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Öğe Application of ice and vapocoolant spray to reduce tetanus vaccine pain: A prospective, randomized, controlled, clinical study(2019) Akcimen, Mehmet; Bedel, Cihan; Selvi, FatihAim: Tetanus is one of the vaccine-preventable diseases, that threatens human health in our country and the world, and one of the most common symptoms after vaccination is localized pain. In this study, we aimed to compare the effectiveness of vapocoolant spray with ice application and control group in reducing the pain during vaccination. Material and Method: This prospective randomized controlled trial included 292 patients who received tetanus vaccination between January 1st, 2017 and April 1st, 2017 and who agreed to participate in the study. Patients were assigned to 3 groups. Before vaccination, vapocoolant spray was applied to Group 1 and ice was applied to Group 2, and application was directly performed to Group 3 (control). The pain at the time of vaccination and at injection was noted between 0-100 using Visual Analogue Scale (VAS). Results: Of the 315 patients included in the study, 292 fulfilled the inclusion criteria. Patients who were applied ice (5.3 ± 7.1) or vapocoolant spray (4.1 ± 5.4) at the time of intervention had statistically significantly lower VAS values than control group (8 ± 10.6) (p = 0.002; p <0.001, respectively). The mean VAS values during injection, in control patients and ice and vapocoolant spray applied patients were found to be as 9.5 ± 8.11; 6.3 ± 7.4; 11.5 ± 10.2, respectively. VAS values at injection were statistically significantly lower in ice-applied patients than in the control group (p = 0.039). Conclusions: Both ice and vapocoolant spray reduce pain occurred during tetanus vaccination compared to the control group. With easy and fast applicability, ice and vapocoolant spray can be used to reduce the pain during the tetanus vaccine.Öğe Evaluation of incidental findings of whole body computed tomography in multiple trauma patients in emergency department(2019) Bedel, Cihan; Korkut, Mustafa; Erman, KursatAim: The aim of this study was to investigate the frequency of incidental findings and the clinically significant ones in whole-body computed tomography (WBCT) scans in multiple trauma patients in the emergency department (ED). Material and Methods: This study was designed as a single-centered retrospective cohort in a tertiary emergency room. Multiple trauma patients who were screened with WBCT in the ED in 2017 were analyzed. Incidental findings (IF) were categorized into 3 groups as group 1 (emergency treatment / need further examination), group 2 (need examination depending on the symptoms of patients) and group 3 (minor findings with no need for further examination). Results: WBCT screening was performed in 206 of 3746 patients (5.4%) who were admitted to the trauma unit in ED due to multiple traumas. A total of 360 IFs were found in 138 (67%) of 206 patients. Of the patients, 13.3% were classified as group 1, 30.9% as group 2, 55.8% as group 3 and IF was detected, respectively (48, 111, 201). Cardiomegaly was the most common finding in group 1 (n = 11). In group 2, hepatomegaly (n = 18) and atherosclerosis (n = 13) were the most common ones observed. Brain calcifications (n = 42) and renal cysts (n = 17) were the most common findings in Group 3. The age distribution of patients with IF was statistically significantly higher compared to those without IF (43.54 ± 18.78, 25.16 ± 11.7, p <0.001, respectively). Conclusion: WBCT is used in the ED with an increasing frequency in multiple trauma patients and causes incidental findings to occur significantly. Some of these findings may be vital and may require further clinical evaluation and follow-up.Öğe The value of the capillary blood ketone measurement in rating of dehydration: An experimental study(2019) Akcimen, Mehmet; Bektas, Ahmet Firat; Yigit, Ozlem; Bedel, CihanAim: In this study, we aimed to determine the value of blood ketone levels in diagnosing and classifying dehydration. Material and Methods: A total of 40 rats were included into the study. Rats were categorized into four groups according to their weight loss: control group (no weight loss), mild dehydration group (3 – 5% weight loss), moderate dehydration group (5 – 10% weight loss) and severe dehydration group (>10% weight loss). The blood samples taken from the rats were analyzed for capillary blood ketone levels, venous blood ketone levels and the other biochemical parameters. Results: There was no significant difference between four study groups according to the venous blood ketone levels and capillary ketone levels. Only Na levels were significantly different between study groups among all the metabolic parameters. (p=0.044). After categorizing the study groups as control and dehydration groups according to the weight loss, a borderline significance was established for Na (146±6 vs 151±2.5; difference: 4.2 mmol/L, %95 CI: -0.2 to 8.6, respectively; p=0.06) and capillary blood ketone (0.4 (IQR:0.3-0.5) vs 0.6 (IQR:0.4-0.7), respectively; p=0.097), while other parameters did not differ significantly. The capillary blood ketone had a sensitivity of 96.7% (95% CI: 82.8 -99.9), specificity of 10% (95% CI: 0.3-44.5) for detecting dehydration. Conclusions: This study showed that there was no significant difference for the development of ketosis in dehydration. However, the borderline significance for the capillary ketone levels indicates the necessity of human studies.Öğe The value of ultra-sensitive troponin I in determining the prognosis of patients with the suspected acute coronary syndrome in the emergency department(2021) Unal, Osman Gursoy; Korkut, Mustafa; Yuruktumen Unal, Aslihan; Bedel, Cihan; Yildiz, ManolyaAim: Acute coronary syndromes (ACS) have significant mortality and morbidity in our country and the world. With the development of technology, early diagnosis and treatment may be possible. Ultra-sensitive troponin I (us-TnI) test developed a few years ago has provided accurate detection of even lower troponin concentrations using a microparticle immunoassay. There are very few studies in the literature about us-TnI showing prognosis. In this study, we aimed to find the value of the newly introduced us-TnI in determining mortality in one-month and three-month follow-ups. Materials and Methods: The study included all patients who were admitted to our tertiary emergency department (ED) between November 2015 and June 2016 and whose us-TnI levels was studied considering ACS. Whether the follow-up of the patients included in the study resulted in death was determined. The patients were classified according to the date of death based on their mortality status at the end of the first month and third month. Results: It was found that of the patients, 4.0% (n=264) died within 1 month after the first troponin measurement, while 6.8% (n=444) died within 3 months after the first troponin measurement. The AUC of the baseline us-TnI value in determining cardiac death at the end of the first month was 0.803 (95% Cl: 0.793-0.813) and the AUC of the baseline us-TnI value in determining cardiac death at the end of the third month was 0.763 (95% Cl: 0.752-0.773). Conclusion: Us-TnI studied at the time of admission to ED is an early indicator of mortality in patients with the diagnosis of ACS.
