Risk factors for mortality and morbidity in Syrian refugee children with penetrating abdominal firearm injuries: an 1-year experience.

BACKGROUND: Despite improvements in technology and surgical techniques, abdominal injuries caused by firearms in children are traumatic with high complication rates and mortality. In this study, factors affecting mortality and complications in penetrating abdominal firearm injuries caused by high-velocity bullets and shrapnel in children as a result of the civil war in Syria were evaluated. METHODS: This study was conducted as a case series with 53 patients admitted to Kilis State Hospital with penetrating abdominal firearm injuries between January 2016 and February 2017. Patients aged between 6 months and 17 years who suffered penetrating abdominal firearm injuries (PAFI) as a result of the civil war in Syria in the state hospital in Kilis Türkiye border province with Syria and were transferred to our hospital and operated on were included in the evaluation. Patients' sociodemographic information, time to surgery, number of abdominal organs injured, type of firearm causing injury, presence of large vessel injury and extremity injury, presence of thoracic injury requiring thoracotomy in addition to laparotomy, colostomy, penetrating abdominal trauma index, pediatric trauma score (PTS), and shock status were evaluated. RESULTS: In our study, it was found that a high penetrating abdominal trauma index significantly increased complication rates and mortality (P<0.001 and P=0.002, respectively). In addition, it was found that lower PTSs significantly increased the development of complications and mortality (P=0.001 and P<0.001, respectively). Mortality was not observed in any of the patients with a PTS>8, whereas mortality was observed in 27.3% of patients with a PTS≤8, and this result was statistically significant (P=0.003). Shock sig-nificantly increased mortality, and no patient who was not in shock died (P<0.001). In our study, it was determined that the increase in the number of injured intra-abdominal organs had a significant effect on both complications and mortality (P<0.001 and P=0.002, respectively). CONCLUSION: The penetrating abdominal trauma index and PTS were found to be effective in predicting mortality and morbidity in pediatric patients with PAFI. It is crucial in this patient group to provide appropriate transport after the first intervention is done rapidly and effectively in conflict zones.

Comparison of Appendicitis Scoring Systems in Childhood Appendicitis.

OBJECTIVE: Appendicitis scoring systems have been developed as a diagnostic tool to improve the decision-making process in patients with suspected appendicitis.The aim of the study was to compare the results of the Alvarado, The Pediatric Appendicitis Score, modified Pediatric Appendicitis Score, Lintula, and Tzanakis scoring systems in childhood appendicitis. We also aimed to see whether our rates of correct diagnosis and negative appendectomy could change, if we had made decisions using the scoring systems. MATERIALS AND METHODS: The patients who underwent appendectomy because of suspected appendicitis between June 2019 and June 2020 were evaluated prospectively. The patients were divided into appendicitis and non-appendicitis groups according to histopathological findings. The obtained data were used to calculate the scores for the scoring systems and statistical analyses. RESULTS: In the study, 141 patients were included. The negative appendectomy rate was 14.8%. The lowest negative appendectomy rate (6.38%) was obtained with the Lintula scoring system. Tzanakis scoring system had the highest accuracy rate (85.1%) compared to the other scoring systems. CONCLUSION: The present scoring systems may assist in establishing the diagnosis of appendicitis and reducing negative appendectomy rates. The Lintula scoring system has the lowest negative appendectomy rate due to its higher specificity compared to Alvarado, Pediatric Appendicitis Score, modified Pediatric Appendicitis Score, and Tzanakis scoring systems. Tzanakis scoring system has the highest accuracy rate in the diagnosis of appendicitis, and thus we believe that it may be used as an alternative scoring system for children.

Rare case cystic scrotal lymphangioma presented as a hydrocele.

INTRODUCTION AND IMPORTANCE: Cystic scrotal lymphangiomas are very uncommon lesions caused by congenital lymphatic malformation. These tumors are usually located in the neck and axilla, occasionally in the mediastinum, retroperitoneum, and thigh. The scrotum and perineum are the least frequented sites. They present as painless scrotal swelling and are easily misdiagnosed as hydrocele. We present here a case of cystic scrotal lymphangioma in a school-aged child who presented to us with a massive scrotal swelling. CASE PRESENTATION: We present here a case of a 6-year-old child who presented with scrotal swelling, which was sonographically identified as chronic hydrocele. The right testis could be felt separately from the mass, and the left scrotum was normal. Scrotal ultrasound reveals multiple cystic lesions with septa in the right hemiscrotum extending to the proximal inguinal canal. Median raphe incision and excision of the lobulated mass Cyst testicular lymphangioma was confirmed histopathologically. CLINICAL DISCUSSION: Cystic lymphangiomas are benign congenital tumors with no identifiable cause. The majority of lymphangiomas (90%) appear during the first two years of life, and half of them are present at birth. Lymphangiomas are categorized into three types: capillary, cavernous lymphangiomas, and cystic hygromas. A scrotal lymphangioma is frequently misdiagnosed as a hydrocele, inguinal hernia, hematocele, varicocele, or even testis torsion. In our case, the diagnosis was made by ultrasonography with Doppler and confirmed by a biopsy of an excised mass lesion. The scrotum is a very uncommon site for cystic lymphangioma. CONCLUSION: A cystic or septate cystic mass discovered intra-operatively should not be dismissed as a complex hydrocele, since cystic lymphangiomas predictably recur if incompletely resected. A proper diagnosis of the scrotal lymphangioma and its extent using the US is essential for planning an appropriate surgical approach.

Not just about machines: Analysis of MRI quality determinants in the Turkish health system context.

This study aims to investigate the determinants of the quality MRI in the Turkish healthcare system. The analysis is done by analysing the referred cases to a major university radiology department in Turkey, and matching the hospital and MRI use characteristics of the source institutions, where the original MRI was taken. Quality of MRI was measured by specialist radiologists. The resulting quality was analysed by gender and imaging area characteristics, source institutional quality, MRI use statistics in source institution and MRI machine use inclination of the source institution. Chi-square and logistic regression were conducted, with regional fixed effects. In the largest dataset, the highest quality institutions have significantly higher average expected MRI quality compared to one level beneath them (0.74 vs. 0.63) (P = 0.02), there is also a significant MRI quality difference between the second highest level of institution, and the third and the fourth (0.63-0.54). Smaller (<0.1) but significant quality difference (P = 0.05) exists for institutions with the lowest two quality levels. In the smaller dataset, with data only from the lowest two institutional quality groups, with a finer institutional quality grading, differences in institutional quality is again found to be a significant driver of MRI quality (P = 0.035).

The prevalence and determinants of unmet health care needs in Turkey.

This study aims to examine the prevalence and determinants of unmet health care needs in Turkey. The nationally representative "Health Survey" data for the latest available year, 2016, is used in the analysis. The reasons for unmet health care needs are divided into three categories which are waiting time, affordability (cost), and the distance to health facilities. The probit methodology is employed to investigate the factors affecting unmet health care needs. Approximately 25% of participants (4392 of 17242) reported an unmet need for health care. Overall, females, individuals in lower income groups, those with chronic illness, those with lower education levels and those in younger age groups are more likely to report unmet health care needs. Estimation results point out that age and having a chronic illness have more influence on the reporting of unmet health care needs as compared to other variables included in the model. Therefore, it seems necessary to reorganize the health care system in Turkey to target the needs of individuals with chronic diseases.

Equity in utilization of health care services in Turkey: an index based analysis.

BACKGROUND: Equity in the use of health care services is an issue which has increasingly been on the health policy agenda over recent years in both middle- and low-income countries. AIMS: The purpose of this study was to investigate the degree and progress of equity in health care utilization in Turkey during 2008-2012. METHODS: Wed use data from health surveys (2008, 2010, 2012) conducted by the Turkish Statistical Institute. The concentration index (CI) and the horizontal equity index (HI) were calculated as a measure of equity, and a Blinder-Oaxaca decomposition analysis was applied. RESULTS: The general practitioner (GP), specialist and inpatient visits display a pro-poor orientation. Averages of the CI and HI indices for 2008-2012 were 0.74 and -0.17 for GP visits, 0.75 and -0.13 for specialist visits, 0.83 and -0.31 for inpatient visits. CONCLUSION: Our findings indicate that health care utilization in Turkey appears to have become equitable over the years; however, the sustainability of equity is an issue of concern.

Assessing Horizontal Equity in the Utilization of Mental Healthcare Services in Turkey: A Gender Perspective.

BACKGROUND: Equity in healthcare services utilization is on the agenda for both research and policy makers, especially after the Millennium Development Goals. Despite the recognition of the importance of mental health services utilization, equity in terms of access has not been widely researched. OBJECTIVE: This study aims to investigate the degree and progress of equity in mental healthcare services utilization in Turkey from a gender perspective. METHODS: The Horizontal Inequity (HI) index is calculated using a nationally representative dataset from the Health Surveys (2014 and 2016) conducted by the Turkish Statistical Institute. The index is calculated for males, females, and all individuals separately to identify gender differences. RESULTS: The results from the HI index indicate pro-poor inequities in the utilization of mental healthcare services in Turkey for both 2014 and 2016. For all individuals, the standardized HI indices were found to be - 0.3320 and - 0.3374 for 2014 and 2016, respectively. In 2014, the standardized HI indices were calculated to be - 0.3504 and - 0.3173 for males and females, respectively. In 2016, the HI indices were found to be - 0.3241 and - 0.3541 for females and males, respectively. CONCLUSIONS: There is a great need for gender-focused policies to improve horizontal equity in mental healthcare services utilization.

Reverse Tubularized Pelvis Flap Method for the Treatment of Long Segment Ureteropelvic Junction Obstruction.

OBJECTIVE: The most common cause of urinary obstruction is ureteropelvic junction (UPJ) obstruction. In short stenosis, a dismembered pyeloplasty is performed, but for long segment stenosis, the procedure is not well defined. We present the reverse flap ureteroplasty method, which we prepared from the pelvis for use in long segment UPJ obstruction. METHODS: Between 2007 and 2016, we operated on 6 cases (4 males, 2 females) with an age range of 2-6 months. After reaching the UPJ region, depending on the length of the long segment obstruction, a flap measuring 25-35 mm in length was prepared from the pelvis so that its width would be 10-12 mm on the pelvis side and 10 mm in the distal portion. It was then reversed and tubularized with an absorbable suture over a 10-French nelaton catheter. The end of this ureter and the end of the distal ureter were spatulated and anastomosed. A double J and minivac drain were used in each case. RESULTS: There were no complications in the postoperative period of all our patients. They were all discharged with good health. Follow-up with renal ultrasonography showed that the anteroposterior diameters were decreased and that parenchymal thicknesses had returned to normal. Secondary stenosis, flap necrosis, and retraction did not develop. CONCLUSION: Because the blood supply of the pelvis is increased in patients with UPJ obstruction, a reverse flap of adequate length with preserved blood supply can be achieved and tubularized. We suggest that this method will be appropriate for the treatment of long segment UPJ obstruction.

Socio-economic and behavioral determinants of prescription and non-prescription medicine use: the case of Turkey.

BACKGROUND: Demographic and socio-economic factors determine pharmaceutical health care utilization for individuals. Prescription and non-prescription medicine use are expected to have different determinants. Even though prescription and non-prescription medicine use is being well researched for developed countries, there are only a few studies for developing countries. OBJECTIVES: This paper aims to analyze the socio-economic and individual characteristics that determine the use of prescription and non-prescription medicine. We examine the issue for the specific case of Turkey since Turkey's health system has undertaken significant changes in the last two decades and especially after 2003 with the "Health Transformation Programme". METHODS: Data from the nationally representative "Health Survey" are used in the analysis. The data set covers the 2008-2016 period with two-year intervals. Pooled multivariate logistic regression is employed to identify the underlying determinants of prescription and non-prescription medicine use. RESULTS: When compared to 2008, non-prescription medicine use decreases until 2012, however, an increasing trend appears after 2012. For prescription medicine use, a decreasing trend emerges after 2012. Findings from the marginal effects indicate that for non-prescription medicine use, the highest effect stems from the health status. For prescription medicine use, the highest marginal effects arise from age, health and employment status indicating the importance of the need and predisposing factors. CONCLUSION: Decreasing non-prescription medicine use largely depends on easier access to health care service utilization. Although having a health insurance has a positive relationship with prescription medicine use, there is still a problem for individuals living a rural area and heaving a lower income level since they are more likely to use non-prescription medicine.