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    Comparison of radiography and computed tomography in emergency department evaluation of ankle trauma
    (2019) Avci, Mustafa; Kozaci, Nalan; Yuksel, Serkan; Etli, Ibrahim; Yilmaz, Yavuz
    Avci, M., Kozaci, N., Yuksel, S., Etli, I., & Yilmaz, Y. (2021). Comparison of radiography and computed tomography in emergency department evaluation of ankle trauma . Annals of Medical Research
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    Determination of optic nerve sheath diameter variability with age in pediatric groups and comparison of increased intracranial pressure and optic nerve sheath diameter in pediatric patients with head trauma
    (2018) Yagar, Alper Burak; Kozaci, Nalan; Avci, Mustafa; Yildiz, Sevim; Karaman, Yasemin
    Aim: The aim of this study is to reveal th evariability of the optic nerve sheath diameter (ONSD) with age and to compare the ONSD with increasing intracranial pressure (ICP) findings in computerised cranial tomography (CCT) images of pediatric patients presenting to the emergency department with head trauma. Material and Methods: The ONSD values of the patients were measured in the transverse sections of the CCT images. The patients who were found to have pathology in CCT images were taken into Group 1 and normal patients were taken in Group 2 as the control group. The data were recorded in the SPSS 21 program. The age, gender, Glasgow Coma Scale, and ONSD values of the groups and the difference between the ONSD values of both eyes were compared. Results: A total 294 patients were included in the study. Sixty eight patients (23%) were enrolled in Group 1 and 226 (77%) patients were enrolled in Group 2. The mean ONSD value of Group 1 was 5.5±1.08 mm whereas that of Group 2 was measured as 4.1±0.69 mm (p<0.001). One hundred sixty seven patients were discharged after 8-hour monitorization in the emergency room. These patients age were between 0 and 60 months. A statistically significant correlation was found between the ONSD values and ages of these patients (r:0.348, p=001). Conclusions: Simultaneous measurement of the ONSD and the ONSD difference is an effective method for determining the increase and severity of ICP in children with head trauma.
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    Effect of vitamin D levels on lipid, glucose, vitamin B12 and C-reactive protein in acute ischemic stroke
    (2021) Kozaci, Nalan; Caliskan, Cafer; Avci, Mustafa; Caliskan, Gulsum; Uysal, Ilhan
    Aim: Stroke ranks second among the causes of death world wideand related disability and death rates are high. Recent studies have shown that vitamin D deficiency is higher in patients with ischemic stroke compared to other patients and vitamin D deficiency has emerged as a new risk factor. The aims of the study are to investigate the relation between levels of vitamin D in patients diagnosed with acute ischemic stroke with levels of vitamin B12, glucose, HbA1c, blood urea nitrogen (BUN), creatinine, C-reactive protein (CRP) and lipids, and to determine the effect of vitamin D deficiency on other factors that increase the risk of acute ischemic stroke.Materials and Methods: Two thousand seven hundred thirty-four patients diagnosed with acute ischemic stroke were included in the study. Results of laboratory tests for levels of vitamin D, vitamin B12, HDL cholesterol, LDL cholesterol, VLDL cholesterol, triglycerides, glucose, HbA1c, BUN, creatinine and CRP were recorded.Results: As for correlation between vitamin D and other parameters, positive correlations between vitamin D and age, vitamin B12, BUN and creatinine, and negative correlations between vitamin D and triglycerides, LDL cholesterol, VLDL cholesterol, glucose, HbA1c and CRP were identified. Vitamin D and HDL cholesterol showed no correlation in normal HDL values, but there was positive correlation in patients with HDL cholesterol levels 40 mg/dL.Conclusion: Vitamin D levels in patients that suffered ischemic stroke were significantly correlated with lipid metabolism, glucose metabolism, inflammation, kidney function and vitamin B12 levels.
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    Fragmented QRS; as a new sign on ECG for pre-diagnosis of non-ST elevation myocardial infarction
    (2018) Ararat, Ertan; Kozaci, Nalan; Avci, Mustafa; Koklu, Erkan
    Aim: The aim of this study is to evaluate the predictive value of fragmented QRS (fQRS) wave to detect non-ST elevation myocardial infarction (Non-STEMI). Material and Methods: The study included patients who were diagnosed with Non-STEMI in emergency department and underwent percutaneous coronary intervention in the cardiology clinic. Coronary artery circulation is anatomically divided as the left anterior descending coronary artery (LAD) (V1-V5), the left Circumflex (LCx) (I, aVL and V5,V6) and the right coronary artery (RCA) (II, III and aVF). Results: Our study included 191 patients. Significant fQRS was detected in 139 (%73) patients and ST/T was detected in 79 (%41) patients. The sensitivity, specificity, of fQRS in the inferior leads to predict RCA lesionwas 76%, 46%, respectively. The sensitivity, specificity, of ST/T in the inferior leads to “predict RCA lesion was 12%, 93%, respectively. The sensitivity, specificity of fQRS in the lateral leads to predict LCx lesion were 44% and 83%, respectively. The sensitivity, specificity of ST/T in the lateral leads to predict LCx lesion were 34%, 74%, respectively. The sensitivity, specificity of fQRS in the anterior leads to predict left LAD lesion were 34% and 82%, respectively. The sensitivity, specificity of ST/T in the anterior leads to predict LAD lesion were 38%, and 81%, respectively. Conclusion: We have compared to fQRS and ST/T on ECG; fQRS has higher sensitivity than ST/T to predict culprit coronary artery lesion. Therefore, evaluation of fQRS in addition to ST/T on ECG may be more valuable in pre-diagnosis of Non-STEMI.
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    Measurement of the pain levels of patients with extremity traumas and assessment of the attitudes of emergency physicians to pain management
    (2018) Akgun, Emrah; Kozaci, Nalan; Avci, Mustafa
    Aim: In this study, we aimed to measure the pain levels of patients with isolated extremity injuries due to low energy trauma, using pain scales in the emergency department (ED). Material and Methods: Patients were included in the studybetween January and March 2017. The trauma-related pain levels of the patients were assessed at the time of the initial examination and in the 45th minute. Three different scales; the ‘Wong-Baker FACES Pain Rating Scale’(WBS), ‘Verbal Rating Scale’(VRS), and ‘Numeric Pain Rating Scale’ (NPRS) were used to measure the levels of pain. Results: 236 patients were included in the study. At the time of the initial admission to the ED, 77% of patients had “Even More” pain and worse according to the WBS, 67% had a pain score of 60 and above according to the Scale NPRS, and 74% had severe and worse pain according to the VRS. Analgesics were given to 11% of patients. A statistically significant decrease was detected in the pain scale scores of patients who were treated in the ED compared to the patients who were not treated (p<0.001). Conclusion: In this study, it was observed that the severity of pain was high in patients with isolated extremity injuries due to low energy trauma and that their pain decreased with the treatment given at the ED. However, it was concluded that treatment for the patients’ pain was not given adequately by emergency physicians.
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    Oxidant and antioxidant levels in patients diagnosed with acute coronary syndrome at the emergency department
    (2021) Tekkanat, Selma; Kozaci, Nalan; Avci, Mustafa; Selvi, Fatih; Yilmaz, Yavuz; Ellidag, Hamit Yasar
    Aim: The aim of this study is to compare high sensitive Troponin T (hs-TnT), total antioxidant capacity (TAC), total oxidant capacity (TOC), oxidative stress index (OSI), ischemia-modified albumin (IMA) levels and IMA/albumin ratios (IMAR) with the results of coronary angiography (CAG) in patients diagnosed with ACS at the emergency department. Materials and Methods: Over a period of nine months, patients that were diagnosed with ACS at the emergency department, admitted to the cardiac intensive care unit, subjected to percutaneous CAG and over the age of 18 were included in the study. Results: One hundred twenty five patients with suspected ACS and 52 healthy volunteers were included in the study. When the patients were evaluated with regards to the length of time between symptoms and arrival, TAC levels were found to decrease especially after the 6 th hour. There was no significant difference between TOC, OSI, IMA and IMAR values in this regard. Conclusion: In early-phase ACS, levels of TOC, OSI, IMA and IMAR rise from the 0th hour onwards. TAC levels gradually decrease after the early phase of ischemia. Therefore, oxidants and antioxidants can be used for early diagnosis of ischemia in ACS, as well as for estimating time of ischemia onset.