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Öğe Acute Deep Venous Thrombosis Associated with Acute Brucellosis: A Case Report(Aves, 2012) Kocak, Sedat; Dikmetas, Cesarettin; Dundar, Zerrin D.; Erdemir, Esma; Kesli, RecepBrucellosis continues to be one of the most widespread zoonoses worldwide. Human brucellosis is a multisystem disease that may present with a broad spectrum of clinical manifestations, but it may also be asymptomatic with only serological evidence of infection. In this paper, a case report is presented of deep venous thrombosis (DVT) developing after a diagnosis of acute brucellosis in a young slaughterhouse worker. A 26-year-old man was diagnosed with DVT which had presented with the complaints of weakness and fever and a one-week history of pain and swelling in the right leg. Ultrasound revealed that the right femoral and popliteal veins were occluded with thrombi. Brucella was diagnosed using Rose-Bengal, tube agglutination, the Brucellacapt test and an enzyme-linked immunoassay using anti-Brucella abortus IgM/G antibody detection at another institution. Although rare, some infectious agents may cause vascular pathologies. These conditions may be life-threatening. Thus, it should be kept in mind that vascular complications may occur during infectious disease and patients should be monitored. Additionally, patients presenting with symptoms of DVT or similar vascular pathologies should be assessed for infectious agents, particularly Brucella and Salmonella, as well as other risk factors.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 Cyanide Intoxication: A Case Report(Emergency Medicine Physicians Assoc Turkey, 2010) Kocak, Sedat; Dundar, Zerrin Defne; Demirci, Serafettin; Cander, Basar; Dogan, HakanIntroduction: Cyanide is a rapid absorbable and powerful poison; even in small doses can cause death in minutes. It is used in many industrial fields; such as mining, chemical industries and agriculture. Recently, its use in gold mining and its enviromental toxicity is on the agenda of our country. Case Report: 60 years old male patient was brought to our clinic after drinking a sip of cyanide in his jewelry shop by 112 emergency team. In physical examination of patient, who was intubated at the scene of accident, general condition was poor, he was unconsciousness, arteriyal blood pressure was 80/50 mmHg and there was no spontaneous respiration. GCS score was 3. Patient's gastric lavage had started at the scene and contuined in our service, then active charcoal was given. The patient was taken to our intensive care unit and mechanically ventilation started with positive inotropic support. Blood cyanide level was >2.0 mg/L. 5 g hydroxycobalamin brought from Ankara could be given 9 hour after poisoning. The patient died at day 4. Discussion: Cyanide inhibits mitochondrial cytochrome oxidase enzyme and disrupts cellular utilization of oxygen lead to cellular hypoxia. Poisoning by oral consumption is a slow process and patient's recovery is sometimes possible. Therefore, the initiation of support and specific treatment as quickly as possible is important. In this case, although effective support treatment was started quickly; the specific antidote treatment could not be begun.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 Effectiveness of Dimethylthiourea Treatment in Experimentally Induced Acute Lung Injury by Smoke Inhalation in Rabbits(Aves, 2010) Kara, Hasan; Kafali, Ertugrul; Ozdinc, Serife; Bayir, Aysegul; Ahmet, A. K.; Cander, Baser; Kocak, SedatObjective: To investigate the effectivenes of Dimethylthiourea (DMTU) treatment on lung tissue in experimental smoke inhalation induced Acute Lung Injury (ALI) in rabbits. Materials and Methods: We used 24 New Zealand type female rabbits. We divided then into three groups as control, sham and DMTU (600 mg/kg). The treatment began immediately after smoke inhalation. The inhalation was performed by the bubble-smoke-intubation method. Arterial blood samples, plasma NO levels and biochemical analysis were performed at the 0th 3rd and 96th hours and tissue samples were collected from the lungat the end of the experiment. Results: Arterial pH and PaO2 levels were significantly high in the DMTU group, compared to the sham group. Blood urea, creatinine, ALT, AST levels were also significantly higher. NO levels did not differ between the groups. In the histopathologic examination; atelectasia, neutrophil penetration, edema, alveoli neutrophil and mucus findings were significantly different between DMTU and the other groups. Conclusion: In our study DMTU, an antioxidant agent, had positive effects on patient arterial blood pH, PaO2, blood urea, creatinine, ALT, AST, LDH levels and lung histology in experimental smoke inhalation induced ALI in rabbits.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 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 Liporotein-associated phospholipase-A2 can be a diagnostic marker in the early stage diagnosis of acute mesenteric ischemia(Tubitak Scientific & Technological Research Council Turkey, 2016) Acar, Tarik; Kocak, Sedat; Cander, Basar; Ergin, Mehmet; Dikmetas, CesareddinBackground/aim: The purpose of this experimental study was to investigate the role of lipoprotein-associated phospholipase-A(2) (Lp-PLA(2)) 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-PLA(2) and C-reactive protein (CRP) parameters were investigated. Results: There was a significant rise in the levels of both Lp-PLA(2) and CRP starting at hour 1 (P < 0.05) (hour 1; Lp-PLA(2), P = 0.003) in the ischemia group. In the sham group, the levels of Lp-PLA(2) and CRP started to rise at hour 3 (P < 0.05) (hour 3; Lp-PLA(2), 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-PLA(2). Conclusion: These findings showed the role of serum Lp-PLA(2) and CRP levels in the early diagnosis of AMI. Thus, further studies are needed to describe the role of Lp-PLA(2) in the early diagnosis of AMI.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 Prognostic Value of Immunosuppressive Acidic Protein (IAP) and Oxidative Stress Status in Critically Ill Patients(Jaypee Brothers Medical Publishers Pvt Ltd, 2021) Tutuncu, Elif O.; Dundar, Zerrin D.; Kilinc, Ibrahim; Tutuncu, Aziz; Kocak, Sedat; Girisgin, Abdullah S.Introduction:The aim of this study was to determine the prognostic value of admission immunosuppressive acidic protein (IAP), interleukin-6 (IL-6), total oxidant status (TOS), and total antioxidant status (TAS) in 161 critically ill patients. Materials and methods: This prospective observational study was carried out in the Emergency Department ICU for 6 months.Critically ill patients were included in the study consecutively. The main outcomes were the need for early mechanical ventilation (MV) and in-hospital mortality. Results:The mean age of 161 patients was 66.5 +/- 17.1 years.The median IL-6 levels of patients who required early MV were significantly higher than ofthe patients who required no MV (p <0.001), and the median IL-6 levels in the non-survivors were significantly higher than in the survivors (p < 0.001). The median IAP levels were not significantly different between the groups (p = 0.464 for early MV and p = 0.340 for the in-hospital mortality group). The AUCs of IL-6 and TOS for predicting in-hospital mortality were 0.819 and 0.608, respectively. Conclusion: The IAP level on admission to ICU is ineffective in predicting the need for early MV and in-hospital mortality; however, iL-6 level on admission is a strong prognostic predictor in critically ill patients. Our findings showed that the burden of oxidative stress was high in general ICU patients. Clinical significance: Our study showed that increased oxidative stress is an important problem in critically ill patients. If measures are taken to reduce oxidative stress by physicians, the prognosis of critically ill patients will be better.Öğe Rapid Emergency Medicine Score and HOTEL Score in Geriatric Patients Admitted to the Emergency Department(Elsevier Taiwan, 2015) Dundar, Zerrin Defne; Karamercan, Mehmet Akif; Ergin, Mehmet; Colak, Tamer; Tuncar, Alpay; Ayranci, Kursat; Kocak, SedatBackground: Emergency risk scoring systems have been defined in order to identify the health status of the patients on admission to the emergency department. In this study, we aimed to investigate the prognostic values of Rapid Emergency Medicine Score (REMS), REMS without age and the HOTEL scores in geriatric patients. Methods: This prospective, single-centered, observational study was carried out between the January 15, 2014 February 28, 2014. Patients admitted to the emergency department during the study period and aged 65 years or older were included in the study. Results: In total, 939 patients were included in the study. In predicting the intensive care unit admission, the area under the curve values of the REMS, REMS without age, and HOTEL scores were 0.772, 0.760, and 0.827 (p < 0.001, for all), respectively. The median (interquartile range) REMS and REMS without age scores of the nonsurvivors were statistically significantly higher than those of the survivors [10 (6) vs. 6 (3), 5 (6) vs. 1(2), respectively; p < 0.001 for both]. Similarly, the HOTEL scores of the nonsurvivors were also statistically significantly higher than those of the survivors [2 (1) vs. 1(1), p < 0.001]. In predicting the in-hospital mortality, the area under the curve values of the REMS, REMS without age and HOTEL scores were 0.833, 0.819, and 0.858 (p < 0.001 for all), respectively. Conclusion: The REMS, REMS without age, and the HOTEL scores cannot be efficiently employed to discriminate geriatric patients requiring hospitalization. Nonetheless, all three scores are proper predictive systems regarding intensive care unit admission and in-hospital mortality in geriatric emergency department patients. Copyright (C) 2015, Taiwan Society of Geriatric Emergency & Critical Care Medicine. Published by Elsevier Taiwan LLC. All rights reserved.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 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.
