The Utilization of Emergency Department and Outpatient Clinics among Evacuated Victims after the 2023 Turkey Earthquake

BACKGROUND

After the 2023 Turkey earthquake, thousands of people evacuated to different fields. Earthquake victims still need health care in the evacuation location. This study aims to determine the emergency department (ED) and outpatient clinic utilization characteristics of the evacuated earthquake victims outside the earthquake zone and to provide suggestions for planning the health care facilities in the regions where the evacuated earthquake victims will be placed.

METHODS

This retrospective, observational study was conducted in a tertiary university hospital from February 7, 2023 through February 20, 2023. All evacuated earthquake victims who presented to the study hospital were included in the study. Non-victim patients were included as the control group. Missing medical records were excluded. Demographic characteristics of the patients, outpatient clinics, International Statistical Classification of Diseases and Related Health Problems-10th Revision (ICD-10) codes, and outcomes were recorded.

RESULTS

A total of 15,128 patients were included in the final analysis. Six-hundred-nine (4.0%) of the patients were evacuated victims. Three-hundred forty-six (56.8%) evacuated victims used the ED. One-hundred fifty-six (25.6%) earthquake victims were in the pediatric age group. Earthquake victims used the ED more than the control group in adult and pediatric age groups (22.5% versus 51.7% and 30.2% versus 71.8%; P <.001, respectively). Earthquake victims frequently presented to the hospital during night shifts in both age groups (P <.05). Pediatric victims were more hospitalized than the control group (4.8% versus 10.9%; P = .001). Diseases of the respiratory system were the most common emergency diagnosis of the victims in both age groups (26.5% and 57.1%, respectively). The most frequently used outpatient clinic was ophthalmology in both age groups (14.6% and 20.5%, respectively).

CONCLUSIONS

Evacuated victims, especially pediatric victims, used the ED more than other outpatient clinics. Diseases of the respiratory system were the most common emergency diagnosis of the victims, and the most frequently preferred outpatient clinic was ophthalmology. The most common diseases and frequently preferred clinics should be considered in planning health care for the evacuated earthquake victims.

The Relationship between Sphenoid Sinus, Carotid Canal, and Optical Canal in Paranasal Sinus Computed Tomography in Children

Objectives  The authors examined the structural differences in the paranasal sinus region at sphenoid sinus in the pediatric population. Methods  Paranasal sinus computed tomography (PNSCT) images of 86 pediatric subjects (30 males, 56 females) were included. In 13 to 15 years of age group ( n =34) and ≥16 years of age group ( n =52), sphenoid sinus pneumatization (SSP), optic canal and carotid canal classifications and dehiscence evaluation were performed. Results  In both sexes, type 1 and type 2 SS pneumatization were observed more frequently on both the right and left sides. On the right side, type 2> type 1; on the left side type 1> type 2 optic canals were detected in both gender. Type 3 optic canals were detected in 8.8 to 14.7% of the 13 to 15 years of age group; and 11.5 to 17.3% of ≥16 years of age group. Type 4 optic canals were detected in 2.9% of the 13 to 15 years of age group and 1.9% of the ≥16 years of age group bilaterally. Optic canal dehiscence was detected in 26.5% of the 13 to 15 years of age group and 17.3% of the ≥16 years of age group. Type 1 and type 2 carotid canals are most common in children, the percentages for type 3 carotid canals were 1.8 to 3.6% in children. Conclusion  In pneumatized SS, optic canal classifications got increased values which showed protrusion into the sphenoid sinus wall. Therefore, in children, the surgeons must be very careful for optic canal being nearer to the sphenoid sinus walls.

Maxillary sinus volume and mucosal thickening according to the septal deviation angle and age of the children

We examined the relationship between nasal septal deviation (SD) angle and maxillary sinus volumes by examining the paranasal sinus computed tomography (PNSCT) images in children. In this retrospective study, PNSCT images of 106 children with one-sided nasal SD were included. According to the SD angle, two groups were identified: Group 1 (n = 54): SD angle ≤ 11°, Group 2 (n = 52): SD angle > 11°. There were 23 children between 9 and 14 years and 83 children between 15 and 17 years. Maxillary sinus volume and mucosal thickening were evaluated. In 15- to 17-year age group, maxillary sinus volumes of males were higher than females bilaterally. For each of the males and females, ipsilateral maxillary sinus volume was significantly lower than the contralateral side in all children and in 15- to 17-year age group. In each of the SD angle values (≤11 or >11) separately, ipsilateral maxillary sinus volume was lower; and in the SD angle > 11° group, maxillary sinus mucosal thickening values were higher than those of the contralateral side. In young children in 9- to 14-year age group, bilateral maxillary sinus volumes decreased, in this group maxillary sinus volume was not affected according to the SD. However, in 15- to 17-year age groups, maxillary sinus volume was lower on the ipsilateral SD side; and ipsilateral and contralateral maxillary sinus volumes of the males were significantly higher than those in the females. SD should be treated at an appropriate time to prevent SD-related maxillary sinus volume shrinkage and rhinosinusitis.

The Effects of Colchicine on the Histopathological Findings of Celiac Disease During Familial Mediterranean Fever Treatment

Familial mediterranean fever (FMF) and Celiac Disease (CD) are both autoinflammatory and autoimmune diseases with common clinical features affecting the gastrointestinal system. Familial mediterranean fever may coexist with CD. Inflammatory cells and cytokines are up-regulated within the intestinal mucosa of patients with CD. In this perspective, lymphocyte infiltration to the lamina propria of the small intestinal mucosa is a critical pathological sign. In the present study, we aimed to find out whether the treatment of an FMF patient with colchicine affects the pathological signs of concomitant developed CD on the same patient. We retrospectively reviewed the medical records of 147 patients with FMF who were followed up in our center between 2015 and 2020. Of the 147 patients with FMF, 3 patients also had CD. In this report, we presented these 3 cases. The findings obtained in this study suggest that pathological findings may be misinterpreted in autoimmune diseases, such as CD, when patients administer anti-inflammatory treatments, such as colchicine.

Clinical significance of MEFV gene variation R202Q

BACKGROUND

The aim of this study was to evaluate the phenotypic features and the clinical significance of the R202Q mutation of the MEFV gene.

METHODS

We retrospectively reviewed the medical records of Familial Mediterranean Fever patients with M694V/- and M694V/R202Q mutations. We compared the patients regarding disease severity, symptoms, age at the onset of symptoms, gender, consanguinity, and family history.

RESULTS

Twenty-one patients (9 males, 12 females) had compound heterozygote mutation (M694V/R202Q), and 37 patients (23 males, 14 females) had M694V/- mutation. The mean age of the patients at the time of diagnosis was 7.3 ± 4.3 and 9.2 ± 3.7 years. The rate of arthritis was significantly higher in patients with M694V/R202Q heterozygote mutation than those with M694V/- heterozygote mutation (76.2% vs 32.4%; p =  < 0.001). The mean severity score was higher in M694V/R202Q heterozygote group although it did not reach statistical significance (8.43 ± 1.69 vs 7.49 ± 1.50; p = 0.082). However, the rate of having a high severity score was significantly higher in the M694V/R202Q mutation group than in the other group (47.6% vs 21.6%, respectively; p = 0.039). The rate of arthritis was significantly higher in patients with M694V/R202Q heterozygote mutation than those with M694V/- heterozygote mutation (76.2% vs 32.4%; p =  < 0.001).

CONCLUSION

Our finding supports the possibility that R202Q may be pathogenic rather than a variation. We found that the R202Q mutation is associated with the inflammatory phenotype of FMF; hence, the typical clinical findings of FMF especially arthritis can be observed in patients with compound mutation including R202Q. Key Points • We found that the R202Q mutation is associated with the inflammatory phenotype of FMF • The patients with the R202Q mutation had a greater rate of arthritis symptoms.

Investigation of Thiol/Disulfide Balance in Obese Rats with Non-Alcoholic Fatty Liver Disease

PURPOSE

Due to the increasing prevalence of obesity worldwide, non-alcoholic fatty liver disease (NAFLD) has reached epidemic dimensions over time. NAFLD is the most common cause of childhood chronic liver disease. There is a relationship between NAFLD and oxidative stress. This study aims to investigate the changes in thiol/disulfide homeostasis parameters to determine the oxidant/antioxidant balance in obese rats with diet-induced NAFLD and healthy rats.

METHODS

Twelve Wistar albino rats were used in this study. Experimentally produced NAFLD obese rats (n=6) and healthy rats were compared. Experimental NAFLD model was created with a special fatty liver diet (Altromin® C1063, Fatty Liver Diet, Exclusivet, Lage, Germany). The biochemical and histopathological features of the groups, as well as serum thiol/disulfide homeostasis parameters, were analyzed and compared.

RESULTS

In the experimentally induced NAFLD rat model, they gained more weight than the control group. Steatosis (at least grade 2) occurred in all rats fed with special fatty liver diet for 12 weeks. Histopathologically, no high-grade inflammation was observed in rats with experimental NAFLD after feeding a diet for 12 weeks. Results revealed that aspartate transaminase and alanine transaminase levels were high, albumin levels were low, oxidant stress parameters increased, and antioxidant thiol groups decreased.

CONCLUSION

Experimental NAFLD is characterized by increased oxidant stress accompanying fatty tissue in the liver. Analysis of thiol/disulfide homeostasis parameters in NAFLD can be used in further studies to develop effective treatment options.

Vitamin D levels in children with COVID-19: a report from Turkey

Several studies have demonstrated that higher levels of vitamin D are associated with better prognosis and outcomes in infectious diseases. We aimed to compare the vitamin D levels of paediatric patients with mild/moderate coronavirus disease 2019 (COVID-19) disease and a healthy control group. We retrospectively reviewed the medical records of patients who were hospitalised at our university hospital with the diagnosis of COVID-19 during the period between 25 May 2020 and 24 December 2020. The mean age of the COVID-19 patients was 10.7 ± 5.5 years (range 1-18 years); 43 (57.3%) COVID-19 patients were male. The mean serum vitamin D level was significantly lower in the COVID-19 group than the control group (21.5 ± 10.0 vs. 28.0 ± 11.0 IU, P < 0.001). The proportion of patients with vitamin D deficiency was significantly higher in the COVID-19 group than the control group (44% vs. 17.5%, P < 0.001). Patients with low vitamin D levels were older than the patients with normal vitamin D levels (11.6 ± 4.9 vs. 6.2 ± 1.8 years, P = 0.016). There was a significant male preponderance in the normal vitamin D group compared with the low vitamin D group (91.7% vs. 50.8%, P = 0.03). C-reactive protein level was higher in the low vitamin D group, although the difference did not reach statistical significance (9.6 ± 2.2 vs. 4.5 ± 1.6 mg/l, P = 0.074). Our study provides an insight into the relationship between vitamin D deficiency and COVID-19 for future studies. Empiric intervention with vitamin D can be justified by low serum vitamin D levels.

The efficacy of adenotonsillectomy on oxidative stress evaluated by thiol / disulfide balance

BACKGROUND

Oxidative stress plays a role in the pathogenesis of many chronic diseases. Upper airway obstruction has been identified as a risk factor for increased oxidative stress-related disorders such as obstructive sleep apnea. The effect of adenotonsillar hypertrophy, which may result in a narrowing of the upper airways, on oxidative stress can be a valuable subject of research. This study aimed to investigate the efficacy of adenotonsillectomy on oxidative stress evaluated using the thiol / disulfide balance.

METHODS

Thirty children who underwent adenotonsillectomy and 30 healthy controls, all aged from 3 to 18 years, were included in the study. Blood samples were taken preoperatively and 3 months postoperatively in the study group; in the control group, baseline blood samples were taken and samples were again taken 3 months later. Thiol / disulfide homeostasis items were analyzed. Antioxidant markers were native thiol, total thiol, and native / total thiol. Oxidative stress markers were disulfide, disulfide / native thiol, and disulfide / total thiol.

RESULTS

At the preoperative period, oxidative stress parameters of thiol / disulfide homeostasis were higher in the study group than in the control group (P < 0.05) and antioxidant activity parameters were lower than in the control group (P < 0.05). Three months postoperatively, oxidative stress parameters were lower than in the control group (P < 0.05), and antioxidant parameters were no different from those in the control group (P > 0.05). In the adenotonsillectomy group considered separately, oxidative stress markers of disulfide and disulfide / native thiol decreased (P < 0.05) and antioxidant markers of native thiol and total thiol increased in the postoperative measurements (P < 0.05).

CONCLUSIONS

Oxidative stress related to adenotonsillar hypertrophy decreased after adenotonsillectomy. The antioxidant parameters of the thiol homeostasis increased after adenotonsillectomy. We concluded that adenotonsillectomy operations should be planned and applied timeously to prevent the adverse effects of adenotonsillar hypertrophies on thiol homeostasis.

Diagnostic Value of Plasma Soluble Triggering Receptor Expressed on Myeloid Cells-1 in Children with Urinary Tract Infections

Objective The aim of the present study was to evaluate the diagnostic value of soluble triggering receptor on myeloid cells-1 as a novel marker for diagnosis of childhood urinary tract infections (UTI).

Methods This study enrolled 30 pediatric patients diagnosed with acute febrile UTIs; 30 healthy children were included as the control group. The blood samples from the patients and healthy controls were collected for a soluble triggering receptor on myeloid cells-1 (sTREM-1) test.

Results The study group was composed of 9 males and 21 females, and the mean age of the study population was 6.6 ± 3.2 (range = 1–14) years. sTREM-1 levels were significantly higher in UTI patients than in the controls (592 ± 323 vs. 490 ± 299 pg/mL, p = 0.04). The receiver operating curve analysis revealed a cut-off value of soluble triggering receptor expressed on myeloid cells-1 of 514 ng/mL (area under the curve = 0.562). When the cut-off value was taken 514 pg/mL, soluble triggering receptor expressed on myeloid cells-1 had a sensitivity of 57% and a specificity of 50% for the diagnosis of UTI.

Conclusion The present study revealed that plasma sTREM-1 level may be elevated in UTI and may therefore serve as a useful predictive tool for the diagnosis of UTI.

Evaluation of Childhood COVID-19 Cases: A Retrospective Analysis

Objective This study aims to evaluate the demographic, epidemiological, and clinical features of novel coronavirus disease 2019 (COVID-19) cases aged between 0 and 18 years.

Methods The demographic characteristics of the patients, admission symptoms, contact and travel histories, clinical onset duration, symptoms, treatments, laboratory findings, radiological images, and polymerase chain reaction (PCR) negation times were evaluated in a retrospective manner. Thirty-eight children (19 boys and 19 girls) were included in the study.

Results The mean age of the patients was 10.36 ± 5.59 years. The average admission times of the patients after the onset of the symptoms was determined as 1.84 ± 2.02 days. Thirteen (34.2%) patients were observed as asymptomatic. The most common identified symptoms were fever, cough, and fatigue (55.2, 34.2, and 13.2%, respectively). Febrile convulsions, myalgia, dizziness, and diarrhea were the least common symptoms. Also, 25-hydroxyvitamin D3 (vitamin D3) levels were low and aspartate aminotransferase (AST) values were higher in the moderate group than the mild group and the relationships were statistically significant (p = 0.044and 0.027). Ferritin levels of the patients with ground glass opacity (GGO) were found statistically and significantly higher than the patients without GGO (p = 0,031). There was more than one lobe and segment involvement in five patients, the average number of affected lobes and segments was 3.8 and 8.8, respectively. High-resolution computed tomography of the 24 patients showed that; GGO in five (20.8%), consolidation + GGO (mixed) in three (12.5%), consolidation (alone) in one, subpleural linear opacities in three (12.5%), and pavement stone opacities in one (4.2%) patient. COVID-19, which is seen less frequently in children, may pose a risk in infants and young children.

Conclusion Especially high ferritin levels may present with lung involvement and low vitamin D levels may worsen the aggravation of the lung involvement. There is a great need for further research on this subject.

Does Subclinical Hypothyroidism Affect Dynamic Thiol / Disulfide Homeostasis and İschemia-modified Albumin Levels in Children?

OBJECTIVE

To determine the effects of subclinical hypothyroidism on oxidative stress in children.

STUDY DESIGN

A cross-sectional study.

PLACE AND DURATION OF STUDY

Department of Paediatrics, Paediatric Endocrinology, and General Outpatient Clinics, Kirikkale University, School of Medicine, from May 2017 to October 2018.

METHODOLOGY

This study included 92 subjects aged between 2 and 18 years. The subjects were divided into two groups. Forty-seven children with subclinical hypothyroidism and 45 healthy controls were evaluated. In order to evaluate oxidative damage, native thiol, total thiol, disulfides, their ratios, and ischemia-modified albumin (IMA) levels were compared between the two groups. The relationship between TSH and IMA levels was assessed.

RESULTS

Age and gender were not significantly different in the two groups. Native thiol, total thiol, disulfides and their ratios were similar in the two groups. Ischemia-modified albumin levels were significantly higher in the patient group than the controls (p<0.001). There was no correlation between TSH and IMA levels in the patient group (r=0.069 p=0.645).

CONCLUSION

Subclinical hypothyroidism may be related to the impairment of IMA, and have a neutral effect on thiol/disulfide balance. Further research is needed to explain the effects of oxidative stress in subclinical hypothyroidism. Key Words: Subclinical hypothyroidism, Childhood, Oxidative stress.

Purtscher-Like Retinopathy Associated with Synthetic Cannabinoid (Bonzai) Use

Purtscher’s retinopathy is a microvascular occlusive disease initially described as retinal edema, cotton wool-like exudation, and hemorrhages occurring after severe head trauma. A similar clinical presentation called Purtscher-like retinopathy is associated with systemic diseases instead of trauma. In the present case, ophthalmic eksamination of a patient with complaints of blurred vision related to substance (Bonzai) use revealed bilateral cotton-wool spots. Purtscher-like retinopathy was diagnosed based on fluorescein angiography and optical coherence tomography findings. This is the first case of Purtscher-like retinopathy associated with Bonzai use described in the literature.