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Today, the demands for emergency health services show an extraordinary increase in cases such as epidemics, earthquakes, natural disasters, and explosions. The accurate estimation of the demand in question will facilitate the crisis management process for extraordinary situations, as it will enable the determination of the number of people who will apply to the emergency services and the effective realization of the relevant resource planning. In this study, it is aimed to estimate the number of applications to an emergency department. For the seasonal data, SARIMA, Holt-Winters and decomposition, which are among the time series analysis methods; Random tree and random forest techniques from machine learning methods are used. For this forecasting study, 396-day "number of patients admitted" data of a hospital located in Ankara is used. Forecasts in each method are performed for seven, fifteen, and thirty days. Correlation corrected square root and average absolute percentage error values are used to determine the most successful one among demand forecasting methods. In the analyzes made, it is observed that SARIMA method gives more effective results than others in forecasting the number of applications to the emergency department. In addition, because of the constantly changing and dynamic nature of the applications made to the emergency services, it is understood that the change in the forecasted number of days has a significant effect on the resulting forecast values. [ABSTRACT FROM AUTHOR]

Earthquakes are the most common type of disaster, which causes life and property loss. After the earthquake, chaotic conditions make the intervention and recovery process difficult. In the management of this process, the resources available (health, shelter, AFAD teams, etc.) it is necessary to successfully allocate it to the debris areas. In the early hours after the earthquakes, the injured are more likely to survive in relation to the severity of injury (heavy and deterrable wounded) and in the correct proportion of the time elapsed; as time progresses, this is less likely. Therefore, the first intervention of the injured from the wreckage must be carried out and those in need must be rushed to the hospital. Therefore, health resources planning is crucial to reducing the devastating effects of the earthquake. In this study, a mathematical model of 0-1 mixed numbers was developed, aimed at minimizing the number of injured people who lost their lives after the earthquake. In the model, it is requested to assign health units (doctors, nurses, equipment) to perform crime scene triage to the debris areas, assign ambulances to the hospital for the transfer of injured people who have been tried at the crime scene, and to decide which hospitals the ambulances should be directed to. The modeling of the model as a markov chain of health changes in the multiperiod and injured people is a contributor to literature. The developed model was tested using the GAMS CPLEX solver with possible earthquake scenario data for the Kirikkale province. The test results show that the model developed can be used as an effective planning tool for healthcare allocation. [ABSTRACT FROM AUTHOR]

Introduction: Multiple endocrine neoplasia 1 (MEN 1) is a rare autosomal dominantly inherited syndrome that results from mutations in the MEN1 gene. It is characterized by multiple tumors of endocrine glands and some other tissues. Early diagnosis is crucial for optimal management. Here we present a patient with delayed diagnosis and preventable metastatic disease. Clinical Case: A 46-year-old male patient who was referred from gastroenterology clinic to our outpatient clinic following distal pancreatectomy. The postoperative pathology was reported as a well-differentiated neuroendocrine tumor (NET) with 3 focuses (60 mm, 9 mm and 2.5 mm in size). Six months ago, he underwent to Magnetic Resonance Imagination (MRI) of the abdomen because of abdominal pain and 17 kg weight loss in a year, that revealed a 69×67 mm cystic lesion in the tail of the pancreas (Figure 1A). Laboratory and physical examinations were in accordance with a nonfunctioning lesion (Table 1). The findings of the Gallium-68 DOTATATE PET/CT suggested residual and metastatic disease during follow-up (At the level of the pancreatic corpus, increased uptake was detected in two lesion sites adjacent to liver segment 3 and in various nodular lesion areas, the largest of which was approximately 20 mm in diameter, adjacent to the duodenum and pancreas (Figure 1B and 1D). No increased uptake was observed in the pancreas and these lesions in preoperative FDG/PET (Figure is not shown). The patient was consultated by oncology clinic and 177-Lutetium-DOTATATE and octreotide treatments were started. Parathyroidectomy and total thyroidectomy 7 years ago was noted in the patient's medical history. Persisting hypercalcemia and elevated PTH were also remarkable in laboratory testing (Table 2). The patient didn't apply to endocrinology clinic after parathyroidectomy and hypercalcemia had been overlooked for 7 years. Further investigation revealed a nonfunctioning 4 mm diameter pituitary lesion (Figure 1C). So the diagnosis of multiple endocrine neoplasia type 1 was suspected. Genetic test detected a c.784-2A>G spice site variant in MEN1 gene in heterozygous form. The patient denied a family history for MEN 1 but he reported that his father died at the age of 40 and his uncle at the age of 39 due to an illness of unknown origin, and two sons of the same uncle were followed up for parathyroid disease. Family screening and genetic counseling were recommended. Surgery of the remaining parathyroid glands and implantation in the forearm and thymectomy were planned. Conclusion: MEN syndromes are rare and hypercalcemia is generally the initial presentation. Persistence of hypercalcemia following parathyroidectomy should be warning, and the possibility of MEN -1 syndrome should also be kept in mind even in the lack of family history. As in the presented case, diagnosis may be delayed due to late appearance of symptoms of other components, especially nonfunctional pancreaticoduodenal tumors. Figure 1. MRI and Ga-68 PET/CT images of the patient A: A 69×67 mm cystic lesion in the tail of the pancreas B: Increased Gallium-68 DOTATATE uptake at the level of the pancreatic corpus adjacent to liver segment 3 (SUVmax: 67.90) C: A nonfunctioning 4 mm diameter lesion in the right half of the pituitary D: Increased uptake of Gallium-68 DOTATATE in nodular lesions adjacent to the duodenum and pancreas (SUVmax: 31.09) Table 1. Laboratory results of the patient ACTH: Adrenocorticotropic hormone, FSH: follicle stimulating hormone, LH: luteinizing hormone, IGF-1: Insülin-like growth factor, TSH: Thyroid stimulating hormone, 1 mg DST: dexamethasone suppression test Table 2. Calcium and PTH levels of the patient before parathyroidectomy and following parathyroidectomy *Before parathyroidectomy ** Following parathyroidectomy PTH: Parathyroid hormone [ABSTRACT FROM AUTHOR]

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Objective: The granulation pattern of pituitary tumors may be important to predict tumor behavior, treatment outcomes, and recurrences. Therefore, we compared densely granulated corticotroph tumor (DGCT) and sparsely granulated corticotroph tumor (SGCT) in terms of clinicopathologic findings. Material and Method: A total of 41 patients (31 females/10 males) were assessed in the study. The granulation patterns were detected by Periodic Acid-Schiff (PAS) and adrenocorticotropic hormone (ACTH) immunoreactivity. Diffuse and strong staining by PAS and ACTH were identified as DGCT, whereas faint staining by PAS and focal, weak staining by ACTH were identified as SGCT. Perinuclear ring-like patterns with low molecular weight keratin were identified as Crooke's cell tumors. DGCTs and SGCTs were compared in terms of clinical findings and treatment outcomes. Results: The majority of the patients (71%) had DGCTs (n=29); whereas 24% of the patients had SGCTs (n=10) and 5% of the patients had Crooke's cell tumors (n=2). DGCTs and SGCTs were similar in terms of age, sex, estimated duration of disease, baseline cortisol and ACTH levels. SGCTs were larger than DGCTs (p=0.034). The remissions with surgery rates were similar between the groups; however, hypothalamic-pituitaryadrenal axis recovery time was longer in SGCTs (p=0.033). Persistent disease after surgery was slightly higher in DGCTs and recurrences were frequent in SGCTs; however, the differences were not statistically significant. Conclusion: DGCTs are often small microadenomas, while SGCTs are larger. Recurrences were slightly more common in SGCTs; however, further studies including larger series are needed to be able to obtain more significant results. [ABSTRACT FROM AUTHOR]