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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 Acil Servise Başvuran Hastalarda Pulmoner Bt Anjiografi Tetkikinin Tanı Verimliliğinin Değerlendirilmesi(2022) Ertem, Şenay Bengin; Aylanç, Nilüfer; Daş, Murat; Bardakçı, OkanAmaç: Acil servislerde ileri görüntüleme yöntemleri giderek artan oranlarda kullanılmaya başlamıştır. Bu hızlı artış beraberinde; hem söz konusu görüntüleme yöntemlerinin tanı verimliliğinin düşük olması olasılığını; hem de bu metotlara bağlı gelişebilecek olası zararları gündeme getirmiştir. Bu konuda acil servislerde pulmoner bilgisayarlı tomografi anjiografi (pulmoner BTA) kullanımı özellikle ön plana çıkmaktadır. Gereç ve Yöntemler: Çalışma, Ocak 2016 ile Haziran 2018 ayları arasında acil servise başvuran ve pulmoner emboli (PE) ön tanısı ile pulmoner BTA tetkiki istenen hastaların radyolojik görüntülerinin ve medikal kayıtlarının retrospektif olarak incelenmesi yöntemiyle yapıldı. Çalışma verileri SPSS 19 paket programı kullanılarak analiz edildi. Sayısal değişkenlerin karşılaştırmasında Mann Whitney U testi kategorik değişkenlerin karşılaştırmasında Ki-Kare testi kullanıldı. İstatistiksel verilerin yorumunda p<0,05 anlamlı olarak kabul edildi. Bulgular: Çalışma döneminde acil servise başvuran ve PE ön tanısı ile pulmoner BTA çekilen toplam 233 hasta tespit edildi. Hastaların 11’i artefaktlar nedeniyle çalışma dışında bırakıldılar. Geriye kalan 222 hastaya ait veriler analiz edildi. Hastaların 19’unda (%8,6) PE pozitif (Grup-1); 203 hasta (% 91,4) Pulmoner emboli negatif (Grup-2) olarak saptandı. Ayrıca PE tespit edilmeyen (Grup-2) hastalardan ikisinde (%0,9) herhangi bir patoloji izlenmedi ve normal olarak raporlandı. Her iki grupta da hastaların acil servise en sık nefes darlığı ikinci sıklıkla göğüs ağrısı, şikayetleri ile başvurdukları görüldü (Tablo-I). Sonuç: Sonuç olarak, PE ön tanısı ile istenen pulmoner BTA’nın tanısal verimliliğini, literatürle uyumlu olarak düşük (%8,6) bulduk. Tetkikin doğruluğunu ve performansını arttırmak için ileri çalışmalara ihtiyaç olduğunu düşünmekteyiz.Öğe Acil Serviste Karbonmonoksit Zehirlenmesi Tanısı Alan Hastalarda Plazma Total Tiyol Seviyelerinin Değerlendirilmesi(Acil Tıp Uzmanları Derneği, 2023) Delice, Orhan; Daş, Murat; Kurtoğlu Çelik, Gülhan; Kavaklı, Havva Şahin; Neşelioğlu, Salim; Hatıl, Semra IşıkoğluObjective: The study aimed to measure the levels of total thiol, an antioxidant parameter, in patients who presented to the emergency department (ED) with carbon monoxide (CO) poisoning under normobaric oxygen therapy (NBOT), evaluate the time-dependent changes in total thiol levels within the first 6 hours, and examine the course of antioxidants in CO poisoning. Materials and Method: The study population consisted of 85 patients diagnosed with CO poisoning in the ED and 50 volunteers. Total thiol level was measured in the study group at the admission (T0), first (T1) and sixth hour (T6). Carboxyhemoglobin levels, cardiac markers, electrocardiography, and routinely requested tests were investigated in patients with poisoning. The total thiol level was measured in the volunteer group. Results: There was a significant decrease in total thiol mean levels between T0 and T1 (pÖğe Akut böbrek hasarı olan hastalarda serum düzeltilmiş ve iyonize kalsiyum seviyelerinin karşılaştırılması(2021) Akman, Canan; Bakirdogen, Serkan; Daş, Murat; Balcı, Serdal; Aykan, Okyanus NecdetGiriş: Hastaneye yatırılan hastalarda akut böbrek hasarı (ABH) sık olarak görülmektedir (%1,92). ABH’lı hastalarda serum düzeltilmiş ve iyonize kalsiyum düzeylerinin acil hemodiyalizi öngörmedeki etkisi bilinmemektedir. Bu çalışmada acil serviste ABH tanısı alan hastalarda serum düzeltilmiş ve iyonize kalsiyum düzeylerini karşılaştırmayı amaçladık. Yöntem: Çalışmamız retrospektif olarak planlandı. Grup 1: En az bir kez acil hemodiyaliz seansı alan ABH hastaları. Grup 2: Hemodiyalize girmeyen AKIN evre 1-3 olan hastalar. Hastaların başvuru anında serum düzeltilmiş ve iyonize kalsiyum, kreatinin ve albümin değerleri incelendi. Çalışmanın tüm verileri SPSS 19.0 ile kaydedildi. İstatistiksel anlamlılık için p <0,050 kabul edildi. Bulgular: Serum düzeltilmiş kalsiyum düzeylerinin ortalaması grup 1'de grup 2'ye göre daha düşüktü ve fark istatistiksel olarak anlamlıydı (p <0,001). Kan gazındaki ortalama iyonize kalsiyum seviyeleri grup 1'de grup 2'ye göre daha düşüktü ve fark istatistiksel olarak anlamlıydı (p = 0,002).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 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 Diagnostic utility of simple hematologic markers in acute gastroenteritis patients admitted to the emergency department(2020) Bardakçı, Okan; Daş, Murat; Akdur, Gökhan; Beyazit, YavuzThe contributions of hematologic parameters to the inflammatory response via different leukocyte and platelet pathways are well known. However, the diagnostic yield ofthese parameters in acute gastroenteritis (AGE) is not yet well understood. This study was planned to investigate the diagnostic value of simple hematological markers,including mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW), platelet distribution width (PDW), and platelet-to-lymphocyteratio (PLR), in patients with AGE admitted to the emergency department. A total of 57 patients with AGE of either viral or bacterial origin and 69 age and sexmatchedcontrol subjects were studied. NLR, PLR, MPV, PDW, and RDW values in all patients were calculated and recorded from complete blood cell counts. A total of126 patients (57 men [45.2%] and 69 women [54.8%]) were included in the study. The mean NLR and PLR values of AGE patients were significantly higher than thoseof health controls (NLR = 4.44 ± 4.1 for AGE patients and 2.22 ± 1.2 for controls [P < 0.001]; PLR = 160.4 ± 102.4 for AGE patients and 113.8 ± 42.6 for controls [P =0.02]. ROC curve analysis suggested that the optimum NLR cut-off point for AGE was 2.08, with a sensitivity, specificity, PPV, and NPV of 70%, 65%, 62%, and 72%,respectively (AUC = 0.704). The optimum PLR cut-off point for AGE was 105.55, with sensitivity, specificity, PPV, and NPV of 71%, 50%, 54%, and 68%, respectively(AUC = 0.648). We demonstrated that NLR and PLR levels are elevated in AGE patients. Thus, NLR and PLR levels can be considered a valuable tool to differentiateacute gastroenteritis from other non-inflammatory emergent conditions.Öğe Evaluation of Medical Skills of Medical Faculty Final Year Students Who Received Emergency Medicine Internship(Tıp Eğitimini Geliştirme Derneği, 2023) Akman, Canan; Toraman, Çetin; Daş, Murat; Bardakcı, Okan; Akdur, Gökhan; Akdur, OkhanAim: The final year of medical school is the last period of students in transition to the profession. In the post-graduation period, they are ready to make clinical decisions and practice in the approach to the emergency patient. Emergency medicine includes acute diagnosis and treatment of diseases (physical and mental) and injuries in all age groups. This management includes knowledge and skills. In emergency medicine internship, students have the opportunity to evaluate patients from many different clinics. In the National Core Education Program (UCEP), the minimum qualifications that a person graduating from medical school should have are presented. In our faculty, medical skills (history taking, physical examination, interventional procedures) are specified together with the goals and objectives. In our study, it was aimed to compare the medical skills of the senior medical faculty students who received emergency medicine internship, along with the medical skills of the students who took the emergency medicine internship as an elective internship according to their field of interest, together with the basic skills aimed to be achieved by the use of UCEP in a university hospital. Methods: This descriptive study covers the 2021-2022 academic year at Çanakkale Onsekiz Mart University Faculty of Medicine. The study started after the approval of the ethics committee. The questionnaire was applied face-to-face to 123 senior students who took emergency medicine internship for the first time and 29 senior students who took emergency medicine internship again optionally according to their field of interest. Questions were asked about demographic information and the status of following, performing and performing basic medicine skills and practices determined by the UÇEP Results: 52.6% of the students who participated in the study answered the reason for choosing a medical faculty as "my ideal profession of medicine". While 87.5% of the students stated that they would like to work as a "specialist physician" after graduation, 70.4% of them stated that they were preparing for the medical specialty exam. During the 8-week practice period of the emergency medicine internship, senior students are on duty for 12 hours. They are in clinical applications such as patient preparation, diagnosis, treatment planning, vascular access, catheterization and suturing. In our study, 99.3% of them stated that they felt competent in performing electrocardiography (ECG), 14.5% in intubation, 32.9% in the proper transportation of a severed limb after trauma, and 44.7% in the ability to provide advanced cardiac life support. Compared with students who are interested in emergency medicine internship and choose emergency medicine internship again as an elective internship; The rate of intubation increased to 27.6% (p=0.009) and the rate of prescribing was 100% (p=0.024). The results are statistically significant. Conclusions: Emergency medicine internships taken by senior medical students contribute to their medical skillsÖğe 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 Prediction of mortality in COVID-19 through combing CT severity score with NEWS, qSOFA, or peripheral perfusion index(W.B. Saunders, 2021) Akdur, Gökhan; Daş, Murat; Bardakçı, Okan; Akman, Canan; Sıddıkoğlu, Duygu; Akdur, Okhan; Akçalı, Alper; Erbaş, Mesut; Reşorlu, Mustafa; Beyazıt, YavuzIntroduction: The assessment of disease severity and the prediction of clinical outcomes at early disease stages can contribute to decreased mortality in patients with Coronavirus disease 2019 (COVID-19). This study was conducted to develop and validate a multivariable risk prediction model for mortality with using a combination of computed tomography severity score (CT-SS), national early warning score (NEWS), and quick sequential (sepsis-related) organ failure assessment (qSOFA) in COVID-19 patients. Methods: We retrospectively collected medical data from 655 adult COVID-19 patients admitted to our hospital between July and November 2020. Data on demographics, clinical characteristics, and laboratory and radiological findings measured as part of standard care at admission were used to calculate NEWS, qSOFA score, CT-SS, peripheral perfusion index (PPI) and shock index (SI). Logistic regression and Cox proportional hazard models were used to predict mortality, which was our primary outcome. The predictive accuracy of distinct scoring systems was evaluated by the receiver-operating characteristic (ROC) curve analysis. Results: The median age was 50.0 years [333 males (50.8%), 322 females (49.2%)]. Higher NEWS and SI was associated with time-to-death within 90-days, whereas higher age, CT-SS and lower PPI were significantly associated with time-to-death within both 14 days and 90 days in the adjusted Cox regression model. The CT-SS predicted different mortality risk levels within each stratum of NEWS and qSOFA and improved the discrimination of mortality prediction models. Combining CT-SS with NEWS score yielded more accurate 14 days (DBA: −0.048, p = 0.002) and 90 days (DBA: −0.066, p < 0.001) mortality prediction. Conclusion: Combining severity tools such as CT-SS, NEWS and qSOFA improves the accuracy of predicting mortality in patients with COVID-19. Inclusion of these tools in decision strategies might provide early detection of high-risk groups, avoid delayed medical attention, and improve patient outcomes.Öğe The diagnostic value of calcium binding protein S100A8/A9 and S100A12 in acute pancreatitis(MediHealth Academy Yayıncılık, 2022) Bardakcı, Okan; Daş, Murat; Şehitoğlu, Hilal; Çetin, Ece Ünal; Atalay, Ünzile; Küçük, Uğur; Kamış, FatihBackground: S100A8/A9 and S100A12 which are the major calcium-binding proinflammatory proteins secreted by granulocytes, has been proposed to be related to distinct disease states of inflammatory origin. This study aims to explore the circulating levels of S100A8/A9 and S100A12 in acute pancreatitis (AP) and reveal their relationship with conventional inflammatory markers. Material and Method: Serum S100A8/A9 and S100A12 were determined in AP patients (male/female: 17/13) by using a specific enzyme-linked immunosorbent assay (ELISA) method at both onset and remission and in 30 healthy controls (male/female: 17/13). Results: Significantly higher S100A8/A9 and S100A12 levels were found in AP patients compared to healthy controls (pÖğe The effect of meteorological variables on spontaneous pneumothorax in two regions with different altitudes(Springer Science and Business Media Deutschland GmbH, 2021) Daş, Murat; Alar, Timuçin; Delice, Orhan; Gedik, İsmail Ertuğrul; Bardakçı, Okan; Akman, Canan; Ulaş, Ali Bilal; Akdur, OkhanSpontaneous pneumothorax (SP) is defined as the presence of free air inside the pleural space. Many studies have reported that meteorological variables may trigger SP, but the mechanism is unknown. The aim of this study was to compare the effects of meteorological variables on the development of SP in two regions with different altitudes. The study was conducted in the Çanakkale (2 m above sea level) and the Erzurum region (1758 m). A total of 494 patients with SP who presented to the hospitals of the two regions between January 2011 and December 2016 were included in the study. The meteorological variables used included ambient temperature, atmospheric pressure, relative humidity, precipitation amount, wind speed, and wind direction (as north and south). The total 2192 days were divided into two as days with and without an SP case presentation. A 4-day period prior to the day a case presented was compared with the other days without any cases to investigate the presence of any lagged effect. Statistical significance was accepted at p < 0.05. Comparison of these two regions showed a significant difference between them. The meteorological variables of the regions that affect SP development were found to be low mean minimum temperature, high daily temperature change, low precipitation, low wind speed and north winds for Erzurum, and only rainy days for Çanakkale. The results have demonstrated that cold weather, sudden temperature changes, north winds, and low wind speed are risk factors for the development of SP at high altitudes.Öğe The Importance of Serum Omentin-1 and Visfatin Levels in Determining Acute Pancreatitis Activation(Nizameddin KOCA, 2025) Tekin, Dilara; Kurtkulağı, Özge; Daş, Murat; Çinpolat, Havva Yasemin; Beyazıt, YavuzBackground Acute pancreatitis is a disease that can lead to serious mortality and morbidity. Therefore, the use of inflammatory markers is of great importance in determining the prognosis of the disease. Omentin-1 and visfatin are newly discovered adipokines associated with inflammation. In this study, we aimed to demonstrate the importance of omentin-1 and visfatin in diagnosing and activating acute pancreatitis. Methods Serum samples from 52 patients diagnosed with acute pancreatitis who presented to the Emergency Department of Çanakkale Onsekiz Mart University Health Practice and Research Hospital between July 2022 and May 2023 were analyzed for serum omentin-1 and visfatin levels, along with routine laboratory tests, during both the initial and remission periods. Disease severity was calculated using the Modified Glasgow Prognostic Score. Correlation analysis was conducted among study variables. Results The marker with the highest sensitivity and specificity in predicting active disease was found to be C-reactive protein (CRP). The sensitivity of serum omentin-1 levels in determining active disease was 84.62%, with a specificity of 73.17%. Serum visfatin levels had a sensitivity of 76.92% and a specificity of 78.05% in determining active disease. According to the Modified Glasgow Prognostic Scoring System, omentin showed the highest sensitivity (82.61%) in distinguishing mild-moderate cases from severe cases, while visfatin had the highest specificity (86.21%). Conclusion In our study, serum levels of omentin-1 and visfatin negatively correlated with disease diagnosis and severity.Öğe To: Perfusion index for assessing microvascular reactivity in septic shock after fluid resuscitation(Associacao de Medicina Intensiva Brasileira - AMIB, 2019) Daş, Murat; Bardakci, Okan; Beyazit, Yavuz[No abstract available]
