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    Efficiency of Rapid Antigen Test in Diagnosis of Acute Streptococcal Tonsillopharyngitis
    (Marmara Univ, Inst Health Sciences, 2019) Acar, Tarik; Ertekin, Birsen; Girisgin, Abdullah Sadik; Ozturk, Esma; Bilgi, Serpil
    Objective: Group A beta hemolytic streptococcus (GABHS) is the most common bacterial cause of acute tonsillopharyngitis. Cases with bacterial infection suspicion should undergo rapid antigen test (RAT) and/or throat culture test in addition to clinical criteria, since it may lead to serious complications. Method: A total of 220 adult and pediatric patients admitted to the emergency department between April-May 2016 with complaints of fever and sore throat, and diagnosed as acute tonsillopharyngitis were prospectively enrolled to the study. All participants had Centor score >= 2 and they underwent RAT. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of RAT results of both groups were compared. Throat culture was considered as gold standard method. Results: Mean age of the study population was 22,5 +/- 16,9 (1-72) years. 57% (n=61) of the pediatric group, and 42.5% (n=48) of adult group were male. Sensitivity of RAT in adults and pediatric group was 62% vs. 57%, and specificity of the test was 96% vs. 97%, PPV was 55% vs. 80%, and NPV was 97% vs. 93%, respectively. Conclusion: We found low sensitivity and PPV values of RAT. Also, low levels of sensitivity decrease the possibility of RAT to be a diagnostic tool for the diagnosis of GABHS.
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    Liporotein-associated phospholipase-A2 can be a diagnostic marker in the early stage diagnosis of acute mesenteric ischemia
    (Tubitak Scientific & Technological Research Council Turkey, 2016) Acar, Tarik; Kocak, Sedat; Cander, Basar; Ergin, Mehmet; Dikmetas, Cesareddin
    Background/aim: The purpose of this experimental study was to investigate the role of lipoprotein-associated phospholipase-A(2) (Lp-PLA(2)) in the diagnosis of acute mesenteric ischemia (AMI) in the early stage. Materials and methods: Twenty-seven New Zealand rabbits were randomly divided into 3 groups in this study. Blood specimens were obtained from the groups at hours 0, 1, 3, and 6. Using the blood samples drawn from all groups, Lp-PLA(2) and C-reactive protein (CRP) parameters were investigated. Results: There was a significant rise in the levels of both Lp-PLA(2) and CRP starting at hour 1 (P < 0.05) (hour 1; Lp-PLA(2), P = 0.003) in the ischemia group. In the sham group, the levels of Lp-PLA(2) and CRP started to rise at hour 3 (P < 0.05) (hour 3; Lp-PLA(2), P = 0.011). At hour 6 of ischemia, the area under the ROC curve was 100%, and the cut-off value of 63.91 ng/mL revealed a sensitivity of 88% and a specificity of 100% for Lp-PLA(2). Conclusion: These findings showed the role of serum Lp-PLA(2) and CRP levels in the early diagnosis of AMI. Thus, further studies are needed to describe the role of Lp-PLA(2) in the early diagnosis of AMI.
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    Measurement of Optic Nerve Sheath Diameter to Detect Increased Intracranial Pressure in Hypertensive Patients
    (Emergency Medicine Physicians Assoc Turkey, 2020) Dikmetas, Cesareddin; Ergin, Mehmet; Duman, Cigdem Savas; Gulpembe, Mustafa; Acar, Tarik; Yavuz, Kenan; Cander, Basar
    Aim: Our aim was to measure optic nerve sheath diameter (ONSDM) by ultrasonography and to detect whether ONSDM reflected intracranial pressure in hypertensive patients. Materials and Methods: This observational study was performed prospectively in 149 individuals, 77 (51.7%) of whom were female, including 54 hypertensive-symptomatic patients, 45 hypertensive-asymptomatic patients, and 50 healthy volunteers referred to Emergency Medicine Service of Necmettin Erbakan University, Faculty of Medicine. Blood pressure was measured on the right and left upper extremities by the same sphygmomanometer following at least five minutes of rest. ONSDM was recorded. All measurements of hypertensive-symptomatic patients were repeated at 30th minute following antihypertensive therapy. Results: Moderate-to-well statistically significant correlations were determined between initial mean systolic blood pressure and ONSDM (rho=0.629, p=0.001) as well as between initial mean diastolic blood pressure and ONSDM (rho=0.561, p=0.001) in all study groups. Statistically significant differences were determined between the mean pre- and post-treatment systolic and diastolic blood pressures as well as the mean pre- and post-treatment ONSDM values of 40 patients who received antihypertensive therapy (p=0.000, p=0.000, p=0.000, respectively). Conclusion: Ultrasonographic ONSDM reflected increased intracranial pressure in hypertensive patients. The reduction of intracranial pressure was also detected by the same method following antihypertensive treatment. Ultrasonographic ONSDM along with clinical findings and blood pressure measurements may be used for evaluation of response to treatment and deciding on further imaging.
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    The Relationship between Routine Blood Parameters and the Prognosis of COVID-19 Patients in the Emergency Department
    (Hindawi Ltd, 2021) Ertekin, Birsen; Yortanli, Mehmet; oezelbaykal, Ozan; Dogru, Ali; Girisgin, A. Sadik; Acar, Tarik
    The aim of this study is to investigate the routine blood parameters of COVID-19 patients at the time of admission to the emergency department and their relationship with the severity of the disease and prognosis. A total of 500 patients, who were diagnosed with severe COVID-19 and hospitalized in the intensive care unit between 01.04.2020 and 01.02.2021 in the emergency department of a pandemic hospital, were retrospectively analyzed. Demographic, clinical, and laboratory data of the patients were obtained from the hospital registry system. Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) were calculated using neutrophil, lymphocyte, monocyte, and platelet counts. These patients were divided into two groups: survivors and deceased. All parameters obtained from routine blood analysis were statistically compared between these two groups. While 280 out of 500 patients survived, 220 died. Of all patients, the mean age was 67 years and 51.8% were males. There was a significant difference between the two groups in terms of age, gender, length of hospital stay, need for mechanical ventilation, white blood cell, neutrophil, lymphocyte, monocyte, eosinophil, platelet counts, CRP, ferritin, procalcitonin values, NLR, MLR, and PLR (p < 0.001 for all). While NLR alone and MLR + NEU and NLR + PLR + MLR combinations had the highest AUC values (0.930, 0.947, and 0.939, respectively), MLR and PLR alone showed the lowest AUC values (0.875 and 0.797, respectively). The sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs) in the prediction of death according to the cutoff values of the parameters have been determined. A significant correlation was determined between age, NLR, MLR, and PLR and duration of hospital stay (p < 0.001 for all). Routine blood parameters and NLR, MLR, and PLR can assist emergency physicians to identify the severity and early prognosis of COVID-19 patients.
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    The role of heparin-binding protein in the diagnosis of acute mesenteric ischemia
    (Turkish Assoc Trauma Emergency Surgery, 2019) Kocak, Sedat; Acar, Tarik; Ertekin, Birsen; Guven, Merve; Dundar, Zerrin Defne
    BACKGROUND: Acute mesenteric ischemia (AMI) is associated with a high mortality rate, yet diagnostic difficulties persist. Although many biomarkers have been investigated for diagnostic purposes, as well as imaging methods, a sufficiently specific and sensitive marker has not been identified. This research was designed to examine whether heparin-binding protein (HBP), which has a role in the early phase of inflammation, could be useful in the diagnosis of AMI. METHODS: Serum samples obtained from a previously performed rabbit model of AMI were used in the study. HBP, C-reactive protein (CRP) and interleukin 6 (IL-6) levels were measured in blood samples obtained at baseline and 1, 3, and 6 hours from subjects that were separated into 3 groups: control, sham, and ischemia. The change in each marker over time and comparisons of the groups were evaluated statistically. RESULTS: A significant difference was not detected at the first hour in any of the studied markers. At the third hour, the CRP and IL-6 levels in the ischemia group indicated a significant increase in comparison with the control and sham groups (p<0.001). The HBP values showed a significant increase at the sixth hour in the ischemia group in comparison with the others (p<0.001). CONCLUSION: The HBP level demonstrated a slower increase in a rabbit model of AMI compared with CRP and IL-6. However, it still has the potential to become an early diagnostic biomarker. Diagnostic sensitivity and specificity should be evaluated in further clinical trials.