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Öğe Acil servise enfeksiyon şüphesi ile başvuran karaciğer nakilli hastalarda prokalsitonin, CRP, serum amiloid A, laktat ve IL-6 belirteçlerinin prognostik değeri(İnönü Üniversitesi, 2016) Gür, AliAmaç: Enfeksiyonlar, tüm nakillerde olduğu gibi karaciğer nakli sonrası da mortalite ve morbiditenin en önemli sebeplerindendir. Enfeksiyöz komplikasyonlar uygun tanı ve tedavi ile önlenebilir nedenler arasında kabul görmektedir. Bu nedenle enfeksiyon riskinin erken tahmini, lokal antimikrobiyal direncin ve spesifik risk faktörlerinin önlenmesine etkin bir yaklaşım sağlayacaktır. Karaciğer nakilli ve enfeksiyon şüpheli hastalarda seçtiğimiz belirteçlerin faydalı belirteçler olup olmadığını birbirleriyle karşılaştırarak araştırmayı amaçladık. Materyal ve Metod: Acil servise enfeksiyon şüphesi ile başvuran karaciğer nakli olmuş 65 hasta çalışmaya dahil edildi. Bu hastaların acil servis başvurusunda ki CRP, PCT, Laktat, SAA ve IL-6 değerlerine bakıldı. Hastalar kültürlerindeki üremelerine göre kültür negatif, kültür pozitif ve kontrol grubu olarak üç gruba ayrıldı. Çalışma parametreleri enfeksiyon varlığına, kültür pozitiflik durumlarına ve kendi aralarındaki ilişkiye göre araştırıldı. Bulgular: CRP, PCT, Laktat, SAA ve IL-6 değerleri enfeksiyon grubundaki hastalarda kontrol grubuna göre daha yüksekti ve enfeksiyon açısından anlamlıydı (p<0.05). CRP, PCT ve IL-6 değerleri kültür pozitif grupta kültür negatif gruba göre daha yüksekti ve anlamlı fark vardı (p<0.05). CRP, PCT ve IL-6 değerlerinin kendi aralarında, Laktat ve SAA ile anlamlı bir ilişki mevcuttu. SAA ve Laktat arasında ki ilişki anlamsızdı (p>0.05). CRP, PCT ve IL-6 parametreleri enfeksiyon riskini tahmin etmekte anlamlıydı (p<0.05). Sonuç: Karaciğer nakli olan enfeksiyon şüphesi ile acile başvuran hastalarda enfeksiyon varlığını tespit etmek için CRP, PCT, Laktat, SAA ve IL-6 parametreleri kullanılabilir. CRP, PCT ve IL-6 değerlerinin anlamlı yüksekliğinde hastaların kültürlerinde üreme olacağı tahmin edilebilir.Öğe Assessment of change in neutrophil-lymphocyte ratio, platelet-lymphocyteratio in patients with acute and chronic urticaria(2018) Gür, Ali; Turgut, Kasım; Güven, Taner; Aytemur, Zeynep Ayfer; Oğuztürk, Hakan; Turtay, Muhammet Gökhan; Yumrutepe, SevgiAbstract: Aim: Urticaria is a skin disease characterized by erythematous, oedematous, itchy,and spontaneously disappearing urticaria lesions. One of the most common skin diseases, it is the most common reason underlying the presentations to emergency departments. Our objective is to investigate the role of systemic inflammation in urticaria pathogenesis by measuring the indicators of Neutrophil-Lymphocyte ratio (NLR) and Platelet-Lymphocyte ratio (PLR) in routine hemograms in patients with acute and chronic urticaria. Material and Methods: Of patients visiting the Dermatology Policlinic of İnönü University Medical School Hospital between July 2017 and February 2018, 69 patients diagnosed with acute urticaria and 188 patients diagnosed with chronic urticaria as well as 90 healthy people taken as controls with an age range of 18to 70 were included in our study. Blood values of patients were studied retrospectively. (For the study, a Research Ethics Approval was obtained from Malatya Research Ethics Board.) Results: No significant difference was detected among the study groups in terms of demographic properties. Whereas a significant difference was noted among the three groups with regard to NLR values, no statistically significant difference was detected among the groups with respect to PLR values. No statistically significant difference was observed between the group of patients with urticaria and the control group in terms of erythrocyte distribution(p: 0.01). On the other hand, when the patient group with chronic urticaria was divided into two subgroups as patients with a complaint duration of 90 days and less, and those with a complaint duration of more than 90 days and evaluated, no statistically significant difference was detected between these groups in terms of RDW, lymphocytes, neutrophils, platelets, NLR and PLR values Conclusion: In our study, we have determined that systemic inflammation has increased in the group of patients with urticaria as compared to the control group. What’s more interesting in this study is our conclusion that the pathways involved in continued inflammation do not change by time in chronic urticaria.Öğe A case of myocardial infarction together with acute appendicitis in Emergency Clinic of Turgut Ozal Medical Center(2017) Sarıhan, Mehmet Ediz; Gürbüz, Şükrü; Gür, AliAbstract: In this study, a case of myocardial infarction (MI) developed in a 55-year old patient who applied to emergency clinic with acute appendicitis was presented. The patient who already had diabetes and hypertension applied to emergency clinic of our hospital due to abdominal pain, and he was diagnosed as having acute appendicitis associated with MI in routine evaluation and analyses. Treatment preference was used for MI for the patient, and the coronary occlusion was opened with using percutaneous transluminal coronary angiography. In the follow up of the patient, the clinical symptoms of the acute appendicitis disappeared, and the patient was discharged with cure without requiring any surgical intervention for the appendicitis. High mortality clinical situations, such as MI, which is stimulated due to various stress factors should be considered in the patients who applied to emergency clinicÖğe Case report: coronary embolism with st segment elevation in a patient with double valve replacement(Turgut Özal Tıp Merkezi Dergisi, 2016) Gür, Ali; Sarıhan, Mehmet EdizThis report describes a case of coronary embolism with ST segment elevation in a patient with aortic and mitral valve replacement admitted to our emergency department with complaining chest pain. A 25- year- old male was admitted to our emergency department complaining chest pain. The patient’s chest pain was sudden, onset and compressive style. In his medical history he had aortic and mitral valve replacement two years ago. He was using warfarin regularly. His physical examination was normal. The ECG showed ST segment elevation in leads II, III and aVF. In laboratory analysis, creatine kinase MB (CK-MB) was 159 U/L (upper limit 25 U/L), troponin-I was 6.8 ng/ml (upper limit 0.01 ng/ml) and CK was 1225 U/L (upper limit 170 U/L). International normalized ratio (INR) was 1.2 although the patient was receiving warfarin treatment. Medical treatment was started in the emergency department immediately and cardiology consultation was requested. Coronary angiography was made to the patient by cardiologist. The patient’s coronary angiography showed thrombus which caused %99 occlusion of circumflex artery (Cx) after OM2 branch. Thrombus aspiration was performed and treatment was contiuned at coronary intensive care unit. In his follow-up examination ECG changes was occurred. The patient’s ECG showed normal sinus rhythm. In his following blood tests; troponin-I, CK and CK-MB decreased normal levels. After warfarin dosage adjustment the INR increased to 3.7. The patient continued to improve clinically and was discharged home. Coronary embolism should be suspected in patients with complaining chest pain, medical history of valve replacement and ST segment elevation. Keywords: Coronary Embolism; St Segment Elevation; Chest Pain.Öğe Clinical analysis of the cancer patients who admitted to the emergency room(BIOMEDICAL RESEARCH-INDIA, 2016) Gürbüz, Şükrü; Turtay, Gökhan; Ögüztürk, Hakan; Güven, Taner; Gür, Ali; Çolak, Cemil; Durak, Mehmet AkifObjective: Patients with cancer diagnosis often admit to emergency room with complaints that are directly or indirectly related to their current condition. We aimed to analyze what complaints the cancer patients admit with most, how long the cancer patients who are treated with antitumor treatment admit to the emergency room after the antitumor treatment, which departments were consulted with these patients most and the outcomes of these patients in the emergency room. Method: In this study, 1946 male and female patients older than 18 years old with oncological diseases who admitted to the emergency room for any complaints were analyzed retrospectively. Results: 879 (45.2%) of the patients were females and 1067 (54.8%) of them were males. The mean age was 59.1. The most common complaint was abdominal pain with 344 (17.7%) patients. The most common malignancy was lung cancer with 335 (17.3%) patients. 610 (31.3%) of the patients in the study were still receiving chemotherapy whereas 1052 (54%) of the patients never had chemotherapy. 285 (14.6%) patients were not receiving chemotherapy although they previously had. It was found that the patients admitted to the emergency room a mean of 69.9 days after the chemotherapy. 651 (33.5%) of the patients were not consulted with any departments whereas other patients were consulted with other departments, with medical oncology being the most consulted department. 1017 (52.2%) patients were discharged from the emergency room and 895 (46%) patients were hospitalized. 33 patients (1.7%) died in the emergency room. Conclusions: Patients with lung cancer admitted to the emergency rooms more often. Cancer patients admitted to the emergency department with abdominal pain and shortness of breath most. Emergency physicians have increased responsibility for tests, treatment and hospitalization of these patients as the patients are generally older and have multiple conditions. Keywords Cancer, Emergency room, Oncology. Introduction Death caused by cancer is the second most common reason after cardiovascular causes in our country, Turkey. With the increase in older population, an increase in new cancer cases and side effects of cancer treatment are expected [1]. This increase affects emergency rooms as well as oncology departments in terms of volume and work force. Cancer patients can admit to emergency rooms for complaints caused by their condition like pain, bleeding and respiratory distress as well as the metabolic, infectious and endocrine problems caused by their condition. In addition to this, these patients can admit for febrile neutropenia or hypersensitivity reactions caused by antitumor medication administered for their treatment, or malnutrition or lack of care caused by inadequacy of social conditions. They also can admit to the hospital for trauma, cardiovascular diseases, pulmonary diseases and other conditions that are not caused by cancer [2,3]. Usually, the benefits of emergency rooms to the cancer patients are more than expected. We aimed to analyze what complaints the cancer patients admit with most, how long the cancer patients who are treated with antitumor treatment admit to the emergency room after the antitumor treatment, which departments were consulted with these patients most and the outcomes of these patients in the emergency room in a period of one year.Öğe Clinical analysis of the cancer patients who admitted to the emergency room(Biomedical research-India, 2016) Gürbüz, Şükrü; Turtay, Muhammet Gökhan; Oğuztürk, Hakan; Güven, Taner; Gür, Ali; Çolak, Cemil; Durak, Mehmet AkifObjective: Patients with cancer diagnosis often admit to emergency room with complaints that are directly or indirectly related to their current condition. We aimed to analyze what complaints the cancer patients admit with most, how long the cancer patients who are treated with antitumor treatment admit to the emergency room after the antitumor treatment, which departments were consulted with these patients most and the outcomes of these patients in the emergency room. Method: In this study, 1946 male and female patients older than 18 years old with oncological diseases who admitted to the emergency room for any complaints were analyzed retrospectively. Results: 879 (45.2%) of the patients were females and 1067 (54.8%) of them were males. The mean age was 59.1. The most common complaint was abdominal pain with 344 (17.7%) patients. The most common malignancy was lung cancer with 335 (17.3%) patients. 610 (31.3%) of the patients in the study were still receiving chemotherapy whereas 1052 (54%) of the patients never had chemotherapy. 285 (14.6%) patients were not receiving chemotherapy although they previously had. It was found that the patients admitted to the emergency room a mean of 69.9 days after the chemotherapy. 651 (33.5%) of the patients were not consulted with any departments whereas other patients were consulted with other departments, with medical oncology being the most consulted department. 1017 (52.2%) patients were discharged from the emergency room and 895 (46%) patients were hospitalized. 33 patients (1.7%) died in the emergency room. Conclusions: Patients with lung cancer admitted to the emergency rooms more often. Cancer patients admitted to the emergency department with abdominal pain and shortness of breath most. Emergency physicians have increased responsibility for tests, treatment and hospitalization of these patients as the patients are generally older and have multiple conditions.Öğe Comparıson of pulmonary functıon testıng among non-smokers, hand-rolledcıgarette smokers and factory made cıgarette smokers(SOUTHEAST ASIAN MINISTERS EDUC ORGANIZATION, SEAMEO-TROPMED, 420-6 RAJVITHI RD,, BANGKOK 10400, THAILAND, 2018) Turtay, Muhammet Gökhan; Kılıç, Talat; Oğuztürk, Hakan; Gür, Ali; Güven, Taner; Çolak, CemilTobacco use causes significant health problems. The aim of this study was to compare the following factors among factory-made cigarette (FMC) smokers, hand-rolled cigarette (HRC) smokers and non-smokers (NS): demographic characteristics, pulmonary function testing (PFT) and carboxyhemoglobin (COHb) levels. PFT included checking: forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC, forced expiratory flow from 25-75% of the vital capacity (FEF25-75) and peak expiratory flow (PEF). We wanted to determine the impact of smoking on pulmonary function testing and to determine any differences in PFTs and COHb levels between FMC and HRC smokers. A total of 182 participants (all males) were included in the study. The subjects in the study were randomly chosen from emergency service admissions which had complaints other than respiratory system. The mean age of study subjects was 40.8 (range: 22-92) years. Mean age of starting smoking among HRC smokers was not significantly different from FMC smokers (95% CI: -0.55-2.37, p=0.220). HRC smokers had significantly lower economic and education levels than FMC smokers (95% CI: 9.0-45.2, p<0.01). NS had highest economic and educational levels (95% CI: 35.9-66.6, p<0.01) of the 3 study groups. The mean [+/- standard deviation(SD)] FEV1/FVC was 76.66 (+/- 7.45) among FMC smokers (95% CI: 74.82-78.51), 77.36 (+/- 8.14) among HRC smokers (95% CI: 75.36-79.36) and 83.13 (+/- 5.08) among NS (95% CI: 81.70-84.56, p<0.01). The mean (+/- SD) FEV1 was 84.50 (+/- 17.80) among FMC smokers (95% CI: 80.12-88.92 ), 89.4 (+/- 15.8) among HRC smokers (95% CI: 85.56-93.32) and 95.30 (+/- 13.3) among NS (95% CI: 91.59-99.07, p<0.01). The mean (+/- SD) PEF was 81.90 (+/- 19.30) among HRC smokers (95% CI: 77.19-86.69), 78.10 (+/- 18.70) among FMC smokers (95% CI: 73.47-82.74) and 86.20 (+/- 16.0) among NS (95% CI: 81.70-90.69, p=0.06). The mean FVC, FEV1, FEV1/FVC, FEF25-75%, and PEF values among NS were significantly (p<0.05) higher for each variable than the mean of these values among FMC and HRC smokers. The mean COHb level among NS was significantly (p<0.05) lower than the mean COHb levels in the two smoking groups. There were no significant differences in PFT results or COHb levels between the two smoking groups (p>0.05). Cigarette smoking cause impairment of pulmonary function equally independent of the cigarette type (FMC, HRC) smoked.Öğe Diffusion-weighted magnetic resonance imaging of thorax in diagnosis of pulmonary embolism(2018) Gür, Ali; Turgut, Kasım; Güven, Taner; Aytemur, Zeynep Ayfer; Oğuztürk, Hakan; Turtay, Muhammet Gökhan; Yumrutepe, SevgiAbstract: Pulmonary embolism (PE) has a high mortality rate and a considerable incidence in emergency care. Thorax computed tomography (CT) angiography is the primary diagnosis method for PE, but has many contraindications. In the present study, we aimed to determine the usability of Diffusion-weighted magnetic resonance imaging (DWMRI) in diagnosis of pulmonary embolism. Patients, diagnosed as pulmonary embolism previously by thorax CT angiography, were taken DWMRI. Demographic parameters, complaints, laboratory values and imaging findings were recorded on standart forms. Twenty nine patients, who were diagnosed as pulmonary emboli, were evaluated. Many of them were female(69%) and the mean of age was 61 years. Dyspnea and chest pain were the main complaints. Atelectasis(69,1%) and pulmonary infarct(30,9%) were determined lesions on CT and DWMRI. Region of interest (ROI) were determined by using MRI (T2) images. Three different ROI values were placed on areas and apparent diffusion coefficient (ADC) values were calculated for peripheric lung lesions. Significant difference was determine between mean ADC values of atelectasis and pulmonary infarct lesions (p<0.05). DWMRI can differentiate peripheric lesions in PE patients, but it is not adequate for diagnosis of PE.Öğe The effect of lactate levels on prognosis in patients with ST-segment elevation myocardial infarction(2020) Gür, Ali; Ulutaş, Zeynep; Turgut, Kasım; Güven, Taner; Yücel, Neslihan; Ermiş, NecipAbstract: Aim: The prognostic role of lactate for early mortality in patients with ST-segment elevation myocardial infarction (STEMI) submitted to primary percutaneous transluminal coronary angiography (PTCA) is not elucidated clearly. This study was conducted with patients that presented to the emergency department (ED) with STEMI and underwent PTCA to investigate whether the changes in lactate values from ED admission to 24 hours after PTCA affected mortality. Material and Methods: This prospective observational study on 143 patients with STEMI was conducted at emergency service and tertiary-level cardiology clinic in a public university hospital. The documentation for each patient included detailed information on demographics, type of myocardial infarction according to electrocardiography and PTCA results, duration of hospital stay, vital signs, laboratory fidings on admission, lactate levels 24 hours after PTCA, and outcome (hospital discharge or death). Results: The lactate values are higher in non-surviving groups measured 24 hours after PTCA (P < 0.001). The differences in the lactate levels from the time of admission to 24 hours after PTCA were signifiantly lower in the non-surviving group (P < 0.001). Conclusion: Among patients presenting to the ED with STEMI, a high lactate level is associated with mortality. Also, the difference between lactate values of the patients after PTCA is associated with the risk of mortality. Therefore, we consider that fist lactate levels in ED and last lactate levels after PTCA in patients with STEMI can provide physicians with an insight into the possibility of mortalityÖğe Long term analysis of patients admitted to the emergency room as a result of occupational accidents(Biomedical Research, 2016) Gürbüz, Şükrü; Aydoğan, Mustafa Said; Çolak, Cemil; Turtay, Muhammet Gökhan; Oğuztürk, Hakan; Gür, Ali; Ekmekyapar, Muhammed; Ercan, AbdullahObjective: We aimed to describe the demographic and clinical features and healthcare costs associated with occupation related injuries between 2010 and 2015. Method: The patients of occupational accidents were evaluated according to age, gender, accident type, trauma localization, duration of hospitalization in the emergency department, prognosis, imperfection types causing to accidents and outcomes and cost spent. Results: 449 patients diagnosed with occupational accidents from January 2010 to December 2014 were included in the analysis. Of injury referring distribution the most common cause of occupational accidents (type of accidents) was extremities injury 141 (31.4%). About 50.1% of all estimated construction occupational accidents treated in the emergency department affected upper extremities. Remaining injuries primarily affected the head, lower extremities and thorax (45%). The mean cost of an inpatient admission following occupational accidents was $232, and the overall costs of patient care for the study sample during this time frame exceeded $26.142 annually. Conclusions: Occupational injuries, illnesses, and fatalities remain a major public health and economic concern around the world. The findings from this study may be beneficial in the development, implementation, and evaluation of injury prevention policies and prevention programs.Öğe Long term analysis of patients admitted to the emergency room as a result of occupational accidents(Biomedical Research, 2016) Gürbüz, Sükrü; Aydoğan, Mustafa Said; Çolak, Cemil; Turtay, Gökhan; Ögüztürk, Hakan; Gür, Ali; Ekmekyapar, Muhammed; Ercan, AbdullahObjective: We aimed to describe the demographic and clinical features and healthcare costs associated with occupation related injuries between 2010 and 2015. Method: The patients of occupational accidents were evaluated according to age, gender, accident type, trauma localization, duration of hospitalization in the emergency department, prognosis, imperfection types causing to accidents and outcomes and cost spent. Results: 449 patients diagnosed with occupational accidents from January 2010 to December 2014 were included in the analysis. Of injury referring distribution the most common cause of occupational accidents (type of accidents) was extremities injury 141 (31.4%). About 50.1% of all estimated construction occupational accidents treated in the emergency department affected upper extremities. Remaining injuries primarily affected the head, lower extremities and thorax (45%). The mean cost of an inpatient admission following occupational accidents was $232, and the overall costs of patient care for the study sample during this time frame exceeded $26.142 annually. Conclusions: Occupational injuries, illnesses, and fatalities remain a major public health and economic concern around the world. The findings from this study may be beneficial in the development, implementation, and evaluation of injury prevention policies and prevention programs.
