Browsing by Author "Muratoglu, Murat"

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Başkent Üniversitesi Ankara Hastanesi acil tıp kliniğe covid-19 ön tanısıyla başvuran hastaların klinik, demografik, radyografik ve laboratuvar özelliklerinin değerlendirilmesi
(Başkent Üniversitesi Tıp Fakültesi, 2021) Özek, Sevil; Muratoglu, Murat
Amaç: 2019 Aralık ayından bu yana ülkemizin ve tüm dünyanın mücadele etmeye devam ettiği COVID-19’un halen kesinliğe kavuşmamış bazı yönlerine ışık tutarak literatüre katkı sağlamak amacıyla yaptığımız bu çalışmamızda, COVID-19 şüpheli olgularda hastalığı tanımlayıcı klinik, demografik, radyolojik ve laboratuvar özelliklerin neler olduğunu göstermeyi, hastalık prognozuna etki eden faktörleri belirlemeyi hedefledik. Gereç ve yöntem: Retrospektif, kesitsel, hastane tabanlı tek merkezli olarak tasarlanan çalışmamıza, Başkent Üniversitesi Ankara Hastanesi Erişkin Acil Servisi’ne 11 Mart 2020 ile 31 Ağustos 2020 tarihleri arasında başvuran 18 yaş ve üstü, gelişinde COVID-19 şüpheli olgu olarak değerlendirilerek dahil edilme kriterlerini karşılayan 1277 hasta dahil edildi. Tüm hastaların demografik verileri, başvuru anındaki vital ve klinik bulguları, uygulanan laboratuvar tetkiklerinin sonuçları, RT-PCR sürüntü örneklerinin neticeleri, bilgisayarlı tomografi sonuçları, aldıkları tedaviler, başvuru anında mevcut yakınmalarının süresi, hastane yatışı gerçekleştiyse hospitalizasyon süreleri, tedavi modaliteleri bilgileri, morbidite ve mortaliteleri hazırlanan veri formlarına kaydedildi. Süreler gün formatında kayıt altına alındı ve primer sonlanım 30 günlük mortalite olarak belirlendi. İstatistiksel değerlendirmeler için SPSS v25.0 paket programı kullanıldı. Bulgular: COVID-19 ön tanısıyla dahil edilen 1277 hastadan 259’unun (%23,4) acil serviste COVID-19 tanısı aldığı görüldü. COVID-19 tanılı hastaların %56,9’u erkek, %43,1 kadındı (p=0,004). YBÜ ve IMV ihtiyacı kadınlarda daha yüksek iken (p<0,001), cinsiyet ve sağkalım arasında istatistiksel olarak anlamlı ilişki yoktu (p=0,158). Yaş ortalaması 54,32±20,177 olarak tespit edildi. Hastalar yaş gruplarına kategorize edildiğinde 65 yaş ve üzerinde mortalite ve komorbiditeler daha sıktı (p<0,001). En sık görülen komorbiditeler sırasıyla HT (%20,3), AF (%11,6) ve DM (%11) olarak kaydedildi. Dahil edilen hasta grubunda şüpheli maruziyet öyküsü bulunan 207 hastanın %40,6’sının son tanısı COVID-19 idi. En sık görülen semptom ateş iken (%44,7), takiben halsizlik (%43,1) ve öksürük (%36,6) görüldü. Nefes darlığının varlığı, daha yüksek YBÜ yatış ihtiyacıyla ilişkiliydi. Aktif sigara kullanan hastaların yarısından fazlasında (%56,6) toraks BT’de infiltrasyon vardı (p=0,03). İnfiltrasyonu olan hastaların başvuru anındaki sPO2 değerleri daha düşük, dakika solunum sayıları daha yüksek saptanırken, BT bulgusu varlığı, trombositopeni, lenfositopeni, yüksek platelet/lenfosit oranları, nötrofili, yüksek CRP, Ddimer, LDH ve AST, bozulmuş böbrek fonksiyon testleri ve yüksek laktat ile ilişkiliydi (sırasıyla p<0,001; p<0,001; p=0,002; p=0,01; p<0,001; p<0,001; p<0,001; p<0,001 p<0,001; ve p<0,001). Hastaların %70,1’inde başvuru anında çekilen BT’lerde infiltrasyon vardı. Başvuruda bakılan PCR testi negatif olup (n=666, %80,2), BT görüntülemesinde şüpheli pnömoni lehine bulgusu olan hastaların (n=251, %37,7) %27,9’unda (n=70) son tanının COVID-19 olduğu görüldü. Primer sonlanım son tanısı COVID-19 olan hastalarda, COVID-19 dışı bir tanı alan gruptakine kıyasla daha yüksekti (%13,6’ya %8,1 ; p<0,001). Sonuç: Hastalığın tanımlayıcı özelliklerini ve prognozunu etkileyen faktörleri bilmek, halen yıkıcı sonuçlarını görmeye devam ettiğimiz COVID-19 ile mücadelede anahtar rol oynamaktadır. İleri yaş, sigara kullanımı, şüpheli maruziyet, erkek cinsiyet, özelikle HT olmak üzere daha fazla komorbidite varlığı, başvuruda nefes darlığı, takipne ve saturasyon düşüklüğü olması, yüksek CRP, LDH, d-dimer ve hs-troponin değerleri, yüksek platelet/lenfosit oranı, lenfositopeni, trombositopeni ve laktat yüksekliğinin hastalıkla ve prognozu ile ilişkili olduğunu gösteren çalışmamızın, özellikle RT-PCR sürüntü testlerinin yanlış negatiflik oranı da göz önünde bulundurulduğunda, semptomatolojisi ile pek çok hastalıkla ayırıcı tanıya girmekte olan COVID-19’un acil servislerde daha hızlı tanınmasını, izolasyon ve tedavi algoritmalarının klinisyenlerce erken aktive edilmesini sağlayabileceğini düşünmekteyiz. Objective: In this study, in order to contribute to the literature by shedding light on some aspects of COVID-19, which our country and the whole world have been struggling with since December 2019, we examined the clinical, demographic, radiological, laboratory features and the factors that affect the prognosis of the disease in suspected COVID-19 cases. Materials and methods: In our retrospective, cross-sectional, hospital-based single-center study, 1277 patients aged 18 years and over who applied to Başkent University Ankara Hospital Adult Emergency Service between March 11, 2020 and August 31, 2020 and who met the criteria for COVID-19 suspected cases on arrival were included. Demographic data of all patients, vital and clinical findings at the time of admission, results of laboratory tests performed, results of RT-PCR swab samples, computed tomography results, treatments they received, duration of current complaints at the time of admission, hospitalization durations, treatment modalities information, morbidity and mortality information were recorded in the prepared data forms. Durations were recorded in day format and the primary outcome was 30-day mortality. SPSS v25.0 package program was used for statistical evaluations. Results: It was observed that 259 (23.4%) of 1277 patients included with the pre-diagnosis of COVID-19 were diagnosed with COVID-19 in the emergency department. 56.9% of the patients diagnosed with COVID-19 were male and 43.1% female (p = 0.004). While the need for ICU and IMV was higher in women (p <0.001), there was no statistically significant relationship between gender and survival (p = 0.158). The average age was determined as 54.32 ± 20.177. When the patients were categorized by age groups, mortality and comorbidities were more common at the age of 65 and over (p <0.001). The most common comorbidities were recorded as HT (20.3%), AF (11.6%) and DM (11%), respectively. In the patient group included, 40.6% of 207 patients with suspected exposure history were diagnosed with COVID-19. The most common symptom was fever (44.7%), followed by weakness (43.1%) and cough (36.6%). The presence of shortness of breath was associated with a higher need for ICU admission. More than half of the active smoking patients (56.6%) had infiltration in thorax CT (p = 0.03). Patients with infiltration have lower sPO2 values at the time of admission and higher minute respiratory rates, while the presence of CT findings was associated with thrombocytopenia, lymphocytopenia, high platelet / lymphocyte ratios, high CRP, D-dimer, LDH and AST, impaired renal function tests and high lactate level (p <0.001; p <0.001; p = 0.002; p = 0.01; p <0.001; p <0.001; p <0.001; p <0.001; p <0.001; and p <0.001, respectively). In 70.1% of the patients, there was infiltration in the CT scan performed at the time of presentation. The last diagnosis of COVID-19 was observed in 27.9% (n = 70) of the patients who had a negative PCR test (n = 666, 80.2%) on admission and had signs in favor of suspicious pneumonia on CT imaging (n=251, %37,7). The primary outcome was higher in patients with the last diagnosis of COVID-19 compared to the group with a non-COVID-19 diagnosis (13.6% vs. 8.1%; p <0.001). Conclusion: Knowing the defining characteristics of the disease and the factors affecting its prognosis plays a key role in combating COVID-19, whose devastating consequences we continue to see. Advanced age, smoking, suspicious exposure, male gender, presence of more comorbidities, especially HT, shortness of breath, tachypnea and low saturation at presentation, high CRP, LDH, d-dimer and hs-troponin values, high platelet / lymphocyte ratio, lymphocytopenia, thrombocytopenia and lactate elevation are associated with the disease and poor prognosis. Considering the false negativity rate of RT-PCR swab tests, we think that our study will enable COVID-19, which is undergoing differential diagnosis with many diseases with its symptomatology, to be recognized faster in emergency services, and early activation of isolation and treatment algorithms by clinicians.
Comparative analysis of triage systems at emergency departments of different countries: Implementation in Kazakhstan
(2021) Pivina, Lyudmila; Messova, Assylzhan M.; Zhunussov, Yersin T.; Urazalina, Zhanar; Muzdubayeva, Zhanna; Ygiyeva, Diana; Muratoglu, Murat; Batenova, Gulnara; Uisenbayeva, Sharbanu; Semenova, Yulia
Medical sorting is aimed at assessment of disease severity and has to be carried out within a short time to determine the priorities for patient care and transportation to the most appropriate place for future treatment. The goal of this study was to provide an integrative review by analyzing the publications on the most common triage systems worldwide in order to select and implement the most reliable system at emergency departments. We searched for publications relevant to our comparative analysis in evidence-based medicine databases. A total of 1,740 literary sources were identified, of which 42 were selected for analysis. Comparative analysis of different triage systems may help implementing the most efficient system in Kazakhstan. The Emergency Severity Index is considered the most reliable and accurate tool used in international practice, and it could provide a basis for introduction of triage system at emergency departments in Kazakhstan.
Cost analysis and characteristics of the patients admitted to emergency service with poisoning
(2018) Kilicli, Elif; Kavalci, Cemil; Findik, Meliha; Muratoglu, Murat
Objective: To investigate the cost analysis and hospitalization rates and modes of poisoning of patients who applied to Bakent University Ankara Hospital Adult Emergency Service. Methods: Poisoning Patients who applied to emergency service due to suicide attempt between 01.01.2011-31.12.2014 were included in the study. Patients' age, gender, date of admission, definite diagnosis, the rate of hospitalization, and hospital costs were examined. A total of 646 patients were included in the study. 208 (32.2%) of the patients were male. The median age of the patients was 29 years. Results: The most causes of poisoning was drug intake. The median cost of the patients was 75.14 TL (IQR: 66.5). Conclusion: There was a positive correlation between age and cost (P<0.05). The majority of the patients apply to emergency dapartment with drug poisoning and female.
Evaluation of Ventricular Repolarization Parameters in Patients Admitted to Emergency Department with Electrical Injury
(2020) Celik, Casit Olgun; Ciftci, Orcun; Muratoglu, Murat; Muderrisoglu, Ibrahim Haldun
Objective: Prolonged T-peak to T-end (Tp-e), a ventricular repolarization parameter, has been related with ventricular arrhythmias (VAs). Novel electrocardiogram (ECG) parameters of ventricular repolarization have received considerable attention recently. In this study, we sought to investigate ventricular repolarization indexes such as the Tp-e and corrected Tp-e (Tp-ec) intervals, Tp-e/QT, Tp-e/QTc, and Tp-ec/QT ratios in patients with electrical injuries (EIs). Methods: Thirty-six patients diagnosed with EIs and 35 age- and sex-matched healthy control patients were included. Admission ECGs of the EI patients were compared with those of the healthy controls. QT and QTc intervals were measured, and the Tp-e and Tp-ec intervals, Tp-e/QT, Tp-ec/QT, and Tp-e/QTc ratios were then calculated from a 12-lead surface ECG. Results: The QT, Tp-e, Tp-e/QT, Tpe/QTc, Tp-ec/QT were not significantly different between the control group and the EI group (p > 0.05). However, the mean QTc interval was significantly higher in the EI group compared to the control group (412.81 +/- 25.46 vs 396.31 +/- 26.47 ms; p:0.009). Furthermore, the Tp-ec and Tp-ec/QT of the EI subgroup with elevated troponin levels significantly differed from those of the EI patients with normal troponin levels (p:0.033 and p:0.016, respectively). Conclusions: This retrospective study indicated that patients with EIs tend to have a prolonged QTc interval. Additionally, Tp-ec and Tp-ec/QT, which reportedly designate the tendency for VAs, were significantly higher in the EI patients with elevated troponin I levels than the EI patients with normal troponin levels, suggesting that patients with myocardial injury may be prone to VAs.
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.
The red cell distribution width to platelet ratio predicts 30-day mortality of acute pulmonary embolism patients
(2019) Findik, Meliha; Kavalci, Cemil; Kayipmaz, Afsin Emre; Muratoglu, Murat; Kilicli, Elif; AAC-2597-2020
Objective: To specify the clinical and sociodemographic characteristics, risk factors, factors affecting mortality including hematologic parameters, and red blood cell distribution width to platelet ratio (RPR) in patients with pulmonary thromboembolism, and to reduce the mortality. Methods: The archive records of patients diagnosed with pulmonary embolism were retrospectively examined. The histories, risk factors, physical examination findings, arterial blood gas analysis, X-rays, laboratory, and computed tomography reports of all cases were obtained via the hospital information system. Logistic regression analysis was performed to determine the independent variables affecting early mortality. Results: A total of 146 patients with a definitive diagnosis of pulmonary thromboembolism were included. Thirteen point seven percent (n=20) of the deceased patients died at early term. Ninety percent of patients with early mortality was 65 years or older. There were significantly differences in age, RPR, D-dimer, creatinine, lymphocyte, pH, and body temperature between patients with and without early mortality (P=0.017, P<0.001, P=0.019, P=0.025, P=0.042, P=0.013, P=0.017, respectively). Logistic regression analysis showed that RPR was a statistically significant and independent risk factors of mortality [P=0.026, OR: 0.254., 95% CI (0.326-5.056)]. In addition, there was a significant difference in pulmonary embolism severity index classification between patients with and without early mortality(P<0.034). Conclusions: RPR is an independent risk factor of mortality of pulmonary embolism patients and may help emergency physician to stratify mortality risks of pulmonary embolism patients.
Serum Neutrophil Gelatinase-Associated Lipocalin Levels In Early Detection Of Contrast-Induced Nephropathy
(2016) Muratoglu, Murat; Kavalci, Cemil; Kilicli, Elif; Findik, Meliha; Kayipmaz, Afsin Emre; Durukan, Polat; https://orcid.org/0000-0002-9586-7509; https://orcid.org/0000-0003-2529-2946; 27439687; AAK-2079-2021; AGG-1308-2022; AAC-2597-2020
Purpose: The purpose of this study was to investigate the role of serum neutrophil gelatinase-associated lipocalin (NGAL) levels in the early detection of contrast-induced nephropathy (CIN). Methods: This prospective study enrolled 74 patients undergoing abdominal tomography with contrast (1 November 2014 - 28 February 2015). Demographic properties (age and sex), symptoms and CT examination results were analysed. Sodium, potassium, urea, creatinine and NGAL levels were measured at 0th, 6th, and 72nd hours. P value < 0.05 was considered statistically significant. Results: CIN developed in 16.2% of the study patients. The mean age was significantly higher in the patients who developed CIN (p<0.05). No significant correlation existed between the occurrence of CIN and patient gender (p>0.05). Urea levels did not differ significantly between the groups at 0th and 6th hours (p>0.05) but was significantly higher in the patients with CIN at 72nd hour (p<0.05). Urea levels did not change significantly over time in the entire group (p>0.05). Creatinine level was not significantly different between the groups (p>0.05) but increased significantly over time (p>0.05). There were no significant differences between the groups with respect to NGAL levels at 0th and 72nd hours (p>0.05) whereas the group with CIN had a significantly higher NGAL level at 6th hour (p<0.05). A NGAL level of 668 mg/dL at 6th hour had a sensitivity of 100%, specificity of 95%, positive predictive value of 80% and negative predictive value of 100% for the detection of CIN. Conclusion: NGAL may be a useful marker for the early detection of CIN.
Why USB-endoscope laryngoscopy is as effective as video laryngoscopy
(2020) Findik, Meliha; Kayipmaz, Afsin E.; Kavalci, Cemil; Sencelikel, Tugce; Muratoglu, Murat; Akcebe, Aysegul; Gungorer, Bulent; Kavalci, Gulsum; 0000-0002-9586-7509; 32593274; AAK-2079-2021
Purpose: To compare the efficacy of a low-cost custom-made universal serial bus (USB) endoscope laryngoscope for intubation with a direct laryngoscope and a high-cost video laryngoscope in a mannequin study. Methods: We used one intubation simulator model (mannequin) in our study. A USB endoscope was mounted to the direct laryngoscope as a custom-made USB endoscope laryngoscope (USB-L). We used a video laryngoscope (Glidescope(R), Verathon, USA) and a direct laryngoscope (Macintosh) for comparison. Intubation time and the correct placement of the tube were measured. Intubations were performed by two operators and results were compared. Results: We found a statistically significant difference between the video and direct laryngoscope groups (p < 0.001), as well as between the USB-L and direct laryngoscope groups (p = 0.001) for Operator 1. For Operator 2, there was a statistically significant difference between the video laryngoscope group and the direct laryngoscope group (p = 0.022); however, we did not find a significant difference between the USB-L group and the direct laryngoscope group (p = 0.154). Furthermore, there were no significant differences between the USB-L and video laryngoscope groups for either operator (p=0.347 for Operator 1 and p>0.999 for Operator 2). Conclusion: Our study showed that USB endoscope laryngoscope provided similar intubation time to video laryngoscopy at a fraction of the cost; and both had superior times in comparison with direct laryngoscopy.