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Öğe Akut tromboembolik olaylarda iskemi modifiye albümin (İMA)'in tanısal değeri(2011) Ertekin, Birsen; Cander, BaşerAkut tromboembolik bir hadise şüphesi ile acil kliniğine gelen hastalarda standart belirteçler ile İMA'nın tanısal değerini ve karşılaştırmalı değerlendirme ile hangi tromboembolik olayda daha fazla tanısal değer taşıdığını ortaya koyabilmektir.Gereç ve yöntem: Çalışmaya Selçuk Üniversitesi Meram Tıp Fakültesi Acil Tıp Ana Bilim Dalı'na akut tromboembolik bir olayla başvuran erkek ve kadın, 18 yaş üzerindeki hastalar ardışık olarak dahil edildi. Çalışma kontrol grubu ve dört hasta grubu (akut koroner sendrom, akut pulmoner emboli, akut iskemik strok, akut periferik damar hastalığı) olmak üzere beş grupta yürütüldü. Mart 2009 `da çalışmaya başlanıldı ve her bir grupta hedeflenen hasta sayısı 30 idi. Grupların hasta sayısı 30'ar hastaya ulaşınca çalışma sonlandırıldı. Gruplardan alınan kan örneklerinde spektrofotometrik yöntem ile serum İMA düzeyleri ölçüldü. ROC eğrisine göre grupların ayrı ayrı sensivite ve spesifisite değerleri hesaplandı. Gruplar arası İMA değerleri karşılaştırıldı ve İMA değerlerinin Troponin, CRP, WBC ve D-dimer ile korelasyonu değerlendirildi.Bulgular: Hasta gruplarının İMA değerleri ile kontrol grubu İMA değerleri karşılaştırıldığında, 4 grubun IMA değerleri kontrol grubundan istatistiksel olarak anlamlı yüksek bulunmuştur (p<0.001). Buna ek olarak, kontrol grubuna göre en anlamlı IMA yükselmesi AİS grubunda (p<0.001), en az yükselme ise PDH grubunda tespit edilmiştir (p<0.001). AKS grubunda optimum İMA cutoff değeri 0,94 ABSU için sensitivite:% 83, spesifisite: %90, AİS grubunda İMA cutoff değeri 0,93 ABSU için sensitivite:% 86, spesifisite: %87, PE grubunda İMA cutoff değeri 0,90 ABSU için sensitivite:% 83, spesifisite: %77 ve PDH grubunda İMA cutoff değeri 0,85 ABSU için sensitivite:% 76, spesifisite: %60 idi. Gruplar arası karşılaştırmada, AKS ve PDH grubunda AKS, AİS ve PDH grubunda AİS, PE ve PDH grubunda ise PE grubu İMA değerleri anlamlı olarak daha yüksek tespit edilmiştir (p=0.034, 0.002, 0.024). İMA'nın Troponin, CRP, WBC ve D-dimer ile arasında anlamlı bir korelasyon bulunamamıştır.Sonuç: Çalışmamızda PDH dışındaki grupların (AKS, AİS, PE) ROC eğrisine göre ölçülen sensitivite ve spesifisite değerlerinin yüksek olması İMA'nın iskemik olaylarda kullanılabilir bir belirteç olduğunu düşündürmektedir. Yine de akut tromboemboli ile seyreden hastalıkların tanısında IMA'nın tanısal değeri konusunda kapsamlı çalışmalara ihtiyaç olduğunu düşünmekteyiz.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 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 Efficacy of Use of Red Cell Distribution Width as a Diagnostic Marker in Acute Appendicitis(2017) Ertekin, Birsen; Kara, Hasan; Erdemir, Esma; Doğan, Emine; Acar, Tarık; Demir, Lütfi SaltukAim: We aimed to investigate the increase in values of red cell distribution width (RDW) and also the dependence of RDW on leukocyte count (WBC) and C-reactive protein (CRP) values in acute appendicitis (AA).Materials and Methods: This study includes data collected from 407 patients who were admitted between January 2012 and July 2014 to the emergency service and underwent an operation owing to a diagnosis of AA confirmed by a pathology report. These patients were divided into two groups, namely, non-complicated and complicated appendicitis, according to the results of the operation. The control group consisted of 100 adult patients with similar complaints not having acute abdominal conditions. The age, gender, and WBC, RDW, and CRP levels of the patients on admission were recorded retrospectively.Results: A total of 350 (86%) of the patient group were diagnosed with non-complicated appendicitis, 34 (8.4%) with plastron appendicitis, and 23 (5.6%) with perforated appendicitis. No significant difference was observed with respect to WBC, RDW, and CRP levels between the AA groups (p<0.05). The WBC, RDW, and CRP values were found to be significantly different in the AA groups from the control group (p>0.05). The sensitivity and specificity of the WBC, RDW, and CRP values in the AA group were 70% and 60%, 41% and 30%, and 51% and 40%, respectively. No dependence of RDW values on WBC or CRP levels was found.Conclusion: RDW values were found to be significantly higher in the AA group than in the control group. The low sensitivity and specificity values of the RDW test reduce the possibility that it might become a hematologic marker to be used in the definitive diagnosis of AA.Öğe 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, SerpilObjective: 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.Öğe Lipoprotein-associated phospholipase-A2 activity and its diagnostic potential in patients with acute coronary syndrome and acute ischemic stroke(Wolters Kluwer Medknow Publications, 2017) Kocak, Sedat; Ertekin, Birsen; Girisgin, Abdullah Sadik; Dundar, Zerrin Defne; Ergin, Mehmet; Mehmetoglu, Idris; Bodur, SaidBackground: The study examined the Lp-PLA(2) activity at the patients presented to the emergency department with acute coronary syndrome (ACS) or acute ischemic stroke (AIS), as well as its diagnostic value. Methods: The prospective study included consecutive male and female patients aged >18 years that presented to the our emergency department with ACS or AIS between November 2009 and January 2010. Blood samples were obtained immediately following diagnosis in the ACS and AIS groups. The diagnostic value of Lp-PLA(2) was determined based on receiver operating characteristic curves, sensitivity, specificity, predictive values, likelihood ratios and accuracy rates. Results: In all, 34 ACS and 32 AIS patients were included in the study, and the control group included 35 patients. Lp-PLA(2) enzyme activity was significantly lower in the ACS and AIS groups than in the control group (26.7 +/- 13.8, 31.4 +/- 13.6, and 41.4 +/- 8.1 nmol min(-1).mL(-1), respectively; p < 0.0001, p = 0.022). In the ACS group the area under the curve (AUC) was 0.825 (95% CI: 0.722-0.929), sensitivity was 71% for an optimal Lp-PLA(2) cut-off value of 31.4 nmol min(-1).mL(-1), and specificity was 91%, whereas in the AIS group the AUC was 0.768 (95% CI: 0.652-0.884), sensitivity was 75% for an optimal Lp-PLA(2) cut-off value of 38.1 nmol min(-1).mL(-1), and specificity was 74%. Conclusions: Lp-PLA(2) enzyme activity was significantly lower during the early stage of both ACS and AIS. The obtained statistic data suggest that low Lp-PLA(2) enzyme activity can be used for diagnostic purposes. Copyright (C) 2016 The Emergency Medicine Association of Turkey. Production and hosting by Elsevier B.V. on behalf of the Owner. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Öğe Red Poppy (Papaver Rhoeas) Poisoning: A Report of Three Cases(Aves, 2016) Kocak, Sedat; Karabulut, Keziban; Ertekin, Birsen; Nak, Himmet; Cander, BasarRed poppy (RP) is a plant that can be widely found in our country. It is known as a medicinal plant among the people. Three cases in which central nervous system (CNS) symptoms developed after eating RP have been presented. Case 1: A 29-year-old female patient was admitted to our clinic with complaints of nausea, vomiting, and convulsions after approximately 1.5-2 h of eating RP. She was apathetic and non-cooperative, and the vital findings were in normal ranges. Pin-point pupils were noted. The patient had tonic seizure once. Case 2: A 9-year-old female patient, daughter of case 1, was brought with her mother with complaints of spasm of the jaw, altered mental status, and convulsion. Agitations started 1 h later after admission. She experienced a generalized tonic-clonic seizure that continued for 5 min. Case 3: A 70-year-old female patient was brought to our clinic with mental status changes 1 hour after she had ingested RP. She was lethargic, disoriented, non-cooperative, and the pupils were miotic. An unconscious consumption of weasel grass causes negative effects, particularly effects on CNS. Because generalized seizure was only observed in the child, it was suggested that children experience more effects. The mental status of these patients was restored within approximately 6 h, and they were discharged. Mortality or morbidity was not observed in these cases. Nevertheless, this does not indicate that it would not cause worse clinical results. To prevent the ignorant consumption of RP and similar weeds, educational and informational activities must be conducted at the public level.Öğe 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, TarikThe 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.Öğe 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 DefneBACKGROUND: 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.
