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Objective: To investigate the clinical, imaging and laboratory findings for diagnosis of acute appendicitis (AA) in patients with a normal white blood cell count (WBCC). Methods: This retrospective cross-sectional study was conducted in Ankara Numune Training and Research Hospital, Ankara, Turkey, during a 1-year period. To determine diagnostic factors in AA in patients with normal WBCC, medical records of eligible patients were reviewed for demographic and clinical variables, as well as patient outcome. Results: A total of 105 patients that had undergone appendectomy and were found to have a normal WBCC were included in the study. Of these patients, 53 (50.5%) were men and 52 (49.5%) were women. The mean age of the patients was 34.2±12.3 (min 14, max 78). The negative exploration rate was identified as 19%. In the multivariate analysis, only the diameter of appendix was statistically significant (p=0.002). ROC analysis revealed the cut off appendiceal diameter as 8 mm. Conclusion: In patients suspected of AA due to ≥8 mm appendiceal diameter determined by imaging, we recommend surgical treatment even if WBCC and neutrophil count are normal.

Patients and Methods: This retrospective and descriptive study included the review of a total of 5238 pathology reports obtained from the medical records of the Somalia Turkey Recep Tayyip Erdogan Education and Research Hospital. Patient characteristics, lesion localization, and histopathology were recorded. Patients with an unconfirmed cancer diagnosis, borderline tumors, intraepithelial neoplasms and metastatic cancers were excluded from the study. The cases were classified according to gender, age, and organ involvement. Results: Of the 1306 patients included in the study, 50.9% (n=666) were female and 49.1% (n=640) were male, and the mean age was 51.1±19.4 years. Of the cases, 5.1% (n=67) were pediatric (0-17 years) and 35.8% (n=468) were in the 18-50 years range. The most common cancer was esophageal cancer (EC) for the overall data (n=284; 21.7%) and in both genders. EC peaked in the fifth decade, and the most common histological type was squamous cell carcinoma (n=256; 91.1%). Liver cancer was the second most common cancer overall (n=99; 7.6%) and in men (n=67; 10.5%). Cervical cancer was the second most common cancer among women (n=88; 13.3%) and ranked fourth in terms of overall incidence (n=88; 6.7%). Breast cancer was the third most common overall (n=95; 7.3%) and in women (n= 7; 13.1%). Conclusion: This study shows that in Somalia, EC is the most common cancer in both genders. These high rates in Somalia suggest that environmental factors and dietary habits may have an effect. To reduce the incidence of EC and prevent its development, the population of Somalia should be educated and effective planning should be undertaken.

Purpose: To report the type and severity of ocular injuries sustained by the survivors of a bomb-loaded explosion that occurred in Mogadishu, Somalia on December 28, 2019. Patients and Methods: The recorded data included age, gender, wounded eye, initial examination of ocular injuries and associated systemic injuries, initial visual acuity, anterior and posterior segment examinations. The type of injury (open vs closed globe), the injured zone of the globe, and the presence of a relative afferent pupil defect were evaluated in all cases where possible. Results: After the explosion, ocular injuries were detected in 28 of 114 patients in our hospital. Thirty-two eyes of 28 patients were included in the study. The mean age was 32.4 ±6.7 years. The number of open-globe injuries was more than that of closed-globe injuries (26 vs 6; 81.25% vs 18.75%, respectively). Zone 1 was the most affected zone in open-globe injuries (18/26 eyes, 61.6%), followed by Zone 3 in six (23%) patients and Zone 2 in four (15.4%) patients. Sixteen open-globe injuries were laceration type (61.5%) and 10 (38.5%) were rupture type. An intraocular foreign body was detected in eight (30.8%) eyes with open-globe injuries. A total of 28 patients had 11 (39.3%) isolated eye injuries, whereas 17 (60.7%) had concomitant systemic injuries. Conclusion: The frequency of blast-related ocular injuries is increasing. Today, the increase in the use of vehicle-borne improvised explosives in terrorist-related explosions leads to more frequent and serious ocular injuries.

Background To describe the severity and types of blast-related extremity injuries and the presence of accompanying vascular injuries (VI) and amputation, and to identify the associated factors affecting the treatment management and clinical course. Methods The study included 101 patients with extremity injuries caused by a bomb explosion. The radiographs and computed tomography angiographies of the patients were evaluated in terms of injury patterns, presence of penetrating fragments and fractures, and localization (upper or lower extremity) and type (open or closed) of injury. The Gustilo-Anderson classification was used for open fractures. According to their severity, open fractures classified as types 1 and 2 were included in Group 1 and those classified as type 3A, 3B and 3C in Group 2. Results As a result of blast exposure, 101 (57.7%) patients had extremity injuries, of which 76 (75.2%) presented with at least one fracture. Of the total of 103 fractures, nine (8.8%) were closed and 94 (91.2%) were open. Thirty-eight (40.4%) of the open fractures were located in the upper extremities, and 56 (59.6%) in the lower extremities and pelvis. Open fractures were most frequently localized in the femur (n = 20; 21.2%), followed by the tibia (n = 18; 19.1%). The majority of patients with open fractures were in Group 1 (71.4%). The duration of hospital stay was longer in Group 2 (12.1 ± 5.8 vs. 6.3 ± 6.7 days, p <  0.0001, respectively). Mortality among patients in Group 2 (45.0%) was significantly higher than in Group 1 (8.0%) (p <  0.0001). Similarly, the injury severity score (ISS) was higher in Group 2 (median 20 vs. 9, p <  0.0001). VI was present in 13 (12.9%) of all patients, and amputation in seven (7.9%). Conclusion The presence of severe open fractures, VI, and high ISS score can be considered as important factors that increase morbidity and mortality. In extremity traumas, through the secondary blast mechanism, contaminated-fragmented tissue injuries occur. Therefore, we believe that it will be beneficial to apply damage control surgery in places with low socioeconomic level and poor hygienic conditions.

Background and Objective:Acute cholecystitis (AC) is an inflammation of the gallbladder. Tokyo Guidelines (TGs) for the diagnosis of AC classified this condition according to severity as mild, moderate and severe. Therapeutic intervention regulated according to the type of severity. This study aimed to determine laboratory parameters that predict the severity of AC at hospital admission.Methods:One-hundred and ten patients with AC were retrospectively reviewed. These patients were treated in our department of surgery within a one-year period (2015–2016). Three patient groups were formed depending on the severity of Acute cholecystitis.Results:The baseline mean values for white blood cell count (WBC), blood urea nitrogen (BUN), creatinine and international normalized ratio (INR) were higher in the severe patient group at a significant level compared to the mild patient group. The WBC level was also significantly higher in the moderate group than the mild group. However, none of the laboratory parameters differentiated the severe group from the moderate group.Conclusion:Acute cholecystitis patients with high WBC, BUN, creatinine and INR levels at admission should be referred to an advanced care center for management.

ConclusionLaboratory parameters alone cannot be sufficient for the diagnosis of acute appendicitis in pregnant patients. If clinical examination, laboratory parameters and USG are not sufficient for diagnosis, MRI is the imaging method that should be considered to reduce negative appendectomy rate.

Background: To determine the severity and types of blast-related extremity injuries and the presence of accompanying vascular injuries (VI) and amputation, and to identify the predictive factors affecting the treatment management and clinical course. Methods: The study included 101 patients with extremity injuries caused by a bomb explosion. The radiographs and computed tomography angiographies of the patients were evaluated in terms of injury patterns, presence of shrapnel fragments and fractures, and localization (upper or lower extremity) and type (open or closed) of injury. The Gustilo-Anderson classification was used for open fractures. According to their severity, open fractures classified as types 1, 2 and 3A were included in Group 1 and those classified as type 3B and 3C in Group 2. Results: As a result of the explosion, 101 (57.7%) patients had extremity injuries, of which 76 (75.2%) presented with at least one fracture. Of the total of 103 fractures, nine (8.8%) were closed and 94 (91.2%) were open. Thirty-eight (40.4%) of the open fractures were located in the upper extremities, and 56 (59.6%) in the lower extremities and pelvis. Open fractures were most frequently localized in the femur (n=20; 21.2%), followed by the tibia (n=18; 19.1%). The majority of patients with open fractures were in Group 1 (74.2%). The duration of hospital stay was longer in Group 2 (11.7±5.8 vs. 6.8±6.7 days, p <0.0001). Mortality among patients in Group 2 (44.4%) was significantly higher than in Group 1 (6.1%) ( p <0.0001). Similarly, the injury severity score (ISS) was higher in Group 2 (median 20 vs. 9, p<0.0001). Similarly, the rate of VI was higher in Group 2 (66.1%) than in Group 1 (2.4%) ( p <0.0001). VI was present in 13 (12.9%) of all patients, and amputation in seven (7.9%). Conclusion: The presence of severe open fractures, VI, and high ISS score can be considered as important factors that increase morbidity and mortality. In extremity traumas, through the secondary blast mechanism, contaminated-fragmented tissue injuries occur. Therefore, we believe that it will be beneficial to apply damage control surgery in places with low socioeconomic level and poor hygienic conditions.