ilker kaçer - Academia.edu (original) (raw)

Papers by ilker kaçer

Journal of contemporary medicine, Nov 20, 2021

Introduction: Pediatric poisoning is a common cause of emergency department admissions. The epide... more Introduction: Pediatric poisoning is a common cause of emergency department admissions. The epidemiology of pediatric poisonings can vary in different countries, even different regions of the same country. It is important to determine the regional factors to decrease morbidity and mortality. This study was aimed to evaluate the epidemiological features, clinical signs, and risk factors of pediatric poisonings. Material and Method: This retrospective descriptive study was carried out in the pediatric emergency department of a tertiary hospital and medical records between January 2016 and December 2020 were retrospectively reviewed. Demographic characteristics, laboratory results, and treatments were recorded. Results: 835 patients aged 4 months-18 years including 450 females (53.9%) were included in the study. Poisonings were most common in summer (n=280, 33.5%) and in the daytime (n=490, 58.7%). The mean age of suicidal poisoning was significantly higher then accidental poisonings (p<0.001). Pharmaceutical agents were statistically significantly higher in patients poisoned due to suicidal attempts (p<0.001). On the other hand, there was not a statistically significant difference between accidental and suicidal poisoning in terms of clinical presentation, length of stay in the hospital, and, intensive care unit requirement (p>0.05). Conclusions: Childhood poisoning is one of the important emergencies that need attention. Pediatric emergency physicians should always keep in mind the possibility of poisoning, even with the lack of medical history. It could be estimated the possible ingested agents according to the age group, and this allows physicians to avoid delay in treatment of these patients.

Muğla Sıtkı Koçman üniversitesi tıp dergisi, Dec 30, 2022

Maksillofasial travma en sık görülen travma tipidir ve yüksek morbidite ve mortalitenin önemli bi... more Maksillofasial travma en sık görülen travma tipidir ve yüksek morbidite ve mortalitenin önemli bir nedenidir. Çocuklarda yaralanmaların neden olduğu sekeller nedeniyle duygusal travmalar meydana gelmekte ve hayatlarının geri kalan kısmı olumsuz etkilenmektedir. Bu çalışmanın amacı, pediatrik maksillofasial travmaların etiyolojisi, epidemiyolojisi ve yaralanma tipini araştırmak ve çocukların yaralanmasını önlemek için önerilerde bulunmaktır. Bu tanımlayıcı retrospektif çalışma, bir bölge üçüncü basamak hastanesinde yapıldı. Ocak 2015 ile Şubat 2020 arasında acil servise maksillofasial travmaya bağlı tüm başvuruların tıbbi kayıtları geriye dönük olarak incelendi. Travmanın etiyolojisi, demografik özellikleri, travma tipi, kaza tipi, yaralanma yeri, uygulanan tedaviler ve mortalite kaydedildi. Çalışmaya 288'i kadın (%28) ve 741'i erkek (%72) olmak üzere 4 ay-18 yaş (ortalama 77.67±59.21 ay) 1029 hasta dahil edildi. Hastaların çoğu (n=390, %37.9) 13-18 yaş grubundaydı. Araştırma nüfusunun büyük çoğunluğu kentsel alanda (n=753, %73.2) yaşıyordu. Yaralanmaların çoğu yaz aylarında görüldü (n=438, %42.6). Kafa+servikal yaralanmalardan sonra en sık üst ekstremite yaralanmaları (n=171, %16.6), en az göğüs yaralanmaları (n=69, %6.7) görüldü. 57 (%5.5) hastanın hastaneye yatırılması gerekti ve ölüm oranı %1.2 (n=12) idi. Pediatrik maksillofasial travmalar en çok erkek cinsiyette, yaz aylarında, kentsel alanlarda ve motosiklet kazalarına bağlı olarak meydana gelmektedir. Çocuklarda maksillofasial travmaların azaltılması için toplumsal farkındalık artırılmalı ve her yaş grubuna uygun oyun alanları oluşturulmalıdır. Maxillofacial trauma is the most common type of trauma and is an important cause of high morbidity and mortality. Emotional traumas occur in children due to sequelae caused by injuries and the rest of their lives are negatively affected. The aim of this study is to investigate the etiology, epidemiology, and injury type of pediatric maxillofacial traumas, and to make recommendations to prevent child injuries. This descriptive retrospective study was conducted in a regional tertiary hospital. The medical records of all maxillofacial trauma-related admissions to the emergency department between January 2015 and February 2020 were retrospectively reviewed. Etiology of trauma, demographic characteristics, type of trauma, accident type, injury site, administered treatments, and mortality were recorded. 1029 patients aged 4 months-18 years (mean 77.67±59.21 months) including 288 females (28%) and 741 males (72%) were included in the study. Most of the patients (n=390, 37.9%) were in the 13-18 age group. The vast majority of the study population lived in the urban area (n=753, %73.2). Most injuries were seen in the summer (n=438, %42.6). After head+cervical injuries, upper extremity injuries (n=171, %16.6) were the most common and thoracic injuries (n=69, %6.7) least. 57 (5.5%) patients were required hospitalization and the mortality rate was 1.2% (n=12). Pediatric maxillofacial traumas occur mostly in the male gender, in summer, in urban areas, and due to motorcycle accidents. In order to reduce child maxillofacial traumas, public awareness should be increased and playgrounds suitable for all age groups should be created.

Harran Üniversitesi týp fakültesi dergisi, Apr 28, 2021

Background: Hand and wrist injuries account for approximately 10% of all emergency department adm... more Background: Hand and wrist injuries account for approximately 10% of all emergency department admissions. Hand traumas, especially hand fractures, are associated with social deprivation except in very young and very old individuals. In this study, we aimed to evaluate the clinical characteristics, risk factors, and the effect of injury on the life of patients admitted to the emergency department for an isolated hand injury. Materials and Methods: Patients who were admitted to the emergency department due to an isolated hand injury between 1 November 2019 and 1 November 2020 were included in the study. Multivariate logistic regression analysis was used to determine the risk factors of permanent disability. Results: The study included 205 patients with a mean age of 28.05 ± 10.85 years, and 142 (69.3%) of them were male. The vast majority of patients (n = 149; 72.7%) were in the 18-35 years age group. The mechanism of injury was blunt trauma in 131 (63.9%) patients and penetrating trauma in 65 (31.7%) patients. Amputation was necessary in 25 (12.2%) patients, and 20 (9.8%) patients had a permanent disability. Results of the logistic regression analysis revealed that male sex and penetrating trauma were independent risk factors for permanent disability (p = 0.012 and p < 0.001, respectively). Conclusions: Evaluation of hand injuries and related factors in our region is important because the results can vary between regions due to differences in lifestyle and working conditions. We found that male sex and penetrating trauma are independent risk factors for permanent disability in patients with isolated hand injury. Preventive measures against such injuries could reduce the permanent disability and related mental and economic burden.

$Research paper thumbnail of Complications, and requirement of opioid use after rib fractures, an analysis of 1074 patients$

Journal of contemporary medicine, May 24, 2021

This study was aimed to determine the risk factors, associated complications, opioid requirements... more This study was aimed to determine the risk factors, associated complications, opioid requirements, and mortality rates of rib fractures. Material and Method: Patients with rib fractures who were admitted to the emergency department between January 1, 2016, and December 31, 2020, were retrospectively analyzed. Patients' demographic data, rib fracture characteristics, trauma mechanism, associated complications, length of stay in the hospital, and inhospital mortality were recorded. Results: A total of 1074 patients were included in the study. Most of the patients were male (n=748, 69.6%) and the mean age was 53.89±15.31 years. The mean number of fractured ribs was 3.65±2.06. All patients with diaphragm laceration, atelectasis, pneumonia, ARDS, pneumomediastinum, lung herniation, flail chest, and empyema had six or more rib fractures. Comparison of died and survived patients showed statistically significant difference for age, gender, side of rib fracture, number of fractured ribs, and accompanying another organ injury. A moderate-strong correlation was found between the number of fractured ribs and pneumothorax, hemothorax, chest tube, opioid use, and length of stay in the hospital. Conclusion: Increased number of fractured ribs were associated with increased complications, opioid use, and length of stay in the hospital. The mortality rate was 8.8% in patients with 6 or more fractures. In-vehicle traffic accidents were the most common mechanism. Many of the rib fractures can be prevented if the measures are improved.

Psychology Health & Medicine, Jan 25, 2021

The COVID-19 related high morbidity and mortality have led to a common fear and anxiety. This stu... more The COVID-19 related high morbidity and mortality have led to a common fear and anxiety. This study aimed to determine the state/trait and death anxiety levels of patients with myocardial infarction (MI) and COVID-19 pneumonia. The study was conducted at the emergency department of a tertiary hospital in Central Anatolia of Turkey. 120 patients with myocardial infarction , 120 patients with COVID-19 pneumonia, and 120 healthy volunteers as a control group were included in the study. The participants filled out the questionnaire that included the State-Trait Anxiety Inventory (STAI) and the Thorson-Powell's Revised Death Anxiety Scale (RDAS). All scores of patient groups were significantly higher than the control group. There was no significant difference in terms of STAI-S, STAI-T, and RDAS scores between COVID-19 pneumonia and MI groups. The anxiety risk increased 2.14-fold for STAI-T and 1.97-fold for STAI-S in patients with COVID-19 pneumonia compared to the control group. In this study, the state/trait and death anxiety levels of patients with COVID-19 pneumonia were as high as patients with myocardial infarction.COVID-19 pneumonia-related anxiety was associated with chronic diseases and smoking. Knowing the level of anxiety in these patients is important to provide better health services in the emergency departments.

The Gazette of the Egyptian Paediatric Association, Dec 5, 2022

Background: Ocular traumas are the leading cause of acquired unilateral blindness in the pediatri... more Background: Ocular traumas are the leading cause of acquired unilateral blindness in the pediatric age group. The aim of this study is to determine the incidence of pediatric ocular injuries, the etiological factors that cause them, and to make some preventive recommendations. Methods: This was a retrospective observational study of pediatric ocular trauma (age < 18 years) presented to the pediatric emergency unit of our tertiary university hospital between January 2016 and December 2020. Demographic data such as age, gender, season, duration of admission, trauma etiology, and type of injury were recorded. Patients with missing medical records were excluded from the study. Results: Two hundred two patients aged a mean of 107.4 ± 40.7 months including 87 females (43.07%) and 115 males (56.93%) were included in the study. Most of the patients (n = 135, 66.83%) were in the 7-11 years of age group. The vast majority of the study population lived in the urban area (n = 119, 58.91%). Most injuries were seen in the summer (n = 108, 53.47%). 59.41% of all patients had closed globe injuries. Hyphema (32.5%) and endophthalmitis (26.6%) were the most common in closed globe injuries. Of the open globe injuries, 39 were penetrating (47.5%), 12 were perforated (14.6%), and 23 were intraocular foreign body injuries (28%). It was determined that the places where the injury occurred were mostly in situations where family control was reduced, such as weddings, holidays, and playgrounds (80.69%). The most common causes of injury were toy guns (35.15%), stones (28.71%), and fireworks (16.34%). Conclusion: This analysis is the first study to provide data on childhood ocular trauma in Aksaray. Most of the childhood ocular injuries can be prevented with simple precautions. For this purpose, effective and preventive strategies should be developed such as raising public awareness, providing parental control, and early intervention.

The Gazette of the Egyptian Paediatric Association, Mar 7, 2022

Background: Constipation constitutes an important part of emergency service applications in our c... more Background: Constipation constitutes an important part of emergency service applications in our country as well as all over the world. We aimed to illuminate the situation in our regional hospital regarding the increase in the emergency department density and the financial burden of applications due to constipation. Methods: This descriptive retrospective study was conducted in a regional tertiary hospital. The medical records of all constipation-related admissions to the emergency department between 01 January 2019 and 31 December 2019 were retrospectively reviewed. The etiology of constipation, complaints, physical examination, imaging studies, treatment modalities, and health expenses costs were recorded. Results: A total of 3271 patients aged 0-17 years (mean 4.24 ± 3.56 years) were included in the study. One thousand nine hundred and seventy-six (60.3%) of the patients were male, and 1295 (39.6%) of them were female. The majority of patients (n = 3107, 95%) were discharged without hospitalization. Health expenditure due to constipation was 834.626 Turkish liras. The health cost of the patients who were treated from the emergency room without hospitalization was 780.126 Turkish liras. Conclusions: In order to reduce unnecessary constipation applications and costs in emergency services, more detailed information should be given to prevent constipation during outpatient services, and dietary counseling should be provided when necessary.

Annals of medical research, 2021

The present study was aimed to determine the epidemiological features, clinical signs, and risk f... more The present study was aimed to determine the epidemiological features, clinical signs, and risk factors of methanol poisonings in our region. As all countries, methanol poisoning continues to be a serious problem in Turkey. The epidemiology of methanol poisoning varies between countries, even between regions of the same country. It is important to evaluate the regional factors to decrease morbidity and mortality. Materials and Methods: This descriptive retrospective study was conducted in a regional tertiary hospital. The medical records of all methanol poisoning-related admissions to the emergency department between January 2016 and December 2020 were retrospectively reviewed. Etiology of poisoning, demographic characteristics, laboratory results including methanol levels, administered treatments, and mortality were recorded. Results: 47 patients aged 18-67 years (mean 31.55±14,88 years) were included in the study. Thirty-nine (82.9%) of the patients were male and 8 (17.1%) of them were female. The vast majority of patients (n = 33, 70.3%) had nausea and vomiting. Twenty (42.5%) patients had blurred vision and 1 (2.1%) patient had blindness. Three (6.3%) patients were in a stupor and 4 (8.5%) were in a coma. The mortality rate of methanol poisonings was 12.7% (n=6). 28 (59.5%) patients survived without complications, whereas, 13 (27.6%) patients survived with a neurological sequel. Conclusions: Methanol poisoning is a serious problem among developing countries, where alcohol is not legal and cheap. High serum methanol levels are associated with a poor prognosis. Time spent from ingestion to treatment is critical to avoid complications and mortality, therefore clinicians should keep in mind methanol poisoning during differential diagnosis in such patients.

American Surgeon, Jan 25, 2022

Background Diagnosis of acute mesenteric ischemia (AMI) in its early stages is important for reve... more Background Diagnosis of acute mesenteric ischemia (AMI) in its early stages is important for reversing ischemic damage. The CRP to albumin (CRP/Alb) ratio has been defined as an inflammatory indicator and is associated with the severity of inflammation and mortality rates. However, the prognostic value of CRP/Alb has not been evaluated in patients with AMI. Here, we aimed to examine the prognostic significance of CRP/Alb and compare it with other inflammatory markers. Materials and Methods In this retrospective, case-control study, we included patients diagnosed with AMI at the emergency department between January 1, 2016, and December 31, 2020. In addition to demographic characteristics, lactate, D-dimer, white blood cell (WBC), CRP/Alb, and neutrophil/lymphocyte ratio (NLR) were recorded. Testing characteristics of CRP/Alb in predicting in-hospital mortality were studied. Results The mean age of 132 patients was 66.48 ± 15.95 years and 71 (53.8%) of them were male. The cut-off value obtained using the receiver operating characteristic (ROC) curve for in-hospital mortality was a CRP/Alb ratio of >1.32 (sensitivity, 93.65%; specificity, 69.57%; +LR, 3.08; −LR, .091; AUC, .782; 95% CI, .70-.85; P < .0001). The comparison of ROC curves between CRP/Alb and WBC, NLR, and lactate revealed a statistically significant difference ( P < .05), whereas there was not any statistically significant difference between the ROC curves of CRP/Alb and D-dimer ( P = .47). Conclusion C-reactive protein/albumin ratio is a powerful predictor of in-hospital mortality for AMI patients. It was superior to WBC, NLR, and lactate. It could be used to determine low-risk patients and help clinicians with treatment options.

European Archives of Oto-rhino-laryngology, Jun 13, 2022

Journal of contemporary medicine, Sep 17, 2021

The aim of this study was to investigate the effects of body mass index (BMI)c on the prognosis o... more The aim of this study was to investigate the effects of body mass index (BMI)c on the prognosis of lipophilic drug intoxication in patients who are admitted to the emergency units. Material and Method: The files of the patients who presented to the emergency department with lipophilic drug poisoning between January 2014 and August 2016 were reviewed. Demographic characteristics, medications taken, complaints at the time of admission, and physical examination findings were recorded. BMIs of the patients were calculated. The group was created according to their BMI. These groups were compared. Results: 202 patients were included in the study. Among the participants, 75 (37,1%) were in the 18-24,9 BMI interval, and 127 (62,9%) were ≥25. A statistically significant difference was observed between BMI groups regarding age, active complaint, hypertension, coronary artery disease, psychiatric disease, atrial fibrillation, need for atropine, need for pralidoxime (PAM), duration of mechanical ventilation and duration of intensive care unit stay (p<0,05). Conclusions: The need for atropine and PAM, duration of mechanical ventilation and intensive care unit stay were observed to be higher in patients with high BMI. BMI maybe used as a prognostic factor for the prognosis of patients with lipophilic drug intoxication; however, more comprehensive studies are needed to support the finding.

The American Journal of Emergency Medicine

European Archives of Oto-Rhino-Laryngology

Eurasian Journal of Emergency Medicine, 2022

Aim: This study aims to evaluate factors related to mortality in occupational injuries admitted t... more Aim: This study aims to evaluate factors related to mortality in occupational injuries admitted to emergency departments (EDs). Materials and Methods: Patients admitted to the ED because of occupational injuries between January 2015 and December 2019 were retrospectively analyzed. The first admission to the ED following each occupational injury was recorded. Results: Three thousand and two hundred and forty patients included in the study. We observed that occupational injuries decreased with age and were more common in males (91.4%), in agriculture (27.6%) and construction (24.9%) industries, and in summer (29.9%) and spring (28%). Additionally, occupational injuries generally occurred due to falling (31.8%) and caused superficial injuries (39.8%). A majority of patients (83.6%) were discharged from the ED. Three hundred and fifty-one and 156 patients were hospitalized in the surgical clinics and intensive care unit respectively. A total of 25 and 18 patients died in ED and intensive care unit, respectively (total 43 deaths, 1.32%). Moreover, increasing age (p=0.000), construction industry (p=0.008), immigration (p=0.037) and working in night shifts (p=0.009) are independent risk factors related to mortality after occupational injuries. Conclusion: The labor conditions of immigrants as well as of those working at night shifts and in construction industry should be supervised. Their job security should be improved and working without social security should not be allowed.

Journal of Emergency Nursing, 2021

Background Several vaccines have been developed and approved for use against SARS-CoV-2; however,... more Background Several vaccines have been developed and approved for use against SARS-CoV-2; however, the use of personal protective equipment (PPE) and precautions against transmission remain important due to the lack of effective specific treatment and whole community immunity. Hydroxychloroquine sulfate (HCQ) was used as a treatment option in the early days of the pandemic; however, it was subsequently removed due to a lack of evidence as an effective treatment for COVID-19. Aim To evaluate the testing and infection characteristics of COVID-19 among health care professionals (HCPs) and determine the efficacy of prophylactic HCQ use to prevent transmission. Methods This retrospective cross-sectional study was carried out between 1 May and 30 September 2020. The HCPs included in the study were doctors, nurses, and paramedical personnel, such as secretaries or technical staff. The medical records of HCPs who had been tested for SARS-CoV-2 using polymerase chain reaction (PCR) were retrospectively analyzed. Student's t-test and Pearson's Chi-square test were used for inter-group comparisons. Results 508 HCPs were included in the study. A total of 152 (29.9%) HCPs were diagnosed with COVID-19. The positive PCR rate was 80.3% (n = 122). A comparison of infected and uninfected HCPs showed a significant difference in terms of age and occupation, and no significant difference in terms of gender, working area, and prophylactic HCQ use. Conclusion Protective measures in low-risk areas of our hospital require improvements. All HCPs should be trained on PPE usage. Furthermore, there was no evidence to support the efficacy of prophylactic HCQ against SARS-CoV-2 transmission.

African Journal of Emergency Medicine, 2021

Introduction Cardiac compression is a cumbersome procedure. The American Heart Association sugges... more Introduction Cardiac compression is a cumbersome procedure. The American Heart Association suggests switching of cardiopulmonary resuscitation (CPR) provider every 2 min to prevent any decrease in resuscitation quality. High quality CPR is associated with improved outcomes. Previous studies have highlighted the difficulties in providing high quality CPR particularly while wearing personal protective equipment (PPE). This study aimed to evaluate the impact of personal protective equipment (PPE) use on CPR quality in prehospital cardiac arrest situations. Methods In this prospective simulation study, we compared the cardiac compression qualities and fatigue rates among prehospital health care professionals (HCPs) who were or were not using PPE. Results A total of 76 prehospital HCPs comprising 38 compression teams participated in this study. The mean compression rate was 117.71 ± 8.27/min without PPE and 115.58 ± 9.02/min with PPE (p = 0.191). Overall compression score was 86.95 ± 4.39 without PPE and 61.89 ± 14.43 with PPE (p < 0.001). Post-cardiac compression fatigue score was 4.42 ± 0.5 among HCPs who used their standard uniform and 7.74 ± 0.92 among those who used PPE (p < 0.001). The overall compression score difference between the two conditions was 25.05 ± 11.74 and the fatigue score difference was 3.31 ± 0.98. Discussion PPE use is associated with decreased cardiac compression quality and significantly higher fatigue rates than those associated with the use of standard uniforms. Routine use of mechanical compression devices should be considered when PPE is required for out-of-cardiac arrests.

Australasian Emergency Care, 2021

Background Tracheal intubation in COVID-19 patients is a potentially high-risk procedure for heal... more Background Tracheal intubation in COVID-19 patients is a potentially high-risk procedure for healthcare professionals. Personal protective equipment (PPE) is recommended to minimize contact with critical patients with COVID-19 infection. This study aimed to primarily examine the effect of PPE use on intubation time and success rate among prehospital healthcare professionals; additionally, we compared intubation times among prehospital health care professionals using PPE with direct laryngoscopy and video laryngoscopy assistance. Methods In this prospective simulation study, we compared the intubation times and success rates among prehospital healthcare professionals who were or were not using PPE. Furthermore, demographic data, previous intubation experience, and previous intubation experience with PPE were recorded. Results Overall time to intubation with PPE use was 51.28 ± 3.89 s, which was significantly higher than that without PPE use (33.03 ± 2.65 s; p < 0.001). In addition, the overall success rate with PPE use was 74.4%, which was significantly lower than that without PPE use (93%;p < 0.001). PPE use increased the average intubation time by 19.73 ± 2.59 s with direct laryngoscopy and by 16.81 ± 2.86 s with video laryngoscopy (p < 0.001). Conclusions PPE use is associated with increased intubation time and decreased success rate. Video laryngoscopy assistance in cases where PPE use is required facilitates faster endotracheal intubation than does direct laryngoscopy assistance.

Disaster Medicine and Public Health Preparedness, 2020

Objective:Personal protective equipment (PPE) use is frequently construed as inconvenient and dis... more Objective:Personal protective equipment (PPE) use is frequently construed as inconvenient and disturbing by health care professionals (HCPs). We hypothesized that new-onset symptoms among HCPs may be associated with extended use of PPE and aimed to investigate risk factors related with new-onset symptoms. In addition, the effects of new-onset symptoms on working performance were evaluated.Methods:In this cross-sectional study, 315 participants filled out a questionnaire that contains 4 main parts: (1) demographics, (2) new-onset symptoms with PPE use, (3) PPE usage hours, and (4) personal opinion about the effect of sensed symptoms on working performance.Results:The mean age was 31.58 ± 4.6 years, and 50.5% (n = 159) were female. New-onset symptom rate was 66% (n = 208). The most common new-onset symptom was headache (n = 115, 36.5%) followed by breathing difficulty-palpitation (n = 79, 25.1%), and dermatitis (n = 64, 20.3%). Extended use of PPE, smoking, and overweight were indepen...

Journal of Contemporary Medicine

Introduction: The novel coronavirus disease (COVID-1 quickly spread all over the world and caused... more Introduction: The novel coronavirus disease (COVID-1 quickly spread all over the world and caused many deaths in Turkey as in the whole world. COVID-19 is potentially lethal and affects the mental health of people. It is important to detect the potential psychological changes in a timely manner during the pandemic. We aimed to determine the anxiety levels and associated risk factors of the society during COVID-19 in Turkey. Methods: This was a cross-sectional study conducted throughout Turkey during the pandemic. The questionnaires were delivered to the participants via Google Forms. The questionnaire was first published on April 15, 2020, and data were collected for a period of 30 days. Results: 8,917 questionnaire forms filled out by Turkish society were included in the study. The anxiety level and fear of death were higher in older, females, parents, smokers, people who have comorbidities, social media users, and people who have higher education levels. Conclusion: The present st...