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    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, Unzile
    Introduction: 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.
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    Advancing ICU mortality prediction in community-
    (Assoc Basic Medical Sci Federation Bosnia & Herzegovina Sarajevo, 2025) Cetin, Ece Unal; Kurtkulagi, Ozge; Kamis, Fatih; Das, Murat; Simsek, Esen; Cetin, Adil Ugur; Beyazit, Yavuz
    Community-acquired pneumonia (CAP) is a leading cause of ICU admissions, with significant morbidity and mortality. Traditional risk stratification tools such as CURB-65, the Pneumonia Severity Index (PSI), and CT severity scores (CT-SS) are widely used for prognosis but could be improved by incorporating novel biomarkers. This retrospective study evaluated the fibrinogen-to-albumin ratio (FAR) as an additional predictor of 30-day mortality in ICU patients with CAP. A total of 158 CAP patients admitted to a tertiary care ICU were included. Baseline data encompassed demographic, clinical, laboratory, and radiological parameters, including FAR, CURB-65, PSI, and CT-SS. Logistic regression and ROC curve analyses were conducted to assess mortality predictors. The 30-day mortality rate was 70.88% (112/158). Higher FAR, PSI, CURB-65, CT-SS, and lactate levels were independently associated with increased mortality (p < 0.05). FAR demonstrated strong discriminatory power (AUROC: 0.704) and significantly improved the predictive accuracy of established models. Adding FAR to PSI increased the area under the receiver operating characteristic (AUROC) from 0.705 to 0.791 (p = 0.009), while combining FAR, CT-SS, and PSI yielded the highest predictive accuracy (AUROC: 0.844, p = 0.032). These findings suggest that FAR, which reflects both inflammation and nutritional status, complements traditional risk assessment tools by providing a dynamic perspective. Integrating FAR into existing models enhances the identification of high-risk patients, enabling timely interventions and more efficient resource allocation in the ICU.
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    Allergic contact dermatitis and periorbital oedema after permanent eyelash dye
    (Sciendo, 2024) Akdur, Okhan; Akdur, Gökhan; Bardakci, Okan; Das, Murat
    Allergic 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.
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    Black Widow Spider Envenomation with Elevated Troponin I Levels
    (Aves, 2018) Das, Murat; Akdur, Okhan; Akman, Canan; Cetinkaya, Yasemin
    Introduction: 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.
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    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, Yavuz
    BACKGROUND: 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.
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    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, Yavuz
    BACKGROUND: 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.
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    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, Okhan
    Background. 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.
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    Implementation of Quebec Shoulder Dislocation Rule in Turkish Patient Population
    (Aves, 2018) Temiz, Aytun; Das, Murat
    Aim: The aim of this study was to investigate whether the Quebec Shoulder Dislocation Rule (QSDR) is valid in Turkish patient population. Materials and Methods: Adult patients with an anterior shoulder dislocation were enrolled in this study. Patients with a severe head injury, multiple trauma, and drug or alcohol intoxication were excluded. All patients were classified according to the associated fracture status. Patients with fracture dislocation were classified as case group (group 1) and patients with isolated dislocation were included to the control group (group 2). Group 1 and 2 patients were statistically compared in terms of risk factors defined by QSDR. Diagnostic performance of this decision tool in predicting a clinically significant fracture was studied. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Results: A total of 248 patients were included in the study. Fracture dislocation was detected in 63 (25.40%) patients (group 1), and no complicated dislocation was detected in 185 (74.59%) patients (group 2). Statistically significant difference was found between groups 1 and 2 in terms of risk factors defined by the QSDR. Sensitivity, specificity, and positive and negative predictive values of the Quebec rule were detected as 100%, 33.51%, 33.87%, and 98.41%, respectively. Conclusion: Our study suggests that QSDR is a useful decision tool to estimate which patient has fracture dislocation of the shoulder in Turkish population. We think that if a shoulder dislocation patient is Quebec-, pre-reduction X-ray could be safely omitted.
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    Point-of-care Lung Ultrasound, Lung CT and NEWS to Predict Adverse Outcomes and Mortality in COVID-19 Associated Pneumonia
    (Sage Publications Inc, 2022) Bardakci, Okan; Das, Murat; Akdur, Gokhan; Akman, Canan; Siddikoglu, Duygu; Simsek, Guven; Kaya, Feyyaz
    Introduction: The appraisal of disease severity and prediction of adverse outcomes using risk stratification tools at early disease stages is crucial to diminish mortality from coronavirus disease 2019 (COVID-19). While lung ultrasound (LUS) as an imaging technique for the diagnosis of lung diseases has recently gained a leading position, data demonstrating that it can predict adverse outcomes related to COVID-19 is scarce. The main aim of this study is therefore to assess the clinical significance of bedside LUS in COVID-19 patients who presented to the emergency department (ED). Methods: Patients with a confirmed diagnosis of SARS-CoV-2 pneumonia admitted to the ED of our hospital between March 2021 and May 2021 and who underwent a 12-zone LUS and a lung computed tomography scan were included prospectively. Logistic regression and Cox proportional hazard models were used to predict adverse events, which was our primary outcome. The secondary outcome was to discover the association of LUS score and computed tomography severity score (CT-SS) with the composite endpoints. Results: We assessed 234 patients [median age 59.0 (46.8-68.0) years; 59.4% M), including 38 (16.2%) in-hospital deaths for any cause related to COVID-19. Higher LUS score and CT-SS was found to be associated with ICU admission, intubation, and mortality. The LUS score predicted mortality risk within each stratum of NEWS. Pairwise analysis demonstrated that after adjusting a base prediction model with LUS score, significantly higher accuracy was observed in predicting both ICU admission (DBA -0.067, P = .011) and in-hospital mortality (DBA -0.086, P = .017). Conclusion: Lung ultrasound can be a practical prediction tool during the course of COVID-19 and can quantify pulmonary involvement in ED settings. It is a powerful predictor of ICU admission, intubation, and mortality and can be used as an alternative for chest computed tomography while monitoring COVID-19-related adverse outcomes.
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    Prediction of adverse outcomes using non-endoscopic scoring systems in patients over 80 years of age who present with the upper gastrointestinal bleeding in the emergency department
    (Turkish Assoc Trauma Emergency Surgery, 2022) Bardakci, Okan; Siddikoglu, Duygu; Akdur, Gokhan; Simsek, Guven; Atalay, Unzile; Das, Murat; Akdur, Okhan
    BACKGROUND: The emergency department (ED) admission rate for elderly patients with non-variceal upper gastrointestinal bleeding (UGIB) is increasing. The AIMS65 and Glasgow-Blatchford score (GBS) are two distinct scoring systems proposed to predict in-hospital and post-discharge mortality, length of stay (LOS), and health-related costs in these patients. The objective of the present study is to evaluate the accuracy of these scoring systems, in conjunction with the Charlson comorbidity index (CCI), to predict 30-day mortality and LOS in UGIB patients who are 80 years of age or older METHODS: A retrospective analysis was undertaken of 182 patients with non-variceal UGIB who were admitted to the ED of Canakkale Onsekiz Mart University Hospital. The AIMS65, GBS, and CCI scores were calculated and adverse patient outcomes were assessed. RESULTS: The mean age of patients was 85.59 +/- 4.33 years, and 90 (49.5%) of the patients were males. The AIMS65 was superior to the GBS (area under the receiver operating characteristic curve [AUROC] 0.877 vs. 0.695, respectively) and CCI (AUROC 0.877 vs. 0.526, respectively) in predicting the 30-day mortality. All three scores performed poorly in predicting the LOS in hospital. The cutoff threshold that maximized sensitivity and specificity for mortality was three for the AIMS65 score (sensitivity, 0.87; specificity, 0.80; negative predictive values [NPV], 0.977; positive predictive values [PPV], 0.392), 14 for GBS (sensitivity, 0.83; specificity, 0.51; NPV, 0.923; PPV, 0.367), and 5 for CCI (sensitivity, 0.91; specificity, 0.22; NPV, 0.946; PPV, 0.145). CONCLUSION: The AIMS65 is a simple, accurate, and non-endoscopic scoring system that can be performed easily in ED settings. It is superior to GBS and CCI in predicting 30-day mortality in elderly patients with UGIB.
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    Prediction of mortality with Charlson Comorbidity Index in super-elderly patients admitted to a tertiary referral hospital
    (Cukurova Univ, Fac Medicine, 2022) Das, Murat; Bardakci, Okan; Akdur, Gokhan; Kankaya, Imran; Bakar, Coskun; Akdur, Okhan; Beyazit, Yavuz
    Purpose: In most countries, there is an ever-increasing admission rate of the elderly population into emergency departments (EDs). In particular, these elderly patients differ from younger patients because they have multiple comorbidities that affect the functionality and quality of life. The goal of this study is to reveal whether the Charlson comorbidity index (CCI) foresee the short- and long-term prognosis of the super-elderly patient population. Materials and Methods: The study was a descriptive, retrospective analysis of emergency department (ED) admissions by patients over 85 years of age and admitted to the Canakkale Onsekiz Mart University (COMU) Hospital between 2013 and 2018. The demographic data of the patients were analyzed according to CCI. Cox-regression analyses were conducted to determine whether the variables affected mortality. Results: A total of 1142 patients aged 85 and older (507 men, 635 women) with a mean age of 86.96 +/- 2.49 were included in the study. According to the multivariable Cox regression analysis male gender, CCI >= 6 and ICU admission were significantly associated with increased mortality rates Conclusion: The CCI predicts short and long-term prognosis in acutely ill, hospitalized super-elderly patients. The CCI could be used to select super-elderly patients at admission as an indicator of improvement at hospital discharge.
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    Prognostic performance of peripheral perfusion index and shock index combined with ESI to predict hospital outcome
    (W B Saunders Co-Elsevier Inc, 2020) Das, Murat; Bardakci, Okan; Siddikoglu, Duygu; Akdur, Gokhan; Yilmaz, Musa Caner; Akdur, Okhan; Beyazit, Yavuz
    Introduction: Peripheral perfusion index (PPI) and shock index (SI) are considered valuable predictors of hospital outcome and mortality in various operative and intensive care settings. In the present study, we evaluated the prognostic capabilities of these parameters for performing emergency department (ED) triage, as represented by the emergency severity index (ESI). Methods: This prospective cross-sectional study included 367 patients aged older than 18 years who visited the ED of a tertiary referral hospital. The ESI triage levels with PPI, SI, and other basic vital sign parameters were recorded for each patient. The hospital outcome of the patients at the end of the ED period, such as discharge, admission to the hospital and death were recorded. Results: A total of 367 patients (M/F: 178/189) admitted to the ED were categorized according to ESI and included in the study. A decrease in diastolic BP, SpO2 and PPI increased the likelihood of hospitalization and 30-day mortality. Based on univariate analysis, a significant improvement in performance was found by using age, diastolic BP, mean arterial pressure, SpO2, SI and PPI in terms of predicting high acuity level patients (ESI < 3). In the multivariable analysis only SpO2 and PPI were found to predict ESI < 3 patients. Conclusion: Peripheral perfusion index and SI as novel triage instruments might provide useful information for predicting hospital admission and mortality in ED patients. The addition of these parameters to existing triage instruments such as ESI could enhance the triage specificity in unselected patients admitted to ED. (C) 2020 Elsevier Inc. All rights reserved.
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    The impact of meteorological parameters on the number of applications to the emergency department with acute urticaria: A retrospective study
    (Public Library Science, 2023) Delice, Orhan; Utlu, Sibel Guclu; Arslan, Senol; Doru, Halil Ibrahim; Das, Murat
    The study aimed to investigate the relationship between the patients who applied to the emergency department with acute urticarial and meteorological factors and determine the associated weather conditions. The relationship between acute urticaria patients who applied to the emergency department of a training and research hospital in a city with high altitude and continental climate characteristics in the eastern part of Turkey between January 2019 and December 2019 and meteorological data was evaluated retrospectively. The necessary data for the weather were obtained from the data of the Erzurum Meteorology Directorate, and the patient data were obtained from the hospital information management system and patient files. The meteorological data of the patients at the date of admission and the characteristics of the patients at that date were compared. The study identified 691 patients who applied to the emergency department diagnosed with urticaria in 2019. According to the seasons, it was observed that the patients applied most frequently in the summer months [n = 239; 34.6%]. In the univariable regression model, which was created by taking the values of weather events as a reference on the days when the urticaria presentation was not observed (Group I), it was determined that every 1-hour increase in the sunshine hour increased the probability of urticaria by 7.4% (p = 0.018). When the meteorological parameters on the days without urticaria (Group I) and the days with urticaria presentation (Group II) were compared, the sunshine hours were 7.9 (4.0-10.6) hours in Group II and 6.65 (3.3-8.85) hours in Group I (p = 0.001). Regarding relative humidity, higher humidity rates were observed in Group I compared to Group II (p = 0.009). In terms of mean temperature, daily maximum, and minimum temperature, higher temperature rates were detected in Group II (p<0.001). A relationship was determined between urticaria attacks and relative humidity and daily maximum and minimum temperature in patients who applied to the emergency department with acute urticaria.