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Duyan M, Günlü S, Sarıdaş A, Ertaş E, Cander B. Evaluation of Compatibility Between Emergency Physicians and Cardiologists in Measuring Pulmonary Artery Pressure: A Prospective, Observational Study. Eurasian J Emerg Med 2023. [DOI: 10.4274/eajem.galenos.2022.88155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
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Duyan M, Saridas A. Relation between partial arterial carbon dioxide pressure and pH value and optic nerve sheath diameter: a prospective self-controlled non-randomized trial study. J Ultrasound 2023; 26:107-116. [PMID: 35511351 PMCID: PMC10063762 DOI: 10.1007/s40477-022-00677-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/14/2022] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE This study aims to determine if there is a correlation between differences in optic nerve sheath diameter (ONSD) and changes in PaCO2 and pH values that were measured in the arterial blood gas (ABG) before and after treatment in COPD patients with acute hypercarbic respiratory failure (AHRF). MATERIALS AND METHODS This study serves as a prospective self-controlled non-randomized trial study conducted in the emergency clinic of a tertiary hospital. Forty-four patients with COPD, who were found to have acidosis and hypercarbia in ABG and had an indication for non-invasive mechanic ventilation (NIMV), were analyzed prospectively. Demographic information, vital findings, initial ABG values, the ONSD measurement (before the NIMV treatment), consciousness state, and the ABG results obtained in the second hour of the monitoring and the ONSD measurement (after the NIMV treatment) were recorded. RESULTS In this study, 13 (29.5%) of the patients were female and 31 (70.5%) were male. The age distribution was evaluated as 68.3 ± 9.2 years; the minimum age was 54 and the maximum was 91. A high level of positively significant correlation was found between the mean ONSD and PaCO2 (p < 0.0001). There is a high fit (0.72) between the mean ONSD and PaCO2. A moderate level of negatively significant correlation was found between the mean ONSD and the pH (p < 0.0001). However, there is an insignificant low fit (0.32) between the mean ONSD and the pH. CONCLUSION The ONSD changed significantly and in a highly correlated manner to acute changes in PaCO2 levels.
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Affiliation(s)
- Murat Duyan
- Department of Emergency Medicine, Emergency Medicine Specialist, Antalya Training and Research Hospital, Varlik District, Kazim Karabekir Street, 07100 Antalya, Turkey
| | - Ali Saridas
- Department of Emergency Medicine, Emergency Medicine Specialist, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
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Duyan M, Vural N. Diagnostic value of end-tidal carbon dioxide in the differential diagnosis of unstable angina and non-cardiac chest pain. Am J Emerg Med 2023; 63:69-73. [PMID: 36327752 DOI: 10.1016/j.ajem.2022.10.026] [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: 08/16/2022] [Revised: 10/06/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE This study aims to investigate the diagnostic value of End-tidal carbon dioxide (ETCO2) measured non-invasively at the bedside in order to distinguish between unstable angina pectoris (UAP) and non-cardiac chest pain among patients who present to the emergency department with chest pain without a history of cardiac pathology. MATERIAL AND METHODS This clinical study is a prospective case-control study among patients presenting to the emergency department of a tertiary hospital with chest pain. After evaluating the inclusion and exclusion criteria, the patients were divided into two groups: 62 patients with UAP and 62 patients with non-cardiac chest pain. Receiver Operating Characteristic (ROC) analysis was used to determine the cut-off in diagnostic value measurements. For UAP prediction, the odds ratio of ETCO2 (including 95% confidence intervals) was calculated using univariate with binary logistic regression analysis. RESULTS ETCO2 had an excellent diagnostic power in detecting UAP, with 35 cut-offs determined (AUC: 0.84, 95% Cl: 0.76-0.90, p < 0.001). When ETCO2, which affects both non-cardiac chest pain and UAP, is evaluated, an ETCO2 of <35 is statistically significant and 9.74 times more common among UAP patients than patients with non-cardiac chest pain. CONCLUSION ETCO2, a non-invasive parameter that can be measured immediately at the bedside, may be proposed as a potential biomarker for differentiating patients with UAP from those with non-cardiac chest pain.
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Affiliation(s)
- Murat Duyan
- Department of Emergency Medicine, Antalya Training and Research Hospital, Antalya, Turkey.
| | - Nafis Vural
- Department of Emergency Medicine, Ereğli State Hospital, Konya, Turkey
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Duyan M, Vural N. Diagnostic value of monocyte-lymphocyte ratio and red cell distribution width - lymphocyte ratio against other biomarkers in children with acute appendicitis, cross-sectional study. Trop Doct 2022; 52:510-514. [PMID: 36062715 DOI: 10.1177/00494755221122489] [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] [Indexed: 11/15/2022]
Abstract
Our study aims to ascertain the diagnostic value of the Monocyte-lymphocyte ratio (MLR) and red cell distribution width (RDW)-lymphocyte ratio (RLR) by comparing them with other biomarkers in distinguishing patients with and without acute appendicitis (AA). A total of 223 children were recruited in the study conducted according to the Cross-Sectional Study design. Patients under 18 years were assigned to 3 groups; AA, nonspecific abdominal pain (NAP), and a control group. According to the outcome of our research, while C-reactive protein (CRP), white blood cell (WBC), neutrophil count (NEU), neutrophil to lymphocyte ratio (NLR), and MLR had excellent diagnostic power, RLR had acceptable diagnostic power, and platelet to lymphocyte ratio (PLR) had only fair diagnostic power. MLR and NLR, which are simple, inexpensive, and easily accessible parameters, can be recommended to be used together with other biomarkers in diagnosing AA in children.
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Affiliation(s)
- Murat Duyan
- Emergency Medicine Specialist, Department of Emergency Medicine, 218503Antalya Training and Research Hospital, Antalya, Turkey
| | - Nafis Vural
- Emergency Medicine Specialist, Department of Emergency Medicine, Ereğli State Hospital, Konya, Turkey
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Yılmaz A, Yılmaz F, Beydilli İ, Sönmez BM, Duyan M, Özdemir M, Komut S, Aksoy Y. Ultrasonographically detected hepatosteatosis independently predicts the presence and severity of coronary artery disease. Afr Health Sci 2022; 22:273-285. [PMID: 36407381 PMCID: PMC9652657 DOI: 10.4314/ahs.v22i2.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Nonalcoholic fatty liver disease (NAFLD) has shown to be associated with coronary artery disease (CAD) Objectives The aim of our study was to evaluate the association between the presence and severity of CAD and NAFLD. Methods The study group consisted of 153 patients who underwent coronary angiographies. Patients were categorized into CAD and non-CAD groups. CAD severity was determined by the number of CAD-involved arteries and the vessel score multiplied by Gensini score, the latter judging CAD severity. Fatty liver was diagnosed by abdominal ultrasonography (USG), with the patients being categorized by the degree of hepatosteatosis, as Grade 0, Grade 1, and Grade 2–3. Results Among the whole study population, 47.1% of patients (n=72) were female and 52.9% of patients (n=81) were male. Forty-three patients had normal coronary arteries; 27 patients had non-critical CAD and side branch disease; and 83 patients had clinically significant CAD (stenosis>50%). The rate of CAD and Gensini score were significantly different between Grade 0, 1 and 2–3 hepatosteatosis groups (p<0.05). Patients with CAD had a significantly higher AST level than those without (p< 0.05). Conclusions Ultrasonographically detected hepatosteatosis independently predicts the presence and severity of CAD.
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Affiliation(s)
- Aykut Yılmaz
- Training and Research Hospital, Department of Cardiology, Siirt /Turkey
| | - Fevzi Yılmaz
- Antalya Education and Research Hospital; Department of Emergency Medicine, Antalya /Turkey
| | - İnan Beydilli
- Antalya Education and Research Hospital; Department of Emergency Medicine, Antalya /Turkey
| | - Bedriye Müge Sönmez
- Numune Education and Research Hospital; Department of Emergency Medicine, Ankara /Turkey
| | - Murat Duyan
- Antalya Education and Research Hospital; Department of Emergency Medicine, Antalya /Turkey
| | - Metin Özdemir
- İstanbul EsenyurtNecmiKadıoğlu State Hospital, Department of Emergency Medicine, İstanbul /Turkey
| | - Seval Komut
- Hitit University, ErolOlçok Training and Research Hospital, Department of Emergency Medicine, Corum, Turkey
| | - Yüksel Aksoy
- Trakya Unıversıty Faculty of Medicine, Department of Cardiology, Edirne /Turkey
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Abstract
In this report, we present a case of acute psychosis that occurred after the loading dose of favipiravir, one of the most prescribed antiviral drugs in many countries, in a patient with COVID-19. A 31-year-old female was readmitted to the emergency department after 3 days of sleep disturbance, intermittent paranoid delusions, auditory hallucinations, and agitation that started after the favipiravir treatment was initiated. A physical examination revealed disorganized speech, distorted orientation, and agitation. All laboratory tests, including drug screening and cerebrospinal fluid analysis, were normal. After excluding all the other causes of acute psychosis, favipiravir treatment was discontinued, antipsychotic treatment was started, and the patient was admitted to the psychiatric ward. The symptoms resolved on the second day of hospitalization. Although acute viral illness does seldomly cause psychosis in patients with increased inflammatory response, in the presented case, none of the inflammatory markers were positive, and acute psychosis was attributed to the loading dose of favipiravir. In conclusion, clinicians should be aware of this rare adverse effect and prescribe cautiously to patients at a high risk of psychosis.
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Affiliation(s)
- Murat Duyan
- Department of Emergency Medicine, Antalya Training and Research Hospital, Antalya, Turkey
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Hacıalioğulları F, Yılmaz F, Yılmaz A, Sönmez BM, Demir TA, Karadaş MA, Duyan M, Ayaz G, Özdemir M. Role of Point-of-Care Lung and Inferior Vena Cava Ultrasound in Clinical Decisions for Patients Presenting to the Emergency Department With Symptoms of Acute Decompensated Heart Failure. J Ultrasound Med 2021; 40:751-761. [PMID: 32865243 DOI: 10.1002/jum.15447] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/10/2020] [Accepted: 07/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES This prospective study was performed to evaluate the diagnostic role of point-of-care lung ultrasound (LUS) and inferior vena cava (IVC) ultrasound in patients with acute decompensated heart failure (ADHF). METHODS A prospective cohort study was conducted between January 2018 and November 2018 on patients with a diagnosis of ADHF in the emergency department (ED). On admission, LUS findings, inspiratory and expiratory IVC diameters, and the inferior vena cava collapsibility index (IVCCI) were obtained. After therapeutic interventions, third-hour changes in LUS and the IVC index and the treatment response were assessed. RESULTS Eighty patients were enrolled. Forty-six (58%) patients had an ejection fraction (EF) greater than 40%, and 34 (42%) had an EF of less than 40%. Significant differences were detected between the admission and third-hour inspiratory IVC diameter, expiratory IVC diameter, and IVCCI (P = .001). There was no correlation between the EF and inspiratory IVC diameter (r = -0.03; P = .976), expiratory IVC diameter (r = -109; P = .336), or IVCCI (r = -0.72; P = .523) and between the B-type natriuretic peptide level and inspiratory IVC diameter (r = -0.58; P = .610), expiratory IVC diameter (r = -0.33; P = .774), or IVCCI (r = -0.78; P = .493) either. A comparison of admission and third-hour numbers of B-lines on LUS imaging showed a significant decrease in the number of B-lines in all zones at the end of 3 hours (P = .001). A significant difference existed between the hospitalized and discharged patients with respect to IVC diameters and number of B-lines. CONCLUSIONS In the ED setting, an assessment of B-lines and measurement of IVC diameters are better markers than the B-type natriuretic peptide level, EF, or chest x-ray for diagnosis of ADHF and can be used to make decisions for hospitalization or discharge from the ED.
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Affiliation(s)
| | - Fevzi Yılmaz
- Department of Emergency Medicine, Health Sciences University, Antalya Education and Research Hospital, Antalya, Turkey
| | - Aykut Yılmaz
- Department of Cardiology, Siirt State Hospital, Siirt, Turkey
| | - Bedriye Müge Sönmez
- Department of Emergency Medicine, Health Sciences University, Ankara Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey
| | - Tayfun Anıl Demir
- Department of Emergency Medicine, Başkent University, Alanya Medical and Research Center, Alanya, Turkey
| | - Mehmet Akif Karadaş
- Alanya Medical and Research Center, Başkent University Hospital, Alanya, Turkey
| | | | - Gizem Ayaz
- Department of Emergency Medicine, Health Sciences University, Antalya Education and Research Hospital, Antalya, Turkey
| | - Metin Özdemir
- Department of Emergency Medicine, Istanbul Esenyurt Necmi Kadıoğlu State Hospital, Istanbul, Turkey
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Abstract
In this report, we present two cases of delayed parosmia, a rare complication that occurs in the late period after COVID-19. A 28-year-old male and a 32-year-old female, found to be positive in rRT-PCR tests for SARS-CoV-2, had a loss of taste and smell, respectively. Following the regaining of their ability to smell after 87 and 72 days, respectively, the male patient reported that the smell he perceived felt the smell of burnt rubber, while the female patient stated that it was similar to the smell of onion. As a result of evaluations, a diagnosis of delayed parosmia was made occurring in the late period secondary to SARS-CoV-2 infection. Although anosmia is a common symptom in the early phase of COVID-19, olfactory damage due to Sars-CoV-2 can be persistent, and distorted sense of smell can be prolonged.
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Affiliation(s)
- Murat Duyan
- Department of Emergency Medicine, Antalya Training and Research Hospital, Antalya, Turkey
| | | | - Murat Altas
- Department of Neurosurgery, Akdeniz University Faculty of Medicine, Antalya, Turkey
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Abstract
In this study, we aimed to present a geriatric patient with the diagnosis of COVID-19 and with contradictory results in rRT-PCR examinations in short time intervals. A 69-year-old male patient was admitted to the emergency room on the 18th day of May 2020, with the complaints of fever, sweating, myalgia, dry cough that continued for 5 days, and the lack of taste that started on the day he applied to the emergency room. Comorbidity factors include diabetes mellitus, bronchial asthma, and hypertension. The patient has a history of 36 years of smoking 1.5 packs per day. High laboratory findings during hospitalization: monocytes, creatinine, CRP (C-reactive protein). In the thorax CT, in the parenchyma areas of both lungs, there are increases in attenuation with multilobe distributions (more visible at the level of the upper lobes) in the form of ground-glass opacities. May 19, 2020, was subjected to the rRT-PCR test, repeated twice on the 19th of May which also resulted in positive. Despite rRT-PCR tests, which were negative on 27th of May and positive on 28th of May, the patient, whose symptoms disappeared, and general condition improved, was discharged on June 1, 2020, with the recommendation for home isolation. In our case, unlike the incubation period only, we encountered a negative rRT-PCR result on the 8th day after diagnosis. Therefore, the COVID-19 pandemic control and filiation evaluation with the rRT-PCR test may produce false negative results.
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Affiliation(s)
- Özkan Görgülü
- Department of Anesthesiology and Reanimation, Antalya Training and Research Hospital, Varlık Mh. Kazım Karabekir Cd, 07100 Antalya, Turkey
| | - Murat Duyan
- Department of Emergency Medicine, Antalya Training and Research Hospital, Antalya, Turkey
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Duyan M, Ünal AY, Özturan İU, Günsoy E. Contribution of caval index and ejection fraction estimated by e-point septal separation measured by emergency physicians in the clinical diagnosis of acute heart failure. Turk J Emerg Med 2020; 20:105-110. [PMID: 32832729 PMCID: PMC7416849 DOI: 10.4103/2452-2473.290065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/19/2020] [Accepted: 05/20/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Although the reliability of e-point septal separation (EPSS) and caval index (CI) is proven in the diagnosis of acute heart failure (AHF), how much they contribute to the initial clinical impression is unclear. This study aimed to determine the diagnostic contribution of EPSS and CI to the initial clinical impression of AHF. METHODS This is a prospective observational study conducted in an academic emergency department (ED). The patients admitted to the ED with acute undifferentiated dyspnea were included. Primary diagnosis was made after an initial clinical evaluation, and a secondary diagnosis was made after EPSS and CI measurements. Independent cardiologists made the final diagnosis. The primary outcome was the diagnostic contribution of EPSS and CI to the primary diagnosis. RESULTS A total of 182 patients were included in the study. The primary diagnosis was found with a sensitivity of 0.55 and specificity of 0.84 and the secondary diagnosis was determined with a sensitivity of 0.78 and specificity of 0.83 in predicting the final diagnosis. The agreement coefficient between the primary and final diagnosis was 0.44 and between the secondary diagnosis and the final diagnosis was 0.61. When the primary diagnosis was coherent with secondary diagnosis, sensitivity and specificity were found to be 0.74 and 0.90, respectively. CONCLUSION Although a detailed history and physical examination are the essential factors in shaping clinical perception, CI and EPSS combined significantly contribute to the initial clinical impression.
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Affiliation(s)
- Murat Duyan
- Department of Emergency Medicine, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | | | | | - Ertuğ Günsoy
- Department of Emergency Medicine, Sivas Numune Hospital, Sivas, Turkey
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Beydilli İ, Duyan M, Yılmaz F, Arslan ED, Korkmaz İ, Akçimen M, Keşaplı M, İmak A, Çakır UC, Kavalcı C, Ararat E, Ellidağ H. Concomitant Substance Use Increases the Toxic Effect of synthetic cannabinoid (Bonsai): A Prospective Study. Acta Biomed 2020; 92:e2021006. [PMID: 33682827 PMCID: PMC7975946 DOI: 10.23750/abm.v92i1.9989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/23/2020] [Indexed: 11/23/2022]
Abstract
Objective: In this study, we aimed to contribute to the literature by evaluating synthetic cannabinoid (bonsai) and additional drugs. Materials and Methods: This prospective study was conducted on 217 patients who admitted to the emergency department (ED) with bonsai intake between December 20, 2014 and January 1, 2016, according to the patient history obtained from the patients. One hundred sixty-eight patients with negative urinary metabolites results were excluded from the study, 49 patients with positive urinary metabolites were included in the study. Patients were divided into two groups. The first group consisted of patients with only bonsai intake and the second group consisted of patients with bonsai and concomitant drug intake. The groups were compared in terms of symptoms, findings, blood gas values, duration of the symptoms, discharge time, hospitalization, and mortality rate. Data were analyzed using the Chi-square, the Fisher’s exact test, the Student t-test, and the Mann-Whitney U test. Data were evaluated at the 95% confidence interval. P<0.05 was considered statistically significant. Results: The mean age of 49 patients included in the study was 26.7±8.9 years and 91.8% (n=45) of the patients were male. Concomitant drug intake was identified in 69.4% of the patients. Concomitant drug use was as follows: cocaine (20.4%, n=10), amphetamines (14.3%, n=7), methamphetamines (8,2%, n=4,) tetrahydrocannabinol (32.7%, n=16), opiates (18.4%, n=9) and alcohol (30.6%, n=15). On admission, the Glasgow Coma Score (GCS) in the bonsai group with an additional substance was significantly higher (p=0,003). The most common symptom was palpitations (tachycardia) (75.5%, n=37). There were no patients hospitalized in the Only Bonsai group (p=0,020). The median time to remission of symptoms and median follow-up time of the patients in the emergency room were 3 hours and 6 hours, respectively. Remission time of the symptoms and hospitalization rates were higher in patients taking concomitant drug (p <0.05). Conclusion: While the bonsai intake alone is not considered mortal to the patients and most of them can be discharged from the ED after signs and symptoms disappear, concomitant drug use can increase the toxic effects of bonsai intake. That is why the follow-up of patients taking concomitant drugs, and the treatment process should be carried out more carefully. (www.actabiomedica.it)
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Affiliation(s)
| | - Murat Duyan
- Antalya Training and Research Hospital; Department of Emergency Medicine.
| | - Fevzi Yılmaz
- Antalya Training and Research Hospital; Department of Emergency Medicine,.
| | - Engin Deniz Arslan
- Antalya Training and Research Hospital; Department of Emergency Medicine,.
| | - İlhan Korkmaz
- Department of Emergency Medicine,Cumhuriyet University Medicine Faculty .
| | - Mehmet Akçimen
- Antalya Training and Research Hospital; Department of Emergency Medicine.
| | - Mustafa Keşaplı
- Antalya Training and Research Hospital; Department of EmergencyMedicine.
| | - Arefe İmak
- Antalya Training and Research Hospital; Department of Emergency Medicine.
| | - Umut Cengiz Çakır
- Antalya Training and Research Hospital; Department of Emergency Medicine.
| | - Cemil Kavalcı
- Yıldırım Beyazıt Training and Research Hospital Department of Emergency Medicine,.
| | - Ertan Ararat
- Antalya Training and Research Hospital; Department of Emergency Medicine,.
| | - Hamit Ellidağ
- Antalya Training and Research Hospital; Department of Biochemistry Medicine.
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Bedel C, Korkut M, Karancı Y, Duyan M. Can We Estimate the Recurrence of Epistaxis with Simple Blood Tests? J Clin Exp Invest 2020. [DOI: 10.5799/jcei/7839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Korkut M, Bedel C, Karancı Y, Avcı A, Duyan M. Accuracy of Alvarado, Eskelinen, Ohmann, RIPASA and Tzanakis Scores in Diagnosis of Acute Appendicitis; a Cross-sectional Study. Arch Acad Emerg Med 2020; 8:e20. [PMID: 32259117 PMCID: PMC7130437] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Many scoring systems have been developed to assist in diagnosis of acute appendicitis (AA). This study aimed to compare the screening performance characteristics of Alvarado, Eskelinen, Ohmann, Raja Isteri Pengiran Anak Saleha (RIPASA), and Tzanakis scores in predicting the need for appendectomy in AA patients. METHODS Our study prospectively evaluated AA patients that were treated in a tertiary hospital's emergency department. The obtained data were used to calculate Alvarado, Tzanakis, RIPASA, Eskelinen and Ohmann scores. Patients were categorized into two groups according to their histopathological results: positive (PA) and negative appendectomy (NA). The accuracy of different scoring systems in diagnosing AA was investigated. RESULTS 74 patients suspected to AA with the mean age of 36.68 ± 11.97 years were studied (56.8% male). The diagnosis was histopathologically confirmed in 65 cases (87.8%). Median Alvarado, Tzanakis, RIPASA, Eskelinen and Ohmann scores were significantly higher in patients with positive appendectomy. The area under the curve (AUC), sensitivity, and specificity of Tzanakis score in the cut-off value of 8 were 0.965, 84.4%, and 100%, respectively. For Ohmann and Alvarado scores, these measures were 0.941; 71.9%, 89.9% and 0.938, 60.9%, 89.9%, respectively. Tzanakis scoring system had the best screening performance in detection of cases with AA. CONCLUSION Tzanakis score is more sensitive and specific than Alvarado, RIPASA, Eskelinen and Ohmann scores in identifying AA patients needing appendectomy.
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Affiliation(s)
- Mustafa Korkut
- Department of Emergency Medicine, Health Science University Antalya Training and Research Hospital, Antalya, Turkey
| | - Cihan Bedel
- Department of Emergency Medicine, Health Science University Antalya Training and Research Hospital, Antalya, Turkey.,Corresponding author: Cihan Bedel; Health Science University Antalya Training And Research Hospital, Kazım Karabekir Street postal zip code: 07100, Muratpaşa, Antalya, Turkey. Phone: +905075641254, Fax: +902422494487, E-mail:
| | - Yusuf Karancı
- Department of Emergency Medicine, Health Science University Antalya Training and Research Hospital, Antalya, Turkey
| | - Ali Avcı
- Department of Emergency Medicine, Karaman State Hospital, Karaman, Turkey
| | - Murat Duyan
- Department of Emergency Medicine, Health Science University Antalya Training and Research Hospital, Antalya, Turkey
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Ozdemir M, Sonmez BM, Yilmaz F, Yilmaz A, Duyan M, Komut S. Is Bedside End-Tidal CO 2 Measurement a Screening Tool to Exclude Pulmonary Embolism in Emergency Department? J Clin Med Res 2019; 11:696-702. [PMID: 31636784 PMCID: PMC6785277 DOI: 10.14740/jocmr3941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/24/2019] [Indexed: 12/23/2022] Open
Abstract
Background Pulmonary embolism (PE) is among the most difficult conditions to diagnose in emergency department. The majority of patients thought to have PE are tested positive for D-dimer and subsequently tested with advanced diagnostic modalities. Novel noninvasive tests capable of excluding PE may obviate the need for advanced imaging tests. We studied the role of combined clinical probability assessment and end-tidal carbon dioxide (ETCO2) measurement for diagnosis of possible PE in emergency department. Methods We included 100 consecutive subjects suspected to have PE and a positive D-dimer test to study clinical probability of PE and ETCO2 levels. ETCO2 > 34 mm Hg was found to be the best cut-off point for diagnosing PE. PE was ultimately eliminated or diagnosed by spiral computed tomography (CT). Results Diagnostic performances of tests were as follows: ETCO2 and D-dimer had a sensitivity of 100% and a negative predictive value (NPV) of 100% at the cut-off levels of 34 mm Hg and 500 ng/mL, respectively; Wells score had a sensitivity of 80% and NPV of 69.7% at a score of 4. Conclusions ETCO2 alone cannot reliably exclude PE. Combining it with clinical probability, however, reliably and correctly eliminates or diagnoses PE and prevents further testing to be done.
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Affiliation(s)
- Metin Ozdemir
- Department of Emergency Medicine, Istanbul Esenyurt Necmi Kadioglu State Hospital, Istanbul, Turkey
| | - Bedriye Muge Sonmez
- Department of Emergency Medicine, Antalya Education and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Fevzi Yilmaz
- Department of Emergency Medicine, Antalya Education and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Aykut Yilmaz
- Department of Cardiology, Siirt State Hospital, Siirt, Turkey
| | - Murat Duyan
- Department of Emergency Medicine, Antalya Education and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Seval Komut
- Department of Emergency Medicine, Erol Olcok Education and Research Hospital, Hitit University, Corum, Turkey
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