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The Utilization of Emergency Department and Outpatient Clinics among Evacuated Victims after the 2023 Turkey Earthquake
(Cambridge Univ Press, 2024) İlhan, Buğra; Eroğlu, Oğuz; Çanak, Hüseyin; Arıkan, Abdullah; Sakallı, Münir; Tursun, Serkan; Deniz, Turgut
Background: After the 2023 Turkey earthquake, thousands of people evacuated to different fields. Earthquake victims still need health care in the evacuation location. This study aims to determine the emergency department (ED) and outpatient clinic utilization characteristics of the evacuated earthquake victims outside the earthquake zone and to provide suggestions for planning the health care facilities in the regions where the evacuated earthquake victims will be placed.Methods: This retrospective, observational study was conducted in a tertiary university hospital from February 7, 2023 through February 20, 2023. All evacuated earthquake victims who presented to the study hospital were included in the study. Non-victim patients were included as the control group. Missing medical records were excluded. Demographic characteristics of the patients, outpatient clinics, International Statistical Classification of Diseases and Related Health Problems-10th Revision (ICD-10) codes, and outcomes were recorded.Results: A total of 15,128 patients were included in the final analysis. Six-hundred-nine (4.0%) of the patients were evacuated victims. Three-hundred forty-six (56.8%) evacuated victims used the ED. One-hundred fifty-six (25.6%) earthquake victims were in the pediatric age group. Earthquake victims used the ED more than the control group in adult and pediatric age groups (22.5% versus 51.7% and 30.2% versus 71.8%; P <.001, respectively). Earthquake victims frequently presented to the hospital during night shifts in both age groups (P <.05). Pediatric victims were more hospitalized than the control group (4.8% versus 10.9%; P = .001). Diseases of the respiratory system were the most common emergency diagnosis of the victims in both age groups (26.5% and 57.1%, respectively). The most frequently used outpatient clinic was ophthalmology in both age groups (14.6% and 20.5%, respectively).Conclusions: Evacuated victims, especially pediatric victims, used the ED more than other outpatient clinics. Diseases of the respiratory system were the most common emergency diagnosis of the victims, and the most frequently preferred outpatient clinic was ophthalmology. The most common diseases and frequently preferred clinics should be considered in planning health care for the evacuated earthquake victims.
The prognostic value of rapid risk scores among patients with community-acquired pneumonia A retrospective cohort study
(Springer Wien, 2023) İlhan, Buğra; Berikol, Göksu Bozdereli; Doğan, Halil
BackgroundCommunity-acquired pneumonia (CAP) is a frequent reason for emergency department (ED) presentations. Various risk scores have been validated in the management of CAP and are recommended for daily practice.ObjectiveThe aim of the study was to evaluate the performance of the rapid risk scores (the rapid acute physiology score (RAPS), the rapid emergency medicine score (REMS), the Worthing physiological scoring system (WPS), CURB-65 and CRB-65) among patients with CAP.MethodsThis retrospective cohort study was conducted in the ED of a tertiary hospital between 1 January 2019 and 31 December 2019. Patients aged & GE; 18 years and diagnosed with CAP were included. Patients who were transferred from another center or with missing records were excluded. Demographic information, vital signs, level of consciousness, laboratory results, and outcomes were recorded.ResultsA total of 2057 patients were included in the final analysis. The 30-day mortality of the patients was 15.2% (n = 312). The WPS achieved the most successful results for all three outcomes, 30-day mortality, intensive care unit (ICU) admission and mechanical ventilation (MV) needs (area under the curve, AUC 0.810, 0.918, and 0.910, respectively; p < 0.001). In the prediction of mortality, RAPS, REMS, CURB-65, and CRB-65 had a moderate overall performance (AUC 0.648, 0.752, 0.778, and 0.739, respectively). In the prediction of ICU admission and MV needs, RAPS, REMS, CURB-65, and CRB-65 had moderate to good overall performance (AUC at ICU admission 0.793, 0.873, 0.829, and 0.810; AUC for MV needs 0.759, 0.892, 0.754, and 0.738, respectively). Advanced age, lower levels of mean arterial pressure and peripheral oxygen saturation, presence of active malignancy and cerebrovascular disease, and ICU admission were associated with mortality (p < 0.05).ConclusionThe WPS outperformed other risk scores in patients with CAP and can be used safely. The CRB-65 can be used to discriminate critically ill patients with CAP due to its high specificity. The overall performances of the scores were satisfactory for all three outcomes.
The Prognostic Accuracy of Get With The Guidelines-Heart Failure Score Alone and with Lactate Among Acute Symptomatic Heart Failure Patients: A Retrospective Cohort Study
(Kare Publ, 2024) İlhan, Buğra; Bozdereli Berikol, Göksu; Doğan, Halil; Bestemir, Attila; Kaya, Adnan
Background: To evaluate the prognostic accuracy of the Get With The Guidelines-Heart Failure (GWTG-HF) score, Shock Index (SI), Modified Shock Index (MSI), and Age Shock Index (Age-SI) alone and with lactate in patients with acute symptomatic heart failure (HF). Methods: A retrospective cohort study was conducted in the emergency department of a tertiary hospital between January 1, 2019, and December 31, 2019. Patients aged > 18 years and diagnosed with acute symptomatic HF were consecutively included in the study. Patients referred from another center and missing medical records were excluded. Arrival type, vital parameters, demographic characteristics, comorbid diseases, consciousness status, laboratory results, and outcomes of the patients were recorded. The primary endpoint of the study was in-hospital mortality. Results: A total A total of 368 patients were included in the final analysis. The in-hospital mortality rate of the patients was 7.6%. The GWTG-HF score outperformed other scores in predicting in-hospital, 24-hour, and 30-day mortality (area under the curve (AUC) = 0.807, 0.844, and 0.765, P < .001, respectively). The overall performance of the GWTG-HF score with lactate (GWTG-HF+L) was better in predicting in-hospital, 24-hour, and 30-day mortality than the original GWTG-HF score (AUC = 0.872, 0.936, and 0.801, P < .001, respectively). Adding lactate values to the SI, MSI, and Age-SI improved their overall performance for all 3 outcomes. Conclusion: Both the GWTG-HF and GWTG-HF+L scores have acceptable discriminatory power in patients with acute symptomatic HF. The GWTG-HF score, SI, MSI, and Age-SI can be used together with lactate to predict mortality in patients with acute HF.
The effect of 8-weeks of combined resistance training and chocolate milk consumption on maximal strength, muscle thickness, peak power and lean mass, untrained, university-aged males
(Frontiers Media Sa, 2023) Yapıcı, Hakan; Gülü, Mehmet; Yağın, Fatma Hilal; Uğurlu, Dondu; Cömertpay, Ertan; Eroğlu, Oğuz; Kocoğlu, Melike
The overarching aim of this study was to investigate the combined effects of chocolate milk consumption (500 mL) with 8-week of resistance training on muscle hypertrophy, body composition, and maximal strength in untrained healthy men. A total of 22 Participants were randomly divided into two experimental groups: combined resistance training (3 sessions per week for 8 weeks) and chocolate milk consumptions (include 30 g protein) Resistance Training Chocolate Milk (RTCM) (Age: 20.9 +/- 0.9 years old) and resistance training (RT) only (Age: 19.8 +/- 0.7 years old). Muscle thickness (MT), using a portable ultrasound, body composition, body mass, maximal strength (one repetition maximum (1 RM), counter movement jump (CMJ) and peak power (PP) were determined at baseline and 8 weeks later. In the RTCM, finding showed a significant improvement in the outcomes compared to the RT group, besides the main effect of time (pre and post). The 1 RM total increased by 36.7% in RTCM group compared to 17.6% increased in the RT group (p < 0.001). Muscle thickness increased by 20.8% in the RTCM group and 9.1% in the RT group (p < 0.001). In the RTCM group, the PP increased by 37.8% compared to only 13.8% increase in the RT group (p = 0.001). The group*time interaction effect was significant for MT, 1RM, CMJ, and PP (p < 0.05), and it was observed that the RTCM and the 8-week resistance training protocol maximized performance. Body fat percentage (%) decreased more in the RTCM (18.9%) group than in the RT (6.7%) group (p = 0.002). In conclusion, chocolate milk (500 mL) with high protein content consumed in addition to resistance training provided superior gains in terms of MT, 1 RM, body composition, CMJ, and PP. The finding of the study demonstrated the positive effect of casein-based protein (chocolate milk) and resistance training on the muscle performance. Chocolate milk consumption has a more positive effect on muscle strength when combined with RT and should be considered as a suitable post-exercise nutritional supplement. Future research could be conducted with a larger number of participants of different ages and longer study durations.
Spontaneous hemopneumothorax observed in a healthy young
(Aves, 2008) Kandiş, Hayati; Güngör, Ahmet; Katırcı, Yavuz; Deniz, Hayati; Deniz, Turgut
Spontaneous hemopneumothorax is a disease rarely accompanied by spontaneous pneumothorax. Delay in diagnosis and treatment may result in mortality. We considered that hemothorax (spontaneous hemopneumothorax) accompanied by spontaneous pneumothorax may develop in a young patient not having trauma and bleeding, we aimed to investigate the existing treatment methods.
Prevalence and associated risk factors of post-traumatic stress disorder among survivors of the 2023 Turkey earthquake
(W B Saunders Co-Elsevier Inc, 2023) İlhan, Buğra; Berikol, Göksu Bozdereli; Eroğlu, Oğuz; Deniz, Turgut
Background: Earthquakes can cause psychological trauma among survivors as well as physical trauma. This study aims to determine the prevalence of post-traumatic stress disorder (PTSD) and identify associated risk factors among earthquake survivors after the 2023 Turkey earthquake. Methods: This prospective cross-sectional study was conducted in the emergency department of a tertiary uni-versity hospital between May 6, 2023, and May 16, 2023. An online questionnaire was sent to the participants. The questionnaire form consisted of three parts. In the first part, the sociodemographic characteristics of the par-ticipants were included. In the second part, the participants were asked about their experiences with the earth-quake. In the third part, the post-traumatic stress disorder checklist for the Diagnostic and Statistical Manual of Mental Disorders, which screens PTSD among the participants, was included. Participants who did not complete all the questions and had severe communication disorders were excluded. Results: The prevalence of probable PTSD among the participants was 51.4% (n = 197). Age (OR: 0.96 95% CI: 0.93-99), female gender (OR: 4.54 95% CI: 2.39-8.61), being the head of the family (OR: 2.00 95% CI: 1.04-3.82), bereavement (OR: 1.71 95% CI: 1.03-2.82), lost loved ones (OR: 3.15 95% CI: 1.67-5.92), low social support (OR: 1.80 95% CI: 1.12-2.90) and receiving emergency care at the field (OR: 6.67 95% CI: 1.03-43.2) were the associated risk factors of PTSD among earthquake survivors. Conclusions: The prevalence of PTSD among survivors three months after the 2023 Turkey earthquake is over half of the survivors. Younger age, female gender, being the head of the family, bereavement, lost loved ones, low so-cial support, and receiving emergency care in the field were the associated risk factors of PTSD among earthquake survivors. Considering survivors may visit EDs until other outpatient clinics are re-established and the high rate of PTSD, rapid psychological evaluations can be performed in emergency departments. Emergency physicians should be aware of possible risk factors and high rate of PTSD. & COPY; 2023 Elsevier Inc. All rights reserved.
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.
A nationwide analysis of emergency medicine residents' CT interpretation in trauma: The Tract-EM study
(W B Saunders Co-Elsevier Inc, 2024) Aslaner, Mehmet Ali; Kad, Gultekin; Kesen, Sevcihan; Kılıç, Atiye Cenay Karabörk; Coşkun, Özlem; Bildik, Fikret; Kele, Ayfer
Objective: To evaluate the accuracy and determine the factors influencing trauma CT interpretation proficiency among emergency medicine (EM) residents in Turkey through the TraCT-EM study (Interpretation of Trauma CT by EMergency Physicians). Methods: This nationwide, multicenter, cross-sectional study was conducted in 29 academic emergency departments (EDs) from April 2023 to March 2024. A total of 401 senior EM residents participated in the study, each interpreting a standardized set of 42 trauma CT series (cranial, maxillofacial, and cervical) derived from seven patients. Interpretation accuracy was assessed, and factors predicting interpretation failure were analyzed using univariate and multivariate regression models. Results: The median accuracy rate of residents was 64.9 %, with higher accuracy in normal CT findings. Using the Angoff method, 14 % of residents scored below the passing threshold. Factors associated with interpretation failure included shorter interpretation times (OR, 0.97; 95% CI, 0.95-0.99), lower self-confidence in detecting serious pathologies (OR, 2.50; 95% CI, 1.42-4.42), reliance on in-hospital radiology department reports (OR, 3.45; 95 % CI, 1.47-8.05), and receiving final radiology reports for CT scans (OR, 3.30; 95 % CI, 1.67-6.52), and lack of in-department training programs (OR, 2.51; 95 % CI, 1.34-4.70). Conclusion: The TraCT-EM study highlighted a 65 % accuracy rate for senior EM residents in trauma CT interpretation, with specific predictors of failure identified. These findings suggest a need for tailored radiology education strategies to enhance training and competency in trauma CT interpretation for EM residents. Further optimization of educational programs could address these gaps, ultimately improving patient outcomes in trauma care. (c) 2024 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
V. Ulusal Travma ve Acil Cerrahi Kongresi bildirilerinin değerlendirilmesi
(2008) Deniz, Turgut; Saygun, Meral; Şahiner, İbrahim Tayfun; Ağalar, Fatih; Taviloğlu, Korhan; Yorgancı, Kaya; Ertekin, Cemalettin
AMAÇ: V. Ulusal Travma ve Acil Cerrahi Kongresi’nde sunulan bildiri özetlerinin öz yazım kılavuzuna uygunluğu değerlendirildi; demografi, metodoloji ve yazım tekniği yönünden incelendi. GEREÇ-YÖNTEM: Kongre kitapçığındaki 451 bildiri değerlendirmeye alındı. Değerlendirilen parametreler; çalışmanın türü ve içeriği, çalışmanın yapıldığı kurumlar, yazar sayısı, başlık kullanımının uyumluluğu, yapısal öz kullanımı, sözcük sayısı, dilin akıcılığı, uygun istatistiksel değerlendirme ve sonuç-öz ilişkisiydi. BULGULAR: Çalışmaların %49’u retrospektif, %29’u olgu sunumuydu. Bildirilerin %33’ü izole organ yaralanması, %26’sı tek sistem yaralanması, %24’ü çoklu sistem yaralanmasına ilişkindi. Çalışmaların %43’ü üniversite, %38’i devlet hastanesi kökenliydi. Çalışmaların %40’ı genel cerrahiyle ilgiliydi, %29’u ise multidisiplinerdi. Çalışmalardaki ortalama yazar sayısı 5,6±1,8 idi; üniversite ve devlet hastaneleri arasında istatistiksel olarak anlamlı farklılık saptandı (p=0,001). Bildirilerin %91’inde yapısal öz vardı, %57’si 100-250, %42’si ise 250-500 sözcük içermekteydi. Çalışmaların %73’ü akıcı olarak değerlendirildi. Tüm bildirilerin %19’unda istatistiksel yöntem uygulandığı belirlendi. Bildirilerin çoğu akıcı idi. İstatistiksel analiz uygulama yönünden üniversite ve devlet hastaneleri arasında anlamlı fark saptandı (p=0,001). Sonuç-öz ilişkisi bildirilerin %71’inde yeterli olarak değerlendirildi. SONUÇ: Bildiri özeti yazma konusunda bazı sorunlarımızın olduğu saptanmıştır. Yapısal öz kullanımı, akıcılık ve yazım kurallarına uyumu artırmaktadır. Özellikle çoklu yaralanlamaları irdeleyen klinik çalışmalar ve deneysel çalışmalar özendirilmeli, bu yönde araştırmalar teşvik edilmelidir.
The evaluation of general knowledge of emergency care providers about child abuse and neglect
(2017) Özen, Mehmet; Ramadan, Hayri; Vural, Sevilay; Coşkun, Figen
Amaç: 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 uygulanmalıdır
Acil Servise Epileptik Nöbetle Başvuran Hastalarda Nöbeti Tetikleyen Faktörler ve Bir Haftalık Takipte Nöbet Tekrarlama Sıklığı
(2019) Bilgin, Ali; Avcı, Sema; Ramadan, Hayri; Coşkun, Figen
Amaç: Bu çalışmada epileptik nöbet geçirme şikayetiyle acil servise başvuran hastalarda, epileptik nöbeti tetikleyen faktörler ve taburculuk sonrası bir haftalık dönemde nöbet tekrarlama durumunun araştırılması amaçlandı. Gereç ve Yöntem: Çalışma, prospektif olarak üçüncü basamak bir eğitim ve araştırma hastanesinin acil servisinde Ocak 2013- Temmuz 2013 tarihleri arasında yapıldı. Çalışmaya toplam 90 hasta dâhil edildi. Tüm hastaların verileri acil servise başvuru anında, standardize edilmiş bir çalışma formuna kaydedildi. Hastalar taburcu edildikten bir hafta sonra telefonla aranarak nöbet geçirme sıklıkları ve ilaç kullanma bilgileri sorgulandı. İstatistiksel analiz SPSS for Windows 18.0 (SPSS Inc., Chicago, USA) programında yapıldı. İstatistiksel olarak p<0.05 anlamlı kabul edildi. Bulgular: Hastalar nöbet sıklığını arttıran faktörler açısından değerlendirildiğinde; yaş, cinsiyet, nöbetten önceki son 24 saat içerisinde alkol alımı, kullanılan antiepileptik ilaçta doz atlanması ve kullanılan antiepileptik ilaç grubu açısından anlamlı fark saptanmadı. Düzenli ilaç kullananlarda, istatistiksel olarak anlamlı (p<0.05) nöbet sıklığında azalma saptandı. Nöbetten önceki son 24 saatte uykusuz kalanlar (p=0.026), stresli bir durumla karşılaşanlar (p=0.048) ve bekar olanlarda (p=0.001) istatistiksel olarak anlamlı nöbet sıklığında artma saptandı. Sonuç: Acil servise nöbet geçirme şikâyetiyle başvuran hastalarda nöbet sıklığını etkileyen faktörler arasında düzenli ilaç kullanımı, medeni durum, son 24 saatte uykusuz kalma veya stresli durum yaşama anlamlı bulunmuştur.
Ülkemizde Acil Tıp Anabilim Dalları’nda acil servislerin fonksiyonel mimari açısından değerlendirilmesi
(2007) Deniz, Turgut; Aydınuraz, Kuzey; Oktay, Cem; Saygun, Meral; Ağalar, Fatih
AMAÇ Ülkemizdeki Acil Tıp Anabilim Dalları’na (ATAD) bağlı acil servislerinin iç ve dış mimari yapıları araştırıldı. GEREÇ VE YÖNTEM Tanımlayıcı tipteki bu araştırmada, çalışmanın yapıldığı tarihte mevcut olan 26 ATAD’ye anket formları gönderildi. Bu anketle acil servislerin iç ve dış mimari yapıları ve fonksiyonel hizmet durumları sorgulandı. Anketi yanıtlayan 22 ATAD’nin verileri değerlendirmeye alındı. Henüz kurulma aşamasında olan ve hizmet vermeyen iki Anabilim Dalı çalışmaya dahil edilmedi. BULGULAR Geri bildirimlerin değerlendirilmesinde ATAD’den ancak %59’unun (n=13) hizmet verdikleri alanın acil servis alanı olarak planlandığı izlendi. Acil servislerin ambulans girişlerinin %77 oranında uygun olmadığı, %54,5 ATAD’de (n=12) acil servis girişinde ambulansların hasta bıraktığı alanın hava koşullarından korumalı olmadığı görüldü. Gelen yanıtlara bakıldığında ancak %59 ATAD’de (n=13) acil serviste triyaj ünitesinin bulunduğu, yine sadece bir ATAD’de (%4,5) acil serviste temizlenme (dekontaminasyon) odası bulunduğu bildirildi. Halen hizmet vermekte olan ATAD’lerine bağlı acil servislerin ancak %32’sinde (n=8) mevcut lokal risk faktörleri doğrultusunda genişleyebilme düzeyinin yeterli olabileceği belirlendi. ATAD’lerin sadece %18’inde (n=4) özürlü tuvaletinin var olması ülke genelinde özürlülere yönelik mimari değişikliklerin eksikliğinin acil servislerde de olduğunun göstergesidir. Acil tıbbın ülkemizde 12 yıllık geçmişi olduğu düşünüldüğünde ATAD’lerin ancak %68’inde (n=15) seminer odalarının var olması, akademik yapılanmaya fiziksel alt yapı yetersizliği olan yerlerde başlandığının göstergesidir. SONUÇ Ülkemizdeki acil tıp yapılanması içerisinde acil servis mimarisine gereken önemin verilmediğini, verilen hizmetteki bilimselliğin mimari yetersizliklerle gölgelendiğini göstermiştir. Acil servis mimari tasarımı, bilimsel veri ve kurallar çerçevesinde sağlanmalıdır. Bunun için hastane ve özellikle acil servis mimarisi hakkında bilgi ve tecrübesi olan mimar veya mimarlar yetkili kişiler ile hedefler üzerinde bir anlaşmaya varmalıdırlar.
Endothelial and Autonomic Functions in Patients with Migraine
(OXFORD UNIV PRESS, 2020) Dogru, Mehmet Tolga; Dilekoz, Ergin; Alpua, Murat; Eroglu, Oguz; Kandemir, Hilseyin; Alp, Caglar; Bolay, Hayrunnisa
Objective It has been shown that patients with migraine have endothelial dysfunction. Migraine patients with aura, especially, have more clinical manifestations of autonomic nervous system dysfunction. We aimed to evaluate the endothelial and autonomic functions in migraine patients during both migraine headache attack and headache-free periods. Design This was a cross-sectional, randomized study. Subjects and Methods A total of 130 participants (67 male and 63 female patients, minimum age = 19 years, maximum age = 71 years, mean age = 38.812.2years) were enrolled into the study. For the statistical evaluation of data, we classified the participants of the study as follows: group 1: headache (+) aura (+); group 2: headache (+) aura (-); group 3: headache (-) aura (+); group 4: headache (-) aura (-). Noninvasive evaluation of endothelial function was performed by flow-mediated dilation (FMD) and pulse wave analysis methods. Heart rate variability measurements were used for noninvasive evaluation of autonomic functions. Results Group 1 had a higher FMD ratio than the control group, group 3, or group 4 (P<0.001, P<0.001, and P=0.003, respectively). Group 4 had lower FMD ratio levels than the other migraine groups and or the control group (P<0.001). Group 3 had the highest high-frequency (HF) power levels among all migraine groups (P<0.001). Group 2 had higher low-frequency/HF ratio values than other migraineurs (P<0.001). Conclusions We concluded that endothelial dysfunction and headache are closely related. Additionally, higher parasympathetic tonus might be associated with the presence of aura.
The Effect of Extractum Cepae, Heparin Sodium, and Allantoin in Experimental Peritoneal Adhesion
(SPRINGER INDIA, 2020) Ozmen, Ismail; Gunal, Yasemin Dere; Atasoy, Pinar; Kisa, Ucler; Yorubulut, Serap; Aslan, Mustafa Kemal; Boybeyi-Turer, Ozlem
The purpose of the study is to investigate the effects of extractum cepae (EC), heparin sodium (HS), and allantoin (AA) on postoperative peritoneal adhesion (PPA) prevention. Forty-eight rats were allocated into six groups (n = 8). PPA was performed by Harris method. In group 1, no additional procedure was done. Abdominal cavity was washed with normal saline in group 2, EC in group 3, HS in group 4, AA in group 5, and EC-HS-AA mixture (EHA-m) in group 6. On the 21st postoperative day, PPA was scored with Nair adhesion score and examined for fibrosis histopathologically and hydroxy-proline levels (OHP) biochemically. Macroscopically, PPA was decreased in groups 2, 4, and 6 compared to groups 1, 3, and 5 (p < 0.05) and decreased in group 2 compared to other groups (p < 0.05). Histopathologically, fibrosis was decreased in groups 2, 4, and 6 compared to other groups and decreased in group 2 compared to other groups (p < 0.05). Tissue OHP level was decreased in groups 2, 3, 4, and 5 compared to groups 1 and 6 (p < 0.05). Tissue OHP level was decreased in group 6 compared to group 1, but the difference was not statistically significant. PPA formation decreases with normal saline, HS and EHA-m, whereas increases with EC and AA both macroscopically and microscopically. Although HS and EHA-m seem to have adhesion prevention effect, washing the intestines with saline seems to be more effective.
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, Figen
Background: 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.
Osborn wave in hypothermia and relation to mortality
(W B Saunders Co-Elsevier Inc, 2019) Eroğlu, Oğuz; Serbest, Sancar; Küfeciler, Tarkan; Kalkan, Asım
Background & aim: The aim of this study was to compare hypothermia patients with and without an Osborn wave (OW) in terms of physical examination findings, laboratory results, and clinical survival. Methods: The study was carried out retrospectively on hypothermic patients. The hypothermic patients were divided into two groups. Group 1 comprised patients with OW on electrocardiogram (ECG), and Group 2 comprised patients without OW on ECG. The Mann-Whitney U test was used to compare the two groups, and the relationships between the variables and the presence of OW and mortality were analyzed with ANOVA. A value of p < 0.05 was considered statistically significant. Results: OW was detected on ECG of 41.9% of the patients (Group 1). The mean body temperature was 30.8 +/- 4.1 degrees C in Group 1 and 33.3 +/- 1.6 degrees C in Group 2 (p = 0.106). The mean creatinine level was 1.01 +/- 0.6 mg/dl in Group 1 and 0.73 +/- 0.5 mg/dl in Group 2 (p = 0.046). The mean bicarbonate level was 15.9 +/- 3.8 mmol/l in Group 1 and 18.6 +/- 3.5 mmol/l in Group 2 (p = 0.038). A relationship was determined between the presence of OW and pH, bicarbonate, and creatinine levels (p = 0.026; 0.013; 0.042, respectively). The mortality rate was 69.2% in Group 1 and 77.8% in Group 2 (p = 0.689). Conclusion: Although there is a relationship between the decrease in bicarbonate levels, changes in kidney functions that cause acidosis, and the presence of OW, it has no effect on mortality. The presence of OW in hypothermic patients is insufficient to make a decision regarding mortality. (C) 2018 Elsevier Inc. All rights reserved.
On demand pancreatic stenting in chronic pancreatitis might provide good palliation of pain
(Univ Catholique Louvain-Ucl, 2019) Etik, D. O.; Parlak, E.; Oguz, D.; Oztas, E.; Kacar, S.; Onder, F. O.; Sahin, B.
Background and aim : Chronic pancreatitis (CP)-related pain is a considerable problem in gastroenterology practice that frequently requires several endoscopic interventions. We aimed to investigate the efficacy of pancreatic duct stenting performed on demand, instead of at defined intervals, for the management of the CP-related pain. Methods : This study is a retrospective evaluation of thirteen years of data. Sixty-seven patients with CP who suffered from intractable pain were enrolled in the study. Pancreatic stenting was performed mainly with single stents according to the diameter of the pancreatic duct and width of the stricture or, less frequently, with multiple stents to achieve stricture resolution. The subsequent endoscopic session was scheduled based on the patient's symptoms. Results : Overall, 65 of 67 patients underwent successful pancreatic cannulation (technical success rate 97%). Fifty-seven patients with a pancreatic stenting history were still undergoing follow-up. Of these patients, 26 patients still had pancreatic ductal stents; however, the stents were removed from 31 patients. Only 8 patients (25%) required furtherendoscopic or surgical intervention because of the re-emergence of pain after a median stent-free period of 17 months (3-127 months). One patient with a biliary stricture and one patient with a pancreatic mass underwent surgery. Pancreatic stents remained for a median length of 14 months (3-84 months). During the follow-up period, 55 of 65 patients became pain-free or had partial pain relief (clinical success rate 84%). Conclusions : On demand replacement of pancreatic stent is feasible in patients with CP and it might provide a good palliation of CP-related pain.
How much apoptosis does carbon monoxide poisoning cause? Primary clinical soluble TWEAK protein level study
(Sage Publications Ltd, 2019) Badem, N. Dindar; Comertpay, E.; Coskun, F.
Carbon monoxide (CO) is an important cause of deaths via poisoning. CO poisoning causes inhibition of O-2 transport and development of tissue hypoxia, which then causes cell apoptosis. A significant indicator of cell apoptosis, soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) protein, is important for the stimulation of apoptosis. The primary purpose of this study is to determine whether apoptosis occurs during acute CO poisoning and to show that sTWEAK protein is an indicator of apoptosis that can be analyzed as a marker in the peripheral blood sample. The secondary aim is to determine the diagnostic and prognostic values of sTWEAK protein. The study was performed prospectively on 43 patients with CO poisoning and 30 healthy volunteer control individuals. The anamneses were taken from all patients, who also underwent physical examination. Complete blood count, biochemical markers, cardiac enzymes, and arterial blood gas measurements were analyzed. All the patients' sTWEAK protein levels were also analyzed. The sTWEAK protein level of patients with CO poisoning was 2278 pg/mL (1197-7234), while the level of the control group was 1609 pg/mL (310-3721). The patients' sTWEAK levels were significantly higher than the controls (area under the curve: 0.77 (0.66-0.89); p < 0.001), and the cutoff value was determined as 1895.50 pg/mL. The cutoff level had a sensitivity of 74.4%, a specificity of 76.7%, a positive predictive value of 82.0%, and a negative predictive value of 67.6%. sTWEAK is a significant indicator of apoptosis in CO poisoning that can be analyzed in the peripheral blood. However, further clinical trials are needed in terms of prognostic criteria.
The relation between scapula fracture and the severity of trauma in blunt thoracic trauma
(Tubitak Scientific & Technical Research Council Turkey, 2018) Algan Kaya, Hatice; Eroglu, Oguz; Gunal, Nesimi; Coskun, Figen; Deniz, Turgut
Background/aim: The aim of this study was to determine the level of presence of scapula fractures (SFs) in cases of blunt thoracic trauma and to identify other injuries accompanying SF. Materials and methods: Blunt thoracic trauma cases with SF determined on direct radiography or computerized tomography (CT) were categorized as Group 1. Group 2 was constituted by selecting cases with high injury severity score (ISS) with no SE The demographic characteristics and all injuries of the patients were evaluated. Results: SF was determined in 77 (11.3%) patients (Group 1), and Group 2 consisted of 607 patients. The ISS was significantly higher in Group 1(27.7 +/- 16.1) than Group 2 (15.9 +/- 9.5) (P < 0.001). The rate of SF with direct radiography was only 9.1%, and more than 90% of patients were evaluated using CT. The most common accompanying injury to SF was rib fracture (44.2%), and the odds ratio was 2.4 (95% CI: 1.51-3.72). Conclusion: The incidence of SF in cases of blunt trauma was higher than in previous studies. The use of CT in blunt trauma can determine SF that cannot be identified through physical examination or radiography, and the most commonly observed accompanying damage in these patients is rib fracture.
Medical students' knowledge of ultrasonography: effects of a simulation-based ultrasound training program
(African Field Epidemiology Network-Afenet, 2018) Eroğlu, Oğuz; Coşkun, Figen
Introduction: The use of simulation devices in medical education is becoming more prevalent with each passing day. The present study aimed to teach medical students to perform ultrasonography via a simulation-based ultrasound training program. Methods: The study was prospectively conducted on final year medical students who had not received previous ultrasound training and who came to the Emergency Department of the Kirikkale University Faculty of Medicine between July 2015 and July 2016. Ultrasound training was provided by two emergency department specialists who are qualified in this field. The training time was determined to be 20h (4h for theoretical lessons, 16h for hands-on). The students were evaluated by a theory test and practical application exam both before and after training. Results: Obtained were compared using the paired sample t-test, and p < 0.05 was considered to be significant. Results: Ninety-six final year medical students were included. Their mean age was 24.1 +/- 2.1 years. The mean test score obtained in the theoretical exam before training was 7.9 +/- 2.2, while that after training was 17.1 +/- 1.6 (p < 0.0001). The mean score obtained in the practical application exam before training was 1.1 +/- 0.9 points and that after training was 10.9 +/- 0.2 points (p < 0.0001). Conclusion: Medical students can learn to use an ultrasound device within a short period of time via simulation-based training programs. New studies must be conducted for the inclusion of ultrasound training programs in the medical education curriculum.

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