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Öğe Cranial Subdural Hematoma Following Spinal Anesthesia: Case Report(2017) Gül, Mehmet; Ayrancı, Mustafa Kürşat; Güner, Hakan; Medni, Mohamed Refik; Cander, BaşarAlthough post dural puncture headache is the most common complication of spinalanesthesia, subdural hematoma is a rare complication. The mortality would be high if untreated. Inthis case, a patient of 28 years old presented to our emergency department with headache after cesarean section performed with spinal anesthesia 20 days prior. She had received analgesic drugtreatment for post dural puncture headache. Despite treatment, she presented to our emergency department for unresolved headache. A subdural hematoma was detected using a brain computed tomography (CT) because of complaint of double vision accompanied by headache. For headacheoccurring after spinal anesthesia without response to medical therapy, subdural hematoma shouldbe considered.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 Epidemiology of atrial fibrillation in Turkey: preliminary results of the multicenter AFTER study(2013) Ertaş, Faruk; Kaya, Hasan; Kaya, Zekeriya; Bulur, Serkan; Köse, Nuri; Gül, Mehmet; Arıbaş, Alpay; Kahya Eren, Nihan; Çağlıyan, Çağlar Emre; Köroğlu, Bayram; Vatan, Bülent; Bilik, Mehmet Zihni; Gedik, Selçuk; Yıldız, Abdülkadir; Aydın, Mesut; Yeter, Ekrem; Kanadaşı, Mehmet; Ergene, Oktay; Özhan, Hakan; Ülgen, Mehmet Sıddık; Oylumlu, MustafaAmaç: Atriyum fibrilasyonu (AF) klinik pratiğimizde en sık rastlanan ritm bozukluğu olup ülkemizde bu konuda yapılmış çok merkezli bir epidemiyolojik çalışma bulunmamaktadır. Bu çalışmanın amacı ülkemizde ilk kez yapılmış olan çok merkezli, ileriye dönük Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER) çalışmasının kayıtlarından yararlanarak AFye klinik yönden yaklaşımımızı değerlendirmektir. Çalışma planı: Ülkemizde nüfus dağılımı göz önünde bulundurularak 17 ayrı üçüncü basamak merkezden, elektrokardiyografisinde en az bir defa AF atağı tespit edilmiş olan ardışık 2242 hasta çalışmaya alındı. Acil polikliniğine başvuran ya da yatmakta olan hastalar çalışmadan dışlandı. Hastaların epidemiyolojik verileri ve uygulanan tedaviler değerlendirildi. Bulgular: Çalışma popülasyonunu oluşturan hastaların %60ı kadındı, hastaların ortalama yaşı 66.812.3 yıl olarak saptandı. Türk nüfusunda en sık görülen AF tipi non-valvular AF (%78) olup, AFli hastaların %81i ısrarcı-kalıcı AFli idi. AFye en sık eşlik eden komorbid durum hipertansiyon (%67) olarak bulundu. Hastaların %15.3ünde inme, geçici iskemik atak ve sistemik tromboemboli hikayesi mevcut iken kanama öyküsü hastaların %11.2sinde kaydedildi. Çalışma süresinde hastaların %50si warfarin, %53ü de aspirin kullanıyordu. Oral antikoagülan ilaç kullanan hastaların %41.3ünde etkin INR düzeyi saptandı. Oral antikoagülan ilaç kullanmamanın en sık nedeni (%69) hekim ihmali olarak saptandı. Sonuç: Bu veriler klinik pratiğimizde özellikle AFli hastaların antitrombotik tedavileri konusunda daha dikkatli olunması gerektiğini göstermektedir.Öğe The Importance of Electrocardiographic Screening in Cardiac Contusion after Blunt Chest Trauma: Case Reports(2013) Uçar Karabulut, Keziban; Narcı, Hüseyin; Cander, Başar; Gül, Mehmet; Duman, ÇetinKünt göğüs travması geçiren hastaların takip ve monitorizasyonu önemlidir.İzole künt göğüs travmasına bağlı kardiyak kontüzyon takiben akut koroner sendrom gelişebileceği unutulmamalıdır. Künt göğüs travması sonucu akut koroner sndrom gelişen iki hasta tanımlamaya çalıştık.Hastarın EKG lerinde inferior derivasyonlarda ST elevasyonu tespit ettik,hastalar medikal tedavi ve koroner anjiografi yapıldı. koroner anjiografi sonucu koroner arterlerde herhangi bir patoloji saptanmadı.Onların durumu, travma ve stres nedeniyle kardiyak kontüzyona bağlandı.Kardiyak kontüzyon izole künt göğüs travmalarında oluşabilir, bununla birlikte hertürlü travma ve stres sonucu akut koroner sendromu gelişebileceği unutulmamalıdır.Öğe İskemik kalp hastalıklarında infeksiyonun rolü(2000) Gül, Mehmet; Kalaycı, Mustafa UygarYapılan çalışmada iskemik kalp hastalıkları etyopatogenezinde infeksiyon ajanları ve inflamasyonun rolü prospektif olarak araştırıldı. Bu amaçla Chlamydia Pneumoniae, Helicobacter Pylori ve Cytomegalovirüs seropozitifliği ile akut faz reaktanlarının kardiyovasküler risk faktörleriyle ilişkisi incelenmiştir. Çalışmaya göğüs ağrısı şikayetiyle ilk ve acil yardım kliniğine başvurup anamnez, fizik muayene ve laboratuvar tetkikleri sonrası anstabil angina pektoris (32 hasta), stabil angina pektoris (26 hasta), akut miyokart infarktüsü (38 hasta) tanısı konulan çalışma grubu ve kardiyak şikayeti olmayan sağlıklı kontrol grubu (30 birey) dahil edildi. Kronik böbrek yetmezliği, kronik karaciğer yetmezliği, sistemik hastalığı, noniskemik kalp hastalığı olanlar, son altı ay içerisinde herhangi bir infeksiyon hastalığı geçirmiş olanlar ve göğüs ağrısı 8 saati geçmiş olgular çalışmaya alınmadı. İlk ve acil yardım kliniğine kabul edilen hasta grubundan başlangıçta ve oniki saat sonra olmak üzere iki kez, kontrol grubundan ise bir kez venöz kan örneği alındı. Rutin tetkiklere ilaveten CRP, fibrinojen, C3, C4, Lipoprotein (a) gibi akut faz reaktanları, serum lipidleri ve adı geçen infeksiyon ajanlarının antikor düzeyleri araştırıldı. Çalışma sonucunda klasik koroner risk faktörlerinden hipertansiyon, aile öyküsü ve hiperlipidemi yönünden gruplar arasında farklılık saptanırken sigara ve diyabetes mellitusun gruplardaki oranı birbirine yakın bulundu. Akut faz reaktanlarının akut koroner sendromlardaki erken dönem seyrinde özellikle beyaz küre, lipoprotein (a) ve C3'ün serum değerleri yönünden istatistiksel olarak anlamlı sonuçlar elde edildi. Akut faz reaktanlarının akut koroner sendromlu olgulardaki ilk 12 saatlik serum değerleri incelendiğinde; Akut miyokart infarktüslü hastalardaki fibrinojen (p<0.01), lipoprotein (a) (p<0.04), C3 (p<0.002), C4 (p<0.02) ve CRP'deki (p<0.05) değişim istatistiksel olarak anlamlı bulundu. İskemik kalp hastalığı etyopatogenezinde suçlanan infeksiyon ajanlarından Cytomegalovirüs ile akut koroner sendromlar arasında ilişki bulunamadı (p>0.05). Anstabil angina pektorisli olgularla Chlamydia pneumoniae IgA (p<0.03); Stabil angina pektoris, anstabil angina pektoris ve akut miyokart infarktüslü olgularla Chlamydia pneumoniae IgG (p<0.000) ve akut miyokart infarktüslü olgularla Helicobacter pylori IgG (p<0.01) arasında anlamlı bir ilişki bulunmuştur. Çalışmada anstabil angina pektorisli olgularda Helicobacter pylori IgG ile sigara (p=0.009), diyabetes mellitus (p=0.029) ve Chlamydia pneumoniae IgA ile sigara (=0.017) arasında istatistiksel olarak anlamlı ilişki bulunmuştur. Akut miyokart infarktüslü olgularda ise sigara ile Helicobacter pylori IgG (p=0.038) ve Chlamydia pneumoniae IgA (p=0.013) arasında istatistiksel olarak anlamlı bir ilişki tesbit edilmiştir.Öğe Prognostic Value of Red Cell Distribution Width in Critically Ill Patients and Comparison with Intensive Care Unit Scoring Systems(2017) Gül, Mehmet; Dündar, Zerrin Defne; Girişgin, Abdullah Sadık; Vişneci, Emin Fatih; Cander, Başar; Dur, AliAim: 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 The role of neopterine in the diagnosis of patients with acute pancreatitis on admission to the emergency department(2016) Gül, Mehmet; Uçar Karabulut, Keziban; Uçar, Yıldız; Erdem, SamiPurpose: There are difficulties observed in the diagnosis of acute pancreatitis in emergency departments due to its different clinical properties and the insufficiencies in the methods of diagnosis. Since there is no specific biochemical indicator, the diagnosis is made usually late or with difficulty. Neopterine is an enzyme secreted from the macrophages and is an indicator of cellular immunity activation. The aim of this study was to determine the role of neopterine in the early diagnosis of acute pancreatitis. Material and Methods: 39 patients, who had been hospitalized with the complaints of abdominal pain and diagnosed as acute pancreatitis via laboratory and screening methods, and 30 healthy controls were included in the study. Amylase, lipase, cholesterol and neopterine were measured in the patients' samples. The diagnoses were confirmed with abdominal ultrasound and computed tomography. Results: The neopterine values in patients with acute pancreatitis were significantly higher than those of the control group. Conclusion: Neopterine is an indicator which is elevated in certain inflammatory and autoimmune situations. We believe that it is important in the early diagnosis of acute pancreatitis. Further experimental and clinical studies should be conducted on the subject.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 Two Case with Tourniquet Syndrome(2013) Ergin, Mehmet; Özer, Muhammed Raşit; Koçak, Sedat; Girişgin, Abdullah Sadık; Gül, Mehmet; Cander, BaşarThe Hair-Thread Tourniquet syndrome is a rare and dangerous, but preventable condition. Involvements of the genitalia, such as of the penis and clitoris, have been reported as well as that of the fingers and toes. We report two patients: a 4-year-old girl with swelling of her 4th finger of the right foot and a 2-month-old infant with swelling of the 3rd and 4th fingers of the right foot. The time interval between the initiation and removal of the hair-thread is critical. Clinical presentation may vary from simple oedema to ulceration, necrosis, and amputation of the organ. Emergency physicians should consider tourniquet syndrome for children with unexplained restlessness. (JAEM 2013; 12: 220-1).Öğe Warfarin Therapy Induced a Rare Complication: Spontaneous Intramural Hematoma of the Jejunum: Case Report(2017) Arslan, Hanifi; Gül, Mehmet; Başar, Cander; Güner, Hakan; Medni, Mohamed RefikWarfarin is an oral anticoagulant drug that prevents clotting, used in treating many diseases as well as prophylaxis. Despite its widespread use and efficacy, it may lead to a wide range ofadverse effects, mainly bleeding, due to its quite narrow therapeutic index and interaction withother medications. Most commonly, it may result in epistaxis, hematuria and subcutaneous hemorrhage. In addition, it is likely to cause bleeding in the gastrointestinal tract, soft tissues, and cerebral region. It is rare to develop intramural hematoma in the jejunum resulted from warfarintoxicity. Here, we present a case admitted to the emergency department with abdominal pain, anddiagnosed with intramural hematoma after physical examination, laboratory findings and imaging.Emergency physicians should consider intestinal hematoma as differential diagnosis in patientsusing warfarin and presenting with abdominal pain.
