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Öğe Assessing the Predictive Value of Combining Risk Scoring Systems and Ultrasonography for Short-Term Adverse Outcomes in Syncope: A Prospective Observational Study(Elsevier Science Inc, 2024) Sekreter, Tarik; Altunci, Yusuf Ali; Uz, Ilhan; Akarca, Funda KarbekBackground: In the emergency department (ED), the role of ultrasonography (USG) in risk stratification and predicting adverse events in syncope patients is a current research area. However, it is still unclear how ultrasound can be combined with existing risk scores. Objectives: In this study, it was aimed to examine the contribution of the use of bedside USG to current risk scores in the evaluation of patients presenting to the ED with syncope. The predictive values of the combined use of USG and risk scores for adverse outcomes at 7 and 30 days were examined. Methods: The Canadian Syncope Risk Score (CSRS), San Francisco syncope rules (SFSR), USG findings of carotid and deep venous structures, and echocardiography results were recorded for patients presenting with syncope. Parameters showing significance in the 7-day and 30-day adverse outcome groups were utilized to create new scores termed CSRS-USG and SFSR-USG. Predictive values were evaluated using receiver operating characteristic (ROC) analysis. The difference between the predictive values was evaluated with the DeLong test. Results: The study was carried out with 137 participants. Adverse outcomes were observed in 45 participants (32.8%) within 30 days. 32 (71.7%) of the adverse outcomes were in the first 7 days. For 30-day adverse outcomes, the SFSR-USG ( p = 0.001) and CSRS-USG ( p = 0.038) scores had better predictive accuracy compared to SFSR and CSRS, respectively. However, there was no sig nificant improvement in sensitivity and specificity values. Conclusion: The use of USG in the evaluation of syncope patients did not result in significant improvement in sensitivity and specificity values for predicting adverse events. However, larger sample-sized studies are needed to understand its potential contributions better. (c) 2024 Elsevier Inc. All rights reserved.Öğe COMPARISON OF CLINICAL FRAILTY SCALE AND EDMONTON FRAIL SCALE IN OLDER ADULTS PRESENTING TO THE EMERGENCY DEPARTMENT(Turkish Geriatrics Soc, 2024) Yucel, Mustafa; Altunci, Yusuf Ali; Ozcete, Enver; Kilavuz, Asli; Karbek Akarca, FundaIntroduction: This study aimed to compare the prognostic values of Edmonton Frail Scale and Clinical Frailty Scale in the emergency department and determine their suitability for patient management. Materials and Method: This study was conducted as a single-center prospective observational study. Patients aged 65 and older who presented to the emergency department were included. Clinical Frailty Scale and Edmonton Frail Scale scores, the emergency department outcomes, length of stay in the emergency department, 30-day mortality, and 30-day readmission data of the patients were recorded. ROC analysis was performed to examine the predictive values on outcomes. DeLong Test was used to compare the predictive values. Results: This study included 400 patients. Intensive care unit admission was significantly more frequent in the frail group according to both Edmonton Frail Scale and Clinical Frailty Scale. The length of stay in the emergency department was significantly longer in the frail group in both classifications. The mortality rate was significantly higher in the frail group in both classifications. The optimal cut off value for predicting mortality was found to be 9 for Edmonton Frail Scale and 7 for Clinical Frailty Scale. There was no significant difference between the predictive values of two scales. Conclusion: We found that two frail scales have good predictive values for adverse outcomes, such as mortality and the need for Intensive care unit admission in the emergency department. We believe that both scores would be valuable in guiding decisions for the emergency department usage due to their similar predictive values.Öğe Comparison of Video Laryngoscopy and Direct Laryngoscopy in the Success of Intubation Performed by Novice Personnel in Patients with Cervical Immobilization: A Manikin Study(Tehran Univ Medical Sciences, 2021) Can, Ozge; Yalcinli, Sercan; Altunci, Yusuf AliIntroduction: Pre-hospital intubation is a challenging but essential intervention. During intubation, it is difficult to identify vocal cords when using a cervical collar and trauma board. Therefore, the success rate of intubation by paramedics decreases in trauma patients. Video laryngoscopy increases intubation success rate and has been recommended for difficult airways in studies. Objective: In this study, we compared the intubation success rates when using a video laryngoscope and a direct laryngoscope in a manikin with simulated cervical immobilization. Methods: In this cross-sectional study, the manikin's neck collar and spine board created a complicated airway model with cervical immobilization. Inexperienced paramedic students tried intubation with both methods, and their trial periods were recorded. Students answered a question evaluating the convenience of the procedure for both methods after the trial. Results: In this study, 83 volunteers, who were first-year and second-year paramedics, participated; 32 (38.6%) of the volunteers were first-year students, while 51 (61.4%) were second-year students. All volunteers had previous intubation experience with direct laryngoscopy, but not with video laryngoscopy. There was a statistically significant difference in the first-attempt success rates of the procedure between the groups in favor of video laryngoscope (p=0.022). Note that there was no significant difference between the groups in terms of first attempt durations (p=0.337). Conclusion: Video laryngoscopy in airway management can increase the success rate of first-attempt intubation by inexperienced pre-hospital healthcare personnel.Öğe Computed tomography vs. magnetic resonance imaging in unstable cervical spine injuries(Turkish Assoc Trauma Emergency Surgery, 2020) Kodik, Meltem Songur; Eraslan, Cenk; Kitis, Omer; Altunci, Yusuf Ali; Biceroglu, Huseyin; Akay, AliBACKGROUND: This study aimed to investigate the role of computed tomography (CT) in identifying missed unstable blunt cervical injuries. METHODS: Patients admitted to the emergency department between June 2014 and June 2018 with a diagnosis of blunt cervical trauma were included in this study. All participants underwent cervical magnetic resonance imaging (MRI) after an initial cervical CT investigation. All imaging results were reviewed, and decisions were taken by the consensus of a team consisting of an emergency medicine specialist, a neuroradiologist, and a neurosurgeon. Other variables included age, sex, the Glasgow Coma Scale, medical comorbidities, multi-trauma, neurological deficits, accompanying intracranial hemorrhage, extremity fractures, and the mechanism of the injury. RESULTS: Data for 195 patients were analyzed. the mean (+/- standard deviation) age of the participants was 47.34 +/- 21.90 years, and 140 (71.8%) were males. Eighteen patients (9.2%) were below age <18. the most frequent mechanism of injury was fall from height (n=100; 51.3%). Using MRI as the gold standard, the sensitivity of CT in diagnosing unstable cervical injury was 77.7% (95% CI [67.1-86.1]), while its specificity was 100.0% (95% CI [59.0-100.0]). CONCLUSION: Although computed tomography is relatively good in diagnosing unstable cervical injuries, its sensitivity in detecting positive cases is not as successful. Thus, the use of MRI in patients with an unstable injury seems to be warranted.Öğe Effects of Silk Sericin on Incision Wound Healing in a Dorsal Skin Flap Wound Healing Rat Model(Int Scientific Literature, Inc, 2016) Ersel, Murat; Uyanikgil, Yigit; Akarca, Funda Karbek; Ozcete, Enver; Altunci, Yusuf Ali; Karabey, Fatih; Cavusoglu, Turker; Meral, Ayfer; Yigitturk, Gurkan; Cetin, Emel OykuBackground: The wound healing process is complex and still poorly understood. Sericin is a silk protein synthesized by silk worms (Bombyx mori). The objective of this study was to evaluate in vivo wound healing effects of a sericin-containing gel formulation in an incision wound model in rats. Material/Methods: Twenty-eight Wistar-Albino rats were divided into 4 groups (n=7). No intervention or treatment was applied to the Intact control group. For other groups, a dorsal skin flap (9x3 cm) was drawn and pulled up with sharp dissection. The Sham operated group received no treatment. The Placebo group received placebo gel without sericin applied to the incision area once a day from day 0 to day 9. The Sericin Group 3 received 1% sericin gel applied to the incision area once a day from day 0 to day 9. Hematoxylin and eosin stain was applied for histological analysis and Mallory-Azan staining was applied for histoimmunochemical analysis of antibodies and iNOS (inducible nitric oxide synthase), and desmin was applied to paraffin sections of skin wound specimens. Parameters of oxidative stress were measured in the wound area. Results: Epidermal thickness and vascularization were increased, and hair root degeneration, edema, cellular infiltration, collagen discoloration, and necrosis were decreased in Sericin group in comparison to the Placebo group and the Sham operated group. Malonyldialdehyde (MDA) levels were decreased, but superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) activities were increased in the sericin group. Conclusions: We found that sericin had significant positive effects on wound healing and antioxidant activity. Sericin-based formulations can improve healing of incision wounds.Öğe Evaluation of substance use in Izmir during the COVID-19 pandemic(Taylor & Francis Inc, 2022) Aydogdu, Melike; Aslan, Rukiye; Can, Ozge; Altunci, Yusuf Ali; Akgur, Serap AnnetteBackground: Substance use can vary in extraordinary periods, such as natural disasters and epidemics. This study scrutinized the toxicological test results of the people who used different types of substances during the 2020 COVID-19 pandemic period in Izmir. Methods: Due to the COVID-19 outbreak, extreme security measures were implemented in March, April, and May of 2020, and the lockdown was imposed at different levels. The patients who were urine tested for illegal substances were also investigated from the point of the socio-demographic characteristics and clinical data. Results: Thirty-six percent of the cases (n = 32) were positive for illegal substances in urinalysis. These substances were: 60% (n = 12) amphetamine-type stimulants (ATS), 20% (n = 4) benzodiazepine, 10% (n = 2) cannabis, 5% (n = 1) buprenorphine, 5% (n = 1) cocaine. Multiple substance use observed in 12 cases. Conclusions: When the pandemic period data were compared with the previous years, the drug test positive rate in the same periods of 2017 and 2018 was 25.9% and 23.9%, respectively. However, this rate increased to 36% during the pandemic period in 2020. In 2017 and 2018, cannabis was the most frequently found substance in the urine on testing with the rate of 41.5% (n = 184) and 50.8% (n = 219), respectively, it was ATS with 60% (n = 2) in 2020.Öğe Flow-safe disposable CPAP efficiency in cardiogenic pulmonary oedema(W B Saunders Co-Elsevier Inc, 2020) Uz, Ilhan; Kiyan, Guclu Selahattin; Ozcete, Enver; Yalcinli, Sercan; Korgan, Mehmet Birkan; Altunci, Yusuf Ali; Yavuzgil, Oguz[No abstract available]Öğe Is the flow-safe disposable continuous positive airway pressure (CPAP) system as effective as non-invasivemechanical ventilation (NIMV) in the treatment of acute cardiogenic pulmonary Oedema?(W B Saunders Co-Elsevier Inc, 2021) Uz, Ilhan; Kiyan, Guclu Selahattin; Ozcete, Enver; Yalcinli, Sercan; Korgan, Mehmet Birkan; Altunci, Yusuf Ali; Yavuzgil, Oguz[No Abstract Available]Öğe New Psychoactive Substance 5-MeO-MiPT in vivo Acute Toxicity and Hystotoxicological Study(Aves, 2021) Altunci, Yusuf Ali; Aydogdu, Melike; Acikgoz, Eda; Guven, Ummu; Dukagac, Fahriye; Atasoy, Asli; Akgur, Serap AnnetteBackground: The hallucinogenic tryptamine analog 5-methoxy-N-methyl-N-isopropyltryptamine (5-MeO-MiPT) causes social problems worldwide. There are several studies on the metabolism; however, not more studies were found in the literature on acute toxicity. Aims: To report the acute toxicity of 5-MeO-MiPT in mice, followed by quantitative toxicological analysis of blood and organs, hystotoxico-logical and immunohistochemical analysis of tissues and cells. Study design: Animal experiment Methods: in vivo experiments were performed using CD1 adult female mice (n=26). Animals were caged in 4 groups randomly. First group was a control (n=3). Second group was vehicle control (n=3) and injected 150 mu L of blank solution (50% dimethyl sulfoxide in saline /0.9% of NaCl). While for acute toxicity experiments, 5-MeO-MiPT was added to a blank solution in order to obtain a dose of 0.27 mg/kg in 150 mu L injection (n=10) and the last group were injected 2.7 mg/kg 5-MeO-MiPT in a 150 mu L injection (n=10). Quantitative toxicological analysis, hystotoxicological and immunohistochemical analysis were performed. Results: in the toxicological analysis, 5-MeO-MiPT was found negative in biological samples which were control, vehicle control, and 0.27 mg/kg dose mice groups. 5-MeO-MiPT was found 2.7-13.4 ng/mL in blood, 11-29 ng/g in kidney, 15.2-108.3 ng/g in liver, and 1.5-40.6 ng/g in the brain in 2,7 mg/kg injected group. in a low dose of the 5-MeO-MiPT liver section, compared with normal tissues, the difference in staining was statistically significant (p<0.0001). in high-dose of 5-MeO-MiPT, H-score showed that the increase in the number of Caspase-3 positive cells was significant compared to the control (p<0.05). in high-dose of 5-MeO-MiPT, intense Caspase-3 immunoreactivity was observed and the increase in the number of Caspase-3 positive cells compared to the control was statistically significant (p<0.05). in brain section, the statistics of the results obtained from the H-score showed that the increase in the number of Caspase-3 positive cells was significant compared to the control (p=0.0183). in vehicle control liver section, there were few Caspase-8 positive cells characterized by a light brown appearance (p=0.0117). in the high-dose 5-MeO-MiPT group, the numbers of positive cells at low and high doses of 5-MeO-MiPT group were statistically significant compared to the control (p<0.05). in the high-dose 5-MeO-MiPT group, Caspase-8 immunoreactivity was detected in the glomerular structures. Compared to control, the increase in Caspase-8 immunoreactivity was found to be statistically significant (p<0.05). Conclusion: Low-dose 5-MeO-MiPT did not cause any serious histopathological effects on the liver, kidney, and brain. High doses induce apoptotic cell death through caspase activity.Öğe Nivolumab, a new immunomodulatory drug, a new adverse effect; adrenal crisis(Elsevier Science Bv, 2017) Akarca, Funda Karbek; Can, Ozge; Yalcinli, Sercan; Altunci, Yusuf AliOwing to the advancements in medicine, new information is obtained regarding cancer, new antineoplastic agents are developed. Frequent use of these new pharmacological agents emergency physicians to be vigilant about their side effects. We present a case of adrenal crisis in a patient with non-small cell lung cancer (NSCLC), caused by an immunomodulatory drug; nivolumab. While adverse events are related to other immunomodulatory drugs have been reported in literature, our case is the first nivolumab-related adrenal failure to be reported. A patient with lung cancer presented to the emergency room(ER) with nausea and vomiting. Hyponatremia, hyperkalemia, persistent hypoglycemia led to the diagnosis of adrenal crisis. Having direct effect on the immune system, these drugs were claimed to be highly reliable. However, there is no reliable data on the side effect profile of these agents. It should be kept in mind that life-threatening auto-immune reactions may occur. Copyright (C) 2017 The Emergency Medicine Association of Turkey. Production and hosting by Elsevier B.V. on behalf of the Owner. This is an open access article under the CC BY-NC-ND license.Öğe The prevalence and risk factors of hand eczema among emergency healthcare workers during the COVID-19 pandemic(2021) Kodik, Meltem Songur; Çetin, Zeynep Dila; Ünal, İdil; Altunci, Yusuf AliAim: The preventive measures to decelerate the spread of the novel coronavirus include intense hand sanitizing which is a risk factor for hand eczema. Occupational hand eczema is common among healthcare workers due to their exposure to wet work and chemical irritants. We aimed to evaluate the prevalence of hand eczema among healthcare workers currently working in the emergency department and investigate the alterations regarding the risk factors during the COVID-19 pandemic that began in March 2020 in Turkey. Materials and Methods: An online survey was sent to healthcare workers in emergency departments all over Turkey. Participants were asked to evaluate their frequency of hand washing, hand eczema, glove use and moisturizer use as prior to and during the COVID-19 pandemic. Hand eczema and associated symptoms were self-reported. Results: Three hundred fifty-four healthcare workers, consisting of 260 emergency physicians and 94 nurses returned the survey. The prevalence of HE among 354 participants with a median age of 32 was 48.6% (n=161). HE was associated with having an atopic history (p<0.001). 54.8% (n=194) of the participants reported having symptoms associated with HE prior to the pandemic and the rate increased significantly to 64.7% (n=229) during the pandemic (p<0.001). The exposure to the risk factors of hand eczema such as hand washing frequency and duration of glove use showed a relevant increase during the pandemic (p<0.001). As well as moisturizer applying frequency which also increased during the pandemic (p<0.001). Conclusion: With the outbreak of the COVID-19 pandemic, Healthcare workers intensified their hand hygiene practices as recommended and increased their risk for hand eczema.Öğe Risk factors for neurological complications and clinical outcomes in patients with left ventricular assist devices(Mre Press, 2021) Kodik, Meltem Songur; Yildiz, Ali Kemal; Uz, Ilhan; Yalcinli, Sercan; Kahraman, Umit; Bolat, Elif; Altunci, Yusuf AliObjectives: Patients with left ventricular assist devices (LVADs) frequently experience cerebrovascular complications. We investigated the complications, including intracranial hemorrhage (ICH) and ischemic stroke (IS), in patients with LVADs. Methods: A historical cohort study was performed at an emergency clinic including patients who underwent LVAD placement between February 16, 2015, and April 1, 2020. of the 295 patients with LVADs, 71 (24.1%) were admitted to the emergency service between the study dates because of IS and ICH. Electronic medical files were reviewed, and patients were categorized as ICH or IS. Results: of the included patients, 245 (83.0%) were male. The most common postoperative complications were pump thrombosis (26.8%, n = 79), blood culture positivity (19.3%, n = 57), and surgical bleeding (5.8%, n = 17). The most frequent LVAD indication was ischemic dilated cardiomyopathy (71.5%, n = 211). The mean age was 49.6 +/- 16.7 and 51.3 +/- 14.8 years for patients with and without neurological complications, respectively (P = 0.415). Neurological complications were seen in 65 (31.3%) patients with and in 6 (6.9%) patients without coronary ischemia (P < 0.001). Neurological complications were found in 39 (30.5%) patients with an implantable cardioverter defibrillator (ICD) and in 32 (19.2%) patients without an ICD (P = 0.024). Neurological complications were found in 19 (61.3%) patients with and in 52 (19.7%) patients without a history of stroke (P < 0.001). Logistic regression analysis revealed that age and Glasgow coma scale (GCS) were the only significant variables independently affecting mortality status. While a younger age was a protective factor, a one-unit increase in the GCS was associated with a 4.1-fold (95% CI: 1.308-13.071) increase in mortality. Conclusions: Coronary ischemia, ICD, cerebrovascular disease, and smoking significantly affected the presence of complications. Moreover, patients with combined IS and ICH had a lower chance of recovering. Interventional procedures should be performed as early as possible, especially in elderly patients with a low GCS.Öğe The role of whole-body computed tomography in determining risky patient group with regard to polytrauma patients in the emergency department(Sage Publications Ltd, 2018) Ozcete, Enver; Kiyan, Selahattin; Uz, Ilhan; Kodik, Meltem Songur; Altunci, Yusuf AliBackround: High rates in trauma-related mortality pose a major health problem and increase every day. Early diagnosis and treatment can be lifesavers for this patient group in the emergency departments, which serve as the first place to admit trauma patients in a hospital. Objectives: We aim to determine high-risk criteria to indicate trauma patients getting the most use from whole-body tomography in patients with multiple traumas and reduce unnecessary computed tomography. Methods: We examined retrospectively all electronic files and computed tomography results of patients, who had been admitted to emergency department due to trauma, and who had undergone whole-body computed tomography. Results: We found that possibility of multiple injuries increased by 5.9 times in patients requiring mechanical ventilation. Possibility of multiple injuries in patients with free fluid in the Focused Assessment with Sonography for Trauma increased by 5.6 times. We also observed that possibility of multiple injuries in patients with Glasgow Coma Score < 13 increased by 4.3 times. Possibility of multiple injuries in hypoxic patients increased by 3.2 times. Possibility of multiple injuries in patients with a pulse >= 120/min increased by 1.8 times. Possibility of multiple injuries in patients with shock index >= 0.9 increased by 1.7 times. Conclusion: High-risk group in terms of multiple traumas involves mechanical ventilation need in trauma patients, positive Focused Assessment with Sonography for Trauma, Glasgow Coma Score being under 13, hypoxia, tachycardia, positive shock index, and extravehicular traffic accidents. Whole-body computed tomography should be performed in this patient group.Öğe Social media, FOAMed in medical education and knowledge sharing: Local experiences with international perspective(Kare Publ, 2016) Cevik, Arif Alper; Aksel, Gokhan; Akoglu, Haldun; Eroglu, Serkan Emre; Dogan, Nurettin Ozgur; Altunci, Yusuf AliSocial media, through the Internet and other web-based technologies, have become a means of communication and knowledge-sharing. In this article, we provide details about the social media traffic of various scientific activities, the organizations of which we have played an active role in. We also provide information in our native language through our FOAMed website, which has been published for about 30 months, with us acting as editors. We are comparing these local and limited ventures with examples from the world and aim to remind that social media sources play a very important role in sharing knowledge in medical training and encouraging local initiatives, like ours, with limited resources. Copyright (C) 2016 The Emergency Medicine Association of Turkey. Production and hosting by Elsevier B.V. on behalf of the Owner. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
