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Öğe A novel biochemical marker for community-acquired pneumonia: Ischemia-modified albumin(W.B. Saunders, 2017) Bolatkale, Mustafa; Düger, Mustafa; Ülfer, Gözde; Can, Çağdaş; Acara, Ahmet Çağdaş; Yiğitbaşı, Türkan; Seyhan, Ekrem Cengiz; Bulut, MehtapIntroduction Community-acquired pneumonia (CAP) is a frequent cause of hospitalization and a leading cause of mortality worldwide. Early diagnosis and the initiation of appropriate antibiotic therapy are essential to reduce pneumonia-related morbidity and mortality. CRP is a well-established biomarker in many clinical settings, but has been traditionally considered not specific enough to be a useful guide in the diagnostic process of pneumonia. There is still a need for more specific and practical markers in CAP for diagnosis. The aim of this study was to investigate the diagnostic value of ischemia-modified albumin (IMA) levels in the diagnosis of CAP in the Emergency Department. Methods The study included 81 patients admitted with CAP and 81 control patients. Initial hour levels of IMA and CRP were measured. The IMA mean levels were compared between the study and control group. Correlation analyses were performed to investigate the association of serum IMA levels with CRP. Results Mean levels of IMA were 0.532 ± 0.117 IU/ml in the study group and 0.345 ± 0.082 IU/ml in the control group. IMA levels were significantly higher in the study group compared to the control group. The IMA level of 0.442 IU/ml had sensitivity of 75.3% and specificity of 91.3% and was positively correlated with CRP levels (r = 0.506; p < 0.05). Conclusion Blood IMA levels significantly increase in adult patients presenting with CAP. IMA may be considered as a novel biomarker in the diagnosis of CAP.Öğe A novel biochemical marker for predicting the severity of ACS with unstable angina pectoris: Asprosin(W B Saunders Co-Elsevıer Inc, 2018) Acara, Ahmet Çağdaş; Bolatkale, Mustafa; Kızıloğlu, İlker; İbişoğlu, Ersin; Can, ÇagdaşIschemic Heart Disease (IHD) is the leading cause of death world-wide, accounting for 12.7% of global mortality[1] . Acute Coronary Syn-drome (ACS) covers a wide spectrum of clinical conditions ranging fromunstable angina to Non-ST Elevation Myocardial Infarction (N-STEMI)and ST Elevation Myocardial Infarction (STEMI). New treatments andmanagement guidelines emerge for the care of patients with ACS; riskstratification is the cornerstone in the initial evaluation of these patients[2] . That inflammatory mediators play a role duringthe evolution of ACSis indicated by the widespread coronary inflammation found during un-stable angina pectoris (UAP), throughout theentire coronary artery bed,and in the extent that ACS outcome is related to a concurrent inflamma-toryresponse[3,4] . Circulatingasprosin,a protein hormone, responds tolow dietary glucose by triggering the release of liver glucose stores, andthe reduction of asprosin protects against the hyperinsulinism associat-ed with metabolic syndrome.Öğe A novel index for prompt prediction of severity in patients with unstable angina pectoris(Hindawi Ltd, 2020) Bolatkale, Mustafa; Acara, Ahmet ÇağdaşObjectives. Rapid risk stratification by emergency department (ED) physicians to evaluate patients with chest pain for predicting the short-term occurrence of major adverse cardiac event (MACE) is crucial. The aim of this study was to investigate the predictive value of platelet-lymphocyte ratio (PLR) levels and compare with the modified heart score (m-HS) and stress testing to predict the severity of high-risk patients with unstable angina pectoris (UAP) in the ED. Methods. This study is prospective which included 316 patients with UAP and 316 control healthy subjects. The study took place from 01 April 2016, until 01 April 2017, in Medipol University. Result. The mean PLR levels in the UAP group were higher than those in the control group (p<0.001). The mean PLR of the m-HS >= 4 group was higher than that in the m-HS <= 3 group (p<0.001). The mean levels of PLR in the subgroups based on the stress testing positivity were higher than those in the stress testing negative subgroup (p<0.001). PLR levels were positively correlated with the m-HS, stress testing, and treatment decision in this study (r = 0.559; p<0.001; r = 0.582; p<0.001; r = 0.789; p<0.001, respectively). Conclusion. A positive correlation was determined with an increase in m-HS, treatment decision, and positive exercise testing as the PLR levels increased, indicating the severity of high risk of UAP in the ED.Öğe Acute traumatic coagulopathy: An unusual presentation(Japan International Cultural Exchange Foundation, 2020) Bolatkale, Mustafa; Acara, A. C.Introduction: Trauma is a leading cause of mortality and morbidity with hemorrhage accounting for 40% of deaths in persons aged 5 to 44 years. The combination of uncontrolled hemorrhage and acute traumatic coagulopathy (ATC) is responsible for over 50% of all trauma-related deaths within the first 48 hrs of admission. In trauma patients coagulation profiles are not routinely examined. Presentation of the Case: The case is here reported of a patient with acute traumatic coagulopathy after an incision to the antecubital region, with the aim of emphasizing the clinical diagnosis of patients presenting with ATC with uncontrolled hemorrhage after low energy trauma. Discussion: An early coagulation screen is an important test to determine ATC in patients with low energy trauma. This case reported here raises the question of the need for a routine coagulation profile for every patient presenting at the Emergency Department (ED) with bleeding to be able to determine ATC and thereby reduce morbidity and mortality. Conclusion: To the best of our knowledge, there have been no previous studies or case reports in literature related to treatment in the ED of ATC after low-energy trauma. Early detection of coagulopathy is important to be able to counteract the haemostatic disturbances and resuscitation strategies targeted at ATC have shown dramatic potential for the reduction of trauma-related mortality.Öğe Comparison of the cardiovascular risk profile of individuals with obesity and abdominal obesity(Japan International Cultural Exchange Foundation, 2017) Koran, Serhat; Bolatkale, Mustafa; Can, Çağdaş; Acara, Ahmet Çağdaş; Kaptanoğulları Harmankaya, Nazmiye ÖzlemIntroduction: Obesity is a worldwide public health problem. In the USA, it is the second leading cause of death after smoking and prevalence is increasing throughout the world. Obesity-related health problems have now become more important than some classic health problems such as malnutrition and infectious diseases. The medical importance of obesity emerges through the close relationship with diseases such as diabetes and coronary artery disease in particular, and other various diseases. Materials and Methods: A total of 177 individuals were included in the study comprising 84 (47.5%) males and 93 (52.5%) females, aged 15- 80 years. The patients were separated into 2 groups of abdominal obesity (n = 94) and obesity (n = 83). Abdominal obesity was defined as waist circumference > 94 cm in males and > 80 cm in females, measured at the level of the umbilicus. For the evaluation of cardiovascular risk profile, lipid profiles (cholesterol LDL, HDL, triglyceride) and inflammatory parameters (CRP and fibrinogen) were examined with early morning 12-hour fasting blood tests. Results: A statistically significant difference was determined between the groups in respect of CRP levels with CRP positivity of 41% in the obese group of 41% and 23.4% in the abdominally obese group. (p < 0.05). The levels of fibrinogen were evaluated as statistically significantly higher in the obesity group than in the abdominal obesity group.(p < 0.05). No statistically significant difference was determined between the groups in respect of HBA1c levels (p > 0.05). Conclusion: The results of the current study showed no statistically significant difference between obese and abdominally obese patients in respect of HBA1c levels and lipid profile but the levels of fibrinogen and CRP were determined to be statistically significantly different. The levels of fibrinogen and CRP in the obese patients were statistically significantly higher than those of the abdominal obesity group (p < 0.05). This indicates a positive correlation between increased BMI and increasing sub-clinical inflammation markers. From the results of this study, abdominal obesity in particular can be assumed as a major risk factor for cardiovascular disease.Öğe Does ischemia-modified albumin level predict severity of obstructive sleep apnea?(Springer, 2021) Düger, Mustafa; Seyhan, Ekrem Cengiz; Günlüoğlu, Mehmet Zeki; Bolatkale, Mustafa; Özgül, Mehmet Akif; Turan, Demet; Uğur, Efsun; Ülfer, GözdeObjective and aim Ischemia-modified albumin (IMA) is a newly recognized marker of chronic inflammation used to evaluate oxidative stress status in patients with various diseases. We explored the possible relationship between IMA levels and obstructive sleep apnea (OSA). Methods In this retrospective study, 169 of 216 sequential patients being evaluated for suspicion of OSAS met inclusion criteria. Polysomnography confirmed OSA in 86 patients (51%) while 81 patients (49%) without OSA were categorized as control subjects. All study participants were tested for blood IMA level, neutrophil/lymphocyte ratio (NLR), C-reactive protein (CRP) level, and red blood cell distribution width (RDW). Results The serum IMA level was significantly higher in patients with OSAS than controls (p = 0.008). The serum IMA level increased significantly as OSAS severity increased (r = 0.50, p < 0.001) and was positively correlated with the AHI (r = 0.41, p < 0.001), CRP level (r = 0.31, p = 0.004), body mass index (r = 0.24, p = 0.022), RDW (r = 0.31, p = 0.03), oxygen desaturation index (ODI) (r = 0.22, p = 0.02), and negatively correlated with the hemoglobin concentration (r = - 0.28, p = 0.04) and minimum hemoglobin oxygen saturation (SpO2) (r = - 0.25, p = 0.02). Receiver operator curve (ROC) analysis showed that the optimal serum IMA, CRP, RDW, and NLR values were not different for predicting OSAS diagnosis (areas under the curves (AUC) = 0.62, 0.59, 0.60, and 0.43, respectively). However, the serum IMA level was superior in reflecting OSAS severity (AUC = 0.78) compared to CRP, RDW, and NLR values (AUC = 0.61, 0.53, and 0.51, respectively) (all p < 0.001). Conclusion Like other markers of inflammation, blood IMA levels were significantly elevated in patients with OSA. However, blood IMA level was a better predictor of disease severity than the other markers.Öğe Endothelial nitric oxide level as a predictor of coronary complexity in patients with unstable angina pectoris(Elsevier Science Inc, 2019) Acara, Ahmet Çağdaş; Bolatkale, MustafaBackground: The Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score is an anatomic scoring system based on coronary angiography that quantifies lesion severity and complexity and predicts morbidity and mortality to guide decision making between coronary artery bypass graft surgery and percutaneous coronary intervention in patients with acute coronary syndrome. The present study aimed to compare nitric oxide levels with the SYN-TAX score in terms of predicting coronary complexity and the treatment decision for unstable angina pectoris in the emergency department. Methods: The study included 120 patients with unstable angina pectoris and 120 control group subjects. Nitric oxide levels were compared with the SYNTAX score and the treatment decision. The UAP group was divided into 2 subgroups, first based on SYNTAX score of <= 18, >18-27 or >27 and then on the treatment decision of coronary angiography, percutaneous coronary intervention, or coronary artery bypass graft surgery. Results: The mean nitric oxide levels in the unstable angina pectoris group were lower than in the control group (P < 0.001). Nitric oxide levels were negatively correlated with the SYNTAX score and the treatment decision (r = -0.227, P = 0.013; r = -0.498, P < 0.001, respectively). The nitric oxide levels were decreased with SYNTAX score >27 compared with >18-27 and = 18 (P = 0.04-0.003, respectively). Nitric oxide levels were decreased in coronary artery bypass graft surgery subgroup compared with the coronary angiography and percutaneous coronary intervention groups (P < 0.001-0.018 and P < 0.001, respectively). Conclusions: Nitric oxide may be considered as a novel biomarker in the prediction of coronary complexity in patients with unstable angina pectoris.Öğe Ischemia modified albumin in patients with obstructive sleep apnea syndrome(European Respiratory Society Journals Ltd, 2018) Seyhan, Ekrem Cengiz; Düger, Mustafa; Bolatkale, Mustafa; Eğri Kansu, Zeynep; Aynacı, Engin[Abstract Not Available]Öğe The effect of brain tomography findings on mortality in sniper shot head injuries(Bmj Publishing Group, 2017) Can, Çağdaş; Bolatkale, Mustafa; Sarıhan, Aydın; Savran, Yusuf; Acara, Ahmet Çağdaş; Bulut, MehtapObjectives Penetrating gunshot head injuries have a poor prognosis and require prompt care. Brain CT is a routine component of the standard evaluation of head wounds and suspected brain injury. We aimed to investigate the effect of brain CT findings on mortality in gunshot head injury patients who were admitted to our emergency department (ED) from the Syrian Civil War. Methods The study group comprised patients who were admitted to the ED with gunshot brain injury. Patients' GCS scores, prehospital intubations and brain CT findings were examined. Results 104 patients were included (92% male, mean age 25 years). Pneumocephalus, midline shift, penetrating head injury, patients with GCS scores <= 6 and patients who had to be intubated in the prehospital period were associated with higher mortality (p < 0.05). Discussion The results of this study demonstrated that pneumocephalus, midline shift, a penetrating head injury, GCS scores <= 6 and prehospital intubation are associated with high mortality, whereas patients with temporal bone fracture, perforating or single cerebral lobe head injury had a higher survival rates. The temporal bone has a relatively thin and smooth shape compared with the other skull bones so a bullet is less fragmented when it has penetrated the temporal bone, which could be a reason for the reduced cavitation effect. In perforating head injury, the bullet makes a second hole and so will have deposited less energy than a retained bullet with a consequent reduction in intracranial injury and mortality. Further studies are required to reach definitive conclusions.Öğe The intracranial number of foreign bodies as a predictor of mortality after penetrating brain injury(W B Saunders Co-Elsevier Inc, 2019) Bolatkale, Mustafa; Acara, Ahmet ÇağdaşIntroduction: Penetrating brain injury (PBI) is the most lethal form of traumatic brain injury, which is a leading cause of mortality. PBI has a mortality rate of 23%-93% and 87%-100% with poor neurological status. Despite the use of various prognostic factors there is still a need for a specific prognostic factor for early prediction of mortality in PBI to reduce mortality and provide good outcomes with cost-effective surgical treatments. The aim of this study was to investigate the predictive value of the number of intracranial foreign bodies (FBs) on mortality in PBI in the Emergency Department. Methods: The study included 95 patients admitted with PBI caused by barrel bomb explosion. The intracranial number of FB was examined by brain computed tomography. Logistic regression was used to assess the association of the intracranial number of FB on mortality. Correlation analyses were performed to investigate the association of Glasgow Coma Scale (GCS) with intracranial number of FB. Results: The optimal cut-off value of the intracranial number of FB calculated for mortality was 2, which was effective for predicting mortality (p <.001). In patients with >2 intracranial FB, the mortality rate was statistically significantly 51-fold higher than those with <= 2 (p <.001). A statistically significant negative correlation was determined between GCS and number FB (r =-0.697; p <.001). Conclusion: When the intracranial number of FB was >2, mortality significantly increased in patients with PBI. The intracranial number of FBs may be considered as a novel prognostic factor for the prediction of mortality in PBI.
