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Öğe Acil serviste pulmoner tromboembolili hastaların farklı puanlama araçları ile değerlendirilmesi(2018) Özer, Muhammet Raşit; Ergin, Mehmet; Altunay, Fatih; Gökal, Aliye Nur; Dündar, Zerrin Defne; Vişneci, Emin Fatih; Koçak, SedatAmaç: Acil serviste pulmoner tromboemboli (PTE) tanısı alan hastaların mortalite ile demografik, klinik, laboratuvar ve skorlamaözellikleri arasındaki ilişkiyi araştırmak.Gereç ve Yöntem: Bu retrospektif çalışmada, 2012-2015 yılları arasında acil servise başvuran torasik bilgisayarlı tomografi (BT) veyapulmoner BT anjiyografisi ile PTE tanısı alan 166 hasta çalışmaya dahil edildi. Hasta grubu Grup I (sağ kalan) ve Grup -II (hayattakalmayan)olarak iki gruba ayrıldı. Hematolojik ve biyokimyasal laboratuvar parametreleri, laktat içeren arteriyel kan gazı değerleri vetüm hastaların klinik şiddeti MWS, PESI ve MEWS skorlama sistemleri kullanılarak değerlendirildi.Bulgular: Arteriyel oksijen basıncı (PaO2) ve laktat düzeyleri açısından, hasta grupları arasında istatistiksel olarak anlamlı bir farkbulundu. Grup II'de, PESI ve MEWS skorları Grup-I hastaları ile karşılaştırıldığında anlamlı olarak yüksek bulundu. Grup II hastalarındaMWS skoru daha yüksekti.Sonuç: Burada kullanılan parametreler ve skorlama araçları sayesinde, PTE olgularını tanılamayı amaçladık. PTE'nin bu bulgularınyardımıyla klinisyen tarafından daha erken teşhis edildiğinde, mortalite ve morbidite oranlarının azaltılacağını ve tedavinin dahaetkili olacağını düşünmekteyiz.Öğe Association of Severity of Coronary Lesion with Markers of Acute Infection and Inflammation in Patients with Acute Coronary Syndrome(2016) Koçak, Sedat; Dündar, Zerrin Defne; Harmankaya, Atıf; Erdemir, Esma; Keşli, Recep; Alibasic, HayrudinAim: Inflammation and some infectious agents play a key role in acute coronary syndrome (ACS) caused by atherosclerosis. The purpose of this study was to assess the effects of inflammatory markers and the positivity of Chlamydia pneumoniae (CP), Helicobacter pylori (HP), and Cytomegalovirus (CMV) on the level of atherosclerosis in patients with ACS. Materials and Methods: Patients (57) that were referred to the emergency unit with classic angina symptoms or angina equivalent symptoms and were determined to have critical lesions in the coronary angiography (<70% stenosis, coronary artery disease (CAD) severity assessed by the Gensini score) were compared with 27 ACS patients who had no critical lesions in terms of procalcitonin (PCT), tumor necrosis factor-alpha (TNF-?), interleukin-2 receptor (IL2r), interleukin-6 (IL-6), and interleukin-10 (IL-10) levels and positivity of CP, HP, and CMV. Also, the two groups of ACS patients were compared in terms of cytokine levels measured at hours 0 and 48. Results: No significant association was found between the degree of the coronary lesion and the inflammatory and infectious agents. However, in patients with critical coronary lesions, as markers of inflammatory agents, the levels of IL-6 were significantly lower and levels of IL-10 were significantly higher (p>0.001 and p0.030, respectively) at hour 48 than originally found at hour 0. Conclusion: There is no association between the severity of coronary lesions and cytokine levels and positivity of infectious agents in ACS since the levels of proinflammatory cytokines in ACS are higher than those in atherosclerosis. The changes in cytokine levels at hour 48 were found to be significant.Öğe Diagnostic and Prognostic Significance of Neutrophil Gelatinase- Associated Lipocalin and Pentraxin-3 in Acute Coronary Syndrome(2017) Özer, Muhammet Raşit; Ergin, Mehmet; Kılınç, İbrahim; Dündar, Zerrin Defne; Özer, Nejla; Önal, Mehmet Akif; Girişgin, Abdullah Sadık; Koçak, Sedat; Gül, Mehmet; Cander, BaşarAim: The aim was to evaluate the levels of serum pentraxin-3 (PTX-3) and neutrophil gelatinase-associated lipocalin (NGAL) and the efficiency of making a diagnosis and to estimate the prognosis in patients with chest pain.Materials and Methods: The study was conducted in the Necmettin Erbakan University Meram Medicine School Emergency Department. Patients who had chest pain and met the inclusion criteria were accepted. They were divided into the following groups: acute coronary syndrome (ACS), a diagnosis other than ACS (non-ACS), and control. The patients in theACS and non-ACS groups were divided into five sub-group -groups: ST Elevated Myocardial Infarction (STEMI) Non- ST Elevated Myocardial Infarction (NSTEMI), Unstable Angina Pectoris (USAP), stable angina, and pulmonary embolus. For all patients, serum PTX-3, serum NGAL, troponin I, and creatine kinase-MB fraction (CK-MB) levels were measured.Results: There were 199 patients in the ACS and non-ACS groups and 30 patientsin the control group. There was no significant difference among the study groups in terms of age and PTX-3 and NGAL levels. When comparing survival and non-survival in terms of in-hospital death, CK-MB and troponin I levels were significantly higher in the ACS and non-ACS groups than in the control groups, whereas there was no significant difference in terms of PTX-3 and NGAL levels.Conclusion: The results of our study demonstrated that PTX-3 and NGAL are not effective biomarkers in the differential diagnosis and the determination of in-hospital mortality in ACS. However, the limitations of the study should be considered. The results confirmed that CK-MB and Troponin I can be safely used in the differential diagnosis and the prediction of mortality.Öğe Epidemiological Characteristics of Geriatric Patients in Emergency Departments: Results of a Multicenter Study(2015) Ergin, Mehmet; Karamercan, Mehmet Akif; Ayrancı, Mehmet; Yavuz, Yücel; Yavaşi, Özcan; Serinken, Mustafa; Acar, Tarık; Avcil, Mücahit; Al, Behçet; Bayramoğlu, Atıf; Durgun, Hasan Mansur; Gölcük, Yalçın; Arzıman, İbrahim; Dündar, Zerrin DefneGirifl: Beklenen yaflam süresinin uzamasının sonucu olarak yafllı popülasyondaki artıfl, bu yaflgrubu için daha sık sağlık bakımı verilmesini zorunlu kılmaktadır. Bu çalıflmada acil servise baflvuran 65 yafl ve üzeri hastaların genel özelliklerini, baflvuru nedenlerini, acil servis ve hastane ziyaretlerinin sonuçlarının saptanması amaçlandı. Gereç ve Yöntem: Çok merkezli, prospektif, gözlemsel çalıflma Türkiye'de 13 hastaneninacil servislerinde bir hafta süre ile gerçekleflti. Çalıflma süresi içinde akut tıbbi veya cerrahi sorunlar ile acil servise baflvuran 65 yafl ve üstü hastalar çalıflmaya dahil edildi. Altmıfl befl yafl altı ve/veya travma nedenli baflvurular ise çalıflma kapsamına alınmadı.Bulgular: Ortalama yaflı 74.87.3 yıl olan toplam 1299 hasta çalıflmaya dahil edildi. Bu hastalardan %51.9'u (n674) 65-74 yafl grubundaydı, %67.5'u (n877) hastaneden taburcu edildive %5.8'i (n75) yatıfl süreci içinde öldü. Acil serviste en sık konulan tanılar kardiyovasküler, gastrointestinal ve solunum hastalıklarıydı. Hastaneden taburcu olan ve hastane yatıflı sırasında ölenhasta grupları kıyaslandığında yafl açısından istatistiksel olarak anlamlı fark varken (p0.001), cinsiyet dağılımı (p0.259), hastane yatıfl süresi (p0.259) ve yoğun bakım ünitesi yatıfl süresi(p0.055) açısından fark tespit edilmedi. Sonuç: Yafllı nüfusunun ve genel nüfusa oranının artıflı ile birlikte yafllı hastaların acil servisbaflvuru sayısı artıyor ve gelecekte daha da artacaktır. Bu çalıflma, çalıflma merkezlerine baflvuranyafllı hastaların demografik özelliklerini ve klinik seyirlerinin sonuçlarını ortaya koymaktadır.Öğe An experimental comparative study on classic tube thoracostomy and thoracostomy with a newly designed thorax drainage catheter(2016) Dündar, Zerrin Defne; Tokur, Mahmut; Ergin, Mehmet; Okumuş, MehmetBackground/aim: The collection of fluids, blood, pus, or air in the pleural cavity is a pathological condition requiring pleural drainage. A newly designed thorax drainage catheter in the prototype phase was used in this experimental study to test its efficacy. Materials and methods: A hemopneumothorax was first caused by a penetrating injury on the frontal axis of the sixth intercostal space on the right hemithorax with a scalpel on 6 female Sus domesticus swine subjects. After resting for 5 min, a tube or catheter was inserted. The same procedure with a tube thoracostomy or thorax drainage catheter was repeated on the left hemithorax. The time periods were recorded. After all procedures were completed, the thoracic organs were assessed for iatrogenic injuries. Results: In terms of time elapsed for procedure, statistically significant differences between the tube thoracostomy and thorax drainage catheter applications were identified (P0.05). Additional iatrogenic injuries were nonexistent for both groups. During the thorax drainage catheter application, a surgical set or the use of sutures was not required. Conclusion: This study showed promising results regarding the efficacy of the thorax drainage catheter for convenient use in prehospital and hospital settings by physicians with little experience with tube thoracostomy.Öğe A pilot experimental study of a catheter to facilitate treatment for penetrating cardiac injury(2014) Dündar, Zerrin Defne; Tokur, Mahmut; Ergin, Mehmet; Kürkçüoğlu, İbrahim CanBackground/aim: Penetrating heart injuries result in high mortality. We designed a new catheter to facilitate the treatment of penetrating cardiac injuries and provide more effective initial bleeding control and fluid replacement. Materials and methods: The cardiac injury model was applied to 8 female 1-year-old Sus domesticus pigs. Subjects were grouped according to whether a Foley catheter or a newly designed catheter was placed into the heart through cardiac lacerations. Changes in systolic blood pressures, mortality, and problems encountered during surgery and other intraoperative findings were recorded. Results: There were higher mean blood pressure measurements in the newly designed catheter group during stages IV to VII. All subjects had tamponade and cardiac activity after completion of the repair of all lacerations in the catheter group, whereas in the other group only one subject did. Intraoperative direct fluid infusion to the heart through the catheters in the diastole was performed in all subjects of both groups. However, regurgitation from the cardiac cavity in the systole was seen only in the Foley catheter group. All of the intraoperative complications were seen in the same group. Conclusion: The newly designed catheter can provide effective initial bleeding control, better initial vital sign stabilization, and fewer intraoperative problems during primary repair of cardiac lacerations.Öğe Prognostic Value of Red Cell Distribution Width in Critically Ill Patients and Comparison with Intensive Care Unit Scoring Systems(2017) Vişneci, Emin Fatih; Cander, Başar; Gül, Mehmet; Dündar, Zerrin Defne; Dur, Ali; Girişgin, Abdullah SadıkAim: This study aimed to investigate the prognostic value of lactate and red cell distribution width (RDW) parameters of patients admitted to emergency service and critical care unit (CCU). Materials and Methods: A total of 147 patients hospitalized in the CCU of Necmettin Erbakan University, Meram Faculty of Medicine, Department of Emergency Medicine, were included in the study. Vital signs, laboratory results, lactate, and RDW values of the patients were recorded. Acute Physiology and Chronic Health Evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores were calculated. Duration of hospitalization and intensive care unit stay and mortalities were recorded. Chi-square, Fisher's exact chi-square, and Student t tests were used for statistical analyzes, and Mann-Whitney U test was used for comparing nonparametric data that were not compatible with a normal distribution. P>0.05 were accepted as statistically significant. Spearman correlation analysis was used to assess whether a linear correlation existed between the parameters. Results: A statistically significant correlation was found between the duration of stay in the CCU for >7 days and total duration of hospitalization (p>0.001). Also, statistically significant correlations were observed between mortalities of 28 days and 3 months, APACHE II and SOFA scores, and mean lactate (for 24 h and during hospitalization) and RDW values (p>0.001, p>0.001, p>0.001, and p>0.05, respectively). Moreover, correlations were noted between APACHE II scores, lactate value during the first admission, and SOFA scores (p>0.001). Correlations were also observed between 48-h SOFA scores and RDW and lactate values (p>0.001). Conclusion: SOFA and APACHE II are the scoring systems used in practice. Efficiencies for mortality assessment of critical patients were confirmed. This study showed that lactate and RDW values, which were compatible with the scoring systems, could be used for assessing prognosis. Wider and more comprehensive studies that can assess scoring systems and lactate and RDW values together for prognostic identification are required to validate the findings.Öğe Prognostic Value of Red Cell Distribution Width in Patients with Organophosphate Poisoning(2015) Dündar, Zerrin Defne; Ergin, Mehmet; Köylü, Ramazan; Günaydın, Yahya Kemal; Özer, Raşit; Cander, BaşarThe aim of this retrospective study was to investigate the prognostic value of red cell distribution width (RDW) and other hematological parameters measured on admission to the emergency department in patients with organophosphate poisoning.Materials and Methods_ All patients aged ? 15 years who were admitted to the emergency department from 2008 to 2013 on account of organophosphate poisoning were included in the study. The written and electronic medical charts of the patients were reviewed. Hematological parameters were recorded. Mechanical ventilation requirement was used as the primary endpoint. Results: A total of 72 patients were included in the study for evaluation. Mechanically ventilated patients had significantly higher leukocyte counts and RDW levels than non-ventilated patients (p0.004 and p0.001, respectively). The area under the receiver-operating characteristic curve of RDW levels for predicting mechanical ventilation requirement was 0.716 (95% CI: 0.581-0.852, p0.010). RDW had a sensitivity of 73%, specificity of 70%, and negative predictive value of 91% with a cut-off value of 14.5% in predicting mechanical ventilation requirement in patients with organophosphate poisoning. Conclusion: RDW can be a valuable and easy-to-use parameter in estimating prognosis in the follow-up of patients with organophosphate poisoning. Conclusion: RDW can be a valuable and easy-to-use parameter in estimating prognosis in the follow-up of patients with organophosphate poisoning.Öğe Rhabdomyolysis Induced by Agaricus Bisporus(2014) Akilli, Nazire Belgin; Dündar, Zerrin Defne; Köylü, Ramazan; Günaydin, Yahya Kemal; Cander, BaşarMushroom poisoning may present with a variety of clinical conditions, extending from simple food poisoning to life-threatening liver and renal failure. Rhabdomyolysis is a recently described syndrome that is observed within the clinical spectrum associated with mushroom poisoning. In this report, we present two patients-one presenting with a state of rhabdomyolysis and the other case with simple symptoms only-following consumption of cultivated mushroom together in the same meal.Öğe The role of oxidative stress in ?-amanitin-induced hepatotoxicity in an experimental mouse model(2017) Dündar, Zerrin Defne; Ergin, Mehmet; Kılınç, İbrahim; Çolak, Tamer; Oltulu, Pembe; Cander, BaşarBackground/aim: This study aimed to evaluate oxidative stress markers of liver tissue in a mouse α-amanitin poisoning model with three different toxin levels. Materials and methods: The mice were randomly divided into Group 1 (control), Group 2 (0.2 mg/kg), Group 3 (0.6 mg/kg), and Group 4 (1.0 mg/kg). The toxin was injected intraperitoneally and 48 h of follow-up was performed before sacrifice. Results: Median superoxide dismutase activities of liver tissue in Groups 3 and 4 were significantly higher than in Group 1 (for both, P 0.001). The catalase activity in Group 2 was significantly higher, but in Groups 3 and 4 it was significantly lower than in Group 1 (for all, P 0.001). The glutathione peroxidase activities in Groups 2, 3, and 4 were significantly higher than in Group 1 (P 0.006, P 0.001, and P 0.001, respectively). The malondialdehyde levels of Groups 3 and 4 were significantly higher than Group 1 (P 0.015 and P 0.003, respectively). The catalase activity had significant correlations with total antioxidant status and total oxidant status levels (r 0.935 and r 0.789, respectively; for both, P > 0.001). Conclusion: Our findings support a significant role for increased oxidative stress in α-amanitin-induced hepatotoxicity.Öğe The role of soluble urokinase plasminogen activator receptor (SuPAR) as an indicator of the severity of acute pancreatitis(2018) Küçükceran, Kadir; Ergin, Mehmet; Kılınç, İbrahim; Karaibrahimoğlu, Adnan; Çolak, Tamer; Tuncar, Alpay; Dündar, Zerrin Defne; Koçak, Sedat; Girişgin, Abdullah Sadık; Gül, Mehmet; Cander, BaşarBackground/aim: Soluble urokinase plasminogen activator receptor (suPAR) has been reported to have a positive correlation with theactivation degree of the immune system. This study’s aim is to investigate the efficiency of SuPAR serum levels in acute pancreatitis (AP)patients in determining the severity of disease.Materials and methods: This prospective research involves patients who arrived at the emergency service, were over 18 years old, hadnontraumatic abdominal pain and diagnosis of AP, and agreed to join the study. Demographic characteristics, contact information,laboratory and imaging test parameters, Ranson’s criteria, the Balthazar Severity Index, the Rapid Acute Physiologic Score (RAPS), andthe modified Glasgow (Imrie) score of all patients were recorded. Two study groups were created as score of 3 (mild, Group I) and 3(severe, Group II) for pancreatitis according to Ranson’s criteria.Results: During the study period, 59 sequential patients with AP were included in the study. It was seen that 79.7% of the study group(n 47) were in Group I. Etiologically 67.8% (n 40) cases were biliary and 32.3% (n 19) were nonbiliary diseases. According to theresults, suPAR level was effective in distinguishing the severity of AP (AUC 0.902, P 0.001 (95% CI: 0.821–0.984)). With regardto determining severe disease, suPAR had an optimum cutoff value of 6.815 ng/mL, sensitivity of 91.66%, specificity of 82.97%, andnegative predictive value of 97.5%.Conclusion: Our study was performed the determine the efficiency of suPAR level in predicting severe disease in AP patients. We foundit significant in indicating the severity of disease according to the study results.Öğe Thrombolysis in STEMI at Prehospital Settings(2014) Ergin, Mehmet; Dündar, Zerrin Defne; Cander, BaşarThrombolysis is a rapidly available but semi-effective treatment, whereas percutaneous coronary intervention is a potentially delayed but highly effective therapy. What about thrombolysis in the prehospital setting for ST-elevated myocardial infarction? Does scientific evidence support or oppose? Which patient group is more eligible for prehospital thrombolysis? Is there any skirmish between emergency medicine and cardiovascular professionals? You can find a history of prehospital thrombolysis on the basis of scientific evidence in this writingÖğe Updated Management of Atrial Fibrillation(2015) Ergin, Mehmet; Dündar, Zerrin Defne; Aslay, Semra; Emet, MücahitAtrial fibrillation (AF) is the most common sustained cardiac arrhythmia. AF is also associated with increased mortality, stroke and other thromboembolic disorders, cardiac failure and hospital admission, diminished quality of life, exercise intolerance, and left ventricular dysfunction. In the literature, there are many reports about the updated management of AF. This report aims at evaluating the previous guidelines and summarizing the prominent points.
