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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 Association between ischemia-modified albumin, homocysteine, vitamin B12 and folic acid in patients with severe sepsis(Walter De Gruyter Gmbh, 2012) Erdem, Said Sami; Yerlikaya, Fatma Humeyra; Cicekler, Humeyra; Gul, MehmetBackground: The aim of the present study was to investigate scrum ischemia-modified albumin (IMA), homocysteine, malondialdehyde (MDA), vitamin B-12 and folic acid levels in patients with severe sepsis, compared to healthy control subjects. Also, we examined associations of these parameters with high-sensitivity C-reactive protein (hsCRP) in patients with severe sepsis and healthy control subjects. Methods: This study was performed on 71 (40 male, 31 female) patients with severe sepsis aged 18-65 years and 70 (34 male, 36 female) healthy control subjects aged 18-65 years. Samples of patients were obtained at study entry within 24 h of onset of severe sepsis. Results: Serum IMA, homocysteine and MDA levels of the patients with severe sepsis were significantly higher than those of the healthy control subjects (p<0.0 I for IMA and homocysteine, and p<0.001 for MDA). There was no significant difference between serum vitamin B12 and folic acid levels of the groups. Serum hsCRP levels were positively correlated with IMA (p<0.01) and MDA (p<0.01) in the patients with severe sepsis. Conclusions: Our findings show that IMA may be useful as a prognostic biomarker because it can indicate the severity of illness in patients with sepsis.Öğe Association between ischemia-modified albumin, homocysteine, vitamin B12 and folic acid in patients with severe sepsis(Walter De Gruyter Gmbh, 2012) Erdem, Said Sami; Yerlikaya, Fatma Humeyra; Cicekler, Humeyra; Gul, MehmetBackground: The aim of the present study was to investigate scrum ischemia-modified albumin (IMA), homocysteine, malondialdehyde (MDA), vitamin B-12 and folic acid levels in patients with severe sepsis, compared to healthy control subjects. Also, we examined associations of these parameters with high-sensitivity C-reactive protein (hsCRP) in patients with severe sepsis and healthy control subjects. Methods: This study was performed on 71 (40 male, 31 female) patients with severe sepsis aged 18-65 years and 70 (34 male, 36 female) healthy control subjects aged 18-65 years. Samples of patients were obtained at study entry within 24 h of onset of severe sepsis. Results: Serum IMA, homocysteine and MDA levels of the patients with severe sepsis were significantly higher than those of the healthy control subjects (p<0.0 I for IMA and homocysteine, and p<0.001 for MDA). There was no significant difference between serum vitamin B12 and folic acid levels of the groups. Serum hsCRP levels were positively correlated with IMA (p<0.01) and MDA (p<0.01) in the patients with severe sepsis. Conclusions: Our findings show that IMA may be useful as a prognostic biomarker because it can indicate the severity of illness in patients with sepsis.Öğe Diagnostic Value of Adropin Levels in Acute Pulmonary Embolism Patients(Galenos Publ House, 2020) Ayranci, Mustafa Kursat; Gul, Mehmet; Sonmez, Leyla Ozturk; Aydemir, Fatma Humeyra Yerlikaya; Medni, Mohamed RefikAim: This study aimed to evaluate the relationship between serum adropin levels in patients with acute pulmonary embolism (PE). Materials and Methods: Patients pre-diagnosed with PE based on computed tomographic pulmonary angiography findings and not fulfilling any of the exclusion criteria were included in the PE group. An identical number of participants with comorbidities similar to those of the PE group were included in the control group. These patientswere selected from those who had been referred to the emergency department and were not considered to have PE based on clinical symptoms and risk scores. Results: Serum adropin levels were found to be high in the PE group. Although the adropin values were high in the case of all comorbidities, the values significantly elevated only in patients with hypertension, acute ischaemic stroke, and previous history of PE. The adropin values were quite different among the Wells score categories, and the mean adropin levels varied significantly between the PE and control groups. Conclusion: In this study, the plasma adropin levels were significantly high in patients with acute PE and exhibited high positive predictivity, sensitivity, and specificity in detecting PE.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 Does Neutrophil Lymphocyte Ratio Have a Clinical Value to Determine the Severity of the Patients with Acute Appendicitis?(Emergency Medicine Physicians Assoc Turkey, 2020) Ozaydin, Vehbi; Dogruyol, Sinem; Bagdigen, Seda Nur; Katipoglu, Burak; Gul, MehmetAim: The aim of our study is to investigate the predictive value of the neutrophil lymphocyte ratio (NLR) assessed in the emergency department to distinguish complicated and uncomplicated patients with acute appendicitis (AA). Materials and Methods: In our study, the files of the patients with AA who visited our emergency clinic between 01.06.2015 and 01.01.2016 and then were operated in our hospital were reviewed retrospectively. The age, gender, the imaging method performed in the emergency clinic with an AA preliminary diagnosis, the result of the radiologic report in terms of AA and histopathological examination results were recorded according to the patients' records. The patients were divided into two groups: Complicated AA ( group 1) and uncomplicated AA (group 2) based on their histopathological analysis results. The laboratory parameters of the patients, which were seen within the first 30 minutes after they visited the emergency clinic, were examined. Results: One hundred and twenty one of the 154 patients who were involved in the study were in group 1 and 33 of the patients were in group 2. A statistically significant difference was found between two groups in terms of the number of white blood cells and NLR (p=0.000). The cut-off value for NLR in the complicated AA distinction was detected as 7.3 (75.8% sensitivity, 81.8% specifity). Conclusion: As an easy and effective analysis method, we think that NLR might be a good guide to diagnose complicated patients with AA quickly.Öğe Occupational burnout, job satisfaction and anxiety among emergency medicine doctors in Turkey(Professional Medical Publications, 2021) Sonmez, Leyla Ozturk; Gul, MehmetObjective: The objective of the study was to investigate possible differences in the levels of anxiety, burnout and job satisfaction among emergency medicine doctors based on their age, gender, employment duration, job title and institution. Methods: General practitioners, residents, specialists and faculty members working in emergency departments (ED) in Turkey were invited to participate in this questionnaire-based study through an e-mail link between September 2018 and January 2019. A total of 141 doctors from different cities of Turkey who completely filled the questionnaire with their own will were recruited for the study. The Maslach Burnout Inventory(MBI) was used to measure occupational burnout levels, the State-Trait Anxiety Inventory(STAI) to measure anxiety levels and the Short Form Minnesota Satisfaction Questionnaire (SFMSQ) to measure job satisfaction levels of doctors working in EDs. In assessing MBI; Emotional Exhaustion score(EE) is considered low for 0-11 points, moderate for 12-17 points and high 3 and very/ extremely satisfied (high) if job satisfaction point 3. Results: The mean age of the study group was 33.3 (?7.3) and mean employment duration was 8.37 (?6.89). In the overall study population, the emotional exhaustion(EE) was high while depersonalization(DP) and reduction of personal accomplishment(PA) were detected at medium level in the evaluation of MBI subscales. In evaluating overall study population for STAI, state and trait anxiety scores both showed the presence of mild to moderate anxiety. The overall study population evaluation results for SFMSQ were, high levels of general and intrinsic job satisfaction and low levels of extrinsic job satisfaction was measured. Younger the age and shorter the duration of employment is found to be associated with a significant increase in EE and DP and a significant decrease in PA. Conclusion: In this study, scale results showed that doctors working in EDs had high levels of occupational burnout and anxiety, while job satisfaction levels were low. In addition, a significant relationship was found between the decrease in ?age and employment duration? and the increase in ?depersonalization?.Öğe Occupational burnout, job satisfaction and anxiety among emergency medicine doctors in Turkey(Professional Medical Publications, 2021) Sonmez, Leyla Ozturk; Gul, MehmetObjective: The objective of the study was to investigate possible differences in the levels of anxiety, burnout and job satisfaction among emergency medicine doctors based on their age, gender, employment duration, job title and institution. Methods: General practitioners, residents, specialists and faculty members working in emergency departments (ED) in Turkey were invited to participate in this questionnaire-based study through an e-mail link between September 2018 and January 2019. A total of 141 doctors from different cities of Turkey who completely filled the questionnaire with their own will were recruited for the study. The Maslach Burnout Inventory(MBI) was used to measure occupational burnout levels, the State-Trait Anxiety Inventory(STAI) to measure anxiety levels and the Short Form Minnesota Satisfaction Questionnaire (SFMSQ) to measure job satisfaction levels of doctors working in EDs. In assessing MBI; Emotional Exhaustion score(EE) is considered low for 0-11 points, moderate for 12-17 points and high 3 and very/ extremely satisfied (high) if job satisfaction point 3. Results: The mean age of the study group was 33.3 (?7.3) and mean employment duration was 8.37 (?6.89). In the overall study population, the emotional exhaustion(EE) was high while depersonalization(DP) and reduction of personal accomplishment(PA) were detected at medium level in the evaluation of MBI subscales. In evaluating overall study population for STAI, state and trait anxiety scores both showed the presence of mild to moderate anxiety. The overall study population evaluation results for SFMSQ were, high levels of general and intrinsic job satisfaction and low levels of extrinsic job satisfaction was measured. Younger the age and shorter the duration of employment is found to be associated with a significant increase in EE and DP and a significant decrease in PA. Conclusion: In this study, scale results showed that doctors working in EDs had high levels of occupational burnout and anxiety, while job satisfaction levels were low. In addition, a significant relationship was found between the decrease in ?age and employment duration? and the increase in ?depersonalization?.Öğe The Relationship Between Acute Ischemic Stroke and Acute Phase Reactants(Emergency Medicine Physicians Assoc Turkey, 2011) Gul, Mehmet; Cander, Basar; Girisgin, Sadik; Tokgoz, Serhat; Kocak, Sedat; Bircan, Metin; Kaya, HalilObjective: The role played by inflammation in the etiopathogenesis of stroke has been intensively investigated in recent years. In this clinical study, the relationship between acute phase reactants (APR) and acute ischemic stroke (AIS) was investigated. Material and Methods: 126 patients with AIS and 104 volunteer individuals as controls were included in the study. White blood count (WBC), C-reactive protein (CRP), fibrinogen, lipoprotein (a) (Lp a) and complementary fragments (C-3 and C-4) levels were investigated both in patients with AIS and the controls. Results: In patients with AIS, WBC and fibrinogen values were significantly higher than the controls (p < 0.001, p < 0.001, p < 0.001, respectively). There was no significant difference between Lp(a), C-3 and C-4 values in patients with AIS and controls (p=0.727, p=0.163, p=0.497, respectively). Conclusion: The most important goal in the prevention of primary stroke is that the risk factors leading to stroke are defined and changed.Öğe Unraveling the Consequences of the COVID-19 Pandemic on Out-of-hospital Cardiac Arrest: A Systematic Review and Meta-analysis(Galenos Publ House, 2023) Dabkowski, Miroslaw; Swieczkowski, Damian; Pruc, Michal; Cander, Basar; Gul, Mehmet; Bragazzi, Nicola; Szarpak, LukaszAim: The aim of this systematic review and meta-analysis was to assess the influence of the Coronavirus disease-2019 (COVID-19) pandemic on the incidence, characteristics, and clinical consequences of out-of-hospital cardiac arrest (OHCA).Materials and Methods: We searched PubMed, Embase, Scopus, Web of Science, and Cochrane Library databases up to May 30, 2023 for studies containing comparative data of OHCA patients in COVID-19 and pre-pandemic periods.Results: A total of 35 articles concerning to 34 studies screening based on the inclusion criteria. COVID-19 was associated with higher incidence of OHCA at home compared with the pre-pandemic period (p<0.001), longer emergency medical services arrival time (p<0.001), longer on-scene time (p<0.001), as well as reduction of shockable rhythms (p=0.02). COVID-19 compared with the pre-pandemic period was associated with lower survival to hospital admission (11.2% vs. 19.3%; p<0.001). Survival to hospital discharge (SHD) was 4.8% vs. 12.9%, respectively (p<0.001), while SHD with a good neurological outcome also varied and amounted to 3.6% vs. 5.8%, respectively (p<0.001).Conclusion: COVID-19, compared with the pre-pandemic period, was characterized by a reduced rate of defibrillation rhythms during OHCA, as well as a worse prognosis in terms of both survival to hospital admission, SHD, and SHD good neurological outcome.
