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    Evaluation of systemic immune inflammation index, HALP score, neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in pediatric burned patients
    (SAUDI MED J, 2025) Doğan, G; İpek, H; Metin, M; Coşkun, N; Afşarlar, ÇE
    Objectives: To evaluate whether there is any relationship between neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio(PLO), systemic immune -inflammation (SII) level and HALP score and the location of involvement, surface width, burn degree in pediatric burn patients to investigate the effect on prognosis. Methods: After obtaining institutional ethical committee approval, a retrospective analysis was conducted on 192 pediatric cases (under 18 years old) treated for burns in our hospital from December 2018 to December 2023. Hemoglobin, leukocyte, neutrophil, platelet and albumin levels. Simultaneously NLR, PLR, SII and HALP scores were calculated. Results: Post-hoc test results revealed that the NLR values in the first-degree burn group were significantly lower than those in the second-degree burn group and the group with combined first- and second-degree burns (p=0.001, p=0.027). Similarly, the SII values in the first-degree burn group were significantly lower than those in the second-degree burn group and the combined burn group (p=0.001, p=0.004). The HALP score values in the combined burn group were significantly lower than those in the first-degree burn group (p=0.031). No significant differences were observed between other groups (p>0.05). Conclusion: These parameters are derived from routinely collected blood tests, making them cost-effective, easily accessible, and practical for patients. Therefore, they could be useful as biomarkers for predicting prognosis in pediatric burned patients.
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    Inflammatory changes in the prepuce and clinical findings according to the stages of phimosis
    (Tubitak Scientific & Technological Research Council Turkey, 2025) Doğan, G; Yılmaz, D; İpek, H; Metin, M; Kahraman, H; Afşarlar, ÇE
    Background/aim: Circumcision refers to the surgical removal of all or part of the prepuce. Circumcision is commonly performed on males in childhood to prevent urinary tract infections and for religious reasons. This study was designed to investigate the inflammatory processes in the prepuce according to the degree of phimosis in patients who underwent circumcision. Materials and methods: We conducted a prospective study on 173 male children under the age of 18 who underwent circumcision between June and September 2024. A comprehensive physical examination of the genitourinary system was performed. Foreskin retraction was assessed and recorded using the Kikiros grading score, and an elective surgical appointment was scheduled accordingly. Results: As the age of the patient decreases, phimosis appears to be more advanced. In Stage 2 phimosis, where the foreskin is more covered, mild to moderate inflammation is observed, whereas in Stage 1 phimosis, where the foreskin is moderately covered, severe inflammation is noted. This suggests that the partial constriction in Stage 1 phimosis may facilitate contamination from external sources. Discussion: It is known that circumcision in boys reduces urinary tract infections. This study investigated the inflammatory processes in the prepuce according to the degrees of phimosis. The results indicate that performing circumcision at younger ages is beneficial for preventing ascending urinary infections and reducing the need for antibiotic treatment.
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    PAN-Immune inflammation value: a new biomarker for diagnosing appendicitis in children??
    (BMC, 2025) Coşkun, N; Metin, M; Doğan, G; İpek, H; Demir, E; Afşarlar, ÇE
    BackgroundThis study investigates the potential of the pan-immune-inflammation values (PIV) index as a biomarker for diagnosing acute appendicitis in children and compares its performance with other systemic inflammatory markers.MethodsA retrospective analysis of 1,514 pediatric patients aged 0-18 years with abdominal pain admitted between 2019 and 2023 was conducted. Patients were categorized into complicated, non-complicated appendicitis, negative appendectomy, and non-surgical treatment groups. Demographic and laboratory data were recorded, and PIV, Systemic Inflammation Index (SII), Systemic Inflammation Response Index (SIRI), Neutrophil-to-Lymphocyte Ratio (NLR), and Platelet-to-Lymphocyte Ratio (PLR) indices were calculated. Receiver Operating Characteristic (ROC) analysis was used to assess predictive performance, with optimal cut-offs evaluated for sensitivity, specificity, and multiple logistic regression (MLR) analyses.ResultsBased on Area Under the Curve (AUC), C-reactive Protein (CRP), lymphocyte, and PLR showed weak predictive value, while White Blood Cell Count (WBC), neutrophil, monocyte, NLR, SII, SIRI, and PIV demonstrated poor predictive value for appendicitis. Optimal cut-offs were 3.40 for NLR, 134.5 for PLR, 1010.3 for SII, 3.47 for SIRI, and 919.3 for PIV, with sensitivity and specificity values of 78.7%, 47.1% for NLR; 64.7%, 47.5% for PLR; 75.6%, 52% for SII; 71.5%, 57.3% for SIRI; and 72.2%, 54.1% for PIV. In the MLR model, PIV above 919.3 increased appendicitis likelihood 2.67-fold (95% Confidence Interval: 2.16-3.37).ConclusionAlthough PIV demonstrated potential as a novel biomarker for pediatric appendicitis, its diagnostic utility remains limited without supplementary clinical and radiological data. Larger prospective studies are recommended to validate these findings and improve clinical decision-making. PIV may serve as a supplementary tool in diagnosing pediatric appendicitis when used alongside other markers and diagnostic methods.Trial registration'retrospectively registered'.