BACKGROUND:Subarachnoid hemorrhage (SAH) is a severe neurological emergency with high morbidity and mortality, primarily due to vasospasm and delayed ischemia. Hesperidin (HSP), a natural flavonoid, possesses strong antioxidant and vasoprotective properties. This experimental animal study examined HSP's neuroprotective role in oxidative stress and vascular remodeling after SAH, focusing on the extracellular regulated kinase 5-Kruppel-like factor 2-endothelial nitric oxide synthase (Erk5-KLF2-eNOS) pathway. METHODS:The study was conducted from 2021 to 2022. Forty female Wistar albino rats were divided into five groups: control (G1, n=8), sham (G2, n=8), SAH + Vehicle (G3, n=8), SAH with low-dose HSP (G4, n=8), and SAH with high-dose HSP (G5, n=8). SAH was induced using a double injection of homologous blood into the cisterna magna. Biochemical markers (superoxide dismutase [SOD], catalase [CAT], glutathione peroxidase [GPx], nitric oxide [NOS]), basilar artery morphometry, and molecular expressions (Erk5, p-Erk5, KLF2, eNOS) were evaluated 48 hours post-SAH. RESULTS:SAH significantly increased oxidative stress and reduced vascular lumen diameter in untreated rats (G3). Both HSP-treated groups (G4 and G5) showed improved antioxidant enzyme levels (SOD, CAT, GPx) and near-normal NOS levels. Morphometric analysis demonstrated significant preservation of basilar artery lumen diameter in treated groups, with no significant changes in wall thickness. Molecular analysis revealed upregulation of the Erk5-KLF2-eNOS pathway, suggesting a role in vasodilation and mitigation of oxidative stress. CONCLUSION:HSP protects against SAH-induced vasospasm and oxidative damage by enhancing antioxidant capacity and modu-lating the Erk5-KLF2-eNOS pathway, suggesting its therapeutic potential.
BACKGROUND:Mediastinitis is a rare but life-threatening complication after upper gastrointestinal (GI) surgery. Although advances in perioperative care have improved outcomes, the prognostic impact of the timing of onset remains unclear. Clarifying whether early-onset versus late-onset mediastinitis influences clinical, microbiological, and surgical outcomes is essential to guide management. METHODS:We retrospectively analyzed 27 patients with mediastinitis after upper gastrointestinal surgery treated at our center between 2015 and 2025. Our institution is a tertiary-level, high-volume center performing complex upper GI procedures. During this period, 728 patients underwent upper GI surgery, among whom anastomotic leakage occurred in 44 (6.1%), and mediastinitis developed in 27 (3.7%). Patients were classified into early-onset (≤14 days) and late-onset (>14 days) mediastinitis groups based on the postoperative interval. Demographic and clinical variables, comorbidities, smoking history, malignancy status, microbiological culture results, surgical interventions, intensive care unit (ICU) admission and duration, hospital stay, duration of antibiotic treatment, complications, and mortality were recorded and compared. RESULTS:During the 10-year study period, 728 patients underwent upper gastrointestinal surgery at our institution, and mediastinitis developed in 27 patients (3.7%) following esophageal or gastric procedures. The median age was 64 years [interquartile range: 54-74.5], and 55.6% were male. Malignancy was present in 70.4%, most frequently gastric adenocarcinoma (n=6). Overall, ICU admission was 81.5%, with a median ICU stay of two days, and mortality occurred in eight patients (29.6%). Culture positivity was observed in 16 patients (59.3%), most commonly with Klebsiella pneumoniae, Proteus mirabilis, and Enterobacter spp. Compared with late-onset mediastinitis, early-onset mediastinitis was associated with significantly shorter ICU stay (median 1 vs. 6.5 days, p=0.020), hospital stay (16 vs. 41 days, p=0.003), and antibiotic duration (14 vs. 35 days, p=0.002). The early-onset group demonstrated a lower mortality rate than the late-onset group (17.6% vs. 50.0%, p=0.102). Late-onset mediastinitis correlated with higher culture positivity and a greater need for complex surgical procedures, including video-assisted thoracic surgery (VATS), thoracotomy, and endoscopic stenting. Reoperations were required in 13 patients (48.1%). When stratified into abdominal and thoracic procedures, abdominal re-operations were more frequently observed in the late-onset group (5/8, 62.5%), whereas thoracic reoperations predominated in the early-onset group (4/5, 80%). Patients without reoperation constituted 51.9% of the cohort (14/27). CONCLUSION:Early-onset mediastinitis after upper GI surgery is associated with improved outcomes. It correlates with better survival, shorter ICU and hospital stay, reduced antibiotic treatment, and a lower need for complex surgical procedures, whereas late-onset mediastinitis is linked to higher microbial burden, more frequent reoperations, and poorer outcomes.
BACKGROUND:This study aimed to investigate changes in vibration sensation in patients with anterior talofibular ligament (ATFL) rupture following acute ankle sprain and to assess its potential use as a proprioceptive assessment tool. METHODS:A 128 Hz tuning fork was applied to the ATFL region-identified as ruptured via ultrasound-while the ankle was positioned in inversion and plantar flexion. Vibration duration was measured using a stopwatch. Data were compared with those from a healthy population and from patients with lateral ankle edema following acute sprain without rupture. The study was prospectively designed. RESULTS:A total of 81 patients (48 male, 33 female) were included, with a mean age of 29.19 years. Among the 27 patients with ATFL rupture, nine had an additional calcaneofibular ligament (CFL) injury and five had an additional posterior talofibular ligament (PTFL) injury (Grade 2-3). The mean vibration duration in ATFL rupture patients was 5.72 seconds on the injured side and 7.87 seconds on the uninjured side, showing a statistically significant difference (p=0.001). At the 12-week follow-up, the mean vibration time improved to 7.65 seconds, which was also statistically significant (p=0.001). CONCLUSION:Proprioceptive impairment due to acute ATFL rupture was associated with reduced vibration sensation at the rupture site. As proprioception improved, vibration sensation also recovered. Therefore, vibration measurement using a tuning fork may serve as a practical proprioceptive assessment tool and an adjunctive diagnostic method.
BACKGROUND:This multicenter retrospective cohort study aimed to develop a novel five-parameter scoring model to predict incidental appendiceal neoplasia in patients aged ≥40 years diagnosed with acute appendicitis. Previous literature has reported a significant increase in the risk of neoplasia, particularly after age 40, and this cut-off value was used as the basis for our study design. METHODS:A multicenter retrospective cohort analysis was conducted across six tertiary hospitals between January 2019 and December 2024. Adult patients aged ≥40 years who underwent appendectomy with preoperative contrast-enhanced computed tomography (CT) and had available laboratory data were included. Predictive variables were identified using multivariate logistic regression. The scoring system incorporated age, female sex, appendix diameter, absence of CT wall enhancement, and low neutrophil count. Diagnostic performance was assessed via receiver operating characteristic (ROC) analysis. RESULTS:Of 2,143 patients analyzed, 122 (5.7%) had incidental neoplasia. The scoring system yielded an area under the ROC curve of 0.641 (95% confidence interval: 0.594-0.690). Using a cutoff score ≥3, sensitivity was 56.6%, specificity 65.4%, positive predictive value 9%, and negative predictive value 96.1%. Patients with a maximum score of 5 had a 33.3% incidence of neoplasia. CONCLUSION:This five-parameter scoring system demonstrates a high negative predictive value and may help identify low-risk patients in whom standard appendectomy can be safely performed. This model, which allows low-risk patients to be safely excluded thanks to its high negative predictive value, provides an innovative contribution to clinical decision-support systems.
BACKGROUND:Traumatic brain injury (TBI) is one of the common reasons for decompressive craniectomy (DC). The management of DC must include cranioplasty procedures. Although both procedures may cause several complications, postoperative outcomes are of greater concern for patients. The timing of cranioplasty (CP) and the type of CP material are the main parameters evaluated retrospectively in this report in terms of their impact on postoperative complications and cosmetic results. METHODS:A total of 47 patients who underwent autologous cranioplasty (n=22) or custom-made titanium cranioplasty (n=25) due to TBI between January 2017 and January 2024 in our department were retrospectively analyzed. The groups were compared in terms of demographic characteristics, complication rates, and operative parameters. Cosmetic results and one-year mortality rates were also reported. The Odom criteria were used for the assessment of cosmetic results. RESULTS:Baseline characteristics and overall complication rates did not differ significantly between the groups. Blood loss was significantly lower in titanium cranioplasty compared to autologous cranioplasty (126.2+-47.9 ml vs. 215.5+-35.6 ml, p<0.001). The highest complication rate was observed in cranioplasties performed 3-6 months after DC. In the early period (<3 months), autologous grafts were associated with significantly more complications than titanium (5/7 vs. 0/7, p=0.021). Cosmetic outcomes were significantly better with titanium, while timing had no effect on cosmetic results. One-year mortality rates were similar between the groups. CONCLUSION:The timing of cranioplasty and the type of cranioplasty material may influence postoperative outcomes in patients with TBI. Titanium plates could be a preferable option for early cranioplasty if autologous bone cannot be used for reconstruction, whereas late cranioplasty appears to be associated with fewer complications overall. Further studies are needed to support these findings.
BACKGROUND:The 2023 Türkiye earthquake resulted in a large number of pediatric victims with musculoskeletal trauma, many of whom developed compartment syndrome (CS) and crush-related complications. This study aimed to identify clinical and biochemical parameters associated with disease severity, renal failure, and limb loss in children affected by the disaster. METHODS:A retrospective analysis was conducted on 103 pediatric patients (0-18 years) admitted after the earthquake. Demographic data, duration of entrapment, laboratory values (creatine kinase [CK], myoglobin, aspartate aminotransferase [AST], alanine aminotransferase [ALT], urea, potassium), and therapeutic interventions (fasciotomy, negative-pressure wound therapy [NPWT], hyperbaric oxygen therapy [HBOT], hemodialysis, and amputation) were evaluated. Receiver operating characteristic (ROC) analyses were used to determine cut-off values predicting adverse outcomes. RESULTS:Forty-seven patients (45.6%) developed compartment syndrome involving 68 limbs and underwent fasciotomy. Thirteen patients (12.6%) required limb amputation, and 19 (18.4%) underwent hemodialysis due to acute kidney injury. An entrapment duration exceeding 8 hours (area under the curve [AUC]=0.84, p<0.001), CK>10,000 U/L, and myoglobin >4,000 ng/mL were independent predictors of renal failure, fasciotomy, and amputation. NPWT was applied in 66% and HBOT in 85% of patients with necrosis, contributing to an 82% limb salvage rate. No amputations occurred in patients without persistent necrosis. Three patients (2.9%) died from severe crush-related injuries and multi-organ failure. CONCLUSION:Prolonged entrapment and markedly elevated CK and myoglobin levels are reliable indicators of adverse outcomes in pediatric earthquake victims with compartment syndrome. Early recognition, timely decompression, and structured wound management (NPWT and HBOT) are essential for improving survival and limb salvage when early surgical intervention is not feasible in large-scale disasters.
BACKGROUND:This study aims to evaluate the mental health outcomes of orthopedists after the 2023 Kahramanmaraş earthquakes through a comprehensive analysis based on orthopedic care and amputations. METHODS:This cross-sectional, questionnaire-based study, conducted six months after the 2023 Kahramanmaraş earthquakes, included a total of 95 orthopedists. The online questionnaire assessed demographic characteristics, professional experience, and mental health outcomes using the Impact of Event Scale-Revised (IES-R) and the Depression Anxiety Stress Scale-21 (DASS-21). Scale scores were analyzed according to earthquake zone challenges, orthopedic care provision, and amputation-related stress factors. RESULTS:Care for earthquake victims was provided by 61.5% of orthopedists in the earthquake area, including local (16.8%) and supporting orthopedists (42.1%), while 36.8% treated victims at referral hospitals outside the area. Overall, 76.8% of participants reported performing amputation surgery on earthquake victims. Performing amputations in the pediatric age group (82.2%), witnessing patients' losses or other earthquake-related difficulties (64.4%), and amputations involving multiple extremities (56.2%) were reported as the three most common stress factors related to amputations. Orthopedists at referral hospitals and local orthopedists reported higher total IES-R scores (11.0 [0-58] and 11.5 [0-46] vs. 1.0 [0-39]), as well as higher avoidance (3.0 [0-20] and 3.0 [0-17] vs. 0.0 [0-13]) and intrusion (4.0 [0-20] and 5.0 [0-20] vs. 0.0 [0-14]) subscale scores. Referral hospital orthopedists showed higher anxiety (2.0 [0-13] vs. 0.0 [0-7]), stress (5.0 [0-16] vs. 2.0 [0-12]), and total DASS-21 scores (11.0 [0-44] vs. 6.0 [0-29]) than supporting ortho-pedists in the disaster zone. Those performing amputations in patients with earthquake-related difficulties reported higher DASS-21 depression scores (4 [0-18] vs. 1 [0-15], p=0.013). IES-R scores were negatively correlated with age (r=-0.203, p=0.049), while other factors showed no correlation with IES-R or DASS-21 scores. CONCLUSION:Our study shows that treating earthquake victims has a significant impact on orthopedists' emotional states and traumatic stress, especially for local and referral hospital orthopedists. The key stress factors included pediatric amputations, multiple extremity amputations, and patient-related difficulties. While tragic events involving relatives did not show a significant association with the scores, performing amputations on patients with earthquake-related difficulties increased depression scores, and younger orthopedists reported higher IES-R scores than older orthopedists. Our findings highlight the need for regular mental health screening, risk group identification, structured psychological support, and resilience training among orthopedic surgeons following large-scale disasters, as well as enhanced preparedness for future emergencies.
BACKGROUND:Vertebral compression fractures of varying severity and morphology may result from trauma and often require the preparation of a forensic medical report. Given the legal implications, accurate measurement of the compression ratio is critical. This study aims to evaluate whether four literature-defined methods for determining compression ratios are consistent with one another and with radiology reports, and to examine whether the choice of method alters the conclusions of forensic medical reports. METHODS:A retrospective review was conducted of forensic reports issued by our Department of Forensic Medicine between June 1, 2014 and June 1, 2024. Forty-two cases met the predefined inclusion criteria. For each vertebral fracture, the compression ratio was calculated using four established methods. Consistency was assessed both among these methods and between each method and the compression ratio documented in the corresponding radiology report. Finally, it was evaluated whether measurement discrepancies would alter the forensic conclusions regarding (1) the effect of the fracture on life functions, (2) permanent weakness or loss of function of one of the senses or organs, and (3) degree of disability. RESULTS:Agreement among the four measurement methods was weak to moderate, with inconsistency rates of 14.8% to 66.7% compared to radiology reports. Forensic report conclusions varied according to the measurement method. CONCLUSION:Method selection significantly influences both calculated compression ratios and the resulting conclusions of forensic reports in vertebral compression fractures. A standardized, universally accepted measurement protocol is therefore required in forensic practice to support fair and consistent legal decisions.
BACKGROUND:Bony mallet finger is a common injury of the distal phalanx that often requires surgical fixation when fracture displacement disrupts joint congruity. Extension-block Kirschner wire fixation, originally described by Ishiguro, is a minimally invasive method with high reported success rates. This study aimed to evaluate the clinical and radiological outcomes of patients with acute bony mallet finger treated with the extension-block technique using Kirschner wires. METHODS:A retrospective review was conducted on 76 patients treated surgically between October 2020 and December 2023. Radiographic union, extension lag, Crawford classification scores, and complications were analysed. Fractures were also categorised according to the Wehbé and Schneider classification. Statistical analyses included the Shapiro-Wilk test, Wilcoxon signed-rank test, and Chi-square or Fisher's exact tests as appropriate. RESULTS:The mean patient age was 34.4 ± 11.6 years. The median injury-to-surgery interval was 3 days, and the median follow-up duration was 18.5 months. Union was achieved in 97% of cases. The median preoperative DIP joint extension lag improved significantly from 8.8° (IQR 5.8-14.2) to 2.1° (IQR 0-4.8) at final follow-up (p < 0.001, r = 0.72). According to the Crawford classification, 80.2% of patients achieved excellent results, 13.2% good, 1.3% satisfactory, and 5.3% poor outcomes. Complications were limited to two non-unions and one malunion (3.9%). CONCLUSION:Extension-block Kirschner wire fixation provides excellent functional and radiographic outcomes in the treatment of acute bony mallet finger when performed early. The technique is safe, effective, and minimally invasive, with low complication rates and high union success.
This report describes the successful treatment (without hepatectomy) of a patient who underwent laparotomy and bullet removal for a gunshot injury to the liver at another institution. The patient was later referred for hemobilia and was found to have an un-recognized tangential injury to the right portal vein branch, resulting in portal vein thrombosis, diagnosed on the twelfth day after injury. The patient subsequently developed severe cholangitis. Hepatic arteriography did not identify the source of hemobilia. Fol-lowing thrombectomy of the main portal vein and its left branch, along with portal vein repair, bilateral external biliary drainage from the common hepatic duct was performed. Hemobilia ceased after portal revascularization. A low-volume biliary fistula developed in the early postoperative period but resolved within 17 days with gradual removal of abdominal drains. The patient experienced no further complications during six months of follow-up. Standard biochemical blood tests remained within normal limits, except for slightly elevated alkaline phosphatase (167 U/L: 40-129) and gamma-glutamyl transpeptidase (100 U/L: 8-61) levels. Follow-up contrast-enhanced computed tomography scans on postoperative day 10 and at six months confirmed patency of the main portal vein and its left branch. Additionally, right lobe atrophy and left lobe hypertrophy were observed. In conclusion, applying principles from elective hepatopancreatobiliary surgery to trauma care, and avoiding major hepatectomy in the setting of severe cholangitis, played a crucial role in achieving a successful outcome.
BACKGROUND:Femoral neck fractures are a serious health concern, particularly among the elderly. The aim of this study is to diagnose and classify femoral neck fractures from plain pelvic X-rays using deep learning and machine learning algorithms, and to compare the performance of these methods. METHODS:The study was conducted on a total of 598 plain pelvic X-ray images, including 296 patients with femoral neck fractures and 302 individuals without femoral neck fractures. Initially, transfer learning was applied using pre-trained deep learning models: VGG-16, ResNet-50, and MobileNetv2. RESULTS:The pre-trained VGG-16 network demonstrated slightly better performance than ResNet-50 and MobileNetV2 for de-tecting and classifying femoral neck fractures. Using the VGG-16 model, the following results were obtained: 95.6% accuracy, 95.5% sensitivity, 93.3% specificity, 95.7% precision, 95.5% F1 Score, a Cohen's kappa of 0.91, and the Receiver Operating Characteristic (ROC) curve of 0.99. Subsequently, features extracted from the convolution layers of VGG-16 were classified using common machine learning algorithms. Among these, the k-nearest neighbor (k-NN) algorithm outperformed the others and exceeded the accuracy of the VGG-16 model by 1%. CONCLUSION:Successful results were obtained using deep learning and machine learning methods for the detection and clas-sification of femoral neck fractures. The model can be further improved through multi-center studies. The proposed model may be especially useful for physicians working in emergency departments and for those not having sufficient experience in evaluating plain pelvic radiographs.
BACKGROUND:This study aims to evaluate traumatic injuries resulting from wounding crimes from a forensic medical perspective, determine the demographic characteristics of the victims, and characterize injury patterns. METHODS:A retrospective review was conducted on 2,164 forensic reports prepared between January 1, 2023 and June 30, 2024 at the Department of Forensic Medicine, Gülhane Training and Research Hospital. Data including gender, age, marital status, educational level, type of assault, nature of the forensic traumatic event, traumatic injuries, affected body regions, and injury characteristics were analyzed using IBM SPSS Statistics 26.0. The results were evaluated statistically. RESULTS:Of the victims, 72.8% were male and 27.2% female. Injuries occurred most frequently in the 21-30 age group (30.4%). A significant decrease in the incidence of injuries was observed with increasing education levels (p<0.05). The fact that 22.1% of victims were university graduates suggests that higher education may serve as a protective factor against victimization. The most common cause of trauma was assault (54.6%), followed by traffic accidents (35.9%). Injuries often involved multiple body regions (39.3%), with the head-neck region (30.6%) and upper extremities (13.4%) being most commonly affected. It was determined that 66.6% of the injuries were mild enough to be treated with simple medical interventions, while 6.9% were life-threatening. Traffic accidents were significantly associated with fractures and dislocations (23.6%). Additionally, facial injuries due to assaults occurred frequently and were statistically significant (68.6%; p<0.05). CONCLUSION:This study highlights the demographic distribution of assault-related crimes and the forensic implications of traumatic injuries, emphasizing the importance of preventive measures and the necessity for multidisciplinary collaboration.
BACKGROUND:Cervical pedicle screws offer biomechanical advantages over other stabilization systems. However, their placement carries a relatively high risk of vascular or neurological injury due to individual differences and the complex structure of the cervical spine. Therefore, understanding patient-specific anatomy is crucial for the safe and accurate placement of pedicle screws. In this study, we present our single-center case series over a seven-year period involving cervical pedicle screw placement in subaxial cases. METHODS:We retrospectively analyzed patients who underwent cervical subaxial pedicle screw placement between 2017 and 2024. A freehand surgical technique was employed, using a mini-laminotomy approach to ensure safe screw placement. During the procedure, the medial, superior, and inferior borders of the pedicle were palpated. RESULTS:A total of 70 cases were analyzed retrospectively. Fifty patients were male, and 20 were female. The patients ranged in age from 20 to 89 years (median age: 64 years). Fifty-seven patients (81.5%) had cervical stenosis as the surgical indication. Of the remaining cases, 11 patients had fractures and two had tumors. Among the 468 pedicle screws placed, 434 were graded as 0-1. The correct placement rate was 92.7%. Thirty-four screws were malpositioned (grade 2-3), representing a rate of 7.3%. CONCLUSION:In our case series, the accuracy of cervical subaxial pedicle screw placement was high. We believe that achieving this level of accuracy requires a strong understanding of anatomy, three-dimensional spatial awareness, and surgical experience.
BACKGROUND:Cystic stump leakage is the most common cause of bile leakage following cholecystectomy, representing a significant postoperative complication that requires prompt intervention. Currently, endoscopic treatment is the preferred management approach. This study aims to identify factors influencing the success of endoscopic therapy for cystic stump leaks by analyzing cases treated at our institution. METHODS:Thirty-seven patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for cystic stump leakage were included in this study. Patient demographics, associated complications, and length of hospital stay were analyzed. RESULTS:All patients showed clinical improvement, with a mean hospital stay of 5.1 days. The presence of comorbidities, emergency surgery, or conversion to open surgery did not significantly impact treatment efficacy. Post-procedure, percutaneous drainage was required in 10 patients (27%). Procedure-related pancreatitis was noted in one patient (2.7%). Statistical analysis revealed that both the need for percutaneous drainage and the length of hospital stay were significantly lower in patients who had pre-existing drains (p<0.03). Additionally, early ERCP was associated with a significantly shorter hospital stay (p<0.01). CONCLUSION:Stent placement via ERCP is a safe and effective strategy for managing cystic stump leaks. Early ERCP intervention following cystic stump leak detection is recommended. Furthermore, percutaneous drainage may be necessary in patients who do not respond adequately to initial treatment.
BACKGROUND:The Modified 5-Factor Frailty Index (mFI-5) has been shown to predict complications following treatment in geriatric patients. However, few studies have compared the mFI-5 with other trauma scoring systems in cases involving multiple injuries. This study aimed to evaluate the Relationship Between mFI-5, Injury Severity Score (ISS), and Geriatric Trauma Outcome Score (GTOS) and their association with mortality in geriatric trauma patients. METHODS:This retrospective cohort study included patients aged 65 and older who were admitted to the emergency trauma unit of a tertiary care hospital. Data collected included laboratory parameters, imaging results, blood transfusion requirements, hospitalization status, intensive care unit admission, surgical intervention, ISS, GTOS, mFI-5 scores, and mortality outcomes. RESULTS:A total of 241 patients were included, with a mean age of 78.12 (±8.34) years. Falls were the most common cause of trauma (n=142, 58.9%). Thoracic injuries were the most frequently observed (n=86, 53.7%). Patients who died within the first 24 hours of admission had significantly higher ISS (14.1 vs. 26.33), GTOS (119.02 vs. 157.33), and mFI-5 (2.53 vs. 3.33) scores (p=0.001, p=0.001, and p=0.017, respectively). Similar trends were noted for one-month and three-month mortality (p=0.001 for all). CONCLUSION:Scoring systems are essential for early mortality prediction in geriatric trauma patients. ISS, GTOS, and mFI-5 scores have shown similar effectiveness in predicting comorbidities, intensive care unit admission, and mortality in geriatric trauma patients. ISS involves a complex calculation, while GTOS, although specifically designed for geriatric patients, requires additional computations based on the ISS. In contrast, mFI-5 may be more practical in emergency settings because it is easy to calculate.
BACKGROUND:On February 6, 2023, Türkiye experienced two devastating earthquakes with epicenters in Pazarcık and Elbistan, measuring 7.7 and 7.6 on the Richter scale. These earthquakes resulted in over 50,000 deaths and widespread destruction of infrastructure. The disaster triggered a large-scale humanitarian crisis, presenting significant medical and psychological challenges. Understanding the scientific response to such events is crucial for enhancing future disaster preparedness and management. METHODS:A systematic search was conducted in the Web of Science database using the terms "Kahramanmaraş earthquake," "Pazarcık earthquake," "Elbistan earthquake," and "Türkiye earthquake 2023." The search covered literature published from February 6, 2023 onward, and focused on medical publications. A total of 371 articles were initially identified; after excluding geological, engineering, and social science studies, 350 articles were included. Bibliometric analysis was performed using the Bibliometrix package in R Studio and visualized with Biblioshiny. Key indicators analyzed included publication volume, citation count, author collaboration, and thematic clustering. RESULTS:The analysis identified 350 articles published in 173 journals, with contributions from 1,739 authors. The average number of co-authors per document was 6.03, indicating a high level of collaboration. However, only 5.429% of the studies involved international authors. The annual growth rate of publications was -11.11%, suggesting a projected decline in research activity. The most cited article was Emergency Medicine Association of Turkey Disaster Committee Summary of Field Observations of February 6th Kahramanmaraş Earthquakes, which emphasized the challenges faced in emergency response. Psychological studies were more numerous; however, publications related to emergency response and trauma care received higher citation counts. Keyword analysis revealed a focus on trauma care, post-traumatic stress disorder (PTSD), surgical management, and public health. Notable clinical advancements included the SAFE-QUAKE (Seismic Activity Forecasting and Evaluation-QUAKE) scoring system for predicting dialysis needs and the Mangled Extremity Severity Score (MESS) for amputation triage. CONCLUSION:The research response to the Kahramanmaraş earthquakes followed a clear progression: an early focus on emergency response and public health, followed by injury and surgical management, and a later emphasis on psychological recovery. Despite a strong domestic research effort, low international collaboration hindered broader knowledge exchange. Sustained funding, enhanced global partnerships, and integrated mental health and trauma care strategies are essential for improving future disaster preparedness and healthcare system resilience.
In conflict-affected regions such as Somalia, injuries resulting from terror-related explosions impose a substantial public health burden. Shrapnel injuries are frequently encountered and often lead to multiple trauma, with penetrating thoracic injuries among the most clinically significant. Although rare, cardiac trauma presents considerable diagnostic and therapeutic challenges for emergency physicians and trauma surgeons. While surgical intervention is typically indicated in hemodynamically unstable patients, the optimal management for retained intracardiac foreign bodies (FBs) in stable patients remains an area of clinical uncertainty. The decision between surgical removal and conservative observation is influenced by several factors, including hemodynamic stability, the presence of cardiac complications, and the characteristics of the retained object. We present a case of a hemodynamically stable patient in Somalia with a retained intracardiac shrapnel fragment following a terror-related explosion. Imaging studies, particularly transthoracic echocardiography, revealed a foreign body within the pericardial space, without evidence of tamponade or myocardial injury. Given the stable clinical course and absence of acute cardiac pathology, a non-operative strategy with close clinical and echocardiographic monitoring was adopted. The patient remained complication-free and was successfully managed. This case underscores the feasibility of conservative treatment in selected hemodynamically stable patients with intracardiac FBs and highlights the necessity of an individualized, multidisciplinary clinical approach in complex trauma scenarios.
BACKGROUND:This study aimed to investigate the relationship between trauma severe enough to cause physical injury and subsequent hearing loss in military personnel exposed to blast events. METHODS:A retrospective review was conducted on 95 patients aged 30-39 who were admitted between 2015 and 2018 due to blast-related injuries and acoustic trauma. A control group of 51 military personnel without complaints was included. Patients were categorized based on the location of trauma, the energy level of the explosion, and the presence of tympanic membrane perforation. Hearing thresholds and clinical characteristics were compared between groups to evaluate the relationship between trauma patterns and auditory outcomes. RESULTS:Patients with head-related injuries had significantly worse air and bone conduction thresholds at multiple frequencies compared to those with injuries in other body regions (p<0.05). Tympanic membrane perforation was significantly associated with eye injuries (p=0.004) and elevated air conduction thresholds (p<0.05), but not with bone conduction thresholds. Exposure to medium and high-energy blasts was associated with elevated hearing thresholds across all frequencies compared to controls (p<0.001). CONCLUSION:Blast-related acoustic trauma is associated with hearing loss across a range of frequencies. Tympanic membrane perforation contributes to air conduction hearing loss. Eye injury may be anatomically related to tympanic membrane damage. Hearing assessment should be integrated into the multidisciplinary care of trauma patients in war zones.
OBJECTIVES:In this study, our objective was to investigate the factors that affect 1-year mortality in patients over 65 years of age who were hospitalized due to hip fracture. METHODS:This retrospective cohort study is based on data from our clinical archives collected between January 2013 and December 2021. All consecutive patients over 65 years of age with hip fractyres admitted to our hospital were considered for inclusion in the study. RESULTS:During the period from January 2013 to December 2021, 834 patients met the inclusion criteria. The one-year mortality rate was 33.5 % (279/834). The mean surgery time was 5.64 days in patients with 1-year mortality; and 4.50 days in patients who lived longer than one year (P = 0,001). The mean values of hemoglobin, creatinine, lymphocyte count, and albumin of patients in the one-year mortality group were 11.47 g/dL, 1.33 mg/dL, 1.10x103/μL and 3.42 g/L, respectively. The same values of those who survived for more than a year were 11.93 g/dL, 1.12 mg/dL, 1.35x103/μL and 3.68 g/L, respectively (P= 0.006, 0.002, 0.001 and 0,000, respectively). CONCLUSIONS:We found that older patient age, delayed surgery, low albumin level, low total lymphocyte count, and high creatinine levels at hospital admission are associated with increased mortality after hip fracture. Comorbidities, number of comorbidities, transfusions, and ICU requirements were not associated with increased mortality, unlike the literature.
BACKGROUND:Non-articular dorsally angulated distal radius fractures (DRFs) are often managed conservatively, yet the optimal cast design remains debated. Dorsoradial (DR) casting leaves the ulnar border open, potentially better accommodating swelling and reducing early cast-related interventions. METHODS:A single-center retrospective cohort study included adults with AO-23-A2/A3 DRFs treated between May 2019 and May 2023. Patients received either a DR cast (n=88) or a conventional circular cast (CC) (n=122) for a standard five-week immobilization. Primary outcomes included functional (Patient-Rated Wrist Evaluation, PRWE) and clinical (Gartland-Werley, GW) scores, along with radiographic alignment (volar tilt, radial inclination, radial height) at a median follow-up of 118.5 weeks. Secondary outcomes were early cast revisions (release or reinforcement) and complications. Statistical tests included Mann-Whitney U, χ²/Fisher, with Bonferroni-adjusted α=0.017. RESULTS:Baseline characteristics were similar across groups: mean age 60±11 years, 87% female, comparable AO subtype distribution, and osteoporosis status. Early revision: DR 22.7% vs. CC 36.1% (absolute risk reduction 13% points; odds ratio: 0.51, p=0.038), primarily due to fewer cast releases for swelling/pain (12.5% vs. 32.8%, p=0.001). Function: PRWE scores were 34±18 (DR) vs. 36±18 (CC), p=0.435; GW scores were good-excellent in 79.5% vs. 77.8%, p=0.508. Radiographic outcomes: final volar tilt and radial height were similar (both p>0.08). DR casts better preserved radial inclination (median change 0°, p=0.057) compared to CC casts, which lost 1.3° (-6%, p<0.001); however, the net 1.2° intergroup difference is below the 5° minimal clinically important difference (MCID) and is clinically negligible. No cases of compartment syndrome or acute carpal tunnel occurred. CONCLUSION:Dorsoradial casting delivers functional and radiographic outcomes equivalent to circular casting while reducing early revision rates by one-fifth. By lowering unplanned cast adjustments and follow-up visits, the DR technique represents a pragmatic alternative for centers with limited monitoring capacity treating dorsally angulated extra-articular DRFs.
