Kıvanç Öncü

Objective: To retrospectively evaluate the demographic and clinical characteristics, presentation timing, diagnosis distribution, hospitalization rates, and 72-hour repeat-visit patterns among patients aged 0 to 17 years presenting to a state hospital pediatric emergency department (PED). Methods: A retrospective cohort study was conducted using electronic health record data from Sinop Atatürk State Hospital (Türkiye) PED between January 1, 2020, and December 31, 2024. A total of 133 880 consecutive patient visits were analyzed. Statistical analyses included descriptive statistics and multivariate logistic regression; robust standard errors and a first-visit sensitivity analysis were applied to account for clustering of repeated visits by the same patient. Results: Of the 133 880 visits analyzed, 53.8% involved male patients, and the mean (SD) age was 7.34 (4.98) years. Upper respiratory tract diseases (ICD-10 codes J06.9, J39.9) were the most common diagnoses, accounting for 37.7% of visits. Presentation volume peaked during the summer season (31.1%) and between 4:00 PM and midnight (48.9%). Respiratory infections predominated in winter, whereas gastrointestinal diagnoses predominated in summer (P < .001). The overall hospitalization rate was 2.6%, rising significantly to 15.0% among infants aged <1 year (P < .001). The 72-hour repeat-visit rate was 6.7% overall, which decreased to 4.7% after excluding follow-up codes (Z00.x). After this adjustment, repeat-visit rates for infants approximated those of other age groups. The crude association between repeat visits and subsequent hospitalization was significant in the full sample (P < .001) but did not persist in the clustering-adjusted sensitivity analysis. Conclusions: Most PED visits did not require hospitalization, exhibiting marked seasonal and diurnal variation. Although the hospitalization rate was significantly higher among infants, unplanned repeat-visit rates were similar across age groups after excluding routine follow-up codes. These findings may inform local health care resource allocation, service capacity optimization, and follow-up planning, particularly for infants and young children.

Background/Objectives: Burn injuries in children represent a significant clinical challenge, as current standard-of-care agents such as silver sulfadiazine (SSD) present limitations, including delayed re-epithelialization. This study aimed to evaluate the therapeutic potential of Castanea sativa (sweet chestnut) flower extract—rich in polyphenols and flavonoids with documented antioxidant, anti-inflammatory, and antimicrobial properties but previously uncharacterized in burn wound healing—applied topically on second-degree burn wounds in a juvenile rat model, comparing its efficacy to SSD and their combination. Methods: Forty five-week-old female Wistar albino juvenile rats were randomly allocated into five groups (n = 8): burn control (Group C), SSD monotherapy (Group BS), vaseline vehicle/sham (Group Sham), 5% chestnut flower extract (Group BCs), and SSD combined with extract (Group BSCs). All topical treatments were applied once daily for 14 days. Healing outcomes were assessed by macroscopic wound closure analysis, systemic organ stress markers (ALT, AST, BUN), oxidative stress indices (MDA, SOD, CAT, GPx, GSH), inflammatory cytokines (TNF-α, IL-1β, IL-6, IL-10), and histopathological/immunohistochemical analyses (Ki-67, VEGF). Results: All active treatment groups demonstrated significant reductions in organ damage markers, oxidative stress burden, and pro-inflammatory cytokine levels, alongside enhanced antioxidant enzyme activity, compared to Group C (p < 0.001). Extract-treated groups exhibited more pronounced suppression of oxidative and inflammatory parameters than SSD monotherapy. The combination group (BSCs) achieved optimal wound healing outcomes, including near-complete re-epithelialization, superior collagen organization, and prominent angiogenesis, corroborated by the highest Ki-67 proliferation index and VEGF expression scores (p < 0.001). Conclusions:C. sativa flower extract significantly accelerates burn wound healing via antioxidant and anti-inflammatory mechanisms. When combined with SSD, a synergistic effect is observed that overcomes the re-epithelialization delays associated with SSD monotherapy. These findings support C. sativa flower extract as a promising candidate for further preclinical and clinical investigation in pediatric burn management, supporting the ethnopharmacological relevance of this plant in traditional wound care practices; further safety and efficacy validation is required before clinical translation.

Background/aim: Invasive mechanical ventilation (IMV) is a fundamental intervention for patients with respiratory failure in intensive care units (ICUs). This nationwide, multicenter point-prevalence study aimed to describe current mechanical ventilation mode preferences (conventional, adaptive, and biphasic) in Turkish ICUs and to report associated clinical outcomes descriptively, without assessing causal relationships. Materials and methods: A nationwide, multicenter point-prevalence study was conducted on 17 April 2024 and included adult patients (≥18 years) who had been receiving IMV for more than 24 h. Data on patient demographics, ventilation mode distribution, ventilatory parameters, and descriptive clinical outcomes on day 28 (weaning status, tracheostomy, and mortality) were recorded without comparative outcome analysis. Results: A total of 426 patients were included. Conventional modes were used in 84.5% of patients, adaptive modes in 10.6%, and biphasic modes in 4.9%. Synchronized intermittent mandatory ventilation (SIMV) was the most commonly used conventional mode. The primary indication for IMV was acute respiratory failure (61%), with pneumonia being the leading cause. Among the 350 orotracheally intubated patients, 25.6% were in the weaning phase on the study day. A total of 59 (16.9%) patients were extubated, 150 (42.9%) underwent tracheostomy, and 64 (18.2%) remained intubated on day 28. Overall, 185 (43.4%) patients died during their ICU stay, 152 (35.7%) remained in the ICU, and 89 (20.9%) were successfully discharged from the ICU. Conclusion: Conventional ventilation modes, particularly SIMV, were more commonly used in Turkish intensive care units (ICUs), whereas adaptive modes were less frequently applied. These patterns may reflect factors such as clinician familiarity, institutional practices, and equipment availability rather than definitive preferences. Although the impact of ventilation modes on clinical outcomes was not comparatively evaluated in this study, the choice of ventilation mode may still influence patient outcomes. Therefore, further prospective and comparative studies are warranted to better elucidate this relationship.

Background Pressure injuries (PIs) are common in intensive care unit (ICU) patients and are associated with increased morbidity, prolonged hospitalization, and elevated healthcare costs. However, reliable biomarkers for early risk stratification remain limited. This study aimed to evaluate whether the Systemic Immune-Inflammation Index (SII), Neutrophil-to-Lymphocyte Ratio (NLR), and Platelet-to-Lymphocyte Ratio (PLR) can predict the risk of PI development in ICU patients. Methods This retrospective cohort study was conducted at Sinop Atatürk State Hospital between January 2023 and June 2024. Adult ICU patients who developed PIs during hospitalization were included. Of the 64 patients, 51 were included in the analysis. Demographics, comorbidities, and laboratory parameters were recorded. SII, NLR, and PLR were calculated at ICU admission and on the day of PI diagnosis. Change ratios and their correlations with time to PI onset were evaluated. Results The mean age of the cohort was 77.6 ± 9.1 years, and 52.9% were female. PIs developed at a mean of 19.4 ± 13 days after ICU admission. Median SII, NLR, and PLR values significantly decreased between admission and diagnosis (all p < 0.001). SII and NLR change ratios showed a significant positive correlation with PI onset time (p = 0.047 and p = 0.011, respectively); PLR did not (p = 0.549). Conclusion Dynamic changes in SII and NLR may reflect systemic inflammation that impairs tissue repair and promotes PI development. Incorporating these markers into risk models could support early detection and prevention. Larger prospective studies are required for validation. Clinical trial number: Not applicable. This study is a retrospective observational analysis and was not registered as a clinical trial.

Drowning is a leading cause of preventable mortality worldwide; however, early in-hospital risk stratification remains limited. Although tools such as the Szpilman score assist in early severity assessment, they may not fully capture the evolving clinical status after admission. This study aimed to develop a simplified and objective model based on readily available parameters to predict in-hospital mortality following seawater drowning. This retrospective study was conducted at a referral emergency department (ED) in northern Turkey between July 1, 2011, and December 31, 2024. Of 190 patients initially included, 166 with complete clinical and laboratory data were analyzed. Data were obtained from institutional and national health information systems. Clinical, physiological, and biochemical variables were assessed. Predictors of in-hospital mortality were identified using receiver operating characteristic (ROC) analysis and multivariable logistic regression. Variables with near-perfect discrimination (e.g., GCS, pH, Szpilman score) were excluded to avoid overfitting. Among the 166 patients, 34 (20.5%) died during hospitalization. CPR and endotracheal intubation rates were significantly higher among non-survivors (CPR: 97.1% vs. 0%; intubation: 97.1% vs. 2.3%; both p < 0.001). Non-survivors also presented with lower GCS (median 3 vs. 15), lower arterial pH, and higher Szpilman scores (all p < 0.001). ROC analysis identified four potential predictors with AUC values between 0.90 and 0.95—pCO₂, lactate, SpO₂, and sodium—all showing significant discriminatory capacity (p < 0.001). These variables were entered into a binary logistic regression model, from which serum sodium (OR = 2.110; 95% CI: 1.310–3.401; p = 0.002) and SpO₂ (OR = 0.902; 95% CI: 0.847–0.961; p = 0.001) emerged as independent predictors. These formed the basis of the SNOP score (Saturation and Natremia-based Outcome Predictor), a two-parameter logistic model demonstrating excellent performance: AUC = 0.996, sensitivity = 99.0%, specificity = 96.2%, and overall accuracy = 98.4%. The SNOP score is a simple, ED-specific tool for early prediction of in-hospital mortality in seawater drowning. It complements existing assessment systems by incorporating objective, admission-based parameters. Prospective multicenter validation is warranted to confirm its clinical applicability and support broader implementation.

Drowning is a significant public health issue, particularly in coastal regions such as Sinop, Turkey, where seasonal variations contribute to a high incidence of cases. However, there is a lack of long-term, population-based studies from the Black Sea region, where distinct environmental factors may influence drowning patterns. This study provides a comprehensive 13-year analysis of seawater drowning cases, including detailed demographic, clinical, and outcome characteristics, to inform prevention strategies and improve emergency response. A retrospective, observational study was conducted on all patients admitted to the regional referral Emergency Department (ED) due to seawater drowning between July 2011 and July 2024. Demographic characteristics, clinical parameters, and outcomes were retrieved from institutional and national health record systems. Descriptive statistical analyses were performed. A total of 198 patients were included, of whom 69.2% were male, with a mean age of 29.6 years. The majority of cases (over 82%) occurred in July and August, and 51% involved tourists. Cardiopulmonary resuscitation (CPR) was performed in 17.7% of patients. Trauma was documented in 7.1% of patients; among these, the most commonly affected regions were the extremities (50.0%) and the head (35.7%). Laboratory analysis showed elevated lactate levels and reduced pH. On admission, most patients had preserved neurological status, while 19.2% presented with severe impairment (GCS ≤8). According to the Szpilman score, 37.9% had mild and 17.7% severe symptoms. The overall mortality was 19.7%, and 22.2% of patients required admission to the intensive care unit (ICU). Notably, 35.9% of all fatal cases (n = 14) involved individuals who drowned while attempting to rescue others. Drowning imposes a substantial burden in coastal regions, disproportionately affecting young males during the summer. Our findings highlight the need for enhanced emergency preparedness and structured clinical response, as well as public education on water safety and safe rescue practices. These findings contribute valuable insight for developing regional and international strategies to mitigate drowning outcomes. Not applicable. This study is a retrospective observational analysis and was not registered as a clinical trial.

Introduction This study aimed to analyze the costs of emergency department (ED) visits among patients aged 65 years and older, with a particular focus on the financial burden of recurrent admissions within a one-year period. Methods A retrospective cross-sectional study was conducted on 143,909 ED visits recorded between January 1, 2014, and December 31, 2014, at the Emergency Department of Ankara Atatürk Training and Research Hospital, Ankara, Turkey. Data for patients aged 65 and older were extracted from the Hospital Information Management System. Cost data were based on the Social Security Institution billing system and converted into US dollars (USD) using the 2014 exchange rate. Patients were categorized by age, gender, diagnosis, and visit frequency. Nonparametric statistical tests were used due to the non-normal distribution of cost variables. A p-value < 0.05 was considered statistically significant. Results A total of 21,458 (15.0%) ED visits were made by patients aged 65 and older. The median cost per visit in this group was $58.16. Costs increased with age: $42.90 for patients aged 65-74, $76.67 for those aged 75-84, and $96.42 for those aged ≥85 (Kruskal-Wallis H = 1,125.3, df = 2, p < 0.001). Among the 19,159 elderly patients who visited the ED, 1,951 (10.2%) had recurrent visits. Within this subgroup, internal medicine diagnoses were most common (1,345 visits, or 68.9%), followed by pulmonary (320, or 16.4%), cardiovascular (211, or 10.8%), and non-specific complaints (231, or 11.8%) as the leading causes. This diagnostic distribution differed significantly from that of single-visit patients (χ² = 42.7, df = 3, p < 0.001). Recurrence rates varied significantly by diagnostic category (χ² = 89.4, df = 5, p < 0.001): the highest recurrence was observed in patients with hematologic conditions (56/355, or 15.8%; adjusted OR = 1.72, 95% CI: 1.28-2.31), followed by psychiatric (8/57, or 14.0%; adjusted OR = 1.45, 95% CI: 0.99-2.12) and pulmonary diagnoses (320/2,358, or 13.6%; adjusted OR = 1.38, 95% CI: 1.22-1.57), all above the overall recurrence rate of 10.2%. The median cost of the first ED visit was significantly higher in the recurrent group ($72.13) compared to the non-recurrent group ($59.76) (Mann-Whitney U = 14.2 × 10⁶, p < 0.001, r = 0.14). Among recurrent cases, the mean cost of the first visit ($101.84) exceeded the average cost of subsequent visits ($93.98) (Wilcoxon T = 2.4 × 10⁵, p < 0.001, r = 0.09). Conclusion Older patients generate disproportionately higher ED costs in Turkey, particularly those with recurrent visits and chronic conditions. These findings support the implementation of geriatric-focused emergency care models and preventive strategies to optimize resource utilization in aging populations.

Kronik yaralar, fizyolojik iyileşme sürecinin tamamlanamadığı, genellikle yetersiz anjiyogenez, bozulmuş innervasyon veya hücresel göç gibi nedenlerle ortaya çıkan yaralardır. Bu bölümde, kronik yara kavramı ve yaygın türleri ele alınmıştır. Venöz ülserler, basınç kaynaklı yaralar, diyabetik ayak ülserleri, iskemik ülserler, malignite ile ilişkili ülserler ve hipertansif ülserler gibi farklı kronik yara türlerinin özellikleri ve nedenleri detaylı bir şekilde açıklanmıştır. Ayrıca, karma etiyolojilere sahip yaraların önemi ve bu tür yaraların değerlendirilmesi, sınıflandırılması ve yönetimine yönelik genel prensipler vurgulanmıştır. Kronik yaraların doğru tanımlanması ve tedavi yaklaşımlarının bireyselleştirilmesi, iyileşme oranlarının artırılması için kritik öneme sahiptir. Chronic wounds are characterized by the failure to complete the physiological healing process, often due to insufficient angiogenesis, impaired innervation, or cellular migration. This chapter explores the concept of chronic wounds and their common types. Conditions such as venous ulcers, pressure injuries, diabetic foot ulcers, ischemic ulcers, malignancy- related ulcers, and hypertensive ulcers are discussed in detail, focusing on their characteristics and underlying causes. Additionally, the importance of identifying mixed etiology wounds and the principles of assessment, classification, and management for such conditions are emphasized. Accurate diagnosis and individualized treatment approaches are crucial for improving healing outcomes in chronic wound management.

Kronik Yara Kavramı ve Çeşitleri Kıvanç ÖNCÜ Yara İyileşmesinin Fizyolojisi Dilek SAĞIR Yara İyileşmesinde Büyüme Faktörleri ve Sitokinlerin Etkileri Burcu DEMİREL YILMAZ Kronik Yara Tedavisi ve Bakımı Anıl ÇELEBİ Hilal Büşra KAYA ÇELEBİ Biyofiziksel ve Biyolojik Teknolojiler İle Yara İyileşmesinin Yönetimi: Negatif Basınçlı Yara Tedavisi Özhan ÖZCAN Biyofiziksel ve Biyolojik Teknolojiler İle Yara İyileşmesinin Yönetimi: Elektriksel Stimülasyon, Işın Tedavisi, Topikal Oksijen Tedavisi, Ozon Tedavisi, Larva Tedavisi, Jet Lavage İrrigasyon Sistemi, Düşük Yoğunluklu Lazer Tedavisi ve Ultrasound Tedavisi Özhan ÖZCAN Hiperbarik Oksijen Tedavisi ile Yara İyileşmesi Hatice CEYLAN Yara İyileşmesinde Kök Hücre Tedavisi Canan VEJSELOVA SEZER Yara Bakımında Kullanılan Pansuman Materyalleri Sezgin UZUN Yara Gelişiminin Önlenmesi ve Yönetimi Bilge BAL ÖZKAPTAN

Heparin, a naturally occurring polysaccharide belonging to the glycosaminoglycans (GAG) family, is ubiquitously found in mast cells. Unfractionated heparin is the least processed form of natural GAG, purified from animal tissue. In a 67-year-old female patient diagnosed with hypertension and asthma, who suffered a femoral fracture due to a fall, intravenous heparin sodium was administered for thromboembolic treatment in the postoperative period following closed reduction. Subsequently, respiratory distress, loss of consciousness, and cardiac arrest occured following profound hypotension. The patient, whose clinical findings were evaluated as anaphylaxis, was successfully resuscitated with prompt intervention. Despite immune-mediated reactions and Heparin-Induced Thrombocytopenia (HIT) being commonly encountered side effects in clinical practice, it is crucial for all healthcare professionals to recognize that widely used anticoagulant agents such as heparin sodium can lead to fatal complications.