Bilateral post-injection fibrosis of the gluteal region mimicking lumbar disc herniation: a case report

Tissue fibrosis is a known complication of intramuscular injections, which is especially seen in children due to vaccinations and injections. Herein we report a case of post injection gluteal fibrosis that had undergone two unsuccessful lumbar discectomies to treat the symptoms of this disease

Bilateral femoral neck fracture in a young patient receiving long-term hemodialysis: a case report with a 4-year follow-up

A 34-year-old male patient who was on hemodialysis developed a bilateral femoral neck fracture (Garden type III) after a minimal trauma. Bipolar cemented arthroplasty was performed in separate sessions. Pathological examination of biopsies obtained from the fracture site revealed osteodystrophy without any amyloid accumulation. Although the patient could walk without support, signs of bilateral prosthetic loosening were noted on X-rays after four years

Cost of pneumococcal infections and cost-effectiveness analysis of pneumococcal vaccination in at risk adults and elderly in Turkey

Pneumococcal infections have a substantial burden in Turkey, particularly in the elderly (>60 years) and at-risk adults (18–59 years). VCR is low at approximately 2%. The first aim of this study was the evaluation of the burden of pneumococcal infections (pneumonia and bacteremia) from a public payer perspective in elderly and at-risk adults. The second aim was the evaluation of cost effectiveness of implementing a large PPV program in these populations. A decision tree model was employed using demographic and epidemiological inputs obtained from Turkish official sources and international literature. Vaccination was assumed to protect for 5 years with 60% and 50% effectiveness against BPP in elderly and at-risk adults respectively. Vaccination effectiveness of 21% against NBPP was assumed for both populations. Costs input were obtained from a previous study conducted between 2002 and 2008 in a public university hospital in Ankara, Turkey. Univariate sensitivity analyses and Monte-Carlo simulations were performed. The vaccination program was cost saving compared to no vaccination. Pneumococcal vaccination with 60% coverage led to a mean of 4,695 LYG in the elderly and 2,134 LYG in at-risk adults with 40% coverage. Mean incremental savings reached 45.4 million YTL in the elderly and 21.8 million YTL in at-risk adults. This analysis suggests that pneumococcal vaccination of elderly and at-risk adults is associated with a positive return on investment from a public payer perspective and supports the continued recommendation of pneumococcal vaccines, as well as their full funding in Turkey

The frequently encountered orthopedic problems in playschool children and the level of avareness of their parents

Amaç: Afyon il merkezinde anaokulunda eğitim gören çocukların edinsel veya doğuştan gelen ortopedik problemleri saptamak ve ebeveynleri bu dönemde sıklıkla hekime getiren; düztabanlık, içe çarpık yürüme ve edinsel kalça çıkığı konularındaki bilgi düzeylerini ortaya koymaktı. Gereç ve yöntem: Afyon il merkezinde eğitim veren 26 anaokulda 1134 anasınıfı öğrencisinin ailelerine anket formu gönderilerek doldurulması istendi. Anket formu demografik ve ailesel bilgiler haricinde iki ana kısımdan oluşuyordu. İlk kısımda ortopedik özür listesi, ikinci kısımda bilgi soruları mevcuttu. Bilgi düzeyi saptanmasında düztabanlık için 10, içe çarpık yürüme için 5 ve edinsel kalça çıkığı için 10 soru soruldu. Yanıtlar doğru ve yanlış şeklinde belirtildi. Bilgi soruları her bir soruya eşit puan verilerek toplam 100 puan üzerinden değerlendirildi. Altmış puan ve üzeri alanlar başarılı kabul edildi. Bulgular: 810 (%71.4) anket formuna yanıt alınabildi. Toplam başarı puan ortalaması 32.8±18.8 bulunmuş, olup aileler araştırılan konuda yeterli bilgiye sahip bulunmamıştır. Annelerin %57.1’si lise ve yüksekokul mezunu iken, babalarının %74.2’si lise ve yüksek okul mezunu idi. Annelerin eğitim seviyesi arttıkça bilgi düzeyleri artmakta olup, ilköğretim ile lise (p=0.003) ve ilköğretim ile yüksekokul eğitimi (p=0.001) alan anneler arasında fark anlamlıydı. Ailelerin bildirimiyle elde edilen ortopedik problem içinde en fazla oranda içe çarpık yürüme ve düztabanlık saptanmıştır. Sonuç: Anaokulu döneminde içe çarpık yürüme ve düztabanlık sık görülen ve daha ziyade aile psikolojisini etkileyen sosyal içerikli problemlerdir. Kalça çıkığı ise erken tanı ile tedavi edilebilecek ciddi bir ortopedik rahatsızlıktır. Çalışma sonucunda saptanan ileri düzeyde ki bilgi yetersizlikleri verilecek eğitimlerle giderilebilir.Aim: The aim of this study is first to determine the congenital and acquired orthopedic problems in playschool children and second to determine the level of avareness of their parents about frequently seen orthopedics problems like pes planus, intoeing and developmental dysplasia of the hip (DDH) in Afyon city in Turkey. Material and Methods: A questionnaire was sent to the parents of 1134 playschool kids in 26 playschools in Af¬yon city center. The questionnaire comprised of two parts: the first part consisted of a list of orthopedic disorders and the second part included questions about these problems. Ten true or false questions were asked regarding pes planus; 5 for intoeing, another 10 for DDH. The overall evaluation was done over 100 points. Parents scoring over 60 were regarded as successful. Result: Eight hundred and 810 (%71.4) parents answered the questionnaire. The mean score was 32.8±18.8 which showed a lack of knowledge of the families. Fiftyseven point one of the mothers were undergraduates, whereas 74.2% of the fathers were graduates. As the level of mothers education increased, so did the level of knowledge. The difference between primary school graduates and high school graduates was significant (P=0.003). The difference between the primary school graduates and college graduates was also significant (P=0.001). The families most successfully reported pes planus and intoeing. Conclusions: Intoeing and pes planus are two commonly encountered problems in playschool children which are readily recognized by the families. DDH is another problem which needs early diagnosis for a timely and successful treatment. There is still lack of knowledge among the families of the playschool kids which can be improved by proper training of the families

Model structure.

<p>(A) Decision tree of patients with diabetes. The projected situation differs from the actual situation only in higher vaccination coverage. Each year, vaccinated and unvaccinated patients with diabetes in both situations have a specific risk of being infected by influenza, which depends on the attack rate and the vaccine effectiveness for those vaccinated. Decision nodes are indicated with squares, and chance nodes are indicated with circles. (B) Resource utilization pathway. GP, general practitioner.</p

Projected health outcomes and costs of different VCRs in Turkish adults with diabetes.

<p>Projected health outcomes and costs of different VCRs in Turkish adults with diabetes.</p

Probabilistic sensitivity analysis represented in a cost-effectiveness plane.

<p>Probabilistic sensitivity analysis using Monte Carlo simulation was performed to evaluate the impact of simultaneous variation of input parameters on the model outcomes. Outputs of 1000 simulations are presented in the cost-effectiveness plane. The black line represents a willingness-to-pay threshold of 21,511 Turkish Lira (TRY) (per capita gross domestic product) per quality-adjusted life year (QALY). Dots above the X-axis are very cost-effective (incremental cost-effectiveness ratio < per capita gross domestic product), those on the X-axis are cost-neutral (incremental cost-effectiveness ratio = 0), and those below the X-axis are cost-saving (incremental costs < TRY 0 are negative while incremental QALYs remain positive).</p