Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Approach to Patients with Syncope in Emergeny Department - An Evidence-Based Review(2014) Ciftci, Orcun; Kavalci, Cemil; Durukan, Polat; https://orcid.org/0000-0001-8926-9142; https://orcid.org/0000-0003-2529-2946; W-5233-2018; AGG-1308-2022Syncope is an important health problem, constituting 1%-5% of all emergency service admissions and up to 6% of all hospitalizations. Substantial experience with patient history and physical examination and time are required to diagnose syncope in patients presenting with transient loss of consciousness. In addition, only up to 50% of patients with syncope can be diagnosed with a final diagnosis, despite all efforts. Thus, management of syncope in emergency departments has shifted from reaching a final diagnosis and treatment to short-, moderate-, or long-term risk stratification systems, allowing decisions for outpatient management, including specialized branch care, or admission for further work-up. This review discusses the definition of syncope-related transient loss of consciousness, differential diagnosis of syncope, diagnostic methods and algorithms, and the main risk stratification studies. It also incorporates the recommendations of the American College of Emergency Physicians (ACEP) 2007 policy statement regarding patients with syncope.Item 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-2597-2020Dexketoprofentrometamol (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.Item The Correlation of TWEAK Level And with Involved Area on MRI in Stroke(2017) Yilmaz, Muhittin Serkan; Yilmaz, Murat; Isik, Bahattin; Yel, Cihat; Kavalci, Cemil; Demirci, Burak; Inan, Selim; Kavak, Rasime Pelin; Balamir, Ilhan; Turhan, Turan; 0000-0003-2529-2946; 0000-0001-6658-7260; AGG-1308-2022; AAD-2829-2021; ABG-1934-2020The aim of this study was to value of TWEAK protein in stroke diagnosis and the correlation between Tweak level and lesion size on diffusion MRI in patients admitted to emergency department for acute stroke. Our study was prospectively conducted in a group of patients diagnosed with stroke in the emergency department and a control group between 1 June 2014 and 31 August 2014. Age, sex, vital parameters, comorbid conditions, neurological deficit level, Tweak level, and involved volume on D-MRI were analyzed. Age, sex, vital parameters, comorbid conditions, and Tweak levels were compared between the patient and control groups. Tweak level was compared with neurological deficit and diffusion on D-MRI imaging in the patient group. The results were evaluated in a confidence interval of 95% and at a significance level of p<0.05. There were no significant differences between both groups with respect to age and sex distribution. The median Tweak level of the patient group was significantly higher (912.1 pg/ml vs 808.3 pg/ml, p<0.05). In the patient group NIHSS score had a positive correlation to MRI lesion size (p<0.05) but not to Tweak level (p>0.05). There was no correlation between Tweak level and the involved area on diffusion MRI (p>0.05). In conclusion, Tweak appears as a parameter that can be used in patients with a clinical presentation consistent with Stroke. It can be used for diagnostic purposes when cranial CT does not support the diagnosis or for supporting diagnosis when D-MRI is not available.Item Hemophagocytic Syndrome: A Case Report(2016) Ozturk, Derya; Altinbilek, Ertugrul; Caltili, Cilem; Kavalci, Cemil; 0000-0003-4201-8850; 0000-0003-2529-2946; 0000-0001-8910-7004; AAB-1368-2019; AGG-1308-2022; AAK-9102-2021Hemophagocytic syndrome, a serious clinical condition accompanying systemic inflammatory disorders, is characterized by massive hypercytokinemia as a result of excessive activation and proliferation of T-lymphocytes and macrophages. This article aims to remind clinicians of the hemophagocytic syndrome in the differential diagnosis of patients with fever, pancytopenia, and hepatosplenomegaly. This condition can be highly fatal despite the administration of appropriate therapy. Early diagnosis of hemophagocytic syndrome is of utmost importance, as a delay in diagnosis significantly worsens the prognosis, and treatment should be tailored to the underlying pathology.Item Importance of Red Blood Cell Distribution Width (RDW) in Patients with Upper Gastrointestinal Haemorrhage(2016) Isik, Bahattin; Yilmaz, Muhittin Serkan; Yel, Cihat; Kavalci, Cemil; Solakoglu, Gorkem Alper; Ozdemir, Metin; Ongar, Murat; Demirci, Burak; https://orcid.org/0000-0003-2529-2946; 26819158; AGG-1308-2022Objective: To explore the effect of red blood cell distribution width levels on the diagnosis and management of upper gastrointestinal haemorrhage. Methods: The retrospective study was conducted at Ankara Numune Education and Research Hospital, Turkey, and comprised record of patients diagnosed with upper gastrointestinal haemorrhage from January 1, 2013, to December 31, 2013. Factors analysed were age, gender, red blood cell distribution width level, admission haemoglobin and haematocrit levels, endoscopy findings classified according to the Forrest system, comorbid diseases, use of medications, unhealthy habits like alcohol usage and smoking, and mortality rate. Results: Of the 147 patients, 93(64%) were men. The overall median age of the sample was 60 years. Besides, 117(79.6%) patients had comorbid diseases, of which hypertension 56(38.4%) was the most common. A total of 24(16.8%) patients were using antiplatelet or anticoagulant drugs, while 30(20.5%) were on non-steroidal anti-inflammatory drugs. Peptic ulcer in 128(87.1%) patients was the most common cause of haemorrhage. The median red blood cell distribution width level of the study population was 15.25% which was significantly higher compared to the reference values (p<0.05).. In contrast, haemoglobin 9.55% (3.7) and haematocrit 28.75% (10.8) were significantly lower (p<0.05). Mortality rates were significantly higher in patients with higher red blood cell distribution width values (p<0.05). Conclusion: Red blood cell distribution width levels were higher during the acute phase of upper gastrointestinal haemorrhage.Item 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-2597-2020Introduction: 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.Item 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-1308-2022Objective: 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.Item The value of Serum BNP for diagnosis of intracranial injury in minor head trauma(2014) Demir, Ali; Kavalci, Cemil; Yilmaz, Muhittin Serkan; Yilmaz, Fevzi; Durdu, Tamer; Ceyhan, Mehmet Ali; Alagoz, Fatih; Yel, CihatObjective: Head injury is the main cause of death among individuals younger than 45 years old. Cranial Computerized tomography (CT) is commonly used for diagnosis of head injury. Brain Natriuretic Peptide (BNP) is a peptide originally isolated from brain ventricles. The main aim of this study is to investigate BNP as an indicator of head injury among patients presenting to emergency department (ED) with minor head trauma. Methods: This was a prospective study conducted at the emergency department of the Numune Training and Research Hospital. A total of 162 patients who presented to the ED with minor head injury were enrolled. The patients were categorized into 2 groups as the cranial CT-negative and positive groups. The normality of the data was tested using One Sample Kolmogorov Smirnov test. Mann-Whitney U test was used to compare 2 independent groups while the Kruskal-Wallis test was utilized for comparison of more than 2 groups. A p-value of <0.05 was considered to be significant. Results: Ninety-six (59.3%) patients were male and 66 (40.7%) were female. The cranial CT-negative group had a median BNP level of 14.5 pg/ml while the cranial CT-positive group had a median BNP level of 13 pg/ml. There was no statistically significant difference between these two groups for serum BNP levels (p > 0.05). Conclusion: This study suggested that serum BNP level wasn't used in defined of intracranial injury.Item Comparison of the Canadian CT head rule and the new orleans criteria in patients with minor head injury(2014) Kavalci, Cemil; Aksel, Gokhan; Salt, Omer; Yilmaz, M. Serkan; Demir, Ali; Kavalci, Gulsum; Ozel, Betul Akbuga; Altinbilek, Ertugrul; Durdu, Tamer; Yel, Cihat; Durukan, Polat; Isik, BahattinAim: The aim of the study was to compare the New Orleans Criteria and the New Orleans Criteria according to their diagnostic performance in patients with mild head injury. Methods: The study was designed and conducted prospectively after obtaining ethics committee approval. Data was collected prospectively for patients presenting to the ED with Minor Head Injury. After clinical assessment, a standard CT scan of the head was performed in patients having at least one of the risk factors stated in one of the two clinical decision rules. Patients with positive traumatic head injury according to BT results defined as Group 1 and those who had no intracranial injury defined as Group 2. Statistical analysis was performed with SPSS 11.00 for Windows. ROC analyze was performed to determine the effectiveness of detecting intracranial injury with both decision rules. p < 0.05 was considered statistically significant. Results: 175 patients enrolled the study. Male to female ratio was 1.5. The mean age of the patients was 45 +/- 21,3 in group 1 and 49 +/- 20,6 in group 2. The most common mechanism of trauma was falling. The sensitivity and specificity of CCHR were respectively 76.4% and 41.7%, whereas sensitivity and specificity of NOC were 88.2% and 6.9%. Conclusion: The CCHR has higher specificity, PPV and NPV for important clinical outcomes than does the NOC.Item Analysis and injury paterns of walnut tree falls in central anatolia of turkey(2014) Ersoy, Suleyman; Sonmez, Bedriye Muge; Yilmaz, Fevzi; Kavalci, Cemil; Ozturk, Derya; Altinbilek, Ertugrul; Alagoz, Fatih; Cesur, Fatma; Yildirim, Ali Erdem; Uckun, Ozhan Merzuk; Akin, TezcanIntroduction: Falls are the second most common cause of injury-associated mortality worldwide. This study aimed to analysis the injuries caused by falls from walnut tree and assess their mortality and morbidity risk. Methods: This is a retrospective hospital-based study of patients presenting to emergency department (ED) of Ahi Evran Univercity between September and October 2012. For each casualty, we computed the ISS (defined as the sum of the squares of the highest Abbreviated Injury Scale (AIS) score in each of the three most severely injured body regions). Severe injury was defined as ISS >= 16. The duration of hospital stay and final outcome were recorded. Statistical comparisons were carried out with Chi-Square test for categorical data and non-parametric spearman correlation tests were used to test the association between variables. A p value less than 0.05 was considered to be statistically significant. Results: Fifty-four patients admitted to our emergency department with fall from walnut tree. Fifty (92.6%) patients were male. The mean age was 48 +/- 14 years. Spinal region (44.4%) and particularly lumbar area (25.9%) sustained the most of the injuries among all body parts. Wedge compression fractures ranked first among all spinal injuries. Extremities injuries were the second most common injury. None of the patients died. Morbidity rate was 9.25%. Conclussion: Falls from walnut trees are a significant health problem. Preventive measures including education of farmers and agricultural workers and using mechanized methods for harvesting walnut will lead to a dramatic decrease in mortality and morbidity caused by falls from walnut trees.