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Öğe Antiepileptic drug poisoning: Three-year experience(Elsevier Science Bv, 2015) Gunaydin, Yahya Kemal; Akilli, Nazire Belgin; Dundar, Zerrin Defne; Koylu, Ramazan; Sert, Ekrem Taha; Cekmen, Bora; Akinci, EmineIntroduction: Antiepileptic drugs, which are also called anticonvulsants, are used in the therapy and prophylaxis of epileptic seizures. The purpose of this paper was to investigate the relevant epidemiological data and to determine which of these drugs was the most frequent cause of intoxication. Another purpose of this study was to determine the neurological, cardiac, and biochemical problems caused by antiepileptics. Material and method: This retrospective study included 95 consecutive patients under 18 years of age with antiepileptic intoxication, presenting to and being followed-up in, the Toxicology Unit between January 2010 and February 2013. The data were obtained by screening the patient files. Results: Of the cases, 67 (70.5%) were self-poisoned by first generation antiepileptics (FGAEs) and 28 (29.5%) by second generation antiepileptics (SGAEs). The Glasgow Coma Scale (GCS) scores and the serum lactate levels of the patients poisoned by FGAEs and SGAEs on admission to emergency department were 15 (25th: 12; 75th: 15; 95th: 15; IQR: 3) and 1.9 (25th: 1.4; 75th: 3.1; 95th: 5.6; IQR: 1.7), and 15 (25th: 14.3; 75th: 15; 95th: 15; IQR: 0.75) and 1.07 (25th: 0.9; 75th: 1.6; 95th: 5.5; IQR: 0.71), respectively. The serum lactate levels of patients poisoned by FGAEs were significantly higher (p < 0.001). Among the cases poisoned by carbamazepine, the most frequent cause of intoxication, the GCS score was significantly lower and serum lactate level was significantly higher in the group with high serum levels of carbamazepine (p = 0.004 and p < 0.001, respectively). In cases poisoned by valproic acid (VPA), the second frequent cause of intoxication, there was neither a significant association between the serum VPA level and the GCS score, nor between the serum lactate level and the systolic blood pressure (p = 0.470, p = 0.897, and p = 0.088, respectively). However, there was a positive correlation between the serum VPA level and the serum ammonia level (kk = 0.742, p < 0.001). Conclusion: First generation antiepileptics are more toxic than SGAEs. In patients with serum carbamazepine level, particularly those over 30 mg/L, serious disorders of consciousness, cardiovascular toxicity, and metabolic disorders may occur. In VPA intoxication, there is a positive correlation between the serum VPA levels and ammonia levels. On account of this finding, one should be more careful about hyperammonemic hepatic encephalopathy as the serum VPA level rises. (C) 2014 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY-NC-ND license.Öğe Comparative effectiveness of standard CPR vs active compression-decompression CPR with CardioPump for treatment of cardiac arrest(W B Saunders Co-Elsevier Inc, 2016) Gunaydin, Yahya Kemal; Cekmen, Bora; Akilli, Nazire Belgin; Koylu, Ramazan; Sert, Ekrem Taha; Cander, BasarBackground: Despite all of the studies conducted on cardiopulmonary resuscitation (CPR), the mortality rate of cardiac arrest patients is still high. This has led to a search for alternative methods. One of these methods is active compression-decompression CPR (ACD-CPR) performed with the CardioPump. Objective: The differences in the restoration of spontaneous circulation; the 1-, 7-, and 30-day survival rates; and hospital discharge rates between conventional CPR and ACD-CPR performed with CardioPump were investigated. In addition, the differences between the 2 methods with respect to complications were also investigated. Methods: Our study was a prospective, randomized medical device study with a case-control group. Cardiac arrest cases brought to our emergency medicine clinic by the 112 emergency ambulances from out of hospital and patients who had developed cardiac arrest inhospital clinics between April 2015 and September 2015 were included in our study. For randomization, standard CPR was performed on odd days of each month, and CPR using CardioPump was performed on the even days of each month. Results: A total of 181 patients were included in our study. The number of patients who received conventional CPR was determined as 86 (47.5%), and the number of patients who received CPR using the CardioPump was determined as 95 (52.5%). We did not identify any difference between conventional CPR and CardioPump ACD-CPR with respect to restoration of spontaneous circulation, discharge rates, and the 1-, 7-, and 30-day survival rates. (P=.384, P=.601, P=.997, P=.483, and P=.803, respectively) The complication rate was higher in the patient group that received conventional CPR (P<.001). Conclusion: As a result of our study, we did not obtain any evidence supporting the replacement of conventional CPR with ACD-CPR performed using CardioPump. (C) 2015 Elsevier Inc. All rights reserved.Öğe THE EFFECT OF SERUM CALCIUM LEVEL ON THE MORBIDITY AND MORTALITY OF PATIENTS WITH GASTROINTESTINAL BLEEDING(Carbone Editore, 2014) Koylu, Ramazan; Dundar, Zerrin Defne; Koylu, Oznur; Akilli, Nazire Belgin; Akinci, Emine; Gonen, Mustafa Onder; Cander, BasarIntroduction: The aim of this study was to investigate the relation of serum calcium, corrected calcium and ionized calcium levels with morbidity and mortality in patients followed-up with the diagnosis of gastrointestinal system bleeding. Methods: Patients over 18 years of age who had presented to the emergency clinics with a suspicion of gastrointestinal bleeding and followed-up at the intensive care units between January 2009 and December 2011 were included in this retrospective study. The demographic properties, biochemical and haematological parameters of the patients, the amount of blood transfusions, the durations of hospital stay and the outcomes were recorded. The patients were divided into two groups, as those who survived (Survival group) and those who died (Exitus group). They were also divided into three groups according to their ionized calcium levels. The differences between the groups were investigated. The relations of the variables with each other were also evaluated in the overall patient group. Findings: A total of 191 patients were included in the study, 126 of whom were male (66.0%) with a mean age of 63.8 +/- 19.0 years. The mean hemoglobin level was 9.4 +/- 2.8 g/dL, the mean calcium level was 8.2 +/- 0.7 mg/dL, the mean corrected calcium level was 8.9 +/- 0.6 mg/dL, and the mean ionized calcium level was 0.88 +/- 0.25 mmol/L. No significant differences were observed in the calcium, corrected calcium and ionized calcium levels between the group that had survived and the group which had died (p>0.05). A positive correlation was observed between the hemoglobin levels and the calcium levels (r=0.45, p<0.001), corrected calcium levels (r=0 37, p<0.001) and the ionized calcium levels (r=0.33, p=0.002). Conclusion: No correlation was observed between the calcium, corrected calcium and ionized calcium levels and the erythrocyte transfusion requirement, duration of hospital stay and mortality in patients with GIS bleeding. However, a weak correlation was observed between the calcium, corrected calcium and ionized calcium levels and the hemoglobin levels.Öğe EVALUATION OF GERIATRIC PATIENTS ADMITTED TO THE EMERGENCY DEPARTMENT DUE TO A TRAFFIC ACCIDENT(Gunes Kitabevi Ltd Sti, 2017) Mesin, Mehmet Zahid; Cihan, Fatma Goksin; Pekgor, Selma; Kutlu, Ruhusen; Eryilmaz, Mehmet Ali; Koylu, RamazanIntroduction: The aim of this study was to evaluate patients aged 65 years and older who were admitted to hospital due to a traffic accident through the last year retrospectively. Materials and Methods: The study included 204 elderly patients admitted to the emergency department of Konya Training and Research Hospital due to a traffic accident between 1st November 2014 and 30th October 2015. The socio-demographic characteristics, accident stories, and treatments of these patients were examined. The data were analyzed by statistical tests. Results: Of the patients, 64.7% (n = 132) were male and 35.3% (n = 72) were female. The traffic accidents occurred most frequently in the spring and summer time (p < 0.001). During winter months, the accidents occurred between 06.00 and 11.59 hours at most, but in other seasons they occurred between 12.00 and 17.59 hours more frequently (p < 0.001). Of the admitted patients, 4.4% (n = 9) lost their lives and 6.9% (n = 14) were hospitalized at the intensive care unit. While 56.4% (n = 115) of the patients were discharged from the emergency department by recovery, 43.6% (n = 89) of the patients were referred to 17 different clinics. Injuries were sustained to one or more parts of the body in 93.1% (n = 190) of the patients. The patients with head trauma had the highest mortality (p. 0.001). Conclusion: New strategies are needed to prevent traffic accidents and to treat geriatric patients more effectively after a traffic accident.Öğe INFLUENCE OF NEUTROPHIL/LYMPHOCYTE RATIO ON PROGNOSIS IN MUSHROOM POISONING(Carbone Editore, 2014) Koylu, Ramazan; Dundar, Zerrin Defne; Koylu, Oznur; Gunaydin, Yahya Kemal; Akilli, Nazire Belgin; Mutlu, Huseyin; Gonen, Mustafa OnderObjective: Mushroom poisoning is a severe poisoning which is commonly seen, particularly, in spring and autumn and may be fatal. This study aimed to study the influence of the neutrophil/lymphocyte ratio on prognosis in patients hospitalized in the toxicology unit with a diagnosis of mushroom poisoning. Methods: A total of 236 patients, admitted to the emergency room and hospitalized due to mushroom poisoning between July 2008 and March 2013, were retropsectively analysed. Patients were analysed in terms of age, gender, medical history, type of mushroom ingested, onset time of symptoms, complaints upon admission, and whether they received extracorporeal therapy and laboratory tests. Results: The mean age of patients hospitalized with mushrom poisoning was 41.88 +/- 17.81 years. Of the patients, 95 (40.3%) were male and 141 (59.7%) were female. In their medical history, 15 (64%) patients had diabetes mellitus, 8 (3.4%) had hypertension and 7 (3.0%) had coronary artery disease. 100 (42.4%) patients had eaten cultivated mushrooms, and 104 (44.1%) had eaten wild mushrooms. The mushroom type could not be determined in 32 (3.6%) patients. Symptoms appeared within the first 6 hours in 99 (843%) patients and after 6 hours in 37 (15.7%). Patients were usually admitted with nausea, vomiting, abdominal pain and diarrhea. 24 (10.2%) patients required hemoperfusion during their follow-up and treatment. Duration of hospital stay was 2.28 +/- 2.20 days in patients with normal liver functions, and 2 (0.8%) patients died. Neutrophil/lymphocyte ratio was 15.14 +/- 15.76 in patients with impaired liver functions, and this was statistically significant compared to patients with normal liver function tests (5.48 +/- 7.69) (p=0.001). Conclusions: These results indicated that patients whose neutrophil/lymphocyte ratio is high upon admission should be monitored carefully both for prognosis and hemoperfusion requirement considering longer duration of hospital stay and more aggressive treatment options.Öğe Intoxication due to Papaver rhoeas (Corn Poppy): Five Case Reports(Hindawi Ltd, 2015) Gunaydin, Yahya Kemal; Dundar, Zerrin Defne; Cekmen, Bora; Akillj, Nazire Belgin; Koylu, Ramazan; Cander, BasarIntroduction. In this paper, we aimed to present five Papaver rhoeas intoxication cases, which is very rare in the literature. Case 1. A 35-year-old female patient was admitted to our emergency roomwith the complaints of nausea, restlessness, and dyspnea developing 3 hours after eating Papaver rhoeas. On physical examination, her general condition was moderate; she was conscious and the vital findings were normal. The pupils were myotic. She was transferred to the toxicology intensive care unit as she experienced a generalized tonic clonic seizure lasting for three minutes. Case 2. A 41-year-old female patient was brought to our emergency room by 112 ambulance as she had contractions in her arms and legs, unconsciousness, and foam coming from her mouth two hours after Papaver rhoeas ingestion. On physical examination, she was confused, the pupils were myotic, and she was tachycardic. Arterial blood gases analysis revealed lactic acidosis. Case 3. A 38-year-old female patient was admitted to our emergency room with complaints of nausea and vomiting two hours after ingestion of Papaver rhoeas. Her physical examination and tests were normal. Case 4. A 34-year-old male patient was admitted to our emergency room with complaints of numbness and loss of power in his arms and legs one hour after Papaver rhoeas ingestion. He was hospitalized at the toxicology intensive care unit for follow-up and treatment. Dyspnea and bradycardia developed on the follow-up. The oxygen saturation without oxygen support was 90%. ECG revealed sinus bradycardia. The cardiac enzymes did not increase. Case 5. A 42-year-old female patient was brought to our emergency room by 112 ambulance with contractions in her arms and legs and unconsciousness two hours after Papaver rhoeas ingestion. On her physical examination, she was confused and the pupilsweremyotic. Arterial blood gases analysis revealed lactic acidosis. Conclusion. All patients were followed up for a few days and then discharged fromthe hospital with recovery. Unconscious consumption of Papaver rhoeas leads to a clinical condition resembling morphine intoxication, CNS depression, and epileptic seizures.Öğe NEUTROPHIL-LYMPHOCYTE RATIO IN PATIENTS WITH PESTICIDE POISONING(Elsevier Science Inc, 2014) Dundar, Zerrin Defne; Ergin, Mehmet; Koylu, Ramazan; Ozer, Rasit; Cander, Basar; Gunaydin, Yahya KemalBackground: Pesticides are highly toxic to human beings, and pesticide poisoning is associated with high morbidity and mortality. The identification of powerful prognostic markers is important for the management of patients with pesticide poisoning in emergency settings. Objective: To investigate the prognostic value of the neutrophil-lymphocyte ratio and hematological parameters measured in patients with pesticide poisoning within the first 24 h after admission to the emergency department (ED). Methods: All patients (>= 15 years old) admitted to the ED from July 2008 through February 2013 due to pesticide poisoning were enrolled in the study. The written and electronic medical charts of patients were reviewed. Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio were calculated for each patient using absolute neutrophil, lymphocyte, and platelet counts. Mechanical ventilation requirement and mortality were used as the primary endpoints. Results: A total of 189 patients were included in the study. The mechanically ventilated patients had significantly higher leukocyte and neutrophil counts, and neutrophil-lymphocyte and platelet-lymphocyte ratios (p < 0.001, p < 0.001, p < 0.001, p = 0.003, respectively), whereas they had significantly lower lymphocyte counts compared to nonventilated patients (p = 0.011). Survivors had significantly higher leukocyte and neutrophil counts, and neutrophil-lymphocyte ratios (p < 0.001, p < 0.001, p = 0.002, respectively), whereas there was no significant difference between groups in terms of lymphocyte counts (p = 0.463), compared to nonsurvivors. Conclusion: Leukocyte counts, neutrophil counts, and neutrophil-lymphocyte ratios measured within the first 24 h after admission to the ED are useful and easy-to-use parameters for estimating prognosis in the follow-up of patients with pesticide poisoning. (C) 2014 Elsevier Inc.Öğe A new marker for myocardial injury in carbon monoxide poisoning: T peak-T end(W B Saunders Co-Elsevier Inc, 2013) Akilli, Nazire Belgin; Akinci, Emine; Akilli, Hakan; Dundar, Zerrin Defne; Koylu, Ramazan; Polat, Mustafa; Cander, BasarObjectives: Carbon monoxide (CO) poisoning frequently affects repolarization, resulting in abnormal electrocardiography findings. The goal of this study was to examine the effect of CO poisoning on the novel transmyocardial repolarization parameters T peak-T end (Tp-e), Tp-e dispersion, and Tp-e/QT and the relationship of these parameters to myocardial injury (MI). Methods: This prospective study included 94 patients with CO poisoning and 40 healthy controls. Participants received an electrocardiography and had their blood drawn at admission and 6 and 24 hours after admission. The QT, Tp-e, Tp-e dispersion, and the Tp-e/QT ratio were calculated. Myocardial injury was determined based on an elevation in troponin any time during the first 24 hours. The patients were divided into 2 subgroups: those with and without MI. Results: T peak-T end, Tp-e dispersion, and the Tp-e/QT ratio were higher at admission than after 6 and 24 hours of hospitalization and were higher than the control group (P < .001). There was a correlation between the carboxyhemoglobin level at admission and Tp-e and Tp-e dispersion (P < .001). The MI subgroup (n = 14) had a higher Tp-e at admission than did the non-MI subgroup (n = 80) (96 [11] milliseconds vs 87 [12] milliseconds, P = .03). There were no any significant differences in the Tp-e dispersion or the Tp-e/QT ratio between the 2 MI subgroups. Receiver operating characteristic analysis showed that a Tp-e cutoff value for MI of 91.5 milliseconds had a sensitivity of 72.7% and a specificity of 67.2%. Conclusion: Transmyocardial repolarization parameters indicative of arrhythmia were prolonged in patients with CO poisoning. T peak-T end was associated with MI. (C) 2013 Elsevier Inc. All rights reserved.Öğe A new marker identification of high risk stroke patients: Jugular saturation(W B Saunders Co-Elsevier Inc, 2020) Guven, Mevlut; Akilli, Nazire Belgin; Koylu, Ramazan; Oner, Vefa; Guven, Merve; Ozer, Muhammed RasitObjectives: The aim of this prospective study; to investigate in emergency patients with stroke the relationship between jugular saturation and National Institutes of Health Stroke Scale (NIHSS), lesion volume and mortality score. Materials and methods: In this prospective study, 82 patients who fulfilling the criteria for inclusion in diagnosed with were enrolled in the study. Patients' demographic data, comorbid conditions and stroke type were recorded. The arterial blood pressure, heart rate, and consciousness were recorded at the emergency department. Glasgow Coma Score (GCS) and National Health Institutions Stroke Scale (NIHSS) scores were calculated. Complete Blood Count (CBC) and biochemical values were obtained at the time of admission to the emergency department. Arterial blood gas and jugular venous blood gas were taken and pO2, SpO2 and lactate values were recorded. Patients were grouped according to jugular desaturation (<50%). After imaging, the lesion was located by a specialist radiologist and the lesion volume was calculated. Afterwards, it was followed up by means of the hospital registry system where the patients were followed up (service, intensive care), hospitalization time and whether in-hospital mortality occurred. Results: 82 patients were included in the study. Of the 82 patients, 36 (43.9%) were male and 46 (56.1%) were female. The mean age was 69.8 +/- 13.3. Patients were divided into two groups, jugular venous saturation <50% and >= 50%. 16 patients with J.SpO2 <50% were detected. There was no difference between the two groups in terms of age, sex, Glasgow Coma Scale (GCS), National Health Institutions Stroke Scale (NIHSS) score, laboratory data other than hemoglobin and lesion volume (p > 0,05). In-hospital mortality occurred in 9 (13.6%) of patients with J.SpO2 >=% 50; In the group with J.SpO2 < % 50, 6 patients (37.5%) died within the hospital and this difference was statistically significant (p < 0,05). Conclusion: SjVO2 measurement can be used to identify high-risk stroke patients and to direct critical interventions. However, no correlation was found between this value and lesion volume and NIHSS scale. (C) 2019 Published by Elsevier Inc.Öğe Prognostic importance of neutrophil-lymphocyte ratio in critically ill patients: short- and long-term outcomes(W B Saunders Co-Elsevier Inc, 2014) Akilli, Nazire Belgin; Yortanli, Mehmet; Mutlu, Huseyin; Gunaydin, Yahya Kemal; Koylu, Ramazan; Akca, Hatice Seyma; Akinci, EmineStudy objective: The number of critically ill patients admitted to the emergency department increases daily. To decrease mortality, interventions and treatments should be conducted in a timely manner. It has been found that the neutrophil-lymphocyte ratio (NLR) is related to mortality in some disease groups, such as acute coronary syndrome and pulmonary emboli. The effect of the NLR on mortality is unknown in critically ill patients who are admitted to the emergency department. Our aim in this study is to evaluate the effect of the NLR on mortality in critically ill patients. Methods: This study was planned as a prospective, observational cohort study. Patients who were admitted to the emergency department because they were critically ill and required the intensive care unit were included in the study. Demographic characteristics, Acute Physiology and Chronic Health Evaluation II (APACHE II), Sepsis-related Organ Failure Assessment, Glasgow Coma Score, and NLR values were recorded upon emergency department admission. The patients were followed up for sepsis, ventilator-associated pneumonia, multiorgan failure, in-hospital mortality, and 6-month mortality. Results: The median (interquartile range) age of the 373 patients was 74 (190) years, and 54.4% were men. Neutrophil-lymphocyte ratio values were divided into quartiles, as follows: less than 3.48, 3.48 to 6.73, 6.74-13.6, and more than 13.6. There was no difference among these 4 groups regarding demographic characteristics, APACHE II score, Sepsis-related Organ Failure Assessment score, Glasgow Coma Score, and length of hospital stay (P > .05). In the multivariable Cox regression model, in-hospital mortality and 6-month mortality NLR were hazard ratio (HR), 1.63 (1.110-2.415; P = .01) and HR, 1.58 (1.136-2.213; P = .007), respectively, and APACHE II scores were detected as independent indicators. Conclusion: The NLR is a simple, cheap, rapidly available, and independent indicator of short- and long-term mortalities. We suggest that the NLR can provide direction to emergency department physicians for interventions, particularly within a few hours after admission, in the critically ill patient group. (C) 2014 Elsevier Inc. All rights reserved.
