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Öğe Assessment of right ventricular functions in patients with sepsis, severe sepsis and septic shock and its prognostic importance: A tissue Doppler study(W B Saunders Co-Elsevier Inc, 2013) Harmankaya, Atif; Akilli, Hakan; Gul, Mehmet; Akilli, Nazire Belgin; Ergin, Mehmet; Aribas, Alpay; Cander, BasarPurpose: This study aims to investigate the potential contributions of the right ventricle (RV) performance evaluated using tissue Doppler imaging (TDI) on the assessment of the severity and prognosis of sepsis. Methods: The study was completed with 55 patients (male/female 26/29, age 66.9 +/- 20.3 years) and 28 healthy controls (male/female 14/14, age 59.4 +/- 18.3 years). The RV-TDI parameters, mainly the RV myocardial peak systolic velocities (Sm, cm/s) and myocardial performance index (MPI) were recorded, in addition to the standard echocardiographic evaluation. Results: The patients were classified into 3 groups based on the severity of sepsis. The RV-Sm value was significantly lower in the severe sepsis-septic shock (n=31) than that of the sepsis (n=24) and the control groups (n=28) (P=.001). The RV-MPI was high both in the severe sepsis-septic shock and the sepsis compared with the control group (P=.02). The patients were classified into 3 groups based on in-hospital mortality. The RV-Sm was lower in non-surviving (n=27) than in the surviving (n=28) and the control groups (n=28) (P=.002). The RV-MPI was found to be higher in the non-surviving patients than the surviving and the control groups (P<.001). Conclusion: Our study shows that the RV dysfunction evaluated using TDI, particularly the RV-Sm and MPI values, were related with the severity of sepsis and mortality. (C) 2013 Elsevier Inc. All rights reserved.Öğe Carbon Monoxide Poisoning and Mechanical Ventilation: Case Report Literature Review(Aves, 2010) Cander, Basar; Dundar, Z. Defne; Yaylali, Cetin; Bayir, Aysegul; Girisgin, SadikCarbon monoxide poisoning is one of the most common lethal poisonings. Neurological or psychiatric sequelae occur in approximately 50-75% of survivors. Carbon monoxide poisoning can be treated with 100% oxygen or hyperbaric oxygen. The Glasgow Coma Scale (GKS) of the male patient who was admitted to our emergency department with CO intoxication due to a heater was 4. The patient's transport to a hyperbaric oxygen treatment center was considered but the conditions were not suitable for transport, so 100% oxygen treatment with mechanical ventilator was initiated. The patient was weaned from the mechanical ventilator at day 5 and he was extubated when his spontaneous breathing was adequate. He was discharged from hospital at the end of the follow-up period, day 14. His general condition was quite good and his GKS was 15 at discharge. Although most of the studies suggested that hyperbaric oxygen treatment was more effi cacious in carbon monoxide poisoning, other studies stated that there was no diff erence between hyperbaric oxygen and 100% oxygen treatment. There is a general opinion that the supportive treatment is very important for survival.Öğe Comparative effectiveness of standard CPR vs active compression-decompression CPR with CardioPump for treatment of cardiac arrest(W B Saunders Co-Elsevier Inc, 2016) Gunaydin, Yahya Kemal; Cekmen, Bora; Akilli, Nazire Belgin; Koylu, Ramazan; Sert, Ekrem Taha; Cander, BasarBackground: Despite all of the studies conducted on cardiopulmonary resuscitation (CPR), the mortality rate of cardiac arrest patients is still high. This has led to a search for alternative methods. One of these methods is active compression-decompression CPR (ACD-CPR) performed with the CardioPump. Objective: The differences in the restoration of spontaneous circulation; the 1-, 7-, and 30-day survival rates; and hospital discharge rates between conventional CPR and ACD-CPR performed with CardioPump were investigated. In addition, the differences between the 2 methods with respect to complications were also investigated. Methods: Our study was a prospective, randomized medical device study with a case-control group. Cardiac arrest cases brought to our emergency medicine clinic by the 112 emergency ambulances from out of hospital and patients who had developed cardiac arrest inhospital clinics between April 2015 and September 2015 were included in our study. For randomization, standard CPR was performed on odd days of each month, and CPR using CardioPump was performed on the even days of each month. Results: A total of 181 patients were included in our study. The number of patients who received conventional CPR was determined as 86 (47.5%), and the number of patients who received CPR using the CardioPump was determined as 95 (52.5%). We did not identify any difference between conventional CPR and CardioPump ACD-CPR with respect to restoration of spontaneous circulation, discharge rates, and the 1-, 7-, and 30-day survival rates. (P=.384, P=.601, P=.997, P=.483, and P=.803, respectively) The complication rate was higher in the patient group that received conventional CPR (P<.001). Conclusion: As a result of our study, we did not obtain any evidence supporting the replacement of conventional CPR with ACD-CPR performed using CardioPump. (C) 2015 Elsevier Inc. All rights reserved.Öğe Cyanide Intoxication: A Case Report(Emergency Medicine Physicians Assoc Turkey, 2010) Kocak, Sedat; Dundar, Zerrin Defne; Demirci, Serafettin; Cander, Basar; Dogan, HakanIntroduction: Cyanide is a rapid absorbable and powerful poison; even in small doses can cause death in minutes. It is used in many industrial fields; such as mining, chemical industries and agriculture. Recently, its use in gold mining and its enviromental toxicity is on the agenda of our country. Case Report: 60 years old male patient was brought to our clinic after drinking a sip of cyanide in his jewelry shop by 112 emergency team. In physical examination of patient, who was intubated at the scene of accident, general condition was poor, he was unconsciousness, arteriyal blood pressure was 80/50 mmHg and there was no spontaneous respiration. GCS score was 3. Patient's gastric lavage had started at the scene and contuined in our service, then active charcoal was given. The patient was taken to our intensive care unit and mechanically ventilation started with positive inotropic support. Blood cyanide level was >2.0 mg/L. 5 g hydroxycobalamin brought from Ankara could be given 9 hour after poisoning. The patient died at day 4. Discussion: Cyanide inhibits mitochondrial cytochrome oxidase enzyme and disrupts cellular utilization of oxygen lead to cellular hypoxia. Poisoning by oral consumption is a slow process and patient's recovery is sometimes possible. Therefore, the initiation of support and specific treatment as quickly as possible is important. In this case, although effective support treatment was started quickly; the specific antidote treatment could not be begun.Öğe Demography and Clinical Consequences of Trauma-Related Amputations in the Emergency Department Short(Aves, 2013) Kocak, Sedat; Ertekin, Birsen; Erdemir, Esma; Girisgin, Abdullah Sadik; Cander, BasarObjective: Total or subtotal traumatic extremity amputations constitute a considerable portion of trauma-related emergency department admissions. In this study, we aimed to establish the patients' age group, educational level and occupational group in which trauma-related extremity amputations are more frequently performed. Material and Methods: Cases presenting to our Emergency Department between August 2006 and August 2008, in whom traumatic extremity amputations were performed were prospectively studied. The data that were recorded on a study form, which included age, sex, educational level, occupation, mechanism of the trauma and hospitalization duration, underwent evaluation. Results: The data of 309 subjects were evaluated in this study. The mean age of the patients was 29 +/- 17.9, with 18.1% of the subjects being female and 81.9% being of male gender. 41.1% of the cases were laborers, 23.6% were self-employed in various fields, and 9.4% were farmers. With respect to the method of trauma in the majority of the amputations, industrial injuries accounted for 65.7%, finger jamming (door-related) accounted for 17.2%, and home injuries accounted for 8.7%. Finger amputation was identified in 93.4%, toe amputation in 4.4%, and others in 2.2%. Conclusion: Traumatic amputation concerns particularly children, youths, and people of low educational level with an active work life. The most frequently affected body parts are the fingers.Öğe A Diagnosis ofTotal Abdominal Aortic Occlusion in a Patient Who Entered the Emergency Department by Walking(Aves, 2014) Dundar, Zerrin Defne; Guven, Merve; Ergin, Mehmet; Cander, Basar; Girisgin, SadikIntroduction: The risk of thrombosis is increased in hypercoagulability. Hypercoagulability can be inherited or acquired. Here, we want to present a patient with inherited hypercoagulability who came to the emergency department by walking and was diagnosed with total abdominal aortic thrombosis and acute renal artery thrombosis. Case Report: A 48-year-old female patient presented to our emergency medicine department with a history of right flank pain for 30 minutes. The pain had started abruptly and was continuous. She came to the emergency medicine department by walking. The contrast-enhanced abdominal computed tomography showed right renal infarction, right artery occlusion, and abdominal aortic thrombus at the level of the iliac bifurcation. Conclusion: Abdominal aortic thrombus is a relatively rare complication of hypercoagulability. Total occlusion of the aorta is generally presented with pain, pallor, weakness, and numbness of the lower limbs. In our case, there was none of these signs due to the blood flow supplied by collaterals. It is a challenge to diagnose total aortic occlusion in a patient that comes to the emergency department by walking.Öğe Diagnostic value of ischemia-modified albumin in acute coronary syndrome and acute ischemic stroke(Professional Medical Publications, 2013) Ertekin, Birsen; Kocak, Sedat; Dundar, Zerrin Defne; Girisgin, Sadik; Cander, Basar; Gul, Mehmet; Doseyici, SibelObjective: To investigate diagnostic value of ischemia-modified albumin (IMA) levels in patients applying to emergency with symptoms of acute coronary syndrome (ACS) and acute ischemic stroke (AIS). Methods: Two patient groups (ACS and AIS) and a control group were constituted. The study was discontinued upon reaching 30 patients in each group. Following patient approval at the initial visit, a total of 10 ml venous blood sample was obtained from all patients with a high clinical suspicion of ACS and AIS. The Troponin I and the IMA levels were determined in the blood samples. Results: Statistically significant higher IMA values were determined in the patient groups compared to the control group (p < 0.001 for both groups). No statistically significant correlation was found between the IMA and the Troponin I values in the ACS and the AIS groups (p>0.05 for both groups). The sensitivity of IMA was 83% and 87% for ACS and AIS, respectively. The specificity of IMA was 90% and 87% for ACS and AIS, respectively. Conclusion: The sensitivity and specificity values, determined according to the optimal cut-off values in the groups demonstrated that IMA could be a useful diagnostic marker in ACS and AIS patients.Öğe Diagnostic value of ischemia-modified albumin in acute coronary syndrome and acute ischemic stroke(Professional Medical Publications, 2013) Ertekin, Birsen; Kocak, Sedat; Dundar, Zerrin Defne; Girisgin, Sadik; Cander, Basar; Gul, Mehmet; Doseyici, SibelObjective: To investigate diagnostic value of ischemia-modified albumin (IMA) levels in patients applying to emergency with symptoms of acute coronary syndrome (ACS) and acute ischemic stroke (AIS). Methods: Two patient groups (ACS and AIS) and a control group were constituted. The study was discontinued upon reaching 30 patients in each group. Following patient approval at the initial visit, a total of 10 ml venous blood sample was obtained from all patients with a high clinical suspicion of ACS and AIS. The Troponin I and the IMA levels were determined in the blood samples. Results: Statistically significant higher IMA values were determined in the patient groups compared to the control group (p < 0.001 for both groups). No statistically significant correlation was found between the IMA and the Troponin I values in the ACS and the AIS groups (p>0.05 for both groups). The sensitivity of IMA was 83% and 87% for ACS and AIS, respectively. The specificity of IMA was 90% and 87% for ACS and AIS, respectively. Conclusion: The sensitivity and specificity values, determined according to the optimal cut-off values in the groups demonstrated that IMA could be a useful diagnostic marker in ACS and AIS patients.Öğe Diamine oxidase in diagnosis of acute mesenteric ischemia(W B Saunders Co-Elsevier Inc, 2013) Karabulut, Keziban Ucar; Narci, Huseyin; Gul, Mehmet; Dundar, Zerrin Defne; Cander, Basar; Girisgin, A. Sadik; Erdem, SamiObjective: Acute mesenteric ischemia (AMI) is an important clinical condition with a high mortality rate in abdominal emergencies due to delay in diagnosis in spite of the new strategies in the management. We have studied the role of diamine oxidase (DAO) in the early diagnosis of AMI. Methods: In the study, 21 New Zeland rabbits were used. Subjects were named as the groups of controls, sham, and ischemia. No intervention was performed in the subjects in the control group. In the subjects from sham and ischemia groups, laparotomy was performed with middle line incision. However, superior mesenteric artery was found and tied in those from ischemia group after the performance of laparotomy. From the animals in 3 groups, blood was drawn at the hours of 0, 1, 3, and 6, and DAO and amylase were studied in these samples. Results: The increase in serum amylase levels was found to be statistically significant in the ischemia group compared with the control and the sham groups (P < .05). The decrease in serum DAO levels was found to be statistically significant in the ischemia group compared with the control and the sham groups (P < .05). Diamine oxidase levels were found to decrease, beginning from the 1 hour after ischemia had been developed, and this rise was found to continue for 6 hours (P < .05). Conclusion: Serum DAO levels were decreased in ischemia. Further clinical and experimental investigations would be valuable to confirm the probable role of DAO in AMI. (c) 2013 Elsevier Inc. All rights reserved.Öğe A Different Presentation of Urinary Tract Infections: Emphysematous Cystitis(Aves, 2013) Ergin, Mehmet; Atabey, Ertan; Atabey, Ersin; Gokmen, Ibrahim Erdem; Visneci, Fatih Emin; Cander, BasarEmphysematous cystitis (EC) tends to be seen in the geriatric population. Half of the patients have diabetes mellitus. Other predisposed factors are urinary retention, steroid and other immune suppressive treatments. We present the case of a 75-yearold female patient admitted to the emergency department with complains of abdominal pain and haematuria. She had diabetes mellitus type 2 and amputation below the knee of the left leg. Her vital signs were in the normal range except mild hypothermia. Her physical examination revealed abdominal sensitivity and a mass of 8x8 cm by palpation. Her laboratory results showed pyuria and haematuria, leukocytosis, and a high level of procalcitonin. Contrast-enhanced abdominal tomography showed gas in the wall and the air-fluid level within the lumen of the urinary bladder, which was pathognomonic for EC. There is great variability in clinical presentation and prognosis in cases of EC. Emergency physicians should know the radiological features of EC and associated pathologies of other abdominal organs to prevent the progression of infection.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 Intoxication due to Papaver rhoeas (Corn Poppy): Five Case Reports(Hindawi Ltd, 2015) Gunaydin, Yahya Kemal; Dundar, Zerrin Defne; Cekmen, Bora; Akillj, Nazire Belgin; Koylu, Ramazan; Cander, BasarIntroduction. In this paper, we aimed to present five Papaver rhoeas intoxication cases, which is very rare in the literature. Case 1. A 35-year-old female patient was admitted to our emergency roomwith the complaints of nausea, restlessness, and dyspnea developing 3 hours after eating Papaver rhoeas. On physical examination, her general condition was moderate; she was conscious and the vital findings were normal. The pupils were myotic. She was transferred to the toxicology intensive care unit as she experienced a generalized tonic clonic seizure lasting for three minutes. Case 2. A 41-year-old female patient was brought to our emergency room by 112 ambulance as she had contractions in her arms and legs, unconsciousness, and foam coming from her mouth two hours after Papaver rhoeas ingestion. On physical examination, she was confused, the pupils were myotic, and she was tachycardic. Arterial blood gases analysis revealed lactic acidosis. Case 3. A 38-year-old female patient was admitted to our emergency room with complaints of nausea and vomiting two hours after ingestion of Papaver rhoeas. Her physical examination and tests were normal. Case 4. A 34-year-old male patient was admitted to our emergency room with complaints of numbness and loss of power in his arms and legs one hour after Papaver rhoeas ingestion. He was hospitalized at the toxicology intensive care unit for follow-up and treatment. Dyspnea and bradycardia developed on the follow-up. The oxygen saturation without oxygen support was 90%. ECG revealed sinus bradycardia. The cardiac enzymes did not increase. Case 5. A 42-year-old female patient was brought to our emergency room by 112 ambulance with contractions in her arms and legs and unconsciousness two hours after Papaver rhoeas ingestion. On her physical examination, she was confused and the pupilsweremyotic. Arterial blood gases analysis revealed lactic acidosis. Conclusion. All patients were followed up for a few days and then discharged fromthe hospital with recovery. Unconscious consumption of Papaver rhoeas leads to a clinical condition resembling morphine intoxication, CNS depression, and epileptic seizures.Öğe 'Lichtenberg Figure' as a Result of Lightning Shock(Aves, 2014) Ergin, Mehmet; Onal, Mehmet Akif; Dikmetas, Cesarettin; Cander, Basar[Abstract Not Availabe]Öğe 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, CesareddinBackground/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.Öğe 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, BasarAim: 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.Öğe Meeting Report of 10th National Emergency Medicine Congress & 1st Intercontinental Emergency Medicine Congress(Aves, 2014) Dundar, Zerrin Defne; Ergin, Mehmet; Karamercan, Mehmet Akif; Satar, Salim; Girisgin, Abdullah Sadik; Yildiz, Mustafa; Cander, BasarThe 10th National Emergency Medicine Congress and the 1st Intercontinental Emergency Medicine Congress were held at Gloria Golf Resort Hotel Congress Center (Antalya, TURKEY) simultaneously between May 15 and 18, 2014. Due to the mining accident in the Soma Coal Mines prior to the congress, the social events were cancelled, and the congresses proceeded with the scientific program. Apart from the National Emergency Medicine Congresses, the EPAT had organized the International Symposium on Emergency Medicine and International Critical Care and Emergency Medicine Congress as part of its mission to get actively involved in the international emergency medicine arena. The Intercontinental Emergency Medicine Congress can be seen as the third link of this chain.Öğe Modified Early Warning Score and VitalPac Early Warning Score in geriatric patients admitted to emergency department(Lippincott Williams & Wilkins, 2016) Dundar, Zerrin Defne; Ergin, Mehmet; Karamercan, Mehmet A.; Ayranci, Kursat; Colak, Tamer; Tuncar, Alpay; Cander, BasarObjectiveThe aim of this study was to evaluate the value of the Modified Early Warning Score (MEWS) and the VitalPac Early Warning Score (VIEWS) in predicting hospitalization and in-hospital mortality in geriatric emergency department (ED) patients.Patients and methodsThis prospective, single-centered observational study was carried out over 1 month at the ED of a university hospital in patients 65 years of age and older presenting to the ED. The vital parameters of the patients measured on admission to ED were recorded. The MEWS and VIEWS were calculated using the recorded physiological parameters of the patients. Hospitalization and in-hospital mortality were used as the primary outcomes.ResultsA total of 671 patients included in the study. The median age of the patients was 75 (11) years, and 375 (55.9%) were men. The MEWS is effective for discriminating patient groups that have been discharged from ED, admitted to a ward and admitted to ICU [1 (2) vs. 1 (1) vs. 3 (3), respectively, P<0.001]. The VIEWS is also effective for discriminating patient groups that have been discharged from ED, admitted to a ward, and admitted to ICU [2 (3) vs. 5 (5) vs. 8 (8), respectively, P<0.001]. The AUCs of the MEWS and VIEWS were 0.727 [95% confidence interval (CI) 0.689-0.765] and 0.756 (95% CI 0.720-0.792) in predicting hospitalization, respectively. The AUCs of the MEWS and VIEWS were 0.891 (95% CI 0.844-0.937) and 0.900 (95% CI 0.860-0.941) in predicting in-hospital mortality, respectively.ConclusionThe MEWS and VIEWS are powerful scoring systems that are easy-to-use for predicting the hospitalization and in-hospital mortality of geriatric ED patients.Öğe NEUTROPHIL-LYMPHOCYTE RATIO IN PATIENTS WITH PESTICIDE POISONING(Elsevier Science Inc, 2014) Dundar, Zerrin Defne; Ergin, Mehmet; Koylu, Ramazan; Ozer, Rasit; Cander, Basar; Gunaydin, Yahya KemalBackground: Pesticides are highly toxic to human beings, and pesticide poisoning is associated with high morbidity and mortality. The identification of powerful prognostic markers is important for the management of patients with pesticide poisoning in emergency settings. Objective: To investigate the prognostic value of the neutrophil-lymphocyte ratio and hematological parameters measured in patients with pesticide poisoning within the first 24 h after admission to the emergency department (ED). Methods: All patients (>= 15 years old) admitted to the ED from July 2008 through February 2013 due to pesticide poisoning were enrolled in the study. The written and electronic medical charts of patients were reviewed. Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio were calculated for each patient using absolute neutrophil, lymphocyte, and platelet counts. Mechanical ventilation requirement and mortality were used as the primary endpoints. Results: A total of 189 patients were included in the study. The mechanically ventilated patients had significantly higher leukocyte and neutrophil counts, and neutrophil-lymphocyte and platelet-lymphocyte ratios (p < 0.001, p < 0.001, p < 0.001, p = 0.003, respectively), whereas they had significantly lower lymphocyte counts compared to nonventilated patients (p = 0.011). Survivors had significantly higher leukocyte and neutrophil counts, and neutrophil-lymphocyte ratios (p < 0.001, p < 0.001, p = 0.002, respectively), whereas there was no significant difference between groups in terms of lymphocyte counts (p = 0.463), compared to nonsurvivors. Conclusion: Leukocyte counts, neutrophil counts, and neutrophil-lymphocyte ratios measured within the first 24 h after admission to the ED are useful and easy-to-use parameters for estimating prognosis in the follow-up of patients with pesticide poisoning. (C) 2014 Elsevier Inc.Öğe A new development in emergency department ultrasonography: Pleural Sliding Sound (PSS)(Professional Medical Publications, 2012) Ergin, Mehmet; Girisgin, Abdullah Sadik; Karaoglan, Osman; Calik, Goknil; Kocak, Sedat; Cander, BasarUltrasonography (USG) is widely used in emergency departments to assist in the diagnosis and treatment of patients. An increasing number of studies in the unconventional use of USG in thorax and lung examination have been conducted in recent years. Sliding lung sound (SLS) has been researched extensively during the last decade was accepted as a radiologic sign in 2008. However, determining SLS requires a certain degree of clinical experience since it is a subjective indicator. We have discovered the pleural sliding sign (PSS), which is as valuable as the SLS, but more objective sign. PSS is present at any time when SLS is present; furthermore, it can be used as a diagnostic sign even when the SLS is doubtful. In this study, we present our views on PSS and in particular wish to share this information with clinicians who are interested in performing emergency USG. We also aim to stimulate further research on this subject.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.
