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Öğe Antiepileptic drug poisoning: Three-year experience(Elsevier Science Bv, 2015) Gunaydin, Yahya Kemal; Akilli, Nazire Belgin; Dundar, Zerrin Defne; Koylu, Ramazan; Sert, Ekrem Taha; Cekmen, Bora; Akinci, EmineIntroduction: Antiepileptic drugs, which are also called anticonvulsants, are used in the therapy and prophylaxis of epileptic seizures. The purpose of this paper was to investigate the relevant epidemiological data and to determine which of these drugs was the most frequent cause of intoxication. Another purpose of this study was to determine the neurological, cardiac, and biochemical problems caused by antiepileptics. Material and method: This retrospective study included 95 consecutive patients under 18 years of age with antiepileptic intoxication, presenting to and being followed-up in, the Toxicology Unit between January 2010 and February 2013. The data were obtained by screening the patient files. Results: Of the cases, 67 (70.5%) were self-poisoned by first generation antiepileptics (FGAEs) and 28 (29.5%) by second generation antiepileptics (SGAEs). The Glasgow Coma Scale (GCS) scores and the serum lactate levels of the patients poisoned by FGAEs and SGAEs on admission to emergency department were 15 (25th: 12; 75th: 15; 95th: 15; IQR: 3) and 1.9 (25th: 1.4; 75th: 3.1; 95th: 5.6; IQR: 1.7), and 15 (25th: 14.3; 75th: 15; 95th: 15; IQR: 0.75) and 1.07 (25th: 0.9; 75th: 1.6; 95th: 5.5; IQR: 0.71), respectively. The serum lactate levels of patients poisoned by FGAEs were significantly higher (p < 0.001). Among the cases poisoned by carbamazepine, the most frequent cause of intoxication, the GCS score was significantly lower and serum lactate level was significantly higher in the group with high serum levels of carbamazepine (p = 0.004 and p < 0.001, respectively). In cases poisoned by valproic acid (VPA), the second frequent cause of intoxication, there was neither a significant association between the serum VPA level and the GCS score, nor between the serum lactate level and the systolic blood pressure (p = 0.470, p = 0.897, and p = 0.088, respectively). However, there was a positive correlation between the serum VPA level and the serum ammonia level (kk = 0.742, p < 0.001). Conclusion: First generation antiepileptics are more toxic than SGAEs. In patients with serum carbamazepine level, particularly those over 30 mg/L, serious disorders of consciousness, cardiovascular toxicity, and metabolic disorders may occur. In VPA intoxication, there is a positive correlation between the serum VPA levels and ammonia levels. On account of this finding, one should be more careful about hyperammonemic hepatic encephalopathy as the serum VPA level rises. (C) 2014 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY-NC-ND license.Öğe THE EFFECT OF SERUM CALCIUM LEVEL ON THE MORBIDITY AND MORTALITY OF PATIENTS WITH GASTROINTESTINAL BLEEDING(Carbone Editore, 2014) Koylu, Ramazan; Dundar, Zerrin Defne; Koylu, Oznur; Akilli, Nazire Belgin; Akinci, Emine; Gonen, Mustafa Onder; Cander, BasarIntroduction: The aim of this study was to investigate the relation of serum calcium, corrected calcium and ionized calcium levels with morbidity and mortality in patients followed-up with the diagnosis of gastrointestinal system bleeding. Methods: Patients over 18 years of age who had presented to the emergency clinics with a suspicion of gastrointestinal bleeding and followed-up at the intensive care units between January 2009 and December 2011 were included in this retrospective study. The demographic properties, biochemical and haematological parameters of the patients, the amount of blood transfusions, the durations of hospital stay and the outcomes were recorded. The patients were divided into two groups, as those who survived (Survival group) and those who died (Exitus group). They were also divided into three groups according to their ionized calcium levels. The differences between the groups were investigated. The relations of the variables with each other were also evaluated in the overall patient group. Findings: A total of 191 patients were included in the study, 126 of whom were male (66.0%) with a mean age of 63.8 +/- 19.0 years. The mean hemoglobin level was 9.4 +/- 2.8 g/dL, the mean calcium level was 8.2 +/- 0.7 mg/dL, the mean corrected calcium level was 8.9 +/- 0.6 mg/dL, and the mean ionized calcium level was 0.88 +/- 0.25 mmol/L. No significant differences were observed in the calcium, corrected calcium and ionized calcium levels between the group that had survived and the group which had died (p>0.05). A positive correlation was observed between the hemoglobin levels and the calcium levels (r=0.45, p<0.001), corrected calcium levels (r=0 37, p<0.001) and the ionized calcium levels (r=0.33, p=0.002). Conclusion: No correlation was observed between the calcium, corrected calcium and ionized calcium levels and the erythrocyte transfusion requirement, duration of hospital stay and mortality in patients with GIS bleeding. However, a weak correlation was observed between the calcium, corrected calcium and ionized calcium levels and the hemoglobin levels.Öğe A new marker for myocardial injury in carbon monoxide poisoning: T peak-T end(W B Saunders Co-Elsevier Inc, 2013) Akilli, Nazire Belgin; Akinci, Emine; Akilli, Hakan; Dundar, Zerrin Defne; Koylu, Ramazan; Polat, Mustafa; Cander, BasarObjectives: Carbon monoxide (CO) poisoning frequently affects repolarization, resulting in abnormal electrocardiography findings. The goal of this study was to examine the effect of CO poisoning on the novel transmyocardial repolarization parameters T peak-T end (Tp-e), Tp-e dispersion, and Tp-e/QT and the relationship of these parameters to myocardial injury (MI). Methods: This prospective study included 94 patients with CO poisoning and 40 healthy controls. Participants received an electrocardiography and had their blood drawn at admission and 6 and 24 hours after admission. The QT, Tp-e, Tp-e dispersion, and the Tp-e/QT ratio were calculated. Myocardial injury was determined based on an elevation in troponin any time during the first 24 hours. The patients were divided into 2 subgroups: those with and without MI. Results: T peak-T end, Tp-e dispersion, and the Tp-e/QT ratio were higher at admission than after 6 and 24 hours of hospitalization and were higher than the control group (P < .001). There was a correlation between the carboxyhemoglobin level at admission and Tp-e and Tp-e dispersion (P < .001). The MI subgroup (n = 14) had a higher Tp-e at admission than did the non-MI subgroup (n = 80) (96 [11] milliseconds vs 87 [12] milliseconds, P = .03). There were no any significant differences in the Tp-e dispersion or the Tp-e/QT ratio between the 2 MI subgroups. Receiver operating characteristic analysis showed that a Tp-e cutoff value for MI of 91.5 milliseconds had a sensitivity of 72.7% and a specificity of 67.2%. Conclusion: Transmyocardial repolarization parameters indicative of arrhythmia were prolonged in patients with CO poisoning. T peak-T end was associated with MI. (C) 2013 Elsevier Inc. All rights reserved.Öğe Prognostic importance of neutrophil-lymphocyte ratio in critically ill patients: short- and long-term outcomes(W B Saunders Co-Elsevier Inc, 2014) Akilli, Nazire Belgin; Yortanli, Mehmet; Mutlu, Huseyin; Gunaydin, Yahya Kemal; Koylu, Ramazan; Akca, Hatice Seyma; Akinci, EmineStudy objective: The number of critically ill patients admitted to the emergency department increases daily. To decrease mortality, interventions and treatments should be conducted in a timely manner. It has been found that the neutrophil-lymphocyte ratio (NLR) is related to mortality in some disease groups, such as acute coronary syndrome and pulmonary emboli. The effect of the NLR on mortality is unknown in critically ill patients who are admitted to the emergency department. Our aim in this study is to evaluate the effect of the NLR on mortality in critically ill patients. Methods: This study was planned as a prospective, observational cohort study. Patients who were admitted to the emergency department because they were critically ill and required the intensive care unit were included in the study. Demographic characteristics, Acute Physiology and Chronic Health Evaluation II (APACHE II), Sepsis-related Organ Failure Assessment, Glasgow Coma Score, and NLR values were recorded upon emergency department admission. The patients were followed up for sepsis, ventilator-associated pneumonia, multiorgan failure, in-hospital mortality, and 6-month mortality. Results: The median (interquartile range) age of the 373 patients was 74 (190) years, and 54.4% were men. Neutrophil-lymphocyte ratio values were divided into quartiles, as follows: less than 3.48, 3.48 to 6.73, 6.74-13.6, and more than 13.6. There was no difference among these 4 groups regarding demographic characteristics, APACHE II score, Sepsis-related Organ Failure Assessment score, Glasgow Coma Score, and length of hospital stay (P > .05). In the multivariable Cox regression model, in-hospital mortality and 6-month mortality NLR were hazard ratio (HR), 1.63 (1.110-2.415; P = .01) and HR, 1.58 (1.136-2.213; P = .007), respectively, and APACHE II scores were detected as independent indicators. Conclusion: The NLR is a simple, cheap, rapidly available, and independent indicator of short- and long-term mortalities. We suggest that the NLR can provide direction to emergency department physicians for interventions, particularly within a few hours after admission, in the critically ill patient group. (C) 2014 Elsevier Inc. All rights reserved.
