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Orhan U, Gulen M, Satar S, Acehan S, Nazik H, Unlu N, Gediklioglu M, Isikber C, Sonmez A, Sonmez GO. Hemodialysis treatment for poisoning patients in the emergency department. Ther Apher Dial 2022; 27:580-586. [PMID: 36504481 DOI: 10.1111/1744-9987.13960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/30/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION We aimed to evaluate the hemodialysis (HD) use in adult patients after acute poisoning in the emergency department. METHODS The study was performed as a retrospective observational cohort study. We analyzed hospital electronic data system and patient files. RESULTS A total of 55 patients were included in the study. Among the 10 toxins exposed, the most common were methanol and metformin. The most common indications for HD treatment were: 67.3% (n = 37) for toxin elimination, 20% (n = 11) for treatment-resistant metabolic acidosis, hemodynamic disorder. The most common complication (50.9%) in all patients was central nervous system depression. Ten patients died from ingestion of methanol, one of aluminum phosphide, and one of opioid-sympathomimetic-hallucinogen agents. CONCLUSION HD is the most commonly used extracorporeal treatment method in the treatment of poisoning patients. HD should be considered without any delay in treating poisoned patients if there is no response to conventional treatments.
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Affiliation(s)
- Ugur Orhan
- Department of Emergency Medicine, Bitlis State Hospital, Bitlis, Turkey
| | - Muge Gulen
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Salim Satar
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Selen Acehan
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Hakan Nazik
- Department of Gynecology and Obstetrics, Adana Middle East Hospital, Adana, Turkey
| | - Nurdan Unlu
- Department of Anesthesiology and Intensive Care, Adana City Training and Research Hospital, Adana, Turkey
| | - Mustafa Gediklioglu
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Cem Isikber
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Ahmet Sonmez
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Gökben Oral Sonmez
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
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Sahin GK, Gulen M, Acehan S, Firat BT, Isikber C, Kaya A, Segmen MS, Simsek Y, Sozutek A, Satar S. Do biomarkers have predictive value in the treatment modality of the patients diagnosed with bowel obstruction? Rev Assoc Med Bras (1992) 2021; 68:67-72. [PMID: 34909965 DOI: 10.1590/1806-9282.20210771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the ability of the biomarkers to predict the surgery treatment and mortality in patients above 18 years of age who were hospitalized with the diagnosis of bowel obstruction from the emergency department. METHODS This is a 2-year retrospective study. The patients' demographic data, laboratory parameters on admission to emergency department, treatment modalities, and the length of hospital stay were recorded. Patients were divided into two groups: conservative and surgical treatment. Statistical analysis was performed to investigate the value of biomarkers in predicting mortality and the need for surgery. Data were analyzed using IBM SPSS version 22. RESULTS A total of 179 patients were included in this study. Of these, 105 (58.7%) patients were treated conservative and 74 (41.3%) were treated operatively. The elevated procalcitonin (PCT) level, C-reactive protein, blood urea nitrogen-to-albumin ratio, and lactate-to-albumin ratio were significantly correlated with surgical treatment, length of hospital stay, and mortality. procalcitonin threshold value of 0.13 ng/mL was able to predict the need for surgical treatment, with a sensitivity of 79% and a specificity of 70.3%. Procalcitonin threshold value of 0.65 ng/mL was able to predict the mortality rate of the patients, with a sensitivity of 92.9% and a specificity of 78.1%. CONCLUSIONS Biomarkers, especially procalcitonin, may be useful in bowel obstruction treatment management and may predict mortality.
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Affiliation(s)
- Gonca Koksaldi Sahin
- Adana City Training and Research Hospital, Department of Emergency Medicine - Adana, Turkey
| | - Muge Gulen
- Adana City Training and Research Hospital, Department of Emergency Medicine - Adana, Turkey
| | - Selen Acehan
- Adana City Training and Research Hospital, Department of Emergency Medicine - Adana, Turkey
| | - Basak Toptas Firat
- Adana City Training and Research Hospital, Department of Emergency Medicine - Adana, Turkey
| | - Cem Isikber
- Adana City Training and Research Hospital, Department of Emergency Medicine - Adana, Turkey
| | - Adem Kaya
- Adana City Training and Research Hospital, Department of Emergency Medicine - Adana, Turkey
| | - Mustafa Sencer Segmen
- Adana City Training and Research Hospital, Department of Emergency Medicine - Adana, Turkey
| | - Yeliz Simsek
- Adana City Training and Research Hospital, Department of Emergency Medicine - Adana, Turkey
| | - Alper Sozutek
- Adana City Training and Research Hospital, Department of General Surgery - Adana, Turkey
| | - Salim Satar
- Adana City Training and Research Hospital, Department of Emergency Medicine - Adana, Turkey
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Isikber C, Gulen M, Satar S, Avci A, Acehan S, Isikber GG, Yesiloglu O. Evaluation of the frequency of patients with cancer presenting to an emergency department. ACTA ACUST UNITED AC 2021; 66:1402-1408. [PMID: 33174934 DOI: 10.1590/1806-9282.66.10.1402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/21/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study aims to determine the demographic characteristics of cancer patients admitted to an emergency department and determine the relationship between the frequency of admission to the emergency department and oncological emergencies and their effect on mortality. METHODS This observational, prospective, diagnostic accuracy study was performed in the ED of a tertiary care hospital. Patients over the age of 18 who were previously diagnosed with cancer and admitted to the emergency service for medical reasons were included in the study. We recorded baseline characteristics including age, gender, complaints, oncological diagnosis, metastasis status, cancer treatments received, the number of ED admissions, structural and metabolic oncological emergency diagnoses in the ED, discharge status, length of hospital stay, and mortality status. RESULTS In our study, 1205 applications related to the oncological diagnosis of 261 patients were examined. 55.6% of the patients were male, and 44.4% were female. The most common metabolic oncological emergency was anemia (19.5%), and the most common structural oncological emergency was bone metastasis-fracture (4.6%.) The mean score of admission of patients to the emergency department was four times (min: 1 max: 29) during the study period. A total of 49.4% (n: 129) of the patients included in the study died during follow-up, and the median time of death was 13 days after the last ED admission. CONCLUSION The palliation of patient symptoms in infusion centers that will be established in the palliative care center will contribute to the decrease in the frequency of use of emergency services.
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Affiliation(s)
- Cem Isikber
- Adana City Training and Research Hospital, Department of Emergency Medicine, Adana, Turkey
| | - Muge Gulen
- Adana City Training and Research Hospital, Department of Emergency Medicine, Adana, Turkey
| | - Salim Satar
- Associate Professor, Adana City Training and Research Hospital, Department of Emergency Medicine, Adana, Turkey
| | - Akkan Avci
- Adana City Training and Research Hospital, Department of Emergency Medicine, Adana, Turkey
| | - Selen Acehan
- Adana City Training and Research Hospital, Department of Emergency Medicine, Adana, Turkey
| | - Gulistan Gul Isikber
- Adana City Training and Research Hospital, Department of Infectious Diseases and Microbiology, Adana, Turkey
| | - Onder Yesiloglu
- Adana City Training and Research Hospital, Department of Emergency Medicine, Adana, Turkey
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Firat BT, Gulen M, Satar S, Firat A, Acehan S, Isikber C, Kaya A, Sahin GK, Akoglu H. Perfusion index: Could this be a new triage tool for upper gastrointestinal system bleeding in the emergency department? A prospective cohort study. SAO PAULO MED J 2021; 139:583-590. [PMID: 34644767 PMCID: PMC9634832 DOI: 10.1590/1516-3180.2021.0106.r1.0904221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/09/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Many scoring systems for predicting mortality, rebleeding and transfusion needs among patients with upper gastrointestinal bleeding (UGIB) have been developed. However, no scoring system can predict all these outcomes. OBJECTIVE To show whether the perfusion index (PI), compared with the Rockall score (RS), helps predict transfusion needs and prognoses among patients presenting with UGIB in emergency departments. In this way, critical patients with transfusion needs can be identified at an early stage. DESIGN AND SETTING Prospective cohort study in an emergency department in Turkey, conducted between June 2018 and June 2019. METHODS Patients' demographic parameters, PI, RS, transfusion needs and prognosis were recorded. RESULTS A total of 219 patients were included. Blood transfusion was performed in 174 patients (79.4%). The PI cutoff value for prediction of the need for blood transfusion was 1.17, and the RS cutoff value was 5. The area under the curve (AUC) value for PI (AUC: 0.772; 95% confidence interval, CI: 0.705-0.838; P < 0.001) was higher than for RS (AUC: 0.648; 95% CI: 0.554-0.741; P = 0.002). 185 patients (84.5%) were discharged, and 34 patients (15.5%) died. The PI cutoff value for predicting mortality was 1.1, and the RS cutoff value was 7. The AUC value for PI (AUC: 0.743; 95% CI: 0.649-0.837; P < 0.001) was higher than for RS (AUC: 0.725; 95% CI: 0.639-0.811; P < 0.001). CONCLUSION PI values for patients admitted to emergency departments with UGIB on admission can help predict their need for transfusion and mortality risk.
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Affiliation(s)
- Basak Toptas Firat
- MD. Emergency Physician, Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey.
| | - Muge Gulen
- MD, PhD. Associate Professor, Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey.
| | - Salim Satar
- MD, PhD. Associate Professor, Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey.
| | - Ahmet Firat
- MD. Internal Medicine Physician, Department of Intensive Care Unit, Cukurova University School of Medicine, Adana, Turkey.
| | - Selen Acehan
- MD. Emergency Physician, Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey.
| | - Cem Isikber
- MD. Emergency Physician, Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey.
| | - Adem Kaya
- MD. Emergency Physician, Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey.
| | - Gonca Koksaldi Sahin
- MD. Emergency Physician, Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey.
| | - Haldun Akoglu
- MD, PhD. Professor, Department of Emergency Medicine, Marmara University School of Medicine, Istanbul, Turkey.
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Gulen M, Satar S, Acehan S, Avci A, Kaya A, Sener K, Isikber C. Benign paroxysmal positional vertigo in emergency department: How to treat? HONG KONG J EMERG ME 2020. [DOI: 10.1177/1024907920972283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The treatment of benign paroxysmal positional vertigo (BPPV) has not been well studied. Many clinicians are indifferent about canalith reposition maneuvers and frequently prefer medical treatments. Objectives: We aimed to detect efficacy of Epley maneuver in relieving symptoms of benign paroxysmal positional vertigo patients diagnosed in emergency department and if medical treatments are useful in patients whose symptoms were not relieved. Methods: The study was conducted as a prospective cohort study in the emergency department of a tertiary hospital. Patients who were over 18 years of age and presented to emergency department with complaints of vertigo symptoms and nausea and had a positive Dix–Hallpike test were included in the study. Patients’ demographic data, possible etiological factors, affected ear, and benign paroxysmal positional vertigo diagnosis in the history were recorded on the study data form. The European Evaluation of Vertigo scale and the Visual Analogue Scale (VAS) score of nausea and vertigo symptoms were graded and recorded for each patient before and after treatment. Results: Ninety patients were included in the study in total. Epley maneuver was carried out to all patients. Vertigo symptoms VAS (VASd) score (p < 0.001), nausea and vomiting VAS (VASnv) score (p < 0.001), and European Evaluation of Vertigo scale score (p < 0.001) of all patients showed a statistically significant decrease after Epley maneuver. A combination of dimenhydrinate and metoclopramide helped to reduce VASd (p = 0.048), VASnv (p = 0.031), and European Evaluation of Vertigo scale scores (p = 0.001) at a statistically significant level more than dimenhydrinate treatment alone. Conclusions: Epley maneuver may be applied to every patient with benign paroxysmal positional vertigo. Dimenhydrinate and/or metoclopramide helps to control patients’ symptoms whose symptoms remain despite Epley maneuver.
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Affiliation(s)
- Muge Gulen
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Salim Satar
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Selen Acehan
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Akkan Avci
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Adem Kaya
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Kemal Sener
- Department of Emergency Medicine, Istanbul Basaksehir City Hospital, Istanbul, Turkey
| | - Cem Isikber
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
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Acehan S, Gulen M, Satar S, Kuvvetli A, Isikber C, Yesiloglu O, Toptas Firat B, Sonmez A, Segmen MS, Ince C. Evaluation of Nutrition Risk in Patients Over 65 Years of Age With Nontraumatic Acute Abdominal Syndrome. Nutr Clin Pract 2020; 35:1070-1079. [PMID: 32935880 DOI: 10.1002/ncp.10575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/11/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The objective of this study is to investigate the power of CRP/Albumin ratio, NRS-2002, mNUTRIC scores to predict nutritional needs and mortality in patients over 65 years of age diagnosed with acute abdominal syndrome in the emergency department and then transferred to the surgical intensive care unit. MATERIAL AND METHOD CRP/Albumin ratio, APACHE II, SOFA, NRS-2002 and mNUTRIC scores were calculated. The analysis of the data was conducted in IBM SPSS Statistics Base 22.0 package program. RESULTS In the analytical evaluation made for nutritional needs, AUC value for mNUTRIC was found to be: 0,683, 95% CI 0,611-0,755, p < 0.001. It was found out that mortality of patients had a statistically significant and moderate correlation with mNUTRIC score (r = 0.537; p < 0.001). In the analytical evaluation made for mortality, mNUTRIC's AUC value (AUC: 0.808, 95% CI 0.736-0.880, p < 0.001) was found to be the highest. When the cut-off value determined to predict mortality was taken as 3.5 for mNUTRIC score, sensitivity was 75.9% and specificity was 69.4%. CONCLUSION The evaluation of the risk of malnutrition through nutritional risk tools in intensive care patients over 65 years of age with acute abdominal syndrome can also predict nutritional needs in the early period besides mortality. Based on our data, the fact that mNUTRIC score cut-off value in older patients hospitalized in intensive care is 3.5 and higher may be a predictor for ICU mortality.
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Affiliation(s)
- Selen Acehan
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Muge Gulen
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Salim Satar
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Adnan Kuvvetli
- Department of General Surgery, Adana City Training and Research Hospital, Adana, Turkey
| | - Cem Isikber
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Onder Yesiloglu
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Basak Toptas Firat
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Ahmet Sonmez
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Mustafa Sencer Segmen
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Cagdas Ince
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
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