Browsing by Author "Celikel, Elif"

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Analysis of the Use of Resources and Features of Presentations and the Trends in Geriatric Patients Presenting to the Emergency Department: 2011-2015
(2016) Akbuga Ozel, Betul; Mamak Ekinci, Elmas Burcu; Kayipmaz, Afsin Emre; Kocalar, Ummu Gulsum; Celikel, Elif; Kavalci, Cemil; 0000-0003-2529-2946; AAE-4242-2020; AAC-2597-2020; AGG-1308-2022
Introduction: The purpose of the present study was to evaluate presentation and resource utilization at the emergency department by patients >= 65 years of age and the associated trends over the years. Materials and Method: This is a descriptive and retrospective study. Data related to patients >= 65 years of age who presented to emergency department of an urban university hospital between January 1, 2011 and December 31, 2015 were gathered from the hospital information management system. The data were analyzed using SPSS v17.0 software. Results: A total of 29,298 (20.3%) of emergency department visits were made by patients >= 65 years of age. The composition of this group of patients was predominantly female and within the 65-74-year-old age group. A 25% increase in the number of emergency department visits by geriatric patients was observed between 2011 and 2015. Among the geriatric presentations, 76.5% had urgent conditions and 9.3% were admitted to the hospital. Most of the non-urgent patients were females of 65-74 years of age (p<0.05). Female patients had the highest wait times before evaluation by a physician and the highest non-admission rates (p>0.05). Patients of 75-84 years of age had the highest total costs as a group, whereas patients >= 85 years of age had the highest per-patient costs. Conclusion: Resource utilization, length of emergency department stay, and hospital costs increased with geriatric patients' age. Analysis of the frequency of ED use and of resource utilization by geriatric patients would allow patient-centered and cost-effective planning for emergency department care.
Association Of Pediatric Vasculitis Activity Score With Immunoglobulin A Vasculitis With Nephritis
(2023) Avci, Begum; Kurt, Tuba; Aydin, Fatma; Celikel, Elif; Tekin, Zahide Ekinci; Sezer, Muge; Tekgoz, Nilufer; Karagol, Cuneyt; Coskun, Serkan; Kaplan, Melike Mehves; Bayrakci, Umut Selda; Acar, Banu; https://orcid.org/0000-0002-5375-379X; 35895124
Background Immunoglobulin A vasculitis with nephritis (IgAVN) is the most serious complication affecting long-term prognosis. Understanding the risk factors and markers for the development of IgAVN is essential. The aim of this study is to identify IgAVN-associated factors and to evaluate the usability of Pediatric Vasculitis Activity Score (PVAS) at diagnosis as an early marker for the development of IgAVN. Methods We conducted a retrospective case-control study of 314 patients divided into two groups: those with nephritis (IgAVN) and without nephritis (non-IgAVN). The groups were compared in terms of clinical symptoms, laboratory values, and PVAS values. Results In total, 18.5% of the patients had IgAVN; they were older than the non-IgAVN patients (median age was 8.8, p < 0.05). Arthritis/arthralgia, abdominal pain, and intestinal bleeding were more common, systolic and diastolic BP were higher in IgAVN (p < 0.05). CRP, serum creatinine, and urine protein/Cr, PVAS were higher, while serum albumin was lower in IgAVN (p < 0.05). The receiver operator characteristic curve (ROC) analysis showed that IgAV patients with a determined cut-off PVAS value greater than 3 had 70.7% sensitivity in predicting whether or not they would develop IgAVN. Logistic regression analysis found that PVAS > 3 and low serum albumin at the time of diagnosis were independent risk factors for IgAVN. Conclusion Our study revealed that PVAS > 3 at diagnosis is an independent predictor of IgAVN. Patients with PVAS > 3 should be followed more closely to ensure early diagnosis and management of IgAVN.
Correlation of CAT Score With Peak Expiratory Flow in Acute Exacerbation of COPD Patients
(2016) Kavalci, Cemil; Yilmaz, Muhittin Serkan; Kayipmaz, Afsin Emre; Isik, Bahattin; Celikel, Elif; Kavalci, Gulsum; Yilmaz, Fevzi; Ozlem, Miray; Sonmez, Bedriye Muge; Celebi, Selman; https://orcid.org/0000-0003-2529-2946; 27692357; AGG-1308-2022; AAC-2597-2020
Introduction: Chronic obstructive pulmonary disease (COPD) leads to physical activity limitation and a significant reduction in quality of life. This study aimed to investigate the correlation between The COPD Assessment Test (CAT) score and peak expiratory flow (PEF), and the factors effecting hospital admission rates of patients with COPD. Methods: This observational study was conducted prospectively. CAT score was calculated and PEF measured at the time of emergency department admission. Descriptive statistics were expressed as number (n), percentage (%), and mean +/- standard deviation. Chi-Square and correlation tests were used for statistical analyses. A p value of less than 0.05 was considered statistically significant. Results: Of 123 patients included in the study, 85 (69.1%) were male and 38 (30.9%) were female. Pulse pressure, pH, blood urea nitrogen, oxygen saturation measured by pulse oximetry (SpO(2)), PO2, PCO2, and SpO(2) values on arterial blood gas analysis, and PEF value were significantly correlated to CAT score (p < 0.05). Conclusion: High CAT score and low PEF value can be used to make the decision of hospitalization from emergency department in acute exacerbations of COPD.
Evaluation of The Effect of Lipid Emulsıon Therapy on The Rat Model in Organophosphate Intoxication and Tissue Pathologies
(2014) Celikel, Elif; Arslan, Engin Deniz; Yilmaz, Fevzi; Turhan, Turan; Unal, Muge Tecder; Turhan, Turan; Turhan, Nesrin; Kavalci, Cemil; Karakilic, M. Evvah; Altunkaynak, Hande Ozge; Unal, Muge Tecder; Demir, Ali; AAH-5151-2020
Introduction and objective: Organophosphates are frequently used for agricultural spraying in an uncontrolled manner in our country. Humans are usually inadvertently exposed to these chemicals via respiratory, transdermal, or tranconjunctival routes whereas they may also be used for suicidal purposes: Having a high morbidity and mortality, this intoxication causes a high emergency department admission rate (1). Previous studies on lipid therapy in cardiac arrest associated with intoxication of lipophilic agents such as antidepressants, anticonvulsants, antihypertensives, and local anesthetics have reported a 55% increase in survival with these therapies (2). We also studied lipid emulsion therapy (LET) in poisoning with organophosphates that are lipophilic. Materials and method: This study used 30 male Wistar-albino rats of 12 months of age weighting 288 to 428 gr. The animals were randomly grouped into 5 groups: Group 1 Was the control group; Group 2 organophosphate+serum physiologic (SF) group; Group 3 organophosphate+LET group; Group 4 arganophosphate + Atropin(A)+ Pralidoxime (PAM) group; and Group 5 organophosphate+LET+A+PAM group. After an 8-hour clinical observation period the rats were sacrificed and Wad pseudocholitiesterase, cholesterol; and triglyceride levels were studied. Renal, hepatic, splenic, and cerebral tissues were sampled to be examined under light microscope. Results : There were significant differences between the groups with respect to cholesterol, triglyceride, but not pseudocholine-sterase level Dizziness was the first observed clinical symptom, followed by hindleg paralysis, foreleg paralysis, and general paralysis. After general paralysis salivation was usually observed together with gasping breathing. Rats with the above clinical course were sacrificed. The clinical picture progressed rapidly after foreleg paralysis. The toxic clinical course was observed in 100% of rats in Group 2 (organophosphate + SF) and Group 3 (Organophosphate +LET) and its mortality rate was high. No significant difference was observed between both groups with respect to time to symptom onset. This may be interpreted as that LET treatment alone was not effective. Conclusion: In the present study we did not observe any beneficial effect of LE treatment alone on mortality of organophosphate intoxication. According to our results, however, it may be beneficial when used in conjunction to Classical therapy. Considering its relatively low side effect profile and pros and cons, we believe that it can be used as a supportive therapy in organophosphate poisoning.
Impact of the Novel Coronavirus Disease 2019 (COVID-19) Pandemic on Cardiac Emergencies and Future Perspectives in Turkey
(2021) Coner, Ali; Kayipmaz, Afin Emre; Celikel, Elif; 0000-0002-5711-8873; ABD-7321-2021
SARS-CoV-2-associated COVID-19 pandemic has affected the daily life of people across the world in 2020. Data about the course of viral involvement continues to be accumulated. COVID-19 is a multi-systemic disease, and the clinical presentations and possible complications may vary widely in different patient groups. The cardiovascular system is a primary target of COVID-19, and direct or indirect effects of viral involvement are observed. In addition to the direct effects of viral involvement on the cardiovascular system, decrement in acute cardiac emergencies has been experienced in many cardiology clinics in Turkey during the pandemic. Moreover, there may be a possible increase in out-of-hospital cardiac arrests in the near future. In this narrative review, we aimed to discuss the cardiac manifestations of COVID-19, the possible drug interactions related to the drugs used for COVID-19 management, and the effect of the pandemic on cardiac emergencies. We believe that understanding the natural mechanism of cardiac involvement of SARS-CoV-2 and emphasizing the data about out-of-hospital arrests will help clinicians effectively deal with the preventable cardiovascular causes of death in the forthcoming waves of COVID-19.
Investigation on Legal Problems Encountered by Emergency Medicine Physicians in Turkey
(2015) Kayipmaz, Afsin Emre; Kavalci, Cemil; Gulalp, Betul; Kocalar, Ummu Gulsum; Giray, Tufan Akin; Yesilagac, Hasan; Ozel, Betul Akbuga; Celikel, Elif; Karagun, Ozlem; 25992872
Background Medicine is a profession that carries certain risks. One risky area of practice is the emergency department. Emergency physicians diagnose and treat a high volume of patients, and are also responsible for preparing reports for forensic cases. In this study, we aim to investigate emergency physicians' legal-administrative problems and reveal their level of understanding on forensic cases. Methods An electronic questionnaire form was prepared after the approval of an ethical committee. This form was sent to the residents, specialists and academicians of emergency medicine by e-mail. The physicians were asked to fill out the form online. All the gathered data was analyzed. Descriptive statistics were presented as frequency percentages with mean and standard deviation. Chi-square tests were used to compare the groups. Correlation between number of complaint cases and age, sex, career, institution, and duration of service in emergency department were investigated. p<0.05 was considered statistically significant. Results 294 physicians participated in the questionnaire. According to the questionnaire, 170 of the physicians were reported to the patient communication units due to medical malpractice. Mean number of compliant reports was 3.20 +/- 3.5. 29 of the physicians received administrative penalties. 42 of the physicians were judged in the court for medical malpractice. 1 physician was fined 5000 Turkish Liras as a result of these judgments. Conclusion We found that the number of complaint reports is negatively correlated with duration of service in emergency medicine and age. There was a significant difference between number of complaint reports and career (p<0.05). The physicians' level of awareness on forensic cases was found to be insufficient. Lack of legislation knowledge may be an important cause of complaint reports concerning emergency physicians, who have a high load of patients. Thus, we think that increasing the frequency of post-graduate education sessions and periodical reviews might be beneficial.