Aim: This study was conducted to determine the D-dimer threshold levels according to age in patie... more Aim: This study was conducted to determine the D-dimer threshold levels according to age in patients diagnosed with pulmonary embolism (PE) by pulmonary computed tomography (CT) angiography. Material and Methods: Patients who had pulmonary CT angiography performed and whose D-dimer test was obtained with the suspicion of pulmonary embolism (PE) in the emergency department of a tertiary university hospital between January 01, 2015, and December 30, 2019, were included in the study. The demographic characteristics of the patients, imaging reports, and 1-month mortality were evaluated retrospectively by examining the hospital information management system and patient files. Patients with missing records and patients who had diagnostic examinations other than the preliminary diagnosis of PE were excluded from the study. Results: Among the 6240 patients included in the study, 58.1% were female. The mean age of the patients was 43±17 years. Of the 1,507 patients who had a pulmonary CT ang...
Hydrocephalus is a common neurological disorder in both childhood and adulthood. Non-communicatin... more Hydrocephalus is a common neurological disorder in both childhood and adulthood. Non-communicating hydrocephalus may occur due to obstruction of the cerebrospinal fluid (CSF) flow pathways by structural anomalies such as tumors, infections, adhesions, and developmental defects while communicating hydrocephalus might develop due to CSF absorption disorders or excess production. In symptomatic cases, treatment is divided into two approaches as medical and surgical. The most commonly used method in surgical treatment is the ventriculoperitoneal (VP) shunt system. The VP shunt system can have numerous advantages and complications and is expected to yield continuous and long-term solutions. One of its advantages is that CSF samples can be taken from the reservoir located on it. In cases suspected of intracranial infection but for whom Lumbar puncture (LP) cannot be performed, the shunt reservoir in the patient provides sufficient opportunity for CSF retrieval.
Eskisehir Medical Journal, Eskisehir City Hospital
34 yaşında erkek sağlık çalışanı, COVID-19 ile enfekte hastaların yattığı klinikte çalışırken, ha... more 34 yaşında erkek sağlık çalışanı, COVID-19 ile enfekte hastaların yattığı klinikte çalışırken, hastadan kan alınan şırınganın iğnesi yanlışlıkla sol elin 2. Parmağının distal falanksın volar yüzeyine kazara saplandı. Şırınganın kullanıldığı hasta 54 yaşında COVID-19 pnömonisi nedeniyle hastanede 3 gündür tedavi alan kadın hastaydı. Sağlık çalışanı 4 hafta boyunca takip edildi. COVID-19 enfeksiyonunu düşündüren hiçbir semptom veya bulgu tespit edilmedi. Sağlık çalışanı 2 doz BNT162b2 (Pfizer-BioNTech) aşısı ile 2 doz arası 42 gün olmak üzere aşılanmıştır. Son aşısı, iğne batması yaralanmasından 1 ay önceydi.Perkütan iğne batması sonucu yaralanma nedeniyle virüs bulaşma riski yok denecek kadar azdır veya yoktur. Bulaşma riski düşünülse dahi hastanın iki doz BNT162b2 aşısı olması kendisini korumuş olabilir. Teorik olarak koronavirüsün kan yoluyla bulaşma riski var gibi görünse de henüz kanıtlanamamıştır. Virüs bulaşmış hastalarda, bulaş riskinin yüksek olduğu solunum yolu ile perkütan ...
Purpose: The aim of the study was to evaluate the mortality prediction performances of delta bica... more Purpose: The aim of the study was to evaluate the mortality prediction performances of delta bicarbonate, delta anion gap, and delta ratio in methanol poisoning (MP) cases. Materials and Methods: This clinical study, which followed a cross-sectional study design, involved patients with MP who were still alive when they initially arrived at the emergency department of a tertiary care hospital. Patients were divided into two groups mortality and non-mortality. Patients who died during treatment and follow-up were assigned to the mortality group, while others were assigned to the non-mortality group. Receiver Operating Characteristic (ROC) analysis was used to determine the cut-off in the diagnostic value measurements of biomarkers predicting mortality. Results: Nine (20%) of the 45 patients in the study died during their follow-up. The two groups showed a significant difference in the averages of pH, bicarbonate (HCO3-), lactate, anion gap, delta anion gap, delta HCO3-, and delta rati...
ST Yükselmeli Miyokard Enfarktüslü Hastalarda Fibrinolitik ile Birlikte Kullanılan Tikagrelorun Etkinliği ve Güvenliği
Akdeniz Medical Journal
Objective: The effectiveness and safety of administration ticagrelor simultaneously with fibrinol... more Objective: The effectiveness and safety of administration ticagrelor simultaneously with fibrinolytic in STEMI remains unclear. Our study aims to compare and evaluate ticagrelor and clopidogrel in STEMI patients treated with fibrinolytics Material and Methods: The study consisted of 180 STEMI patients over 18 age who were given fibrinolytic therapy and had no absolute contraindications for treatment. Ticagrelor was given to 94 patients and clopidogrel was given to 86 patients. Loading doses were given to patients concurrently with fibrinolysis, followed by maintenance doses. The primary outcome was six-month follow-up for all-cause mortality, major cardiovascular events, stroke, recurrent MI, target vessel revascularization, and major bleeding. The secondary outcome was to evaluate patients over 75 years of age, use of rivaroxaban, and major adverse events that will develop in patients with chronic kidney disease. Results: There was no significant difference between the groups in te...
Aim: To evaluate the degree of agreement between emergency physicians (EPs) and cardiologists in ... more Aim: To evaluate the degree of agreement between emergency physicians (EPs) and cardiologists in measuring pulmonary arterial pressure (PAP) (measurement with simplified Bernoulli equation).
In adult polycystic kidney patients, heart involvement is frequently observed in the progressing ... more In adult polycystic kidney patients, heart involvement is frequently observed in the progressing process of the disease, as well as the pathologies created in various other organs. Among others, left ventricular hypertrophy and mitral valve prolapse are generally observed. A 42-year-old female patient, receiving dialysis due to chronic renal failure resulting from autosomal dominant polycystic kidney disease, was admitted to the cardiology outpatient clinic with complaints of high blood pressure, dyspnea and abdominal pain. During clinical examinations, a cyst was detected in the tricuspid valve on echocardiography. In this case study, we aimed to present a patient with a cyst on the tricuspid valve, which has not been previously encountered in adult polycystic kidney patients.
Objectives In our study, we aimed to reveal the frequency and determinants of adverse events in p... more Objectives In our study, we aimed to reveal the frequency and determinants of adverse events in patients with diabetes mellitus, who presented to the emergency department for any reason, had uncomplicated hyperglycemia, but were decided to be treated as an outpatient. Results As the patient group with a plasma glucose level of 200 mg/dl and above and normoglycemic diabetic patients were evaluated, no signi cant difference was found in terms of re-admission to the emergency department and the frequency of hospitalization. (Respectively, within seven days p=0.738, 0.805, within thirty days p=0.130, 0.697). In the patient group with plasma glucose level of 200 mg/dl and above, waiting times in the emergency department (p= 0.012) and average uid replacement were higher (p=0.002). As the factors affecting re-admission were evaluated, it was found signi cant that the patient had insulin-dependent diabetes. (Within in seven days OR:2.20, %95 GA 1,.26-3.84, p = 0.005; within thirty days OR:2.48, %95 GA 1.39-4.41, p = 0.002). Other factors such as gender, age, admission glucose level and diabetes type were not found to be effective. Conclusions The high blood glucose level of diabetic non-complicated hyperglycemia cases admitted to the emergency department was not found to have an effect on recurrent admissions and hospitalizations for any reason in the rst seven and thirty days. Treatment and follow-up planning should be done carefully in insulin-dependent diabetic patients with a high probability of re-admission and hospitalization in this group
Demiroğlu Bilim University Florence Nightingale Journal of Medicine, 2019
Azygos lobe is a rare congenital variation usually located in the right lung and more common in m... more Azygos lobe is a rare congenital variation usually located in the right lung and more common in males. Although it is asymptomatic and does not require special treatment, it should always be considered in the differential diagnosis of lung lesions. In this article, we report a 52-year-old male patient who was admitted to the emergency room with trauma and computed tomography revealed azygos lobe.
Objectives: The aim of our study was to evaluate the association between the presence and severit... more Objectives: The aim of our study was to evaluate the association between the presence and severity of CAD and NAFLD. Methods: The study group consisted of 153 patients who underwent coronary angiographies. Patients were categorized into CAD and non-CAD groups. CAD severity was determined by the number of CAD-involved arteries and the vessel score multiplied by Gensini score, the latter judging CAD severity. Fatty liver was diagnosed by abdominal ultrasonography (USG), with the patients being categorized by the degree of hepatosteatosis, as Grade 0, Grade 1, and Grade 2-3. Results: Among the whole study population, 47.1% of patients (n=72) were female and 52.9% of patients (n=81) were male. Forty-three patients had normal coronary arteries; 27 patients had non-critical CAD and side branch disease; and 83 patients had clinically significant CAD (stenosis>50%). The rate of CAD and Gensini score were significantly different between Grade 0, 1 and 2-3 hepatosteatosis groups (p<0.05...
Purpose: The aim of our study was to assess the significant value of the systemic inflammatory in... more Purpose: The aim of our study was to assess the significant value of the systemic inflammatory index (SII) and red cell distribution width/lymphocyte ratio (RLR) in patients with carbon monoxide poisoning (COP). Materials and Methods: Based on a retrospective cross-sectional study design, this study was conducted among patients 18 years and older who presented to the hospital's emergency department with COP. The patients were separated into troponin positive and negative groups as an outcome of serial troponin measurements. Receiver operating characteristic (ROC) analysis was used to determine the cut-off value of neutrophil/lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), RLR, and SII to predict troponin positivity. Results: This study included 195 patients with CO exposure, 50 of whom had positive troponin tests. It was discovered that the diagnostic power of NLR, RLR, MLR, and SII was acceptable for identifying troponin positivity (AUC: 0.71-0.77). According to ROC...
Background Acute appendicitis (AA) is one of the most frequent causes of abdominal pain requiring... more Background Acute appendicitis (AA) is one of the most frequent causes of abdominal pain requiring emergency intervention in adults. Approximately one-third of cases present with atypical clinical symptoms. This study aims to compare the monocyte-to-lymphocyte ratio (MLR), red cell distribution width (RDW) to lymphocyte ratio (RLR), and systemic immune inflammation index (SII) with other biomarkers in distinguishing patients with and without AA. Methodology A total of 347 patients (AA 125, nonspecific abdominal pain 90, and control group 132) were enrolled in the study according to the cross-sectional study design. Receiver operating characteristic (ROC) analysis was used to determine the cutoff in diagnostic value measurements. Statistical significance was determined by the statistics of sensitivity, specificity, positive predictive value, and negative predictive value. Comparison of ROC curves of C-reactive protein (CRP), white blood cell (WBC), neutrophil count (NEU), neutrophil-tolymphocyte ratio (NLR), MLR, and SII was evaluated with the pairwise comparison of ROC curves and 95% confidence interval. Results In detecting AA, CRP, WBC, NEU, NLR, MLR, and SII have excellent diagnostic power (area under the curve [AUC] 0.80-0.88), while RDW, lymphocyte count, monocyte (MON) count, and RLR had acceptable diagnostic power (AUC 0.70-0.77). When the power in the diagnosis of AA was compared, a significant difference was found between CRP and NEU, CRP and SII, WBC and NEU, and WBC and SII. Conclusions The diagnosis of AA remains dependent on many factors. Inflammatory biomarkers assist this process. MLR and SII may be recommended to use in diagnosing AA in adults, along with other clinical findings. RLR is adequate but not superior.
Anaphylaxis is a sudden onset of systemic hypersensitivity caused by mast cell and basophil degra... more Anaphylaxis is a sudden onset of systemic hypersensitivity caused by mast cell and basophil degranulation. Food, Hymenoptera venom, and drug allergy are among the leading causes of anaphylaxis, particularly in adults. We can consider anaphylaxis caused by swallowing food or medication as a form of poisoning. Because in anaphylaxis, just like in poisoning, an allergen entering the body poses a life-threatening risk. Therefore, the allergen should be removed from the digestive system immediately. However, the decontamination of the gastrointestinal tract is not routinely used to prevent further absorption of allergens from the intestine into the systemic circulation. Among the gastrointestinal decontamination methods is the use of activated charcoal. In this article, we present four patients who developed anaphylaxis due to drug and food intake and were administered oral activated charcoal after their primary treatment (on average, 15-45 minutes after the first presentation) was completed. The youngest of the patients was 22 years old, and the oldest was 40. No side effects, prolonged anaphylactic state, and biphasic reactions were observed in the follow-up of the patients. All patients were discharged after 48-72 hours of hospitalization. The routine approach to poisoning treatment includes patient stabilization, toxidrome recognition, antidote administration, and supportive care, as well as measures to enhance toxin elimination. In anaphylaxis caused by oral allergens, the substance that initiates the reaction can be compared to a kind of toxin. Eliminating the allergen and reducing its absorption could be achieved by administering activated charcoal. Activated charcoal should be considered adjunctive therapy in treating food and oral drug-induced anaphylaxis. This treatment, when administered in a timely manner, might prevent the development of biphasic reactions and the prolongation of the allergic process in anaphylaxis.
Background: Acute pulmonary embolism (APE) is a cardiovascular emergency that has a high morbidit... more Background: Acute pulmonary embolism (APE) is a cardiovascular emergency that has a high morbidity and mortality probability. The aim of this study is to investigate the clinical value of the systemic immune inflammation index (SII) in predicting high-risk patients admitted to the emergency department with a diagnosis of Acute pulmonary embolism (APE). Materials and Methods: This clinical study, which was conducted according to a cross-sectional study design, included 193 patients diagnosed with APE who presented to the emergency department of a tertiary hospital. According to the guideline, patients with Pulmonary Embolism Severity Index (PESI) class III–V or sPESI ≥I were identified as high risk. ROC (Area Under the Curve) analysis was used to determine the cut-off in predicting high-risk APE. Results: In our research, 71 of the patients had high-risk APE. In detecting high-risk APE, SII was found to have excellent diagnostic power (AUC: 0.84), while neutrophil to lymphocyte ratio...
Background: Even with immediate surgical intervention, acute aortic dissection (AAD) is a cardiov... more Background: Even with immediate surgical intervention, acute aortic dissection (AAD) is a cardiovascular emergency with a high mortality rate. The purpose of this study was to look at the relationship between in-hospital mortality and red cell distribution width (RDW)/lymphocyte ratio (RLR), monocyte/lymphocyte ratio (MLR), and systemic immune inflammation index (SII) in patients with type B acute aortic dissection (BAAD). Materials and methods: 59 BAAD patients who presented to the emergency room of a tertiary hospital were included in this cross-sectional study. The predictive ability and cut-off value of biomarkers for mortality were evaluated using Receiver Operating Characteristic (ROC) analysis. The variables believed to be connected to in-hospital mortality were subjected to multiple regression analysis, and the odds ratio was calculated. Results: The study consisted of 59 patients in total, 44 of whom (74.6%) were male. 17 of these patients died in the hospital. In terms of ...
Diagnostic value of monocyte-lymphocyte ratio and red cell distribution width- lymphocyte ratio against other biomarkers in children with acute appendicitis, cross-sectional study
Objective: Although serum calcium (Ca) and erythrocyte distribution width (RDW) can be used to pr... more Objective: Although serum calcium (Ca) and erythrocyte distribution width (RDW) can be used to predict the severity of acute pancreatitis (AP), their sensitivity and specificity are limited. The goal of this study is to see how well the serum calcium ratio of RDW, which may be measured at presentation, predicts the severity of AP in patients with AP. Materials and methods: AP patients admitted to a tertiary hospital's Emergency Department between 14 February 2021 and 14 February 2022 were screened retrospectively. According to the 2012 Atlanta classification guidelines, AP severity was classified as mild acute pancreatitis (MAP), moderate acute pancreatitis (MSAP), and severe acute pancreatitis (SAP). During admittance to the emergency department, vital signs, laboratory exams, and imaging findings were gathered from the database. Results: This study comprised 384 AP patients, including 166 males (56.8%), 239 patients with MAP, and 145 patients with MSAP or SAP. The mean RDW/Ca ...
Objective: In this study, we aimed to evaluate the relationship between laboratory electrolyte di... more Objective: In this study, we aimed to evaluate the relationship between laboratory electrolyte disturbances and drugs taken in poisoning cases who applied to the Emergency Department and took drugs for suicidal purposes. Materials and Methods: This study is a retrospective study. Patients aged 18 years and older who were diagnosed with drug poisoning in the Adult Emergency Clinic of Okmeydanı Training and Research Hospital Emergency Medicine Clinic were included in the study. Data analysis was done in SPSS 15.0 program. The significance level was taken as p<0.05. Results: 162 patients were included in the study. The mean age of the patients was 27 (range 18-61) years. Thirty-four (20.99%) of the patients were male. Considering the frequency of the drugs taken, 34 (21.1%) of the patients had NSAIDs (most common), 33 (20.5%) had paracetamol and/or its compounds, 29 (17.7%) had SSRI, had TCA, 149 (55.3%) had other drugs. It was observed that the serum Na values of the patients who took and did not take high-dose NSAIDs changed statistically (p=0.000). The laboratory test results of the patients who took and did not take these drugs were compared, and no statistically significant difference was found (p>0.05). Conclusion: According to our suicidal study findings, the amount of drugs taken by our patients is not correlated with their blood levels. Although more than half of our patients have taken toxic doses of the drugs, most of the poisonings are mild and our results can not be generalized to severe poisoning cases.
Syncope is a common complaint in emergency clinics, but the symptoms of syncope are quite compreh... more Syncope is a common complaint in emergency clinics, but the symptoms of syncope are quite comprehensive. In this study, we are going to present a case of a non-parasitic giant liver cyst that caused compression of the inferior vena cava with the right atrium in a 47-year-old female patient with a history of autosomal dominant polycystic kidney disease who applied to the emergency department due to syncope. In the examinations performed in the emergency department, we detected a giant liver cyst pressing on the inferior vena cava, right atrium, and ventricle of the heart, which prevents venous return. Sclerotherapy with catheterization was applied to the non-parasitic giant liver cyst and the drainage catheter was kept in the cyst cavity for one week to prevent an early recurrence.
Uploads
Papers by murat Duyan