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Öğe Cerebral Venous Sinus Thrombosis After Spinal Anesthesia: Case Report(Elsevier Science Bv, 2011) Yucel, Neslihan; Akgun, Feride Sinem; Tekin, Yusuf Kenan; Altinayar, Sibel; Alkan, AlpayCerebral venous sinus thrombosis is a rare clinical disorder which frequently shows up as prolonged headache unresponsive to standard therapies following spinal anesthesia. In this study, a 24 years old male presenting to our emergency department (ED) after many visits to other ED with headache which started following spinal anesthesia underwent fifteen days ago and being diagnosed with cerebral sinus venous thrombosis upon the evaluations is reported.Öğe Characteristics of patients who are newly diagnosed with cancer after visiting the emergency department(Drunpp-Sarajevo, 2011) Yucel, Neslihan; Akgun, Feride Sinem; Ertan, Cem; Serin, Meltem; Ozgur, KarciogluThe purpose of this study was to assess clinical characteristics and survival times for patients who presented to a university hospital emergency department with acute problems and were subsequently admitted and diagnosed with cancer. Methods: The patients were 143 individuals who were newly diagnosed with cancer after admission to the emergency department at a university hospital. Medical records were reviewed and data were retrospectively evaluated. Results: The patients included 90 males and 53 females, and the median age was 68 years. At time of diagnosis, 73 patients had locoregional disease and 70 had metastatic disease. Most common primary tumor sites were lung (n = 33), gastric (n = 28), colorectal region (n = 23) and brain (n = 13). Of 143 patients, 33 died of their disease in hospital and 110 were discharged. Most common signs and symptoms were pain (n = 35), bleeding (n = 24) and shortness of breath (n = 23). Medical conditions that necessitated emergency admission were increased intracranial pressure (n = 27), hemorrhage (n = 23), infection (n = 23) and intestinal obstruction (n = 21). The median survival time for the 143 patients total was 6.2 +/- 1.2 months (range, 4.1-8.3 months). Conclusion: Emergency departments play an important role in the diagnosis and treatment of cancer patients, and even in screening for this disease. Individuals with undiagnosed cancer often present an unique set of challenges for emergency physicians because their presentation can range from vague-related symptoms to clear symptoms of malignancy that demand immediate treatment. In order for emergency physicians to be able to diagnose cancer in this patient group, it is important to maximize awareness of the cancer-related symptoms that these individuals may display.Öğe Do the patients referred to the emergency department really deserve an urgent medical intervention?(2019) Akgun, Feride SinemAim: In this study, it was aimed to evaluate the urgency of the patients considering their referral complaints indicated by 112 ambulance service crew and their anamnesis obtained in the emergency department (ED) as well. The evaluation was performed according to the World Health Organization (WHO) - 32 - Emergency Parameters (EP).Material and Methods:This retrospective study was carried out examining the data of all patients brought to our hospital’s ED by the 112-ambulance service between the dates January 05, 2017 and October 31, 2017. Qualitative and quantitative evaluations are based on the WHO-32-EP.Results: Findings: The age of the emergency patients was found to be statistically higher than that of non-emergency patients (p= 0.024). It was observed that 171 patients evaluated according to their referral complaints were not in an urgent condition and that 109 patients evaluated according to their anamnesis obtained in the ED were not in an urgent condition as well. When the relationship between the complaints of the patients at the moment of the referral to the ED by 112 ambulance crew, and their anamnesis obtained in the ED, it was found that 24.6% (n = 99) of these patients were not in an urgent condition. Most of the complaints reported by 112 ambulance crew were not found in the WHO-32-EP (n=170).Conclusion: Awareness-raising training may be useful for 112 ambulance service crews that provide on-site emergency medical care so that they can make accurate decisions about diagnosis and perform accurate initial intervention as well. Keywords: Emergency Referral; Emergency Medicine; WHO; 112 Emergency Service.Öğe Efficacy of ProBNP and CRP/ Albumin ratio in patients with acute heart failure in the Emergency Department(2020) Karaman, Esra; Ozturk, Tuba; Akgun, Feride SinemAim: Heart failure (HF) is one of the most common diseases in patients over 65 years of age.It is a clinical condition which is often mortal and requires intensive care follow-up. Therefore, some tests are used to predict the diagnosis, treatment and prognosis. In this study, we aimed to compare the effect of natriuretic peptides (ProBNP) and CRP/albumin ratio on mortality and prognosis in patients who referred to the emergency department (ED) with HF. Material and Methods: The patients with ICD codes of I50 and J81 in two different hospital ED between 2018 and 2019 were analyzed retrospectively. Demographic data of the patients and the parameters planned to be studied were recorded in a Microsoft Excel 2010 file. NCSS (Number Cruncher Statistical System) 2007 software was used for the statistical analysis.Results: Our study consisted of 301 patients. A very weak positive (CRP/albumin ratio increased as the ProBNP value increased) correlation of 0.193 between ProBNP measurements and CRP/albuminratios of the participants was found to be statistically significant(r=0.193; p=0.001; p0.01).Conclusion: According to our study, no significant correlation was found between ProBNP and CRP/albumin ratio. The CRP/albumin ratio is not appropriate to be used alone to determine the definitive diagnosis and mortality in cases with acute HF. However, since there are not enough studies regarding this subject, more studies need to be done in a more extended period and with more patients.Öğe Electrical Injuries: The Demographical and Clinical Features(Galenos Yayincilik, 2010) Oguzturk, Hakan; Turtay, Muhammet Gokhan; Ertan, Cem; Akgun, Feride Sinem; Tekin, Yusuf KenanAim: Electrical injuries are an important health problem in our country, as well as worldwide. The aim of this study was to explore the demographic characteristics, complications and mortality associated with electrical injuries. Methods: In this study, 38 patients who had been exposed to electrical injuries and treated at the Emergency Department of, Faculty of Medicine, Inonu University between October 2008 and October 2010 were reviewed. Data pertaining to the patients were analysed retrospectively. Results: Out of 38 patients, 28 (73.7%) were male and 10 (26.3%) female. Electrical injuries were most frequently encountered in the 17-29 year age group, constituting 39.5% of cases. Eight (21.1%) patients were exposed to high voltage and 30 (78.9%) to low voltage. Among the circumstances leading to electrical injury, household accidents (63.2%) prevailed over the occupational accidents (36.8%). Two patients died due to sepsis. The overall mortality rate was 5.3 % and the mean hospital stay was 4.1 +/- 5.2 days. Conclusion: The results obtained from this research with respect to the demographic and clinical features can help the development of a particular strategy for electirical injuries.Öğe Evaluation of neutrophil-to-lymphocyte ratio as a marker of inflammatory response in spondylodiscitis(2018) Karaarslan, Numan; Yilmaz, Ibrahim; Caliskan, Tezcan; Akgun, Feride Sinem; Bilir, Bulent; Dogan, Mustafa; Ates, OzkanAim: Spondylodiscitis, if not diagnosed on time, can cause morbidity or mortality at high rates. This study was carried out with the aim of testing the hypothesis that “neutrophil-to-lymphocyte ratio can be used” especially in cases where it is difficult to diagnose spondylodiscitis. Material and Methods: This study involved 24 patients admitted to the State Hospital of Ministry of Health and Namik Kemal University for spondylodiscitis between January2014 and June2017. After excluding the cases that did not meet the inclusion criteria (n=6), the remaining cases (n=24) were referred to as the study group. A control group was created from healthy volunteers (n=24) who applied for routine physical checkups at the clinic between the same dates and who were similar in terms of age, sex, and body mass index to the study group. Hemogram parameters of the cases in both groups; white blood cell, C-reactive protein, erythrocyte sedimentation rate, and neutrophil-to-lymphocyte ratio were statistically compared. Results: Patients in the spondylodiscitis group, compared to healthy volunteers had statistically significant neutrophil-to-lymphocyte ratio value. Conclusion: Especially in cases where the diagnosis of spondylodiscitis is not assured, the neutrophil-to-lymphocyte ratio parameter, which is less costly than other diagnostic methods and the analysis results of which can be obtained in a shorter time, may be used to support clinical diagnosis.Öğe Evaluation of patient transfers to the emergency department of a university hospital(Elsevier Science Bv, 2010) Ertan, Cem; Akgun, Feride Sinem; Yucel, NeslihanObjective: The tiered health care delivery system helps patients get the medical care they need while avoiding unnecessary consumption of the limited sources in the case a proper patient flow is managed within the system. We aimed to analyze the profile and transfer conditions of the patients referred to our center with this cross-sectional study. Methods: A total of 541 patients who were referred to our emergency department within the first two months of 2006 were evaluated. The demographic data, vital signs and diagnoses at the time of referral, the means of patient transfer and the distribution patterns of the patient transfers based on the days of the week and the hours of the day were recorded. Results: The mean age of the patients was 47.97 +/- 21.02, and 245 were (45.3%) male. 98.5% of the patients were referred without prior consulting to the receiving facility. The most common pre-tranfer diagnosis was abdominal pain (9.6%). While 87.2% of the patients were transported with ambulances, only 77.7% of them had appropriate medical personnel accompanying them. The busiest days for patient transfers were Fridays (19.6%), Mondays (16.8%) and Saturdays (14.4%) respectively. The busiest interval of the day was between 12: 00 pm and 23: 59 pm (67.4%). Conclusions: Our study showed that most of the transfers were performed by hospital ambulance services without consulting to the receiving facility. Almost 20% of the patients were not accompanied by a doctor in the ambulance. Patients were transferred after business hours and without proper specific diagnoses made. Most the patients were transferred without an appropriate epicrisis; therefore the receiving facilities were not informed about the prior interventions performed on patients.Öğe Evaluation of the effect of apixaban on the primary intact intervertebral disc cell cultures(2019) Akgun, Feride Sinem; Karaarslan, Numan; Yilmaz, İbrahim; Ozbek, Hanefi; Yasar Sirin, Duygu; Simsek, Abdullah Talha; Kaplan, Necati; Ates, OzkanAim: Apixaban is a frequently preferred pharmacological agent in clinics to prevent deep vein thrombosis and pulmonary embolism. Such new oral anticoagulants may cause hemorrhage’s in tissues and/or organs or may cause gastrointestinal symptoms without bleeding. It is also reported in the literature that it may lead to mental disorders, unwanted disorders in the urinary tract and skeletal-muscle system. However, when the literature is examined, there are no studies, which are of high-evidential value, evaluating the efficacy of apixaban on healthy, intact intervertebral disc tissue, and matrix-like structures. In this pharmaco-molecular study, it was aimed to investigate the effects of a new oral anticoagulant agent containing the active ingredient apixaban on the intact intervertebral disc tissue cells, extracellular matrix (ECM) structure and to evaluate its positive and / or negative effects on gene expressions of cartilage oligo matrix protein (COMP), chondroadherin (CHAD), and Matrix Metalloproteinase (MMP)s.Material and Methods: The primary cell cultures were prepared from the intact tissues of the patients with the traumatic intervertebral disc herniation. Apixaban was administered to the cultures and molecular analyses were performed for 21 days. The data obtained from the apixaban-administered and non-apixaban-administered samples were evaluated statistically and the significance value was accepted as P 0.05.Results: The changes were observed in the cell proliferation and the expressions of the mentioned genes in the apixaban-administered group. The suppression of COMP value and the increase in MMP-13 value may be indicative of the development of matrix degeneration in the apixaban-administered group, compared to the non-drug-administered control group. Conclusion: The selectivity is one of the most important features of the drugs. However, it should not be forgotten that no drug will only produce the desired effect.Öğe HETEROTOPIC OSSIFICATION; CASE REPORT(Aves, 2011) Oguzturk, Hakan; Turtay, Muhammet Gokhan; Dogan, Metin; Akgun, Feride SinemHeterotrophic ossification is the development of bone in abnormal areas like muscle tissue. Neurogenic, traumatic and congenital are just a few of the causes which vary a lot. The most significant factor affecting prognosis is prolonged immobilization. Emergency departments are places where immobile patients most frequently apply due to their varied complaints. In this report we presented an immobile patient with heterotrophic ossification and reviewed the literature. Heterotrophic ossification should be taken into consideration while assessing the possible causes of the complaints such as joint or extremity pain, restriction of movement in patients with immobilization.Öğe Hypernatremia in the Emergency Department(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2012) Yucel, Neslihan; Sahin, Idris; Akgun, Feride Sinem; Koz, Suleyman; Berber, Ilhami; Ozdemir, Muzaffer GalipINTRODUCTION: To determine the symptoms, clinical characteristics, prevalence and outcome of patients with hypernatremia who presented at the emergency department. MATERIA LAND METHODS: We retrospectively studied patients who presented at the emergency department with hypernatremia (Na>148 meq/l) from January 2008 to December 2008. RESULTS: A total of 25.545 cases presented at the Emergency Department and hypernatremia was seen in 86 patients. The prevalence of hypernatremia was 0.34%. The mean age was 69.5 +/- 15.2 (2096, median age: 75) years and 51 of them (59%) were male. Forty percent of the patients died. There were no significant differences according to age, gender and admission Na levels. A comorbid disease were seen 99% of patients. Cerebrovascular disease(CVD), dementia/Alzheimer and hypertension were the most common co-morbid diseases (respectively, 34%, 34%, and 27%). Central neurological system disorders (such as thrombotic or hemorrhagic CVD, Alzheimer, etc.) were seen in 72% of the cases. Fifty patients had acute infection at the time of admission. Acute urinary infection, pneumonia and acute CVD were the most common acute illnesses. CONCLUSION: Hypernatremia is usually seen in the geriatric population and associated with a high mortality and morbidity rate and the majority of patients with hypernatremia have a comorbid disease. The prevalence of hypernatremia was 0.34% in our emergency department.Öğe TÖTM acil servisine başvuran hastaların değerlendirilmesinde modifiye erken uyarı skoru ve mainz acil değerlendirme skoru kullanımının hasta prognozunu öngörmedeki etkinliği(İnönü Üniversitesi, 2011) Akgun, Feride SinemSon yıllarda, acil servisler ve yoğun bakım birimlerinde kritik hastaların taburculuk ve hastalık ciddiyetinin değerlendirilmesinde kullanılabilecek skorlama sistemlerine olan ilgi giderek artmaktadır. Bu çalışmada amacımız acil servise başvuran hastaların hastalık ciddiyetlerini belirleme ve hastaneye yatırılan hastaların sonlanımlarını öngörmede MEES ve mEWS sistemlerinin etkinliğini araştırmaktır. Materyal ve Metot: 01 Ocak ? 15 Şubat 2011 tarihleri arasında, İnönü Üniversitesi Turgut Özal Tıp Merkezi Acil Servisi'ne herhangi bir yakınma ile başvuran ve acil serviste müdahale edilen veya gözlem altında tutulan tüm hastalar arasından hastaneye yatışı gerçekleştirilen 1051 hasta çalışma evrenimizi oluşturdu. Çalışmaya alınan hastaların yaşının, cinsiyetinin, triaj kategorisinin, acil servise başvuru saatlerinin, mEWS ve MEES parametrelerinin herhangi bir kliniğe yatırıldığında yatış yerlerine ve mortalitelerine göre etkileri araştırıldı. İstatistiksel verilerin analizinde windows için SPSS paket programının 16.0 nolu versiyonu kullanıldı. Veriler ortalama, standart sapma (SD), ve yüzde olarak özetlendi. Risk faktörlerinin hesaplanması amacıyla univariate ve multivariate analizler kullanıldı. Bulgular: Çalışmaya alınan hastaların yaş ortalamaları 58±19'du ve bunların 467'si (%44) kadın, 584'ü (%56) erkekti. Hastaların 21'i (%2) triaj 1 kategorisi, 646'sı (%61) triaj 2 kategorisi ve 384'ü ise (%37) triaj 3 kategorisindeydi. Bu hastaların 341'i (%32) yoğun bakıma, 710'u ise (%68) herhangi bir sevise yatırıldı. Çalışmaya alınan 1051 hastadan 935'i (%89) hastaneden taburcu edilirken, 116 hasta (%11) hastanede ex oldu. Hastaların mortalitelerine göre GKS, AVPU ve mEWS değerleri istatistiksel olarak anlamlıydı (p<0.0001).Hastaların mortalitelerine göre delta MEES değerleri istatistiksel olarak anlamsız olarak bulundu (p<0.127). Yapılan multivariate analizde hastaların mortalitelerini belirlemede hasta yaş grupları, GKS ve mEWS değerleri ve yatış yerlerini belirlemede ise yaş grupları, GKS ve AVPU değerleri etkin faktörler olarak bulundu. Sonuç: Çalışmamızın sonuçları mEWS değerlendirmesinin acil serviste kullanımının hasta prognozunu ön görmede ve hastaların yatacağı birimlerin belirlenmesinde etkin ve güvenilir bir araç olduğunu desteklemektedir. Aynı zamanda acil servislerde kolayca kullanılabilen GKS ve AVPU değerlerinin de güvenilir yol göstericiler olduğunu ortaya koymuştur. Diğer yandan MEES değerleri acil servislerde kullanım için uygun bulunmamıştır.
