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Öğe A Rare Cause of the Emergency Department Visit: Internal Jugular Vein Thrombosis(Emergency Medicine Physicians Assoc Turkey, 2021) Akdur, Gokhan; Bardakci, Okan; Akdur, Okhan; Das, Murat; Atalay, UnzileIntroduction: Detection of the internal jugular vein thrombus (IJVT) in the Emergency Department with bedside ultrasonography is not common. Case Report: A 43 years old male patient was admitted to our emergency department with the complaint of pain, swelling and redness on the left side of the neck, which was noticed after chemotherapy 1 day ago. The swelling and redness of the hand, starting from the left clavicle and extending to the corner of the left mandible, were detected in the physical examination of the patient. The patient underwent bedside ultrasonography imaging by the emergency medicine specialist. Ultrasonography examination of the patient was performed with 5-12 MHz linear probe. After visualization of the vascular structures carotid, vascular structures were observed in the sagittal and longitudinal plane by gradual compression. Hyper echoic thrombus was seen in the incompressible internal jugular vein. Conclusion: IJVT can lead to complications such as pulmonary embolism, septic embolism, cerebral venous thrombosis. These complications may decrease with early diagnosis and treatment. It is a rare condition in IJVT Emergency Services. The increasing use of bedside ultrasonography by emergency physicians will prevent possible complications that will enable these patients to be easily diagnosed and successful treatments in recent years.Öğe Accidental Hypothermia and Transcranial Doppler Sonography: Case Report(Mary Ann Liebert, 2021) Bardakçı, Okan; Akdur, Gökhan; Akdur, Okhan; Daş, MuratWe present a patient who was diagnosed with hypothermia in the emergency department and the changes in bedside transcranial Doppler (TCD) measurements during and immediately after the diagnoses were recorded. To the best of our knowledge, this is the first case report in the literature in which TCD data were shared in an accidental hypothermia patient in the emergency department. A 78-year-old male patient was brought to the emergency department with the complaint of speech impairment. The respiratory rate was 24 bpm, pulse rate 40 bpm, body temperature 25.6 degrees C, blood pressure 80/50 mmHg, and glasgow coma scale 11. On electrocardiography, sinus bradycardia (40 bpm) and a small deflection (J wave) at the end of the QRS complex were observed. Immediately after the patient's admission, right middle cerebral artery end diastolic velocity (EDV) was 13.42 cm/s, peak systolic velocity (PSV) was 40.25 cm/s, and pulsatile index (PI) was 1.26 cm/s. After 1 hour, her body temperature was 34.5 degrees C. Measurements with TCD were repeated 1 hour later at the same point and EDV was found to be 26.12 cm/s, PSV 84.02 cm/s, and PI 1.33. At the fourth hour, the patient's body temperature was 36.4 degrees C, he was normothermic, and his mental status completely normalized. The patient was hospitalized for follow-up and treatment. This case supports that it can be used in the evaluation of cerebral perfusion and improvement during treatment in patients with accidental hypothermia in their admission to the emergency department.Öğe Allergic contact dermatitis and periorbital oedema after permanent eyelash dye(Sciendo, 2024) Akdur, Okhan; Akdur, Gökhan; Bardakci, Okan; Das, MuratAllergic contact dermatitis is a rare cause of emergency room visits. However, it can progress to life-threatening conditions such as urticaria and angioedema. In this report, we describe a case that developed severe allergic contact dermatitis around the eye applying an eyelash dye containing p-Phenylenediamine. A 21-year-old female patient was admitted to the emergency department with the complaint of swelling and redness around both eyes. Swelling and redness started 3 days ago with permanent eyelash dye (containing p-Phenylenediamine) application in the beauty center. Clinically, periocular edema and rash was suspected to be an allergic reaction to a substance contained in the eyelash dye. For allergic contact dermatitis, 40 mg methylprednisolone, 45.5 mg pheniramine maleate, IV bolus was administered. The vesicular rash was thought to be a herpes lesion. She was discharged from the emergency department, with an initial dose of 16 mg methyl prednisolone (discontinued by reducing the dose), 500 mg oral valacyclovir twice a day, mupirocin cream on twice a day and oral levocetrizine 5 mg once daily. It was observed that the patient's lesions and redness regressed after 2 weeks. The effects of cosmetic products, which are the agents that come into contact with the skin most often, may differ individually. Agents included in cosmetic products, such as in our case, may cause severe contact dermatitis that requires treatment. Beauticians should also be informed about PPD. Patients who have had allergic reactions due to the use of PPD-containing dyes should use PPD-free cosmetic products. © 2024 Okhan Akdur et al., published by Sciendo.Öğe Biceps Tendon Rupture Diagnosed by Physical Examination and Bedside Ultrasonography in the Emergency Department(Aves, 2015) Yildirim, Ahmet; Akdur, Okhan; Balci, Serdal; Beggi, HalilIntroduction: A complete tear of the proximal long head of biceps tendon is a rare clinical condition that is caused by direct or indirect trauma. We report the case of a patient with a proximal long-head biceps (PLHB) rupture diagnosed by bedside ultrasonography (BUS) and physical examination in the emergency department (ED). Case Report: A-55-year-old, right-handed man presented to ED with pain in the right shoulder and weakness in the elbow. Two days before, while he was lifting a 5-kg object from the ground, he felt a sudden pain, a burning sensation, and an audible pop in his right shoulder. On physical examination, there was a severe pain and tenderness over the anterior aspect of the shoulder, proximal part of the biceps muscle, and distally located biceps muscle mass. An emergency medicine physician performed BUS with a 7.5- to 12-MHz linear transducer. In BUS, there was a hypoechoic area in the right shoulder bicipital groove, but there were no tendon fibers. The evaluation of both the physical examination and sonographic findings revealed a PLHB rupture. Conclusion: BUS is a fast and cost-effective imaging method for the diagnosis of PLHB total rupture in ED.Öğe Bicycle related injuries in adults and children in the central anatolian region: Analysis of 4 years(2012) Özkan, Seda; Akdur, Okhan; İkizceli, İbrahim; Durukan, Polat; İpekci, Afşın; Sözüer, Erdoğan MütevelliAmaç: Çalışmamızda bisiklet kazalarına bağlı yaralanmalarla acil servisimize başvuran çocuk ve erişkin hastaların yaralanma özelliklerinin araştırılması ve karşılaştırılması amaçlanmıştır. Gereç ve Yöntemler: Çalışma Ocak 2005-Aralık 2008 tarihleri arasında acil servise bisiklet kazası ile gelen olguların dosyalarına acil servis ve arşiv kayıtlarından ulaşılarak geriye dönük olarak gerçekleştirildi. Hastalar erişkin ve çocuk yaş grubu olmak üzere iki gruba ayrıldı. Hastaların yaş, cinsiyet, kazaların oluştuğu aylar, yaralanmanın oluştuğu mekan, yaralanma mekanizması, yaralanan vücut bölgeleri, tanı ve tedaviler, taburculuk ve yatış oranları incelendi. İki grubun karşılaştırılmasında Student t testi kullanıldı. Bulgular: Toplam olgu sayısı 150 bulundu. Olguların %79’unu çocuk, %21’ini erişkin yaş grubu oluşturdu. Kazaların sayısının özellikle yaz aylarında arttığı tespit edildi. Çocuklarda oluşan kazaların %71.4’ü erişkinlerin ise tamamı cadde ve sokakta meydana gelmiştir. Çocuklarda (%91) ve erişkinlerde (%90) bisikletten düşme en fazla görülen yaralanma mekanizmasıydı. Baş-boyun bölgesi çocuklarda %32, erişkinlerde ise %40 ile en fazla yaralanmaya maruz kalan vücut bölgesi tespit edildi. Çocuk olguların %78’i, erişkinlerin ise %84’ü acil serviste takip ve tedavi sonrası taburcu edildi. Yaralanma şiddeti açısından iki grup arasında anlamlı fark mevcuttu. Sonuç: Bisiklet kazalarına bağlı yaralanmaların çoğu cadde-sokaklarda, okulun tatil olduğu yaz aylarında ve çocuklarda meydana gelmektedir. Ciddi yaralanmalar erişkinlerde daha fazla görülmektedir. (JAEM 2012; 11: 35-40)Öğe Bicycle Related Injuries in Adults and Children in the Central Anatolian Region: Analysis of 4 Years(Aves, 2012) Ozkan, Seda; Akdur, Okhan; Ikizceli, Ibrahim; Durukan, Polat; Ipekci, Afsin; Sozuer, Erdogan MutevelliObjective: We aimed to investigate and compare the features of child and adult injuries due to bicycle accidents admitted to our emergency department. Material and Methods: The study was carried out retrospectively by searching the files of patients admitted to the emergency department due to bicycle accidents in the emergency department and archive records between the dates of January 2005-December 2008. The patients were divided into two groups as adults and children. Age and sex of the patients, season or month of injuries, place and mechanism of injury, site of the injury, diagnosis and treatment modalities, discharge and hospitalization rates were evaluated. Student t test was used for two group comparison. Results: A total of 150 patients were included in the study. 79% of the patients were in the child age group, 21% were adults. It was determined that the number of accidents increased especially in the summer months. 71.4% of accidents concerning children and all adult accidents occurred in the streets. Falling off the bicycle was the most common cause of injury in children (91%) and adults (90%). The head and neck region was the most common body site subjected to injury in both children (32%) and adults (40%). There was a significant difference between the two groups with respect to injury severity. Conclusion: Most of the injuries due to bicycle accidents in children happen, in the streets, in summer months and during school vacations. Although not statistically significant, it was seen that adult injuries were more serious.Öğe Black Widow Spider Envenomation with Elevated Troponin I Levels(Aves, 2018) Das, Murat; Akdur, Okhan; Akman, Canan; Cetinkaya, YaseminIntroduction: The black widow spider is found worldwide. Alpha-latrotoxin is responsible for the toxic effects related to the spider bite. We report the case of a patient who presented at the emergency department after being bitten by a black widow spider that later developed increased cardiac enzymes. Case Report: The patient was a 24-year-old male who had been bitten by a black spider inside his shoe while he was working in the garden. The patient was referred to the emergency department of department of emergency medicine Canakkale Onsekiz Mart University Faculty of Training and Research Hospital with nausea, vomiting, and severe rigidity in the abdomen for the differential diagnosis of acute abdomen. With severe sweating, the patient had rales in the lower lung zones, and abdominal examination revealed diffuse abdominal guarding. Blood biochemistry revealed creatine kinase (CK): 1838 U/L, CKMb: 71.6 U/L, and troponin I: 0.14 ng/mL. In follow-ups, the troponin I levels increased to 3.01 ng/mL. Electrocardiography revealed normal sinus rhythm. He was followed with a bedside monitor for 3 days in the emergency department. When the patient's troponin I and CK levels decreased, at the end of the third day he was discharged.. Conclusion: Black widow envenomation should be followed for cardiac toxicity other than symptoms, such as muscle spasms, sweating, anxiety, and headache.Öğe Çanakkale Onsekiz Mart Üniversitesi Sağlık Uygulama ve Araştırma Hastanesi Hastane Afet ve Acil Durum Planı 2020(Çanakkale Onsekiz Mart Üniversitesi Sağlık Uygulama ve Araştırma Hastanesi, 2020) Akdur, Okhan[No Abstract Available]Öğe Characteristics of acute adult poisonings in a university hospital emergency department in central Turkey: a three-year analysis(Pakistan Medical Assoc, 2012) Avsarogullari, Levent; Senol, Vesile; Akdur, Okhan; Akin, Aynur; Durukan, Polat; Ozkan, SedaObjective: 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.Öğe Clinical Picture, Radiological Findings, and Physical Examination in Tracheobronchial Foreign Body Aspiration: Which One is More Important?(Aves, 2013) Gedik, Ismail Ertugrul; Alar, Timucin; Omur, Dilek; Akdur, OkhanTracheobronchial foreign body aspiration is more frequent in children between 6 months-3 years of age, whereas it is seen less often in adults. The diagnosis of TBFB aspiration can be delayed in the adult population due to the lack of clinical suspicion. A case of a 56-year-old male patient admitted to the emergency department with a history of aspiration of a piece of carrot 4 hours previously, a cough and stridorous breathing is presented. His physical examination revealed reduced respiratory sounds in the lower zone of the left lung. There was no radiological clue of a tracheobronchial foreign body. Thus, we performed rigid bronchoscopy and found that the left lower lobe basal segment bronchus was almost totally obstructed by a foreign body (carrot) of 1.5x1 cm, which was removed. This was based on the clinical suspicion derived from the history and the physical examination alone. We emphasise that history and physical examination are more important in the diagnosis of organic or non-opaque tracheobronchial foreign body aspiration.Öğe Comparison of different risk stratification systems for prediction of acute pancreatitis severity in patients referred to the emergency department of a tertiary care hospital(Turkish Assoc Trauma Emergency Surgery, 2022) Bardakci, Okan; Akdur, Gokhan; Das, Murat; Siddikoglu, Duygu; Akdur, Okhan; Beyazit, YavuzBACKGROUND: Prognostic prediction and estimation of severity at early stages of acute pancreatitis (AP) are crucial to reduce the complication rates and mortality. The objective of the present study is to evaluate the predicting ability of different clinical and radiological scores in AP. METHODS: We retrospectively collected demographic and clinical data from 159 patients diagnosed with AP admitted to Canakkale Onsekiz Mart University Hospital between January 2017 and December 2019. Bedside index for severity AP (BISAP), and acute phys-iology and chronic health evaluation II (APACHE II) score at admission, Ranson and modified Glasgow Prognostic Score (mGPS) score at 48 h after admission were calculated. Modified computed tomography severity index (CTSI) was also calculated for each patient. Area under the curve (AUC) was calculated for each scoring system for predicting severe AP, pancreatic necrosis, length of hospital stay, and mortality by determining optimal cutoff points from the (ROC) curves. RESULTS: mGPS and APACHE II had the highest AUC (0.929 and 0.823, respectively) to predict severe AP on admission with the best specificity and sensitivity. In predicting mortality BISAP (with a sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of 75.0%, 70.9%, 98.2%, and 12.0%, respectively, [AUC: 0.793]) and APACHE II (with a sensitivity, specificity, NPV and PPV of 87.5%, 86.1%, 99.2%, and 25.0%, respectively, [AUC: 0.840]). CONCLUSION: mGPS can be a valuable tool in predicting the patients more likely to develop severe AP and maybe somewhat better than BISAP score, APACHE II Ranson score, and mCTSI.Öğe Comparison of Macintosh, McCoy and C-MAC D-Blade video laryngoscope intubation by prehospital emergency health workers: a simulation study(Springer-Verlag Italia Srl, 2017) Yildirim, Ahmet; Kiraz, Hasan A.; Agaoglu, Ibrahim; Akdur, OkhanThe aim of the this study is to evaluate the intubation success rates of emergency medical technicians using a Macintosh laryngoscope (ML), McCoy laryngoscope (MCL), and C MAC D-Blade (CMDB) video laryngoscope on manikin models with immobilized cervical spines. This randomized crossover study included 40 EMTs with at least 2 years' active service in ambulances. All participating technicians completed intubations in three scenarios-a normal airway model, a rigid cervical collar model, and a manual in-line cervical stabilization model-with three different laryngoscopes. The scenario and laryngoscope model were determined randomly. We recorded the scenario, laryngoscope method, intubation time in seconds, tooth pressure, and intubation on a previously prepared study form. We performed Friedman tests to determine whether there is a significant change in the intubation success rate, duration of tracheal intubation, tooth pressure, and visual analog scale scores due to violations of parametric test assumptions. We performed the Wilcoxon test to determine the significance of pairwise differences for multiple comparisons. An overall 5 % type I error level was used to infer statistical significance. We considered a p value of less than 0.05 statistically significant. The CMDB and MCL success rates were significantly higher than the ML rates in all scenario models (p < 0.05). The CMDB intubation duration was significantly shorter when compared with ML and MCL in all models. CMDB and MCL may provide an easier, faster intubation by prehospital emergency health care workers in patients with immobilized cervical spines.Öğe COVID-19 pandemic hospital management experience in Turkey(Acad Nacional Medicina Mexico, 2020) Akdur, Okhan[Anstract Not Available]Öğe Diagnostic methods for carbon monoxide poisoning(Nova Science Publishers, Inc., 2023) Daş, Murat; Akdur, Okhan; Akdur, GökhanThe diagnosis of Carbon Monoxide (CO) poisoning consists of three elements: symptoms associated with carbon monoxide poisoning, exposure to CO, and an increase in COHb levels. The most common symptoms in people exposed to CO are non-specific complaints such as headache, nausea, vomiting, and dizziness. The most common environments that produce CO are counted as stoves or ovens using wood or coal as fuel, heaters using propane fuel, and building or forest fires. The COHb level is performed most accurately by co-oximetry blood gas analysis devices with samples obtained from arterial or venous blood samples. There is no correlation between Dechb level and clinical status. In victims with normal COHb levels, the diagnosis should be managed according to the complaints of exposure to CO and admission. © 2024 Nova Science Publishers, Inc. All rights reserved.Öğe Diagnostic utility of hematological indices in predicting adverse outcomes and severity of acute pancreatitis based on BISAP and modified score(Turkish Assoc Trauma Emergency Surgery, 2022) Akdur, Gokhan; Bardakci, Okan; Das, Murat; Akdur, Okhan; Beyazit, YavuzBACKGROUND: The neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte-ratio (PLR), and red blood cell distribution width (RDW) are simple indicators of inflammatory status previously established as a severity indicator in distinct disease states. This study aimed to determine the impact of these simple hematologic indices with conventional inflammation markers such as C-reactive protein (CRP) and white blood cells in acute pancreatitis (AP) patients and their relationship with AP risk stratification scores including Bedside Index for Severity of Acute Pancreatitis (BISAP) and modified Glaskow Prognostic score (mGPS) scores. METHODS: This retrospective study was performed in the emergency department of Canakkale Onsekiz Mart University. A total of 171 patients (male/female: 68 [39.8%]/103 [60.3%]) with AP and 59 age and gender matched healthy subjects (male/female: 23 [39%]/36[61%]) as controls were enrolled in the present study. The patients were grouped according to severity and adverse outcomes according to BISAP and mGPS and a comparative analysis was performed to compare the NLR, PLR, and RDW between groups. RESULTS: The mean NLR values of AP patients and control group were 9.62 +/- 6.34 and 2.04 +/- 1.08, respectively (p<0.001), while the mean PLR values of AP patients and control group were 221.83 +/- 122.43 and 83.30 +/- 38.89, respectively (p<0.001). Except from RDW, all the other hematologic indices were found to be elevated (p<0.05 for WBC; NLR, PLR, and CRP) on both mild and severe disease at disease onset. NLR and PLR showed significant predictive ability for estimating serious complications associated with AP. CONCLUSION: The present study showed that NLR and PLR is increased in AP. Moreover, peripheral blood NLR and PLR values can predict disease severity and adverse outcomes associated with AP and can be used as an adjunctive marker for estimating disease severity.Öğe Diagnostic utility of microhematuria in renal colic patients in emergency medicine: correlation with findings from multidetector computed tomography(2019) Daş, Murat; Bardakçı, Okan; Yurtseven, Ersan; Akman, Canan; Beyazit, Yavuz; Akdur, OkhanAlthough urine analysis is a simple and inexpensive method for the initial evaluation of renal colic patients presenting in emergency departments, it is regarded as unreliable for an exact diagnosis of urinary system stones. The aim of the present study is to assess the association between clinical demographics, and stone size and location, with the combined utility of urinalysis and unenhanced multidetector computed tomography (MDCT) in the emergency department. After gaining local Ethics Committee approval, a retrospective study was conducted with data from 186 patients who presented at our emergency service with flank pain and documented urolithiasis. Stone location and size was determined by MDCT, and the presence of microhematuria confirmed by urinalysis. The presence of hydronephrosis and clinical complaints were also recorded. A total of 186 patients were included in the present study, in which an absence of microhematuria was recorded in 24.7% patients. Urine density was found to be elevated in the microhematuria group (p=0.001). Upper urinary tract stones and hydronephrosis were found to be associated with the presence of microhematuria. Although statistically insignificant, an increased trend of microhematuria was observed with stones over 5 mm in size. Urinary stone size and location are directly associated with the incidence of microhematuria. Absence of microhematuria does not preclude MDCT imaging, however, especially in cases where stones are suspected in patients with renal colic.Öğe Does usage of peritonism tests in an emergency department have any benefit?(Medical Association of Zenica-Doboj Canton, 2014) Akdur, Okhan; Durukan, Polat; Ozkan, Seda; Sozuer, Erdogan M.; Avsarogullari, Levent; Ikizceli, IbrahimAim 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>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.Öğe Effects of Standard Treatment Alone Versus Standard Treatment plus Plasmapheresis on the Levels of Serum Pseudocholinesterase and Erythrocyte Acetylcholinesterase in Critically Patients with Organophosphate Poisoning: Randomized Controlled, Open-label, Clinical Trial(2023) Sezgin, Gülten Can; Sipahioğlu, Hilal; Gündoğan, Kürşat; Coşkun, Ramazan; Temel, Şahin; Yazıcı, Cevat; Akdur, OkhanObjective: Organophosphates are the insecticides commonly used worldwide. Inadequate treatment in organophosphates poisoning increases morbidity, and mortality. Purpose of the work was to determine the effect of standard treatment alone versus standard treatment plus plasmapheresis on the levels of serum pseudo-cholinesterase, and erythrocyte acetyl cholinesterase in severe patients with organophosphates poisoning. Material and Method: This research is a prospective study. Patients diagnosed with organophosphates poisoning were included in the work. The patients were divided into two groups as the intervention group, and the standard group. The intervention group, plasmapheresis was performed in addition to the standard treatment. Results: The research was conducted with forty cases. (Intervention group n:21, standard group n:19). Serum pseudo-cholinesterase values were 482.5 u/L at baseline, 3723 u/L after plasmapheresis. Erythrocyte acetyl cholinesterase values were 1.91 u/mL on admission, 2.53 u/mL after plasmapheresis. Erythrocyte acetyl cholinesterase and serum pseudo-cholinesterase values were compared between the two groups daily from the admission of patients to intensive care units during the first 5 days, and on the last day in the intensive care units. There was no statistical difference between two groups (p> 0.05), except for the second day. It was observed that there was a statistically significant difference between the pseudo-cholinesterase values in the second day comparison of both groups (p=0.028). Conclusion: In conclusion, plasmapheresis treatment may contribute positively to pseudo-cholinesterase level. This treatment may have provided additional time for the organophosphates to be eliminated from the body. Although acetyl cholinesterase reactivation is achieved with oxime treatment, the clinical effect of this treatment is not clear.Öğe Evaluation of the factors predicting the need for intensive care of patients with COVID-19 aged above 65 years: data from an emergency department in Turkey(Associacao Medica Brasileira, 2021) Akman, Canan; Daş, Murat; Bardakcı, Okan; Akdur, Gökhan; Akdur, OkhanOBJECTIVE: Individuals aged ≥65 years are more susceptible to COVID-19 disease and admission to intensive care is most notable. The scoring systems (national early warning score, quick sequential organ failure assessment, shock index) are recommended for rapid assessment of patients in emergency room conditions. The goal of our study is to evaluate scoring systems in conjunction with predictive factors of need for admission to intensive care of patients ≥65 years old with a diagnosis of COVID-19 who applied to the emergency room. METHODS: Patients were divided into two groups according to evolution in the emergency room, being those who needed or not intensive care. National Early Warning Score, quick sequential organ failure assessment, shock index scores and serum biochemistry, blood count and blood gas values were evaluated from hospital information management system records. RESULTS: Of the patients included in the study, 80.8% were admitted to the ward and 14.5% to the unit of intensive care. Lymphocyte count, base deficit and bicarbonate levels were lower, and the levels of C-reactive protein, lactate, D-dimer, urea and lactate dehydrogenase were higher in patients who needed intensive care. Quick sequential organ failure assessment and shock index were considered significant in the group admitted to the intensive care unit. CONCLUSIONS: We recommend that quick sequential organ failure assessment and shock index be used quickly, practically and easily in predicting the need for intensive care unit in patients aged ≥65 years in emergency department diagnosed with COVID-19.Öğe Haemogram indices are as reliable as CURB-65 to assess 30-day mortality in Covid-19 pneumonia(Scientific Scholar Llc, 2022) Bardakci, Okan; Das, Murat; Akdur, Gokhan; Akman, Canan; Siddikoglu, Duygu; Beyazit, Yavuz; Akdur, OkhanBackground. Mortality due to Covid-19 and severe community-acquired pneumonia (CAP) remains high, despite progress in critical care management. We compared the precision of CURB-65 score with monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio ( NLR), platelet-to-lymphocyte ratio (PLR) in prediction of mortality among patients with Covid-19 and CAP presenting to the emergency department. Methods. We retrospectively analysed two cohorts of patients admitted to the emergency department of Canakkale University Hospital, namely (i) Covid-19 patients with severe acute respiratory symptoms presenting between 23 March 2020 and 31 October 2020, and (ii) all patients with CAP either from bacterial or viral infection within the 36 months preceding the Covid-19 pandemic. Mortality was defined as in-hospital death or death occurring within 30 days after discharge. Results. The first study group consisted of 324 Covid-19 patients and the second group of 257 CAP patients. The non-survivor Covid-19 group had significantly higher MLR, NLR and PLR values. In univariate analysis, in Covid-19 patients, a 1-unit increase in NLR and PLR was associated with increased mortality, and in multivariate analysis for Covid-19 patients, age and NLR remained significant in the final step of the model. According to this model, we found that in the Covid-19 group an increase in 1-unit in NLR would result in an increase by 5% and 7% in the probability of mortality, respectively. According to pairwise analysis, NLR and PLR are as reliable as CURB-65 in predicting mortality in Covid-19. Conclusions. Our study indicates that NLR and PLR may serve as reliable predictive factors as CURB-65 in Covid-19 pneumonia, which could easily be used to triage and manage severe patients in the emergency department.
