AMAÇ: Ýntimal hiperplazi arterlerin hemodinamik strese karþý normal adaptif bir özelliði olduðu kadar arteriyel injurilerin iyileþmesinin karakteristik bir özelliðidir.Ýntimal hiperplazi,invaziv vasküler giriþimler için önemli bir klinik problemdir ve bypass greftlerinin uzun dönem sonuçlarýný etkiler. Ýntimal hiperplaziyi azaltmak çeþitli farmakolojik ajanlar deneysel çalýþmalarda baþarýyla kullanýlmaktadýr.
GEREÇ VE YÖNTEM: Çalýþmamýzda parsiyel transekte edilip primer onarýlan sýçan abdominal aortlarýnda deksametazonun intimal hiperplaziye etkisini araþtýrdýk.
Çalýþmamýzda 20 adet Wistar Albino cinsi rat rastgele 4 gruba ayrýldý. Grup A (Kontrol grubu) (n=5) ratlara laparotomi yapýldý ve abdominal aorta bulundu, dönüldü. Gru Sonuç olarak yüksek doz deksametazonun sýçan abdominal aortlarýnda intimal hiperplaziyi inhibe edebileceðini söyleyebiliriz. p B’deki ratlara (n=5) laparotomi yapýldý, Abdominal aorta bulundu, dönüldü. Abdominal aorta parsiyel transekte edilip 8.0 prolen ile dikilmiþtir. Grup C deki ratlara (n=5) 0.1 mg/kg deksametazon intraperitoneal uygulandý. Laparotomi yapýldý. Abdominal aorta bulundu, dönüldü. Abdominal aorta parsiyel transekte edilip 8.0 prolen dikiþ ile dikildi. Ýþlemden sonra 2 hafta deksametazon tedavisine devam edildi. Grup D’deki ratlara iþlem öncesi 0.2 mg/kg deksametazon intraperitoneal uygulandý. Abdominal aorta bulundu, dönüldü. Abdominal aorta parsiyel transekte edilip 8.0 prolen dikiþ ile dikildi. Ýþlemden sonra 2 hafta deksametazon tedavisine devam edildi. Tüm sýçanlar 2 hafta sonra sakrifiye edildikten sonra primer onarýlan abdominal aortlar eksize edildi ve histopatolojik olarak incelendi.
BULGULAR: Ýncelemeler sýrasýnda çekilen dijital fotoðraflar üzerinden “Olympus analySÝS 5” görüntü analiz programý ile intima ve media kalýnlýklarý mm cinsinden ölçülerek intimal ve medial alan hesaplanarak intima/media oraný kontrol grubu ile karþýlaþtýrýlarak incelenecektir. Abdominal aort transeksiyonu ve onarýmý sonrasý düþük doz deksametazon ve deksametazon verilmeyen gruplarýn intima/media oranlarý kýyaslandýðýnda istatiksel olarak anlamlý deðildir. Yüksek doz deksametazon verilen grupta deksametazon verilmeyen ve düþük doz deksametazon verilen gruplara göre inti-ma/media oranlarý istatiksel olarak daha düþük bulunmuþtur.
SONUÇ: Sonuç olarak yüksek doz deksametazonun sýçan abdominal aortlarýnda intimal hiperplaziyi inhibe edebileceðini söyleyebiliriz..

BACKGROUND: Intimal hyperplasia is a normal adaptive feature of arteries in response to injuries, which include invasive vascular interventions. Its development limits the long-term success of bypass grafts. Various pharmacological agents have been successfully employed in experimental models to reduce the degree of intimal hyperplasia. In our study, we investigated the efficacy of dexamethasone in reducing intimal hyperplasia in rat abdominal aortas after partial transection and primary repair.
METHODS: In this study, 20 Wistar Albino rats were randomly selected and divided into four groups to compare the effects of low- and high-dose dexamethasone on intima and media thickness compared to the control. Group A (n=5) was the control group, where only skin incision and laparotomy were performed. For Group B (n=5), a median laparotomy was performed, the abdominal aorta was partially transected, and repaired with an 8.0 prolene suture. Doses of 0.1 mg/kg and 0.2 mg/kg dexamethasone were administered in Group C (n=5) and Group D (n=5), respectively. After two weeks, all rats were euthanized, and the repaired abdominal aortas were excised and examined histopathologically. Intima and media thicknesses were measured using the ‘Olympus AnalySIS 5’ program (Olympus Corporation, Japan) after digital photos were taken.
RESULTS: Based on the measurements, we demonstrated that after transection and repair of the abdominal aorta, the intima/media ratio was not significantly different between the low-dose dexamethasone and non-dexamethasone groups. The intima/media ratio was significantly lower in the high-dose dexamethasone group than in the non-dexamethasone and low-dose dexamethasone groups.
CONCLUSION: After vascular interventions, dexamethasone treatment may reduce intimal hyperplasia and increase patency by providing vascular remodeling.

AMAÇ: Bu çalýþmada, çeþitli endikasyonlarla kontrastsýz toraks BT çekilen hastalarda BT parametreleri ile hemoglobin (Hb) düzeyleri iliþkilendirilerek kontrastsýz toraks bilgisayarlý tomografisinin (BT) anemiyi öngörme potansiyeli araþtýrýldý.
GEREÇ VE YÖNTEM: Retrospektif çalýþma, Ocak-Haziran 2023 tarihleri arasýnda merkezimizde 24 saat içinde kontrastsýz toraks BT taramasý ve tam kan sayýmý yapýlan 150 hastayý kapsamaktadýr. Dýþlama kriterleri arasýnda akut kanama, demir birikimi bozukluklarý, yakýn zamanda transfüzyon, gebelik ve bazý toraks BT artefaktlarý yer aldý. Hounsfield Ünitesi (HU) ölçümleri çýkan aort, sol ventrikül boþluðu ve inen aorttan elde edilmiþ ve Hb ve hematokrit (Htc) deðerleriyle karþýlaþtýrýldý. "Aortik Halka Ýþareti (ARS)" ve "Hiperdens Septum Ýþareti (HSS)" gibi anemi göstergeleri deðerlendirildi. BULGULAR: Anemik hastalar (%48), anemik olmayan hastalara kýyasla her üç yerden BT ölçümümde de anlamlý derecede daha düþük HU ölçümleri gösterdi. Özellikle HSS ve ARS varlýðý anemi ile güçlü bir þekilde iliþkiliydi. Anemiye karþýlýk gelen HU ölçümleri için eþik deðerler ROC analizi ile elde olunmuþ olup, HU ölçümleri ile Hb/Htc seviyeleri arasýnda güçlü pozitif korelasyonlar ortaya koyuldu.
SONUÇ: Bu çalýþma, kontrastsýz toraks BT parametrelerinin, özellikle de HU ölçümleri ile ARS ve HSS varlýðýnýn anemi ile anlamlý bir iliþkisi olduðu sonucuna varmýþtýr. Bu BT göstergeleri, hastalarda anemiden þüphelenmek için güvenilir, invazif olmayan belirteçler olarak kullanýlabilir ve durumun erken teþhisine ve yönetimine yardýmcý olabilir.

BACKGROUND: This study explored the potential of non-contrast thoracic computed tomography (CT) to predict anemia by correlating CT parameters with hemoglobin (Hb) levels in patients who underwent non-contrast thoracic CT for various indications.
METHODS: This retrospective study included 150 patients who underwent non-contrast thoracic CT scans and complete blood counts within 24 hours at our center between January and June 2023. Exclusion criteria included acute bleeding, iron accumulation disorders, recent transfusions, pregnancy, and certain thoracic CT artifacts. Hounsfield Unit (HU) measurements were obtained from the ascending aorta, left ventricular cavity, and descending aorta, and compared with Hb and hematocrit (Htc) values. Anemia indicators such as the “Aortic Ring Sign (ARS)” and the “Hyperdense Septum Sign (HSS)” were also evaluated.
RESULTS: Anemic patients (48%) exhibited significantly lower HU measurements at all three CT scan locations and higher instances of ARS and HSS compared to non-anemic patients. Notably, the presence of HSS and ARS was strongly associated with anemia. Thresholds for HU measurements corresponding to anemia were determined using receiver operating characteristic curve analysis, which also revealed strong positive correlations between HU measurements and Hb/Htc levels.
CONCLUSION: The study concludes that non-contrast thoracic CT parameters, particularly HU measurements and the presence of ARS and HSS, are significantly associated with anemia. These CT indicators could serve as reliable, non-invasive markers for predicting anemia in patients, potentially aiding in the early diagnosis and management of the condition.

AMAÇ: Çalýþmamýzda penetran batýn yaralanmalarýnýn özellikleri, orjinleri, yaralanma derecesi, sonuçlarý, raporlanmasý, adli týbbi boyutunun tartýþýlmasý amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Bu çalýþmada 01.01.2016-31.12.2020 tarihleri arasýnda Kütahya Saðlýk Bilimleri Üniversitesi Evliya Çelebi Eðitim ve Araþtýrma Hastanesi acil sevisine baþvurusu bulunan 28619 vaka taranarak penetran batýn yaralanmasý bulunan 85 olgunun adli raporlarý ve týbbi evraklarý etik kurul onayý alýnarak retrospektif olarak deðerlendirilmiþtir.
BULGULAR: Çalýþmaya dahil edilen olgularýn %87.1’i erkek, %12.9’u kadýnlardan oluþmaktadýr. Ortalama yaþ 31±13 yýl olarak bulunmuþtur. Orjinleri incelediðinde %87.1’i kasten yaralama neticesinde geliþmiþ olduðu görülmüþtür. Olgularýn maruz kaldýðý olaylarýn gerçekleþme saati 20.00-04.00 saatleri arasýnda yoðunlaþmýþtýr. %36.5’inde alkol saptanmýþ olup, %30.6’sýnda alkol saptanmamýþtýr. Olgularýn %32.9’unda alkol testi istenmediði anlaþýlmýþtýr. Olgularda en sýk görülen yaralanmanýn %69.4 oranýnda kesici delici alet yaralanmasý ve %27.1 oranýnda ateþli silah yaralanmasý olduðu belirlenmiþtir. Vakalarýn %68.2'sinde organ hasarý saptanmýþ ve en sýk hasar gören organýn ince baðýrsak olduðu görülmüþtür. Mevcut yaralarýn ortalama sayýsý 3.6 bulunmuþtur. Olgularýn %61.2'sinde batýn içi kanama, %8,2'sinde ise batýn içi arter yaralanmasý tespit edilmiþtir. Penetran batýn yaralanmalarýnýn ölüm oraný %8.2 olarak bulunmuþtur.
SONUÇ: Adli travmatolojide travmanýn aðýrlýk derecesi deðerlendirilmesinde en aðýr grubu oluþturan yaþamsal tehlikenin ve organ iþlev kaybýnýn meydana gelmesi penetran batýn yaralanmalarýnda sýklýkla görülmektedir. Penetran batýn yaralanmalarý bizim çalýþmamýzda ve literatürdeki çalýþmalarda en sýk þiddet olaylarý sonucu meydana gelmektedir.

BACKGROUND: This study aims to discuss the characteristics, origins, degree of injury, results, reporting, and forensic medical aspects of penetrating abdominal injuries.
METHODS: In this study, 28,619 cases who applied to the emergency department of Kutahya Health Sciences University Evliya Celebi Training and Research Hospital between January 1, 2016 and December 31, 2020 were reviewed. The forensic reports and medical documents of 85 cases with penetrating abdominal injuries were evaluated retrospectively, with the approval of the ethics committee.
RESULTS: Among the patients included in the study, 87.1% were male and 12.9% were female. The mean age was found to be 31±13 years. When the origins of the cases were analyzed, 87.1% were found to have developed as a result of intentional injury. The incidents predominantly occurred between 20: 00 and 04: 00 hours. As a result of the examinations performed at the hospital after the incident, alcohol was detected in 36.5% of the cases, while 30.6% of the individuals did not consume alcohol. It was observed that 32.9% of the cases were not tested for alcohol. The most common injuries identified were sharp injuries, accounting for 69.4% of cases, and firearm injuries, comprising 27.1%. Organ damage was noted in 68.2% of the cases, with the small intestine being the most frequently damaged organ. The average number of wounds present was 3.6. Intra-abdominal hemorrhage was detected in 61.2% of the cases, and intra-abdominal artery injuries were found in 8.2%. The mortality rate for penetrating abdominal injuries was 8.2%.
CONCLUSION: In forensic traumatology, penetrating abdominal injuries commonly lead to life-threatening conditions and loss of organ function, which represent the most severe category in trauma severity assessment. Penetrating abdominal injuries most often result from violent incidents, as observed in our study and in the literature.

AMAÇ: Travma iliþkili adrenal yaralanmalar, gözden kaçabilen ve nadir olduðu düþünülen olgulardýr. Bu çalýþmada, travma iliþkili ciddi yaralanmalarda adrenal bez yaralanmasý görülme sýklýðý, ve hastalarýn erken dönem sonuçlarýna etkisini deðerlendirme amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Üçüncü basamak refere travma merkezine, Ocak 2012 ve Ocak 2023 arasý travma protokolü ile baþvuran, bilgisayarlý tomografi çekilen tüm hastalar retrospektif olarak incelendi. Geliþinde ölü kabul edilenler ve eksik verisi olanlar çalýþmadan çýkartýldý. Hastalar yetiþkin ve pediyatrik olarak iki gruba; radyolojik veya klinik olarak tanýsý konulan adrenal yaralanmasý olup olmamasýna göre de alt gruplara bölündü. Demografik veriler, yaralanma mekanizmasý, yaralanma ciddiyet skoru, eþlik eden diðer abdominal organ yaralanmalarý, ve 30-günlük mortalite oranlarý karþýlaþtýrýldý. BULGULAR: Toplam 1253 hasta çalýþmaya dahil edildi: 950 yetiþkin ve 303 pediyatrik. Yetiþkin grubunda adrenal yaralanma 45 (%4,7) hastada görüldü. Mekanizmalar incelendiðinde araç içi trafik kazasý (%26,7 vs. %14,3) ve yaya kazasýnýn (%37,8 vs %15,5) adrenal yaralanmalý hastalarda daha sýk olduðu görüldü. Penetran travma adrenal yaralanmalý grupta daha azdý. Sað tarafýn yaralanma oraný daha fazlaydý (%55,6). Adrenal yaralanmasý olan hastalarýn yaralanma ciddiyet skorlarý daha yüksekti ve eþlik eden karaciðer (%17,8 vs. %3,9), dalak (%11,1 vs. %3,6) ve böbrek (%15,6 vs. %1,3) yaralanma oranlarý daha fazlaydý. Pediyatrik grupta adrenal yaralanma 30 hastada tespit edildi (%14,8). Yetiþkin grubu gibi, adrenal yaralanma daha çok künt travma iliþkiliydi ve sað taraf dominanttý (%60). Yetiþkin grubuna kýyasla, yaralanma ciddiyeti skoru, yaralanma olan ve olmayan gruplar arasý benzerdi. Eþlik eden organ yaralanmasý yetiþkin grubu gibi adrenal yaralanma olan hastalarda daha fazlaydý. 30-günlük mortalite oraný, hem yetiþkin hem pediyatrik grupta anlamlý olarak yüksekti (yetiþkin: %15,6 vs. %2.9, pediyatrik: %10 vs. %1,8). Adrenal yaralanmalý hastalarda mortaliteye en çok etki eden faktörler majör baþ&boyun ve toraks yaralanmalarýydý.
SONUÇ: Yüksek enerjili travmalara baðlý adrenal yaralanmalar nadir deðildir. Genellikle künt travma ve eþlik eden diðer abdominal organ yaralan-malarý ile beraber görülürler. Otuz-günlük mortalite oranlarý, yaralanma olan hastalarda daha yüksektir.

BACKGROUND: Adrenal gland injury (AGI) associated with trauma is an uncommon and often overlooked condition. This study aimed to evaluate the frequency of AGI in individuals with severe trauma injuries and investigate the outcomes of patients with AGI.
METHODS: All patients admitted to a tertiary trauma referral center under the trauma protocol who had a computed tomography (CT) scan between January 2012 and January 2023 were analyzed retrospectively. Patients who were dead on arrival and patients with incomplete data were excluded. They were classified into two main groups, adult and pediatric, and further subcategorized by the presence or absence of radiologically evident AGI. Demographic data, mechanism of injury, injury severity scores (ISS), presence of concurrent abdominal injury, and 30-day mortality rates were compared. A separate analysis was performed for factors affecting mortality rates.
RESULTS: A total of 1,253 patients were included: 950 adults and 303 pediatric patients. In the adult group, AGI was detected in 45 (4.7%) patients and was more commonly associated with the following mechanisms of injury: motor vehicle accidents (26.7% vs. 14.3%) and pedestrian accidents (37.8% vs. 15.5%). Injury to the right side was more common (55.6%). Patients with AGI had higher rates of concurrent liver (17.8% vs. 3.9%), spleen (11.1% vs. 3.6%), and kidney injuries (15.6% vs. 1.3%). In the pediatric population, AGI was detected in 30 patients (14.8%), a significantly higher rate compared to the adult group. Similar to the adult group, AGI was more commonly associated with concurrent abdominal injuries and had a right-sided dominance (60%), but the rate of concurrent abdominal injuries was higher in the pediatric group (80% vs. 46%). The 30-day mortality was significantly higher in both adult and pediatric AGI groups compared to patients without AGI (adult: 15.6% vs. 2.9%, pediatric: 10% vs. 1.8%). In patients with AGI, major head and neck injuries and chest injuries were associated with mortality.
CONCLUSION: Adrenal gland injuries due to trauma are not uncommon. They are usually associated with blunt trauma and other concurrent abdominal organ injuries. The major contributors to mortality in patients with AGI were major head and neck injuries and chest injuries.

AMAÇ: Bu çalýþma, Acil Saðlýk Hizmetleri (ASH) saðlayýcýlarý tarafýndan yapýlan hastane öncesi deðerlendirmeler ve ön tanýlarýn, bir metropol Acil Servis hekimleri tarafýndan verilen nihai tanýlarla karþýlaþtýrýldýðýnda doðruluðunu ve kalitesini deðerlendirmeyi amaçlamaktadýr.
GEREÇ VE YÖNTEM: Bu retrospektif gözlemsel çalýþma, 1 Ocak 202–31 Aralýk 2022 tarihleri arasýnda Ankara, Türkiye'deki Yenimahalle ASH Komuta Merkezi'nden elde edilen kayýtlarý kullanmýþtýr. Veriler, tekrar eden ASH baþvurularý ayrý ayrý sayýlarak, bireysel hastalar yerine vaka olarak kaydedilmiþtir. Vakalar, ASH çaðrý zamaný, ASH istek nedenleri, yaþ, cinsiyet, uyruk ve hastaneye varýþ günü gibi kategorilere ayrýlarak sosyoekonomik etkiler ve yoðunluk kalýplarý deðerlendirilmiþtir. Çalýþma, sahada çözülen vakalar, ASH transferini reddedenler ve 18 yaþ ve üstü hastalar hariç tutularak, 2.528 pediatrik vakayý içermiþtir. Veri analizi IBM SPSS 27.0 kullanýlarak yapýlmýþ olup, istatistiksel anlamlýlýk p<0.05 olarak belirlenmiþtir. BULGULAR: Çalýþma 2.528 vakayý içermektedir. Veriler, ASH saðlayýcýlarýnýn ortalama 9.9 ± 4.7 yýllýk deneyime sahip olduðunu ortaya koymuþtur. 1.839 vakada (%72.7) ASH saðlayýcýsý kadýn iken, 689 vakada (%27.3) ASH saðlayýcýsý erkektir. Hastalarýn ortalama yaþý 9.2±5.8 yýl olup, 1.173'ü (%46.4) kýz ve 1.355'i (%53.6) erkektir. Ön taný doðruluðu, daha genç ve erkek hastalarý içeren vakalarda daha yüksek bulunmuþtur. Ayrýca, mesai saatleri (08: 00-15: 59) içinde, mesai saatleri dýþýna (16: 00-23: 59) kýyasla daha düþük ön taný doðruluðu gözlemlenmiþtir. ASH çaðrýlarýnýn çoðunluðu týbbi nedenlerle (%70.5, 1.783 vaka) yapýlýrken, travma ile ilgili çaðrýlar (%29.5, 745 vaka) ikinci sýrada gelmektedir.
SONUÇ: Bu çalýþma, ASH saðlayýcýlarýnýn hastane öncesi deðerlendirmeler ve ön tanýlarýn doðruluðunu ve kalitesini artýrmak için sahada eðitimlerini iyileþtirme gereðini vurgulamaktadýr. Bulgular, daha genç ve erkek hastalarýn daha yüksek ön taný doðruluðu oranlarýna sahip olduðunu ve mesai saatlerinde doðrulukta belirgin bir azalma olduðunu, bu durumun hedeflenmiþ eðitim ve protokol ayarlamalarý için potansiyel alanlar olduðunu önermektedir.

BACKGROUND: This study aims to evaluate the accuracy and quality of prehospital assessments and preliminary diagnoses made by Emergency Medical Services (EMS) providers compared to the final diagnoses given by Emergency Department physicians in a metropolitan area.
METHODS: This retrospective observational study utilized records from the Yenimahalle EMS Command Center in Ankara, Türkiye, from January 1, 2021, to December 31, 2022. Data were recorded as cases rather than individual patients, with repeated EMS admissions counted separately. Cases were categorized by EMS call time, reasons for EMS requests, age, gender, nationality, and weekday of hospital arrival to assess socioeconomic impacts and congestion patterns. The study included 2.528 pediatric cases, excluding patients aged 18 and older, those who refused EMS transfer, and cases resolved at the scene. Data analysis was conducted using IBM SPSS 27.0, with statistical significance set at p<0.05.
RESULTS: The study included 2.528 cases. The data revealed that EMS providers had an average of 9.9±4.7 years of experience. In 1.839 cases (72.7%), the EMS provider was female, and in 689 cases (27.3%), the EMS provider was male. Patients had an average age of 9.2±5.8 years, with 1.173 (46.4%) being female and 1.355 (53.6%) being male. Preliminary diagnosis accuracy was higher in cases involving younger and male patients. Additionally, a lower preliminary diagnosis accuracy rate was observed during office hours (08: 00-15: 59) compared to non-office hours (16: 00-23: 59). The majority of EMS calls were for medical reasons (1,783 cases, 70.5%), followed by trauma-related calls (745 cases, 29.5%).
CONCLUSION: This study highlights the need for improved on-field training for EMS providers to enhance the accuracy and quality of prehospital assessments and preliminary diagnoses. The findings suggest that younger and male patients have higher preliminary diagnosis accuracy rates, and there is a noticeable decrease in accuracy during office hours, indicating potential areas for targeted training and protocol adjustments.

AMAÇ: Bu çalýþma, erken dönem yanýk hastalarýnda üç farklý egzersiz protokolünün fonksiyonel kapasite üzerine etkisini araþtýrmak amacýyla planlandý.
GEREÇ VE YÖNTEM: Yanýk Merkezinde (servis ve yoðun bakým ünitesinde) yatan toplam 25 hasta çalýþmaya dahil edildi. Çalýþmaya dahil edilen bireyler yanýk yüzdesi ve yanýk tipine göre kovaryant adaptif randomizasyon yöntemi ile üç gruba ayrýldý: 1-standart tedavi, 2-standart tedavi + aerobik egzersiz eðitimi, 3-standart tedavi + hastanýn metabolik durumuna göre belirlenen kombine egzersiz (aerobik ve dirençli egzersiz). Bireyler hastaneye yatýþlarýnýn ilk gününden itibaren altý hafta boyunca haftalýk olarak deðerlendirildi. Fonksiyonel kapasiteyi deðerlendirmek için 6 dakikalýk yürüme testi, fizyolojik tüketim indeksi ve Týbbi Araþtýrma Konseyi kas gücü ölçümleri kullanýldý. Tüm hastalarýn metabolik durumlarýný ölçmek için taþýnabilir metabolizma takip cihazý kullanýldý.
BULGULAR: Standart tedaviye ek olarak verilen aerobik egzersizler ve metabolik duruma göre belirlenen kombine egzersiz (aerobik ve direnç) fonksiyonel kapasite üzerinde standart tedaviye göre daha etkiliydi (p<0.05). Metabolik duruma göre belirlenen kombine egzersizi (aerobik ve direnç) yapan hastalarda fonksiyonel kapasitedeki iyileþme diðer iki gruba göre daha hýzlýydý (p<0.05).
SONUÇ: Standart tedaviye ek olarak verilen aerobik egzersizler ve metabolik duruma göre belirlenen kombine egzersiz (aerobik ve direnç), fonksiyonel kapasiteyi geliþtirmede standart tedaviye göre daha etkilidir. Bu yaklaþýmýn potansiyel uzun vadeli faydasýný belirlemek için daha fazla kontrollü çalýþmaya ihtiyaç vardýr.

BACKGROUND: This study investigated the effects of three different exercise protocols on functional capacity in early-stage burn patients.
METHODS: A total of 25 patients hospitalized in the Burn Center (wards and intensive care unit) were included in the study. The individuals were divided into three groups by covariate adaptive randomization according to burn percentage and type: 1 - standard treatment, 2 - standard treatment + aerobic exercise training, 3 - standard treatment + combined exercise (aerobic and resistance) determined by metabolic status. Individuals were evaluated weekly for six weeks from the first day of hospitalization using the 6-minute walk test, physiological cost index, and Medical Research Council muscle-strength measurements to assess functional capacity. A portable metabolism tracker device measured the metabolic status of all patients.
RESULTS: Aerobic exercises and combined exercise (aerobic and resistance), when added to standard treatment and determined by metabolic status, were more effective in enhancing functional capacity than standard treatment alone (p<0.05). Patients performing the combined exercise (aerobic and resistance) showed faster improvement in functional capacity determined according to metabolic status than those in the other two groups (p<0.05).
CONCLUSION: Aerobic exercises, when added to standard treatment and combined with aerobic and resistance exercises based on metabolic status, are more effective at improving functional capacity than standard treatment alone. Further controlled studies are required to explore the potential long-term benefits of this approach.

AMAÇ: Kalça kýrýðý ameliyatlarýnda mortalite ve morbidite geliþimine katkýda bulunan çeþitli faktörler vardýr. Bu çalýþmada anestezi tipi, anestezi yönetimi, cerrahi yöntem, ameliyatýn zamanlamasý gibi deðiþtirilebilir faktörlerin 30 günlük mortalite oraný, yoðun bakým ünitesine yatýþ ve komplikasyonlar üzerindeki etkisini araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Bir Eðitim ve Araþtýrma Hastanesinde Ocak 2021 ile Aralýk 2023 tarihleri arasýnda kalça kýrýðý nedeniyle ameliyat edilen toplam 400 hasta retrospektif olarak analiz edildi. Hastalar iki gruba ayrýldý: serviste takip edilenler Grup 1 (n=304) ve yoðun bakým ünitesinde takip edilenler Grup 2 (n=96) olarak adlandýrýldý.
Demografik özellikler, Amerikan Anestezistler Derneði fiziksel durum skorlarý, komorbidite tipi, anestezi tipi, cerrahi yöntem, cerrahi gecikme süresi, cerrahi süre, kan transfüzyon gereksinimi ve komplikasyonlar kaydedildi.
BULGULAR: Grup 2'deki hastalarýn yaþ ortalamasý, komorbidite ve mortalite oranlarý Grup 1'e göre daha yüksekti (p<0.001). Komorbidite türleri açýsýndan, koroner arter hastalýðý ve kronik böbrek yetmezliði olan hastalarda yoðun bakým ünitesine yatýþ oraný daha yüksek bulundu (p<0.001). Ortalama cerrahi gecikme ve hastanede kalýþ süresi Grup 2'de daha yüksekti (p<0.001). Yapýlan multivaryant lojistik regresyon analizinde; yaþ (p<0.001, QR=1.91 Cl=1.046-1.137), ASA skoru (p<0.001 QR=3.872 Cl=1.913 - 7.838), cerrahi gecikme süresi (p<0.001, QR=2.029 Cl=1.365-3.017), cerrahi yöntem (p=0. 003, QR= 2.003 Cl=1.258-3.188) ve hastanede kalýþ süresi (p=0.006, QR=1.147 Cl: 1.04-1.266) 30 günlük mortalite için prediktif faktörler olarak belirlendi.
SONUÇ: Bu çalýþmada yaþ, ASA sýnýflandýrmasý, hastanede kalýþ süresi, cerrahi yöntem ve cerrahi gecikmenin hem morbidite hem de mortalite için prediktif faktörler olduðu bulunmuþtur. Bunlar arasýnda cerrahi gecikme süresi, tüm faktörler göz önünde bulundurulduðunda deðiþtirilebilir bir parametre olarak görülmektedir.

BACKGROUND: Various factors contribute to the development of mortality and morbidity in hip fracture surgeries. This study aims to investigate the effects of modifiable factors such as the type of anesthesia, anesthesia management, surgical method, and timing of surgery on 30-day mortality rates, intensive care unit admissions, and complications.
METHODS: A total of 400 patients who underwent hip fracture surgery between January 2021 and December 2023 at a Training and Research Hospital were retrospectively analyzed. Patients were divided into two groups: those followed in the ward, named Group 1 (n=304), and those in the intensive care unit, named Group 2 (n=96). Recorded data included demographic characteristics, American Society of Anesthesiologists (ASA) physical status scores, types of comorbidities, anesthesia type, surgical method, surgical delay time, duration of surgery, blood transfusion requirements, and complications.
RESULTS: Patients in Group 2 had higher mean age, comorbidity, and mortality rates compared to Group 1 (p<0.001). In terms of types of comorbidities, the rate of intensive care unit admission was higher in patients with coronary artery disease and chronic renal failure (p<0.001). Mean surgical delay and length of hospital stay were also higher in Group 2 (p<0.001). In multivariate logistic regression analysis, age (p<0.001, Odds Ratio [OR]=1.91, Confidence Interval [CI]=1.046-1.137), ASA score (p<0.001, OR=3.872, CI=1.913-7.838), duration of surgical delay (p<0.001, OR=2.029, CI=1.365-3.017), surgical method (p=0.003, OR=2.003, C=1.258-3.188), and length of hospital stay (p=0.006, OR=1.147, CI=1.04-1.266) were determined as predictive factors for 30-day mortality.
CONCLUSION: This study found that age, ASA classification, length of hospital stay, surgical method, and surgical delay were predictive factors for both morbidity and mortality. Among these, surgical delay time appears to be a modifiable parameter when all factors are considered.

AMAÇ: Deprem ve diðer doðal afetlerde doðrudan travmaya baðlý olarak ciddi sayýda yaralanma meydana gelmektedir. Ayrýca afetin aþýrý iþ yükü yüklenen saðlýk kurumlarýný da etkilemesi nedeniyle saðlýk çalýþanlarý deprem sýrasýnda önemli zorluklarla karþý karþýya kalmaktadýr. Bu baðlamda yakýn çevrede saðlýk hizmeti veren hastaneler önemli bir rol oynamaktadýr. Ancak doðru planlamayla saðlýk krizi en iyi þekilde yönetilebilir.
GEREÇ VE YÖNTEM: 6 Þubat 2023'te Türkiye'nin güney ve ortadoðu bölgelerinde meydana gelen depreme baðlý yaralanma nedeniyle Mersin Þehir Eðitim ve Araþtýrma Hastanesi'ne baþvuran hastalar üzerinde tek merkezli retrospektif bir çalýþma yapýldý. Çalýþma kriterlerini karþýlayan toplam 2155 hasta analize dahil edildi.
BULGULAR: Çalýþmamýza dahil edilen 2155 hastanýn %46.8'i (n=1009) erkek olup yaþ ortalamasý 45.86±17.68 yýl idi. Düþmeler (% 57.2, n=1233) en sýk görülen yaralanma mekanizmasý olup, vakalarýn %71.9'u (n=1550) hastanemize kendi imkanlarý ile baþvurmuþtur. Kranial bölgede en sýk görülen yaralanmalar yumuþak doku yaralanmasý ve cilt kesileri iken, torasik bölgede yumuþak doku yaralanmasý ve kaburga kýrýklarý en sýk görülen yaralanmalardý. Abdominal yaralanmalar içindeen sýk yumuþak doku yaralanmasý ve retroperitoneal kanama saptanýrken, üst ve alt ekstremitede ise yumuþak doku yaralanmasý ve kýrýklarý en sýk olarak saptandý. Olgularýn %11,1'inde (n=240) üst ekstremitede, %21.3'ünde (n=458) alt ekstremitede kýrýk tespit edildi.Rabdomiyoliz en sýk görülen yaralanma türlerinden biriydi (n=443, %20,6). Vakalarýn %9.2'sinde (n=198)Crushsendromu ve akut böbrek hasarý saptandý; bu durum 40 (%1.8) hastada toplam 46 amputasyona ve 132 (%6.1) hastada 164 fasiyotomiye yol açtý. Ortopedi bölümü en sýk cerrahi müdahale ve hastaneye yatýþlarý gerçekleþtirdi. Vakalarýn %3.0'ýnda (n=62) mortalite gözlendi.
SONUÇ: Bu çalýþma deprem sonrasýnda iþ yükünde ve hasta hacminde önemli bir artýþ olduðunu ortaya koymuþtur. Deprem gibi ciddi travma riski yüksek olan afetlerde kýrýk, ezilme sendromu, amputasyon, fasiyotomi gibi durumlara hýzlý müdahale için çok sayýda saðlýk profesyoneline ihtiyaç vardýr. Afet planlamasý ve olasý sonuçlara karþý hazýrlýklý olmak, hastaneleri ilgilendiren saðlýk krizini hafifletecek ve mortalite ve morbiditede önemli azalmalara yol açacaktýr.

BACKGROUND: In earthquakes and other natural disasters, there is a significant number of injuries directly resulting from trauma. Additionally, due to the disaster’s impact on overloaded health institutions, healthcare providers face significant challenges during earthquakes. In this context, nearby hospitals providing health services play a crucial role. Nonetheless, with proper planning, the health crisis can be managed in the best possible way.
METHODS: A single-center retrospective study was conducted on patients admitted to Mersin City Training and Research Hospital due to injuries attributed to the earthquake that occurred in the southern and mid-eastern regions of Türkiye on February 6, 2023. A total of 2,155 patients meeting the study criteria were included in the analysis.
RESULTS: Of the 2,155 patients enrolled in the study, 46.8% (n=1009) were male, with a mean age of 45.86±17.68 years. Falls (57.2%, n=1233) were the most common mechanism of injury, and 71.9% (n=1550) of cases presented to the hospital on their own. Among the head injuries, the most common types were soft tissue injury and lacerations, while soft tissue injury and rib fractures were most common in the thoracic region. Soft tissue injury and retroperitoneal bleeding were the most commonly recorded types among abdominal injuries, whereas soft tissue injury and fractures were most common in the upper and lower extremities. Fractures were identified in 11.1% (n=240) of cases in the upper extremities and 21.3% (n=458) in the lower extremities. Rhabdomyolysis was one of the most frequently observed injury types (n=443, 20.6%). Crush syndrome and acute kidney injury were recorded in 9.2% (n=198) of cases, leading to a total of 46 amputations in 40 (1.8%) patients and 164 fasciotomies in 132 (6.1%) patients. The orthopedics department performed the most frequent surgical interventions and hospitalizations. Mortality was noted in 2.87% (n=62) of cases.
CONCLUSION: This study demonstrated a significant increase in workload and patient volume following the earthquake. There is a need for a large number of healthcare professionals for expedient intervention in conditions such as fractures, crush syndrome, amputation, and fasciotomy in disasters with a high risk of serious trauma, such as earthquakes. Disaster planning and preparedness for possible consequences will mitigate the healthcare crisis involving the hospitals and lead to significant reductions in mortality and morbidity.

AMAÇ: Çalýþmamýzýn amacý, Türkiye'de Kahramanmaraþ depremi sonrasý yoðun bakýmda takip edilen crush sendromu tanýlý hastalarda nötrofil-lenfosit oraný (NLR), lenfosit-monosit oraný (LMR) ve trombosit-lenfosit oranýnýn (PLR) 28 günlük mortalite üzerindeki prognostik etkisini deðerlendirmektir.
GEREÇ VE YÖNTEM: Bu çalýþmaya deprem sonrasý crush sendromu tanýsýyla yoðun bakým ünitesine yatýrýlan toplam 63 yetiþkin hasta dahil edildi. Hastalarýn týbbi kayýtlarý takip formlarý ve hastane veri sistemi kullanýlarak incelendi.
BULGULAR: Hastalarýn ortalama yaþý 38.9±17.3 yýl ve enkaz altýnda geçen ortanca süre 31.5 saat idi. 28 günlük mortalite oraný %27 idi. Tek deðiþkenli genelleþtirilmiþ tahmin denklemleri (GEE) veya diðer analizlerde, 28 günlük mortalite gruplarý arasýnda anlamlý bulunan deðiþkenler (veya aday deðiþkenler) ve biyolojik bir faktör olarak yaþ, çok deðiþkenli GEE modeline dahil edildi. Sürekli renal replasman tedavisi (CRRT), serum sodyum konsantrasyonu, sýralý organ yetmezliði deðerlendirme (SOFA) skoru ve PLR'nin mortalite üzerindeki etkisi istatistiksel olarak anlamlýydý. SONUÇ: Yüksek SOFA skorlarý, CRRT gerekliliði, artmýþ serum sodyum seviyeleri, ve azalmýþ PLR deðerleri deprem sonrasý crush sendromu tanýlý hastalarda 28 günlük mortaliteyi artýrmaktadýr.

BACKGROUND: The aim of our study is to assess the prognostic impact of the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) on 28-day mortality in patients admitted to the intensive care unit with crush syndrome following the Kahramanmaraþ earthquake in Türkiye.
METHODS: A total of 63 adult patients with crush syndrome admitted to the intensive care unit after the earthquake were enrolled in this study. The medical records of the patients were examined using follow-up forms and the hospital data system.
RESULTS: The mean age of the patients was 38.9±17.3 years, and the median time under debris was 31.5 hours. The 28-day mortality rate was 27%. In univariate generalized estimating equations (GEE) and other analyses, variables that are significant (or candidate variables) between 28-day mortality groups included age as a biological factor. These variables were included in the multivariate GEE model. The effects of continuous renal replacement therapy (CRRT), serum sodium concentration, Sequential Organ Failure Assessment (SOFA) score, and PLR on mortality were statistically significant.
CONCLUSION: Elevated SOFA scores, the necessity for CRRT, increased serum sodium levels, and decreased PLR values are associated with increased 28-day mortality in patients with crush syndrome after an earthquake.

AMAÇ: Kafa travmasý, ölüm ve sakatlýðýn önde gelen nedenleir. Aðýr kafa travmasý için standart tedavi protokolleri mevcutken, bebeklerde ve yenidoðanlarda pozitif görüntüleme bulgularý olan hafif kafa travmalarý için net takip standartlarý bulunmamaktadýr. Orta ve hafif kafa travmasý olan çocuklarda kontrol beyin BT görüntülemesi rutin olarak önerilmezken, bebekler ve yenidoðanlarda kontrol görüntüleme ihtiyacý belirsizliðini korumaktadýr.
GEREÇ VE YÖNTEM: Çalýþmamýz retrospektif, gözlemsel ve tanýmlayýcý bir çalýþmadýr. Ankara Etlik Þehir Hastanesi Etik Kurulu onayý ile acil servise izole kafa travmasý ile baþvuran 1 yaþ altý hastalar incelendi. Dahil edilme kriterleri arasýnda acil servise baþvuru, birden fazla beyin BT çekilmesi ve hafif kafa travmasý (GKS >13) yer aldý. Eksik takip verileri veya çoklu travmasý olan hastalar hariç tutuldu. Yaþ, cinsiyet, travma mekanizmasý, ilk ve kontrol beyin BT bulgularý, hastaneye yatýþ ve cerrahi iþlemler kaydedildi ve SPSS istatistik paketi kullanýlarak analiz edildi.
BULGULAR: Tarama sonucu bulunan 238 hastadan 154'ü çalýþmaya dahil edildi. Bu 154 hastanýn %66.9'u erkekti ve yaþ ortalamasý 5.99 aydý. En sýk baþvuru semptomu %79.2 ile travma bölgesinde þiþlikti. En sýk görülen travma mekanizmasý %85.1 ile düþme (<90 cm) idi. Kontrol BT'de patolojik ilerleme hastalarýn %5.2'sinde gözlendi ve yalnýzca %1.9'unda cerrahi tedavi gerekti. Hastalarýn %34.4'ü hastaneye yatýrýldý. Beyin parankimal patolojisi olan hastalar, kontrol BT'de daha yüksek oranda patolojik ilerleme ve daha uzun hastanede kalýþ gösterdi.
SONUÇ: Hafif kafa travmalý bebeklerde kontrol beyin BT taramalarý, beyin parankimal patolojisi olan vakalar dýþýnda hasta sonuçlarýný deðiþtirmemektedir. Çalýþma verileri izole kafatasý kýrýklarýnda tekrar görüntülemenin faydasý olmadýðýný gösterdi. Görüntüleme artefaktlarý, taramalarýn tekrarlanmasýný gerektirmiþ ve bu da radyasyona maruz kalmanýn artmasýna katkýda bulunmuþtur. Gereksiz tekrarlanan görüntüleme, radyasyona maruz kalmayý ve maliyetleri artýrmaktadýr. Hastalarýn küçük bir yüzdesinde intrakraniyal patolojinin ilerlemesi gözlendi, bu da kontrol görüntüle-menin yalnýzca beyin parankimal hasarý varlýðýnda yapýlmasýný haklý göstermektedir. Bu bulgularý doðrulamak için daha büyük örneklem büyüklüðüne sahip prospektif çalýþmalara ihtiyaç vardýr.

BACKGROUND: Head trauma is a leading cause of death and disability. While standard treatment protocols exist for severe head trauma, no clear follow-up standards are available for mild head trauma with positive imaging findings in infants and newborns. Although routine follow-up brain computed tomography (CT) imaging is not recommended for children with moderate and mild head trauma, the necessity for follow-up imaging in infants and newborns remains uncertain.
METHODS: Our study is a retrospective, observational, and descriptive study. Infants under 1 year old presenting to the emergency department with isolated head trauma were reviewed with the approval of the Ethics Committee of Ankara Etlik City Hospital. Inclusion criteria included presentation to the emergency department, undergoing more than one brain CT scan, and sustaining mild head trauma (Glasgow Coma Scale [GCS] >13). Patients with incomplete follow-up data or multiple traumas were excluded. Age, gender, mechanism of trauma, initial and follow-up brain CT findings, hospital admission, and surgical procedures were recorded and analyzed using the SPSS statistical package.
RESULTS: Out of 238 screened patients, 154 were included in the study. Of these, 66.9% were male and the average age was 5.99 months. The most common presenting symptom was swelling at the trauma site, observed in 79.2% of cases. The most common mechanism of injury was falling from a height of less than 90 cm, accounting for 85.1% of cases. Pathological progression on follow-up CT was observed in 5.2% of the patients, and only 1.9% required surgical treatment. A total of 34.4% of the patients required hospitalization. Patients with parenchymal brain pathology had a higher rate of pathological progression on follow-up CT and a longer hospital stay.
CONCLUSION: Follow-up CT scans in infants with mild head trauma do not alter patient outcomes except in cases with brain parenchymal pathology. Study data indicated that repeat imaging is not beneficial for isolated skull fractures. Imaging artifacts often necessitated repeated scans, contributing to increased radiation exposure. Unnecessary repeat imaging escalates radiation exposure and healthcare costs. Only a small percentage of patients exhibited progression of intracranial pathology, justifying follow-up imaging solely in the presence of brain parenchymal injury. Larger prospective studies are necessary to confirm these findings.

AMAÇ: Ateþli silah yaralanmalarý gibi yüksek enerjili yaralanmalar, alt ekstremitelerde aþýrý yumuþak doku ve kemik kaybýna neden olabilir.Bu tür yaralanmalarda öncelikli olarak ekstremitenin korunmasý hedeflense de,ekstremitenin kurtarýlmasý ve fonksiyonun restorasyonu için tekrarlanan cerrahi iþlemler hastaya hem fiziksel hem de psikolojik açýdan zarar verici sonuçlar doðurabilmektedir.Çalýþmanýn temel amacý ateþli silah yaralanmasý sonrasý erken dönemde alt ekstremite amputasyonu yapýlan hastalarýn fiziksel ve psikolojik bulgularý ile geç dönemde amputasyon yapýlan hastalarýn sonuçlarýnýn deðerlendirilmesidir. Ayrýca geç diz altý amputasyon uygulanan hastalarda prognozu etkileyen faktörleri de deðerlendirilmiþtir.
GEREÇ VE YÖNTEM: Bu retrospektif çalýþmaya Mart 2017 ile Mart 2022 tarihleri arasýnda ateþli silahlara baðlý alt ekstremite yaralanmasý sonrasý diz altý amputasyon uygulanan hastalar dahil edildi. Yaralanmanýn hemen ardýndan götürüldükleri ilk merkezde acil diz altý amputasyon uygulanan hastalar erken amputasyon grubunu oluþturdu.Baþka bir merkezde yapýlan ilk müdahalenin ardýndan tedavilerinin devamý için üçüncü basamak sevk merkezimize nakledilen ve daha sonra diz altý amputasyon uygulanan hastalar geç amputasyon grubunu oluþturdu. Hastalar yaþ, cinsiyet, amputasyon tarafý, fantom uzuv aðrýsý varlýðý ve travma sonrasý stres bozukluðu açýsýndan deðerlendirildi.
BULGULAR: Toplam 35 hastanýn bilgileri hastane kayýtlarýndan elde edildi; Erken amputasyon grubunda 16, Geç amputasyon grubunda ise 19. Hastalarýn tamamý erkekti. Yaralanma anýnda ortalama yaþ 25.5±5.3 yýl (aralýk, 20-45 yýl) ve ortalama takip süresi 37±17 ay (aralýk, 25-72 ay) idi. Yaþanan fantom uzuv aðrýsý karþýlaþtýrýldýðýnda gruplar arasýndaki fark istatistiksel olarak anlamlýydý; Erken amputasyon grubunda 1 (%10) hastanýn, Geç amputasyon grubunda ise 9 (%90) hastanýn fantom uzuv aðrýsý yaþadýðý görüldü (p=0.010). Erken amputasyon grubunda 3 (%23) hastada, Geç amputasyon grubunda ise 10 (%77) hastada Travma sonrasý stres bozukluðu tanýsý konuldu (p=0.039).
SONUÇ: Geç diz altý amputasyon uygulanan hastalarýn Fantom uzuv aðrýsý ve Travma sonrasý stres bozukluðundan daha yüksek oranda etkilendikleri belirlendi. Alt ekstremitede ciddi açýk yaralanmasý olan hastalarda ekstremite koruyucu cerrahiye karar verirken geç diz altý amputasyon ile iliþkili kötü sonuçlarýn dikkate alýnmasý çok önemlidir. Hastalar bu olumsuz sonuçlar konusunda iyice bilgilendirilmelidir.

BACKGROUND: High-energy casualties such as firearm injuries may result in extensive loss of soft tissue and bone in the lower extremities. Although the primary aim in these types of injuries is the preservation of the extremity, repeated surgical procedures for extremity salvage and subsequent restoration of function could have detrimental effects on the patient both physically and psychologically. The main aim of this study is to evaluate the physical and psychological outcomes of patients who underwent lower extremity amputation in the early period after a firearm injury compared with the results of patients who underwent amputation in the late period. We also evaluated the factors affecting the prognosis in patients undergoing late below-knee amputation (BKA).
METHODS: This retrospective study included patients who underwent BKA following a lower extremity injury caused by firearms between March 2017 and March 2022. Patients who underwent emergency BKA at the first center they were taken to immediately after the injury constituted the early amputation (EA) group. Patients who were transferred to our tertiary-level referral center for continuation of treatment after the first intervention at another center and later underwent BKA constituted the late amputation (LA) group. The patients were evaluated regarding age, gender, amputation side, presence of phantom limb pain (PLP), and post-traumatic stress disorder (PTSD).
RESULTS: Information was available from hospital records for a total of 35 patients; 16 in the EA group and 19 in the LA group. All patients were male. The mean age at the time of injury was 25.5±5.3 years (range, 20-45 years), and the mean follow-up period was 37±17 months (range, 25-72 months). In the comparison of PLP experienced, the difference between the groups was statistically significant, with PLP experienced by 1 (10%) patient in the EA group and by 9 (90%) in the LA group (p=0.010). PTSD was diagnosed in 3 (23%) patients in the EA group and 10 (77%) patients in the LA group (p=0.039).
CONCLUSION: Patients who underwent late BKA were found to be affected by PLP and PTSD at a higher rate. When deciding on extremity-preserving surgery for patients with severe open injuries to the lower extremity, it is crucial to consider the poor outcomes associated with late BKA. Patients should be thoroughly informed about these negative outcomes.

AMAÇ: Okulda þiddet en geniþ tanýmýyla okulda, okul çevresinde, okula giderken veya okula iliþkin herhangi bir çevrede fiziksel, psikolojik, cinsel þiddet ve zorbalýk içeren eylemler bütünü olarak tanýmlanmaktadýr. Okul ortamýný çocuðun günlük yaþamýnýn büyük bir kýsmýný geçirdiði bir yer olarak düþündüðümüzde, çocuðun yaþamý üzerindeki etkisi azýmsanamayacak kadar büyüktür. Bu çalýþmada anabilim dalýmýzda adli raporlarý düzenlenen okulda þiddet ve zorbalýk olgularýnýn özellikleri paylaþýlarak; okul içi þiddet ve zorbalýk olgularýnýn tespiti ve engellenmesine yönelik çözüm önerilerinin sunulmasý ile bu hususta literatüre katký saðlamak amaçlanmýþtýr.
GEREÇ VE YÖNTEM: 01.01.2012-31.12.2022 tarihleri arasýnda Dokuz Eylül Üniversitesi Týp Fakültesi Adli Týp Anabilim Dalýnca düzenlenen toplam 14330 adli rapor incelendi ve toplam 125 olgunun okulda þiddet gördüðü tespit edildi. Öðrenci olmayan 5 olgu analiz dýþý býrakýlarak çalýþmaya sadece öðrenci olan 120 olgu dahil edildi. Sosyodemografk veriler, þiddetin türü, olayýn geçtiði yer, okul çaðý, yaralanma orjini, ruhsal deðerlendirme sonuçlarý vb. deðerlendirildi. Verilerin istatistiksel analizi SPSS 29.0 paket programý kullanýlarak yapýldý.
BULGULAR: Toplam 120 olgunun 90’ný (%75) erkek, 25’i (%25) kadýndý. Olgularýn en sýk ortaöðretim (n=73, %60.8), ikinci sýklýkta ise (n=36, %30) ilköðretim düzeyinde þiddete maruz kaldýðý tespit edildi. Maruz kalýnan þiddetin türü incelendiðinde; en sýk (n=96, %80) fiziksel, ikinci sýklýkta cinsel (n=21, %17.5) þiddet olduðu görüldü. Erkeklerin %91.1’nin (n=82) fiziksel, kadýnlarýn ise %43.3’ünün (n=13) cinsel þiddete maruz kaldýðý saptandý. Cinsiyete göre maruz kalýnan þiddetin türü arasýnda istatistiksel olarak anlamlý bir iliþki bulundu (p<0,001). Þiddet sonrasý ruhsal deðerlendirmesi yapýlan olgulara en sýk konulan tanýnýn travma sonrasý stres bozukluðu (TSSB) (n=15, %45.5) olduðu görüldü.
SONUÇ: Þiddet ve zorbalýk eylemleri ile mücadelede, farklý kültürlerdeki okullarda zorbalýk nedenlerinin analiz edilmesi, problem alanýna iliþkin uygun giriþimlerin planlanýp uygulanmasý ve sonuçlarýnýn yaygýnlaþtýrýlmasý ile tekrar edebilir olaylarý önlemeye dayalý stratejilerin daha etkin sonuçlar vereceði kanaatindeyiz.

BACKGROUND: Violence at school is broadly defined as a range of acts including physical, psychological, and sexual violence, as well as bullying. These can occur at school, in the school environment, on the way to school, or in any school-related environment. Considering the school environment as the place where a child spends most of their daily life, its impact on the child's life cannot be underestimated. This study aims to contribute to the literature by sharing characteristics of school violence and bullying cases with forensic reports prepared in our department, and by presenting solution suggestions for detecting and preventing these issues.
METHODS: Between January 1, 2012 and December 31, 2022, a total of 14,330 forensic reports issued by the Dokuz Eylül University Faculty of Medicine, Department of Forensic Medicine, were analyzed. It was found that 125 cases involved school violence. Five cases involving non-students were excluded, leaving 120 student cases for inclusion in the study. Sociodemographic data, type of violence, incident location, educational stage, injury origin, and psychiatric assessment results were assessed. Statistical analysis of the data was performed using the SPSS 29.0 package.
RESULTS: Of the 120 cases analyzed, 90 (75%) were male, and 30 (25%) were female. The cases were most frequently subjected to violence at the secondary education stage (n=73, 60.8%) and, secondarily, at the primary education stage (n=36, 30%). When the type of violence was analyzed, it was found that physical violence was the most common (n=96, 80%), followed by sexual violence (n=21, 17.5%). Among these, 91.1% (n=82) of males and 43.3% (n=13) of females were exposed to physical and sexual violence, respectively. A statistically significant relationship was found between the type of violence and gender (p<0.001). Post-traumatic stress disorder (PTSD) was the most common diagnosis among those who underwent psychiatric assessments after experiencing violence (n=15, 45.5%).
CONCLUSION: To effectively combat violence and bullying, we believe that strategies based on analyzing the causes of bullying in schools across different cultures, planning and implementing appropriate interventions tailored to the problem area, and preventing recurrence by disseminating the results will yield more effective outcomes.