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Papers by umut payza
Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 2020
Acil servisler Türkiye nüfusunun üzerinde bir başvuru yükü altındadır. Bu sebeple acil servislerd... more Acil servisler Türkiye nüfusunun üzerinde bir başvuru yükü altındadır. Bu sebeple acil servislerde hastalara verilen hizmet kalitesindeki düşüş toplumun ciddi bir kesimini etkileyecektir. Aynı zamanda yüksek başvuru sayıları ciddi bir mali yükü ve hizmet kalitesinde düşüşü de beraberinde getirecektir. Bu ve benzer birçok neden sebebiyle 'Acil servis yoğunluğu' ciddi bir halk sağlığı sorunu haline gelmiştir. Bu çalışmanın amacı acil tıp kliniğine başvuran ve acil müdahale ihtiyacı olmayan hastaların gözünden acil servislere bakış açılarını ve aciliyet algısını değerlendirmektir. Acil servislerin uygun olmayan kullanımı için analitik bir değerlendirme yapmaktır. Gereç ve Yöntemler: 4 ay boyunca İzmir Katip Çelebi Üniversitesi Atatürk Eğitim ve Araştırma Hastanesine başvuran, acil müdahale ihtiyacı olmayan, 919 hasta çalışmaya dahil edilmiştir. Bulgular: Eğitim durumları incelendiğinde ise, katılımcıların %14,5'inin herhangi bir eğitim almadıkları görüldü. %7,5'u ilkokul, %7,9 ortaokul, %65,8'i lise düzeyinde eğitim almıştır. Başvuranların %4,3'ü ise üniversite mezunudur. Bununla beraber, acil servisler genç yaş grubu hastalar tarafından poliklinik yoğunluğu gibi nedenlerle kullanılmaktadır. Aciliyet algısındaki değerlendirme hem hastalarca hem de sağlık çalışanları tarafından doğru anlaşılamamıştır. Sonuç: Hastaların aciliyet algısında yanıldıkları ve eğitim düzeyi ne olursa olsun acil servisleri amaçları dışında kullandıklarını gözlemledik.
Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, 2021
Extended duration extracorporeal membrane oxygenation (ECMO), using dual-lumen cannulas, is being... more Extended duration extracorporeal membrane oxygenation (ECMO), using dual-lumen cannulas, is being used with increased frequency to support patients, including those with COVID-19; both as a bridge to transplant and lung recovery. During such an extended duration of support, there are several factors that might lead to the attrition of the physical structure of the ECMO cannulas, predisposing them to the risk of fracture. Although rare, fracture of the ECMO cannula can be a potentially lethal event. Here, we present a case where fracture of a dual lumen cannula during veno-venous (VV) ECMO support resulted in a cerebrovascular accident. We discuss the potential contributing factors and suggest steps to mitigate the risks for such a complication.
Cukurova Medical Journal, 2021
Amac: Şok indeksi ve modifiye sok indeksi travma, pulmoner emboli ve aort diseksiyonu olan hastal... more Amac: Şok indeksi ve modifiye sok indeksi travma, pulmoner emboli ve aort diseksiyonu olan hastalarin hemodinamik durumunu degerlendirmek icin kullanilmistir. Bu calismada ST elevasyonlu miyokard infarktus hastalarinda major istenmeyen kardiyak olay parametrelerinin bir gostergesi olarak sok indeksi ve modifiye sok indeksinin etkinligini degerlendirmeyi amacladik. Gerec ve Yontem: Calismaya ST elevasyonlu miyokard enfarktusu olan toplam 194 hasta dahil edildi. Şok indeksi ve modifiye sok indeksinin major istenmeyen kardiyak olayi ve major istenmeyen kardiyak olay parametrelerini ayri ayri ongorme acisindan degerlendirildi. Bulgular: Calismaya toplam 194 hasta dahil edildi. 7 gunluk mortalite sok indeksi <0.66 grubunda %2.4 ve sok indeksi ≥ 0.66 grubunda %11.6 idi. Major istenmeyen kardiyak olay gelisme orani sok indeksi <0.66 icin %4.0 ve sok indeksi ≥0.66 icin %17.4 idi. 7 gunluk mortalite modifiye sok indeksi <0.93 grubunda %3.0 ve modifiye sok indeksi ≥0.93 grubunda% 11....
Objective: Emergency services are under a burden application about over numbers of the Turkey'... more Objective: Emergency services are under a burden application about over numbers of the Turkey's population. For this reason, the decrease in the quality of service provided to patients in emergency services will affect a significant part of the society. At the same time, the high number of applications will entail a significant financial cost. In addition, burnout in employees and violence against health personnel are other important events. For these and similar reasons, ‘Emergency department overcrowded’ has become a serious public health problem. The aim of this study was to evaluate the perspectives and perceptions of emergency patients. And, to make an analytical assessment for the improper use of emergency services. Materials and Methods: 919 patients who no need emergency treatment, admitted to Izmir Katip Çelebi University Atatürk Training and Research Hospital for 4 months were included in the study. Results: When the educational status was examined, we found that 14.5%...
Sağlık Bilimleri Dergisi, 2020
One of the main parts of the health system is medical residents. The residents who are new to the... more One of the main parts of the health system is medical residents. The residents who are new to the profession are under serious pressure due to inexperience and the difficulties related with jobs. However, it would not be correct to evaluate the physician as an employee only. Healthcare professionals are also a part of society. In this study, we aimed to determine the depression levels of medical residents. 141 medical residents were included in this descriptive cross-sectional study. Depression status was evaluated by Beck Depression Inventory.
Objective: In this study, we investigated the effect of the QTc interval in cirrhosis patients on... more Objective: In this study, we investigated the effect of the QTc interval in cirrhosis patients on mortality and morbidity in esophageal variceal hemorrhages. Material and Method: It was retrospectively scanned in a single-centred design. The QTC intervals before and during the bleeding were calculated. The demographic characteristics and mortality status were recorded. Results: Bleeding was detected in 117 of the 156 patients. A total of 83% of these were male, and 17% were female. The QTc interval in these patients measured at the time of bleeding was longer than that measured before bleeding (p<0.001). The QTc interval of the patients who died due to bleeding was found to be 509.9 ms. It was calculated for males as 520.6 ms, and 487.4 ms for females. In the ROC analysis that was conducted for the QTc in terms of mortality, the sensitivity was 82.4% and specificity was 79.7% for 464.0 ms in males (AUC:0.785; 95% CI 0.724-0.825). The sensitivity was 77.8% and the specificity was ...
Amac: Ortak embiriyolojik baglari nedeniyle irritable barsak sendromu (IBS) olan hastalarda kardi... more Amac: Ortak embiriyolojik baglari nedeniyle irritable barsak sendromu (IBS) olan hastalarda kardiyak etkilenmeyi degerlendirmek ve QT, QTc, QTd, QTcd ile iliskili intervalde olan degisiklikleri arastirmak. Metod: Calisma prospektif olarak calisildi. Calismaya 01.01.2016-31.12.2018 yillari arasinda irritable barsak sendrom tanisi almis 96 hasta dahil edildi. Ayrica 100 saglikli gonullu ile bir kontrol grubu olusturuldu. Acil servisimize bu hastalar davet edilerek elektrokardiyogramlari cekildi. Hastalarda ve gonullulerde duzeltilmis QT sureleri ve QT dispersiyonlari Bazzet formulu kullanilarak hesaplandi. Bulgular: Calismaya katilan irritable barsak sendromu tanisi olan gonullu erkeklerin yas ortalamasi 47,9 ve kadinlarin ise 40,2 idi. Saglikli gonullulerde kadinlarin yas ortalamasi 40.7, erkeklerin ise 43.6 idi. Hastalarin yas ortalamasi da QT ve QTc’de her hangi bir uzama gorulmezken, QTd ve QTcd degerlerinde saglikli gonullulere kiyasla uzama oldugu goruldu. Sonuc: Saglikli gonull...
Objective: The study was planned to determine the suitability of using Rockall and Blatchford sco... more Objective: The study was planned to determine the suitability of using Rockall and Blatchford scoring systems in emergency departments by evaluating their success in estimating the need for endoscopy and hospitalization along with mortality possibilities in upper GIS bleedings. Material and Method: Hematemesis, melena, gastrointestinal hemorrhage, hemoptysis, nausea and vomiting, syncope ICD 10 diagnosis codes were entered during the application to the emergency department and 644 patients subject to endoscopy were scanned with 644 patient protocol numbers, 188 patients were included in the study. Rockall and Data about Blatchford scores, patient mortality, hospitalization and discharge were entered into the system. The calculated scores were compared. Results: The general age average was 65.16 ± 16.61 Rockall score average was calculated as 2.75 ± 1.88, Blatchford score average was calculated as 9.72 ± 3.84. Based on the Rockall scores, 86 (45.7%) of 188 patients were low risk, 102...
Biomedical Research, 2018
Background: Pulmonary embolism (PE) is one of the major causes of mortality, morbidity and hospit... more Background: Pulmonary embolism (PE) is one of the major causes of mortality, morbidity and hospitalizations. We aimed to investigate the effect of neutrophil/lymphocyte ratio (NLR) on 1-year mortality. Material and methods: Among the patients, were referred to the emergency department of our hospital within 1-year who underwent computed tomography pulmonary angiography (CTPA), patients who were interpreted as PE after CTPA were included in the study. Results: The optimal NLR cutoff value for the power in predict 1-year mortality was determined as 4.74 with ROC analysis. The NLR cutoff value of 4.74 had sensitivity of 61%, specificity of 75%. There were statistically significant differences between groups in terms of NLR on 1-year mortality and mortality in patients with a NLR greater than 4.74 was statistically significant higher than in patients with a NLR of 4.74 or less. Conclusion: We believe that NLR can be used in evaluating 1-year mortality of pulmonary embolism.
Bitlis Eren University Journal of Science and Technology, 2020
Objective: Motorcycle accidents progress with higher mortality than other accidents. There can be... more Objective: Motorcycle accidents progress with higher mortality than other accidents. There can be many different factors in the emergence of accidents. The aim of this study is to evaluate the effects of alcohol and other demographic characteristics on motorcycle accidents. Materials and Methods: Patients who were admitted to the emergency department after motorcycle accidents between 01.
Bitlis Eren University Journal of Science and Technology, 2019
Turkey is one of the most popular immigration countries because of the wars that are ongoing in i... more Turkey is one of the most popular immigration countries because of the wars that are ongoing in its southern border and its location on access routes to Europe. Migrations continue because of wars and political turmoil. The increasing number of migrants requires revising the public healthcare planning. In our study, we compared the behaviors of immigrants and local people. We examined to which extent immigrants used the clinics of our hospital. We interpreted the adequacy of the current healthcare system for migrants. We analyzed the hospital admissions of migrants and local residents who applied to our hospital between January 2014 and December 2018 in retrospective fashion. We determined the rates of referral to clinics. We determined that the highest referral rates of the migrants were made to emergency services, gynecology and obstetrics. We observed that the birth rates increased in migrants in the following period. However, despite the traumas, immigrants did not use psychiatric units. The existing healthcare and social policies must be revised by considering especially the needs of immigrants and their use of healthcare systems. We believe that primary healthcare services must be delivered equally to all individuals to reduce the intensity of emergency services, gynecology and obstetrics departments, and pediatric services. We also believe that the trauma that iscaused by immigration must not be underestimated.
Cukurova Medical Journal, 2019
The aim of this study was to compare thiol/disulphide haemostasis levels between healthy voluntee... more The aim of this study was to compare thiol/disulphide haemostasis levels between healthy volunteers and the patients who were admitted to emergency with the complaint of ST Elevation myocardial infarction (STEMI). Materials and Methods: This case-control study was carried out in the Department of Emergency Medicine. The participants consisted of 48 healthy volunteers and 48 hospitalized patients with STEMI. The thiol / disulphide level was evaluated in each study group. The association of Thiol levels (native/total) was evaluated in patients with STEMI. Results: No significant difference was found between the patients with STEMI and healthy volunteers regarding their age or gender. The disulphide (SS) levels were similar in both groups. The total thiol (TT) and native thiol (SH) levels were much lower and the SS/TT levels were much higher in the patients with STEMI when compared with the volunteers. Conclusion: This study revealed that the oxidant/antioxidant ratio was shifted to the oxidative side in patients with STEMI. An abnormal thiol/disulphide state might be considered as an important factor in the pathogenesis and in monitoring the treatment response. The thiol resources may be used for diagnosis of STEMI.
Annals of Medical Research, 2019
It was evaluating the shock index and the modified shock index, which are strongly correlated wit... more It was evaluating the shock index and the modified shock index, which are strongly correlated with the severity of the shock. Determining the risk analysis in terms of early mortality of patients diagnosed with pulmonary thromboembolism (PE) in order to specify treatment options and prognosis. Therefore, it is important to determine the severity of pulmonary embolism correctly. The available algorithms, such as the pulmonary embolism severity index, provide a prediction of the patients according to clinical findings. These algorithms score abnormal vital signs, medical findings, age, and comorbid diseases. However, vital signs in normal physiological limits cause errors in determining the severity of the disease. In this case, the problem is a lack of correlation between the severity of the disease and vital signs. Consequently, we need a more reliable parameter. In our study, we searched for a parameter that can be calculated easily in a dynamic manner, and which is not affected by normalized vital signs. We attempted to find a parameter that could indicate the severity of the disease. Therefore, we evaluated the shock index and the modified shock index, which are strongly correlated with the severity of the shock. Material and Methods: Patients diagnosed with pulmonary embolism were screened retrospectively between January 2012 and December 2017. A total of 99 patients whose pulmonary embolism was confirmed by angio-thoracic tomography were included in the study. Heart rate, systolic and diastolic blood pressure were measured in these patients. Mean arterial pressure, shock index and the modified shock index were also calculated. The values showing the severity of the disease were evaluated. Result When all the parameters were examined, the predictive power of deaths within 30 days was significant at differing degrees (p<0.05). In ROC analysis, shock index was the most prominent parameter with its clinical utility and sensitivity. This was followed by pulse count and modified shock index, which are other valuable parameters. Conclusion: At the time of admission to the emergency department, we found that the shock index could be easily calculated with vital signs and display a better correlation with the severity of the disease. Although systolic-diastolic blood pressure, pulse rate and mean arterial pressures calculated in pulmonary embolism are within physiological limits, the shock index shows particularly better correlation and sensitivity of the severity of the disease.
Konuralp Tıp Dergisi, 2019
Objective: Chronic subdural hematoma (CSDH) is a frequently encountered entity in neurosurgery. T... more Objective: Chronic subdural hematoma (CSDH) is a frequently encountered entity in neurosurgery. The objective of this study was to describe the use of unbiased Cavalieri principle to assess CSDH volume to total brain volume fraction (Percentage) and compare it with the clinical features of the patients. Methods: A total of 33 patients were included in the study. Computed tomography (CT) was acquired from the hospital-imaging database. The ratio of hematoma volume, brain volume, and hematoma volume to brain volume were measured via CT by two clinicians. Measurements were compared with clinical findings. Results: The sample consisted of 22 males and 11 females and mean age 67,27±12,63 years. The measured hematoma volume was 89,78 ± 54,13 cm3, the brain volume was 1329,91 ± 2098,35 cm3 and the percentage volume was 8,14 ± 4,92 cm3. The brain volume values of the cases with impaired consciousness were found to be statistically significant (p <0.05). Conclusions: It should be kept in mind that the bleeding volume of patients with vomiting may be higher.
Konuralp Tıp Dergisi, 2019
Objective: Pulmonary embolism (PE) is one of the major causes of mortality, morbidity and hospita... more Objective: Pulmonary embolism (PE) is one of the major causes of mortality, morbidity and hospital admission. We aimed to investigate the association of the Simplified Pulmonary Embolism Severity Index (sPESI) and mortality within 3 months. Methods: A total of 118 patients were included in the study. Patients who died within 3 months after PE diagnosis were defined as Group 1. Other patients were defined as Group 2. The sPESI score was calculated and recorded. The effect of these scoring systems on 3-month mortality rate was investigated. Results: There were 31 patients (26.3%) in Group 1 and 87 patients (73.7%) in Group 2. When the sPESI scores of the patients were examined, there was difference between Group 1 and 2 in terms of 3-month mortality. The sPESI had a sensitivity of 43.3% and a specificity of 79.4% for predicting 3-month mortality. Conclusions: It is important to categorize patients diagnosed with PE in the emergency department according to their risk profiles in terms of their treatment needs.
Hong Kong Journal of Emergency Medicine, 2019
Introduction: Allergic acute myocardial infarction with ST-segment elevation is rare, and vasocon... more Introduction: Allergic acute myocardial infarction with ST-segment elevation is rare, and vasoconstrictor mediators released from mast cells are responsible for its pathogenesis. Several medications have been reported to lead to acute myocardial infarction with ST-segment elevation, as a part of systemic allergic reactions and this entity is known as Kounis syndrome (KS). Case presentation: We presented a patient with recurrent KS who had no allergic reactions, except coronary spasm after parenteral diclofenac administration. First, she experienced anterior myocardial infarction with ST-segment elevation after administration of diclofenac 2 years ago. The second presentation was acute inferior-posterior myocardial infarction with ST-segment elevation with atrioventricular complete block leading to cardiogenic shock. She had no significant coronary stenosis responsible for each myocardial infarction with ST-segment elevation. However, she had a catheter-induced coronary spasm of non-...
Cumhuriyet Medical Journal, 2017
This paper describes the developments in the Netherlands to establish a national Network for Digi... more This paper describes the developments in the Netherlands to establish a national Network for Digital Heritage. This network is based on three pillars: to make the digital heritage visible, usable and sustainably preserved. Three working programmes will have their own but integrated set of dedicated actions in order to create a national infrastructure in the Netherlands, based on an optimal use of existing facilities. In this paper the focus is on the activities related to the sustainable preservation of the Dutch national digital heritage.
Cumhuriyet Medical Journal, 2017
This paper describes the developments in the Netherlands to establish a national Network for Digi... more This paper describes the developments in the Netherlands to establish a national Network for Digital Heritage. This network is based on three pillars: to make the digital heritage visible, usable and sustainably preserved. Three working programmes will have their own but integrated set of dedicated actions in order to create a national infrastructure in the Netherlands, based on an optimal use of existing facilities. In this paper the focus is on the activities related to the sustainable preservation of the Dutch national digital heritage.
Biomedical Research, 2018
Objective: Inflammatory reaction, which causes tissue damage in Acute Coronary Syndrome (ACS), le... more Objective: Inflammatory reaction, which causes tissue damage in Acute Coronary Syndrome (ACS), leads to deterioration. White Blood Cell (WBC), Neutrophil (N), Lymphocyte (L) and Neutrophil/ Lymphocyte (N/L) ratios were used to refer to the inflammation. High neutrophil levels show us acute inflammatory situation and low lymphocyte levels show us physiological stress. That is why N/L ratio is a valuable parameter which enables us to guess patient prognosis in Emergency Department (ED). In this study, white cell and NLR relations with ACS in patients with chest pain is evaluated. Material and method: Patients referring to ED with chest pain within 3 months were investigated retrospectively. 100 patients were included in the study. Patients' WBC count, NLR and WBC values, gender, Troponin-I and CK-MB positivity, history of Coronary Heart Disease (CHD) and additional diseases were examined according to the final diagnoses. All the patients were divided into three groups according to ACS: Unstable Angina Pectoris (USAP), Non-ST Elevated Myocardial Infarction (NSTEMI), and ST-Elevated Myocardial Infarction (STEMI). Mortality and morbidity levels in hospital and after discharge were also examined in the study. Findings: WBC values in patients with positive Troponin-I were found statistically higher than patients with negative Troponin-I (p<0.05). In STEMI group, WBC values were statistically higher than USAP group (p<0.0083). When patients' N/L ratio average distribution was examined; Troponin-I and CK-MB positive patients' NLR was found to be statistically higher than Troponin-I and CK-MB negative ones (p<0.05). Conclusion: N/L ratio, which is a marker of inflammatory process in the myocardial vascular bed, may be considered as a risk marker. For this reason, N/L ratio at admission can be used as an auxiliary parameter for predicting the diagnosis of ACS.
Meandros Medical and Dental Journal, 2017
Objective: Although acute aort dissection (AAD) is quite difficult to be diagnosed in the emergen... more Objective: Although acute aort dissection (AAD) is quite difficult to be diagnosed in the emergency department, the mortality of it is very high. Therefore, the purpose of our study is to discuss the evidence of demographic characteristics, clinical, laboratory of the AAD patients who applied to emergency department over mortality. MaterialsandMethods: In our research including 73 patients with AAD diagnosed whom admitted to emergency department on January 2010-October 2015. Sex, age, presenting complaints, past medical history, arterial blood pressure, pulse, laboratory tests, transthoracic echocardiography (TTE), thoracoabdominal computerized tomography (CT), mortality and DeBakey type have been recorded on patient information form. Statistical analysis was performed in IBM SPSS Statistics Version 22.0 software package. The comparison between the two groups of data Pearson chi-square, Fisher's exact and chi-square tests were used for statistical analysis of trends. P<0.05 was considered statistically significant. Results: Fourty seven patients (64.4%) were male and 26 (35.6%) were women. In the background of the patients it was identified hypertension as the most common rate of 68.5%. The most common complaints identified were chest pain (53.4%) and back pain (42.5%). It has been determined 68 (93.1%) patients to whom CT have scanned and 27 out of 42 (64.3%) patients to whom TTE have scanned were found to have AAD. According to the DeBakey classification, 31 (42.5%) were DeBakey type 1, 18 (24.7%) DeBakey type 2 and 24 (32.9%) DeBakey type 3 as the AAD. Conclusion: Aortic dissection is still a highly mortality disease. The most important condition to reduce the mortality was thought the early diagnosis and the appropriate surgical intervention. Amaç: Akut aort diseksiyonu (AAD) acil serviste tanısı oldukça zor konulmasına rağmen mortalitesi çok yüksek bir hastalıktır. Bu nedenle, acil tıp kliniğine başvuran AAD tanılı hastaların demografik özellikleri, klinik, laboratuvar ve radyolojik bulgularının mortalite üzerine etkilerini araştırmayı amaçladık. Gereç ve Yöntemler: Çalışmamızda Ocak 2010 ile Ekim 2015 tarihleri arasında acil tıp kliniğinde AAD tanısı konulan ve çalışmaya dahil edilen 73 hasta geriye dönük incelendi. Yaş, cinsiyet, başvuru şikayetleri, özgeçmişleri, arteriyel kan basınçları, nabız sayısı, istenilen laboratuvar tetkikleri, transtorasik ekokardiyografi (TTE), kontrastlı torakoabdominal bilgisayarlı tomografi (BT) mortalite ve diseksiyon tipi
Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 2020
Acil servisler Türkiye nüfusunun üzerinde bir başvuru yükü altındadır. Bu sebeple acil servislerd... more Acil servisler Türkiye nüfusunun üzerinde bir başvuru yükü altındadır. Bu sebeple acil servislerde hastalara verilen hizmet kalitesindeki düşüş toplumun ciddi bir kesimini etkileyecektir. Aynı zamanda yüksek başvuru sayıları ciddi bir mali yükü ve hizmet kalitesinde düşüşü de beraberinde getirecektir. Bu ve benzer birçok neden sebebiyle 'Acil servis yoğunluğu' ciddi bir halk sağlığı sorunu haline gelmiştir. Bu çalışmanın amacı acil tıp kliniğine başvuran ve acil müdahale ihtiyacı olmayan hastaların gözünden acil servislere bakış açılarını ve aciliyet algısını değerlendirmektir. Acil servislerin uygun olmayan kullanımı için analitik bir değerlendirme yapmaktır. Gereç ve Yöntemler: 4 ay boyunca İzmir Katip Çelebi Üniversitesi Atatürk Eğitim ve Araştırma Hastanesine başvuran, acil müdahale ihtiyacı olmayan, 919 hasta çalışmaya dahil edilmiştir. Bulgular: Eğitim durumları incelendiğinde ise, katılımcıların %14,5'inin herhangi bir eğitim almadıkları görüldü. %7,5'u ilkokul, %7,9 ortaokul, %65,8'i lise düzeyinde eğitim almıştır. Başvuranların %4,3'ü ise üniversite mezunudur. Bununla beraber, acil servisler genç yaş grubu hastalar tarafından poliklinik yoğunluğu gibi nedenlerle kullanılmaktadır. Aciliyet algısındaki değerlendirme hem hastalarca hem de sağlık çalışanları tarafından doğru anlaşılamamıştır. Sonuç: Hastaların aciliyet algısında yanıldıkları ve eğitim düzeyi ne olursa olsun acil servisleri amaçları dışında kullandıklarını gözlemledik.
Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, 2021
Extended duration extracorporeal membrane oxygenation (ECMO), using dual-lumen cannulas, is being... more Extended duration extracorporeal membrane oxygenation (ECMO), using dual-lumen cannulas, is being used with increased frequency to support patients, including those with COVID-19; both as a bridge to transplant and lung recovery. During such an extended duration of support, there are several factors that might lead to the attrition of the physical structure of the ECMO cannulas, predisposing them to the risk of fracture. Although rare, fracture of the ECMO cannula can be a potentially lethal event. Here, we present a case where fracture of a dual lumen cannula during veno-venous (VV) ECMO support resulted in a cerebrovascular accident. We discuss the potential contributing factors and suggest steps to mitigate the risks for such a complication.
Cukurova Medical Journal, 2021
Amac: Şok indeksi ve modifiye sok indeksi travma, pulmoner emboli ve aort diseksiyonu olan hastal... more Amac: Şok indeksi ve modifiye sok indeksi travma, pulmoner emboli ve aort diseksiyonu olan hastalarin hemodinamik durumunu degerlendirmek icin kullanilmistir. Bu calismada ST elevasyonlu miyokard infarktus hastalarinda major istenmeyen kardiyak olay parametrelerinin bir gostergesi olarak sok indeksi ve modifiye sok indeksinin etkinligini degerlendirmeyi amacladik. Gerec ve Yontem: Calismaya ST elevasyonlu miyokard enfarktusu olan toplam 194 hasta dahil edildi. Şok indeksi ve modifiye sok indeksinin major istenmeyen kardiyak olayi ve major istenmeyen kardiyak olay parametrelerini ayri ayri ongorme acisindan degerlendirildi. Bulgular: Calismaya toplam 194 hasta dahil edildi. 7 gunluk mortalite sok indeksi <0.66 grubunda %2.4 ve sok indeksi ≥ 0.66 grubunda %11.6 idi. Major istenmeyen kardiyak olay gelisme orani sok indeksi <0.66 icin %4.0 ve sok indeksi ≥0.66 icin %17.4 idi. 7 gunluk mortalite modifiye sok indeksi <0.93 grubunda %3.0 ve modifiye sok indeksi ≥0.93 grubunda% 11....
Objective: Emergency services are under a burden application about over numbers of the Turkey'... more Objective: Emergency services are under a burden application about over numbers of the Turkey's population. For this reason, the decrease in the quality of service provided to patients in emergency services will affect a significant part of the society. At the same time, the high number of applications will entail a significant financial cost. In addition, burnout in employees and violence against health personnel are other important events. For these and similar reasons, ‘Emergency department overcrowded’ has become a serious public health problem. The aim of this study was to evaluate the perspectives and perceptions of emergency patients. And, to make an analytical assessment for the improper use of emergency services. Materials and Methods: 919 patients who no need emergency treatment, admitted to Izmir Katip Çelebi University Atatürk Training and Research Hospital for 4 months were included in the study. Results: When the educational status was examined, we found that 14.5%...
Sağlık Bilimleri Dergisi, 2020
One of the main parts of the health system is medical residents. The residents who are new to the... more One of the main parts of the health system is medical residents. The residents who are new to the profession are under serious pressure due to inexperience and the difficulties related with jobs. However, it would not be correct to evaluate the physician as an employee only. Healthcare professionals are also a part of society. In this study, we aimed to determine the depression levels of medical residents. 141 medical residents were included in this descriptive cross-sectional study. Depression status was evaluated by Beck Depression Inventory.
Objective: In this study, we investigated the effect of the QTc interval in cirrhosis patients on... more Objective: In this study, we investigated the effect of the QTc interval in cirrhosis patients on mortality and morbidity in esophageal variceal hemorrhages. Material and Method: It was retrospectively scanned in a single-centred design. The QTC intervals before and during the bleeding were calculated. The demographic characteristics and mortality status were recorded. Results: Bleeding was detected in 117 of the 156 patients. A total of 83% of these were male, and 17% were female. The QTc interval in these patients measured at the time of bleeding was longer than that measured before bleeding (p<0.001). The QTc interval of the patients who died due to bleeding was found to be 509.9 ms. It was calculated for males as 520.6 ms, and 487.4 ms for females. In the ROC analysis that was conducted for the QTc in terms of mortality, the sensitivity was 82.4% and specificity was 79.7% for 464.0 ms in males (AUC:0.785; 95% CI 0.724-0.825). The sensitivity was 77.8% and the specificity was ...
Amac: Ortak embiriyolojik baglari nedeniyle irritable barsak sendromu (IBS) olan hastalarda kardi... more Amac: Ortak embiriyolojik baglari nedeniyle irritable barsak sendromu (IBS) olan hastalarda kardiyak etkilenmeyi degerlendirmek ve QT, QTc, QTd, QTcd ile iliskili intervalde olan degisiklikleri arastirmak. Metod: Calisma prospektif olarak calisildi. Calismaya 01.01.2016-31.12.2018 yillari arasinda irritable barsak sendrom tanisi almis 96 hasta dahil edildi. Ayrica 100 saglikli gonullu ile bir kontrol grubu olusturuldu. Acil servisimize bu hastalar davet edilerek elektrokardiyogramlari cekildi. Hastalarda ve gonullulerde duzeltilmis QT sureleri ve QT dispersiyonlari Bazzet formulu kullanilarak hesaplandi. Bulgular: Calismaya katilan irritable barsak sendromu tanisi olan gonullu erkeklerin yas ortalamasi 47,9 ve kadinlarin ise 40,2 idi. Saglikli gonullulerde kadinlarin yas ortalamasi 40.7, erkeklerin ise 43.6 idi. Hastalarin yas ortalamasi da QT ve QTc’de her hangi bir uzama gorulmezken, QTd ve QTcd degerlerinde saglikli gonullulere kiyasla uzama oldugu goruldu. Sonuc: Saglikli gonull...
Objective: The study was planned to determine the suitability of using Rockall and Blatchford sco... more Objective: The study was planned to determine the suitability of using Rockall and Blatchford scoring systems in emergency departments by evaluating their success in estimating the need for endoscopy and hospitalization along with mortality possibilities in upper GIS bleedings. Material and Method: Hematemesis, melena, gastrointestinal hemorrhage, hemoptysis, nausea and vomiting, syncope ICD 10 diagnosis codes were entered during the application to the emergency department and 644 patients subject to endoscopy were scanned with 644 patient protocol numbers, 188 patients were included in the study. Rockall and Data about Blatchford scores, patient mortality, hospitalization and discharge were entered into the system. The calculated scores were compared. Results: The general age average was 65.16 ± 16.61 Rockall score average was calculated as 2.75 ± 1.88, Blatchford score average was calculated as 9.72 ± 3.84. Based on the Rockall scores, 86 (45.7%) of 188 patients were low risk, 102...
Biomedical Research, 2018
Background: Pulmonary embolism (PE) is one of the major causes of mortality, morbidity and hospit... more Background: Pulmonary embolism (PE) is one of the major causes of mortality, morbidity and hospitalizations. We aimed to investigate the effect of neutrophil/lymphocyte ratio (NLR) on 1-year mortality. Material and methods: Among the patients, were referred to the emergency department of our hospital within 1-year who underwent computed tomography pulmonary angiography (CTPA), patients who were interpreted as PE after CTPA were included in the study. Results: The optimal NLR cutoff value for the power in predict 1-year mortality was determined as 4.74 with ROC analysis. The NLR cutoff value of 4.74 had sensitivity of 61%, specificity of 75%. There were statistically significant differences between groups in terms of NLR on 1-year mortality and mortality in patients with a NLR greater than 4.74 was statistically significant higher than in patients with a NLR of 4.74 or less. Conclusion: We believe that NLR can be used in evaluating 1-year mortality of pulmonary embolism.
Bitlis Eren University Journal of Science and Technology, 2020
Objective: Motorcycle accidents progress with higher mortality than other accidents. There can be... more Objective: Motorcycle accidents progress with higher mortality than other accidents. There can be many different factors in the emergence of accidents. The aim of this study is to evaluate the effects of alcohol and other demographic characteristics on motorcycle accidents. Materials and Methods: Patients who were admitted to the emergency department after motorcycle accidents between 01.
Bitlis Eren University Journal of Science and Technology, 2019
Turkey is one of the most popular immigration countries because of the wars that are ongoing in i... more Turkey is one of the most popular immigration countries because of the wars that are ongoing in its southern border and its location on access routes to Europe. Migrations continue because of wars and political turmoil. The increasing number of migrants requires revising the public healthcare planning. In our study, we compared the behaviors of immigrants and local people. We examined to which extent immigrants used the clinics of our hospital. We interpreted the adequacy of the current healthcare system for migrants. We analyzed the hospital admissions of migrants and local residents who applied to our hospital between January 2014 and December 2018 in retrospective fashion. We determined the rates of referral to clinics. We determined that the highest referral rates of the migrants were made to emergency services, gynecology and obstetrics. We observed that the birth rates increased in migrants in the following period. However, despite the traumas, immigrants did not use psychiatric units. The existing healthcare and social policies must be revised by considering especially the needs of immigrants and their use of healthcare systems. We believe that primary healthcare services must be delivered equally to all individuals to reduce the intensity of emergency services, gynecology and obstetrics departments, and pediatric services. We also believe that the trauma that iscaused by immigration must not be underestimated.
Cukurova Medical Journal, 2019
The aim of this study was to compare thiol/disulphide haemostasis levels between healthy voluntee... more The aim of this study was to compare thiol/disulphide haemostasis levels between healthy volunteers and the patients who were admitted to emergency with the complaint of ST Elevation myocardial infarction (STEMI). Materials and Methods: This case-control study was carried out in the Department of Emergency Medicine. The participants consisted of 48 healthy volunteers and 48 hospitalized patients with STEMI. The thiol / disulphide level was evaluated in each study group. The association of Thiol levels (native/total) was evaluated in patients with STEMI. Results: No significant difference was found between the patients with STEMI and healthy volunteers regarding their age or gender. The disulphide (SS) levels were similar in both groups. The total thiol (TT) and native thiol (SH) levels were much lower and the SS/TT levels were much higher in the patients with STEMI when compared with the volunteers. Conclusion: This study revealed that the oxidant/antioxidant ratio was shifted to the oxidative side in patients with STEMI. An abnormal thiol/disulphide state might be considered as an important factor in the pathogenesis and in monitoring the treatment response. The thiol resources may be used for diagnosis of STEMI.
Annals of Medical Research, 2019
It was evaluating the shock index and the modified shock index, which are strongly correlated wit... more It was evaluating the shock index and the modified shock index, which are strongly correlated with the severity of the shock. Determining the risk analysis in terms of early mortality of patients diagnosed with pulmonary thromboembolism (PE) in order to specify treatment options and prognosis. Therefore, it is important to determine the severity of pulmonary embolism correctly. The available algorithms, such as the pulmonary embolism severity index, provide a prediction of the patients according to clinical findings. These algorithms score abnormal vital signs, medical findings, age, and comorbid diseases. However, vital signs in normal physiological limits cause errors in determining the severity of the disease. In this case, the problem is a lack of correlation between the severity of the disease and vital signs. Consequently, we need a more reliable parameter. In our study, we searched for a parameter that can be calculated easily in a dynamic manner, and which is not affected by normalized vital signs. We attempted to find a parameter that could indicate the severity of the disease. Therefore, we evaluated the shock index and the modified shock index, which are strongly correlated with the severity of the shock. Material and Methods: Patients diagnosed with pulmonary embolism were screened retrospectively between January 2012 and December 2017. A total of 99 patients whose pulmonary embolism was confirmed by angio-thoracic tomography were included in the study. Heart rate, systolic and diastolic blood pressure were measured in these patients. Mean arterial pressure, shock index and the modified shock index were also calculated. The values showing the severity of the disease were evaluated. Result When all the parameters were examined, the predictive power of deaths within 30 days was significant at differing degrees (p<0.05). In ROC analysis, shock index was the most prominent parameter with its clinical utility and sensitivity. This was followed by pulse count and modified shock index, which are other valuable parameters. Conclusion: At the time of admission to the emergency department, we found that the shock index could be easily calculated with vital signs and display a better correlation with the severity of the disease. Although systolic-diastolic blood pressure, pulse rate and mean arterial pressures calculated in pulmonary embolism are within physiological limits, the shock index shows particularly better correlation and sensitivity of the severity of the disease.
Konuralp Tıp Dergisi, 2019
Objective: Chronic subdural hematoma (CSDH) is a frequently encountered entity in neurosurgery. T... more Objective: Chronic subdural hematoma (CSDH) is a frequently encountered entity in neurosurgery. The objective of this study was to describe the use of unbiased Cavalieri principle to assess CSDH volume to total brain volume fraction (Percentage) and compare it with the clinical features of the patients. Methods: A total of 33 patients were included in the study. Computed tomography (CT) was acquired from the hospital-imaging database. The ratio of hematoma volume, brain volume, and hematoma volume to brain volume were measured via CT by two clinicians. Measurements were compared with clinical findings. Results: The sample consisted of 22 males and 11 females and mean age 67,27±12,63 years. The measured hematoma volume was 89,78 ± 54,13 cm3, the brain volume was 1329,91 ± 2098,35 cm3 and the percentage volume was 8,14 ± 4,92 cm3. The brain volume values of the cases with impaired consciousness were found to be statistically significant (p <0.05). Conclusions: It should be kept in mind that the bleeding volume of patients with vomiting may be higher.
Konuralp Tıp Dergisi, 2019
Objective: Pulmonary embolism (PE) is one of the major causes of mortality, morbidity and hospita... more Objective: Pulmonary embolism (PE) is one of the major causes of mortality, morbidity and hospital admission. We aimed to investigate the association of the Simplified Pulmonary Embolism Severity Index (sPESI) and mortality within 3 months. Methods: A total of 118 patients were included in the study. Patients who died within 3 months after PE diagnosis were defined as Group 1. Other patients were defined as Group 2. The sPESI score was calculated and recorded. The effect of these scoring systems on 3-month mortality rate was investigated. Results: There were 31 patients (26.3%) in Group 1 and 87 patients (73.7%) in Group 2. When the sPESI scores of the patients were examined, there was difference between Group 1 and 2 in terms of 3-month mortality. The sPESI had a sensitivity of 43.3% and a specificity of 79.4% for predicting 3-month mortality. Conclusions: It is important to categorize patients diagnosed with PE in the emergency department according to their risk profiles in terms of their treatment needs.
Hong Kong Journal of Emergency Medicine, 2019
Introduction: Allergic acute myocardial infarction with ST-segment elevation is rare, and vasocon... more Introduction: Allergic acute myocardial infarction with ST-segment elevation is rare, and vasoconstrictor mediators released from mast cells are responsible for its pathogenesis. Several medications have been reported to lead to acute myocardial infarction with ST-segment elevation, as a part of systemic allergic reactions and this entity is known as Kounis syndrome (KS). Case presentation: We presented a patient with recurrent KS who had no allergic reactions, except coronary spasm after parenteral diclofenac administration. First, she experienced anterior myocardial infarction with ST-segment elevation after administration of diclofenac 2 years ago. The second presentation was acute inferior-posterior myocardial infarction with ST-segment elevation with atrioventricular complete block leading to cardiogenic shock. She had no significant coronary stenosis responsible for each myocardial infarction with ST-segment elevation. However, she had a catheter-induced coronary spasm of non-...
Cumhuriyet Medical Journal, 2017
This paper describes the developments in the Netherlands to establish a national Network for Digi... more This paper describes the developments in the Netherlands to establish a national Network for Digital Heritage. This network is based on three pillars: to make the digital heritage visible, usable and sustainably preserved. Three working programmes will have their own but integrated set of dedicated actions in order to create a national infrastructure in the Netherlands, based on an optimal use of existing facilities. In this paper the focus is on the activities related to the sustainable preservation of the Dutch national digital heritage.
Cumhuriyet Medical Journal, 2017
This paper describes the developments in the Netherlands to establish a national Network for Digi... more This paper describes the developments in the Netherlands to establish a national Network for Digital Heritage. This network is based on three pillars: to make the digital heritage visible, usable and sustainably preserved. Three working programmes will have their own but integrated set of dedicated actions in order to create a national infrastructure in the Netherlands, based on an optimal use of existing facilities. In this paper the focus is on the activities related to the sustainable preservation of the Dutch national digital heritage.
Biomedical Research, 2018
Objective: Inflammatory reaction, which causes tissue damage in Acute Coronary Syndrome (ACS), le... more Objective: Inflammatory reaction, which causes tissue damage in Acute Coronary Syndrome (ACS), leads to deterioration. White Blood Cell (WBC), Neutrophil (N), Lymphocyte (L) and Neutrophil/ Lymphocyte (N/L) ratios were used to refer to the inflammation. High neutrophil levels show us acute inflammatory situation and low lymphocyte levels show us physiological stress. That is why N/L ratio is a valuable parameter which enables us to guess patient prognosis in Emergency Department (ED). In this study, white cell and NLR relations with ACS in patients with chest pain is evaluated. Material and method: Patients referring to ED with chest pain within 3 months were investigated retrospectively. 100 patients were included in the study. Patients' WBC count, NLR and WBC values, gender, Troponin-I and CK-MB positivity, history of Coronary Heart Disease (CHD) and additional diseases were examined according to the final diagnoses. All the patients were divided into three groups according to ACS: Unstable Angina Pectoris (USAP), Non-ST Elevated Myocardial Infarction (NSTEMI), and ST-Elevated Myocardial Infarction (STEMI). Mortality and morbidity levels in hospital and after discharge were also examined in the study. Findings: WBC values in patients with positive Troponin-I were found statistically higher than patients with negative Troponin-I (p<0.05). In STEMI group, WBC values were statistically higher than USAP group (p<0.0083). When patients' N/L ratio average distribution was examined; Troponin-I and CK-MB positive patients' NLR was found to be statistically higher than Troponin-I and CK-MB negative ones (p<0.05). Conclusion: N/L ratio, which is a marker of inflammatory process in the myocardial vascular bed, may be considered as a risk marker. For this reason, N/L ratio at admission can be used as an auxiliary parameter for predicting the diagnosis of ACS.
Meandros Medical and Dental Journal, 2017
Objective: Although acute aort dissection (AAD) is quite difficult to be diagnosed in the emergen... more Objective: Although acute aort dissection (AAD) is quite difficult to be diagnosed in the emergency department, the mortality of it is very high. Therefore, the purpose of our study is to discuss the evidence of demographic characteristics, clinical, laboratory of the AAD patients who applied to emergency department over mortality. MaterialsandMethods: In our research including 73 patients with AAD diagnosed whom admitted to emergency department on January 2010-October 2015. Sex, age, presenting complaints, past medical history, arterial blood pressure, pulse, laboratory tests, transthoracic echocardiography (TTE), thoracoabdominal computerized tomography (CT), mortality and DeBakey type have been recorded on patient information form. Statistical analysis was performed in IBM SPSS Statistics Version 22.0 software package. The comparison between the two groups of data Pearson chi-square, Fisher's exact and chi-square tests were used for statistical analysis of trends. P<0.05 was considered statistically significant. Results: Fourty seven patients (64.4%) were male and 26 (35.6%) were women. In the background of the patients it was identified hypertension as the most common rate of 68.5%. The most common complaints identified were chest pain (53.4%) and back pain (42.5%). It has been determined 68 (93.1%) patients to whom CT have scanned and 27 out of 42 (64.3%) patients to whom TTE have scanned were found to have AAD. According to the DeBakey classification, 31 (42.5%) were DeBakey type 1, 18 (24.7%) DeBakey type 2 and 24 (32.9%) DeBakey type 3 as the AAD. Conclusion: Aortic dissection is still a highly mortality disease. The most important condition to reduce the mortality was thought the early diagnosis and the appropriate surgical intervention. Amaç: Akut aort diseksiyonu (AAD) acil serviste tanısı oldukça zor konulmasına rağmen mortalitesi çok yüksek bir hastalıktır. Bu nedenle, acil tıp kliniğine başvuran AAD tanılı hastaların demografik özellikleri, klinik, laboratuvar ve radyolojik bulgularının mortalite üzerine etkilerini araştırmayı amaçladık. Gereç ve Yöntemler: Çalışmamızda Ocak 2010 ile Ekim 2015 tarihleri arasında acil tıp kliniğinde AAD tanısı konulan ve çalışmaya dahil edilen 73 hasta geriye dönük incelendi. Yaş, cinsiyet, başvuru şikayetleri, özgeçmişleri, arteriyel kan basınçları, nabız sayısı, istenilen laboratuvar tetkikleri, transtorasik ekokardiyografi (TTE), kontrastlı torakoabdominal bilgisayarlı tomografi (BT) mortalite ve diseksiyon tipi