Analysis of wound types and wound care methods after the 2023 Kahramanmaras earthquake.

OBJECTIVES: This study aims to investigate the types of wounds and wound care in earthquake victims rescued from collapsed buildings after the 2023 Kahramanmaras earthquake. PATIENTS AND METHODS: Between February 8th, 2023 and March 1st, 2023, a total of 94 patients (46 males, 48 females; mean age: 40.2±15.5 years; range, 16 to 77 years) with earthquake-related wounds who were trapped under rubble were retrospectively analyzed. Data including age, sex, duration of being trapped under rubble, type and location of the wound, bacterial cultures from deep tissue, and wound care methods used were recorded. RESULTS: The mean duration of being trapped under rubble was 58±38.1 h. Wounds were most commonly located on the lower extremities, followed by the upper extremities. The most common type of wounds were abrasions, followed by necrotic wounds due to crushing. Wound and skin antiseptics, debridement and negative pressure wound therapy (NPWT) were the most common wound care methods used. CONCLUSION: Various types of injuries and wounds may occur after natural disasters. Chronic wound care is as important as the management of life-threatening acute pathologies. Preparations should be made properly for the long-term treatment of patients after disasters. Methods such as NPWT, debridement creams containing collagenase, wound and skin antiseptics, and hyperbaric oxygen therapy can provide satisfactory short-term results. A broader and more intense application of these treatments is thought to be beneficial, particularly in crush injuries.

Preoperative predictive factors affecting sentinel lymph node positivity in breast cancer and comparison of their effectiveness with existing nomograms.

This study aimed to establish a strong regression model by revealing the preoperative predictive factors for sentinel lymph node (SLN) positivity in patients with early stage breast cancer (ESBC). In total, 445 patients who underwent SLN dissection for ESBC were included. All data that may be potential predictors of SLN positivity were retrospectively analyzed. Tumor size >2 cm, human epidermal growth factor receptor 2 (HER2) + status, lymphovascular invasion (LVI), palpable tumor, microcalcifications, multifocality or multicentricity, and axillary ultrasonographic findings were defined as independent predictors of SLN involvement. The area under the receiver operating characteristic (ROC) curve (AUC) values were 0.797, 0.808, and 0.870 for the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram, MD Anderson Cancer Center (MDACC) nomogram, and our regression model, respectively (P < .001). The recent model for predicting SLN status in ESBC was found to be stronger than existing nomograms. Parameters not included in current nomograms, such as palpable tumors, microcalcifications, and axillary ultrasonographic findings, are likely to make this model more meaningful.

Seasonal effects on the mechanisms of burn injuries.

Objectives: This study aimed to evaluate seasonal effects on the mechanisms of burn injuries in patients requiring hospitalization. Material and Methods: A retrospective evaluation was made using the information of 419 hospitalized burns patients, including demographic data, degree and percentage of burn injury, cause and mechanism of burn injury, morbidity and mortality. Burn mechanisms were grouped as thermal burns (flame, boiling liquid, contact), chemical burns and electrical burns. When calculating the percentage of body surface area burned, the rule of nines was applied. Seasonal classification was made appropriate to the northern hemisphere. Results: According to the seasons, the most burns were seen in spring months (n= 130, 31.0%). In the examination of the mechanism of burn injury, the most common type of injury was boiling liquid in 159 patients followed by flame injury in 146 patients. There was an increase in electrical and chemical burns in spring and summer. A statistically significant difference was determined between the types of burns according to the seasons (p= 0.024). The burn injury occurred as a result of a workplace accident in 82 cases, the majority of which were in autumn, and summer, and the difference in the seasons was determined to be statistically significant (p= 0.045). There was a statistically significant increase in the exposure of individuals aged >65 years to boiling liquid burns in winter and summer months (p= 0.014). Conclusion: The results of this study showed a seasonal effect on the types of burn injuries. A higher rate of thermal burns was expected to be found in winter, but this was not the case in patients with indications for hospitalization, as chemical and electrical burns in workplace accidents were seen more frequently in warmer seasons of spring and summer. In this context, burns units should be prepared for patient profiles to vary according to the season.

The Relationship Between Mammographic Density and Factors Affecting Breast Cancer Risk.

Objectives: Although the relationship between breast cancer (BC) risk factors and mammographic density (MD) patterns is not clear, high MD is well known as an independent risk factor for BC. Thus, the aim of this study was to examine the association between MD and BC risk factors in BC patients and find a correlation between MD and tumor characteristics in BC patients. Methods: Our data included 242 patients with BC. Furthermore, the MD (type I - <25%; type II - 25-50%; type III - 51-75%; and type IV - >75%) was categorized according to percentile density, and the various types of MD were compared using risk factors for BC and tumor characteristics of patients. Results: The results of this study indicated that younger age, pre-menopausal status, younger menarche age, nulliparity, low body mass index, and smoking significantly increase the percentage of MD (p<0.001, p<0.001, p=0.04, p<0.001, p=0.003, and p=0.01, respectively). Moreover, the distribution of MD patterns showed significant differences according to tumor subtypes. Type 4 mammographic pattern was higher in patients with human epidermal growth factor receptor 2 (Her2) type of tumor (p=0.01). Conclusion: Higher MD is related to reproductive risk factors and tumor subtypes, especially Her2 type, in BC patients. Further studies are needed to identify the factors related to breast density.

Comparison of the newly developed Fournier's gangrene mortality prediction model with existing models.

BACKGROUND: Many predictive factors and scoring systems associated with Fournier's gangrene have been proposed, including comorbidities, vital signs, biochemical and hematological parameters, and demographic characteristics of the patient. The aim of this study was to determine the strengths of the scoring systems that have been formed by revealing these factors from a wider perspective and in a larger patient population. METHODS: The patient population included 144 patients, 21 of whom died. Age, biochemical and hematological parameters, Uludag Fournier's Gangrene Severity Index (UFGSI), Fournier's Gangrene Severity Index (FGSI), and Age-Adjusted Charlson Comorbidity Index (ACCI) scores were analyzed using the Mann Whitney U-test due to their non-parametric distribution. Categorical data such as comorbidities, gender, need for positive inotropes, diversion ostomy status, and UFGSI grading status was analyzed with the Chi-square test, and independent risk factors were determined from the significant data emerging from univariate and multivariate logistic regression analysis. Their strengths were compared using the logistic regression model (Fournier's Gangrene Mortality Prediction Model: FGMPM) created through ROC analysis of the FGSI, UFGSI, and ACCI scores. RESULTS: The results of the statistical analyses showed that albumin (p<0.001) and need for positive inotropic support (p<0.001) were independent risk factors for mortality and ROC analysis revealed that the created FGMPM regression model (AUC: 0.995) was a stronger model than the FGSI (AUC: 0.874), UFGSI (0.893), and ACCI (0.788) scoring systems. CONCLUSION: The results of this study revealed that albumin and the need for positive inotropic support are independent risk factors for mortality. It is thought that the determination of these two parameters can be used to predict mortality more practically than the parameters used in the UFGSI and FGSI.

The effect of intraoperative neuromonitoring on the number of lymph nodes excised and recurrence when applied during neck dissection in cases of papillary thyroid cancer.

PURPOSE: The aim of this study was to evaluate the effect of neuromonitoring on the number of lymph nodes (LNs) removed when applied during neck dissection. METHODS: A total of 166 patients receiving neck dissection due to papillary thyroid cancer were separated into 2 groups (monitoring group, n = 76; non-monitoring group, n = 90). RESULTS: The number of LNs dissected was observed to be statistically significantly higher in the monitoring group (P = 0.001), and the difference between the groups in the number of positive LNs was significant (P = 0.031). There was seen to be a negative relationship between the number of positive LNs dissected and recurrence (r = -0.404, P = 0.005). CONCLUSION: Intraoperative neuromonitoring during neck dissection makes a positive contribution to the prevention of the development of recurrence by increasing the number of LNs excised and the number of metastatic LNs.

An Evaluation of the Factors Affecting Failure of the Procedure in Reoperated Thyroidectomies: A Retrospective Analysis.

BACKGROUND: The aim of this study was to determine the factors affecting procedure failure in revision thyroidectomy surgery. METHODS: A total of 148 patients applied with revision surgery were separated into 2 groups according to the surgical success status. Comparisons were made of the 2 groups of patients where residual tissue was totally excised (Group 1, n:132) and patients where residual tissue could not be completely excised (Group 2, n:16). The patients were examined in respect of factors affecting the success of the procedure. RESULTS: The patients comprised 133 (89.9%) females and 15 (10.1%) males with a mean age of 49.68±12.02 years. Surgical failure was observed in 7 patients as the lesion could not be determined despite the use of intraoperative USG, and in 9 patients because of weak signal or signal loss. The determination of residual tissue ≤25mm on preoperative USG examination was seen to have a significant negative effect on surgical success (r=-0.329, p0.001). The patient having undergone ≥3 previous operations was determined to have a negative effect on surgical success (r=-0.229, p=0.005), and nerve damage on the opposite side to the lesion in a previous surgical procedure was determined to be the most important factor with a negative effect on surgical success (r=-0.571, p<0.001). In multinomial logistic regression analysis of the factors affecting success, the preoperative presence of nerve damage in the contralateral lobe to the lesion (OR: 33.11, 95% CI: 4.22-192.28, p<0.001) and lesion size ≤25 mm (OR: 10.10, 95% CI: 3.54-75.01, p=0.001) were determined to contribute significantly to surgical failure. CONCLUSION: The results of this study clearly showed that as residual tissue size ≤25mm and contralateral nerve damage in the preoperative ultrasonographic evaluation are associated with surgical failure, alternative treatment methods such as radioactive iodine ablation may be preferred in these patients.

What is the effectiveness of the Tzanakis scoring system modified by the Delta Neutrophil Index in the diagnosis of acute appendicitis in pregnant women?

INTRODUCTION: Acute appendicitis is the most common cause of abdominal pain that is unrelated to pregnancy in pregnant women. The aim of this study was to evaluate the performance of the Alvarado, Ohmann, and Tzanakis scores in the prediction of acute appendicitis in pregnant women and compare the hematological parameters. PATIENTS AND METHODS: Herein, 1542 patients, aged 18-49 years, who were admitted to the emergency department with abdominal pain and underwent appendectomy were evaluated retrospectively. Of these, 140 female patients, including 35 who were pregnant and had been diagnosed with acute appendicitis, were included in the study. The obtained data were used to calculate the Alvarado, Tzanakis, and Ohmann scores. Histopathological evaluation reports were examined, and the diagnosis of acute appendicitis was confirmed. Those with different histopathological diagnoses were recorded as negative appendectomy. RESULTS: In the pregnant and non-pregnant women, the Tzanakis scoring system showed the best predictive performance in terms of the sensitivity and accuracy percentage from the Alvarado and Ohmann scoring systems (84.85%, 85.71% vs. 92.93%, and 92.38%, respectively). When the parameters showing infection were compared, the Delta Neutrophil Index (DNI) was significantly higher in the pregnant appendicitis patients (P = 0.012). When the Tzanakis scoring system was modified with the DNI, the sensitivity, accuracy, and negative predictive values were significantly increased (93.94%, 94.29%, 50% vs. 94.95%, 94.29%, and 50%, respectively). CONCLUSION: The Tzanakis scoring system appeared to be more effective than the other scoring systems in the diagnosis of acute appendicitis. Modification of the Tzanakis scoring system with the DNI was more successful in predicting appendicitis in pregnant women.

Effects of sagging breasts and other risk factors associated with mastalgia: a case-control study.

The aim of this study is to compare patients with and without mastalgia and to analyze the factors affecting mastalgia and its severity. The patient's age, height, weight, educational status, marital status, and occupation were recorded in all subjects. In addition, the women were asked about the presence of any risk factors for mastalgia, such as tea and coffee consumption, smoking, alcohol consumption, and weight gain. The sternal notch to nipple distance (SNND) was measured to determine whether there was breast sagging. Mastalgia was significantly more common in women with BMIs of > 30 kg/m2 (OR: 2.94, CI 1.65-5.24), those who were primary school graduates or illiterate (OR: 2.96, CI 1.6-5.46), and those with SNND values of 22-25 cm (OR: 2.94, CI 1.79-4.82). In these women, drinking more than 6 cups of tea a day (OR: 2.15, CI 1.32-3.5), smoking at least 10 cigarettes a day (OR: 2.94, CI 1.78-4.83), and drinking alcohol at least once a week (OR: 2.1, CI 1.12-3.91) were found to be important factors that increased the risk of mastalgia. As a result, it has been found that severe mastalgia complaints cause by obesity, sagging breasts, never giving birth, unemployment anxiety, regular smoking, alcohol use, and excessive tea consumption.

Diagnostic value of modified systemic inflammation score for prediction of malignancy in patients with indeterminate thyroid nodules.

BACKGROUND: Approximately 20% of the thyroid biopsies render an indeterminate (ID) cytology. We evaluated the diagnostic value of preoperative modified systemic inflammation score (mSIS) in predicting the malignancy of ID thyroid nodules (TNs). METHODS: Data of 162 patients with indeterminate TNs were examined retrospectively. The mSIS was calculated as follows: mSIS 0 [patients with albumin (ALB) ≥ 4.0 g/dL and lymphocyte-to-monocyte ratio (LMR) ≥ 3.4], mSIS 1 [ALB < 4.0 g/dL or LMR < 3.4], and mSIS 2 [ALB < 4.0 g/dL and LMR < 3.4]. RESULTS: Patients were classified into mSIS 0 (n = 105), mSIS 1 (n = 34) and mSIS 2 (n = 23) groups. The malignancy rates for the mSIS 0, 1 and 2 groups were 34.3%, 64.7% and 100% respectively. Preoperative mSIS was significantly associated with the presence of thyroid malignancy (p < 0.001). CONCLUSIONS: If the mSIS of patients with ID cytology is 1 or 2, appropriate surgical treatment should be performed without delay, due to the increased risk of malignancy.

The effect of a structured patient education intervention on the quality of life for coronary artery bypass grafting patients: A prospective randomised controlled study.

This study aimed to determine the effectiveness of structured patient education on the quality of life for coronary artery bypass grafting patients. The research included 80 patients (40 control, 40 experimental) who underwent coronary artery bypass graft surgery at the cardiovascular surgery ward of a university hospital in Western Turkey and met the criteria to be included in the sample. The following documents were used to collect data: Patient Information Form, Knowledge Level Form and SF36 Quality of Life Scale. It was determined that the structured planned patient education for coronary artery bypass grafting patients effectively improved the patients' knowledge level and quality of life.

Associated Features with Non-Sentinel Lymph Node Involvement in Early Stage Breast Cancer Patients who Have Positive Macrometastatic Sentinel Lymph Node.

OBJECTIVE: The main goal of this study is to determine the clinico-pathological factors that correlate non-sentinel lymph nodes (LNs) involvement in clinically node negative breast cancer (BC) patients with positive macrometastatic sentinel lymph node (SLN) in order to derive future evidence to define a subgroup where completion axillary lymph node dissection (cALND) might not be recommended. MATERIALS AND METHODS: Total 289 SLN biopsies were performed in clinically node negative BC patients between March 2014 and April 2017. Seventy patients who performed cALND due to positive macrometastatic SLN were retrospectively selected and classified into two groups, according to non-SLN involvement (NSLNI). Clinico-pathological features of patients were examined computerized and documentary archives. RESULTS: Extracapsular extension (ECE) of SLN, number of harvested SLNs, metastatic rate of SLNs, absence of ductal carcinoma in situ (DCIS) and presence of multilocalization were significantly associated with the likelihood of non-SLN involvement after univariate analysis (p<0,05). Absence of DCIS and presence of multilocalization were found to be significant after multivariate analysis. CONCLUSION: Careful examination of clinico-pathological features can help to decide avoiding cALND if enough LNs are removed and the rate of SLN metastases is low, particularly in case DCIS accompanying invasive cancer in patients without multi localized tumour.

The predictive value of physical examination in the decision of laparotomy in penetrating anterior abdominal stab injury.

A selective conservative treatment for penetrating anterior abdominal stab injuries is an increasingly recognized approach. We analyzed patients who followed-up and treated for penetrating anterior abdominal stab injuries. The anterior region was defined as the area between the arcus costa at the top and the mid-axillary lines at the laterals and the inguinal ligaments and symphysis pubis at the bottom. An emergency laparotomy was performed on patients who were hemodynamically unstable or had symptoms of peritonitis or organ evisceration; the remaining patients were followed-up selectively and conservatively. A total of 175 patients with purely anterior abdominal injuries were included in the study. One hundred and sixty-five of the patients (94.29%) were males and 10 (5.71%) were females; the mean age of the cohort was 30.85 years (range: 14-69 years). While 16 patients (9%) were made an emergency laparotomy due to hemodynamic instability, peritonitis or evisceration, the remaining patients were hospitalized for observation. During the selective conservative follow-up, an early laparotomy was performed in 20 patients (12%), and a late laparotomy was performed in 13 patients (7%); the remaining 126 patients (72%) were discharged after non-operative follow-up. A laparotomy was performed on 49 patients (28%); the laparotomy was therapeutic for 42 patients (86%), non-therapeutic for 4 patients (8%), and negative for 3 patients (6%). A selective conservative approach based on physical examination and clinical follow-up in penetrating anterior abdominal stab injuries is an effective treatment approach.

[Hydatid cyst involvement of shoulder and deltoid muscle: a case report]. / Omuz ve deltoid kasta kist hidatik: Olgu sunumu.

Hydatid cyst is seen an endemic disease in many countries in the world. Cysts arising from Echinococcus granulosis occur most commonly in the liver and secondly in the lungs. Primary cystic involvement in the musculoskeletal system without lung or liver involvement is very rare. Treatment consists of surgical resection. Anthelmintic medication before and after surgery can be used. In this article, we present a very rare case of 29-year-old female with hydatid cyst involving shoulder, starting from subcutaneous tissue and extending up to the deltoid muscle. The patient was managed with surgical resection and anthelmintic drugs.