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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 rare case of transdermal methanol intoxication(AVES, 2017) Karaoğlu, Ulaş; Sarıhan, Aydın; Bulut, MehtapIntroduction: Methanol is a clear, colorless, and highly toxic liquid which is a common component of antifreeze solutions, paints, varnishes, gasoline mixtures, and various solvents. Even though methanol is used only in industry, when ingested accidentally or for suicide it may cause methanol intoxication which has high mortality rates. Methanol intoxication is generally seen after accidental or suicidal oral intake. Methanol can be absorbed by inhalation or through the skin, which rarely leads to clinical toxicity. Case Report: Herein, we present a case of methanol intoxication associated with absorption through the skin which is one of the rare ways of poisoning. We aim to emphasize that methanol intoxication rarely occurs after dermal exposure. Conclusion: Emergency department physicians must consider methanol intoxication in patients of high anion gap metabolic acidosis with visual symptoms even if the patient has no history of oral intake.Öğe Acil servise başvuran yaşlı hastalarda prognostik faktörlerin incelenmesinde kullanılan tarama skorlarının karşılaştırılması(İstanbul Medipol Üniversitesi Tıp Fakültesi, 2018) Bahadırlı, Suphi; Bulut, MehtapGiriş ve Amaç: Bu çalışmadaki amacımız; acil servise (AS) başvuran 65 yaş üstü hastalar arasında AS`den hastaneye yatış ve mortalite; AS`den taburcu olduktan sonra tekrar AS`e başvuru, hastaneye yatış ve ölüm olasılığı gibi yüksek riskli prognostik faktörleri saptamada kullanılan ISAR (Identification of Seniors At Risk) ve SC (Silver Code) skorlama sistemlerini karşılaştırmaktır. Gereç ve Yöntem: Tek merkezli, prospektif, gözlemsel bir çalışma olup, Medipol Mega Hastanesi AS'ye 21.12.2015 - 10.09.2016 tarihleri arasında başvuran 65 yaş ve üstü tüm hastalar incelenmiştir. AS'e geldiğinde ex-duhul olan hastalar; çalışmaya katılmak istemeyen hastalar; bilgi alınamayan hastalar çalışmaya dahil edilmemiştir. Hastaların ISAR ve SC skorları hesaplanmıştır. ISAR ve SC skorlama sistemlerinin ilk AS'e başvurudaki hastaneye yatış ve mortalite ile 30. gün ve 6.aydaki AS'e tekrar başvuru, hastaneye yatış ve mortaliteyi öngörmedeki duyarlılık, özgüllük, pozitif prediktif değer (PPD) ve negatif prediktif değerlerini (NPD) göstermek için receiver operating characteristic (ROC) analizi yapılmıştır. Bulgular: Çalışmaya alınan 497 hastanın yaş ortanca değeri 73'tü (IQR: 68.5, 79.0). 268'i (%53.9) kadın, 229'u (%46.1) erkekti. AS başvurusundan 1 ay sonra SC risk grupları arasında mortalitede artış yokken ISAR pozitif grupta mortalite 6.6 kat artmıştır. AS başvurusundan 6 ay sonra mortalite risk gruplarına göre incelendiğinde SC yüksek riskli grupta 2 kat, ISAR pozitif grupta ise 35 kattan fazla artmıştır. Sonuç: İncelediğimiz tüm parametrelerde SC ve ISAR skorlamaları ile oldukça yakın ve anlamlı sonuçlar elde edilmiştir. Ancak ISAR mortaliteyi öngörmede SC'ye göre çok daha başarılı olmuştur. Yine kolay uygulanabilirliği nedeniyle ISAR'ın SC'ye göre daha kullanışlı olduğunu düşünmekteyiz.Öğe Acil serviste inme ve hematolojik parametreler arasındaki ilişki değerlendirilmesi(İstanbul Medipol Üniversitesi Tıp Fakültesi, 2019) Bahçeli, Elgin; Bulut, MehtapGiriş ve Amaç: Amacımız dünyada ölüm nedenleri arasında ön sıralarda yer alan iskemik inme ile kolay ulaşılabilir, ucuz ve hızlı bir test olan hematolojik parametrelerin ilişkisini araştırmaktır. Gereç ve Yöntem: Araştırma tek merkezli, retrospektif olup Medipol Mega Üniversitesi Hastanesi Acil Servisine başvuran 18 yaş ve üzeri akut iskemik inme ve GİA tanısı alan hastalar dahil edildi. Hastaların hematolojik parametreleri ile TOAST sınıflamasına göre inme alt grupları, acil serviste klinik sonlanma durumları ve yatış süreleri değerlendirildi. Hematolojik parametrelerin yoğun bakım ünitesine (YBÜ) yatış durumunu öngörmedeki etkinlikleri ROC (Receiver Operating Characteristic) eğrisi kullanılarak karşılaştırıldı. Bulgular: Toplam 152 hastanın 97'si (%63,8) erkek ve 55'i (%36,2) kadındı. Hastaların yaş ortalaması 64,38 ± 13,69 olarak saptandı. YBÜ'de takip edilen hastaların lökosit (WBC), nötrofil, monosit ve lökositin ortalama platelet hacmine oranı (WMR) servis hastalarına göre istatistiksel olarak yüksek bulundu. Ortalama eritrosit hacminin platelete oranı (MPR) YBÜ'de takip edilen hastalarda servis hastalarına göre daha düşük bulundu. WBC, nötrofil, monosit, ortalama eritrosit hacminin platelete oranı (MPR) ve WMR değerlerinin acil servisten yoğun bakıma yatışı öngörme başarısı istatistiksel olarak anlamlı bulunmuş olup WMR'nin öngörme gücü (AUC: 0,699 ± 0,056) en yüksek saptandı. Sonuç: Sonuç olarak GİA ve iskemik inmeli hastalarda WBC, nötrofil, monosit, WMR ve MPR, YBÜ'ye yatışı öngörmede kullanılabilir.Öğe Assessing prognosis with modified early warning score, rapid emergency medicine score and worthing physiological scoring system in patients admitted to intensive care unit from emergency department(Elsevier, 2019) Gök, Raziye Gizem Yüksel; Gök, Alper; Bulut, MehtapIntroduction: In this study our purpose is to examine the effectiveness and reliability of MEWS (Modified Early Warning Score), REMS (Rapid Emergency Medicine Score) and WPS (Worthing Physiological Scoring System) scoring systems for prediction of the prognosis and mortality rate of critically ill patients scheduled to be admitted to intensive care unit (ICU) among emergency department (ED) patients. Methods: This single-centered retrospective study was performed on medical, surgical and trauma patients referred to the ED and admitted to ICU of University Hospital between 23 July 2013 and 26 November 2015. Results: Mortality and the duration of stay in ICU were significantly correlated with systolic blood pressure (SBP) and WPS score compared to other variables (p = 0.014, p = 0.010 respectively). The decrease in SBP increased the mortality by 2 (OR: %95 CI 1.1-3.5) fold and the increase in WPS increased the mortality by 2.4 (OR: %95 CI 1.2-4.5) fold. Conclusions: In our study, there was a more significant correlation between WPS score and mortality and duration of stay in ICU compared to other scores.Öğe Assessment of emergency service attendance due to rabies suspect animal bites in the van region(Emergency Medicine Physicians Association of Turkey, 2019) Varışlı, Behçet; Yıldırım, Sinan; Çelik, Hamit; Bulut, Mehtap; Ocak, ÖzgülAim: Rabies is a zoonotic viral disease transmitted by the bite of an animal. In Turkey, 100,000 individuals are administered prophylaxis annually after contact with animals carrying the risk of rabies. In this study, we investigated compliance with treatment and the affecting factors. Materials and Methods: The study assessed data from a total of 813 patients with potential animal bites throughout the year 2013. Results: The mean age of participants in the study was 22.6 +/- 16.8 years, and 80.6% (n=655) were male. Participants of both sexes mainly attended in the spring and summer months; however, it was identified that the rate of women attending in winter was higher than men. Also, five doses of vaccination were ordered for nearly all patients, independent of immunoglobulin administration; however, the rate of patients completing all five doses remained at about 30%. Conclusion: Increasing awareness of rabies will aid in the control of the significant public health problem of potential bite cases. As the young population is at risk, it is necessary to take precautions for the childhood age group.Öğe Emergency department overcrowding in Turkey: Reasons, facts and solutions(Nepal Medical Association, 2014) Durmuş Çakır, Oya; Eren Çevik, Şebnem; Bulut, Mehtap; Güneyses, Özlem; Akköse Aydın, ŞuleIntroduction: The purpose of this study was to determine the factors affecting the long waiting times of the patients in a university hospital. Methods: This study included 3000 of the adults above 18 years and pediatric trauma patients under 18 years who applied to emergency department between February 2009 and April 2009. The examination period of the physician, length of stay, length of hospitalization, waiting times for hospitalization and follow up times in the emergency department were recorded. Moreover, the patients were divided into four groups according to the reasons for waiting. Results: In our study, the time period between 4 pm-12 pm was determined as the busiest time for the applications. Average length of stay in the emergency department for 3000 patients was 146.7 +/- 160.2 minutes. The length of stay for the patients consulted was longer than the length of stay for the ones who were not consulted. Because of the fact that our hospital did not have appropriate bed capacity, 41.1% of the patients waited less than two hours, 13.4% of the patients waited more than 8 hours. It was also found that the waiting times of the Group two patients (206,7 +/- 145,2 minutes) was longer than Group one (95,5 +/- 73,9 minutes) patients and the waiting times of Group three patients (470,7 +/- 364,7 minutes) was longer than Group one patients. Conclusions: In conclusion, cooperation of the managers, relevant departments and a multidisciplinary approach are necessary to achieve the goals to reduce overcrowding in the emergency departments.Öğe NSTEMI hastalarında prognozun değerlendirilmesinde hematolojik parametreler ile TIMI risk skoru arasındaki ilişkinin incelenmesi(İstanbul Medipol Üniversitesi Tıp Fakültesi, 2019) Karaoğlu, Ulaş; Bulut, MehtapGiriş ve Amaç: Çalışmamızda NSTEMI hastalarında prognozun öngörülmesinde hematolojik parametrelerin (lökosit sayısı (WBC), nötrofil sayısı, lenfosit sayısı, MPV, nötrofil/lenfosit oranı (NLR), platelet/lenfosit oranı (PLR), WBC/MPV oranı (WMR)) etkiliğini değerlendirmeyi, ayrıca hematolojik parametrelerin TIMI risk skoru ile olan uyumunu incelemeyi amaçladık. Gereç ve Yöntem: Bu çalışma tek merkezli, retrospektif ve gözlemsel bir kohort çalışması olup, NSTEMI tanısı alan, 18 yaş ve üzeri 259 hasta dahil edilmiştir. 1 senelik takip süresi içerisinde kararsız angina pektoris (USAP) nedeniyle hastaneye yatış, invaziv tedavi veya ilaç kullanımını gerektiren aritmiler, ölümcül olmayan MI veya kardiyak nedenli ölüm görülmesi majör istenmeyen kardiyak olay (MACE) olarak tanımlanmıştır. Hematolojik parametrelerin MACE'yi öngörmedeki etkinlikleri ROC eğrisi kullanılarak karşılaştırılmıştır. Bulgular: Çalışmaya dahil edilen 259 hastanın 188'i (%72,6) erkek olup hastaların yaş ortalaması 60,4 ± 11,9'dur. 1 yıllık takipte 60 hastada (%23,2) MACE görülmüştür. Başvuru anındaki yüksek WBC, nötrofil, NLR, PLR ve WMR değerleri uzun dönem prognozla, WBC, WMR ve NLR değerleri de TIMI skoruyla uyumlu bulunmuştur. Parametrelerin MACE öngörme gücü ROC analizi ile değerlendirildiğinde AUC değeri WBC, WMR ve NLR için sırasıyla 0,670 (%95 GA 0,590-0,750), 0,664(0,582-0,746), 0,689 (0,610-0,767) olarak saptanmıştır. Sonuç: Basit, hızlı ve ucuz bir tetkik olan hemogram parametrelerinden özellikle WBC, nötrofil, WMR, PLR ve NLR'nin NSTEMI hastalarında prognozu (MACE) öngörme gücü anlamlı bulunmuştur. Ayrıca WBC, WMR ve NLR değerleri TIMI skoruyla uyumlu saptanmıştır. Bunlar arasında NLR'nin prognozu öngörme gücü diğerlerinden daha yüksek saptanmıştır.Öğe Stroke in a young patient(Bozok Üniversitesi Tıp Fakültesi, 2018) Bahadırlı, Suphi; Karaoğlu, Ulaş; Sarıhan, Aydın; Bulut, MehtapStroke is the second leading cause of major morbidity and mortlaity in the world. However, acute ischemic attacks are very rare in the pediatric and young age groups (5-10%). In this case we aimed to take attention to stroke must kept in mind in young adults and pediatric patients. A 15-year-old male patient presented to the emergency department with a severe acute headache in the left side of the head. Vital signs were normal. Right hemiparesis present in physical examination. CT findings were normal. On the diffusion MRI acute infarction was detected. He was admitted to pediatric neurology service with acute stroke diagnosis. Childhood stroke is a neglected area, with both professionals and the general public lacking awareness of the problem and its potential consequences.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 unusual reason of the hand injury: Sneeze Sagittal band rupture(BMJ Publishing Group, 2016) Sarıhan, Aydın; Can, Çağdaş; Bulut, Mehtap[Abstract Not Available]
