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Öğe Blindness following Rupture of Hepatic Hydatid Cyst: A Case Report(Medical Univ Bialystok, 2009) Yucel, N.; Kayaalp, C.; Liceli, A.; Baysal, T.; Yilmaz, M.A 19 year-old woman admitted to Emergency Department with hypotension, sudden loss of vision and acute abdominal pain. Ultrasound and computed tomography demonstrated an occipital infarct in brain and ruptured intraperitoneal cyst of hydatid liver disease. Urgent laparotomy was performed and it included aspiration of cyst contents, peritoneal washing and drainage. Her vision loss improved by 15 hours postoperatively but generalized seizures were started. Weakness in all extremities was present. Cranial MRI demonstrated ischemia in the areas of middle, posterior and anterior cerebral arteries. She was discharged from the hospital with severe neurological deficits (unable to walk, not able to eat herself). Neurological deficits were improved with physiotherapy after two years. There was no recurrence of hydatid cysts in the follow-up of three years. We assumed that anaphylaxis after intraperitoneal rupture of hydatid liver cyst resulted with hypotension and reduced cerebral perfusion, caused the acute vision loss and other neurological symptoms. This unusual presentation of intraperitoneal rupture should be kept in mind particularly in endemic areas of hydatid disease.Öğe Characteristics of the admissions of cancer patients to emergency department(Zerbinis Medical Publ, 2012) Yucel, N.; Erkal, H. Sukru; Akgun, F. Sinem; Serin, M.Purpose: To identify the characteristics of admission of patients with cancer in the emergency department of a university hospital. Methods: The medical records of 468 emergency department admissions of 336 cancer patients due to medical conditions that were related either to their cancer or its treatment were reviewed and retrospectively analysed. Results: There were 226(67%) males and 110 females (37%), with a median age of 60 years (range 17-93). Regarding cancer staging, 156 (46%) patients had locoregional disease and 180 (54%) metastatic disease. Regarding performance status (PS), 321 (69%) were Eastern Cooperative Oncology Group (ECOG) 1-2, and 147 (31%) were ECOG 3-4. The main causes of emergency department admission were cancer progression in 188 (40%) patients, cancer-related signs and symptoms in 203 (43%) and treatment-related complications in 77 (16%). The most common primary cancer sites were the thorax, the gastrointestinal system and the genitourinary system. The medical condition necessitating emergency department admission was local tumor compression in 144 (31%) admissions, infection in 86 (19%) and end-of-life support in 63 (13%). Conclusion: Cancer patients seeking nonscheduled medical care and admitting to emergency departments present many challenges to the emergency physician. Due to the associated high morbidity and mortality, initial evaluation of the patient in the emergency department and therapy have utmost importance in the outcome of the patient. Accurate diagnosis and appropriate treatment of cancer-related problems can improve the quality of life dramatically in patients with cancer.Öğe Histopathological efficiency of amifostine in radiation-induced heart disease in rats(Comenius Univ, 2018) Gurses, I; Ozeren, M.; Serin, M.; Yucel, N.; Erkal, H. S.OBJECTIVE: Amifositine is a phosphorylated thiol that holds its radioprotective actions by several indirect mechanisms. The purpose of this study was to evaluate histopathologically whether amifositine administration prior to irradiation would have a long-term protective effect on heart tissue in an experimental rat model. METHODS: Single dose of 18 Gy radiation and sham radiation exposure were used in related groups. A dose of 200 mg/kg of amifostine was injected intraperitoneally 30 min prior to radiation exposure. Analyses were performed 6 months after irradiation. RESULTS: Vascular damage and vasculitis were significantly decreased in amifositine treatment group. At the same time, significant thickening of the medial layer was accompanied by vascular damage in irradiated groups. The number and severity of myocyte necrosis were diminished with amifostine. Nevertheless, it could not prevent epicardial and myocardial fibrosis. Severe myocardial fibrosis was observed prominently in three regions, particularly on the apex, tips of papillary muscles and in sites adjacent to the atrioventricular valves. The anti-inflammatory effect of amifostine was not seen. CONCLUSION: The development of vascular damage and vasculitis were prevented by the use of amifostine. There was a correlation between vascular damage and fibrosis development. According to histopathological results, amifostine could be used as a protective agent against the side effects of radiotherapy (Tab. 4, Fig. 2, Ref. 22).Öğe Investigation of in vivo radioprotective and in vitro antioxidant and antimicrobial activity of garlic (Allium Sativum)(Verduci Publisher, 2012) Batcioglu, K.; Yilmaz, Z.; Satilmis, B.; Uyumlu, A. B.; Erkal, H. S.; Yucel, N.; Gunal, S.OBJECTIVE, In this study, we aimed to assess the in vivo antioxidant potential via evaluating radioprotective effects in kidney and liver tissues of rats and in vitro antimicrobial and radical scavenger activity of garlic extract. MATERIALS AND METHODS, Thirty-two mature female Wistar rats were divided into four groups, each consisting of eight rats. Experimental groups were control group (1), GE group (2), irradiation group (3) and both GE and irradiation group (4). For the rats in two groups (group 3 and 4), irradiation was performed on a Cobalt-60 unit using a single fraction of 20 Gy. The GE was given to rats once a day during the month before irradiation and continued for five days after irradiation. The garlic cloves were peeled on crushed ice and 50 g of garlic was cut into small pieces and homogenized in 75 mL of 0.9% NaCl. The concentration of this garlic preparation was considered to be 500 mg/mL on the basis of weight of the starting material (0.5 g/mL). This extract was administered to rats by oral gavage. RESULTS, Our findings suggest that the use of garlic extract could be useful for addressing the limited therapeutic gain due to the radiation sensitivity of normal tissues adjacent to the tumour which are exposed to radiation, by strengthening the antioxidant system. In vitro and in vivo experiments seem to yield similar conclusions. CONCLUSIONS, It can be stated that garlic is may be recommended to be sufficiently included in the diets of radiotherapy patients considering its antioxidant and antimicrobial efficacy.Öğe Nutritional evaluation of non-traumatic patients admitted to the hospital from Emergency Department(Verduci Publisher, 2022) Gurbuz, S.; Ekmekyapar, M.; Durak, M. A.; Oguzturk, H.; Turtay, M. G.; Yucel, N.; Demir, T. O.OBJECTIVE: Malnutrition is a common condition, especially among hospitalized patients which are overlooked by many clinicians. Malnutrition was found to be associated with increased hospitalization duration, increased admission frequency. increase in infection frequency and severity, bad wound healing, gait disturbances, fallings. and fractures. In this study, we aimed to determine malnutrition frequency in patients who were admitted to the emergency department for non-trauma causes and hospitalized. PATIENTS AND METHODS: 245 patients were admitted to the Emergency Department for non-trauma causes and hospitalized and 245 control group patients were included in this study. Hospitalized patients were assessed with NRS-2002 (Nutritional Risk Screening) and Mini Nutritional Assessment (MNA). Age, gender. height. weight, body mass index (BMI), malnutrition status. and wards of the patients were screened. RESULTS: 140 (57.1%) of the hospitalized patients had malnutrition according to NRS-2002 and MNA. There was a statistically significant difference between the control group and the hospitalized patients who were malnourished (Pearson chi-square test: p<0,001). There was a significant relation between hospitalized departments and malnutrition (p<0.05). There was a significant difference in age and height between hospitalized patients and the control group (p<0.0001) whereas no significant difference was found between the height and BMI (p>0.05). There was a significant relationship in terms of hospitalization and malnutrition. CONCLUSIONS: The nutritional state of the patients admitted to the emergency department for non-trauma conditions is an important factor and should not be overlooked.Öğe Predictors of mortality in septic shock: findings for 57 patients diagnosed on admission to emergency or within 24 hours of admission to intensive care(Sage Publications Ltd, 2012) Yucel, N.; Togal, T.; Gedik, E.; Ertan, C.; Kayabas, U.; Akgun, F. S.; Bayindir, Y.Objective: To identify the risk factors that influence outcome for patients who are diagnosed with septic shock in the emergency department at presentation or within 24 hours after admission to intensive care unit. Methods: A retrospective study of 57 adult patients with septic shock was conducted between March 1, 2006 and August 31, 2009. Results: The patients were 23 males and 34 females with a median age of 67 years (20 to 92 years). Thirty-three (58%) of 57 patients died in hospital and 24 (42%) survived. Multivariate analysis identified low blood pH (OR <0.001; 95% CI <0.001-0.53) and low bicarbonate level (OR 0.81; 95% CI 0.70-0.95) at emergency department or intensive care unit admission as useful predictors of 3-day in-hospital mortality. Low blood pH (OR <0.001; 95% CI <0.001-0.05), low bicarbonate level (OR 0.75; 95% CIs 0.61-0.91), long duration of symptoms (OR 1.49; 95% CI 1.04-2.13), high MEDS score (OR 1.56; 95% CIs 1.06-2.30), and high SOFA score (OR 1.57; 95% CI 1.12-2.20) were risk factors for 14-day in-hospital mortality. Renal failure (OR 7.58; 95% CI 1.28-44.77), lower pulmonary tract infection (OR 3.58; 95% CI 1.10-11.58), high MEDS score (OR 1.42; 95% CI 1.05-1.93) and high APACHE II score (OR 1.34; 95% CI 1.13-1.60) were risk factors for 28-day in-hospital mortality. Conclusions: Several factors signaling poor short-term outcome for this patient group are low blood pH, low serum bicarbonate level, longer duration of symptoms lower respiratory tract infection and renal failure. MEDS and SOFA scores might be helpful in the ED to stratify patients with septic shock according to mortality risk. (Hong Kong j. emerg.med. 2012;19:375-386)Öğe The prognastic efficiencies of modified early warning score and mainz emergency evaluation score for emergency department patients(Nıgerıan journal of clınıcal practıce, 2018) Akgun, F. S.; Ertan, C.; Yucel, N.Background: Recently, there is an increasing interest for scoring systems to evaluate the critically ill patients by means of the severeness of their disease and their availibility for discharge in the emergency departments and intensive care units. Our aim in this study is to evaluate the efficiency of the mEWS and MEES scoring systems in assessing the severeness of the disease and predicting the mid term prognosis of the patients hospitalized following their emergency care in our emergency room. Material and Method: Patients, who attended to Inonu University Department of Emergency Medicine and hospitalized following their emergency care were included to our study. The effects of age, sex, triage categories, mEWS and MEES scores on the site of hospitalization and mortality was evaluated. Statistical analyses were performed by SPSS for Windows version 16.0. The data was summarized as means, standart deviation and percents. Univariate and multiavriate analyses were performed for risk factor calculations. Results: The mean age of the patients was 5819 and 584 (56%) were male. Triage group 1 patients accounted for 21 of all (2%), while 646 (61%) were in group 2 and 384 (37%) were in triage group 3. Of all patients, 341 (32%) were hospitalized to ICU. While discharged patients accounted for 89% (935 patients) of the study group, 116 patients (11%) died at the hospital. The GCS, AVPU and mEWS values were statistically significant by means of patient mortality (P < 0.0001), but the delta MEES value was not (P < 0.127). Conclusion: The results of our stuy suggests that mEWS evaluation is an effective and reliable tool for predicting outcome and hospitalization areas of ED patients. Our results also displayed that the easily available GCS and AVPU scales are reliable guides in patient management. MEES values, on the other hand, are not convenient for ED use.Öğe The prognastic efficiencies of modified early warning score and mainz emergency evaluation score for emergency department patients(Wolters Kluwer Medknow Publications, 2018) Akgun, F. S.; Ertan, C.; Yucel, N.Background: Recently, there is an increasing interest for scoring systems to evaluate the critically ill patients by means of the severeness of their disease and their availibility for discharge in the emergency departments and intensive care units. Our aim in this study is to evaluate the efficiency of the mEWS and MEES scoring systems in assessing the severeness of the disease and predicting the mid term prognosis of the patients hospitalized following their emergency care in our emergency room. Material and Method: Patients, who attended to Inonu University Department of Emergency Medicine and hospitalized following their emergency care were included to our study. The effects of age, sex, triage categories, mEWS and MEES scores on the site of hospitalization and mortality was evaluated. Statistical analyses were performed by SPSS for Windows version 16.0. The data was summarized as means, standart deviation and percents. Univariate and multiavriate analyses were performed for risk factor calculations. Results: The mean age of the patients was 5819 and 584 (56%) were male. Triage group 1 patients accounted for 21 of all (2%), while 646 (61%) were in group 2 and 384 (37%) were in triage group 3. Of all patients, 341 (32%) were hospitalized to ICU. While discharged patients accounted for 89% (935 patients) of the study group, 116 patients (11%) died at the hospital. The GCS, AVPU and mEWS values were statistically significant by means of patient mortality (P < 0.0001), but the delta MEES value was not (P < 0.127). Conclusion: The results of our stuy suggests that mEWS evaluation is an effective and reliable tool for predicting outcome and hospitalization areas of ED patients. Our results also displayed that the easily available GCS and AVPU scales are reliable guides in patient management. MEES values, on the other hand, are not convenient for ED use.Öğe The prognastic efficiencies of modified early warning score and mainzemergency evaluation score for emergency department patients(Wolters kluwer medknow publıcatıons, wolters kluwer ındıa pvt ltd , a-202, 2nd flr, qube, c t s no 1498a-2 vıllage marol, andherı east, mumbaı, 400059, ındıa, 2018) Akgun, F. S.; Ertan, C.; Yucel, N.Background: Recently, there is an increasing interest for scoring systems to evaluate the critically ill patients by means of the severeness of their disease and their availibility for discharge in the emergency departments and intensive care units. Our aim in this study is to evaluate the efficiency of the mEWS and MEES scoring systems in assessing the severeness of the disease and predicting the mid term prognosis of the patients hospitalized following their emergency care in our emergency room. Material and Method: Patients, who attended to Inonu University Department of Emergency Medicine and hospitalized following their emergency care were included to our study. The effects of age, sex, triage categories, mEWS and MEES scores on the site of hospitalization and mortality was evaluated. Statistical analyses were performed by SPSS for Windows version 16.0. The data was summarized as means, standart deviation and percents. Univariate and multiavriate analyses were performed for risk factor calculations. Results: The mean age of the patients was 5819 and 584 (56%) were male. Triage group 1 patients accounted for 21 of all (2%), while 646 (61%) were in group 2 and 384 (37%) were in triage group 3. Of all patients, 341 (32%) were hospitalized to ICU. While discharged patients accounted for 89% (935 patients) of the study group, 116 patients (11%) died at the hospital. The GCS, AVPU and mEWS values were statistically significant by means of patient mortality (P < 0.0001), but the delta MEES value was not (P < 0.127). Conclusion: The results of our stuy suggests that mEWS evaluation is an effective and reliable tool for predicting outcome and hospitalization areas of ED patients. Our results also displayed that the easily available GCS and AVPU scales are reliable guides in patient management. MEES values, on the other hand, are not convenient for ED use.
