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 The Value of Serum NGAL in Determination of Dialysis Indication(2014) Cemil, Kavalci; Elif, Celikel; Serkan, Muhittin; Fevzi, Yilmaz; Deniz, Arslan Engin; Tamer, Durdu; Polat, Durukan; https://orcid.org/0000-0003-2529-2946; 25255577; AGG-1308-2022Objective: To investigate if Neutrophil Gelatinase-associated Lipocalin can be used or not as a biochemical marker to determine the indications for emergency dialysis treatment. Methods: The study was conducted at the Emergency Department of Numune Taraining and Research Hospital, Ankara, Turkey, in 2012, and comprised 60 patients who had uraemic symptoms and abnormal laboratory tests, including elevated potassium, blood urea nitrogen, and creatinine level or lowered pH and bicarbonate. They were divided in to 2 equal groups as those having indication for dialysis (Group 1) and those not having such indications (Group 2). Relevant values, including that of Neutrophil Gelatinase-associated Lipocalin, were compared between the two groups. To assess the utility of Neutrophil Gelatinase-associated Lipocalin measurements at varying cut-off values to predict indications for dialysis, a conventional receiver operating characteristic curve was generated and the area under the curve was calculated. P<0.05 was considered statistically significant. Results: The mean age of the 30 patients in Group 1 was 68.29 +/- 16.9 years, while in Group 2 it was 66.47 +/- 14.2 years (p<0.65). The mean Neutrophil Gelatinase-associated Lipocalin level was 817.65 +/- 334.76ng/mL in Group 1 and 398.97 +/- 202.42ng/mL in Group 2 (p<0.001). The best cut-off level for Neutrophil Gelatinase-associated Lipocalin to predict emergency haemodialysis indication was 615ng/mL with a sensitivity of 82% and a specificity of 80%, and the areas under curve was 0.84. Conclusion: Serum Neutrophil Gelatinase-associated Lipocalin level may be a determining parameter for indication of emergency haemodialysis.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 NEUTROPHIL LYMPHOCYTE RATIO IN PREDICTING SEVERITY OF INJURY, COMPLICATIONS AND MORTALITY IN CAUSTIC INGESTION CASES(2020) Rezan, Karaali; Firdevs, Topal; Umut, Payza; Yesim, Akyol Pinar; Cemil, Kavalci; Zeynep, Karakaya; Esad, Topal FatihBackground: Caustic ingestion is still alife-threatening condition. In this study, we investigated the significance of the neutrophil lymphocyte ratio (NLR) in predicting the severity of the injury, complications and mortality at an early stage in the emergency department. Material and methods: 133 patients included in the study. Endoscopic findings and Complete Blood Count (CBC) parameters were retrieved from hospital files. The data were divided into two groups Zargar grade 0, land 2A as Group1, 2B, 3A and 3B as Group 2. The Zargar scores and the laboratory values were evaluated with Spearman's Correlation. Results: We found that NLR and White Blood Cells ( WBC) values of Group 1 cases were statistically significant and lower than NLR and WBC values of Group 2 cases (p<0,05). Values in Group 2 patients showed that AUC value for the 6.99 cut-off value of the NLR WaS 0.913 sensitivity 100% and specificity was 78,3% (p <0.05). The 0,801 AUC for the 11.9 value of the WBC, sensitivity 66,7 and specificity 84.4 were found to be statistically significant (p <0,05). NLR> 7,33 AUC 0,915 (p<0.05) and AUC value for WBC> 11,9 was found to be 0,870 (p <0.05 ) for the patients with late complications. Interns of mortality no statistical relationship was found (p> 0,05). Conclusion: Endoscopy (EGD) is the valid gold standard method to determine the injury. In the literature, which patient groups should undergo endoscopy is also unclear. In addition, performing endoscopy in each patient will increase both the cost and the possibility of endoscopy-related complications. In our study NLR was statistically significant in predicting the severity of injury and possibility of complications in corrosive ingestion. Moreover, it can be obtain through affordable and routine blood count.