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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 Liporotein-Associated Phospholipase-A2 Can Be A Diagnostic Marker İnthe Early Stage Diagnosis Of Acute Mesenteric İschemia(2016) Acar, Tarık; Koçak, Sedat; Cander, Başar; Ergin, Mehmet; Dikmetaş, CesareddinBackground/aim: The purpose of this experimental study was to investigate the role of lipoprotein-associated phospholipase-A2 (LpPLA2 ) in the diagnosis of acute mesenteric ischemia (AMI) in the early stage. Materials and methods: Twenty-seven New Zealand rabbits were randomly divided into 3 groups in this study. Blood specimens were obtained from the groups at hours 0, 1, 3, and 6. Using the blood samples drawn from all groups, Lp-PLA2 and C-reactive protein (CRP) parameters were investigated. Results: There was a significant rise in the levels of both Lp-PLA2 and CRP starting at hour 1 (P > 0.05) (hour 1; Lp-PLA2 , P 0.003) in the ischemia group. In the sham group, the levels of Lp-PLA2 and CRP started to rise at hour 3 (P > 0.05) (hour 3; Lp-PLA2 , P 0.011). At hour 6 of ischemia, the area under the ROC curve was 100%, and the cut-off value of 63.91 ng/mL revealed a sensitivity of 88% and a specificity of 100% for Lp-PLA2 . Conclusion: These findings showed the role of serum Lp-PLA2 and CRP levels in the early diagnosis of AMI. Thus, further studies are needed to describe the role of Lp-PLA2 in the early diagnosis of AMI.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).
