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Background Knee dislocation is a rare but severe orthopedic emergency with a substantial risk of limb-threatening complications. This retrospective national database cohort study aimed to describe the epidemiology of traumatic knee dislocations and identify risk factors for vascular and neurological injuries. Methods A total of 164 patients diagnosed with knee dislocation between 2016 and 2023 were included in this retrospective study. Data were obtained from the Ministry of Health system, and diagnoses were confirmed. Demographics, injury mechanisms, associated fractures, and complications were evaluated using International Classification of Diseases (ICD) codes. Logistic regression was used to identify independent risk factors. Results The study population consisted primarily of males (81.7%) with an average age of 31.74 years. Vascular injuries occurred in 19.5% of patients, most commonly involving the popliteal artery. Neurological injury was present in 20.1%. In patients with open injuries, infection, vascular injury, amputation, debridement, and soft tissue defect repair were found to be significantly higher. Despite these findings, open injury was not an independent predictor of vascular injury in multivariate analysis. Charlson Comorbidity Index (CCI) > 0 independently predicted the need for vascular procedures. Younger age was associated with neurological injury. Intensive Care Unit (ICU) admission was associated with systemic injuries. The overall amputation rate was 1.2%. Conclusion Traumatic knee dislocations frequently involve serious neurovascular complications. While open injuries were associated with a more complicated clinical course, only CCI independently predicted the need for vascular intervention. Early recognition of patients with comorbidities and significant concomitant injuries may improve outcomes. Level of evidence Level IV.

Background and Objectives: The presence of comorbidities in both the pre- and post-diagnostic periods is a critical consideration in the diagnosis and management of patients with cancer. This study aimed to investigate the prevalence and burden of pulmonary and extrapulmonary comorbidities in patients diagnosed with lung cancer (LC) and malignant pleural mesothelioma (MPM). Materials and Methods: The data were obtained from official patient records of the Turkish Ministry of Health. Patients diagnosed with either lung cancer (LC) or malignant pleural mesothelioma (MPM) between 2015 and 2018 were included in the study. Comorbidities were classified as pulmonary or extrapulmonary. Results: A total of 74,835 patients with LC and 1678 patients with MPM were included. The burden of comorbid conditions increased significantly in the post-diagnostic period in both males and females across both cancer types. When the two cancer groups were compared with respect to diagnostic periods, comorbidities such as hypertension (HT), phlebitis/venous thrombosis/thrombophlebitis, pulmonary embolism, pneumothorax, and pleural effusion were significantly more prevalent in the MPM group (p < 0.05). Compared with the pre-diagnostic period, the comorbidity risk in LC was highest for pulmonary embolism, ARF, and pneumonia in the post-diagnostic period, whereas renal failure was the most frequent comorbidity in the MPM group (p < 0.001 and p = 0.024). When comparing changes in comorbidity burden between sexes in the lung cancer group, male patients had higher frequencies of pulmonary embolism, pneumonia, pneumothorax, and coronary artery disease than females. In contrast, in the female lung cancer group, the prevalence of chronic renal failure was higher than in males (OR = 2.14 vs. 2.00), whereas acute renal failure was more prominent in the male patient group (OR = 2.64 vs. 1.94). In gender-based comparison of comorbid conditions among patients with MPM, the risk of renal failure was higher in females than in males (CRF and ARF respectively: OR = 2.63 vs. 2.16 and OR = 6.80 vs. 5.44). Additionally, increased rates of COPD were observed in male patients within this group (OR = 1.93 vs. 1.81). Conclusions: Patients with LC and MPM are burdened not only by their primary malignancies but also by a wide spectrum of comorbidities, particularly in the post-diagnostic period. Comprehensive knowledge of comorbid conditions is essential for clinicians to guide clinical decision-making, anticipate disease progression, and optimize treatment strategies, thereby informing national healthcare policies. Future studies incorporating matched control groups or longitudinal designs with standardized surveillance protocols may help conduct better research.

Major heart failure (HF) trials remain insufficient in terms of assessing the differences in clinical characteristics, biomarkers, treatment efficacy, and safety because of the under-representation of women. The study aimed to present sex-related disparities in HF management, including differences in demographics, co-morbidities, cardiac biomarkers, prescribed medications, and treatment outcomes. The study utilized anonymized data from the Turkish Ministry of Health's National Electronic Database between January 1, 2016, and December 31, 2022. The cohort analysis included 2,501,231 adult patients with HF. Specific therapeutic combinations were analyzed using a Cox regression model to obtain relative risk reduction for all-cause death. The primary end point was all-cause mortality. In the cohort, 48.7% (n = 1,218,911) were male, whereas 51.3% (n = 1,282,320) were female. Female patients exhibited a higher median age (71 vs 68 years) and manifested higher prevalence of diabetes mellitus, anemia, atrial fibrillation, anxiety, and ischemic stroke. Male patients demonstrated higher rates of previous myocardial infarction, dyslipidemia, chronic obstructive pulmonary disease, and chronic kidney disease. Higher concentrations of natriuretic peptides were observed in female patients. Renin-angiotensin aldosterone inhibitor, β blockers, mineralocorticoid receptor antagonists, sodium/glucose cotransporter 2 inhibitor (SGLT2i), and ivabradine were more commonly prescribed in male patients, whereas loop diuretics, digoxin, and ferric carboxymaltose were more frequent in female patients. Male patients had higher rates of cardiac resynchronization therapy and implantable cardioverter defibrillator implantation rates. All-cause mortality and hospitalization rates were higher in male patients. Compared with monotherapy, all combinations, including SGLT2i, showed a beneficial effect on all-cause mortality in both female and male patients with HF. In hospitalized patients with HF, the addition of digoxin to renin-angiotensin aldosterone inhibitor, mineralocorticoid receptor antagonists, and β blockers was superior to monotherapy regarding all-cause mortality in female patients with HF compared with male patients with HF. In conclusion, this study highlights that sex-specific responses to HF medication combinations compared with monotherapy and differences in co-morbidities underscore the importance of tailored management strategies. Digoxin showed a contrasting effect on all-cause mortality between both sexes after hospitalization, whereas SGLT2i exhibited a consistent beneficial effect in both sexes when added to all combinations. •By understanding and addressing differences in guideline-directed medical treatment responses between sex, healthcare providers can optimize patient outcomes and reduce the burden of heart failure (HF) on patients and healthcare systems.•The most effective combinations of HF drugs in reducing all-cause mortality were those with sodium/glucose cotransporter-2 inhibitors in both male and female patients.•The use of digoxin showed different responses in male and female hospitalized patients with HF when added into first-line guideline-directed medical therapy.•Compared with monotherapy, each combination, including recommended drugs by the current guidelines, did not show similar efficacy on all-cause mortality in both sexes with HF.

Diagnosing femoroacetabular impingement (FAI) is challenging and surgical indications for hip arthroscopy are still evolving. This study analyzes the two years leading up to surgery in a large cohort of patients with FAI. We hypothesized that patients with FAI experience diagnostic challenges causing delayed treatment. We assessed the 2-year diagnostic journeys of patients prior to hip arthroscopy by analyzing recurring hip-related hospital visits, magnetic resonance imaging (MRI), the geographical distribution, and healthcare settings of these visits related to hip pain using data from a nationwide database. Medical records in the national e-health database were reviewed to identify patients who underwent hip arthroscopy between January 2017 and May 2023. Patients aged 18–65 years with a minimum of 2 years of prior medical records were included. The number of clinic visits and MRI scans in the 2 years prior to hip arthroscopic FAI surgery were analyzed with distributions of age and sex. 1754 patients who were confirmed to have complete procedure notes were included in the study. Only 30 of the 81 provinces of Türkiye had hip arthroscopy entries (37.0%). The majority of patients presented at university hospitals on their first visit (35.3%), and 1544 patients (88%) underwent MRI prior to surgery. The median number of clinic visits was 9 (SD: 7.7) and that of MRI scans was 2 (range: 1–7) per patient. Patients under 40 years had a higher mean of orthopedic surgery clinic visits (M: 8.8, SD: 5.1) than those over 40 years (M: 8.1, SD: 6.0) ( p  = 0.01). There was no significant difference between men and women in mean orthopedic clinic visits (8.5 vs. 8.4, respectively). The findings suggest that patients with FAI undergo a considerable number of physician visits (median of 9) and MRI scans (median of 2) in the 2 years preceding hip arthroscopy in Türkiye. These results may indicate diagnostic challenges, delays in determining the need for surgery, and potential reluctance to undergo hip arthroscopy. Addressing these issues would require implementing strategies to reduce the time from symptom onset to treatment initiation and alleviate the financial burden associated with delayed diagnosis.

Background In the contemporary management of heart failure with reduced ejection fraction (HFrEF), the recommended quadruple guideline-directed medical therapy (GDMT) consists of angiotensin receptor-neprilysin inhibitor (ARNI), evidence-based beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), and sodium-glucose cotransporter-2 inhibitors (SGLT-2i). This study explored the impact of adding implantable cardioverter-defibrillator (ICD) therapy to this comprehensive regimen in HFrEF patients. Methods Utilizing deidentified data from the National Electronic Database of the Turkish Ministry of Health, we conducted a nationwide retrospective cohort study on 5450 HFrEF patients receiving quadruple GDMT, including ARNI. Among them, 709 patients underwent additional ICD or cardiac resynchronization therapy defibrillator (CRT-D) implantation. Propensity score matching ensured balanced baseline characteristics between groups. Primary endpoint was determined as all-cause mortality. Results In the matched cohort, all-cause mortality occurred in 108 out of 619 patients (17.4%) in the GDMT group and 101 out of 619 patients (16.3%) in the ICD group, with a hazard ratio (HR) of 0.74 and a 95% confidence interval (CI) ranging from 0.57 to 0.98. The median follow-up time was 1365 days in the matched cohort, 1283 days in the GDMT group. Subgroup analyses consistently demonstrated benefits, particularly among individuals aged 61 years and older (HR: 0.60, 95% CI: 0.42–0.87, p  = 0.006), those with sinus rhythm (HR: 0.55, 95% CI: 0.34–0.89, p  = 0.013), individuals not using amiodarone (HR: 0.61, 95% CI: 0.42–0.89, p  = 0.011), and those with an estimated glomerular filtration rate lower than 61.9 (HR: 0.66, 95% CI: 0.48–0.91, p  = 0.011). Conclusions This study may offer a glimmer of hope that even after achieving the best current optimal medical therapy, the addition of device therapy could still yield positive outcomes in the management of patients with HFrEF. Graphical Abstract

In this study, we aim to report the outcome of COVID-19 in hematopoietic cell transplant (HCT) recipients. HCT recipients (n = 32) with hematological disease and hospitalized for COVID-19 were included in the study. A cohort of age and comorbid disease-matched hospitalized COVID-19 patients with hematological malignancy but not underwent HCT (n = 465), and another cohort of age and comorbid disease-matched hospitalized COVID-19 patients without cancer (n = 497) were also included in the study for comparison. Case fatality rate (CFR) was 5.6% in patients without cancer, 11.8 in patients with hematological malignancy and 15.6% in HCT recipients. The CFR in HCT recipients who were not receiving immunosuppressive agents at the time of COVID-19 diagnosis was 11.5%, whereas it was 33% in HCT recipients who were receiving an immunosuppressive agent at the time of COVID-19 diagnosis. In conclusion, our study reveals that for the current pandemic, HCT recipients, especially those receiving immunosuppressive drugs, constitute a special population of cancer patients.

Background The use of biological agents in various diseases in children has been increasing and the risk of tuberculosis (TB) increases with them. We aimed to investigate the role of biological agents in children diagnosed with TB in a moderate level of TB country where TB screening is mandatory before and during biological agent treatment. Study design and methods This was a retrospective cohort study. All patients who were 0–18 years old and diagnosed with TB-related ICD-10 in the national health database system between 2018 and 2023 were included in the study. The number of patients, demographic characteristics, treatments used by the patients, underlying diseases, and organ involvement of TB were recorded. Children using and not using biological agents were compared. Results A total of 4351 children were diagnosed with TB, and 1.9% of them were treated with biological agents. The age of diagnosis was older ( p  = 0.001), and both pulmonary and extrapulmonary involvement was more frequent in children using biological agents ( p  = 0.001). Pulmonary involvement was more frequent in rheumatological diseases ( p  = 0.001), and naproxen usage was higher in children with pulmonary involvement ( p  = 0.014). Naproxen was found to increase the risk of pulmonary TB in children using biological agents (OR:3.824, p  = 0.033). Conclusions The low frequency of TB may be due to effective TB screening before and during the therapy. The age of diagnosis was older, pulmonary and extrapulmonary TB involvement was more common in children using biological agents, which may be related to the immunosuppressive effects. Children using biological agents who are also using naproxen should be closely followed up in terms of pulmonary TB.

Background Concomitant knee injuries, such as meniscal tears, are observed in up to 80% of cases and can have a detrimental impact on outcomes following anterior cruciate ligament reconstruction (ACLR). Over recent decades, there has been a growing recognition of the importance of preserving meniscal tissue. Consequently, the prevalence of meniscal-preserving procedures has been on the rise. Purpose The objective of this study was to examine the prevalence of concurrent meniscal procedures, assess the success rate, and identify factors associated with the failure of meniscal repair in patients undergoing ACLR. Methods All patients who underwent ACLR due to anterior cruciate ligament (ACL) injury between January 2015 and December 2022 were extracted from the Republic of Türkiye National health system using operation-specific procedure codes. Patients with multiple ligament injuries, revision ACL patients, and patients with missing data were excluded from the study. The treatment methods were grouped into the subsets of meniscectomy, meniscal repair, transplantation, and meniscectomy + repair. The distribution of ACLR and meniscus treatment methods according to years, age and sex groups, hospital characteristics, and geographical regions was examined. A secondary analysis was performed to assess the effect of patient demographics and hospital healthcare level on revision meniscal procedures in the ACLR + concomitant meniscal repair group. Results A total of 91,700 patients who underwent ACLR between 2015 and 2022 were included in the study. A concomitant meniscal procedure was noted in 19,951(21.8%) patients (16,130 repair,3543 meniscectomy). In the 8 years studied, meniscus repair rates increased from 76.3%to87.9%, while meniscectomy rates decreased from 23.7%to12.1% ( p  < 0.001). The revision meniscus surgery rate following ACLR + meniscal repair was 3.7%at a mean follow-up of 50 ± 26 months. The interval between primary and revision surgery was 20.5 ± 21.2 months. The meniscectomy rates were higher in community hospitals, while private hospitals showed the lowest revision meniscus surgery rates. Younger age was associated with increased meniscus repair failure rates. Conclusion The propensity towards using repair techniques to treat meniscal tears during concurrent ACLR has significantly increased in Turkey. Age and the healthcare level of the treating hospital affect the success of meniscal repair.

Background The primary objective of this study was to examine the incidence of fractures among individuals aged 20–64 years over a 7-year timeframe by utilising an electronic recording system that is integrated with a substantial portion of the Turkish population. Methods De-identified health records were acquired from the nationwide personal health recording system. Four age groups were established: 20–34, 35–44, 45–54, and 55–64 years. Incidence rates were further analysed according to sex and age group. Results A total of 3,286,991 fractures were recorded in the 7-year time period, with male patients accounting for 62.1% of those cases. The overall fracture incidence rate in the Turkish adult population was 1029/100,000. The incidence rate was 727.44/100,000 for women and 1158.86/100,000 for men ( p  < 0.001). The age group with the highest number of fractures was 20–34 years with 1337.012 (37.3%) fractures. Wrist fractures (17.46%), finger fractures (14.4%), and foot fractures (11.85%) accounted for 43.7% of all fractures. In women, the incidence of fractures, excluding those of the hand and wrist, increased significantly as the age groups increased ( p  < 0.05). Conclusion Wrist, finger, and foot fractures were found to be the most common fractures among individuals aged 20–64 years. Fracture incidence was highest in men and in the age group of 20–34 years, encompassing individuals who are more active in work and sports.

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.