined as 201,061 and the number of patients with this code entered at least three times was determined as 82,225. The prevalence of MS in Turkey was calculated as 96.4 per 100,000 and the female/male ratio as 2.1/1. The incidence of MS in 2022 was 6.2 per 100,000 and the mean patient age was 43.1 ± 13.3 years (female: 43.0 ± 13.1 vs male: 43.2 ± 13.7) while the mean age at first diagnosis was 34.0 ± 13.0 (female: 33.6 ± 12.6 vs male: 34.9 ± 13.7). CONCLUSION: The research was conducted via Official Database of Turkey, which includes population of 85 million and provides valuable insights into the prevalence and incidence rates of this chronic disease.

Elevating healthcare through artificial intelligence: analyzing the abdominal emergencies data set (TR_ABDOMEN_RAD_EMERGENCY) at TEKNOFEST-2022.

OBJECTIVES: The artificial intelligence competition in healthcare at TEKNOFEST-2022 provided a platform to address the complex multi-class classification challenge of abdominal emergencies using computer vision techniques. This manuscript aimed to comprehensively present the methodologies for data preparation, annotation procedures, and rigorous evaluation metrics. Moreover, it was conducted to introduce a meticulously curated abdominal emergencies data set to the researchers. METHODS: The data set underwent a comprehensive central screening procedure employing diverse algorithms extracted from the e-Nabiz (Pulse) and National Teleradiology System of the Republic of Türkiye, Ministry of Health. Full anonymization of the data set was conducted. Subsequently, the data set was annotated by a group of ten experienced radiologists. The evaluation process was executed by calculating F1 scores, which were derived from the intersection over union values between the predicted bounding boxes and the corresponding ground truth (GT) bounding boxes. The establishment of baseline performance metrics involved computing the average of the highest five F1 scores. RESULTS: Observations indicated a progressive decline in F1 scores as the threshold value increased. Furthermore, it could be deduced that class 6 (abdominal aortic aneurysm/dissection) was relatively straightforward to detect compared to other classes, with class 5 (acute diverticulitis) presenting the most formidable challenge. It is noteworthy, however, that if all achieved outcomes for all classes were considered with a threshold of 0.5, the data set's complexity and associated challenges became pronounced. CONCLUSION: This data set's significance lies in its pioneering provision of labels and GT-boxes for six classes, fostering opportunities for researchers. CLINICAL RELEVANCE STATEMENT: The prompt identification and timely intervention in cases of emergent medical conditions hold paramount significance. The handling of patients' care can be augmented, while the potential for errors is minimized, particularly amidst high caseload scenarios, through the application of AI. KEY POINTS: • The data set used in artificial intelligence competition in healthcare (TEKNOFEST-2022) provides a 6-class data set of abdominal CT images consisting of a great variety of abdominal emergencies. • This data set is compiled from the National Teleradiology System data repository of emergency radiology departments of 459 hospitals. • Radiological data on abdominal emergencies is scarce in literature and this annotated competition data set can be a valuable resource for further studies and new AI models.

Characteristics of diabetes mellitus patients in Turkey: An analysis of national electronic health records.

BACKGROUND: It was estimated that there were 537 million people with diabetes mellitus in 2021, representing 10.5% of the global adult population. Diabetes prevalence in Turkey is 13.5%, according to a meta-analysis and 17.3% according to a recent study. Although the primary purpose of Electronic Health Records (EHRs) is clinical, researchers can use them to conduct epidemiologic investigations. This study aims to document the prevalence of diabetes and to evaluate the healthcare utilization of people with diabetes compared to the people without diabetes, based on national EHR. METHODS: Only people over 14 years old were included in the analysis. Our criteria for being diabetic were 1) having an HbA1c over 6.5% (48 mmol/mol), 2) having a prescription with DM diagnosis, ICD-10 codes E10-E14, or 3) having at least two fasting blood glucose measurements over 126 mg/dl. RESULTS: At the end of 2020, there were 7,178,674 individuals with diabetes, with 11.12% prevalence, 13.10% in women while 9.12% in men. Age-adjusted healthcare facility admission per capita was 15.5 for people with diabetes, 9.5 for people without diabetes, while the number of prescriptions was 7.9 for people with diabetes while 4.5 for people without diabetes in 2019. The mean number of prescriptions containing antidiabetics was 2.88 per person with diabetes in 2019. DISCUSSION: Approximately 11% of Turkish people have diagnosed with diabetes. We estimate that about one-third of people with diabetes are undiagnosed and the majority of these people are men. The results show that such large databases have the capability of supplying a vast amount of information to the scientific community.

The outcome of COVID-19 in patients with hematological malignancy.

In this study, we aim to report the outcomes for COVID-19 in patients with hematological malignancy in Turkey. Data from laboratory-confirmed 188 897 COVID-19 patients diagnosed between 11 March 2020 and 22 June 2020 included in the Republic of Turkey, Ministry of Health database were analyzed retrospectively. All COVID-19 patients with hematological malignancy (n = 740) were included in the study and an age, sex, and comorbidity-matched cohort of COVID-19 patients without cancer (n = 740) at a 1:1 ratio was used for comparison. Non-Hodgkin lymphoma (30.1%), myelodysplastic syndrome (19.7%), myeloproliferative neoplasm (15.7%) were the most common hematological malignancies. The rates of severe and critical disease were significantly higher in patients with hematological malignancy compared with patients without cancer (P = .001). The rates of hospital and intensive care unit (ICU) admission were higher in patients with hematological malignancy compared with the patients without cancer (P = .023, P = .001, respectively). The length of hospital stay and ICU stay was similar between groups (P = .7, P = .3, retrospectively). The rate of mechanical ventilation (MV) support was higher in patients with hematological malignancy compared with the control group (P = .001). The case fatality rate was 13.8% in patients with hematological malignancy, and it was 6.8% in the control group (P = .001). This study reveals that there is an increased risk of COVID-19-related serious events (ICU admission, MV support, or death) in patients with hematological malignancy compared with COVID-19 patients without cancer and confirms the high vulnerability of patients with hematological malignancy in the current pandemic.

Perioperative SARS-CoV-2 infection among women undergoing major gynecologic cancer surgery in the COVID-19 era: A nationwide, cohort study from Turkey.

OBJECTIVE: The objective of this study was to determine the rate of perioperative SARS-CoV-2 infection among gynecologic cancer patients undergoing major surgery. METHODS: The database of the Turkish Ministry of Health was searched in order to identify all consecutive gynecologic cancer patients undergoing major surgery between March 11, 2020 and April 30, 2020 for this retrospective, nationwide, cohort study. The inclusion criteria were strictly founded on a final histopathological diagnosis of a malignant gynecologic tumor. COVID-19 cases were diagnosed by reverse transcriptase- polymerase chain reaction testing for SARS-CoV-2. The rate of perioperative SARS-CoV-2 infection and the 30-day mortality rate of COVID-19 patients were investigated. RESULTS: During the study period, 688 women with gynecologic cancer undergoing major surgery were identified nationwide. The median age of the patients was 59 years. Most of the surgeries were open (634/688, 92.2%). There were 410 (59.6%) women with endometrial cancer, 195 (28.3%) with ovarian cancer, 66 (9.6%) with cervical cancer, 14 (2.0%) with vulvar cancer and 3 (0.4%) with uterine sarcoma. The rate of SARS-CoV-2 infections confirmed within 7 days before or 30 days after surgery was 46/688 (6.7%). All but one woman was diagnosed postoperatively (45/46, 97.8%). The rates of intensive care unit admission and invasive mechanical ventilation were 4/46 (8.7%) and 2/46 (4.3%), respectively. The 30-day mortality rate was 0%. CONCLUSION: In the COVID-19 era, gynecologic cancer surgery may be performed with an acceptable rate of perioperative SARS-CoV-2 infection if the staff and the patients strictly adhere to the established infection control measures.

COVID-19 clinical course and blood groups: Turkish population-based study

Background/aim: SARS-CoV-2 enters the cell through the binding of the S glycoprotein on the surface of the virus to the angiotensin- converting enzyme 2 (ACE-2) in the host cells and also SARS-CoV S protein binding to ACE-2 was inhibited by anti-A antibodies. The aim of the study was to investigate the relationship between blood groups and the course of COVID-19 in Turkey. Materials and methods: Laboratory confirmed COVID-19 patients aged 18 and over (n = 39.850) were randomized in age and sex- matched groups according to blood groups. Results: Advanced age, male sex and blood group A were found to be related with increased rate of intensive care unit (ICU) admission (OR = 1.089, 95% CI: 1.085­1.093 for age; OR = 1.963, 95% CI: 1.737­2.218 for male sex; OR = 1.216, 95% CI: 1.023­1.446 for blood group A). When blood group O individuals were compared to non-O individuals, no significant difference was observed regarding the rate of hospital and ICU admission, mechanical ventilation (MV) support, length of hospital and ICU stay, and case fatality rate (CFR). The CFR in patients with blood group A, B, O, and AB were 2.6%, 2.2%, 3.1%, and 2.3%, respectively. There were no significant differences between Rh-negative and positive patients regarding the rate of hospital and ICU admission (p = 0.280 and p = 0.741, respectively), also the rate of MV support and CFR was similar (p = 0.933 and p = 0.417). Conclusion: Our study revealed that ABO and Rh blood groups do not have any impact on the rate of hospital admission, hospital and ICU stay, MV support, and CFR.

Outcome of COVID-19 in patients with chronic myeloid leukemia receiving tyrosine kinase inhibitors.

INTRODUCTION: In this study, we aim to report the outcome of COVID-19 in chronic myeloid leukemia (CML) patients receiving tyrosine kinase inhibitor (TKI). METHOD: The data of 16 laboratory-confirmed COVID-19 patients with CML receiving TKI and age, gender, and comorbid disease matched COVID-19 patients without cancer at a 3/1 ratio (n = 48), diagnosed between March 11, 2020 and May 22, 2020 and included in the Republic of Turkey, Ministry of Health database, were analyzed retrospectively. RESULTS: The rates of intensive care unit (ICU) admission, and mechanical ventilation (MV) support were lower in CML patients compared to the control group, however, these differences did not achieve statistical significance (p = 0.1, and p = 0.2, respectively). The length of hospital stay was shorter in CML patients compared with the control group; however, it was not statistically significant (p = 0.8). The case fatality rate (CFR) in COVID-19 patients with CML was 6.3%, and it was 12.8% in the control group. Although the CFR in CML patients with COVID-19 was lower compared to the control group, this difference did not achieve statistical significance (p = 0.5). When CML patients were divided into 3 groups according to the TKI, no significant difference was observed regarding the rate of ICU admission, MV support, CFR, the length of stay in both hospital and ICU (all p > 0.05). CONCLUSION: This study highlights that large scale prospective and randomized studies should be conducted in order to investigate the role of TKIs in the treatment of COVID-19.

Adoption rates of electronic health records in Turkish Hospitals and the relation with hospital sizes.

BACKGROUND: Nation-wide adoption of electronic health records (EHRs) in hospitals has become a Turkish policy priority in recognition of their benefits in maintaining the overall quality of clinical care. The electronic medical record maturity model (EMRAM) is a widely used survey tool developed by the Healthcare Information and Management Systems Society (HIMSS) to measure the rate of adoption of EHR functions in a hospital or a secondary care setting. Turkey completed many standardizations and infrastructural improvement initiatives in the health information technology (IT) domain during the first phase of the Health Transformation Program between 2003 and 2017. Like the United States of America (USA), the Turkish Ministry of Health (MoH) applied a bottom-up approach to adopting EHRs in state hospitals. This study aims to measure adoption rates and levels of EHR use in state hospitals in Turkey and investigate any relationship between adoption and use and hospital size. METHODS: EMRAM surveys were completed by 600 (68.9%) state hospitals in Turkey between 2014 and 2017. The availability and prevalence of medical information systems and EHR functions and their use were measured. The association between hospital size and the availability/prevalence of EHR functions was also calculated. RESULTS: We found that 63.1% of all hospitals in Turkey have at least basic EHR functions, and 36% have comprehensive EHR functions, which compares favourably to the results of Korean hospitals in 2017, but unfavorably to the results of US hospitals in 2015 and 2017. Our findings suggest that smaller hospitals are better at adopting certain EHR functions than larger hospitals. CONCLUSION: Measuring the overall adoption rates of EHR functions is an emerging approach and a beneficial tool for the strategic management of countries. This study is the first one covering all state hospitals in a country using EMRAM. The bottom-up approach to adopting EHR in state hospitals that was successful in the USA has also been found to be successful in Turkey. The results are used by the Turkish MoH to disseminate the nation-wide benefits of EHR functions.

The epidemiology of osteoporosis in Türkiye: A comprehensive analysis using the e-Nabiz database.

Objectives: The study aimed to define the epidemiology of osteoporosis and low bone mass based on bone mineral density at the femoral neck and the lumbar spine in adults 50 years and older in Türkiye. Patients and methods: The retrospective study included all patients diagnosed with osteoporosis with a bone mineral density scan between January 2016 and May 2023 in the e-Nabiz database, a government-run online healthcare database including over 68 million of active users. The data was categorized according to patient demographics, presentation age (0-17, 18-64, and >65 years), geographic regions, and healthcare levels. Results: A total of 4,253,039 patients (723,863 [17.0%] males, 3,529,176 [83.0%] females) were diagnosed with osteoporosis. Of the patients, 2,432,607 (57.2%) belonged to the 18-64 years age group, 1,783,690 (41.9%) were in the >65 years group, and 36,742 (0.9%) were in the 0-17 years group. The mean age at presentation was 61.1±14.4 (range, 0 to 110) years. The Marmara region had the highest number of cases with 1,330,325 (31.3%), and the Aegean region had the lowest with 194,009 (4.6%). Istanbul had the highest rate of osteoporosis as a province (18.4%), followed by Ankara (7.5%). The lowest rates were recorded in Bayburt (0.0%) and Tunceli (0.1%), respectively. Conclusion: Registry studies provide reliable information in epidemiological studies. In this study, the first of its kind in Türkiye, we reported the geographical distribution of osteoporosis. As expected, there were more osteoporosis patients in the more densely populated areas of the country. Secondary and tertiary care centers had more entries compared to primary care centers. The annual incidence of osteoporosis showed a declining trend over the years.

Exploring Regional Disparities in Heart Failure Epidemiology and Outcomes: A Comprehensive Study Across Geographical Regions in Türkiye.

Background: Heart failure (HF) is a common condition that affects 1-3% of the general population. Its prevalence exhibits notable international and intranational disparities, partly explained by socioeconomic status, religion, ethnic diversity, and geographic factors. A comprehensive understanding of the epidemiological symptoms of HF in different regions of Türkiye has yet to be revealed. Aims: To examine epidemiological data from 2016 to 2022, focusing on crucial patient characteristics and geographical regions, to determine the incidence and prevalence of HF in Türkiye across seven diverse geographical regions. Study Design: A nationwide population-based retrospective cohort study. Methods: The comprehensive National Electronic Database of the Turkish Ministry of Health was used in this study to obtain data that covers the whole Turkish population from January 1, 2016, to December 31, 2022. The International Classification of Diseases-10 (ICD-10) codes were used to identify adults with HF (n = 2,701,099) and associated comorbidities. Türkiye is divided into seven geographically distinct regions. Epidemiological characteristics and survival data of these regions were analyzed separately. All-cause mortality was set as the primary outcome. Results: In , the total estimated prevalence of adult patients with HF is 2.939%, ranging from 2.442% in Southeastern Anatolia to 4.382% in the Black Sea Region. Except for the Eastern Anatolia Region, the three most often reported comorbidities were hypertension, dyslipidemia, and anxiety disorders. The rates of prescribing guideline-directed medical therapy (GDMT) for HF and other medications varied significantly. GDMT prescription rates were lowest in the Eastern Anatolia Region (82.6% for beta-blockers, 48.7% for RASi, 31.8% for mineralocorticoid receptor antagonists, and 9.4% for SGLT2i). The Mediterranean and Aegean regions had the highest median N-terminal brain natriuretic peptide (NT-proBNP) levels of 1,990,0 pg/ml (518.0-6,636,0) and 1,441,0 pg/ml (363.0-5,000,0), respectively. From 2016 to 2022, 915,897 (33.9%) of 2,701,099 patients died. The Eastern Anatolia Region had the lowest all-cause mortality rate of 26.5%, whereas the Black Sea Region had the highest all-cause mortality rate of 35.3%. Conclusion: Our real-world analysis revealed geographic disparities in HF characteristics, such as decreased mortality in socioeconomically challenged regions. Higher stress susceptibility in developed regions may increase the likelihood of adverse outcomes.

Deciphering mortality risk of diabetes medications in heart failure patients with diabetes mellitus under triple guideline-directed medical therapy.

BACKGROUND: Scientific evidence regarding the impact of different combinations of diabetes medications in heart failure patients with diabetes mellitus (HFwDM) remains limited. AIM: We aimed to investigate the effect of monotherapy and combination therapy for DM on all-cause mortality in HFwDM under triple guideline-directed medical therapy (GDMT). METHOD: This nationwide retrospective cohort study included adult HFwDM under triple GDMT between January 1, 2016 and December 31, 2022.We collected the data from the National Electronic Database of the Turkish Ministry of Health.We created various combination including different diabetes medications based on the current guidelines for DM.The primary endpoint was all-cause mortality. RESULTS: A total of 321,525 HFwDM under triple GDMT (female:49%, median age:68[61-75] years) were included. The highest rate of prescribed combination therapy was metformin and sulfonylureas (n = 55,266). In Cox regression analysis, insülin monotherapy had the highest risk for all-cause mortality (HR:2.25, 95CI%:2.06 - 2.45), whereas combination therapy including metformin, SGLT2i, and sulfonylureas provided the most beneficial effect on survival (HR:0.29, 95CI%:0.22-0.39) when compared to patients not receiving diabetes medication. Among patients taking diabetes medications, the inclusion of SGLT2i demonstrated a survival benefit (p < 0.05), despite concurrent use of volume-retaining medications such as insulin and thiazolidinediones. Conversely, combinations of diabetes medications without SGLT2i did not demonstrate any survival benefit compared to patients not taking diabetes medication (p > 0.05). CONCLUSION: This study underscored the use of SGLT2i as monotherapy or as a part of combination diabetes medications to improve survival among HFwDM, while also highlighting that combinations lacking SGLT2i did not confer any survival benefit.

Navigating Heart Failure: Unveiling Sex Disparities in Guideline-Directed Medical Therapy Combinations.

Major heart failure (HF) trials remain insufficient in terms of assessing the differences in clinical characteristics, biomarkers, treatment efficacy, and safety because of the under-representation of women. The study aimed to present sex-related disparities in HF management, including differences in demographics, co-morbidities, cardiac biomarkers, prescribed medications, and treatment outcomes. The study utilized anonymized data from the Turkish Ministry of Health's National Electronic Database between January 1, 2016, and December 31, 2022. The cohort analysis included 2,501,231 adult patients with HF. Specific therapeutic combinations were analyzed using a Cox regression model to obtain relative risk reduction for all-cause death. The primary end point was all-cause mortality. In the cohort, 48.7% (n = 1,218,911) were male, whereas 51.3% (n = 1,282,320) were female. Female patients exhibited a higher median age (71 vs 68 years) and manifested higher prevalence of diabetes mellitus, anemia, atrial fibrillation, anxiety, and ischemic stroke. Male patients demonstrated higher rates of previous myocardial infarction, dyslipidemia, chronic obstructive pulmonary disease, and chronic kidney disease. Higher concentrations of natriuretic peptides were observed in female patients. Renin-angiotensin aldosterone inhibitor, ß blockers, mineralocorticoid receptor antagonists, sodium/glucose cotransporter 2 inhibitor (SGLT2i), and ivabradine were more commonly prescribed in male patients, whereas loop diuretics, digoxin, and ferric carboxymaltose were more frequent in female patients. Male patients had higher rates of cardiac resynchronization therapy and implantable cardioverter defibrillator implantation rates. All-cause mortality and hospitalization rates were higher in male patients. Compared with monotherapy, all combinations, including SGLT2i, showed a beneficial effect on all-cause mortality in both female and male patients with HF. In hospitalized patients with HF, the addition of digoxin to renin-angiotensin aldosterone inhibitor, mineralocorticoid receptor antagonists, and ß blockers was superior to monotherapy regarding all-cause mortality in female patients with HF compared with male patients with HF. In conclusion, this study highlights that sex-specific responses to HF medication combinations compared with monotherapy and differences in co-morbidities underscore the importance of tailored management strategies. Digoxin showed a contrasting effect on all-cause mortality between both sexes after hospitalization, whereas SGLT2i exhibited a consistent beneficial effect in both sexes when added to all combinations.

Survival in systemic sclerosis associated pulmonary arterial hypertension in the current treatment era-results from a nationwide study.

INTRODUCTION: Pulmonary arterial hypertension (PAH) is a leading cause of mortality in systemic sclerosis (SSc). This nationwide study aims to describe real world treatment characteristics and assess survival rates of patients with SSc-PAH. METHODS: In this retrospective cohort study, patients with SSc-PAH were identified from Turkish Ministry of Health National Electronic Database (from January 2016 to September 2022), using ICD-10 codes. Data on demographics, treatment characteristics, and death was collected. Kaplan-Meier curves were used to calculate cumulative probabilities of survival at 1, 3, and 5 years. RESULTS: Five hundred forty-seven patients (90.7% female) with SSc-PAH were identified. Median age at PAH diagnosis was 59.9 (50.0-67.4) years. During a median follow-up duration of 3.2 (1.5-4.8) years, 199 (36.4%) deaths occurred. Estimated survival rates at 1, 3, and 5 years were 90.2%, 73.2%, and 56.6%, respectively. Survival was similar among patients with and without interstitial lung disease (p = 0.20). Patients who used immunosuppressives had better survival than those who did not (p < 0.001). No difference was observed in survival rates according to initial PAH-specific treatment regimen (monotherapy or combination) (p = 0.49). CONCLUSION: Compared to most of historical cohorts, higher survival rates for SSc-PAH were observed in this study. Early diagnosis of PAH may have contributed to these findings. The impact of immunosuppressive therapy on prognosis of SSc-PAH needs to be further investigated in prospective studies. Key Points • Early diagnosis is pivotal for better outcomes in SSc-PAH. • Implementation of PAH treatment guidelines in routine clinical practice is still poor and should be improved. • Effect of immunosuppressive therapies on disease course has to be defined in SSc-PAH.

Association between hyponatremia, inflammation, and mortality in patients undergoing peritoneal dialysis: A nationwide observations.

INTRODUCTION: Hyponatremia is the most common electrolyte disorder often present in peritoneal dialysis (PD) patients. The aim of this retrospective study was to investigate the effect of hyponatremia on mortality in patients undergoing PD. METHODS: The health records of adult individuals with an inserted PD catheter identified via the centralized national e-health database were used. RESULTS: The mean age of the 846 patients included in the study was 52.48 years (±14.6). The mean sodium level was 136.51 mEq/L. Sodium levels <137 mEq/L were associated with higher death risk independent of comorbidities. There was a 0.821 times less reduction in mortality for each mEq /L increase in serum sodium. CONCLUSION: Our study provides evidence that monitoring and adjusting serum sodium levels is crucial in managing PD patients with hyponatremia, as low serum sodium level was found to be a significant and independent predictor of mortality.

A Nationwide Chronic Disease Management Solution via Clinical Decision Support Services: Software Development and Real-Life Implementation Report.

BACKGROUND: The increasing population of older adults has led to a rise in the demand for health care services, with chronic diseases being a major burden. Person-centered integrated care is required to address these challenges; hence, the Turkish Ministry of Health has initiated strategies to implement an integrated health care model for chronic disease management. We aim to present the design, development, nationwide implementation, and initial performance results of the national Disease Management Platform (DMP). OBJECTIVE: This paper's objective is to present the design decisions taken and technical solutions provided to ensure successful nationwide implementation by addressing several challenges, including interoperability with existing IT systems, integration with clinical workflow, enabling transition of care, ease of use by health care professionals, scalability, high performance, and adaptability. METHODS: The DMP is implemented as an integrated care solution that heavily uses clinical decision support services to coordinate effective screening and management of chronic diseases in adherence to evidence-based clinical guidelines and, hence, to increase the quality of health care delivery. The DMP is designed and implemented to be easily integrated with the existing regional and national health IT systems via conformance to international health IT standards, such as Health Level Seven Fast Healthcare Interoperability Resources. A repeatable cocreation strategy has been used to design and develop new disease modules to ensure extensibility while ensuring ease of use and seamless integration into the regular clinical workflow during patient encounters. The DMP is horizontally scalable in case of high load to ensure high performance. RESULTS: As of September 2023, the DMP has been used by 25,568 health professionals to perform 73,715,269 encounters for 16,058,904 unique citizens. It has been used to screen and monitor chronic diseases such as obesity, cardiovascular risk, diabetes, and hypertension, resulting in the diagnosis of 3,545,573 patients with obesity, 534,423 patients with high cardiovascular risk, 490,346 patients with diabetes, and 144,768 patients with hypertension. CONCLUSIONS: It has been demonstrated that the platform can scale horizontally and efficiently provides services to thousands of family medicine practitioners without performance problems. The system seamlessly interoperates with existing health IT solutions and runs as a part of the clinical workflow of physicians at the point of care. By automatically accessing and processing patient data from various sources to provide personalized care plan guidance, it maximizes the effect of evidence-based decision support services by seamless integration with point-of-care electronic health record systems. As the system is built on international code systems and standards, adaptation and deployment to additional regional and national settings become easily possible. The nationwide DMP as an integrated care solution has been operational since January 2020, coordinating effective screening and management of chronic diseases in adherence to evidence-based clinical guidelines.

Exploring the landscape of CA-125 testing: A comprehensive analysis of Ministry of Health data.

OBJECTIVE: The aim of this study was to investigate the utilization patterns and clinical implications of cancer antigen 125 (CA-125) testing in the diagnosis of ovarian and endometrial cancers using a large-scale dataset obtained from the Ministry of Health. METHODS: A retrospective analysis was conducted on anonymized data collected between 2017 and 2021, comprising 3.917.240 individuals who underwent CA-125 testing. The data included demographic information, test results, diagnoses, and clinical characteristics. Descriptive statistics and comparative analyses were performed to assess the utilization trends and clinical outcomes associated with CA-125 testing. RESULTS: Among the study population, CA-125 testing was primarily requested for female individuals, with the highest number of tests performed in the age group of 18-64 years. The overall positive rate for CA-125 was 13.31%, with slightly lower rates observed in females (13.18%) than males (14.07%). The study identified a significant association between elevated CA-125 levels and cancer diagnoses, with 19.88% of positive CA-125 results indicating cancer, whereas 10.51% had no cancer diagnosis. Furthermore, the study revealed a higher likelihood of cancer detection among individuals aged 65 years and above, with a positive rate of 17.79%. CONCLUSION: Our findings provide valuable insights into the utilization patterns and clinical implications of CA-125 testing in ovarian and endometrial cancer diagnosis. While CA-125 remains a prominent tumor marker, its interpretation should consider age, gender, and clinical context. The study emphasizes the potential benefits of integrating additional markers and imaging modalities to enhance diagnostic accuracy. These findings contribute to optimizing the use of CA-125 testing for early detection and management of gynecological malignancies, thereby improving patient outcomes.

Hypertriglyceridemia and its impact on hematological indicators: A study based on Turkish national health database.

OBJECTIVE: The hematocrit (Hct) to hemoglobin (Hb) ratio, generally at 3.0 in healthy individuals, can vary in certain disease states. An emerging area of interest is the potential influence of triglyceride concentrations on this ratio and hemoglobin A1C (HbA1c) levels. This study aimed to identify the changes in HbA1c and the Hct/Hb ratio as triglyceride concentration increases. METHODS: This research involved an extensive analysis of 35,656,613 laboratory samples taken between January 2015 and December 2022 in Türkiye, including the respective triglyceride, Hb, Hct, and HbA1c results. The laboratory test results were obtained from the national health database of the Turkish Ministry of Health. The triglyceride levels were divided into 24 groups, each incremented by 100 mg/dL from a range of 0-3099 mg/dL. Mean and standard deviation values of Hb and Hct were calculated for each group, and the Hct/Hb ratio was graphically represented. RESULTS: The average HbA1c values ranged between 4.37±0.85 and 7.76±3.19 across the groups, Hb averages ranged from 9.75±1.7 to 14.03±2.21, Hct averages from 27.35±4.97 to 38.86±5.66, and Hct/Hb ratios varied between 2.77 and 3.03. The overall average for all samples was identified as 5.15±0.13 for HbA1c, 38.48±5.13 for Hct, 12.73±1.65 for Hb, and 3.02 for the Hct/Hb ratio. CONCLUSION: It was observed that the Hct/Hb ratio gradually decreased as triglyceride levels increased. Evaluating anemia based on Hb concentration in individuals with hypertriglyceridemia might be misleading. It is recommended to use a correction factor based on triglyceride level.

Cesarean section rates in Turkey 2018-2023: Overview of national data by using Robson ten group classification system.

Objective: Cesarean section (CS) rates continue to rise globally because of various factors. Medically unnecessary cesarean operations have no benefit to the mother or child's health. Since the World Health Organization (WHO) has determined that the acceptable CS rate should not be more than 10-15%, it also stated the use of a classification system to compare different patient groups and facilities. Turkey has the highest CS rates globally and has been rising over the years. This study aims to assess CS rates between 2018 and 2023 using National Health Data and to analyze them according to the Robson classification system and WHO reference values to discuss possible measures against increasing rates. Materials and Methods: In this study, we assessed the rates of CSs between 2018 and 2023; the CS rate including all 5-years and analysis of CS rates for each Robson group as advocated by WHO. Also, another assessment was done of the facilities where the CSs were applied (Public, private, or university hospitals). Results: The total number of births recorded between 2018 and2023 was 6.161.976. The overall CS rate was 57.55%. The number of total CS operations was 3.546.049. The primary CS rate was 28.83% (N:1.776.503). Significant differences were observed between the public and private centers for each Robson group. Conclusion: The CS rates of Groups 1-4 are obviously higher than expected. The CSs of these groups cumulatively affect the rates of other groups. Nulliparous women have CSs mostly in private hospitals. There is a need for improvements in the health system in this regard for better maternal and child health.

Cost analysis of 25-hydroxy vitamin D tests in Turkiye with big data: A cross-sectional study.

OBJECTIVE: The high prevalence of vitamin D deficiency in the population causes physicians to request more vitamin D tests and increases laboratory costs. It is aimed at investigating the demanded numbers and cost analyzes of 25-hydroxyvitamin D (25(OH)D) tests with the big data obtained from the national information health system of the Turkish Ministry of Health. METHODS: Between 2017 and 2018, all inpatient and outpatient tests and 25(OH)D tests in all medical biochemistry laboratories in Turkiye were determined based on department and institution type. The cost amount, distribution among health institutions, and test request rates were calculated. In both years, the top ten most expensive tests, according to health institutions, were evaluated. RESULTS: The total number of medical biochemistry tests performed in 2017 and 2018 was 1.424.948.155 and 1.713.134.326, respectively. The number of 25 (OH)D tests analyzed in the same years was 8.698.393 and 13.919.127, respectively. When the data of the 2 years are compared, the consumption of 25 (OH)D tests increased by 37% in General hospital laboratories, whereas it increased by 115.09% in primary health laboratories. When all health institutions were evaluated, the increase rate in 25 (OH)D test demand was 60%, while the cost increase rate was 23%. CONCLUSION: This report showed that the demands for 25(OH)D testing are increasing steeply, especially in primary health-care facilities. In this direction, laboratory information system test demand restrictions in accordance with national and international guidelines are important issues for policymakers.

The effect of vitamin D status on non-alcoholic fatty liver disease: a population-based observational study.

INTRODUCTION: The effect of vitamin D status on steatosis has not been fully elucidated. In this study, we planned to investigate this interaction using a large-scale population-based cohort. MATERIAL AND METHODS: Patients diagnosed with simple steatosis (K76.0) and non-alcoholic steatohepatitis (NASH) (K75.8) by using the International Classification of Diseases 10th Revision (ICD-10) coding system, and who had 25-hydroxyvitamin D (25OHD) measurements at the diagnosis, were included in the study. Control group comprised subjects without liver diseases. Age, gender, alanine aminotransferase (ALT) and 25OHD levels, and the date of the measurements were recorded. RESULTS: We compared ALT and 25OHD measurements between the patient and control groups, and between the simple steatosis and NASH subgroups. 25OHD levels were lower and ALT levels were higher in the patient group (p < 0.001, effect size = 0.028, and p < 0.001, effect size = 0.442, respectively). Logistic regression analysis showed that when 25OHD levels decrease by 1 ng/dL, it increases the risk of being in the patient group by 3.7%. CONCLUSION: Our results suggest that vitamin D status may be related to the development of non-alcoholic fatty liver disease (NAFLD). Although this relationship is weak, it may be important in the pathogenesis of steatosis.