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Background: Inaccurate test results may be a reason why vitamin D deficiency is seen as a common problem worldwide. Interferences from the sample matrix during testing are the most important factors in measurement errors. In this study, the relationship between triglycerides and total cholesterol levels and vitamin D levels in Turkey was investigated. Methods: The 25-hydroxyvitamin D test results and lipid test results studied in Turkey in 2021 were compared. Data were obtained from the Ministry of Health National Health Database. Simultaneously, 25-hydroxyvitamin D, triglyceride, and total cholesterol levels were studied, and 1,135,644 test results were taken as the basis. Results: In the group of patients with total cholesterol levels between 0-10.33 mmol/L, the proportion of patients below 20 mg/L ranged from 56.8% to 61.8%. In the patient group with cholesterol between 10.36-259 mmol/L, the rate of patients with less than 20 mg/L was between 70.8-100%, while the rate of patients with cholesterol above 100 mg/L was 0%. The mean 25-hydroxyvitamin D level was 20.1 mg/L in the patient group with a total cholesterol level between 0-10.33 mmol/L, and 16 mg/L in the patient group with a cholesterol level above 10.36 mmol/L. The mean 25-hydroxyvitamin D level was 20.11 mg/L in the patient group with triglycerides 0-10.16 mmol/L, and the 25-hydroxyvitamin D level was 12.28 mg/L in the patient group with triglycerides 10.17-113 mmol/L. The proportion of patients with vitamin D levels above 100 mg/L was found to be 0% in the group of patients with triglycerides above 10.17-113 mmol/L. Conclusions: According to this study, there is a risk of toxicity when administering vitamin D therapy in patients with high cholesterol and triglycerides levels. This study is the first of this size in the literature. High triglycerides and cholesterol levels can cause inaccurate measurement of vitamin D levels, so care should be taken when evaluating these tests.

Background: Across the world, 25-hydroxyvitamin D (25-OHD) deficiency is a major health problem associated with many chronic diseases in the geriatric population. Prior to this study, there were no data regarding 25-OHD levels among individuals over the age of 65 in Turkey. The aim of this study was to assess 25-OHD levels and seasonal variations in these values among people over the age of 65 in Turkey. Methods: This study included vitamin D measurements taken in 2016, 2017, and 2018 from the Turkish population over the age of 65. The age, gender, and seasonal average data of the study population were defined. The study data were obtained from the database of the Ministry of Health, and a Kolmogorov-Smirnov test was used to assess the distribution of the data. Medians and interquartile ranges (IQRs) were calculated for all categories, as the data were nonparametric. Results: The number of vitamin D measurements taken from the geriatric individuals included in this study was 305,329 for 2016, 576,452 for 2017, and 752,837 for 2018. The medians and IQRs of the 25-OHD levels in this population were 16 mg/L (IQR 7.45-24.55 mg/L) for 2016, 16.1 mg/L (IQR 7.8-24.4 mg/L) for 2017, and 16.4 mg/L (IQR 8.95-23.85 mg/L) for 2018. Conclusions: While the 25-OHD levels of older men tended to increase during the period of seasonal sunlight in Turkey, this variability was observed in elderly women. This suggests that older women tend to live more sedentary lives and have insufficient sun exposure. Overall, the median 25-OHD levels of individuals over the age of 65 tended to decrease each year.

Objectives: This comprehensive study aimed to describe the epidemiologic and demographic distribution of slipped capital femoral epiphysis (SCFE) in Türkiye, a condition that globally presents at a rate of 10.8 cases per 100 000 children. Utilizing data from the Ministry of Health, we examined the specifics of SCFE in Türkiye, comparing the findings with those of other populations to clarify the country's unique epidemiological profile., Methods: In this retrospective analysis, the Ministry of Health's database was used to extract medical records of children under the age of 16 diagnosed with SCFE from 2016 to 2023. Patients were evaluated based on sex, age at diagnosis, comorbidities, complications, time of diagnosis and BMI., Results: Our analysis identified 720 children with SCFE, with the average age at diagnosis being 12.9 years. The prevalence of SCFE in Türkiye was found to be 0.005% for the year 2022. The occurrence of SCFE showed no correlation with seasons. It was noted that the majority of patients received treatment at university and high-level hospitals (59.9%), with none being treated at lower-level public hospitals. A total of 58 patients were found to have additional growth and developmental diseases. Notably, only 33 cases (4.6%) involved avascular necrosis during follow-up., Conclusion: This study provides the first epidemiological and demographic analysis of SCFE in Türkiye. Interestingly, our data suggest that male patients are twice as likely to develop SCFE compared to their female counterparts., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: The study addresses the growing number of hemodialysis (HD) patients undergoing joint arthroplasty, who are at higher risk of complications and mortality. Previous research has often overlooked deaths after discharge. This study aimed to examine early outcomes in a large nationwide cohort of patients who underwent arthroplasty for elective and fracture-related reasons., Methods: Between 2016 and 2022, a study was conducted using the e-Nabız database of the Türkiye Ministry of Health, focusing on patients aged 18 years and above who underwent elective or fracture-related arthroplasty. This study included 1,287 patients reliant on dialysis who underwent total hip arthroplasty, total knee arthroplasty, or hemiarthroplasty (HA), with 7.7% of them receiving dialysis for the first time. Propensity score matching was used to create an equally sized group of non-dialysis-dependent patients, ensuring demographic balance in terms of age, sex, a comorbidity index, and surgery type. The primary objective was to compare mortality rates 10, 30, and 90 days after arthroplasty., Results: The first-time dialysis patients who underwent HA had significantly higher 30- and 90-day mortality rates compared to the chronic dialysis group (P = .040 and P < .001, respectively). Also, the HD patients consistently exhibited higher 90-day mortality rates across all surgery types. With total knee arthroplasty, HD patients had a mortality rate of 8.7%, in stark contrast to 0% among non-HD patients (P < .001). Similarly, with total hip arthroplasty, HD patients had a 12% mortality rate, while non-HD patients had a markedly lower rate of 2.7% (P = .008). In the case of HA, HD patients had a significantly elevated 90-day mortality rate of 31.9%, in contrast to 17.1% among non-HD patients (P < .001)., Conclusions: Joint arthroplasty has higher rates of mortality and complications among HD patients. Surgical decisions must be based on patients' overall health, necessitating collaboration among specialists. These patients should be closely monitored., (Copyright © 2024 Elsevier Inc. All rights reserved.)

We evaluate the epidemiology and incidence of pediatric proximal femur fractures, treatment trends among different hospital levels, and complication rates among different treatment modalities by examining a national health registry in Türkiye. The health records of individuals aged ≤16 years admitted to public, private, and university hospitals were collected via the e-health database of the Turkish Ministry of Health. A total of 2388 children treated for proximal femur fractures from 2016 to 2021 with at least 2 years of follow-up were included in the study. While 2033 (85.1%) patients were treated with closed reduction and spica casts, 355 (14.8%) were operated on. Mean age was 8.603 ± 5.11 years. Male incidence was 2-fold greater compared to female patients (36.4% female and 63.6% male patients; P <  0.001). The frequency of cases was significantly increased in the age groups of 3-4 and 13-16 years. Comorbidities causing limited ambulation were detected in 6.5% of all cases, and 163 (8.0%) patients in the conservative group and 98 (27.6%) patients in the surgery group had at least one complication. The incidence was 0.45 per 100 000 children aged ≤16 years. This study reports the largest patient cohort to date, providing evidence on the epidemiology and incidence of pediatric proximal femur fractures using health registry data. We have found that the most common treatment modality for proximal femur fractures is closed reduction with spica casts. The rate of avascular necrosis is similar among patients treated surgically and those treated conservatively., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: This study evaluated national trends in cemented and uncemented reverse shoulder arthroplasty (RSA) for proximal humerus fractures using a comprehensive national surgical database. This study aimed to compare RSA used in the treatment of proximal humerus fractures with the literature and to determine the country's trend., Methods: A cross-sectional study was conducted using the health records of individuals aged ≥ 18 years who underwent RSA for proximal humerus fractures between 2016 and 2022. Patients were divided into cemented and uncemented groups, and demographic data (age, sex), duration of hospital stay, transfusions, revisions, mortality, and Charlson Comorbidity Index (CCI) scores were analyzed., Results: A total of 618 cemented RSA and 1,364 uncemented RSA procedures were reviewed. Patients who underwent cemented RSA were significantly older than those who had uncemented RSA ( p = 0.002). Transfusion rates were higher in the cemented RSA group ( p = 0.006). The frequency of revision surgery was 6.1%. Younger age and male sex were associated with revision ( p < 0.001). CCI scores were higher among transfused patients than non-transfused patients ( p < 0.001). The incidence of cemented RSA was 11.7% and 49% in 2016 and 2022, respectively. Differences were found among hospital types and geographical regions., Conclusions: While cemented RSA has been gaining attention and increased application in recent years for proximal humerus fractures, uncemented RSA still predominates. The choice between these 2 methods is largely influenced by regional and hospital-level factors. The type of RSA and high CCI scores were found to have no significant impact on the risk of surgical revision., Competing Interests: CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported., (Copyright © 2024 by The Korean Orthopaedic Association.)

Background: Scientific evidence regarding the impact of different combinations of diabetes medications in heart failure patients with diabetes mellitus (HFwDM) remains limited., Aim: We aimed to investigate the effect of monotherapy and combination therapy for DM on all-cause mortality in HFwDM under triple guideline-directed medical therapy (GDMT)., Method: This nationwide retrospective cohort study included adult HFwDM under triple GDMT between January 1, 2016 and December 31, 2022.We collected the data from the National Electronic Database of the Turkish Ministry of Health.We created various combination including different diabetes medications based on the current guidelines for DM.The primary endpoint was all-cause mortality., Results: A total of 321,525 HFwDM under triple GDMT (female:49%, median age:68[61-75] years) were included. The highest rate of prescribed combination therapy was metformin and sulfonylureas (n = 55,266). In Cox regression analysis, insülin monotherapy had the highest risk for all-cause mortality (HR:2.25, 95CI%:2.06 - 2.45), whereas combination therapy including metformin, SGLT2i, and sulfonylureas provided the most beneficial effect on survival (HR:0.29, 95CI%:0.22-0.39) when compared to patients not receiving diabetes medication. Among patients taking diabetes medications, the inclusion of SGLT2i demonstrated a survival benefit (p < 0.05), despite concurrent use of volume-retaining medications such as insulin and thiazolidinediones. Conversely, combinations of diabetes medications without SGLT2i did not demonstrate any survival benefit compared to patients not taking diabetes medication (p > 0.05)., Conclusion: This study underscored the use of SGLT2i as monotherapy or as a part of combination diabetes medications to improve survival among HFwDM, while also highlighting that combinations lacking SGLT2i did not confer any survival benefit., (Copyright © 2023. Published by Elsevier B.V.)

Objective: Osteogenesis imperfecta is a rare connective tissue disorder with an estimated number of 4-20 cases per 100 000 inhabitants. Although the prevalence differs among regions, there are only a few number of national registry studies published previously. The aim of this study was to determine the prevalence of osteogenesis imperfecta among the pediatric age group in Türkiye, together with the patient and hospital characteristics., Methods: Via the e-health database of the Turkish Ministry of Health, we collected and retrospectively evaluated the medical records of the patients who were under 18 years of age with the diagnosis of osteogenesis imperfecta between 2016 and 2022. Total number of fractures, treatment modalities, and the hospital characteristics were also recorded. Two thousand seven hundred forty patients were extracted with a mean age of 9.77 ± 4.81 years., Results: The prevalence of osteogenesis imperfecta in Türkiye among the pediatric population was calculated as 11.6 per 100 000 individuals. The median annual incidence was 31.5 per 100 000 live births between 2016 and 2022. There were 17.4 hospital admissions per patient per year. The mean age at the time of in-hospital mortality was 4.08 ± 5.03 years. The fracture rate per patient per year was 0.56 and conservative treatment was the most commonly preferred modality for all ages., Conclusion: This is the first registry-based nationwide study of osteogenesis imperfecta patients in Türkiye, providing important characteristics of the disease. Together with the help of the ongoing development of national health database systems, precision in patient identification would yield substantial benefits in terms of management of osteogenesis imperfecta., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: The artificial intelligence competition in healthcare at TEKNOFEST-2022 provided a platform to address the complex multi-class classification challenge of abdominal emergencies using computer vision techniques. This manuscript aimed to comprehensively present the methodologies for data preparation, annotation procedures, and rigorous evaluation metrics. Moreover, it was conducted to introduce a meticulously curated abdominal emergencies data set to the researchers., Methods: The data set underwent a comprehensive central screening procedure employing diverse algorithms extracted from the e-Nabız (Pulse) and National Teleradiology System of the Republic of Türkiye, Ministry of Health. Full anonymization of the data set was conducted. Subsequently, the data set was annotated by a group of ten experienced radiologists. The evaluation process was executed by calculating F 1 scores, which were derived from the intersection over union values between the predicted bounding boxes and the corresponding ground truth (GT) bounding boxes. The establishment of baseline performance metrics involved computing the average of the highest five F 1 scores., Results: Observations indicated a progressive decline in F 1 scores as the threshold value increased. Furthermore, it could be deduced that class 6 (abdominal aortic aneurysm/dissection) was relatively straightforward to detect compared to other classes, with class 5 (acute diverticulitis) presenting the most formidable challenge. It is noteworthy, however, that if all achieved outcomes for all classes were considered with a threshold of 0.5, the data set's complexity and associated challenges became pronounced., Conclusion: This data set's significance lies in its pioneering provision of labels and GT-boxes for six classes, fostering opportunities for researchers., Clinical Relevance Statement: The prompt identification and timely intervention in cases of emergent medical conditions hold paramount significance. The handling of patients' care can be augmented, while the potential for errors is minimized, particularly amidst high caseload scenarios, through the application of AI., Key Points: • The data set used in artificial intelligence competition in healthcare (TEKNOFEST-2022) provides a 6-class data set of abdominal CT images consisting of a great variety of abdominal emergencies. • This data set is compiled from the National Teleradiology System data repository of emergency radiology departments of 459 hospitals. • Radiological data on abdominal emergencies is scarce in literature and this annotated competition data set can be a valuable resource for further studies and new AI models., (© 2023. The Author(s), under exclusive licence to European Society of Radiology.)

Introduction: Pulmonary arterial hypertension (PAH) is a leading cause of mortality in systemic sclerosis (SSc). This nationwide study aims to describe real world treatment characteristics and assess survival rates of patients with SSc-PAH., Methods: In this retrospective cohort study, patients with SSc-PAH were identified from Turkish Ministry of Health National Electronic Database (from January 2016 to September 2022), using ICD-10 codes. Data on demographics, treatment characteristics, and death was collected. Kaplan-Meier curves were used to calculate cumulative probabilities of survival at 1, 3, and 5 years., Results: Five hundred forty-seven patients (90.7% female) with SSc-PAH were identified. Median age at PAH diagnosis was 59.9 (50.0-67.4) years. During a median follow-up duration of 3.2 (1.5-4.8) years, 199 (36.4%) deaths occurred. Estimated survival rates at 1, 3, and 5 years were 90.2%, 73.2%, and 56.6%, respectively. Survival was similar among patients with and without interstitial lung disease (p = 0.20). Patients who used immunosuppressives had better survival than those who did not (p < 0.001). No difference was observed in survival rates according to initial PAH-specific treatment regimen (monotherapy or combination) (p = 0.49)., Conclusion: Compared to most of historical cohorts, higher survival rates for SSc-PAH were observed in this study. Early diagnosis of PAH may have contributed to these findings. The impact of immunosuppressive therapy on prognosis of SSc-PAH needs to be further investigated in prospective studies. Key Points • Early diagnosis is pivotal for better outcomes in SSc-PAH. • Implementation of PAH treatment guidelines in routine clinical practice is still poor and should be improved. • Effect of immunosuppressive therapies on disease course has to be defined in SSc-PAH., (© 2024. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).)

Background: Many studies on multiple sclerosis (MS) reveal different prevalence and epidemiologic results., Objectives: In this study, we aimed to determine the epidemiologic profile of MS using official health records in Turkey., Methods: Patients diagnosed with MS from the official health data of the Ministry of Health, representing the entire population of Turkey, were included in the study. Prevalence and incidence calculations were performed using the data on gender, age, year of birth, city of residence, and year of diagnosis., Results: As a result of the study, the number of patients with the ICD code G35 was determined as 201,061 and the number of patients with this code entered at least three times was determined as 82,225. The prevalence of MS in Turkey was calculated as 96.4 per 100,000 and the female/male ratio as 2.1/1. The incidence of MS in 2022 was 6.2 per 100,000 and the mean patient age was 43.1 ± 13.3 years (female: 43.0 ± 13.1 vs male: 43.2 ± 13.7) while the mean age at first diagnosis was 34.0 ± 13.0 (female: 33.6 ± 12.6 vs male: 34.9 ± 13.7)., Conclusion: The research was conducted via Official Database of Turkey, which includes population of 85 million and provides valuable insights into the prevalence and incidence rates of this chronic disease., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background/aim: Our primary aim was to investigate the effects of concomitant celiac disease (CD) on the clinical characteristics of Behçet's syndrome (BS) patients., Materials and Method: The study was a retrospective, nationwide, multicenter study. Turkish Ministry of Health National Electronic Database (e-Nabız) is used under Health Ministry's supervision to extract the subject's data., Statistical Analysis: Statistical analyses were made by the Statistical Package for Social Sciences (SPSS) software version 20 (IBM Corp., Armonk, New York). Continuous variables were presented by mean ± standard derivation (SD) or median (min-max) according to normality and compared by student-t test. A binary logistic regression analysis was performed to further investigating the relation between having a concomitant CD with each BD manifestation and comorbidity, frequencies of which were detected to be significantly different in the student-test., Results: A total of 84,241 patients diagnosed with BS were analyzed, and CD was identified in 175 (0.21 %) patients. The group with CD had a mean age of 41.30 ± 13.69 which was significantly younger. the prevalence of females was significantly higher (71.4%). The mean age of first admission for BS was also significantly younger in the group with CD (36.64 ± 13.28). BS patients with CD had a significantly higher prevalence of inflammatory bowel disease (27.2% vs. 7.3%, p < 0.001). When comorbid conditions were investigated depression (35.4% vs. 23.3%, p < 0.001), migraine (7.4 % vs. 2.6%, p < 0.001), fibromyalgia (10.9% vs. 4.5%, p < 0.001) and osteoporosis (12.6% vs. 6.6%, p = 0.001) were significantly more frequent in BS patients with CD., Conclusion: Our results suggest coexistence of CD in BS patients is related to female dominance and probably to an earlier disease onset. Several CD-related comorbidities as well as inflammatory bowel disease were more frequent in the CD group which implied an increased overall disease burden., Competing Interests: Conflict of interest: The authors declared no conflict of interest., (© TÜBİTAK.)

Extensive research into dementia has more recently honed in on several key areas. These areas include the advancement of techniques such as the accumulation of amyloid-β and tau proteins, the monitoring of cerebral hypometabolism rates etc. The primary objective of this study is to explore the intricate interplay between Alzheimer's disease (AD)-other dementias (D) and various chronic illnesses in terms of time, intensity, and connectivity. In this context, we retrospectively examined data of 149,786 individuals aged 65 and above who received diagnoses of AD and D in the year 2020. At first, logistic regression (LR) analysis has been made with "sex", "age" and "foreigner" (citizenship status) independent variables for AD and D. The LR models shows that while "sex" and "age" variables have a small rate on the risk of developing AD/D, it is detected that being a foreigner increase the risk of AD and D as 69.8% and 88.5% respectively. Besides, the LR models have middle-level success prediction rate for both of the two dependent variables. Additionally, we used the parallel coordinates graphs method within the R Studio to visualize their relationships and connections. The findings of this investigation strongly suggest that AD/D don't stand as isolated conditions, but rather stem from intricate interactions and progressive processes involving diverse chronic diseases over time. Notably, ailments including hypertension, coronary artery disease, diabetes, hyperlipidemia, and psychological disorders, contribute substantially to the emergence of both AD and D. This study highlights that the fight against AD/D can only be possible with next-generation prophylactic interventions that can predict and manage risks. Such an approach holds the potential to potentially lower AD and dementia to levels that are amenable to treatment., (© 2024. The Author(s).)

Objectives: The study aimed to define the epidemiology of osteoporosis and low bone mass based on bone mineral density at the femoral neck and the lumbar spine in adults 50 years and older in Türkiye., Patients and Methods: The retrospective study included all patients diagnosed with osteoporosis with a bone mineral density scan between January 2016 and May 2023 in the e-Nabız database, a government-run online healthcare database including over 68 million of active users. The data was categorized according to patient demographics, presentation age (0-17, 18-64, and >65 years), geographic regions, and healthcare levels., Results: A total of 4,253,039 patients (723,863 [17.0%] males, 3,529,176 [83.0%] females) were diagnosed with osteoporosis. Of the patients, 2,432,607 (57.2%) belonged to the 18-64 years age group, 1,783,690 (41.9%) were in the >65 years group, and 36,742 (0.9%) were in the 0-17 years group. The mean age at presentation was 61.1±14.4 (range, 0 to 110) years. The Marmara region had the highest number of cases with 1,330,325 (31.3%), and the Aegean region had the lowest with 194,009 (4.6%). Istanbul had the highest rate of osteoporosis as a province (18.4%), followed by Ankara (7.5%). The lowest rates were recorded in Bayburt (0.0%) and Tunceli (0.1%), respectively., Conclusion: Registry studies provide reliable information in epidemiological studies. In this study, the first of its kind in Türkiye, we reported the geographical distribution of osteoporosis. As expected, there were more osteoporosis patients in the more densely populated areas of the country. Secondary and tertiary care centers had more entries compared to primary care centers. The annual incidence of osteoporosis showed a declining trend over the years., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2024, Turkish Society of Physical Medicine and Rehabilitation.)

Introduction: Scoliosis is characterized as a three-dimensional deformity of the spine, affected by variety of factors, including biological, mechanical, hormonal, and genetics., Methods: Our study's primary objective was to delineate the demographics, incidence, and prevalence of scoliosis from a nationwide perspective, analyze the surgical intervention rates, with the aim of offering more insightful guidance to orthopedic physicians. This nationwide cohort study was conducted from digital database for healthcare information management. Relevant population data, for children under 18 years old, was extracted from the official government census within the period of January 2015 to December 2022. Utilizing diagnostic code of M41 [Scoliosis] was used to define the patient pool from ICD-10. Demographic variables, type of operations (posterior only, anterior only, or combined), and complications were documented. Incidence and prevalence values were calculated using population figures and case numbers., Result: There were 276,521 patients with an average incidence of 129 per 100,000. Frequency of females was 1.45 times greater than that of males (p < 0.001). A total of 10,417 surgeries were performed in 10,311 patients during the inspection period (3.8% of all cases). Posterior fusion was by far the most common surgical approach (n = 10.111; 97%) followed by anterior fusion (n = 200; 1,9%)., Conclusions: Our findings reveal a significant increase in the average incidence of scoliosis diagnosis, rising from 107 per 100,000 individuals in 2015 to 161 per 100,000 in 2022. Scoliosis now impacts an estimated 1.2% of children and adolescents in Turkey. The risk is 1.45 times higher in females than in males., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Heart failure (HF) is a common condition that affects 1-3% of the general population. Its prevalence exhibits notable international and intranational disparities, partly explained by socioeconomic status, religion, ethnic diversity, and geographic factors. A comprehensive understanding of the epidemiological symptoms of HF in different regions of Türkiye has yet to be revealed., Aims: To examine epidemiological data from 2016 to 2022, focusing on crucial patient characteristics and geographical regions, to determine the incidence and prevalence of HF in Türkiye across seven diverse geographical regions., Study Design: A nationwide population-based retrospective cohort study., Methods: The comprehensive National Electronic Database of the Turkish Ministry of Health was used in this study to obtain data that covers the whole Turkish population from January 1, 2016, to December 31, 2022. The International Classification of Diseases-10 (ICD-10) codes were used to identify adults with HF (n = 2,701,099) and associated comorbidities. Türkiye is divided into seven geographically distinct regions. Epidemiological characteristics and survival data of these regions were analyzed separately. All-cause mortality was set as the primary outcome., Results: In , the total estimated prevalence of adult patients with HF is 2.939%, ranging from 2.442% in Southeastern Anatolia to 4.382% in the Black Sea Region. Except for the Eastern Anatolia Region, the three most often reported comorbidities were hypertension, dyslipidemia, and anxiety disorders. The rates of prescribing guideline-directed medical therapy (GDMT) for HF and other medications varied significantly. GDMT prescription rates were lowest in the Eastern Anatolia Region (82.6% for beta-blockers, 48.7% for RASi, 31.8% for mineralocorticoid receptor antagonists, and 9.4% for SGLT2i). The Mediterranean and Aegean regions had the highest median N-terminal brain natriuretic peptide (NT-proBNP) levels of 1,990,0 pg/ml (518.0-6,636,0) and 1,441,0 pg/ml (363.0-5,000,0), respectively. From 2016 to 2022, 915,897 (33.9%) of 2,701,099 patients died. The Eastern Anatolia Region had the lowest all-cause mortality rate of 26.5%, whereas the Black Sea Region had the highest all-cause mortality rate of 35.3%., Conclusion: Our real-world analysis revealed geographic disparities in HF characteristics, such as decreased mortality in socioeconomically challenged regions. Higher stress susceptibility in developed regions may increase the likelihood of adverse outcomes.

Background: The aim of this study is to determine the demographic data, fracture treatment methods, and medical treatments of patients diagnosed with osteopetrosis in the national registry., Methods: Patients with International Classification of Diseases (ICD)-10 code Q78.2 for osteopetrosis between January 1, 2016 and April 11, 2023 were retrospectively reviewed. Data on sex, age at time of diagnosis, fracture history, mortality, and use of medications were evaluated for all patients. In addition, open reduction and internal fixation, closed reduction and internal fixation, closed reduction and casting, and conservative treatment methods were noted. The number of patients requiring deformity surgery was determined. The incidence and prevalence of osteopetrosis were also calculated in this cross-sectional study., Results: A total of 476 patients diagnosed with osteopetrosis were identified. The mean age at time of diagnosis of these patients was 5.79 ± 5.43 years. A total of 101 patients died. As the age at diagnosis decreased, the mortality rate of the patients increased with statistical significance ( P <0.001). A total of 192 fractures were seen in 121 osteopetrosis patients in this study. Femur fractures were most common among these patients with osteopetrosis. A history of fracture was statistically significantly less common in patients using a combination of vitamin D + calcium compared with patients not using such medication ( P <0.001). In this 7-year cross-sectional study, the incidence was found to be 1 in 416,000 and the prevalence was 0.00199% in the population under 18 years of age., Conclusion: Younger age at diagnosis is associated with higher mortality in patients with osteopetrosis. In addition, the combination of vitamin D and calcium were associated with lower fracture incidence., Level of Evidence: Prognostic Level II., Competing Interests: The authors declare no conflicts of interests., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background/aim: It was aimed to evaluate the positive effects of health behaviors (general hygiene, wearing face masks, physical distancing, and travel restrictions) acquired during the coronavirus disease 2019 (COVID-19) pandemic on the prevention of other infectious diseases in Ankara Province, Türkiye., Materials and Methods: This study was designed retrospectively. Among the notifiable group A infectious diseases, acute intestinal infections (AIIs) with International Classification of Diseases, Tenth Revision diagnosis codes A09 (diarrhea and gastroenteritis presumed to be of infectious origin), R11 (nausea and vomiting), and K52 (other noninfectious gastroenteritis and colitis), as well as influenza, tuberculosis, measles, varicella, malaria, and meningococcal meningitis were included in the scope of this study.The data of the selected infectious diseases in Ankara Province for the last 2 years before the pandemic (January 2018-December 2019) and for the 2-year period of the pandemic (January 2020-December 2021) were analyzed after checking the data. The number of cases were presented as frequencies, the 1-sample chi-squared test was used in the statistical analysis and the statistical significance level (α) was taken as 0.05., Results: The findings for each disease/disease group were discussed under separate headings. Comparing the prepandemic period (2018-2019) with the pandemic period (2020-2021), the decreases in the number of cases of selected infectious diseases, except influenza, were statistically significant., Conclusion: Undoubtedly, the experience gained from the pandemic struggle will guide us in shaping our future lives. From this point forward, we should be aware that living in crowded environments and as a highly mobile population, that unhygienic habits are unfavorable for the spread of all infectious diseases, and we should take care to continuously apply the precautions for healthy living in our new lifestyle., Competing Interests: Conflict of interest: The authors report no conflicts of interest with this work., (© TÜBİTAK.)

Background: The distribution of fractures may vary according to age and gender. In a country like Türkiye, which has high population density and covers a large geographical area, it is important to understand the regional variations in fractures and identify the health institutions in which patients seek treatment to plan new health-care investments effectively. The objective of our study was to investigate the distribution of fractures across the seven regions of Türkiye considering age, gender, and the level of health institutions the patients visited., Methods: Between January 2021 and May 2023, the total number of fractures, locations of the fractures, patient age and gender, geographical regions, and levels of the health-care institutions to which the patients presented were examined through the e-Nabız personal health record system. Age groups were divided into pediatric (0-19 years), adult (20-64 years), and geriatric (≥65 years) categories. Geographical regions included the Marmara, Central Anatolia, Black Sea, Eastern Anatolia, Aegean, Mediterranean, and Southeastern Anatolia regions., Results: A total of 2,135,701 patients with 2,214,213 fractures were analyzed. Upper extremity fractures were the most common among all considered fracture groups (1,154,819 fractures, 52.2%). There were 643,547 fractures in the pediatric group, 1,191,364 fractures in the adult group, and 379,302 fractures in the geriatric group. While the total number of fractures was higher among men with 1,256,884 fractures (58.9%), the rate among women was higher in the geriatric group (67.2%). Geographically, the highest number of fractures was observed in the Marmara region (714,146 fractures), and 67.92% of all patients presented to secondary health-care institutions (1,500,780 fractures). The most commonly diagnosed fracture in the study population was distal radius fractures. The most common fracture in the geriatric group was femur fractures while distal radius fractures were the most common fractures in the adult and the pediatric groups., Conclusion: By understanding the distribution of fractures in Türkiye based on fracture site, geographical region, age, and gender, it becomes possible to improve the planning of patient access to health-care services. In regions with limited health resources, a more successful resource distribution can be achieved by considering fracture distributions and age groups.

Background: The digitalization studies in public hospitals in Türkiye started with the Health Transformation Program in 2003. As digitalization was accomplished, the policymakers needed to measure hospitals' electronic health record (EHR) usage and adoptions. The ministry of health has been measuring the dissemination of meaningful usage and adoption of EHR since 2013 using Electronic Medical Record Adoption Model (EMRAM). The first published study about this analysis covered the surveys applied between 2013 and 2017. The results showed that 63.1% of all hospitals in Türkiye had at least basic EHR functions, and 36% had comprehensive EHR functions. Measuring the countrywide EHR adoption level is becoming popular in the world. This study aims to measure adoption levels of EHR in public hospitals in Türkiye, indicate the change to the previous study, and make a benchmark with other countries measuring national EHR adoption levels. The research question of this study is to reveal whether there has been a change in the adoption level of EHR in the three years since 2018 in Türkiye. Also, make a benchmark with other countries such as the US, Japan, and China in country-wide EHR adoption in 2021., Methods: In 2021, 717 public hospitals actively operating in Türkiye completed the EMRAM survey. The survey results, deals with five topics (General Stage Status, Information Technology Security, Electronic Health Record/Clinical Data Repository, Clinical Documentation, Closed-Loop Management), was reviewed by the authors. Survey data were compared according to hospital type (Specialty Hospitals, General Hospitals, Teaching and Research Hospitals) in terms of general stage status. The data obtained from the survey results were analyzed with QlikView Personal Edition. The availability and prevalence of medical information systems and EHR functions and their use were measured., Results: We found that 33.7% of public hospitals in Türkiye have only basic EHR functions, and 66.3% have extensive EHR functions, which yields that all hospitals (100%) have at least basic EHR functions. That means remarkable progress from the previous study covering 2013 and 2017. This level also indicates that Türkiye has slightly better adoption from the US (96%) and much better than China (85.3%) and Korea (58.1%)., Conclusions: Although there has been outstanding (50%) progress since 2017 in Turkish public hospitals, it seems there is still a long way to disseminate comprehensive EHR functions, such as closed-loop medication administration, clinical decision support systems, patient engagement, etc. Measuring the stage of EHR adoption at regular intervals and on analytical scales is an effective management tool for policymakers. The bottom-up adoption approach established for adopting and managing EHR functions in the US has also yielded successful results in Türkiye., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Objective: The aim of our study, in light of the World Health Organization Multi-Country Survey (WHO-MCS) data examining the data of the Ministry of Health for the year 2022, comparing the cesarean sections (C/S) performed in the Republic of Turkey (TR) with the WHO-MCS data, and comparing the number of cesarean sections applied more than the reference values., Materials and Methods: According to the database of the Turkish Ministry of Health, in 2022, 1166175 deliveries took place in the Republic of Turkey, and 706370 (60.5%) cesarean section deliveries were recorded as 365764 (51%) primary C/S. Using the Ministry of Health registration system based on the Robson classification., Results: The number and rate of C/S operations performed per birth in 2022 in TR (n=706370; 60.50%) were found to be significantly higher when compared to the number and rate of C/S on a global scale (n=246062; 21.10%), (p<0.001). When cesarean section operations performed in the Ministry of Health hospitals, private institutions, foundation universities, public universities and other public unit hospitals were compared with WHO MCS reference values and C/S ratios, 44.2% versus 24.7% (p=0.05), versus 77.4%, versus 34.2% (p<0.001), 74.3% versus 29.5% (p<0.001), 75% versus 35.8% (p<0.001), 69.3% versus 35.9% (p<0.001)., Conclusion: The amount of cesarean sections performed according to the total number of births in the Turkish Republic is relatively high and its cost nearly 1 billion 750 million TL.

Background: Cerebral Palsy (CP) is the most prevalent neurodevelopmental disorder in childhood. Our aim is to identify the demographics of CP in Turkish children in addition to clinical associations and surgical preferences., Methods: Based on national health system data and the International Classification of Diseases (ICD)-10 code for CP, data were evaluated from a total of 53,027 children with CP born between 2016 and 2022, and 9658 of them underwent orthopedic surgery in those years. The incidence and frequency of CP were assessed for the parameters of age and gender. Age at the time of surgery; codes pertaining to surgical interventions; and regions, cities, and hospitals where diagnoses and surgical procedures were performed were also evaluated., Results: There were 29,606 male (55.8%) and 23,421 (44.2%) female patients. The diagnoses of the patients were mostly (76.1%) performed in secondary and tertiary hospitals. The prevalence of CP among children in 2016-2022 was estimated to be 7.74/1000 children. The minimum and maximum incidence rates of cerebral palsy among children between 2016 and 2022 were calculated to be 0.45 and 1.05 per 1000, respectively. Tenoplasty-myoplasty tendon transfer operations were the most common surgeries (47.1%)., Conclusion: CP remains a significant health challenge, underpinning a considerable proportion of childhood motor dysfunction. A dedicated national registry system for CP focused on classifying the condition, streamlining treatment, and tracking outcomes would be a valuable tool in our collective efforts to address this critical issue more effectively.

Background: Health records changed over time in the countries, and also Türkiye passed from paper versions to personal health records (PHR) and put patients at the center of the system by allowing them to become the master of their health data., Aims: Presenting the current state of the e-Nabız application nationwide in Turkey, and to evaluate the benefits of patients’ online access to electronic health records and the system’s interoperability., Study Design: A descriptive observational study., Methods: In the Turkish PHR system (e-Nabız), services to patients to manage their health are categorized and analyzed within the scope of national digital health services. In addition, the data validation in the e-Nabız within itself has been systematically expressed., Results: The Turkish PHR system allows users to use 30 different services for treatment, prevention, health promotion, and health-related and interrelated areas. Moreover, some statistics regarding the categories specified in the e-Nabız system are included. Today, data is flowing from 28,608 system-integrated health facilities and 39 e-Nabız integrated public institutions. In addition, 4.5 billion transactions are done by people by 2023 and 220 million users are queried by physicians to reach patients’ labs and results. Plus, the e-Nabız is adopted by 82% of the Türkiye population., Conclusion: There is no universal model for the content of the PHR. Given its importance to the patient, the content evolved and will continue to grow over the years. With the advent of coronavirus disease 2019, the system is equipped with three new services. The importance of these services over time and in the future has been demonstrated with increasing momentum.

Background: It was estimated that there were 537 million people with diabetes mellitus in 2021, representing 10.5% of the global adult population. Diabetes prevalence in Turkey is 13.5%, according to a meta-analysis and 17.3% according to a recent study. Although the primary purpose of Electronic Health Records (EHRs) is clinical, researchers can use them to conduct epidemiologic investigations. This study aims to document the prevalence of diabetes and to evaluate the healthcare utilization of people with diabetes compared to the people without diabetes, based on national EHR., Methods: Only people over 14 years old were included in the analysis. Our criteria for being diabetic were 1) having an HbA1c over 6.5% (48 mmol/mol), 2) having a prescription with DM diagnosis, ICD-10 codes E10-E14, or 3) having at least two fasting blood glucose measurements over 126 mg/dl., Results: At the end of 2020, there were 7,178,674 individuals with diabetes, with 11.12% prevalence, 13.10% in women while 9.12% in men. Age-adjusted healthcare facility admission per capita was 15.5 for people with diabetes, 9.5 for people without diabetes, while the number of prescriptions was 7.9 for people with diabetes while 4.5 for people without diabetes in 2019. The mean number of prescriptions containing antidiabetics was 2.88 per person with diabetes in 2019., Discussion: Approximately 11% of Turkish people have diagnosed with diabetes. We estimate that about one-third of people with diabetes are undiagnosed and the majority of these people are men. The results show that such large databases have the capability of supplying a vast amount of information to the scientific community.

Objective: The artificial intelligence competition in healthcare was organized for the first time at the annual aviation, space, and technology festival (TEKNOFEST), Istanbul/Türkiye, in September 2021. In this article, the data set preparation and competition processes were explained in detail; the anonymized and annotated data set is also provided via official website for further research., Materials and Methods: Data set recorded over the period covering 2019 and 2020 were centrally screened from the e-Pulse and Teleradiology System of the Republic of Türkiye, Ministry of Health using various codes and filtering criteria. The data set was anonymized. The data set was prepared, pooled, curated, and annotated by 7 radiologists. The training data set was shared with the teams via a dedicated file transfer protocol server, which could be accessed using private usernames and passwords given to the teams under a nondisclosure agreement signed by the representative of each team., Results: The competition consisted of 2 stages. In the first stage, teams were given 192 digital imaging and communications in medicine images that belong to 1 of 3 possible categories namely, hemorrhage, ischemic, or non-stroke. Teams were asked to classify each image as either stroke present or absent. In the second stage of the competition, qualifying 36 teams were given 97 digital imaging and communications in medicine images that contained hemorrhage, ischemia, or both lesions. Among the employed methods, Unet and DeepLabv3 were the most frequently observed ones., Conclusion: Artificial intelligence competitions in healthcare offer good opportunities to collect data reflecting various cases and problems. Especially, annotated data set by domain experts is more valuable.

Aim: The effect of hypertension (HT) and antihypertensive therapies such as renin-angiotensin-aldosterone system (RAAS) blockers on the disease course in COVID-19 patients is controversial. The purpose of this study was to evaluate the effect of HT and antihypertensive therapies on the course of COVID-19 disease., Method: The age, sex, comorbid diseases, and antihypertensive therapies of 132,790 patients with positive COVID-19 real-time transcriptase polymerase chain reaction (RT-PCR) tests in the Turkish Health Ministry National COVID-19 database between 11 March and 31 May 2020, were examined and analyzed., Results: Forty-one percent of the 132,790 patients in this study (median age: 40, 47.3% female) were hospitalized for treatment, and 4.5% were followed-up in the intensive care unit (ICU). The most frequent comorbid disease, at 19.5%, was HT (n = 25,863). Mortality was determined in 4.9% of HT patients and 1.9% of non-HT patients (p < .001). HT, age, and male gender emerged as independent predictors of hospitalization and admission to the ICU, while HT was not a predictor of mortality. In addition, no adverse effect of any antihypertensive treatment, including RAAS inhibitors, on mortality was detected., Conclusion: Based on Turkish national data, HT is common in COVID-19 patients, but does not appear to be an independent predictor of mortality, and no adverse effect of RAAS inhibitors on COVID-19-related mortality was observed.

Previous studies reported that COVID-19 patients with cancer had higher rates of severe events such as intensive care unit (ICU) admission, mechanical ventilation (MV) assistance, and death during the COVID-19 course compared to the general population. However, no randomized study compared the clinical course of COVID-19 in patients with hematologic cancers to patients with solid cancers. Thus, in this study, we intend to reveal the outcome of COVID-19 in hematologic cancer patients and compare their outcomes with COVID-19 patients with solid cancers. The data of 926 laboratory-confirmed COVID-19 patients, including 463 hematologic cancer patients and an age-gender paired cohort of 463 solid cancer patients, were investigated retrospectively. The frequencies of severe and critical disease, hospital and ICU admission, MV assistance were significantly higher in hematologic cancer patients compared with the solid cancer patients (p = 0.001, p = 0.045, p = 0.001, and p = 0.001, respectively). The hospital stay was longer in patients with hematologic cancers (p = 0.001); however, the median ICU stay was 6 days in both groups. The case fatality rate (CFR) was 14.9% in patients with hematologic cancers, and it was 4.8% in patients with solid cancers, and there was a statistically significant difference regarding CFR between groups (p = 0.001). Our study revealed that COVID-19 patients with hematologic cancers have a more aggressive course of COVID-19 and have higher CFR compared to COVID-19 patients with solid cancers and support the increased susceptibility of patients with hematologic cancers during the outbreak., (© 2021. Società Italiana di Medicina Interna (SIMI).)

Background/aim: SARS-CoV-2 enters the cell through the binding of the S glycoprotein on the surface of the virus to the angiotensin- converting enzyme 2 (ACE-2) in the host cells and also SARS-CoV S protein binding to ACE-2 was inhibited by anti-A antibodies. The aim of the study was to investigate the relationship between blood groups and the course of COVID-19 in Turkey., Materials and Methods: Laboratory confirmed COVID-19 patients aged 18 and over (n = 39.850) were randomized in age and sex- matched groups according to blood groups., Results: Advanced age, male sex and blood group A were found to be related with increased rate of intensive care unit (ICU) admission (OR = 1.089, 95% CI: 1.085–1.093 for age; OR = 1.963, 95% CI: 1.737–2.218 for male sex; OR = 1.216, 95% CI: 1.023–1.446 for blood group A). When blood group O individuals were compared to non-O individuals, no significant difference was observed regarding the rate of hospital and ICU admission, mechanical ventilation (MV) support, length of hospital and ICU stay, and case fatality rate (CFR). The CFR in patients with blood group A, B, O, and AB were 2.6%, 2.2%, 3.1%, and 2.3%, respectively. There were no significant differences between Rh-negative and positive patients regarding the rate of hospital and ICU admission (p = 0.280 and p = 0.741, respectively), also the rate of MV support and CFR was similar (p = 0.933 and p = 0.417)., Conclusion: Our study revealed that ABO and Rh blood groups do not have any impact on the rate of hospital admission, hospital and ICU stay, MV support, and CFR., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

Background/aim: COVID-19 has now become a global pandemic. Understanding the routes of transmission is vital in the mitigation and suppression of the disease. İstanbul has become one of the disease’s epicenters. This study aims to describe the first COVID-19 case and contact tracing efforts around it in İstanbul., Materials and Methods: The descriptive study was conducted in İstanbul, Turkey. The first COVID-19 cases and those associated with them were investigated with contact tracing, and primary and secondary cases were described., Results: The source case was an individual who returned to Turkey from international travel at the beginning of March and tested PCR (–). The index case is the brother of the source case and is considered the first PCR (+) case diagnosed in İstanbul. Contact tracing revealed 23 PCR (+) cases, 14 of which resulted in hospitalization and three deaths., Conclusions: This study described cases of the first COVID-19 cluster in İstanbul. Moreover, contact tracing was used in this first cluster. This contributed to contact tracing algorithms in Turkey., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

Introduction: In this study, we aim to report the outcome of COVID-19 in chronic myeloid leukemia (CML) patients receiving tyrosine kinase inhibitor (TKI)., Method: The data of 16 laboratory-confirmed COVID-19 patients with CML receiving TKI and age, gender, and comorbid disease matched COVID-19 patients without cancer at a 3/1 ratio (n = 48), diagnosed between March 11, 2020 and May 22, 2020 and included in the Republic of Turkey, Ministry of Health database, were analyzed retrospectively., Results: The rates of intensive care unit (ICU) admission, and mechanical ventilation (MV) support were lower in CML patients compared to the control group, however, these differences did not achieve statistical significance (p = 0.1, and p = 0.2, respectively). The length of hospital stay was shorter in CML patients compared with the control group; however, it was not statistically significant (p = 0.8). The case fatality rate (CFR) in COVID-19 patients with CML was 6.3%, and it was 12.8% in the control group. Although the CFR in CML patients with COVID-19 was lower compared to the control group, this difference did not achieve statistical significance (p = 0.5). When CML patients were divided into 3 groups according to the TKI, no significant difference was observed regarding the rate of ICU admission, MV support, CFR, the length of stay in both hospital and ICU (all p > 0.05)., Conclusion: This study highlights that large scale prospective and randomized studies should be conducted in order to investigate the role of TKIs in the treatment of COVID-19.