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Öğe Alpha-Amanitin Poisoning, Nephrotoxicity and Oxidative Stress: An Experimental Mouse Model(Kowsar Publ, 2015) Ergin, Mehmet; Dundar, Zerrin Defne; Kilinc, Ibrahim; Colak, Tamer; Oltulu, Pembe; Girisgin, Abdullah SadikBackground: Alpha-amanitin (alpha-AMA) plays a major role in Amanita phalloides poisoning, showing toxic effects on multi-organs, particularly on the liver and kidneys. Studies have shown a relationship between alpha-AMA-related injuries and reactive oxygen species. Objectives: We aimed to investigate whether there is renal injury and its relationship with oxidative stress after intraperitoneal injection of alpha-AMA in mice experimental poisoning models. Materials and Methods: There were 37 male BALB/c laboratory mice treated with alpha-AMA, according to the study groups: control group (n = 7); low dose (0.2 mg/kg) (n = 10); moderate dose (0.6 mg/kg) (n = 10), and high dose (1 mg/kg) (n = 10). The sample size was detected according to the ethical committee's decision as well as similar studies in the literature. After a 48-hour follow-up period, all the subjects were sacrificed for pathological and biochemical assays. The study was held in Turkey. Results: alpha-AMA poisoning in mice results in inflammatory changes and necrosis in renal structures. There were statistically significant differences between the study groups regarding measured levels of catalase, superoxide dismutase, glutathione peroxidase, total antioxidant status (TAS), total oxidant status (TOS) and malonyl dialdehyde in renal homogenates of mice (P < 0.001, P < 0.001, P < 0.001, P < 0.001, P < 0.001, and P = 0.001, respectively). The TOS and TAS measurements helped to eliminate cumbersome analysis of diverse oxidant and antioxidant molecules. The TOS levels in renal homogenate of mice were significantly higher in all the intoxication groups compared to the control group (5.73, 7.02, 7.77, and 9.65 mmol trolox eq/g protein and P = 0.002, P = 0.001, and P = 0.001, respectively). The TAS levels in moderate and high-dose groups were significantly lower than all the other groups treated with alpha-AMA (0.130, 0.152, 0.065, and 0.087 mmol trolox eq/g protein and P = 0.031, P = 0.001, and P = 0.001, respectively). Conclusions: Our results indicated that alpha-AMA poisoning in mice led to inflammatory changes and necrosis in renal structures. Biochemical analysis showed a shift in the oxidative/anti-oxidative balance towards the oxidative status.Öğe Bag-Valve-Mask versus Laryngeal Mask Airway Ventilation in Cardiopulmonary Resuscitation with Continuous Compressions: A Simulation Study(Cambridge Univ Press, 2021) Dundar, Zerrin Defne; Ayranci, Mustafa Kursat; Kocak, Sedat; Girisgin, Abdullah SadikIntroduction: The 2017 International Liaison Committee on Resuscitation (ILCOR) guideline recommends that Emergency Medical Service (EMS) providers can perform cardiopulmonary resuscitation (CPR) with synchronous or asynchronous ventilation until an advanced airway has been placed. In the current literature, limited data on CPR performed with continuous compressions and asynchronous ventilation with bag-valve-mask (BVM) are available. Study Objective: In this study, researchers aimed to compare the effectiveness of asynchronous BVM and laryngeal mask airway (LMA) ventilation during CPR with continuous chest compressions. Methods: Emergency medicine residents and interns were included in the study. The participants were randomly assigned to resuscitation teams with two rescuers. The cross-over simulation study was conducted on two CPR scenarios: asynchronous ventilation via BVM during a continuous chest compression and asynchronous ventilation via LMA during a continuous chest compression in cardiac arrest patient with asystole. The primary endpoints were the ventilation-related measurements. Results: A total of 92 volunteers were included in the study and 46 CPRs were performed in each group. The mean rate of ventilations of the LMA group was significantly higher than that of the BVM group (13.7 [11.7-15.7] versus 8.9 [7.5-10.3] breaths/minute; P <.001). The mean volume of ventilations of the LMA group was significantly higher than that of the BVM group (358.4 [342.3-374.4] ml versus 321.5 [303.9-339.0] ml; P = .002). The mean minute ventilation volume of the LMA group was significantly higher than that of the BVM group (4.88 [4.15-5.61] versus 2.99 [2.41-3.57] L/minute; P <.001). Ventilations exceeding the maximum volume limit occurred in two (4.3%) CPRs in the BVM group and in 11 (23.9%) CPRs in the LMA group (P = .008). Conclusion: The results of this study show that asynchronous BVM ventilation with continuous chest compressions is a reliable and effective strategy during CPR under simulation conditions. The clinical impact of these findings in actual cardiac arrest patients should be evaluated with further studies at real-life scenes.Öğe Comparison of Emergency Department Patient Visits One Year Before and After the Star of the COVID-19 Pandemic(Erciyes Univ Sch Medicine, 2022) Kucukceran, Kadir; Ayranci, Mustafa Kursat; Girisgin, Abdullah Sadik; Kocak, Sedat; Dundar, Zerrin DefneObjective: Planning for emergency department (ED) services based on epidemiological data is essential. This study retrospectively examined ED patient presentations at a tertiary hospital 1 year before and 1 year after the start of the coronavirus 2019 (COVID-2019) pandemic to assist with planning efforts. Materials and Methods: The study period was March 1, 2019 to February 28, 2021. The patient cases were separated into 2 groups using a reference date of March 2020. The period between March 1, 2019 and February 29, 2020 was defined as the pre-COVID period, or ordinary circumstances, and the period between March 1, 2020 and February 28, 2021 was defined as the period following the COVID-19 outbreak, which reflected extraordinary conditions. The primary outcome was the difference in the number of patients and the mortality rate between groups. Results: A total of 74,063 (62%) people presented at the ED in the pre-COVID period, and there were 45,397 (38%) ED visits in the post-COVID period. The median daily number of patients seen in the pre-COVID period was significantly higher than that of the post-COVID period (200.5 [181-219.25] vs. 123 [103.5-139], respectively [p<0.001]). The in-hospital mortality rate and the hospitalization rate in the post-COVID period were significantly higher than in the pre-COVID period (in-hospital mortality rate: 1105 [2.4%], 852 [1.2%], [p<0.001]; hospitalization rate: 9404 [20.7%], 9019 [12.2%], [p<0.001]). Conclusion: Although the number of patients presenting at the ED decreased in the period after the outbreak of COVID-19, the number of those who died increased. While the number of hospitalized patients was similar between the 2 groups, the hospitalization rate was greater in the post-COVID period. This information and additional detailed study may prove useful to ED planning efforts.Öğe Comparison of Emergency Department Patient Visits One Year Before and After the Star of the COVID-19 Pandemic(Erciyes Univ Sch Medicine, 2022) Kucukceran, Kadir; Ayranci, Mustafa Kursat; Girisgin, Abdullah Sadik; Kocak, Sedat; Dundar, Zerrin DefneObjective: Planning for emergency department (ED) services based on epidemiological data is essential. This study retrospectively examined ED patient presentations at a tertiary hospital 1 year before and 1 year after the start of the coronavirus 2019 (COVID-2019) pandemic to assist with planning efforts. Materials and Methods: The study period was March 1, 2019 to February 28, 2021. The patient cases were separated into 2 groups using a reference date of March 2020. The period between March 1, 2019 and February 29, 2020 was defined as the pre-COVID period, or ordinary circumstances, and the period between March 1, 2020 and February 28, 2021 was defined as the period following the COVID-19 outbreak, which reflected extraordinary conditions. The primary outcome was the difference in the number of patients and the mortality rate between groups. Results: A total of 74,063 (62%) people presented at the ED in the pre-COVID period, and there were 45,397 (38%) ED visits in the post-COVID period. The median daily number of patients seen in the pre-COVID period was significantly higher than that of the post-COVID period (200.5 [181-219.25] vs. 123 [103.5-139], respectively [p<0.001]). The in-hospital mortality rate and the hospitalization rate in the post-COVID period were significantly higher than in the pre-COVID period (in-hospital mortality rate: 1105 [2.4%], 852 [1.2%], [p<0.001]; hospitalization rate: 9404 [20.7%], 9019 [12.2%], [p<0.001]). Conclusion: Although the number of patients presenting at the ED decreased in the period after the outbreak of COVID-19, the number of those who died increased. While the number of hospitalized patients was similar between the 2 groups, the hospitalization rate was greater in the post-COVID period. This information and additional detailed study may prove useful to ED planning efforts.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 and Prognostic Significance of Neutrophil Gelatinase-Associated Lipocalin and Pentraxin-3 in Acute Coronary Syndrome(Galenos Publ House, 2017) Ozer, Muhammet Rasit; Ergin, Mehmet; Kilinc, Ibrahim; Dundar, Zerrin Defne; Ozer, Nejla; Onal, Mehmet Akif; Girisgin, Abdullah SadikAim: 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 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 An Experimental Study: Does the Neuroprotective Effect Increase When Hypothermia Deepens After Traumatic Brain Injury?(Kowsar Publ, 2015) Girisgin, Abdullah Sadik; Kalkan, Erdal; Ergin, Mehmet; Keskin, Fatih; Dundar, Zerrin Defne; Kebapcioglu, Sedat; Kocak, SedatBackground: Experimental approaches have been promising with the use of therapeutic hypothermia after Traumatic Brain Injury (TBI) whereas clinical data have not supported its efficacy. Objectives: This study aimed to investigate whether using selective deeper brain cooling correlates with a more neuroprotective effect on Intracranial Pressure (ICP) increments following TBI in rats. Materials and Methods: Adult male Sprague-Dawley rats (mean weight = 300 g; n = 25) were subjected to brain injury using a modified Marmarou method. Immediately after the onset of TBI, rats were randomized into three groups. Selective brain cooling was applied around the head using ice packages. Intracranial Temperature (ICT) and ICP were continuously measured at 0, 30, 60, 120, and 180 minutes and recorded for all groups. Group 1 (n = 5) was normothermia and was assigned as the control group. Group 2 (n = 10) received moderate hypothermia with a target ICT of between 32 degrees C-33 degrees C and Group 3 (n = 10) was given a deeper hypothermia with a target ICT of below 32 degrees C. Results: All subjects reached the target ICT by the 30th minute of hypothermia induction. The ICT was significantly different in Group 2 compared to Group 1 only at the 120th minute (P = 0.017), while ICP was significantly lower starting from the 30th minute (P = 0.015). The ICT was significantly lower in Group 3 compared to Groups 1 and 2 starting from the 30th minute (P = 0.001 and P = 0.003, respectively). The ICP was significantly lower in Group 3 compared to Group 1 starting from 30th minute (P = 0.001); however, a significant difference in ICP between Group 3 and Group 2 was observed only at the 180th minute (P = 0.047). Conclusions: Results of this study indicate that selective brain cooling is an effective method of decreasing ICP in rats; however, the deeper hypothermia caused a greater decrease in ICP three hours after hypothermia induction.Öğe Is it possible to objectify the visual pain scale?(Professional Medical Publications, 2015) Ergin, Mehmet; Girisgin, Abdullah Sadik; Dundar, Zerrin Defne; Calik, Goknil Saniye; Ertas, Izzetin; Egici, Mehmet TaskinObjectives: To test our hypothesis that a new modified VAS (mVAS) is superior and more objective than VAS in evaluating pain perception and treatment response between genders who have renal colic pain. Methods: The individuals in patient and control groups were first asked to mark the pain perceived during access of IV line (VAS IV score). Then the patients with renal colic were asked to mark the pain they experienced before treatment (VAS RC score) and at 15 and 30 minutes after the administration of the first analgesic drug. The modified VAS scores (mVAS score) were obtained by subtracting the VAS IV score from VAS RC score. Results: When VAS was used, the female patients had significantly higher level of pain at 0, 15, and 30th minutes than men (p = 0.012, p = 0.001, and p = 0.003, respectively). However, there was not any significant difference at 0 and 30th min between sexes while female patients had significantly higher level of pain scores only at 15th minute according to mVAS scores (p = 0.027). Conclusion: We think that the mVAS is superior and more objective than VAS in evaluating pain perception and abolished the difference in the perceived level of pain due to gender.Öğe Lactate and NEWS-L are fair predictors of mortality in critically ill geriatric emergency department patients(W B Saunders Co-Elsevier Inc, 2020) Dundar, Zerrin Defne; Kocak, Sedat; Girisgin, Abdullah SadikIntroduction: In this study, we aimed to investigate the prognostic power of the first lactate level measured in the emergency department (ED), National Early Warning Score (NEWS), and NEWS-lactate (NEWS-L) on ED admission in critically ill geriatric patients. Methods: This retrospective observational study was conducted in the ED of a university hospital. Consecutive patients >= 65 years of age admitted to our ED between July 1, 2017, and December 31, 2017, and transferred to the intensive care unit after the ED follow-up period were included in the study. The predictive performances of lactate, NEWS, and NEWS-L in terms of in-hospital mortality were compared. Results: A total of 455 patients were included in the statistical analyses. The in-hospital mortality rate was 22.9%. The mean lactate, NEWS, and NEWS-L of non-survivors was significantly higher than those of survivors (2.9 +/- 2.2 vs. 1.9 +/- 1.5 mmol/L, 8.9 +/- 4.1 vs. 6.1 +/- 3.7, and 11.8 +/- 5.0 vs. 8.1 +/- 4.4, respectively, for all p < 0.001). The AUCs of the lactate, NEWS, and NEWS-L were respectively 0.654 (95% CI 0.594-0.713), 0.686 (95% CI 0.628-0.744), and 0.714 (95% CI 0.658-0.770) in predicting in-hospital mortality. Conclusions: According to the results of this study, we conclude that ED admission lactate level and NEWS are low-accuracy predictors of in-hospital mortality in critically ill geriatric patients. Although the combination of lactate level with physiological parameters increases the predictive performances of both parameters, NEWS-L is still not a powerful predictor to make definitive clinical decisions for critically ill geriatric ED patients. (C) 2019 Elsevier Inc. All rights reserved.Öğe Limitations in thrombolytic therapy in acute ischemic stroke(Professional Medical Publications, 2012) Kocak, Sedat; Dogan, Emine; Kokcam, Melek; Girisgin, Abdullah Sadik; Bodur, SaidObjective: The eligibility for thrombolytic therapy for patients who present to the emergency department with Acute Ischaemic Stroke (AIS) has been researched in this study. Methodology: Patients who had presented to the emergency department of our hospital between March 2008-2009 and diagnosed as AIS clinically and radiologically were included in the study prospectively. Results: One hundred and twelve patients were included in the study. Forty nine (43.8 %) were female and the mean age was 68.7 +/- 12.2 (median 71.5). The mean time from the onset of symptom to hospital admission was 12.2 +/- 12.9 hours (median 6 hours). Two (1.8%) patients did not have any contraindication for thrombolytic therapy. Arrival time at the hospital of three hours and higher was the single contraindication in 40 (35.7%) patients. The most common four contraindications were delayed admission, multilobar infarct or hypodensity of more than 1/3 of the hemisphere, hypertension and mild neurological symptoms respectively. Conclusions: Our data suggest that the primary barrier to the delivery of thrombolytic therapy for AIS is delayed arrival of the patient to a hospital, and up to 1/3 of our patients, the percentage arriving within 4 hours of the onset of stroke symptoms, might be eligible for attempted re-perfusion.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 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 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 Predictive value of D-dimer/albumin ratio and fibrinogen/albumin ratio for in-hospital mortality in patients with COVID-19(Wiley-Hindawi, 2021) Kucukceran, Kadir; Ayranci, Mustafa Kursat; Girisgin, Abdullah Sadik; Kocak, SedatIntroduction Due to the high mortality of coronavirus disease 2019 (COVID-19), there are difficulties in the managing emergency department. We investigated whether the D-dimer/albumin ratio (DAR) and fibrinogen/albumin ratio (FAR) predict mortality in the COVID-19 patients. Methods A total of 717 COVID-19 patients who were brought to the emergency department from March to October 2020 were included in the study. Levels of D-dimer, fibrinogen and albumin, as well as DAR, FAR, age, gender and in-hospital mortality status of the patients, were recorded. The patients were grouped by in-hospital mortality. Statistical comparison was conducted between the groups. Results Of the patients included in the study, 371 (51.7%) were male, and their median age was 64 years (50-74). There was in-hospital mortality in 126 (17.6%) patients. The area under the curve (AUC) and odds ratio values obtained by DAR to predict in-hospital mortality were higher than the values obtained by the all other parameters (AUC of DAR, albumin, D-dimer, FAR and fibrinogen: 0.773, 0.766, 0.757, 0.703 and 0.637, respectively; odds ratio of DAR > 56.36, albumin < 4.015, D-dimer > 292.5, FAR > 112.33 and fibrinogen > 423:7.898, 6.216, 6.058, 4.437 and 2.794, respectively). In addition; patients with concurrent DAR > 56.36 and FAR > 112.33 had an odds ratio of 21.879 with respect to patients with concurrent DAR < 56.36 and FAR < 112.33. Conclusion DAR may be used as a new marker to predict mortality in COVID-19 patients. In addition, the concurrent high DARs and FARs were found to be more valuable in predicting in-hospital mortality than either separately.Öğe The role of the BUN/albumin ratio in predicting mortality in COVID-19 patients in the emergency department(W B Saunders Co-Elsevier Inc, 2021) Kucukceran, Kadir; Ayranci, Mustafa Kursat; Girisgin, Abdullah Sadik; Kocak, Sedat; Dundar, Zerrin DefneIntroduction: Due to the high mortality and spread rates of coronavirus disease 2019 (COVID-19), there are currently serious challenges in emergency department management. As such, we investigated whether the blood urea nitrogen (BUN)/albumin ratio (BAR) predicts mortality in the COVID-19 patients in the emergency department. Methods: A total of 602 COVID-19 patients who were brought to the emergency department within the period from March to September 2020 were included in the study. The BUN level, albumin level, BAR, age, gender, and in-hospital mortality status of the patients were recorded. The patients were grouped by in-hospital mortality. Statistical comparison was conducted between the groups. Results: Of the patients who were included in the study, 312(51.8%) were male, and their median age was 63 years (49-73). There was in-hospital mortality in 96(15.9%) patients. The median BUN and BAR values of the patients in the non-survivor group were significantly higher than those in the survivor group (BUN: 24.76 [17.38-38.31] and 14.43 [10.84-20.42], respectively [p < 0.001]; BAR: 6.7 [4.7-10.1] and 3.4 [2.5-5.2], respectively [p < 0.001]). The mean albumin value in the non-survivor group was significantly lower than that in the survivor group (3.60 +/- 0.58 and 4.13 +/- 0.51, respectively; p < 0.001). The area-under-the-curve (AUC) and odds ratio values obtained by BAR to predict in-hospital COVID-19 mortality were higher than the values obtained by BUN and albumin (AUC of BAR, BUN, and albumin: 0.809, 0.771, and 0.765, respectively; odds ratio of BAR>3.9, BUN>16.05, and albumin<4.01: 10.448, 7.048, and 6.482, respectively). Conclusion: The BUN, albumin, and BAR levels were found to be reliable predictors of in-hospital mortality in COVID-19 patients, but BAR was found to be a more reliable predictor than the BUN and albumin levels. (c) 2021 Elsevier Inc. All rights reserved.Öğe Which site is least painful during intravenous cannulation?(Derman Medical Publ, 2018) Karabulut, Keziban Ucar; Girisgin, Abdullah SadikAim: The aim was to determine the least painful cannulation site in patients via the Visual Analogue Scale. Material and Method: Of 104 patients (53 women) admitted to the Emergency Department of Meram Medical School of Necmettin Erbakan University, 45 were cannulated through antecubital site, 33 by wrists and 26 via dorsal. No difference was detected between groups as to age and gender. All cases were cannulated by the same nurse using pink cannulas. The patients were asked to mark the severity of pain during procedure on the Visual Analogue Scale where scores range from 0 to 10. Results: When a significant difference was found between the groups via the Kruskal-Wallis test as to the Visual Analogue Scale scores, the Mann-Whitney-U test with Boferroni correction was performed. Therefore, while the pain on antecubital site was found to be significantly lower during cannulation compared to that found on wrist and dorsal, no difference was found between the pain scores detected on wrist and dorsal. Discussion: The antecubital site, a commonly used area for cannulation, was determined to be the least painful area when compared to other sites. It provides easy access to the vein, which may why it is commonly used, and may also be one of the reasons. It is the least painful area during cannulation. In the present study performed in 104 patients, the antecubital area was significantly the least painful cannulation site compared to wrist and dorsal. In patients required to be cannulated, the antecubital site is considered preferable due to painlessness unless specific complications are present.
