Hilal Hocagil - Academia.edu (original) (raw)

Papers by Hilal Hocagil

Background: There are scales to decide hospitalization or follow up in patients presenting to the... more Background: There are scales to decide hospitalization or follow up in patients presenting to the emergency department after suicide attempt. Modified Sad Persons scale (MSPS) is the scaling system for adult suicide generated using the initials of 10 major demographic risk factor in the literature. The aim of our study is to investigate the reliability of the MSPS patients who are evaluated in the emergency department after suicide attempt for deciding admission or discharging of patients in our population. Materials and methods: Patients admitted to our emergency department with suicide attempts was evaluated by MSPS. All patients were evaluated by MSPS also consulted to a psychiatrist concurrently. MSPS suggestions are compared with psychiatry decisions. All data were inputted into SPSS analyzed statistically. Result: There were 205 patients totaly and 147of them were female. Psychiatrics decide hospitalization for 95% of patients MSPS score higher than 8. 131 patients MSPS score less than 6 are evaluated by psyhiatrics and 5 (3.8%) of them were decided for hospitalization. MSPS has sensitivity 90%, specificity 84%, positive predictive value 67%, negative predictive value 96% for deciding hospitalization when compared with psychiatric evaluation. Conclusion: Giving the decision of discharging or hospitalization of patients presenting in the emergency department after suicide attempt is a serious dilemma for doctors working in the emergency department. There is a need for objective evaluation of such patients of in the emergency department. Although MSPS does not meet all the requirements but can be used in the emergency department.

Journal of emergency medicine case reports, Jun 23, 2022

Aortoenteric fistulas are defined as an abnormal connection between the aorta and any portion of ... more Aortoenteric fistulas are defined as an abnormal connection between the aorta and any portion of the gastrointestinal tract. It can occur after aortic repair surgery or spontaneously (primary). The common clinical features of primary aortoenteric fistula are upper gastrointestinal bleeding, abdominal pain, and pulsatile abdominal mass. The reasons are inflammatory destruction of an aortic aneurysm, infection, tumors and ingestion of foreign bodies. We represent a case of a primary aortoenteric fistula due to plum kernel which is rarely seen. A 76-year-old man admitted to emergency department with abdominal pain. On computed tomography angiography, there was hypodense restricted lesion with widespread air image which was located around the abdominal aorta. It was determined that abdominal aorta is surrounded by organised hematoma. A plum kernel, was detected in the operating room, was the reason for the aortoenteric fistula. Graft was placed in the abdominal aorta. He died in the first day after surgery. Primary aortoenteric fistulas should be considered in differential diagnosis of abdominal pain, upper gastrointestinal bleeding and shock in patient with aortic aneurysm. Kernels of any fruit considered to be harmless just as plum kernel and should be noted that may cause aortoenteric fistula.

Kafkas Tıp Bilimleri Dergisi, Dec 1, 2020

Aim: Congestive heart failure (CHF) and pneumonia are the most important causes of potentially de... more Aim: Congestive heart failure (CHF) and pneumonia are the most important causes of potentially death due to dyspnea in patients presenting at the Emergency Department. Early diagnosis and suitable treatment are lifesaving in cases of both CHF and pneumonia. The aim of this study was to investigate the diagnostic ability of the soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) which is an inflammatory biomarker in the differential diagnosis of pneumonia from CHF. Material and Method: This prospective study was conducted from 1 Jun 2014 to 30 May 2015 in the emergency medicine departments of urban and university hospitals. Patients presenting with dyspnea were evaluated and divided into two groups according to the diagnoses made according to international guidlines; CHF group and pneumonia group. The groups were compared in respect of clinical and demographic characteristics and sTREM-1 levels. Results: 15 patients were evaluated in each group. Pulse rate was higher in the CHF group (p<0.001), and respiration rate and temperature values were higher in the pneumonia group (p=0.002, p=0.008). On the chest radiographs, significant infiltration was observed in the pneumonia group, and cardiomegaly in the CHF group (p<0.001). The sTREM-1 levels were higher in the pneumonia group than the CHF group, and the difference was statistically significant (p=0.044). Conclusion: We think that STEM can be used in the differential diagnosis of dyspnea in the emergency departments, but this should be supported by more comprehensive studies.

Türk Nöroloji Dergisi, 2018

Objective: To determine the priority in the treatment of patients with primary headaches accompan... more Objective: To determine the priority in the treatment of patients with primary headaches accompanied by high blood pressure. In our study, we investigated whether there was a relationship between the decline in headache after treatment and the change in the average arterial pressure. Materials and Methods: This prospective observational study was performed with 101 patients who were admitted to the hospital emergency department with primary headache accompanied by high blood pressure. After treatment, the decrease in the severity of headaches, mean arterial pressure, and percentage value for the drop of mean arterial pressure were calculated for all patients. Results: In the study, 25 (24.8%) patients' headache decreased 3 levels, 43 (42.6%) patients' headache decreased 2 levels, and 23 (22.8%) patients' headache decreased one level. The mean arterial pressure value at admission was 118.58±12.65 mmHg, and after treatment at the 30 th minute decreased to 98.41±13.43 mmHg. Although there was a statistically significant (p<0.001) decrease in the mean arterial pressure value of patients with 2-3 level decrease in the headache severity, there was no statistically significant (p>0.05) drop in the mean arterial pressure value of the patients with one level decrease in headache severity after treatment. Conclusion: This study showed that when a primary headache, which is often associated with high blood pressure, was treated instead of treating high blood pressure as a secondary cause of headache, blood pressure decreased spontaneously.

Neuropsychiatric Disease and Treatment, Feb 1, 2016

Background: Here we aimed to investigate sociodemographic characteristics, psychiatric history, a... more Background: Here we aimed to investigate sociodemographic characteristics, psychiatric history, and association between sociodemographic characteristics and anxiety levels of violenceexposed patients admitted to emergency clinic. Methods: This study consists of 73 violence-exposed patients admitted to emergency clinic who were literate and agreed to participate in the study. A sociodemographic data form created by us to investigate alcohol-substance abuse, suicide attempt, previous history of trauma, self and family history of psychiatric disorders and Beck Anxiety Inventory was given to the patients. Results: Of the patients exposed to violence 63% (n=46) were female and 27% (n=27) were male. Of these patients, 68.5% (n=50) were married, 43.8% (n=25) were workers, 34.2% were housewives, 11% were unemployed, and 11% were civil servants. Of the violence-exposed patients, 56.2% (n=41) were primary school, 21.9% (n=16) were high school, and 21.9% (n=16) were university graduates. Smoking and alcohol use rates were 54.8% (n=40) and 17.8% (n=13), respectively. The most common trauma type was assault using physical force with a ratio of 78.1% (n=57). In addition, anxiety scores were high in 42.5% (n=31) and moderate in 9.6% (n=7) of the patients. Mentioned psychiatric disorder was present in 17.8% (n=13) of the patients and 19.2% (n=14) of the patients' relatives. The correlation between sociodemographic characteristics and anxiety scores revealed that married patients had higher anxiety scores (P,0.01) and patients assaulted by their parents had lower anxiety scores (P,0.00). Conclusion: A total of 63% of the violence-exposed patients admitted to emergency room were females, 56.2% were primary school graduates, and 43.8% were factory workers; this result shows that low socioeconomical status and education level affect exposure to trauma especially in females. In addition, ~20% of the patients and patients' relatives had a psychiatric disorder and 53.4% of perpetrators were parents, spouses, and children; this result shows that psychiatric history and family relations are one of the issues that should be taken into account and treated.

A Prospective Study: Is Handheld Micropower Impulse Radar Technology (Pneumoscan) a Promising Method to Detect Pneumothorax?

Turkish Journal of Trauma and Emergency Surgery, 2015

This study aimed to discuss the effectiveness of Pneumoscan working with micropower impulse radar... more This study aimed to discuss the effectiveness of Pneumoscan working with micropower impulse radar (MIR) technology in diagnosing pneumothorax (PTX) in the emergency department. Patients with suspicion of PTX and indication for thorax tomography (CT) were included into the study. Findings of the Thorax CT were compared with the results of Pneumoscan. Chi-square and Fisher&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s exact tests were used in categorical variables. One hundred and fifteen patients were included into the study group; twelve patients presented with PTX diagnosed by CT, 10 of which were detected by Pneumoscan. Thirty-six true negative results, sixty-seven false positive results, and two false negative results were obtained, which resulted in an overall sensitivity of 83.3%, specificity of 35.0% for Pneumoscan. There was no statistically significant difference between the effectiveness of Pneumoscan and CT on the detection of PTX (p=0.33). There was no difference between the size of PTX diagnosed by CT and PTX diagnosed by Pneumoscan (p=0.47). There was no statistically significant difference between Pneumoscan and CT on detecting the localisation of the PTX (p=1.00). For the 10 cases diagnosed by Pneumoscan, mean chest wall thickness was determined as 50.3 mm while mean chest wall thickness for two false negatives diagnosed by Pneumoscan was 56.5 mm. However, no statistically significant difference was found between the chest wall thickness and the effectiveness of Pneumoscan on the detection of the PTX (p=0.77). Among sixty-seven false positives diagnosed by Pneumoscan, 46.3% had additional medical signs such as bronchiectasis, pulmonary consolidation, pulmonary edema or pulmonary tumor when they had a reading with CT. The relationship between having additional medical signs at the reading with CT and the effectiveness of Pneumoscan on the detection of the PTX was investigated and no significant difference was found (p=0.472). Using Pneumoscan to detect PTX is controversial since the device has a high false positive ratio. Wherein, false positive diagnosis can cause unjustifiable chest tube insertion. In addition, the device failed to show the size of the PTX, and therefore, it did not aid in determining the treatment and prognosis on contrary to traditional diagnostic methods. The findings could not demonstrate that the device was efficient in emergency care. Further studies and increasing experience may change this outcome in upcoming years.

Therapeutics and Clinical Risk Management, 2015

Objective: The aim of this study was to investigate QT dispersion (QTd), which is the noninvasive... more Objective: The aim of this study was to investigate QT dispersion (QTd), which is the noninvasive marker of ventricular arrhythmia and sudden cardiac death, and P-wave dispersion, which is the noninvasive marker of atrial arrhythmia, in patients with conversion disorder (CD). Patients and methods: A total of 60 patients with no known organic disease who were admitted to outpatient emergency clinic and were diagnosed with CD after psychiatric consultation were included in this study along with 60 healthy control subjects. Beck Anxiety Inventory and Beck Depression Scale were administered to patients and 12-lead electrocardiogram measurements were obtained. Pd and QTd were calculated by a single blinded cardiologist. Results: There was no statistically significant difference in terms of age, sex, education level, socioeconomic status, weight, height, and body mass index between CD patients and controls. Beck Anxiety Inventory scores (25.2±10.8 and 3.8±3.2, respectively, P,0.001) and Beck Depression Scale scores (11.24±6.15 and 6.58±5.69, respectively, P,0.01) were significantly higher in CD patients. P-wave dispersion measurements did not show any significant differences between conversion patients and control group (46±5.7 vs 44±5.5, respectively, P=0.156). Regarding QTc and QTd, there was a statistically significant increase in all intervals in conversion patients (416±10 vs 398±12, P,0.001, and 47±4.8 vs 20±6.1, P,0.001, respectively).

Düşük Seviyedeki Karbon Monoksit Zehirlenmesinde Asemptomatik Miyokardiyal Hasarlanma

Karbon monoksit zehirlenmesi önemli bir morbidite ve mortalite nedenidir. Klinikle daima korele o... more Karbon monoksit zehirlenmesi önemli bir morbidite ve mortalite nedenidir. Klinikle daima korele olmasa da nörolojik belirtiler düşük, kardiyak belirtiler ise yüksek CO seviyelerinde görülebilmektedir. Düşük düzeydeki CO maruziyeti çok nadiren miyokardiyal hasarlanma nedenidir fakat imkânsız değildir. Bu vaka raporunda kardiyak belirti ve bulguları olmaksızın troponin seviyesi yüksek olan ve karbon monoksit seviyesi %20 olan hastayı sunmayı amaçladık. 26 yaşında erkek hasta acil servise bulantı kusma yakınması ile başvurdu. İlk bakılan EKG'de DII, DIII ve aVF'de 1 mm ST segment depresyonu ve DI-aVL'de ST segment elevasyonu mevcuttu. Hastanın laboratuvar değerlerinde; Troponin I 1.5 ng/mL, FCOHb 20.7% idi. İlk bakılan ekokardiyografide sol ventrikülde global hipokinezi vardı. Hastanın koroner anjiyografisi normaldi. CO zehirlenmesi düşünülen tüm hastalar CO seviyesine, kardiyak semptom ve bulguların olup olmadığına bakılmaksızın miyokardiyal hasarlanma için EKG, kardiyak n...

İntihar Amaçlı İlaç Alımı Nedeni ile Acil Servise Başvuran Hastalarda Rabdomiyolizin Araştırılması: Prospektif Orijinal Klinik Çalışma

Objective: Drug-induced rhabdomyolysis is the most common cause of disorders leading to acquired ... more Objective: Drug-induced rhabdomyolysis is the most common cause of disorders leading to acquired muscular inflammation. The aim of this study is to investigate rhabdomyolysis frequency in patients admitted to the emergency room (ER) due to one or different types of multiple drug ingestion with suicidal intentions. Material and Methods: This prospective clinical study was performed between June 2013 and November 2013 in Dr. Lütfi Kırdar Kartal Training and Research Hospital’s ER, which had a daily admittance average of 800-1000 patients. The study included 103 patients. Creatinephosphokinase in the blood and myoglobin in the urine examined at the 3rd , 6th, 12th and 24th hours of admission to the ER. Results: Of the patients, 77 (74.8%) were female and 26 (25.2%) were male. Mean age was 28.8±9.5 years. Male subjects ingested a greater variety and a greater number of drugs than female subjects (p<0.05). Creatine phosphokinase level was found to be higher in the patients who took a ...

Eurasian Journal of Emergency Medicine

Aim: Urinary stone disease is a common cause of comorbidity in the population. It causes an incre... more Aim: Urinary stone disease is a common cause of comorbidity in the population. It causes an increased sympathetic tone due to pain during renal colic attacks. It is thought that increased sympathetic tone may also trigger vasospasm in coronary arteries and make ischemic changes more pronounced. However, there is no study in the literature that evaluating electrocardiogram parameters in patients with renal colic pain. In this study, the electrocardiogram parameters such as QT corrected for heart rate (QTc) interval, QTc dispersion, T peak-end (Tp-e) interval and Tp-e/QTc that are recorded when the patients are pain-free and during an episode of renal colic attack have been compared. Materials and Methods: Patients who were clinically suspected of having renal colic and whose diagnosis was confirmed by abdominal computed tomography were included in this prospective observational study. On electrocardiograms in the episode of renal colic attack and when they are painless; QTc interval, QTc dispersion, Tp-e interval and Tp-e/QTc parameters were compared. Results: Mean age of the 101 patients included in this study was 44.19±14.13 and 48.5% of them were female. Maximum QTc interval, and QTc dispersion parameters were significantly higher during renal colic attacks than pain-free periods. QTc interval was higher for females compared to males. Conclusion: We found that renal colic pain is associated with increased QTc max and QTc dispersion. QTc interval was higher for females compared to males. These findings suggest that patients with renal colic pain may be under risk for ventricular arrhythmias especially in females.

Vascular, 2022

OBJECTIVES Several examination techniques have been described for the diagnosis of leg deep vein ... more OBJECTIVES Several examination techniques have been described for the diagnosis of leg deep vein thrombosis. These previously described examination techniques aim to detect muscle pain that occurs secondary to increased pressure in the posterior compartment of the leg. However, to the best of our knowledge no studies investigated the frequency of muscle pain on the anterior compartment in patients with leg deep vein thrombosis the objective of this study is to investigate the prevalence of muscle pain in the anterior compartment. METHODS The patients who were diagnosed with acute deep vein thrombosis were included in this prospective cross-sectional study. Each patient was examined using the techniques that determine the pain on the posterior compartment as well as using the technique we described to detect muscle pain on the anterior compartment. RESULTS Two hunderd forty three patients were enrolled in the study. Among those, both distal and proximal deep vein thrombosis was prese...

Annals of Medical Research, 2021

Aim: Oncological emergencies constitute a considerable part of emergency admissions. The early an... more Aim: Oncological emergencies constitute a considerable part of emergency admissions. The early and correct diagnosis ofoncological emergencies increases both life quality and decreases mortality rate due to oncologic emergency. In this study, weevaluated the admissions of oncologic patients to emergency service.Materials and Methods: This study was conducted retrospectively and patients with cancer admitted to emergency service of thirddegree university hospital between October 2012-2013. Demographic characteristics of the patients, the frequency of admission,admission time, diagnosis, co morbid diseases, and treatment process were investigated.Results: In the study 1472 admission that belongs to 593 patients are assessed. 59,2 % of patients are male, 40.8 % of patientsare female. Mean of age is 62. Repeated admission rate is 55.81%. The two most frequent complaints are dyspnea 14.2% andstomachache 10.4%. The two most common types of cancer were lung (19.73%) and stomach (12.47%) ca...

Urology journal, 2014

Abdominal and flank pain with sudden onset is one of the most common patient presentations to eme... more Abdominal and flank pain with sudden onset is one of the most common patient presentations to emergency departments (ED). Renal infarction is a rare cause of abdominal and flank pain. Usually the symptoms of renal infarction are nonspecific, so the diagnosis is frequently missed or delayed. Especially if a patient has a disease such as nephrolithiasis and pyelonephritis, the possibility of delay or a misdiagnosis will increase. This may lead to irreversible loss of renal function. Diagnosis requires high degree of suspicion. In other words, ‘no suspicion, no disease’. Renal infarction was first described in 1940 by Hoxie and Kogan. Although it is uncommon, it is responsible for considerable morbidity and mortality. In this case series, we aim to increase awareness of this condition and decrease the delay and misdiagnosis of renal infarctions.

Non Steroid Anti Enflamatuar İlacın Tetiklediği Kounis Sendromu

Kounis sendromu anafilaktik, anafilaktoid ve asiri duyarlilik reaksiyonlarini iceren mast hucre a... more Kounis sendromu anafilaktik, anafilaktoid ve asiri duyarlilik reaksiyonlarini iceren mast hucre aktivasyonu ile akut koroner sendromun birlikte bulundugu nadir gorulen bir sendromdur. Kounis sendromlu vakayi tanimlamayi amacladik. 68 yasinda erkek hasta acil servise sirt agrisi nedeni ile basvurdu. Intramuskuler analjezik tedavisi sonrasi halsizlik, tum vucutta yanma gibi semptomlar gelisti. Hastanin fizik muayenesinde kan basinci 75/45 mmHg, kalp hizi 90 atim/dakika ve solunum hizi dakikada 14 idi. Cilt hiperemik ve uvulada odem mevcuttu. Elektrokardiyografide D2,D3,aVF,V5,V6 derivasyonlarinda ST segment elevasyonu, V1,V2,V3, D1,aVL derivasyonlarinda ST segment depresyonlari mevcuttu. Perkutanoz koroner anjiografi sonrasi koroner arterleri normal olarak tespit edildi. Alerjen maruziyeti sonrasi akut koroner sendrom gelisen ve cilt bulgulari ve hipotansiyonu olan hasta kounis sendromu olarak degerlendirildi. Kounis sendromunun; vazospastik alerjik anjina, alerjik miyokardiyal enfark...

Kafkas Journal of Medical Sciences, 2020

Prehospital and Disaster Medicine, May 1, 2019

Medical Journal of Western Black Sea, 2018

Kounis syndrome is a very rare syndrome which includes anaphylactic, anaphylactoid and hypersensi... more Kounis syndrome is a very rare syndrome which includes anaphylactic, anaphylactoid and hypersensitivity reactions accompanied with mast cell activation and acute coronary syndrome. In this case we aimed to define kounis syndrome. A 68 years old male patient applied to emergency department with back pain. After administration of the intramuscular analgesic; the patient suffered from symptoms such as dizziness, burning sensation all over the body. Patient was examined and blood pressure was 75/45 mmHg, heart rate was 90 beats/minute and respiratory rate was 14 /minute. The patient was detected with hyperemic skin and minimal uvular edema. Electrocardiography findings were ST segment elevations at derivations D2, D3, aVF, V5, V6 and ST segment depressions at derivations V1, V2, V3, D1, aVL. After percutaneous coronary angiography, coronary arteries were detected normal. The patient, newly diagnosed with acute coronary syndrome after allergen exposure, with positive skin findings and hypotension was evaluated as Kounis syndrome. There are 3 types of Kounis syndrome. These are defined as vasospastic allergic angina, allergic myocardial infarction and eosinophil and mast cell infiltration related stent thrombosis. The patient, without abnormal coronary arteries findings, was detected with coronary artery syndrome secondary to vasospasm. Increased exposure to allergens, increased awareness of physicians about Kounis syndrome, overconsumption of medicines contributes to increase this syndrome. The incidence of Kounis Syndrome has increasing but diagnosis of Kounis Syndrome is inadequate and easily overlooked. Most of all patients, presented with allergic reactions, should be evaluated for Kounis syndrome.

Turkish Journal Of Neurology, 2018

Turkiye Klinikleri Journal of Medical Sciences, 2019

habdomyolysis, due to the destruction of the muscle cells, is a severe syndrome that can cause li... more habdomyolysis, due to the destruction of the muscle cells, is a severe syndrome that can cause life-threatening electrolyte disorders and renal insufficiency, manifested with increased lactate dehydrogenase (LDH), creatine phosphokinase (CPK) and myoglobin levels in plasma. 1 Rhabdomyolysis may include a wide spectrum of symptoms ranging from