Publications by authors named "Seda Ozkan"

32 Publications

Comparison of Trauma Severity Scores (ISS, NISS, RTS, BIG Score, and TRISS) in Multiple Trauma Patients.

J Trauma Nurs 2021 Apr-Jun 01;28(2):100-106

Emergency Service, Sincan Dr Nafiz Körez State Hospital, Ankara, Turkey (Dr Höke); Department of Emergency Medicine, Dışkapı Yıldırım Beyazıt Education and Traning Hospital, Ankara, Turkey (Dr Usul); and Department of Emergency Medicine, University of Cerrahpaşa, I.stanbul, Turkey (Dr Özkan).

Background: Trauma severity scoring systems are routinely used to monitor trauma patient outcomes. Yet, the most accurate scoring system remains an elusive target.

Objective: We aim to compare trauma severity scales (ISS, NISS, RTS, TRISS, and BIG) in multitrauma patients and investigate BIG as one of the new trauma severity scoring systems.

Methods: The demographic data of the patients, vital signs, injury mechanisms, body regions exposed to trauma, final diagnosis, the injury severity scales-Injury Severity Score (ISS), New Injury Severity Score (NISS), Revised Trauma Score (RTS), base deficit, international normalized ratio, and Glasgow Coma Scale (BIG), and Trauma and Injury Severity Score (TRISS)-the length of stay in hospital, and the progress of the patients were examined.

Results: A total of 426 cases were included in the study. The best performing score in determining mortality was TRISS (area under the curve [AUC]: 0.93, sensitivity 97.1% and specificity 76.7%). This was followed by the NISS, BIG, ISS, and RTS, respectively. For the prediction of intensive care unit admission, the NISS was the most successful with an AUC value of 0.81. There was a significant relationship in terms of the length of stay in all trauma scores (p < .05).

Conclusions: The most successful score in predicting mortality in trauma patients was the TRISS, whereas the NISS was the most successful in predicting intensive care unit admission. The newly developed BIG score can be used as a strong scoring method for predicting prognosis in trauma patients.
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http://dx.doi.org/10.1097/JTN.0000000000000567DOI Listing
March 2021

Efficacy of Serum Angiotensin II Levels in Prognosis of Patients With Coronavirus Disease 2019.

Crit Care Med 2021 Feb 26. Epub 2021 Feb 26.

Cerrahpasa Faculty of Medicine, Department of Emergency Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey. Cerrahpasa Faculty of Medicine, Department of Medical Biochemistry, Istanbul University-Cerrahpasa, Istanbul, Turkey. Cerrahpasa Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Istanbul, Turkey. Cerrahpasa Faculty of Medicine, Department of Intensive Care, Istanbul University-Cerrahpasa, Istanbul, Turkey.

Objectives: We aimed to determine serum angiotensin II levels in patients with coronavirus disease 2019 infection and to investigate the effect of these levels on the prognosis of the disease.

Design: The study was planned prospectively and observationally.

Setting: The study was conducted in a tertiary university hospital.

Patients: Coronavirus disease 2019 patients older than 18 years old, polymerase chain reaction test positive, with signs of pneumonia on tomography, and hospitalized were included in the study. ICU need, development of acute respiratory distress syndrome, and in-hospital mortality were considered as primary endpoints.

Interventions: Blood samples were taken from patients three times for angiotensin II levels.

Measurements And Main Results: Angiotensin II levels were studied by enzyme-linked immunosorbent assay method. The SPSS 24.0 program (Statistics Program for Social Scientists, SPSS, Chicago, IL) was used to analyze the data. A total of 112 patients were included in the study, of which 63.4% of the patients were men. The serum angiotensin II levels were statistically significantly lower in the patients with coronavirus disease 2019 compared with the healthy control group (p < 0.001). There was no statistical significance between the serum angiotensin II levels measured at three different times (p > 0.05). The serum angiotensin II levels of the patients with acute respiratory distress syndrome were found to be statistically significantly lower than those without acute respiratory distress syndrome in three samples collected at different clinical periods (p < 0.05). The angiotensin II levels of the patients who required admission to the ICU at all three times of blood sample collection were found to be statistically significantly lower than those who did not (p < 0.05). Although the serum angiotensin II levels of the patients who died were low, there was no statistically significant difference in mortality at all three times (p > 0.05).

Conclusions: The serum angiotensin II levels decrease significantly in patients with coronavirus disease 2019, and this decrease is correlated with lung damage.
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http://dx.doi.org/10.1097/CCM.0000000000004967DOI Listing
February 2021

The role of plasma presepsin levels in determining the incidence of septic shock and mortality in patients with sepsis.

J Infect Dev Ctries 2021 Jan 31;15(1):123-130. Epub 2021 Jan 31.

Department of Emergency Medicine, Etimesgut Şehit Sait Ertürk State Hospital, Ankara, Turkey.

Introduction: The present study aimed to investigate the role of plasma presepsin in the early detection of septic shock and in determining the prognosis and mortality of patients with sepsis.

Methodology: The study was conducted in the emergency department between 1 January 2017 and 1 July 2017. A total of 106 patients 18 years of age or older who were diagnosed with sepsis according to the quick sequential organ failure assessment (qSOFA) criteria were included in this prospective study. The patients' symptoms, vital signs, additional diseases, demographic attributes, laboratory results, Mortality in Emergency Department Sepsis (MEDS) scores, imaging findings and treatments were recorded. Moreover, the patients' blood samples were collected to measure plasma presepsin, procalcitonin and CRP levels.

Results: In total, 55.7% of the patients were female. The median age of the patients was 78 (24-103) years, and their 30-day mortality rate was 67%. The presepsin level was significantly higher in the sepsis group than in the healthy control group (p < 0.001). The presepsin levels did not differ significantly between the sepsis and septic shock groups (p = 0.12). Similarly, the procalcitonin levels did not differ significantly between the sepsis and septic shock groups (p > 0.05). There was no significant difference in the presepsin, procalcitonin and CRP levels between survivor and non-survivor patients (p = 0.74).

Conclusions: The plasma presepsin level was found to be ineffective in determining the incidence of septic shock and mortality in patients with sepsis in the emergency department.
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http://dx.doi.org/10.3855/jidc.12963DOI Listing
January 2021

Chest Computed Tomography Findings of Eight Patients With Covid-19 Diagnosis: Case Series.

Acta Biomed 2021 01 19;91(4):e2020136. Epub 2021 Jan 19.

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COVID-19 is an infectious disease caused by the virus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and declared a pandemic on March 11, 2020, by the world health organization. In Turkey, the first cases began to appear on March 11, 2020. After the cases in China, the appearance of ground glass with or without consolidation in the posterior and periphery of the bilateral lung is determined as the main finding of COVID-19. In this article, we wanted to share the tomography findings of eight patients who were diagnosed with COVID-19 in our emergency department and who had lung involvement.
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http://dx.doi.org/10.23750/abm.v91i4.9722DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7927549PMC
January 2021

Comparison of pneumonia severity scores for patients diagnosed with pneumonia in emergency department.

Indian J Med Res 2020 Oct;152(4):368-377

Department of Emergency Medicine, Antalya Training & Research Hospital, Antalya, Turkey.

Background & Objectives: : Sepsis due to pneumonia or pneumonia itself is one of the main causes of deaths in patients despite the advanced treatment methods. The optimal prognostic tool in pneumonia is still not clear. This study was aimed to compare the pneumonia severity scores and the possibility of using the new scores in patients who were diagnosed with pneumonia in the emergency department.

Methods: : Demographic data, laboratory and imaging results, confusion, elevated blood urea nitrogen, respiratory rate and blood pressure plus age ≥65 yr (CURB-65), pneumonia severity index (PSI), national early warning score (NEWS), NEWS-lactate (NEWS-L) scores, hospitalization, referral, discharge and 30-day mortality of patients who were diagnosed with pneumonia in emergency department were recorded.

Results: : A total of 250 patients were included in the study. The most successful score in predicted mortality was found to be NEWS-L. This was followed by NEWS, CURB-65 and PSI, respectively. Most successful scores in anticipation of admission to the intensive care unit were NEWS-L followed by NEWS. This was followed by CURB-65 and PSI scores, respectively. The most successful score in anticipation of hospital admission was NEWS-L, followed by NEWS, CURB-65 and PSI, respectively. There was a significant difference between all pneumonia severity scores of the patients who died and survived within 30 days. There was a significant difference between the scores of patients in intensive care unit (ICU) and service, compared to non-ICU patients.

Interpretation & Conclusions: : NEWS-L score was found to be the most successful score in predicting mortality, ICU admission and hospitalization requirement. Both NEWS-L and NEWS scores can be used in determining the mortality, need for hospitalization and intensive care of the patients with pneumonia in the emergency department.
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http://dx.doi.org/10.4103/ijmr.IJMR_595_18DOI Listing
October 2020

Relationship between right ventricular dilatation and blood copeptin levels in patients with acute pulmonary embolism.

Clin Respir J 2020 Oct 9;14(10):965-972. Epub 2020 Jul 9.

Department of Cardiology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.

Purpose: In this study, we aimed to investigate the importance of copeptin in the diagnosis of acute pulmonary embolism, detection of right ventricular dilatation and clinical severity and prognosis of pulmonary embolism.

Materials And Methods: In the study three groups were created; Group 1: Pulmonary embolism patients with right ventricular dilatation in echocardiography, Group 2: Pulmonary embolism patients without right ventricular dilatation in echocardiography, Group 3: Healthy people. Five mL of venous blood was collected for the measurement of serum copeptin from the patients and control group. D-dimer and troponin were studied with routine blood samples. Complaints, symptom and physical examination findings, tomography and echocardiography results, laboratory results of patients and treatments they received were recorded for the statistical analysis.

Results: Copeptin levels of acute pulmonary embolism patients were significantly higher than healthy individuals (P < 0.001). Copeptin values of Group 1 patients were significantly higher than Group 2 patients and Group 3 patients (P < 0.001). There was a statistically significant difference the levels of copeptin, D-dimer and troponin between patients with right ventricular dilatation and patients without right ventricular dilatation (P < 0.05). AUC value in detecting right ventricular dilatation of copeptin was found to be 0.82, while specificity was 83.3% and sensitivity was 69.6%. Copeptin, D-dimer and troponin levels of patients with increased pulmonary artery pressure were statistically significantly higher than patients with normal pulmonary artery pressure (P < 0.05).

Conclusion: Copeptin can be used in the diagnosis of acute pulmonary embolism and in the detection of right ventricular dilatation in pulmonary embolism.
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http://dx.doi.org/10.1111/crj.13230DOI Listing
October 2020

The role of presepsin in the diagnosis of chronic obstructive pulmonary disease acute exacerbation with pneumonia.

Biomark Med 2020 01 8;14(1):31-41. Epub 2019 Nov 8.

Department of Emergency Medicine, University of Istanbul-Cerrahpasa, Faculty of Medical, 34098, Istanbul, Turkey.

In this study, we aimed to investigate the role of presepsin in detecting concomitant pneumonia in patients presenting with acute exacerbation of chronic obstructive pulmonary disease (COPD) in the emergency department. Three groups were formed in the study. Group 1: patients diagnosed with acute exacerbation of COPD; group 2: patients with acute exacerbation of COPD + pneumonia; group 3: healthy individuals. Presepsin levels of the patients in group 2 were significantly higher than those of group 1 and group 3 (p < 0.05). There was a statistically significant difference in erythrocyte sedimentation rate, CRP, procalcitonin and presepsin values between two patient groups (p < 0.05). Presepsin can be used to diagnose pneumonia in patients with acute exacerbation of COPD admitted to the emergency department.
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http://dx.doi.org/10.2217/bmm-2019-0183DOI Listing
January 2020

Comparison of ultrasound and physical examination with computerized tomography in patients with blunt abdominal trauma.

Ulus Travma Acil Cerrahi Derg 2019 Jul;25(4):369-377

Department of Radiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara-Turkey.

Background: In cases of blunt abdominal trauma, the abdomen is the third most affected region. Computerized tomography (CT) is the gold standard for the evaluation of these patients. However, considering its damaging effects and high cost, it may not be proper to refer every patient applying to the emergency unit for a CT examination. In this study, our objective was to compare the accuracy of ultrasonography (US) and physical examination in blunt abdominal trauma patients to the gold standard CT in order to prevent unnecessary CT examinations.

Methods: In this retrospective study, the files and images of 2248 patients, who applied to the emergency department of our hospital were screened. A total of 535 adult patients who underwent CT scanning after the ultrasonographic and physical examinations were included in the study. The findings of the US and physical examinations, the intraabdominal free fluid, and organ lacerations were compared to the results of CT. The compatibility, sensitivity, specificity, positive estimated value, and the negative estimated value of the obtained data were analyzed with statistical methods.

Results: The sensitivity of US in the demonstration of the intraabdominal free fluid was comparable with the sensitivity of CT in the patients with blunt abdominal trauma (p=0.302). The sensitivity and specificity of US was 49.6% and 99.3% respectively in the determination of the intraabdominal organ injuries. The sensitivity and specificity of the physical examination was 59% and 87% respectively in the determination of the free fluid and organ injury as compared to CT. Although the sensitivity and specificity of the physical examination were high separately in the organ injuries according to the statistical calculations, they seemed not to have had a statistically significant predictive value (p<0.001).

Conclusion: Even though US is a reliable method for the determination of the intraabdominal fluid, US and physical examination are not reliable in the determination of the organ injuries as compared to CT.
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http://dx.doi.org/10.5505/tjtes.2018.88288DOI Listing
July 2019

Endosulfan induced cardiac arrest treated with intravenous lipid emulsion.

Acta Biomed 2019 01 15;89(4):573-575. Epub 2019 Jan 15.

Kars Harakani State Hospital.

Objective: Endosulfan is an organochlorine pesticide with high lipophilic features that makes it a well-absorbed agent and penetrates easily to the site of action. Endosulfan toxicities may result in disastrous complications and have high rates of mortality. Several case reports and some researchs discuss the evidence supporting intravenous lipid emulsion (ILE) therapy as a rescue therapy in lipophilic agents' toxicity.

Case Report: A 33-years-old healthy woman with  a history of endosulfan ingestion of uncertain quantity in a suicide attempt six hours ago was admitted to our emergency department. Cardiac arrest ensued after one hour of admission. Cardiopulmonary resuscitation was initiated in accordance with advanced cardiac life support (ACLS) algorithm for asystole. During resuscitation, 2 mL/kg bolus of 20% intravenous lipid emulsion (ILE) was administered for three times at five-minute intervals in addition to ACLS guidance. Spontaneous circulation returned after twenty minutes of resuscitation. No additional antidotal or vasopressor therapies were required during the hospital course of the patient. To our knowledge, this is the first reported case with responded use of ILE treatment for endosulfan toxicity.

Conclusion: This case report indicates that ILE treatment should be considered for life-threatening endosulfan intoxications.
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http://dx.doi.org/10.23750/abm.v89i4.6582DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502109PMC
January 2019

Evaluation of intra-abdominal solid organ injuries in children.

Acta Biomed 2019 01 15;89(4):505-512. Epub 2019 Jan 15.

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Aim: In our study we investigated characteristics and degree of intra-abdominal solid organ injuries according to tomographic imaging in pediatric patients who presented to our emergency clinic with possible abdominal injuries and to whom US and/or abdominal tomography were applied.

Materials And Methods: 1066 pediatric patients were included in the study. The age, gender, injury localization, injury type, injury mechanism, abdominal US and CT results, and treatment specifics of patients were evaulated.

Results: 58.5% of cases were male. Average age of children was 7.1±4.6 70.8% of the injuries occured in the outdoors. As for injury type, 92.8% of the injuries were blunt and 7.2% were penetrating traumas. The most common mechanism of injury was motor vehicle accidents at 41.4%. The most common abdominal physical examination finding was tenderness with a prevelance of 67%. In patients with solid organ injury, liver injury was detected in 47% of patients, spleen injury was detected in 36% of patients and renal injury was detected in 17% of patients. Grade II injury was the most common grade. 96.5 of patients were provided conservative treatment and 3.5% of patients were treated surgically.

Conclusion: Solid organ injuries due to abdominal trauma in children are generally related to blunt trauma and are severe injuries. CT angio is an important imaging method for detecting solid organ injuries, classification of the injury and treatment determination. Greater than 90% of solid organ injuries in children can be treated successfully with conservative methods.
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http://dx.doi.org/10.23750/abm.v89i4.5983DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502091PMC
January 2019

Red blood cell distribution width as a predictor of long-term mortality in patients with carbon monoxide poisoning.

Turk J Emerg Med 2018 Dec 14;18(4):158-161. Epub 2018 Jul 14.

Department of Cardiology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.

Objectives: Elevated red blood cell distribution width (RDW) is an independent prognostic factor for cardiovascular events that are major causes of mortality in patients with carbon monoxide (CO) poisoning. Due to the limited number of studies, we aimed to investigate the relationship between RDW levels and long-term mortality for these patients.

Method: This retrospective study included patients with CO poisoning, who presented to the emergency department. Baseline characteristics, laboratory results and survival status were retrieved from patients' hospital records. The severity of poisoning was determined according to COHb level and/or clinical signs and symptoms.

Results: The study included 571 patients (median age was 37.0 years) and less than half of these patients were male (n = 206, 36.1%). There were mild-moderate CO poisoning in 389 (68.1%) patients and severe poisoning in 182 (31.9%). At a median follow-up of 6.2 years, there were 33 deaths (5.8%). Univariate cox-regression analysis demonstrated that age, gender, presence of hypertension or diabetes mellitus, levels of hemoglobin, RDW, creatinine and alanine-aminotransferase, and white-blood-cell count were potential covariates of long-term all-cause mortality. In the multivariate analysis, the median age and RDW level remained independent predictors of mortality (age, Odds ratio [OR]: 1.070 95% confidence interval [CI]: 1.030-1.110, p = 0.001; RDW, OR: 1.221 95% CI: 1.042-1.431, p = 0.013). Patients with higher RDW levels had a significantly worse prognosis in terms of mortality than with lower RDW levels (log-rank test, p = 0.003).

Conclusion: This study demonstrated that RDW level is an independent predictor of long-term mortality in patients with CO poisoning.
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http://dx.doi.org/10.1016/j.tjem.2018.05.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6261103PMC
December 2018

Elevated cardiac enzymes due to mushroom poisoning.

Acta Biomed 2014 Dec 17;85(3):275-6. Epub 2014 Dec 17.

Department of Emergency Medicine, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.

Mushroom poisoning is an important reason of plant toxicity. Wild mushrooms that gathered from pastures and forests can be dangerous for human health. The clinical outcomes and symptoms of mushroom toxicity vary from mild gastrointestinal symptoms to acute multiple organ failure. Toxic effects to kidney and liver of amatoxin are common but cardiotoxic effects are unusual. In this case, we reported the cardiotoxic effect of amatoxin with the elevated troponin-I without any additional finding in electrocardiography, echocardiography and angiography.
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December 2014

Ataxia caused by a single dose of dexketoprofen trometamol.

Acta Biomed 2014 Dec 17;85(3):269-70. Epub 2014 Dec 17.

Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.

Mushroom poisoning is an important reason of plant toxicity. Wild mushrooms that gathered from pastures and forests can be dangerous for human health. The clinical outcomes and symptoms of mushroom toxicity vary from mild gastrointestinal symptoms to acute multiple organ failure. Toxic effects to kidney and liver of amatoxin are common but cardiotoxic effects are unusual. In this case, we reported the cardiotoxic effect of amatoxin with the elevated troponin-I without any additional finding in electrocardiography, echocardiography and angiography.
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December 2014

Anton syndrome during oxygen-ozone therapy.

Am J Emerg Med 2015 Jun 2;33(6):856.e1-2. Epub 2014 Dec 2.

Department of Emergency Medicine, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.

Ozone (O₃) gas is a molecule that consists of 3 oxygen atoms, found out in the mid-19th century [1]. Ozone gas preserves humans from detrimental influences of ultraviolet radiation [1]. In spite of harmful effects of O₃ gas, investigators think that it has excessive curative effects [1]. Nowadays, O₃ therapy is used for many fields of medicine in precise therapeutic doses [1] and [2]. It is known that O₃ therapy is helpful in dental procedures, cerebrovascular diseases, tinnitus, acquired immunodeficiency syndrome, hypercholesterolemia, sensorial hypoacusis, senile dementia, multiple sclerosis, irradiation sensitive tumors, herpes simplex and herpes zoster virus infections, muscular hypertonia, and chronic otitis media, etc.[2]. The complications and disadvantages of O₃ therapy could be observed in the future. Herein, we presented a case of ischemic stroke after an oxygen-O₃ therapy, which is called also Anton syndrome.
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http://dx.doi.org/10.1016/j.ajem.2014.11.041DOI Listing
June 2015

Importance of neutrophil gelatinase-associated lipocalin in differential diagnosis of acute and chronic renal failure.

Iran Red Crescent Med J 2014 Aug 5;16(8):e14133. Epub 2014 Aug 5.

Department of Emergency Medicine, Faculty of Medicine, Erciyes University, Kayseri, Turkey.

Background: Neutrophil Gelatinase-associated Lipocalin (NGAL) protein is easily detected in the blood and urine soon after acute renal injury. NGAL gains features of an early, sensitive and noninvasive biomarker for acute renal injury. Recent evidences suggest that its expression is also increased in CRF reflecting the severity of disease.

Objectives: In the present study, we aimed to investigate whether blood NGAL level plays a role in the differential diagnosis of acute and chronic renal failure.

Patients And Methods: This was a prospective case-control study. Fifty patients presented to emergency department with acute renal failure (ARF), 30 with chronic renal failure (CRF) and 20 healthy individuals as control group were included in this study. Blood pH, HCO3(-), BUN, creatinine and potassium values were evaluated in all patients. Blood NGAL values were evaluated in all groups. BUN, serum creatinine and NGAL values were statistically compared between patients and controls.

Results: Median NGAL levels in patients was 304.50 (29), and 60 (0) in control, which was statistically significant between the two groups (Z = -6.477, P < 0.001). The median NGAL values were 261.50 ± 291 in ARF group and 428.50 ± 294 in CRF group. There was a significant difference in NGAL level between ARF and CRF groups (Z = -2.52, P = 0.012). Median BUN values were 153.46 ± 82.47 in ARF group and 169.40 ± 93.94 in CRF group. There was no significant difference in BUN value between ARF and CRF groups (P > 0.05). Median creatinine values were 2.84 ± 2.95 in ARF group and 4.78 ± 4.32 in CRF group. In serum creatinine values, a significant difference was found between ARF and CRF groups (P < 0.05).

Conclusions: Serum NGAL levels of ARF and CRF patients were significantly higher than healthy individuals. In addition, NGAL values of patients with CRF were significantly higher than those of ARF. Serum NGAL values can be used to detect renal injury and differentiate ARF and CRF.
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http://dx.doi.org/10.5812/ircmj.14133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4222006PMC
August 2014

The accuracy rate of Alvarado score, ultrasonography, and computerized tomography scan in the diagnosis of acute appendicitis in our center.

Niger J Clin Pract 2014 Jul-Aug;17(4):413-8

Department of Emergency Medicine, Erciyes University Medical School, Kayseri, Turkey.

Objective: In this study, we aim to compare the relationship between the Alvarado score, ultrasonography, and multislice computerized tomography (CT) findings used for the diagnosis of the patients who presented to our emergency unit with clinical features suggestive of acute appendicitis.

Materials And Methods: Seventy-four patients operated with the diagnosis of acute appendicitis were included in the study. The demographic characteristics of the patients, physical findings, blood parameters, Alvarado scores, the radiological method used for the diagnosis, the surgical methods (open or laparoscopic) and the pathology results were recorded on the standard proforma. The collected data were analyzed with Statistical Package for Social Sciences (SPSS 15 for Windows, SPSS Inc., Chicago, Illinois, USA) computer program.

Results: During study period, the sensitivity of ultrasonography was found to be as 71.2%, specificity as 46.7%, the positive predictive value (PPV) as 82.2%, the negative predictive value (NPV) as 31.8%, and the accuracy rate was determined as 65.7%. The sensitivity of tomography was determined as 97.2%, the specificity as 62.5%, PPV as 92.1%, and NPV as 83.3%, and the accuracy rate was determined as 90%. The sensitivity of the Alvarado score was calculated as 54%, the specificity as 73.3%, the PPV as 88.2% and the NPV as 29.7%, and the accuracy rate was determined as 57.7%.

Conclusion: In conclusion, computerized tomography (CT) was found to have higher specificity and sensitivity than Alvarado score and USG which are not sufficient on their own for taking the decision for surgery. We also found that CT scan had lower negative laparotomy rate when compared with the other two modalities.
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http://dx.doi.org/10.4103/1119-3077.134001DOI Listing
September 2014

Does usage of peritonism tests in an emergency department have any benefit?

Med Glas (Zenica) 2014 Feb;11(1):105-9

1Department of Emergency Medicine, Canakkale Onsekiz Mart University Medical School, Canakkale, 2Erciyes University Medical School, Departments of Emergency Medicine, Kayseri, Turkey, 3Department of Emergency Medicine,Istanbul University Cerrahpasa Medical School; Istanbul, Turkey.

Aim: To evaluate the usage of inspiration, expiration, cough, and heel drop jarring tests that are applied for determination of peritonism in cases with acute abdominal pain.

Methods: A prospective study based on observation of patients between 16-65 years of age and presented to the Emergency Department within a 3-month period starting from June 2007, was conducted. The patients were asked to rate their pain level between "0" and "10". Following the measurement of the vital signs, 4 tests were conducted by an emergency medicine resident. The medical records of all the patients were reviewed after 3 months. Data concerning clinical diagnosis, hospital admission and discharge processes, and surgical results, were all recorded.

Results: Seventy-seven patients had peritonism tests performed. Inspiration test was positive in 29 (of 51, 56.9%) patients admitted to the hospital. However, there was no correlation between the cases admitted to the hospital and the other 3 tests (p more than 0.05). Twenty-one (of 34, 61.8%) patients which have been subjected to surgical treatment, showed positive inspiration test results. Surgical treatment was performed on nine (of 11, 81.8%) patients who showed positive results for all 4 tests.

Conclusion: The applied tests are helpful in determining a serious abdominal disease, particularly alongside findings of rebound, tenderness, and laboratory results.
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February 2014

Syncope Associated with Carbon Monoxide Poisoning due to Narghile Smoking.

Case Rep Emerg Med 2013 25;2013:796857. Epub 2013 Mar 25.

Department of Emergency Medicine, Erciyes University Medical School, 38039 Kayseri, Turkey.

Narghile smoking is a traditional method of tobacco use, and it has been practiced extensively for 400 years. Traditionally, narghile smoking is a matter of culture mainly in Middle East, Asia, and Africa. In recent years, its use as a social activity has increased worldwide, especially among young people. Narghile smoking is an unusual cause of carbon monoxide poisoning. Narghile smoking, compared to cigarette smoking, can result in more smoke exposure and greater levels of carbon monoxide. We present an acute syncope case of a 19-year-old male patient who had carbon monoxide poisoning after narghile smoking.
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http://dx.doi.org/10.1155/2013/796857DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3621151PMC
April 2013

Characteristics of acute adult poisonings in a university hospital emergency department in central Turkey: a three-year analysis.

J Pak Med Assoc 2012 Feb;62(2):129-33

Department of Emergency Medicine, Erciyes University Medical School, Kayseri, Turkey.

Objective: To evaluate the etiologic and demographic characteristics of acute adult poisoning cases and to obtain up-to-date information on acute poisonings.

Methods: A retrospective study was conducted to evaluate 1254 adults who presented with acute poisoning to the Emergency Department of our tertiary care university hospital in central Turkey from January 2007 to December 2009. The data extracted from each chart related to age, gender, marital status, agent involved in the poisoning, season of event, route of poisoning, time between ingestion or exposure and arrival at the casualty ward, mechanism of toxic exposure (unintentional or intentional), level of consciousness, length of stay in the ward, and outcome.

Results: Acute poisonings comprised 1.40% of Emergency Department patients; 65% were female, while 47% were between the ages of 16 and 25 years. Medicinal drugs were the most common cause of poisonings (68%), followed by gases (9.5%). Antidepressants were the most frequent drug ingested (18%), followed by analgesics (16%). Intentional poisonings constituted the majority of cases (78%). Most suicide attempts were made by women (68%) and majority of the patients were married (57%). Twenty patients (1.6%) died during their hospital stay, with organophosphate pesticides being the most common agent (n = 8) involved in fatal poisonings.

Conclusion: Pharmaceutical agents, carbon monoxide and pesticides are the three most common poisoning agents. Deliberate self-poisoning is common in adults in the area of the study; the risk being highest in females and younger adults. These up-to-date data provide important information on the characteristics of acute poisonings and can guide activities such as professional training, preventive measures, community education and new research.
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February 2012

A rare entity in ED: posterior reversible encephalopathy syndrome.

Am J Emerg Med 2012 Nov 3;30(9):2099.e1-3. Epub 2012 May 3.

Department of Neurology, Erciyes University Faculty of Medicine, Kayseri, Turkey.

Posterior reversible encephalopathy syndrome is a clinico-neuroradiologic entity with typical symptoms and symmetric high-signal intensity lesions in the bilateral parietooccipital lobes on T2-weighted or fluid-attenuated inversion recovery magnetic resonance imaging. In this presentation, we report a case of posterior reversible encephalopathy syndrome who was admitted to our emergency department because of seizure and deterioration of consciousness. The aim of this presentation is to alert the emergency physicians about one of the hypertensive emergencies with neurologic symptoms associated with hypertension.
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http://dx.doi.org/10.1016/j.ajem.2012.02.003DOI Listing
November 2012

Cervicofacial emphysema and pneumomediastinum after a high-speed air drill endodontic treatment procedure.

Am J Emerg Med 2012 Nov 4;30(9):2095.e3-6. Epub 2012 Feb 4.

Faculty of Medicine, Department of Emergency Medicine, Erciyes University, Kayseri, Turkey.

Cervicofacial subcutaneous emphysema is defined as the abnormal introduction of air in the subcutaneous tissues of the head and neck. It is mainly caused by trauma, head and neck surgery, general anesthesia, and coughing or habitual performance of Valsalva maneuver. The occurrence of subcutaneous emphysema after dental treatment is rare, and diffusion of gas into the mediastinum is much rarer, especially when the procedure is a nonsurgical treatment. The most common dental cause of pneumomediastinum is the introduction of air via the air turbine handpiece during surgical extraction of an impacted tooth. Only 6 cases of pneumomediastinum after endodontic treatment have been reported between 1960 and 2008. Pneumothorax is defined clinically as an “accumulation of air or gas between the parietal and visceral pleurae,” and although it is often not a medical emergency, it can result in respiratory distress, tension pneumothorax, shock, circulatory collapse, and even death. Although there are many possible causes of dyspnea during a dental procedure, 1 rare complication is pneumothorax. Although specific closed turbine systems are available for oral surgical procedures, these drills may be used in exodontia to section teeth and facilitate tooth extraction. We report a case of cervical subcutaneous emphysema and pneumomediastinum occurring after an endodontic treatment of right first molar using an air-tribune drill. We present here in a case of massive pneumomediastinum and cervicofacial subcutaneous emphysema that occurred after opening the access cavity for endodontic treatment. We describe its etiologies and guidelines for its prevention during nonsurgical endodontic treatment.
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http://dx.doi.org/10.1016/j.ajem.2012.01.006DOI Listing
November 2012

Contrast-induced nephropathy risk due to emergency contrast-enhanced computed tomography.

Eur J Emerg Med 2012 Feb;19(1):20-3

Department of Emergency Medicine, Erciyes University Medical School, Kayseri, Turkey.

Objective: In this study, we aimed to compare serum creatinine, blood urea, and glomerular filtration rate (GFR) levels of patients at baseline and 48 h after the administration of radiocontrast agent in the emergency department.

Method: We prospectively enrolled 114 patients who underwent contrast-enhanced computed tomography scan and had a baseline creatinine level of 1.5 mg/dl or less. Serum creatinine and blood urea levels were measured at baseline and 48 h after the administration of radiocontrast agent. GFR and Mehran risk score were calculated at baseline and 48 h after the administration of radiocontrast agent.

Results: Baseline mean serum creatinine was 1.03±0.25 mg/dl. Forty-eight hours after the administration of radiocontrast agent, mean serum creatinine was 1.04±0.31 mg/dl, baseline mean blood urea was 8.14±4.04 mmol/l, mean blood urea was 8.42±4.42 mmol/l, baseline mean GFR was 76.74±27.08 ml/min, and mean GFR was 77.21±27.92 ml/min. There were no significant differences between baseline and 48 h after the administration of radiocontrast agent serum creatinine, blood urea levels, and GFR (P>0.05).

Conclusion: There was no statistically significant difference between basal and 48 h after the administration of radiocontrast agent serum creatinine and GFR levels of patients who were enrolled in this study. Results had shown that administration of intravenous radiocontrast agent (≤100 ml) for emergency imaging in the emergency department did not produce a risk for contrast-induced nephropathy in patients with serum creatinine levels of 1.5 mg/dl or less.
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http://dx.doi.org/10.1097/MEJ.0b013e32834749b3DOI Listing
February 2012

Machine-related farm injuries in Turkey.

Ann Agric Environ Med 2010 ;17(1):59-63

Erciyes University, Department of Emergency Medicine, Kayseri, Turkey.

Traumas connected with agricultural production can result in serious injuries and mortality. The objective of the study was to describe the characteristics of agricultural machines related work injury cases admitted to the Emergency Department, and to asses factors related to injury severity and hospital admission in the Central Anatolian Region of Turkey. All the cases presented related to injuries caused by work with agricultural machines between January 2006-November 2007 were included in the study. Information was collected concerning the demographic structures of the patients. Injury sites, injury types, and clinical features were recorded. Initial injury severity scores of all the cases were diagnosed at hospital admission. 91.9 percent of the cases were male. Mean age was 35.8 +- 17.0. The most common machine causing injuries was a tractor with 46 percent of cases, and all of these were fall traumas. 18.9 percent of the cases was considered as slight injury, 43.2 percent as moderate, and 37.9 percent as severe. Two male cases resulted in fatality. Our findings suggest that tractors are the most dangerous agricultural machines, and falls from tractors as the most common injury mechanism among machine-related injuries, especially for young people. In the rural areas of our country, Turkey, agricultural machines cause serious injuries that require hospitalization.
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February 2011

Occupational injuries admitted to the Emergency Department.

Ulus Travma Acil Cerrahi Derg 2010 May;16(3):241-7

Department of Emergency Medicine, Erciyes University Faculty of Medicine, Kayseri, Turkey.

Background: We aimed to identify the characteristics, causes and rates of injuries associated with occupational accidents.

Methods: Patients who presented to the Emergency Department due to injuries occurring as a result of occupational accidents were determined retrospectively. In occupational injuries, several parameters were evaluated, such as gender, occurrence mechanism, injury type, injury localization, severity score of the injury, and the type of profession.

Results: The number of occupational injury admissions in the Emergency Departments of our two centers during 2006 was 1038. Mean age of the cases was 31.6+/-9.6. The most common mechanism of injuries was determined to be caught-in-machinery, at 31.5%, followed by blunt object injury (21.5%), fall from height (18.9%), penetrating-sharp object injury (17%), ocular foreign body (3.9%), and others. Isolated extremity injuries (74.2%) were the most common injury site, followed by multiple bodily injuries (8.5%), facial injuries (5.5%) and head-neck injuries (4.6%). While 90% of cases were discharged after treatment in the Emergency Department, 7% were referred to various departments for hospitalization.

Conclusion: In the majority of cases, patients with injuries associated with occupational accidents presented to Emergency Departments. Observations in Emergency Departments may help reveal details of occupational injuries and prevent workplace-related accidents.
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May 2010

Poisoning severity score, Glasgow coma scale, corrected QT interval in acute organophosphate poisoning.

Hum Exp Toxicol 2010 May 4;29(5):419-25. Epub 2010 Mar 4.

Canakkale Onsekiz Mart University Faculty of Medicine, Department of Emergency Medicine, Canakkale, Turkey.

The aim of this study was to investigate effectiveness of the poisoning severity score (PSS), Glasgow coma scale (GCS), and corrected QT (QTc) interval in predicting outcomes in acute organophosphates (OP) poisoning. Over a period of 2 years, 62 patients with OP poisoning were admitted to emergency department (ED) of Erciyes University Medical School Hospital. The age, sex, cause of contact, compound involved, time elapsed between exposure and admission to the ED, duration of hospital stay, and cardiac manifestations at the time of presentation were recorded. GCS and poisoning severity score (PSS) was calculated for each patient. Electrocardiogram (ECG) analysis included the rate, rhythm, ST-T abnormalities, conduction defects, and measurement of PR and QT intervals. Sixty-two patients with OP poisoning presented to our ED from January 2007 to December 2008 from which 54 patients were included in the study. The mean age was 34.1 +/- 14.8 years. Of the cases, 53.7% were female. Twenty-six patients had a prolonged QTc interval. Mean PSS of men and women was 1.8 +/- 1.0. No statistically significant correlation was found between the PSS and QTc intervals of the cases. A significant correlation was determined between the GCS and PSS of grade 3 and grade 4 cases. GCS is a parameter that helps clinician to identify advanced grade OP poisoning patients in the initial assessment in the ED. However, ECG findings, such as prolonged QTc interval, are not effective in determination of short-term prognosis and show no relationship with PSS.
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http://dx.doi.org/10.1177/0960327110364640DOI Listing
May 2010

The effect of piracetam on brain damage and serum nitric oxide levels in dogs submitted to hemorrhagic shock.

Ulus Travma Acil Cerrahi Derg 2008 Oct;14(4):277-83

Department of Emergency Medicine, Medicine Faculty of Erciyes University, Kayseri, Turkey.

Background: To demonstrate the effect of piracetam on changes in brain tissue and serum nitric oxide levels in dogs submitted to hemorrhagic shock.

Methods: The subjects were randomized into four subgroups each consisting of 10 dogs. Hemorrhagic shock was induced in Group I for 1 hour and no treatment was given to this group. Blood and saline solutions were administered to Group II following 1 hour hemorrhagic shock. Blood and piracetam were given to Group III following 1 hour shock. No shock was induced and no treatment was applied to Group IV. Blood samples were obtained at the onset of the experiment and at 60, 120 and 180 minutes for nitric oxide analysis. For histopathological examination, brain tissue samples were obtained at the end of the experiment.

Results: The observed improvement in blood pressure and pulse rates in Group III was more than in Group II. Nitric oxide levels were increased in Group I; however, no correlation between piracetam and nitric oxide levels was determined. It was seen that recovery in brain damage in Group III was greater than in the control group.

Conclusion: Piracetam, added to the treatment, may ecrease ischemic damage in hemorrhagic shock.
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October 2008

[Injuries due to parachute jumping].

Ulus Travma Acil Cerrahi Derg 2008 Jul;14(3):201-4

Department Of General Surgery, Erciyes University Medical School, Kayseri, Turkey.

Background: Parachuting is performed for sportive and occupational purposes and demands a high level of controlled physical performance. In conjunction with the growing interest in parachuting, injury rates in the emergency departments are also increasing. We thus aimed to evaluate the mechanism and characteristics of injuries due to parachuting.

Methods: Parameters of the patients injured and presenting to the emergency department, including mean age, body area exposed to injury, definite diagnosis, applied treatment modalities, and admission to/discharge from the hospital, were all recorded in a previously prepared form and analyzed. Degree of injury was detected by calculating the Injury Severity Score (ISS) using the Abbreviated Injury Scale (AIS).

Results: Mean ISS of the patients was 8.15+/-4.29. The most commonly affected body sites were the extremities. Of the extremity injuries, 13 (81%) involved lower extremities and 3 (19%) involved upper extremities. The most commonly affected site in the lower extremities was the ankle (47%). Head injuries followed extremity injuries as the second most affected site.

Conclusion: Injuries from parachute jumping mostly occur during landing due to loss of balance. Loss of balance was seen to result from change in wind direction and personal factors. When jumpers acquire adequate knowledge about phases of parachute jumping and landing, probability of injury will decrease.
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July 2008

Electrocardiographic findings of acute organophosphate poisoning.

J Emerg Med 2009 Jan 4;36(1):39-42. Epub 2008 Mar 4.

Department of Emergency Medicine, Kocatepe University Medical Faculty, Afyonkarahisar, Turkey.

In this study, we evaluated 85 patients who presented to our Emergency Department with organophosphate (OP) poisoning and discuss their associated electrocardiographic (ECG) abnormalities. Over a period of 3 years, 85 patients with OP poisoning were included in this retrospective study. ECG analysis included the rate, rhythm, ST-T abnormalities, conduction defects, and measurement of PR and QT intervals. The mean age was 32.2 +/- 14.9 years. Sixty percent of the patients were female. The mean corrected QT interval (QTc interval) was 0.435 +/- 0.052 s. Prolongation of the QTc interval (55.5%) was the most common ECG abnormality, followed by sinus tachycardia (31.8%). Elevation of the ST segment and low amplitude T waves were seen in 15 cases (17.6%). Patients with OP poisoning might reveal ECG abnormalities such as QTc interval prolongation or non-specific ST-T changes. QTc interval prolongation cannot be used as a unique predictive factor in determining short-term prognosis in OP poisoning. We found no clear relation between OP poisoning-related malignant ventricular dysrhythmia and QTc interval.
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http://dx.doi.org/10.1016/j.jemermed.2007.08.063DOI Listing
January 2009

Experimental inhalation of chlorine gas produced with a different method; effects of N-acetyl cysteine on acute pulmonary damage.

Toxicol Mech Methods 2008 Jan;18(9):739-43

Erciyes University Faculty of Medicine, Department of Emergency Medicine, Kayseri, Turkey.

ABSTRACT The two most common gas inhalation injuries encountered in emergency departments are carbon monoxide and chlorine inhalations. In this study, chlorine was produced through a method different to the previous experimental models. Rats were subjected to inhale chlorine, after which the effects of N-acetylcysteine on pulmonary damage were evaluated. A total of 50 rats were equally divided into five groups. Group 1 received nothing. Groups 2 and 3 were taken as 6 h, groups 4 and 5 as 24 h control and N-acetylcysteine groups, respectively. Firstly, 200 ppm chlorine gas was given for 20 min. Then, 40 mg/kg N-acetylcysteine was given intraperitoneally. The same procedure with the same dose was repeated 3 h later. The same procedures were applied to the control group but this time saline was used. Tissue samples of lungs were taken. Glutathione levels of the rats in the N-acetylcysteine group sacrificed at 24 h were significantly higher than those of the control group. Histopathological evaluation of the pulmonary tissues of the rats sacrificed at 6 and 24 h revealed mild-to-moderate degrees of tissue damage. The degree of tissue damage at 6 h and 24 h N-acetylcysteine group rats was lower than that in the control group. As a result, tissue damage resulting from experimental chlorine inhalation can be alleviated by N-acetylcysteine. This is mainly the result of the antioxidant effects of the N-acetylcysteine.
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http://dx.doi.org/10.1080/15376510802354912DOI Listing
January 2008