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Öğe Acil Servise Başvuran Şiddete Maruz Kalmış Kadınların Demografik Ve Klinik Özellikleri İle Hastane Maliyetleri(2016) Yılmaz, Yasemin Aydın; Ramadan, Hayri; Çiftçi, Handan; Erkek, Aylin; Vural, Sevilay; Çoşkun, FigenGiriş: Acil servise şiddete maruz kalma nedeni ile başvuran kadınların ve şiddet uygulayıcılarının sosyo-demografik özelliklerini, şiddetin türü, sıklığı ve şeklini belirlemek ve tedavi masraflarının yaklaşık maliyetini hesaplamaktır. Gereç ve Yöntem: Bu çalışma 01.11.2012- 01.06.2013 tarihleri arasında Ankara Eğitim ve Araştırma Hastanesi Acil Tıp Kliniğine şiddete maruz kalma beyanı ile başvuran tüm kadınların dahil edildiği prospektif bir çalışmadır. Bu çalışmada şiddet mağduru ve şiddet uygulayıcılarının sosyodemografik özellikleri, şiddetin türü, sıklığı, şekli ve hastane maliyeti arasındaki ilişki Pearson ki-kare testi ve Fisher'in kesin testi kullanılarak araştırıldı. Bulgular: Altı aylık süre içerisinde darp nedeni ile acil servisimize başvuran toplam 656 kadın hastanın 303'ü çalışmaya dahil edilmiştir. Yaş ortalamaları 32.8711.38 olup, minimum yaş 18, maksimum yaş 92'dir. Evli (%79.2), çocuklu (%75.9). gelir getiren bir işte çalışmayan (%71) ve öğrenim durumu ortaokul ve altı (%67) olan kadınların şiddete daha çok maruz kaldığı tespit edilmiştir. Partneriyle birlikte yaşayan kadınlar evli kadınlara göre daha sık cinsel şiddet görmektedir (p0.05). En sık şiddet uygulayan kişiler eşlerdir (%61.7). Şiddet uygulayan kişilerin darp ederken alkollü olması (p0.005) ya da madde kullanmış olması (p0.004) daha fazla tedavi maliyeti gerektirmektedir. Darp edilenlerin %53.5'inin tedavi maliyeti 80 TL'nin altında olup, ortalama maliyet 81 TL'dir. Yatan hastaların maliyeti ise ortalama 1535 TL olarak hesaplanmıştır. Sonuç: Şiddete uğrayan kadınların yaklaşık üçte ikisinin 35 yaşın Sosyodemografik özellikleri incelendiğinde evli, çocuklu, gelir getiren bir işte çalışmayan ve öğrenim durumu ortaokul ve altı olan kadınların daha çok şiddete maruz kaldığı tespit edilmiştir. Hastane maliyetinin düşük olmasının nedeni ülkemiz şartlarında sağlık hizmetlerinin ucuz olması ve katılımcıların çalışmaya dahil edilen başvurularının maliyetinin hesaplanmasıdır.Öğe 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 ArıkanIntroduction: 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.Öğe Bir Çaydanlık Dolusu Datura: Hemoroidim Var Ama Umrumda Değil.(2017) Eroğlu, Oğuz; Çoşkun, Tijen; Kaya, Hatice Algan; Vural, Sevilay; Çoşkun, FigenDoğada sayısız çeşitte bitki bulunmaktadır. Bu bitkilerin bir kısmının insan hayatını tehdit edici özelliklere sahip olduğu bilinmekteyken, bir kısmının ise çiğnenerek, yutularak, içilerek, tüttürülerek veya sürülerek kullanılmasının bazı hastalıkları tedavi ettiğine inanılmaktadır. Çok eski zamanlardan beri devam eden bitkilerle tedavi etme alışkanlığı, bugün internet gibi kullanım ve ulaşım sahası sınırsız olan bir dünyada, her an gözümüze çarpmakta ve daha düne kadar halk arasında “kocakarı ilacı” olarak tarif edilen birtakım bitkiler, bilimsel formüllerle insanlara sunulmaktadır. Bitkisel tedavi kürü olarak sunulan bu formüller, hayatı tehdit edici zehirlenmelere neden olabilir. Bu yazıda internetten edinilen bir tarif sonrası, hemoroid tedavisi için kullanılan Datura Stramonium bitkisine bağlı zehirlenme olgusunun sunulması amaçlanmıştır.Öğe The Diagnostic Value of sTWEAK in Acute Ischemic Stroke(GALENOS YAYINCILIK, 2020) Comertpay, Ertan; Vural, Sevilay; Eroglu, Oguz; Badem, Nermin Dindar; Bilgili, Yasemin Karadeniz; Coskun, FigenBackground: Considering the critical role of early diagnosis and management of acute ischemic stroke, biomarkers that can reliable assist in the diagnosis are still needed. These biomarkers should rapidly analyze, have high specificity for brain damage, and be available in the emergency settings for early diagnosis and exclusion of other conditions that mimic acute ischemic stroke. Soluble tumor necrosis factor-like weak inducer of apoptosis, a protein involved in the regulation of several biological functions, could be a potential acute ischemic stroke biomarker. Aims: To investigate the diagnostic value of soluble tumor necrosis factor-like weak inducer of apoptosis in patients with acute ischemic stroke and examine the relationship between ischemic area volume determined at diffusion-weighted magnetic resonance imaging and soluble tumor necrosis factor-like weak inducer of apoptosis. Study Design: A prospective, case-control study. Methods: This case-control prospective study included 36 patients with acute ischemic stroke and 36 healthy volunteers. Information on age, sex, presence of chronic disease, neurological examination findings, times of presentation to the emergency department after acute ischemic stroke, soluble tumor necrosis factor-like weak inducer of apoptosis levels, ischemic area volumes at diffusion-weighted magnetic resonance imaging, and 6-month mortality rates after stroke were recorded. The results were analyzed on SPSS 22.0 software (SPSS Inc., Chicago, IL, USA), and p<0.05 was considered statistically significant. Results: A soluble tumor necrosis factor-like weak inducer apoptosis cut-off value of 995.5 pg/mL exhibited a sensitivity of 80.5% and a positive predictive value of 82.5% with an area under the curve of 0.84 (95% confidence interval: 0.74-0.94; p<0.001). The mean soluble tumor necrosis factor-like weak inducer of apoptosis level - in the acute ischemic stroke group (1968.08=1441.99 mu g/L) were significantly higher than those in the control group (704.81 +/- 291.72 14,1) (p<0.001). No correlation was observed between soluble tumor necrosis factor-like weak inducer of apoptosis levels and ischemic area volume measured at diffusion-weighted magnetic resonance imaging (r=-0.008; p=0.07). The mean ischemic area volume was 505.68 +/- 381.10 and 60.96=80.89 mm(3) in the nonsurviving and surviving patients, respectively (p =.002). Conclusion: Soluble tumor necrosis factor-like weak inducer of apoptosis can be used in the diagnosis of acute ischemic stroke. However, it is inconclusive in estimating ischemic area volume and early mortality following acute ischemic stroke. Ischemic area volume measured at diffusion-weighted magnetic resonance imaging is a marker of poor prognosis and can be used in predicting early mortality.Öğe Evaluation of brain computed tomography results in pediatric traumas(2023) Cömertpay, Ertan; Özsan, Sinan Oğuzhan; Yeşilyurt, Ömer; Eroğlu, Oğuz; Vural, Sevilay; Coşkun, FigenAims: 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.Öğe The evaluation of general knowledge of emergency care providers about child abuse and neglect(2017) Özen, Mehmet; Ramadan, Hayri; Vural, Sevilay; Coşkun, FigenAmaç: Çocuk istismarı ve ihmali, karmaşık nedenleri ve trajik sonuçları sebebiyle tıbbi, yasal, gelişimsel ve psikososyal bir halk sağlığı sorunudur. Toplum içindeki gerçek insidansı tam olarak bilinmemektedir. Çalışmamızda acil servislerde çalışan hekimler ve yardımcı sağlık personelinin çocuk istismarı ve ihmali hakkında bilgi düzeylerini ölçmeyi; elde edilen sonuçları sağlık çalışanı olmayan kontrol grubuyla karşılaştırmayı amaçladık.Gereç ve Yöntemler: Çalışmamıza Ankara İlindeki Eğitim Araştırma, Üniversite ve Devlet hastanelerinde çalışan acil doktorları, pediatri hekimleri ve diğer sağlık çalışanlarından oluşan 400 kişilik bir çalışma grubu ve 105 katılımcıdan oluşan kontrol grubu dahil edilerek yapılmıştır. Katılımcılara hem demografik sorulardan oluşan hem de çocuk istismarı ve ihmali konusunda genel olarak inanılan mitleri içeren birer anket uygulanmıştır.Bulgular: Demografik sorular ve mitler içeren ankette, doktorlar ve yardımcı sağlık çalışanlarının çalıştıkları kurumların mitlere bakış açısını etkilediği, deneyim süresinin sağlık çalışanları için bir değişken olduğu, çocuk istismarı konusunda eğitim almış olmanın belirleyici olduğu fakat çocuk sahibi olmanın cevaplardaki doğruluğu anlamlı şekilde etkilemediği tespit edilmiştir (p>0,05). Kontrol grubunun başarı oranları her mit için yardımcı sağlık personeli ile benzerlik göstermiştir (p> 0,05). Ancak kontrol grubunun 7, 18, 19, 22, 25, 27, 30 ve 35 numaralı mitlerde doktorlara göre düşük doğruluk oranları tespit edilmiştir.Sonuçlar: Acil servislerinde ve çoğunlukla çocuk yaş grubunun bakıldığı pediatrik acil servislerinde çalışan tüm sağlık çalışanlarının çocuk istismarı ve ihmaline dair belirti ve bulgularını bilmeleri gerekmektedir. Ayrıca yasal birimlere bildirmeye yönelik sorumlulukları mevcuttur. Bu konudaki mitleri çürütmeye yönelik düzenli eğitim programları hem sağlık sisteminde hem de toplum düzeyinde uygulanmalıdırÖğe Karın Ağrısının Nadir Bir Nedeni: Apendiks Mukosel Olgu Sunumu(2018) Pehlivanlı, Faruk; Karaca, Gökhan; Daphan, Çağatay Erden; Eroğlu, Anıl Oğuz; Vural, Sevilay; Coşkun, FigenApendiksin mukoseli, apendiks lümeninin anormal müsinöz sekresyonu sebebiyle dilatasyonu ile karakterize nadir görülen klinik bir durumdur. İnflamatuar bir duruma veya tümör kaynaklı olabilir. Mukosel, mukozal hiperplazi, müsinöz kistadenom veya müsinöz kistadenokarsinom sonucunda oluşabilir. Apendiks müsinöz kistadenomu en sık görülen şekli olup çok farklı klinik durumlarla kendini belli eder. Apendektomi spesimenlerinin %0.2?0.3’ünde saptanır. Preoperatif tanı konması zordur ve sıklıkla laparotomide saptanır. Rüptür riski, klinik olarak cerrahları zorlamaktadır. Cerrahi planlanmasında tam bir konsensus olmamakla birlikte genellikle apendektomi ya da sağ hemikolektomi ameliyatları uygulanır. Bu yazımızda plastron apendisit tanısıyla takip edilip sağ alt kadran ağrısı ve kitle saptanan apendiks mukosel olgusunu literatür eşliğinde tartıştık.Öğe The diagnostic value of neurogranin in patients with carbon monoxide poisoning: Can it show early neurological damage?(W B Saunders Co-Elsevier Inc, 2021) Yesilyurt, Omer; Comertpay, Ertan; Vural, Sevilay; Eroglu, Oguz; Badem, Nermin Dindar; Cankaya, Imran; Bilgili, Yasemin KaradenizBackground and aim: Carbon monoxide poisoning is a toxicological emergency that causes neurological complications. High serum neurogranin can be detected in acute or chronic conditions where brain tissue is damaged. This study aimed to investigate the diagnostic value of serum neurogranin level and its role in demonstrating neurological damage in patients admitted to the emergency department with carbon monoxide poisoning. Materials and methods: The study was conducted prospectively on patients with carbon monoxide poisoning (patient group) and healthy volunteers (control group). Demographic characteristics and scrum neurogranin level of all participants and symptoms at admission, neurological examination findings, laboratory results, and Diffusion-Weighted Magnetic Resonance Imaging results of the patient group were recorded. We used an independent sample t-test to compare neurogranin levels and bivariate correlation analysis to compare the relationship between serum neurogranin levels and data belonging to the patient group. Results: Sixty eight participants (patient group, n- 36; control group, n- 32) were included in the study. Serum neurogranin level was significantly higher in patients with carbon monoxide poisoning (0.31 +/- 0.16 ng/ml) compared to control group (0.22 +/- 0.10 ng/ml) (p = 0.015). The mean Glasgow Coma Scale of the patients with carbon monoxide poisoning was 14.59 +/- 0.23, and of Diffusion Weighted Magnetic Resonance Imaging results were completely normal in 94.4% (n = 34). There was no correlation between serum neurogranin level and Diffusion Weighted Magnetic Resonance Imaging results (r = -0.011; p = 0.953). Conclusion: Serum neurogranin level may be a new diagnostic biomarker in patients admitted to the emergency department with carbon monoxide poisoning. The high serum neurogranin levels detected in patients with normal diffusion-weighted imaging after carbon monoxide poisoning suggest that there is neurological damage in these patients, even if imaging methods cannot detect it. (C) 2021 Elsevier Inc. All rights reserved.Öğe USE OF LACTATE CLEARANCE IN DETERMINING SERUM LACTATE LEVELS AND EFFECTIVENESS OF TREATMENT IN CARBON MONOXIDE POISONINGS(2017) Emektar, Emine; Ramadan, Hayri; Yüzbaşıoğlu, Yücel; Vural, Sevilay; Çoşkun, FigenObjective: This study aims to determine the feasibility of using the rate of lactate clearance to evaluate the metabolic response to treatment in patients with carbon monoxide (CO) poisoning after their lactate levels were measured on initial presentation to the emergency department (ED). Material and Methods: Patients older than 18, who presented with CO poisoning to the ED of Keçiören Training and Research Hospital between November 2010 and February 2011 were enrolled in the study. Lactate levels upon admission (Lactate-1) and after 6 hours of treatment (Lactate-2) were compared to calculate the lactate clearance rate. Lactate levels of 1.7 mmol/l or greater were considered as positive. Results: A total of 100 patients were enrolled in the study (62 females and 38 males). We found that 94% of patients had elevated lactate levels on admission to the ED. When lactate levels and CO values were compared, the CO values were found to be significantly higher in the elevated lactate level group compared to non-elevated patients. The rate of lactate clearance was 52% in the standard oxygen therapy group compared to 64% in the hyperbaric oxygen therapy (HOT) group, which suggests a faster removal of lactate with this treatment modality. Conclusion: We conclude that lactate levels increase in patients with CO poisoning, and that those levels are correlated with carboxyhemoglobin (COHb) levels. The rate of lactate clearance can be used to evaluate the effectiveness of therapy. Patients with metabolic acidosis and significantly increased lactate should be referred for HOT in early phases of management.Öğe Warning: This may be as dangerous as firearm injuries;"grease-gun injury": A case report(African Field Epidemiology Network-Afenet, 2015) Eroglu, Oguz; Sari, Elif; Vural, Sevilay; Coskun, FigenHigh-pressure injection gun (Grease-gun) injuries mainly occur with industrial labourers. Injuries associated with high pressure grease guns are very rare and frequently involve the hand and chest. The non-dominant hand is generally injured since the grease gun is usually held in the dominant hand. Even if high-pressure injection injury causes only a small lesion in the skin, it is still characterized by severe damage to subcutaneous tissue. Since initial presentation may be deceptive, treatment is frequently delayed. The characteristics of the material injected need to be known as a priority, and systemic intoxication must be ruled out. The risk of amputation is 16-55%. With solvents it goes up to 50-80%. Surgical treatment must be performed immediately, under general anesthesia or plexus block. Foreign material and necrotic tissue must be early debrided with wide microsurgical exploration. Positive outcomes in reacquisition of hand functions can be obtained with long-term and early physiotherapy.
