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    A DEMOGRAPHIC ANALYSIS OF PATIENTS PRESENTING TO THE TERTIARY EMERGENCY DEPARTMENT BETWEEN THE FIRST RESTRICTION PERIOD AND THE FIRST NORMALIZATION PERIOD IN THE COVID-19 PANDEMIC
    (2022) Ünlü, Kağan; Özsan, Sinan Oğuzhan; Cömertpay, Ertan; Deniz, Turgut
    Objective: The COVID-19 virus has become a global threat by spreading all over the world. Countries are often unprepared for pandemics or other disasters, especially in the beginning, they experience organizational problems and the health system is adversely affected by this situation. The aim of this study is to analyze the patients who applied to the emergency department from the date of the first case in our country to the first day of the normalization process and to investigate the effects of different restraint decisions on the emergency patient characteristics. Material and Methods: This study was carried out retrospectively on patients who applied to the emergency department of Kırıkkale University Medical Faculty Hospital between 11.03.2020 and 01.06.2020. During this period, the dates of the critical restriction decisions regarding the pandemic were determined, and the patients were divided into four different periods according to the time of admission. Period-I: Between 11 March and 21 March, Period-II: Between 21 March and 3 April, Period-III: Between 3 April and 4 May, and Period-IV: Between 4 May and 1 June. Demographic data, application forms, units for which consultation was requested, diagnoses and hospitalization status of all patients were recorded. Obtained data were evaluated with SPSS 22.0 program and p<0.05 value was considered significant. Results: It was determined that 6507 patients applied to the emergency department during the study period. Period-I, n=1111; Period-II, n=723; Period-III consisted of n=2231 and Period-IV consisted of n=2442 patients. While the number of patient admissions was 78.39±28.46/day, 8.4% of them applied by ambulance. While 14.9% of all patients were infectious diseases emergencies, 17.3% were trauma. While simple traumas constituted 36.7% of the trauma patients, this was followed by falls and stab wounds. In Periods III and IV, the rate of stab wounds, blow and gunshot wounds increased. The highest number of consultations was requested from the Obstetrics and Gynecology clinic, followed by Internal Medicine and Cardiology. 14.8% of all patients were hospitalized and treated. The highest number of hospitalizations was in Internal Medicine, followed by Gynecology and Obstetrics and Cardiology. Conclusion: As the pandemic process progressed, the rate of admissions by ambulance increased, and the characteristics of trauma cases changed. The application of pregnant patients to the hospital continued even during the pandemic.
  • Küçük Resim
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    Akut iskemik inme hastalarında sTWEAK proteini yüksekliği ile diffüzyon magnetik görüntülemede (DWI) saptanan iskemik alan volümünün korelasyonu ve prognostik değerliliği
    (Kırıkkale Üniversitesi, 2017) Cömertpay, Ertan; Çoşkun, Figen
    Çalışmamızda akut iskemik inmeli hastalarda sTWEAK düzeyleri ile DWI'da ölçülen lezyon alanı arasında ilişki değerlendirildi. Kırkbir akut iskemik strok hastası ve 41 kontrol çalışmaya dahil edildi. Hastaların yaş, cinsiyet, kronik hastalıklar, acil servise başvuru zamanları, acil servis muayeneleri, GKS'laları ve 7 günlük prognostik durumları değerlendirildi. Hastaların 32'sinin (%78) inme ile ilgili şikayeti ilk 3 saat içinde, 6'sının (%14.7) 4-6 saat arasında ve 3'ünün de (%7.3) 7-12 saat arasında başlamıştı. Şikayetlerin başlama zamanı ile yaş, düzenli ilaç kullanma durumu, kullanılan ilaçlar, acil servisteki değerlendirme bulguları, bulgu sayısı ve GKS açısından istatistiksel olarak anlamlı bir fark saptanmadı (p>0.05). Hastaların acil değerlendirmesi sırasında tespit edilen bulgu sayıları ile GKS ve MRI'da ölçülen iskemik alan hacimleri açısından istatistiksel olarak anlamlı fark saptandı (sırasıyla p=0.001; p=0.022). Hastalardan ilk 7 gün içinde exitus (%19.5) olanlarla yaşayanlar arasında BUN, kreatinin ve MRI'da ölçülen iskemik alan hacmi açısından istatistiksel olarak anlamlı fark saptandı (sırasıyla p=0.011; p=0.029; p=0.004). İnme hastalarının DWI'da ölçülen iskemik alan hacmi ile GKS arasında negatifyönde, güçlü düzeyde (r= -0.61), BUN (r=0.40) ve kreatinin (r=0.36) arasında pozitif yönde, orta düzeyde istatistiksel olarak anlamlı bir ilişki saptandı (p<0.05). Çalışmamıza dahil edilen inme hastaları ile sağlıklı kontroller arasında sTWEAKdüzeyleri açısından istatistiksel olarak anlamlı fark saptandı (p<0.001). İnme hastalarının sTWEAK düzeyleri sağlıklı kontrollerden anlamlı olarak yüksekti [AUC:0.86 (0.77-0.94); p<0.001] ve cut-off değeri 995.5pg/ml olarak belirlendi. sTWEAK için belirlenen 995.5pg/ml cut-off değerinin sensitivitesi %80.5, spesifisitesi %82.5, pozitif prediktif değeri %82.5 ve negatif prediktif değeri %80.5 olarak hesaplandı. Sonuç olarak sTWEAK akut inme tanısında değerli bir belirteçtir ancak erken dönem prognoz tahmininde anlamlı bulunmamıştır.
  • Küçük Resim
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    Be Aware of Critical Drugs in Emergency Departments: An Extreme Iatrogenic Insulin Overdose via Subcutaneous and Intramuscular Routes
    (Emergency Medicine Physicians Assoc Turkey, 2021) Coşkun, Figen; Vural, Sevilay; Eroğlu, Oğuz; Cömertpay, Ertan; Durmaz, Senay Arıkan
    Introduction: Insulin is a highly used parenteral medication in emergency departments. Although most severe insulin overdoses occur as suicide attempts, medication errors can be the reason. We aimed to highlight the potential medication errors in emergency departments due to the poor control of critical drugs like insulin and the similarities between the brand names of drugs, as we experienced during this case. Case Report: We present a 75-year-old diabetic woman with an extreme insulin overdose. A total of 3000 UI of insulin was administered by subcutaneous and intramuscular routes. She developed typical and atypical episodes of hypoglycemia requiring intravenous dextrose, a high-calorie diet, and glucagon administration. Almost all of the classic side effects of glucagon occurred during her intensive care unit follow-up. She recovered without any sequela or recurrence of hypoglycemia at the end of 5 days of admission. Conclusion: Insulin overdose can be a life-threatening condition by causing hypoglycemia. Albeit rare, insulin overdose can occur as a medication error in hospitals. To prevent such incidents for emergency departments, the medication errors should be objectively laid out, and proactive strategies should be integrated without adversely affecting acute care.
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    Evaluation of brain computed tomography results in pediatric traumas
    (2023) Cömertpay, Ertan; Özsan, Sinan Oğuzhan; Yeşilyurt, Ömer; Eroğlu, Oğuz; Vural, Sevilay; Coşkun, Figen
    Aims: The use of brain computed tomography (CT) in the management of childhood head traumas is increasing every day. However, due to the more prominent harmful effects of radiation caused by CT in children and the increase in health expenditures, rules have been settled to determine brain CT indications, especially in children with mild head trauma. The aim of this study is to contribute to the literature by sharing the demographic characteristics, clinical findings and Brain CT results of pediatric patients who admitted to the emergency department (ED) with head trauma. Methods: The study was conducted retrospectively in children who admitted to Kırıkkale University Hospital ED with head trauma. The demographic characteristics of the patients, their complaints at admission, Glasgow coma score (GCS), examination findings, follow-up and treatment management in the ED, and brain CT results were recorded. Chi-square test was used to compare the data. A value of p<0.05 was considered statistically significant. Results: 234 children with head trauma were included in the study. Mean age of the study group was: 9.13±6.36 /years and 57.3% (n=134) were males. While 7.2% of the children were <2 years old, 92.8% of them were ?2 years old. Mean GCS was 14.92±0.79. Falling from a height was the most common cause of head trauma with 30.8%, followed by falling from the same level with 21.8% and in-vehicle traffic accident with 18.4%. Headache (37.2%), nausea-vomiting (36.8%) and loss of consciousness (13.7%) were the three most common admission symptoms after head trauma. Headache was found to be significantly higher in the ?2 age group and nausea-vomiting in the <2 age group compared to the other group (p=0.006; p<0.001, respectively). While 97.9% of brain CT results were normal, the most common pathological finding was linear fracture (2.1%). In terms of brain CT results, no difference was found between children <2 years and ?2 years of age (p=0.527). Conclusion: Majority of the pediatric patients we evaluated in our study had minor head trauma, and most of the brain CT results were normal. Headache, nausea, vomiting, and loss of consciousness were the three most common symptoms after head trauma. Nausea-vomiting was observed more frequently in children aged <2 years and headache was observed inchildren aged ?2 years after head trauma, compared to other age groups.
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    METANOL ZEHİRLENMESİ NEDENİYLE ACİL SERVİSE BAŞVURAN HASTALARIN RETROSPEKTİF ANALİZİ
    (2021) Cömertpay, Ertan; Eroğlu, Oğuz; Deniz, Turgut
    Amaç: Metanol zehirlenmesi ülkemizde son zamanlarda sıkça karşılaşılan bir zehirlenme türüdür. Zehirlenme durumunda vakaların hızla tanınıp tedavi altına alınması sayesinde mortalite ve morbidite oranları azaltılabilir.Bu çalışmanın amacı, acil servise başvuran metanol zehirlenmesi hastalarının demografik özellikleri, fizik muayene bulguları ve laboratuvar sonuçları ile sağ kalım arasındaki ilişkiyi araştırmaktır.Gereç ve Yöntemler: Hastalar metanol zehirlenmesi sonrası eksitus olanlar ve hayatta kalanlar olmak üzere 2 farklı gruba ayrıldı. Tüm hastaların demografik özellikleri, başvuru şikayetleri, fizik muayene bulguları ve laboratuvar sonuçları ve klinik sonlanımları kaydedildi. Grupların karşılaştırılmasında Chi-square, Student t-test ve Mann-Whitney U testi kullanıldı. p<0.05 değeri istatistiksel olarak anlamlı kabul edildi.Bulgular: Çalışmaya metanol zehirlenmesi sonrası eksitus olan (n=5) ve hayatta kalanlar (n=12) olmak üzere toplam 17 hasta dahil edildi. Metanol zehirlenmesi sonrası en sık başvuru şikâyeti görme bozukluğu (%70.6) iken, bunu nefes darlığı (%35.3) ve bulantı-kusma (%35.3) takip ediyordu. Gruplar arasında başvuru şikâyeti bakımından farklılık saptanmadı. Her iki grupta da başta solunum sayısı (hiperventilasyon) olmak üzere vital bulguların ortalama değeri, normal değerinin üstündeydi. Ancak, vital bulgular bakımından gruplar arasında farklılık saptanmadı. Eksitus olan hasta grubundaki kreatinin düzeyi ve baz açığı seviyesi hayatta kalan gruptakilere göre anlamlı olarak artmışken, bikarbonat ve pH düzeyi ise anlamlı oranda azalmış olarak tespit edildi (sırasıyla p=0.015; 0.002, 0.020; 0.002).Sonuç: Metanol zehirlenmesi sonrası ölen hastalarda, kreatinin değerindeki ve baz defisitindeki artış, derinleşen asidoz ve azalmış bikarbonat düzeyi kötü klinik sonlanımla uyumludur. Görme bozukluğuna eşlik eden hiperventilasyon ve bilinç kaybı durumlarında metanol zehirlenmesi akla gelmeli ve bir an önce uygun tedavi prosedürlerine başlanmalıdır.
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    Öğe
    Significance of thiol/disulphide homeostasis and ischemia modified albumin levels in chronic obstructive pulmonary disease
    (2019) Eroğlu, Oğuz; Badem, Nermin Dindar; Baccıoğlu, Ayşe; Cömertpay, Ertan; Neselioglu, Salim; Erel, Özcan
    Objectives: The severity of inflammation occurring during chronic obstructive pulmonary disease (COPD) isclosely associated with oxidative stress. The aim of this study was to investigate the diagnostic value ofThiol/disulphide homeostasis (TDH) and ischemia modified albumin (IMA) levels in evaluating oxidativestress in COPD patients.Methods: This prospective study was performed with COPD patients presenting to the Kırıkkale UniversityHospital and with healthy volunteers. Subjects’ demographic data (age, sex, body mass index, and smokingstatus), native thiol (NT), total thiol (TT), disulphide (Ds), IMA levels and Ds/NT, Ds/TT and NT/TT ratioswere recorded. Statistical analysis was performed with SPSS 21.0 software.Results: One hundred ninety subjects were enrolled in the study, 141 COPD patients and 49 healthy volunteers.No difference was determined between the patient and control groups in terms of age, sex or body mass index.The antioxidant markers; NT and TT levels and NT/TT ratio were significantly lower in the patient groupcompared to the control group (p < 0.001, p < 0.001, and p < 0.003, respectively). The oxidant markers; IMAlevels and Ds/NT and Ds/TT ratios were significantly higher in the patient group (p = 0.006, p = 0.003, and p= 0.003, respectively). Significant negative correlation was determined between antioxidant and oxidantparameters. Sensitivity values were NT: 87.2%, TT: 83.3%, Ds/NT ratio: 68.1%, Ds/TT ratio: 68.1%, and IMA:77.8%.Conclusions: TDH was impaired in favor oxidants in COPD patients. TDH parameters and IMA can be usedto monitor oxidative stress emerging in COPD.