Browsing by Author "Kayipmaz, Afsin Emre"

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Acute Dystonic Reaction Due To Dexketoprofen Trometamol
(2015) Kayipmaz, Afsin Emre; Giray, Tufan Akin; Tasci, Suleyman Serdar; Kavalci, Cemil; Kocalar, Ummu Gulsum; 0000-0003-2529-2946; 0000-0003-4619-4034; 26564300; AGG-1308-2022; AGQ-5015-2022; AAC-2597-2020
Dexketoprofentrometamol (DKP), is a tromethamine salt of the water-soluble S-enantiomer of ketoprofen. As with all other non-steroidal anti-inflammatory agents, the most common side effect of DKP is gastric complications. In this paper, we report a case of dystonic reaction after intravenous DKP use. A 24-year-old man was admitted to our hospital after suffering a leg burn from boiling oil. He had no drug hypersensitivity. An intravenous preparation containing the active ingredient DKP was injected for analgesia, after which the patient experienced an involuntary flexion response in both upper extremities. With a suspected diagnosis of dystonia, biperiden lactate 5 mg/ml was administered via the intramuscular route and the contractions abated within 30 seconds of the injection. As non-steroidal anti-inflammatory agents are commonly used and prescribed in emergency departments, it should be kept in mind that an acute dystonic reaction can develop against one of these agents, DKP.
Adequacy of Physicians Knowledge Level of Cardiopulmonary Resuscitation to Current Guidelines
(2015) Gulsum, Kocalar Ummu; Deniz, Arslan Engin; Cemil, Kavalci; Kayipmaz, Afsin Emre; Gulsum, Kavalci; Sukru, Yorulmaz; Akin, Giray Tufan
Aim: The purpose of this study is to test the level of information on CPR and suitability to current application of the phsicians practicing in hospital ANEAH. Material and Method: The form of a test of 20 questions fort his purpose has been prepared in accordance with the 2010 AHA-ERC CPR guidelines. This form distributed to volunteer physicians to fill in. A total of 173 physicians agreed to participate in he study. The results were analyzed statistically and tried to determine the factors affecting the level of information. Results:According to the results of the study physicians gender, age and the total duration of physicians and medical asistance doesn't affect the level of information. The number of CPR within I month positively affect the level of knowledge. The number of theoretical and practical training in medical school, have taken the positive impact the level of knowledge of physicians. The training period after graduation, significantly increased the level of physicians information, The order of these training sessions with the asistant courses, congress, seminars and lessions on the sempozims are effective. Discussion: CPR trainig programs for physicians should be standardized, updated and expanded. Recurent in-service trainig should be provided to increase phsicians knowledge on skills.
Analysis of geriatric patients with minor spinal trauma admitted to the emergency department of a university hospital
(2019) Giray, Tufan Akin; Kayipmaz, Afsin Emre; Sonmez, Erkin; Haberal, Kemal Murat; Yilmaz, Cem; Kavalci, Cemil; Oguzturk, Hakan
Objective: To retrospectively analyze patients aged 65 years and over, who were admitted to a level II trauma center in Turkey due to minor spinal trauma in a period of 4 years. Methods: The study included 64 patients aged 65 years and over, who were admitted to the Emergency Department of Baskent University Ankara Hospital between January 2011 and January 2015 and diagnosed with vertebral trauma. The information of the patients was obtained from the medical records. The clinical characteristics of patients including localizations and types of fracture, presence of additional system injuries and treatment options were investigated. Results: The most common cause was fall, accounting for 51 (79.7%), with 7 (10.9%) due to intra-vehicle traffic accident, and 6 (9.4%) due to out-of-vehicle pedestrian injury. The most common site of trauma was the lumbar region. Of the fractures, 46.9% (n=30) were in the lumbar region, 37.5% (n=24) in the thoracic region and 15.6% (n=10) were in the cervical vertebra region. Fourteen (21.9%) patients had an additional injury. Given the fracture types, 47 fractures (74.6%) were compression, 14 fractures (22.2%) were spinous process and 2 fractures (3.2%) were burst fractures. Twenty patients (31.2%) had multilevel vertebral fractures. Conclusions: The results of our study demonstrated the importance of vertebral fractures in the geriatric age group. In this age group, falls and motor vehicle accidents are the leading causes of vertebral traumas. Taking the necessary measures to prevent the risk factors which increase with aging is the most important step in preventing the mortality and morbidity that may occur as a result of vertebral fracture.
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.
Canadian C-Spine Criteria and Nexus in The Spinal Trauma: Comparison at A Tertiary Referral Hospital in Turkey
(2017) Caltili, Cilem; Ozturk, Derya; Altinbilek, Ertugrul; Yapar, Nikola; Serin, Mehmet; Gunduz, Harika; Kayipmaz, Afsin Emre; Kavalci, Cemil; https://orcid.org/0000-0003-2529-2946; AAC-2597-2020; AGG-1308-2022
Objective: Spinal trauma and the ensuing neurological problems transform a person's social life and result in significant economic and non-economic burden. We compared the diagnostic performances of the National Emergency X-Radiography Utilization Study (NEXUS) Low-Risk Criteria (NLC) with the Canadian C-Spine Rule (CCSR) criteria in identifying lesions. Methods: This retrospective study was conducted on 724 patients after obtaining approval from the ethical board of the hospital. The demographic characteristics of the patients (age, gender), their medical histories, season, trauma occurrence mechanism, hospital arrival time following the development of spinal trauma, their Glasgow Coma Score at the time of admission, their complaints at the time of admission (such as pain, paresthesia, and loss of muscle strength), their spinal trauma lesion levels, and compatibility of the applied viewing methods with the NEXUS and CCSR criteria were collected from the patients' files. Results: A total of 2,442 cases were diagnosed with spinal trauma. For patients with a spinal fracture, the sensitivity and specificity of CCSR were 99.7% and 17.9%, respectively, while the sensitivity and specificity of NEXUS were 97.6% and 27.2%, respectively. Positive predictive value (PPV) and negative predictive value (NPV) of CCSR were, respectively, 16.3% and 99.7%, while the PPV and NPV of NEXUS were 17.7% and 98.6%, respectively. Conclusions: This study showed that the CCSR criteria are more sensitive than the Nexus criteria.
A Comparison of Two Coronary Artery Bypass Graft Surgery Techniques with Respect to Acute Kidney Injury
(2015) Beyazpinar, Deniz Sarp; Gultekin, Bahadir; Kayipmaz, Afsin Emre; Kayipmaz, Cagri; Sezgin, Atilla; Giray, Tufan Akin; Kavalci, Cemil; 0000-0003-2529-2946; 0000-0003-4619-4034; AAC-2597-2020; AGG-1308-2022; ABA-7388-2021; ABA-9675-2021; AGQ-5015-2022
Background: This study aims to compare the conventional coronary artery bypass graft (CABG) surgery and on-pump beating heart bypass grafting (OPBHB) with respect to acute kidney injury and subsequent dialysis requirement. Methods: Between January 2012 and October 2013, medical records of 77 patients who underwent conventional CABG and 76 patients who underwent OPBHB for coronary artery disease in our clinic were retrospectively analyzed. Results: There was no significant difference in preoperative renal function test results between the groups. However, there was a significant difference in cardiopulmonary bypass time and length of intensive care unit stay (p<0.05). Seven (9.21%) of 76 patients in OPBHB group and 11 (14.28%) of 77 patients in CABG group developed acute kidney injury; however, it did not indicate a statistically significant difference between the groups (p>0.05). One patient in OPBHB group and four patients in CABG group also needed dialysis. Conclusion: Our study results suggest that OPBHB is superior to the conventional CABG in terms of acute kidney injury and, more importantly, development of acute renal failure in patients with a serum creatinine level of 1-1.3 mg/dL.
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.
Cyanide ingestion
(2017) Kayipmaz, Afsin Emre; Coskun, Abuzer; Ozkan, Fikret; Ozbay, Sedat; Okur, Osman Mahir; Gulunay, Behnan; Eren, Sevki Hakan; Ucar, Asuman; Kavalci, Cemil; AAC-2597-2020
Cyanide is one of the oldest poisons. It has recently been introduced into industrial use in the gold enrichment process in gold mines. A 36-year-old man engaged in silver polishing business was brought to our emergency department by his colleagues with impaired consciousness and foamy saliva expectoration after accidentally drinking a sip of water mixed cyanide used for silver polishing. His general status was poor, and he was unconscious upon admission. The patient was administered the antidote three hours after his admission and extubated 11 hours after admission. His vital signs gradually returned to normal. On follow-up his urine color turned red; therefore, a second consultation was made with the poison information center, which recommended administering a second dose of antidote. After doing so, the patient gradually recovered, and he was discharged with normal liver enzymes, normal consciousness, and good overall status on 4th day of admission.
Demographics, Management Strategies, and Problems in ST-Elevation Myocardial Infarction from the Standpoint of Emergency Medicine Specialists: A Survey-Based Study from Seven Geographical Regions of Turkey
(2016) Kayipmaz, Afsin Emre; Ciftci, Orcun; Kavalci, Cemil; Karacaglar, Emir; Muderrisoglu, Haldun; 0000-0001-8926-9142; 0000-0002-9635-6313; 0000-0002-2538-1642; 27760229; W-5233-2018; AAG-8233-2020; AAC-2597-2020; ABI-6723-2020
Background This study aimed to explore the ST segment elevation myocardial infarction (STEMI) management practices of emergency medicine specialists working in various healthcare institutions of seven different geographical regions of Turkey, and to examine the characteristics of STEMI presentation and patient admissions in these regions. Methods We included 225 emergency medicine specialists working in all geographical regions of Turkey. We e-mailed them a 20-item questionnaire comprising questions related to their STEMI management practices and characteristics of STEMI presentation and patient admissions. Results The regions were not significantly different with respect to primary percutaneous coronary intervention (PCI) resources (p = 0.286). Sixty six point two percent (66.2%) of emergency specialists stated that patients presented to emergency within 2 hours of symptom onset. Forty three point six percent (43.6%) of them contacted cardiology department within 10 minutes and 47.1% within 30 minutes. In addition, 68.3% of the participants improved themselves through various educational activities. The Southeastern Anatolian region had the longest time from symptom onset to emergency department admission and the least favorable hospital admission properties, not originating from physicians or 112 emergency healthcare services. Conclusion Seventy point seven percent (70.7%) of the emergency specialists working in all geographical regions of Turkey comply with the latest guidelines and current knowledge about STEMI care; they also try to improve themselves, and receive adequate support from 112 emergency healthcare services and cardiologists. While inter-regional gaps between the number of primary PCI capable centers and quality of STEMI care progressively narrow, there are still issues to address, such as delayed patient presentation after symptoms onset and difficulties in patient admission.
Differences Between Adolescent and Adult Cases of Suicidal Drug Intoxication
(2016) Dogan, Halil; Adiguzel, Lokman; Uysal, Emin; Sarikaya, Sezgin; Ozucelik, Dogac Niyazi; Okuturlar, Yildiz; Giray, Tufan Akin; Kayipmaz, Afsin Emre; Yazicioglu, Mustafa; Sisek, Cem; https://orcid.org/0000-0003-4619-4034; AGQ-5015-2022; AAC-2597-2020
Objective: Drug intoxications are among the major causes of emergency department admissions. There is a limited number of studies exploring the differences between adolescent and adult cases of intoxication. We aimed to compare adolescent and adult cases of drug intoxication to determine demographic and clinical properties of intoxications and necessary measures that have to be taken in both age groups. Material and Methods: Adolescent (9-19 years of age) and adult (19 years or older) cases of drug intoxication that presented to our Emergency Department between 1 June 2009 and 30 June 2010 were retrospectiely reviewed. Age, sex, purpose of drug intake, whether or not an antidote was used, single-or multidrug intake, the group of the offending drug, duration of hospital stay, and clinical outcomes were recorded. Results: This study included a total of 278 patients, of which 39.2% (n=109) were adolescent and 60.8% (n=169) were adult. Among adolescents, 15.6% (n=17) were male and 84.4% (n=92) were female while % 20.1 (n=34) of adults were male and 79.9% (n=139) were female. The mean age was 16.68 +/- 1.774 years in the adolescents and 27.87 +/- 7.264 in the adults. An antidote was used in 30% (n=3) of the adolescents and 70% (n=7) of the adults. Suicidal drug intake formed 39.2% (n=109) of the cases in the adolescents and 60.8% (n=169) in the adults. Multi-drug intake had a rate of 51.9% (n= 42) in the adolescents and 48.1% (n=39) in the adults. Paracetamol was the offending agent in 46.9% (n= 23) of the adolescents, while antidepressnats were responsible for 65.2% (n=30) of the drug intoxications in the adults. Duration of hospital stay was 1.19 +/- 0.775 hours in the adolescents and 1.15 +/- 0.617 hours in the adult cases. None of the patients in both groups died. Conclusion: Acute intoxications are an important medical problem for emergency departments. The most common suicide method is drug intake. Drug intoxications were more prevalent in women in both adolescent and adult age groups. Suicidal drug intoxications were more common in the adults compared to the adolescents. Paracetamol was the most commonly taken drug in the adolescents while antidepressants were the most common drugs in the adults. Multi-drug intake was more common in the adolescents than the adults. It is possible to reduce the number of drug intoxications by determining risk factors, taking necessary measures, and planning appropriate population-based educational activities.
Effect of Platelet-Lymphocyte Ratio and Lactate Levels Obtained on Mortality with Sepsis and Septic Shock
(2018) Biyikli, Ebru; Kayipmaz, Afsin Emre; Kavalci, Cemil; 0000-0002-0520-0349; 0000-0003-2529-2946; 29225011; AAJ-7628-2021; AGX-8305-2022; AGG-1308-2022; AAC-2597-2020
Background: Sepsis is a potentially fatal condition with high treatment costs, and is especially common among the elderly population. The emergency management of septic patients has gained importance. Objective: Herein, we investigated the effect of admission lactate levels and the platelet-lymphocyte ratio (PLR) on the 30-day mortality among patients older than 65 years who were diagnosed with sepsis and septic shock according to the qSOFA criteria at our hospital's emergency department. Methods: This observational study was conducted retrospectively. We obtained information regarding patients' demographic characteristics, comorbid conditions, hemodynamic parameters at admission, initial treatment needs at the emergency department. Results: 131 patients received a diagnosis of sepsis and septic shock at our emergency department in two years. Among these, 45% (n=59) of the patients died within 30 days of admission. Forty (30.5%) patients required mechanical ventilation. There was a significant difference between the survival and non-survival groups with regard to systolic and diastolic blood pressures (p = 0.013 and 0.045, respectively). There were significant differences between the two groups with respect to the Glasgow Coma Scale score (p < 0.001) and BUN levels (p < 0.001). The mortality status according to qSOFA scores was revealed a significant difference between the two groups (p < 0.001). Conclusion: Our results showed that the patients who died within 30 days of admission and those who did not had comparable PLR and lactate levels (p=0.821 and 0.120, respectively). We opine that serial lactate measurements would be more useful than a single admission lactate measurement for the prediction of mortality. (C) 2017 Published by Elsevier Inc.
The Effect of Pycnogenol (R) on Spatial Learning and Memory in Rats with Experimental Closed Head Injury
(2017) Kayipmaz, Afsin Emre; Erdem, Remzi; Yilmaz, Cem; Deniz, Emine Ebru; Kavalci, Cemil; Ozdemir, Alperen; Guler, Irem; Caferoglu, Eda; Kalyoncu, Fatma Serra; Guven, Ozgur; 0000-0002-2353-8044; AAK-2948-2021; AAC-2597-2020
Aim: Trauma is a leading cause of emergency admissions. In this study, we investigated the effect of Pycnogenol (R) on spatial learning and memory (SLM) function in rats subjected to closed head injury. Methods: The study was a randomized, experimental study of four groups, each containing six rats. Pycnogenol (R) was administered to rats in two groups (group three and four) daily for five days starting on day one. A Barnes maze was used to test SLM in the rats in all four groups. Group 1: These rats did not have a closed head injury and were not administered Pycnogenol (R). Group 2: On the day three, closed head trauma was inflicted. Group 3: Pycnogenol (R) was administered to the rats. On day three, closed head trauma was inflicted. Group 4: Only Pycnogenol (R) was administered. At the end of day five, the brain tissue of the 24 rats was removed. Results: There were no significant differences between the groups in mean SLM durations on days one through five. No significant differences were detected in the pathological examination between of the four groups. Conclusion: Future studies that employ biochemical markers and free radical levels in the brain are needed.
Epidemiological and cost analysis of burn injuries admitted to the emergency department of a tertiary burn center
(2016) Eser, Tolga; Kavalci, Cemil; Aydogan, Cem; Kayipmaz, Afsin Emre; 0000-0003-1547-1297; 27610329; AAJ-5296-2021; AAC-2597-2020
Background: Burn injury is an emergency medical condition that rapidly develops as a result of tissue exposure to electrical, chemical or thermal energy. Therefore, its treatment usually begins at the emergency department. In this study we aimed to perform an epidemiological analysis of burn injuries presenting to the emergency department of a tertiary burn center, and factors affecting the cost of their medical care. Methods: Patients who presented to Baskent University Ankara Hospital Adult Emergency Department with burn injuries between January 2012 and December 2014 were studied for age, sex, time of admission, type of burn injury, clinical prognosis, mortality rate, percent burn area, and total cost of care. A total of 264 patients were enrolled. Chi square test was used for the comparison of categorical variables. Non-parametric tests were used for the comparison of continuous variables. Results: This study included 179 (67.8 %) women and 85 (32.2 %) men. The most common types of burn injuries were hot water burns and scalding. Eleven point seven percent of the patients sustained burn injuries in occupational accidents. 95.1 % of the patients were discharged from the emergency and 4.5 % of them were hospitalized. Only 1 (0.4 %) patient died. There was no significant difference between patient outcomes (discharge vs. hospital admission) with respect to the cost of care (p = 0.846) No significant difference was found between the cost of care of surgical and non-surgical management of burn injuries (p = 0.206). No significant difference was found between the costs of care of different types of burn injuries (p = 0.053). There was a significant difference between burn degrees with respect to the cost of care (p = 0.038). A significant difference was found between the costs of care of patients with a percent burn area of less than 10 % and those with a percent burn area of more than 10 % (p < 0.001), indicating that as percent burn area increased, a proportional increase occurred in the cost of care. Conclusions: Burn degree and percent burn area were the main determinants of the cost of care of burn injuries. In conclusion, burn injuries are preventable by taking occupational measures and raising public awareness about domestic accidents.
Hair-Thread Tourniquet Syndrome Originating from A Haemangioma in an Adult Patient
(2016) Okur, Osman Mahir; Coskun, Abuzer; Kayipmaz, Afsin Emre; Ozbay, Sedat; Kavalci, Cemil; Kocalar, Ummu Gulsum; https://orcid.org/0000-0003-2529-2946; 27427144; AAC-2597-2020; AGG-1308-2022
Hair-thread tourniquet syndrome is an emergency condition rarely encountered since its first description, and it may be potentially dangerous unless treated. The potential hazard of the condition stems from hair strands wrapping around and strangulating various body processes such as fingers, penis, or clitoris. In this paper we aimed to report the first case of hair-thread tourniquet syndrome affecting a haemangioma of an adult patient. A 68-year-old woman presented to emergency department for pain in the mass on her back. On physical examination, a haemangioma with a size of about 3x3 cm was noted on the right scapula. When inspected closely, it appeared edematous and strangulated, and there were hair strands wrapped to the bottom of the wound. The hair strands were removed and the strangulated haemangioma was excised.
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.
Metoclopramide-induced acute dystonic reaction misinterpreted as conversion disorder and seizure
(2017) Ozel, Betul Akbuga; Aksel, Gokhan; Kilicli, Elif; Muratoglu, Murat; Kavalci, Cemil; Gulalp, Betul; Kayipmaz, Afsin Emre; 0000-0002-9586-7509; AAK-2079-2021; AAC-2597-2020
Metoclopramide, an antiemetic, is the most common cause of drug-induced dystonic reactions. 20-year-old female patient, complaining of involuntary bilateral upward medial deviation of the eyes, generalized muscle contractions and uncontrollable cry was brought into the emergency department(ED) by an ambulance. The diagnosis of the ambulance crew was conversion or seizure. The patient has all of dystonic reaction symptoms, including facial, neck, back, and extremity spasms, opisthotonus, oculogyric crisis, torticollis, trismus. The history revealed 40 mg of metoclopramide intake. Biperiden (5 mg) was infused in 100 ml saline. Symptoms were completely resolved. She was discharged from the ED. Drug-induced dystonic reactions can be confused with conversion, seizures, encephalitis, tetanus and hypocalcemic tetany. It is important for emergency physicians to know the drugs that may have dystonic reaction as potential side effects, recognize the clinical presentation of drug-induced dystonic reactions, and properly manage them in the ED.
Neutrophil to Lymphocyte Ratio As A Predictor of Severe Coronary Artery Disease and Left Ventricular Systolic Dysfunction of Any Degree in Geriatric Patients Presenting to Emergency Department with Acute Coronary Syndrome
(2017) Ciftci, Orcun; Kayipmaz, Afsin Emre; Aydos, Tolga Resat; Muderrisoglu, Ibrahim Haldun; 0000-0002-1832-9336; 0000-0001-8926-9142; AAJ-7279-2020; AAC-2597-2020; W-5233-2018
Introduction: We examined the role of the neutrophil-to-lymphocyte ratio (NLR) for predicting severe coronary artery disease and left ventricular systolic dysfunction of any degree in geriatric patients presenting to emergency department with non-ST-elevation acute coronary syndrome. Materials and Method: We retrospectively reviewed data for patients aged >= 65 years with non-ST-elevation acute coronary syndrome who underwent coronary angiography between April 2011 and January 2016. Patients were divided into Group 1 (101 patients; severe [>50%] lesions in one or more epicardial artery or branch) and Group 2 (65 patients; no severe lesions). The key clinical parameters, including NLR were compared among the groups and the power of NLR as a predictor of severe coronary artery disease and left ventricular systolic dysfunction of any degree was determined. Results: Group 1 included more patients who were male, older, or smoked; these had higher troponin I, mass CK-MB, NLR, but a lower left-ventricular ejection fraction. NLR was an independent predictor of severe coronary disease and left ventricular systolic dysfunction of any degree with good sensitivity and moderate specificity. Conclusion: Neutrophil-to-lymphocyte ratio is a simple, rapid, and cheap parameter that can predict severe coronary artery disease and left ventricular systolic dysfunction of any degree in geriatric patients with non-ST-elevation acute coronary syndrome.
Notes on patient compensation system suggestion
(2016) Kayipmaz, Afsin Emre; Ciftci, Orcun; Kavalci, Cemil; Yilmaz, Serdar; Muderrisoglu, Haldun; 27067560
Predictors of Obstructive Coronary Artery Disease vs Non-obstructive Lesions on Coronary Angiography in Patients with Non-ST Elevation Myocardial Infarction. A Retrospective Analysis from a University Hospital
(2017) Ciftci, Orcun; Kayipmaz, Afsin Emre; Karacaglar, Emir; Yilmaz, Kerem Can; Muderrisoglu, Ibrahim Haldun; 0000-0001-8926-9142; 0000-0002-2538-1642; AAC-2597-2020; AAJ-1331-2021; W-5233-2018; ABI-6723-2020
Red Blood Cell Distribution Width Increases During Infection in Renal and Liver Graft Recipients
(2017) Kayipmaz, Afsin Emre; Findik, Meliha; Kavalci, Cemil; Akdur, Aydincan; Moray, Gokhan; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0003-2529-2946; 0000-0002-8726-3369; 0000-0003-2498-7287; 26767568; AAJ-8097-2021; AGG-1308-2022; AAA-3068-2021; AAC-2597-2020; AAE-1041-2021
Objectives: Organ transplant is an effective treatment for patients with end- stage renal and hepatic failure. Increased use has introduced more emergency department admissions of infectious origin after transplant. Because infections usually manifest with simple complaints and fever, emer gency physicians need laboratory tests and radiologic imaging procedures to quickly detect the presence and source of infection. Our aim was to analyze fever-related emergency admissions of renal and hepatic graft recipients and determine whether admitted patients had increased red blood cell distribution width and mean platelet volume levels. Materials and Methods: We reviewed the medical records of renal and hepatic graft patients who presented to our emergency department with fever during a 4-year period. Our analyses included 150 patients in which complete blood count and C-reactive protein results were available and the source of infection was determined. We compared results with a control group of 150 transplant patients without any infectious findings. Results: In the 150 solid-organ graft recipients who presented to our emergency department with fever, significant differences were observed versus control patients with respect to white blood cell count, neutrophil-to-lymphocyte ratio, red blood cell distribution width, mean platelet volume, and C-reactive protein levels (P <.05). We determined that C-reactive protein levels, red blood cell distribution width, mean platelet volume, and lymphocyte count were independent indicators of infection on multiple logistic regression analyses. We also determined that red blood cell distribution width had a specificity of 94% and a sensitivity of 26%. Conclusions: We found a significantly higher red blood cell distribution width in emergency admissions of infectious origin of renal and hepatic graft recipients than in the control group (P <.001), suggesting that this measurement is a suitable marker of infection for the emergency setting by virtue of rapid availability of test results and lack of extra costs.