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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 Comparison of tricuspid and mitral annular plane systolic excursion in determination of acute blood loss in healthy volunteers(Springer Science and Business Media Deutschland GmbH, 2023) Sarıhan, Aydın; Güllüpınar, Birdal; Sağlam, Caner; Karagöz, Arif; Tandon, Shikha; Turhan, Ajda; Koran, Serhat; Ünlüer, Erden ErolUltrasound is used more and more in determining acute blood loss. This study is to compare tricuspid annular plane systolic excursion (TAPSE) and mitral annular plane systolic excursion (MAPSE) measurement to determine volume loss pre and post blood donation in healthy volunteers. The systolic, diastolic and mean arterial blood pressures and pulses of the donors were measured in the standing and supine position by the attending physician, then, inferior vena cava (IVC), TAPSE and MAPSE measurements were made pre and post blood donation. Statistically significant differences were found in systolic blood pressure and pulse rate values that obtained in the standing position, and in the systolic blood pressure, diastolic blood pressure, mean arterial pressure and pulse values that obtained in the supine position (p < 0.05). The difference between IVC expiration (IVCexp) pre and post blood donation was 4.76 +/- 2.94 mm, and the difference in IVC inspiration (IVCins) was 2.73 +/- 2.91 mm. In addition, the MAPSE and TAPSE differences were 2.16 +/- 1.4 mm and 2.98 +/- 2.13 mm, respectively. Statistically significant differences were found between IVCins-exp, TAPSE and MAPSE values. TAPSE and MAPSE can be helpful in the early diagnosis of acute blood loss.Öğe COVID-19 ve acil servislerde yarattığı etik sorunlar(İzmir Hastaneline Yardım ve Bilimsel Araştırmaları Teşvik Derneği, 2022) Can, Çağdaş; Sarıhan, Aydın; Güllüpınar, Birdal; Koran, Serhat; Bülbül, Emre; Ünlüer, E. ErolGiriş Tıbbın temel etik ilkeleri otonomi, fayda, zarar vermemek, adalet, dayanışma, görev bilinci, güven ve karşılıklılıktır Biz bu çalışmada COVID 19 şüphesi veya tanısıyla acil servise başvuran hastalarda pandemi ilişkili en sık görülen etik sorunları anket formu aracılığıyla sorgulayarak yorumlamayı hedefledik Materyal Metod Çalışmanın evrenini 15 Nisan 2021 15 Mayıs 2021 tarihleri arasında Manisa Merkezefendi Devlet Hastanesi Acil COVID 19 polikliniğine başvuran ateş, boğaz ağrısı, nefes darlığı ve ishal gibi semptomları olan hastalar oluşturdu Bu hastalara anket formu dağıtılarak veri analizi yapıldı Araştırma verileri SPSS 23 0 programı aracılığıyla değerlendirildi Kategorik değişkenlerin karşılaştırılmasında pearson ki kare testi ve fisherin kesinlik testi kullanıldı İstatistiksel anlamlılık düzeyi p< 0 05 olarak belirtildi Bulgular Çalışmaya katılanların yaş ortalaması 45 05 18 1 aralığında olup 134 ’ü erkek 51 0 ve 129 ’u bayan 49 0 idi Çalışmaya katılan 150 57 0 hasta COVID 19 tedavisinde kullanılan ilaçlar hakkında bilgisi olmadığını söylerken, 113 43 0 hasta ilaçlar hakkında yeterli bilgisi olduğunu ifade etti Çalışmaya katılan hastaların 106 ’sı 40 3 COVID 19 tedavisinde kullanılan ilaçların faydasız olduğunu ifade ederken, 19 ’u 7 2 çok faydalı olduğunu vurguladı Çalışmaya katılan 162 61 6 hasta COVID 19 tanısı/şüphesiyle takip edildiği süre içinde yakınlarına ulaşma konusunda zorluk çekmediğini ifade ederken, 90 34 2 hasta aynı konuda zorluk çektiklerini vurguladı Cinsiyet ve COVID 19 aşısı yaptırma, hastaneye yatış oranları ve ertelenen hastalık varlığı arasında kadın cinsiyet lehine anlamlı istatistiksel oran saptandı Sonuç Pandemi döneminde tıp etiğini bilmek acil serviste görülebilecek olası etik sorunların saptanmasında ve yönetiminde kolaylık sağlayacaktır.Öğe Evaluation of patients admitted to the emergency department with the suspect of acute renal colic with the modified STONE score(Emergency Medicine Physicians Association of Turkey, 2022) Güllüpınar, Birdal; Ayvat, Pınar; Ünlüer, Erden Erol; Koran, SerhatAim: Renal colic pain is one of the most common agonizing forms of pain that is frequently treated in emergency departments. Computed tomography (CT), which is used for the detection of kidney stones, is a costly application. Therefore, scoring systems that predict stone have been developed. This study was conducted to investigate the diagnostic accuracy of the Modified STONE Score (MSS) to predict stones. Materials and Methods: Among those who applied to the emergency department with renal colic pain, patients with CT were examined. Three hundred and thirty-seven patients included in the study were divided into two groups as those with and without kidney stones. It was examined whether there was a difference between these two groups in terms of personal, seasonal, laboratory findings and MSS. Results: We found that ureteral stone history, pain duration less than 6 hours, presence of hematuria and nausea/vomiting, C-reactive protein (CRP) value below 0.5 mg/dL, The MSS above 9, age <= 50 years were factors that increase stone. The MSS was significantly high in the stone-detected group. When the STONE score is calculated for all patients and divided into three groups (low, moderated, and high modified STONE scores), the prevalence of ureteral stones increases towards the high MSS group. Conclusion: We found that the modified STONE score was quite successful in predicting ureteral stones. We determined that emergency physicians can diagnose stones using this score and avoid unnecessary CT. The diagnostic value of this score may increase when nausea/ vomiting factor is added.Öğe New hematological parameters as early diagnosis and prognostic markers in critically patients(Via Medica, 2022) Güllüpınar, Birdal; Sağlam, Caner; Yavru, Emine Vildan; Aksoy, Elif Eren; Koran, Serhat; Evrin, Togay; Ünlüer, Erden ErolINTRODUCTION: Nucleated red blood cells and immature granulocytes are not normally detected in the blood of healthy adults. We aimed to investigate the effect of nucleated red blood cells and immature granulocytes on mortality in order to identify critically ill patients who were admitted to the emergency department, at high risk of death, and who was not traumatic. MATERIAL AND METHODS: This study was performed retrospectively in the emergency department of a tertiary education and research hospital between January 2021 and June 2021. All patients who died out of trauma and patients who were discharged from the emergency department on the same day were included. Nucleated red blood cells and immature granulocytes parameters were compared between the two groups. The primary outcome was all-cause death in the emergency department. RESULTS: Of the 188 patients included in the study, 129 (68.6%) were male. Nucleated red blood cells (1.88 ± 6.9/?L; 0.02 ± 0.08), % immature granulocytes (2.91 ± 3.04/?L; 0.58 ± 1.63) and immature red blood cells in deceased patients' granulocyte count (0.38 ± 0.46/?L; 0.04 ± 0.04) was significantly more significant than the control group (p < 0.001). When the area under the curve was examined, the highest value was found in nucleated red blood cells (Area under the curve = 0.920, p < 0.001). In multivariate regression analysis, high nucleated red blood cells, immature granulocyte count, and white blood cell levels were associated with all-cause mortality in the emergency department. CONCLUSIONS: High nucleated red blood cells and immature granulocyte levels may be associated with increased mortality during admission to the emergency department.Öğe Search for the clinical effectiveness of Korean Tae-Geuk acupuncture therapy in chronic tension-type headache(Ediciones Doyma, S.L., 2021) Koran, Serhat; Sang, Jeon Eun; Burcu, Polat; Arıcı Düz, Özge; Sarıhan, AydınBackground: Korean acupuncture comes from the far-eastern tradition and has unique approaches to acupuncture point selection. Objectives: There are several types of acupuncture methods. Among these, Tae-Geuk acupuncture and Saam acupuncture adopt five phase characteristics, using five vital points. Cho-sun acupuncture regulates Qi using acupunctures and meridians according to the flow of Qi. In this project, the effects of Korean Tae-Geuk acupuncture on chronic tension-type headache (TTH) were examined. Methods: This study is a randomized controlled study involving sham acupuncture (placebo acupuncture), and everything is clear except for the data processing phase. The purpose of the study; was to measure the safety and efficacy of Korean Tae-Geuk acupuncture in patients with chronic TTH. Groups used; acupunture + traditional pharmacological therapy, traditional pharmacological therapy only and placebo korean acupuncture + traditional pharmacological therapy groups. Seven treatment sessions were applied over a four-week period. Changes in pain and quality of life and side effects were examined during treatment and within 3 months after the completion of treatment. Results were evaluated by using the visual analog scale for pain and pain log records. Results: Korean Tae-Geuk acupuncture is a more effective treatment than placebo and traditional pharmacological treatment in chronic TTH. Korea Tae-Geuk acupuncture showed significant improvement in clinically chronic TTH during treatment and in 3 months follow-up after treatment. Conclusion: Tae-Geuk acupuncture is a treatment branch of Sasang Constitution Medicine. Acupuncture points do not change according to acupuncture practitioner or disease.Öğe The role of mitral annular plane systolic excursion in prediction of acute blood loss in healthy voluntary blood donors(Medical communications, 2022) Güllüpınar, Birdal; Sağlam, Caner; Koran, Serhat; Turhan, Ajda; Ünlüer, Erden ErolAim: The aim of this study is to compare the diameter of the inferior vena cava with mitral annular plane systolic excursion measurement in order to determine the volume loss before and after blood donation in healthy volunteers. Material and methods: The study was a singlecenter, prospective, cross-sectional study which included 46 healthy blood donors donating in a tertiary care hospital's blood bank. The inclusion criteria for the study were: volunteers aged 18-65 years, over 50 kg in weight, who met blood donation criteria, with hemoglobin values of 13.5 g/dL for males and >12.5 g/dL for females. After obtaining written consent, the systolic, diastolic, and mean arterial blood pressure along with the pulse rate of the donors were measured in standing and lying positions by the attending physician. Next, inferior vena cava and mitral annular plane systolic excursion measurements were made both pre and post blood donation. Results: The decrease in both inferior vena cava diameter and mitral annular plane systolic excursion values measured pre and post blood donation was found to be statistically significant (p <0.05). There was no difference between the other variables pre and post blood donation. Conclusions: Our study revealed that decreased inferior vena cava and mitral annular plane systolic excursion values correlated in determining blood loss post blood donation. Mitral annular plane systolic excursion may be useful to predict blood loss in the early stages of hemorrhagic shock.Öğe Trombolitik tedavi alan akut iskemik inmeli hastalarda mortaliteyi tahmin etmede çekirdekli kırmızı kan hücresi, olgunlaşmamış granülosit sayısı ve yüzdesinin rolü(İzmir Bozyaka Eğitim ve Araştırma Hastanesi, 2022) Güllüpınar, Birdal; Koran, Serhat; Öcek, Özge; Ortan, Pınar; Ünlüer, Erden ErolGiriş: İnme, dünyada ikinci en büyük ölüm nedenidir. Aynı zamanda dünya çapında engelliliğin önde gelen nedenidir. Bu çalışmanın amacı; akut iskemik inme (AIS) nedeniyle intravenöz trombolitik tedavi (IVT) alan hastalarda kısa vadeli mortaliteyi tahmin etmede çekirdekli kırmızı kan hücresi (NRBC), immatur granülosit sayı (IGS) ve yüzdesi (%IG)’nin etkili bir prediktif belirteç olup olmadığını araştırmayı amaçladık. Gereç ve Yöntem: Ocak 2021-Ekim 2021 tarihleri arasında IVT alan AIS hastalar retrospektif olarak tarandı. Bu hastalar yaş, cinsiyet, inme risk faktörleri, Ulusal Sağlık Enstitüleri İnme Ölçeği (NIHSS), acil servise başvuru anında beyaz kan hücresi, NRBC, IGS ve %IG parametreleri kaydedildi. Mortalite gelişen ve gelişmeyen grup olmak üzere ikiye ayrıldı. Birincil sonuç, 1 aylık mortaliteyi içermesidir. İkincil sonuç ise semptomatik intrakraniyal kanamadır. Bulgular: Çalışmamıza acil serviste IVT uyguladığımız 61 hastadan 51’i dahil edildi. Hastaların 13’ünde (%25,5) takip sırasında mortalite gelişti. NRBC ortalaması mortalite gelişen hastalarda 0,35±0,27 iken, mortalite gelişmeyen hastalarda ise 0,01±0,05 olarak bulundu. IG ortalaması mortalite gelişen hastalarda 0,20±0,16 iken, mortalite gelişmeyen hastalarda 0,04±0,03 idi. Hem NRBC hem de IG istatiksel olarak anlamlıydı. Ayrıca iki hastada intraparankimal kanama gözlendi. Sonuç: Çalışmamız IVT ile tedavi edilen AIS hastalarında periferik kanda artmış NRBC, % IG ve IGS değerleri mortalitenin erken bir biyobelirteci olabilir.Öğe Üst gastrointestinal kanamalı hastalarda mortaliteyi tahmin etmede çekirdekli kırmızı kan hücresi ve immatür granülosit yüzdesinin rolü(İzmir Bozyaka Eğitim ve Araştırma Hastanesi, 2022) Sağlam, Caner; Güllüpınar, Birdal; Çetinbilek, Pınar Hanife; Koran, SerhatGiriş: Üst Gastrointestinal (GI) kanamalar, önemli bir morbidite ve mortalite nedenidir. Acil servis (AS)’te yüksek riskli hastaların erken tespiti için kolaylıkla hesaplanabilen basit ve ucuz yöntemlere ihtiyaç vardır. Bu çalışmanın amacı; AS’e üst GI kanama ile başvuran hastalarda, hastane içi mortaliteyi tahmin etmede çekirdekli kırmızı kan hücresi (NRBC) ve immatür granülosit yüzdesi (% IG)’ nin etkili bir prediktif belirteç olup olmadığını araştırmayı amaçladık. Gereç ve Yöntemler: Bu çalışma Ocak 2021-Haziran 2021 tarihleri arasında AS’e başvuran üst GI kanamalı hastalar üzerinde retrospektif olarak yapıldı. AS’de endoskopi ile GI kanama tanısı alan hastaların demografik özellikleri, komorbidite, triajda ilk yaşamsal bulguları, başvuru semptomları, kanama nedeni, labaratuvar parametreleri, endoskopik tedavi ve sonuçlar kaydedildi. Hastalar taburculuk ve ölü olarak iki gruba ayrıldı. % IG ve NRBC ve diğer parametreler kaydedildi. Çalışmanın amacı hastane içi mortaliteydi. Bulgular: Bu çalışmaya 63’ü erkek olmak üzere 89 hasta dahil edildi. Taburcu edilen hasta sayısı 72 iken ölen hasta sayısı 17 idi. Taburcu olan hastalara göre % IG ve NRBC değerleri ölen grupta daha yüksekti. Hastane içi mortalite için yapılan ROC analizinde; % IG’nin %100 sensitivite, %97.22 spesifite değeri bulundu. Ayrıca NRBC’nin %76.47 sensitivite, %73.61 spesifite değeri bulundu. Hastane içi ölüm oranını tahmin etmede %IG; en yüksek AUC, sensitivite, spesifite değere sahipti. Sonuç: % IG ve NRBC değerlerinin yüksek olması üst GI kanamalı hastalarda hastane içi mortalitenin bir göstergesi olabilir.Öğe Verification of endotracheal tube position by emergency nurses using ultrasound: A repeated measures cadaver study(Elsevier Science Inc., 2022) Sağlam, Caner; Güllüpınar, Birdal; Karagöz, Arif; Tandon, Shikha; Bilge, Okan; Aykır, Merve; Vural, Ayşegül; Koran, Serhat; Ünlüer, Erden ErolIntroduction: Endotracheal intubation is a lifesaving procedure frequently performed in emergency departments. It is associated with some potential risks. Rapid and reliable confirmation of endotracheal tube placement during intubation is critical. Nurses play an important role in the care of patients in various settings. Ultrasound can be performed and interpreted not only by physicians but also by nurses. The aim of this study was to evaluate how well nurses without previous ultrasound experience can determine both esophageal and tracheal localization of endotracheal tubes in cadavers after a short ultrasound training. Methods: This was a repeated measures study with an educational intervention and no control/contemporaneous comparison group. The study was performed to evaluate the ability of emergency nurses to confirm correct endotracheal tube placement and identify esophageal intubations. A total of 7 emergency nurses were given theoretical education and hands-on training about ultrasound. They diagnosed tracheal or esophageal intubation using ultrasound. Results: Four cadavers were used 8 times each for the study. A total of 32 intubation procedures were evaluated with ultrasound by each nurse. In the analysis based on 224 responses, sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and overall accuracy of ultrasound applied by nurses to detect tracheal intubation were 95.61% (90.06%-98.56%), 97.27% (92.24%-99.43%), 35.06 (11.48-107.10), 0.05 (0.02-0.11), and 96.43% (93.08%-98.45%), respectively. The mean time to evaluate the tube location by ultrasound was 6.57 seconds. Discussion: The results support that ultrasound can be performed by nurses for the confirmation for esophageal and tracheal intubations quickly and accurately.
