Displacement after a war or an armed conflict always leads to unexpected health problems, both among migrating people and in places to which new people have migrated. This study aimed to determine the health care needs and trends of Syrian patients. This retrospective study was conducted in a secondary care hospital in the city of Nevşehir, in central Turkey, between January 2013 and December 2017. All Syrian patients who visited the outpatient clinics and emergency department (ED) were enrolled in the study. Over a span of five years, 41 723 Syrian patients visited the hospital's outpatient clinics and ED. The patients' median age was 23 (inter-quartile range (IQR) = 7-34), and 57.7% of them were female. In 2017, one-third of the Syrian patients visited the ED, a rate that was higher than that found among local patients (30.3% vs 25.0%, P < 0.001, respectively). The rate of pediatric clinic admissions among Syrian patients was about four times greater than the rate of local patients (20.1% vs 5.2%, P < 0.001, respectively), and Syrians' rate of admission to the obstetrics and gynecology clinic was about three times greater than the rate of local patients' admissions (12.3% vs 4.3%, P < 0.001, respectively). This study showed that Syrian patients' visits to the hospital, and especially the ED, are increasing. Further, the needs and expectations of these patients in terms of health care are different from local demands. New approaches should be applied to provide an appropriate use of health care facilities.

Turkthoracj, Turkish Thoracic Journal

OBJECTIVES: Sternal fractures (SFs) are rare pathologies that mainly occur as a result of traffic accidents, which can cause mortality due to concomitant complications. In this study, we aimed to evaluate clinical processes and termination status of patients diagnosed with a SF in the emergency department. METHODOLOGY: Patients diagnosed with a SF in the emergency department during 8 years were retrospectively reviewed. The demographic and clinical characteristics of the patients were recorded, and standard data forms were created. RESULTS: In total, 128 patients were included in the study; 81 (63.3%) patients were male, and the mean age was 49.4 years. When the fracture mechanism was examined, car traffic accidents were the most common type and the cause of fracture in 85 (66.4%) patients. The most common thoracic pathology accompanying SFs was rib fractures (35.9%), and the most common extrathoracic pathology was cranial pathology (27.3%). Pericardial effusion was detected in 12 (9.4%) patients. Of the participating patients, one died and the others were hospitalized. CONCLUSION: Since SFs and associated complications can be life-threatening, emergency room physicians should consider it in the diagnosis. In particular, the necessary examinations and follow-up should be done to assess cardiac damage.

Amaç: Geriatrik travma hastalarındaki demografik özellikleri, travma şiddet skorları, travmanın oluş mekanlarını, hastalara istenen konsültasyonları ve sonlanış şekillerini tespit etmeyi hedefledik. Aynı zamanda olayın oluşu ile acil servise başvuru arasında geçen sürenin ve travma skorlarının mortalite ile ilişkisini ortaya çıkarmayı amaçladık. Gereç ve Yöntem: Bu çalışma retrospektif olarak 01.01.2011-31.12.2011 tarihleri arasında Erciyes Üniversitesi Tıp Fakültesi Acil servisine 65 yaş ve üzeri başvuran 250 hasta ile yapılmıştır. Cinsiyet, yaş, travmadan sonra geçen süre, travma mekanizması, tanılar, istenilen konsültasyonlar, yaralanma bölgesi, GKS, ISS ve sonlanış şekilleri araştırılmıştır. Bulgular: Bu hastaların %51,6’sı kadın, %48,4’ü erkektir. Hastaların yaş ortalaması 73,3’tür. Hastaların %32,4’ü ilk 1 saatlik zaman diliminde iken %11,2’si ilk 24 saatlik zaman dilimi sonrası acil servise müracaat etmiştir. Hastalarda sırasıyla en çok yumuşak doku travması (%36,4) saptanmışken travma bölgelerine de bakıldığında en sık %51,6 oranla ekstremite olduğu da tespit edilmiştir. Hastaların 86’sına herhangi bir branştan konsultasyon istenmezken; 79 hastaya ortopedi, 44 hastaya beyin cerrahi konsültasyonu istenmiştir. Çalışmadaki hastaların %54,8’i acil servisten tedavi sonrası taburcu olmuş, %28,4’ü servise yatmış, %12’si yoğun bakım şartlarında takibe alınmış ve %4,8’i yani 12 hasta exitus olmuştur. Hastaların acil servise başvuru süreleri, GKS ve ISS puanları ile acil serviste sonlanışları kıyaslanmış ve istatistiksel olarak anlamlı ilişki tespit edilmiştir. Sonuç: Geriatrik travma hastaları genç hastalara göre daha mortal ve morbid seyretmektedir. Yaşlılığa bağlı olarak genellikle medikal ek problemleri de mevcuttur. Tedavi süreçleri daha zahmetli ve emek istemektedir. Bu nedenle hastalar daha dikkatli ve multisistemik olarak değerlendirilmelidir.

Background: Risk scores and shock index used in upper gastrointestinal system (GSB) bleeding have an important place in determining the treatment and clinical course of the patient. The aim of this study is to evaluate the predicted success in mortality by analyzing shock indices together with Glasgow Blatchford Scoring (GBS) and Rockall Scoring (RS), whichare used in upper GI bleeding. Methods: This study was conducted with a retrospective analysis of patients who were hospitalized with a diagnosis of upper GI bleeding from the emergency department of a single-center secondary care health institution. For each patient, age, gender, treatment procedures performed in the emergency department or clinic, and endoscopy results were evaluated. Mortality and discharge status of the patients were compared with the scoring values. Result: 86 patients were evaluated in the study. The average age was 69.09±19.07 and the most applications were in the 61-79 age range (48.8%). The most common presenting complaints of the patients were bloody vomiting and black stools. On physical examination, melena was positive in 64% of the patients. 89.5% of the patients were treated in intensive care. The mortality rate was 10.5%. In patients with death, the shock index value was ≥0.75 in all patients and the average was 1.07. As a result of the study, it was seen that GBS, RS and shock index were successful in predicting mortality. Conclusion: Current scoring systems need to be developed in order to manage patients with upper GI bleeding, which is frequently seen in emergency departments today, more quickly and to reduce patient costs.