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Acil Serviste Kardiyopulmoner Resüsitasyon Yapılan Hastaların Değerlendirilmesi; Retrospektif Çalışma
(Bolu Abant İzzet Baysal Üniversitesi, 2021) Araç, Songül; Zengin, Yılmaz; İçer, Mustafa; Gündüz, Ercan; Dursun, Recep; Durgun, Hasan; Üstündağ, Mehmet
GİRİŞ ve AMAÇ: Kardiyak arrest tedavisinde yapılacak işlemlerin tamamı Kardiyopulmoner resüsitasyon (KPR) olarak adlandırılmaktadır. Tüm ölümlerin yaklaşık %20’si ani kardiyak arrest nedeniyle olmaktadır. Çalışmamızda hastane içi ve dışı kardiyak arestlerin özelliklerini tanımlamak ve sonuçlarımızı literatür ile karşılaştırmak amaçlandı. YÖNTEM ve GEREÇLER: Bu çalışmada 01.01.2013 ile 31.05.2015 tarihleri arasında acil servise başvuran tüm yaş gruplarında etyolojiden bağımsız olarak Kardiyopulmoner Resüsitasyon uygulanan hastalar retrospektif olarak incelendi. Tüm olgular yaş, cinsiyet, başvuru saati, komorbidite varlığı, biyokimyasal parametreler, kullanılan ilaçlar, hasta sonlanımı, yoğun bakım ihtiyacı, yatış sonrası hastanede kalış süreleri ve mortalite gibi sosyodemografik ve klinik özellikleri bakımından araştırıldı. TARTIŞMA ve SONUÇ: Tüm hastalarda HT varlığı sağ kalım lehine anlamlı iken, erkek cinsiyeti ve saat 06:01-12:00 arası başvuru mortalite lehine anlamlı bulundu. Hastane içi kardiyak arestte 21 dakika ve üzeri uygulanan KPR artmış mortalite ile ilşkili bulunmuştur. Kardiyopulmoner Resüsitasyonun kalitesini arttırmak amaçlı kayıt sistemlerinin ve standardizasyonun oluşturulması gerekliliği görülmektedir.
The adrenal gland: An organ neglected in pediatric trauma cases
(Urology and Nephrology Research Centre, 2016) Aydoǧdu, Bahattin; Okur, Mehmet Hanifi; Arslan, Serkan; Arslan, Mehmet Şerif; Zeytun, Hikmet; Basuguy, Erol; İçer, Mustafa
Purpose: Adrenal Gland Injury (Agi) Caused By Trauma May Cause Bleeding And Life-Threatening Problems In Children. The Objective Of This Study Was To Analyze The Prevalence Of Agi In Final Diagnoses Of Trauma. Materials And Methods: The Records Of 458 Patients With Abdominal Trauma (Out Of A Total 8,200 Pediatric Patients With Trauma Of Any Sort), Who Were Referred To Our Clinic Between January 2009 And July 2014, Were Reviewed Retrospectively. The Numbers Of Patients With Agi And Their Ages, Gender, Trauma Patterns, Affected Organs, Pediatric Trauma Scores (Ptss), And Injury Severity Scores (Isss) Were Recorded, As Well As The Associated Ultrasound (Us) And Tomographic Scan Data, Treatments, And Complications. Computed Tomography (Ct) Scans Obtained After Trauma Were Subjected To Both Primary And Secondary Evaluation. Results: In Total, 28 Patients With Agi Were Detected; Their Average Age Was 8.54 ± 4.09 (3–17) Years. Twenty (71%) Patients Were Male And 8 (29%) Were Female. Nineteen (68%) Patients Had Fallen From Heights; The Most Commonly Injured Organs Were The Kidneys, Spleen, And Lungs. Injuries Were Right-Sided In 26 (92.9%) Patients. The Mean Iss Was 13.2 (Range 5–50) And The Mean Pts 8.6 (Range 0–11). Seven Patients Had Iss > 16 And Nine Had Pts < 8. Agi Was Diagnosed By Ct In 14 (50%) Patients And In 3 (9%) By Us At Primary Evaluation. Upon Secondary Scan Inspection Focusing On The Possibility Of Adrenal Gland Injury, Such Injury Was Ultimately Detected In 28 Patients. All Patients Underwent Conservative Follow-Up, And One Died. Conclusion: We Recommend Calculation Of The Pts, As Well As Other Trauma Scores, When Pediatric Patients SufferIng Multiple Or Blunt Abdominal Trauma(S) Present To The Emergency. In Addition, We Believe That In Children With Trauma Involving The Liver, Spleen Or Kidneys, Careful Evaluation Using A Ct Scan Would Increase The Diagnosis Of Agi And Reveal A Realistic Rate Of Agi In Trauma Cases.
AFFECTING FACTORS ON EARLY MORTALITY IN ELDERLY PATIENTS DIAGNOSED WITH PULMONARY EMBOLISM IN EMERGENCY DEPARTMENT
(2015) Zengin, Yılmaz; Gülolu, Cahfer; Dursun, Recep; İçer, Mustafa; Gündüz, Ercan; Taylan, Mahşuk; Durgun, Hasan Mansur
Giriş: Tüm dünyada olduğu gibi Türkiye'de de yaşlı nüfus oranı hızla artmaktadır. Pulmoneremboli ve venöz tromboli insidansının yaşla birlikte arttığı bilinmektedir. Pulmoner emboli tanı vetedavisindeki büyük ilerlemelere rağmen pulmoner emboli yaşlılarda daha yüksek oranda mortalite ile sonuçlanmaktadır. Bu çalışmada, acil serviste pulmoner emboli tanısı alan yaşlı hastalarınsosyodemografik ve klinik özelliklerini değerlendirmek ve mortalitenin azaltılabilmesi için erkenmortalite üzerindeki etkili faktörlerin belirlenmesi amaçlanmıştır. Gereç ve Yöntem: Bu çalışma 01.01.2009 tarihi ile 30.09.2014 tarihleri arasında acil servise başvuran 65 yaş ve üzeri olan ve pulmoner emboli şüphesi ile çekilen kompüterize tomografikpulmoner anjiografilerinde pulmoner emboli tanısı kesinleşen 139 hasta hastane bilgisayar kayıtsisteminden retrospektif olarak incelendi. Bulgular: Bu çalışmada hastaların 87'si (%61,8) kadın, 52'si (%38,2)'si erkekti. Hastaların takibinde 13 kişi (9,4%) yaşamını kaybetti. Çalışmada pulmoner embolili yaşlı hastalarının acil başvuru anındaki özellikleri ile erken mortalite arasındaki faktörlerin araştırıldığı analizde immobilite,bayılma, taşikardi, hipotansiyon, Troponin T yükselmesi, koroner arter hastalığı, serebrovaskülerhastalık, masif boyutlu pulmoner emboli olması, bilateral pulmoner emboli olması, Wells skorlamasında muhtemel pulmoner emboli olması ve Modifiye Genava skorlamasında muhtemel pulmoner emboli olmasının istatistiksel olarak ilişkili faktörler olduğu tespit edildi( p değerleri sırasıyla 0,002; 0,033; 0,000; 0,000; 0,006; 0,037; 0,011; 0,000; 0,030; 0,023; 0,018).Sonuç: İmmobilite, senkop, taşikardi, hipotansiyon, Troponin T yükselmesi, koroner arterhastalığı, serebrovasküler hastalık, masif boyutlu pulmoner emboli olması, bilateral pulmoner emboli olması, Wells skorlamasında muhtemel pulmoner emboli olması ve Modifiye Genava skorlamasında muhtemel pulmoner emboli olması yaşlı pulmoner embolili hastalarda erken mortaliteüzerine etkili faktörler olarak bulunmuştur
Analysis of fall from height cases due to electrical injury: evaluation by comparing with fall from height and only electrical injury cases
(Dicle Üniversitesi Tıp Fakültesi, 2023) İçer, Mustafa
Objective: Trauma is the leading cause of deaths worldwide. Electrical injury causes many damage to the body according to the elektrical load, considerably mortality. Falls from height are one of the most common causes of trauma in the world, it is a condition with high morbidity and mortality. Falls from height due to electrical injury that caused by mechanisms both electrical injury and falling from a height are complex injuries . Although cases of falling from height due to electrical injury have been reported in the literature, there are no studies examining them. The aim of this study is to examine cases of falls from height due to electrical injury, its clinical features were compared to only electrical injury cases and only falls from height. Methods: This is a retrospective cross-sectional study. Cases admitted to the emergency department of Dicle University Hospital between January 2015 and December 2021 were examined. In this study, 75 cases who fell from a height due to electrical injury, 75 cases who had only electrical injury, and 75 cases who fell only from a height were received. Trauma cases included in the study were examined age, gender, ground of fall, fall height, workplace accident and suicide status, electrical voltage, burn and trauma scores, laboratory findings, mortality. Results: Among the 75 cases falling from height due to electrical injury, 69 (92%) survived, 6 (8%) died. The median age was 24 (IQR: 17-37) years old. Of the cases, 70 (93.30%) were male, 53 (70.70%) were high voltage, 35 (46.70%) were workplace accidents. Among the variables examined, lactic dehydrogenase (LDH), creatinine kinase (CK), creatinine kinase myocardial band (CK-MB), total body burn surface area (TBSA%), Glasgow Coma Scale (GCS), Abbreviated Injury Scale (AIS) for burns were the factors affecting mortality( p<0.05). Comparison of cases who fell from a height due to electric injury and cases of only electric injury TBSA%, AIS for burns, Abbreviated Burn Severity Index (ABSI), Injury Severity Score (ISS), complications, high voltage, length of stay (LOS) were higher in patients who fell from height due to electric injury, with a significant difference (p<0.001). Comparison of cases of falling from a height due to electric injury and cases of only falling from height age, male gender, workplace accident rate were higher in patients who fell from height due to electric injury, with a significant difference (p<0.001). Conclusion: Falls from height due to electrical injury are major traumas that affect young adult men and have high mortality and complication rates, caused by high-voltage electrical injury. This trauma mechanism shows differences from only electric injury and only falls from height injuries.
Assessment of adult patients with hypernatremia: A single center experience
(Dicle Üniversitesi Tıp Fakültesi, 2015) Gündüz, Ercan; Zengin, Yılmaz; İçer, Mustafa; Durgun, Hasan Mansur; Dursun, Recep; Gündüzalp, Ahmet; İpek, Mustafa; Güloğlu, Cahfer
Objective: In the present study, determination of symptoms, clinical characteristics, prevalence and recovery rates was aimed in patients who applied to the emergency service and diagnosed with hypernatremia. Methods: Patients who applied to Dicle University Medical School Emergency Service during January 2013-December 2014 and whose serum Na>148 mEq/L were included in the study. The study was conducted retrospectively. Results: Hypernatremia prevalence was determined as 0.21% in the cases who applied to the emergency service. The average age in all patients was 69±22 and the median age was 72 years. The average hospitalization period was 13.3±10.9 days. The mortality rate was 75.7% and male gender domination (56%) was determined in patients who developed mortality. When mortality and recovery groups were compared statistically; significant difference was determined (p<0.05) in terms of hospitalization period, glucose, urea, creatinine and calcium averages. The complaints of our patients who applied to the emergency service were changes in consciousness (92.7%), oral intake disorder (83.4%) and fever (48.6%) based on frequency order. The accompanying comorbid states were cerebrovascular illness (36.9%), Dementia/ Alzheimer (32.4%) and hypertension (28.9%) based on frequency order. Conclusion: Consequently, hypernatremia is a fluidelectrolyte disorder progressing with high mortality and could be observed in older patients and in patients whose oral intake is defective and who have cerebrovascular illness and dementia
A Bomb explosion in Diyarbakir: Clinical findings and management of emergency department
(Dicle Üniversitesi Tıp Fakültesi, 2016) İçer, Mustafa; Zengin, Yılmaz; Durgun, Hasan Mansur; Dursun, Recep; Arı, Baran; Ekinci, Mustafa; Üstündağ, Mehmet; Orak, Murat; Güloğlu, Cahfer
Objectives: In this study, we present management of emergency department, patients’ clinical findings and mortality analysis after a bomb explosion. Methods: Patients brought to Diyarbakır Dicle University Hospital emergency department after the explosion at 5 June 2015 were retrospectively examined. Patients’ age, gender, triage, system injuries, hypotension, blood transfusion, admission to the ICU, Intensive care unit surgical treatment, amputation and trauma scores (Glasgow Coma Score (GCS), Revised Trauma Score (RTS), Injury Severity Score (ISS), Trauma Score-Injury Severity Score (TRISS), Shock index) were studied. Factors affecting emergency department management and mortality were analyzed. Results: The mean age was found as 29.64±12.88 years in survivors and 36±19.98 years in deaths. GCS, ISS and shock index were found as the factors affecting mortality (p≤0.05). Wounded taken to the resuscitation room, hypotension, blood transfusion, intubation, treatment in ICU and amputation were correlated with mortality (p<0.05). Conclusion: A fast and effective triage system must be applied in EDs following a bomb explosion. The explosion of a bomb on the open areas are the most common injury to the lower extremity injury. Mortality is most often associated with lower limb amputations.
The differences between cases with primary and recurrent shoulder dislocation: A tertiary center study
(Dicle Üniversitesi Tıp Fakültesi, 2021) Yeşil, Ahmet; İçer, Mustafa; Güloğlu, Cahfer; Gem, Mehmet
Objective: The aim of this study is to compare demographic and clinical characteristics of cases with primary and recurrent shoulder dislocations. Methods: Cases who presented to a tertiary center Emergency Medicine Clinic with shoulder dislocation between January 2013 and December 2016 were evaluated.The cases were divided into two groups as primary (Group 1) and recurrent (Group 2) dislocations.Characteristics such as age, gender, seasonal period, dislocation side, causes of trauma, accompanying additional injuries and treatment modalities were compared between the groups. Results: 119 cases were included in the study. 64.7% (n=77) of the cases were classified as Group 1, and 35.3% (n=42) as Group 2. There was no difference between Group 1 and Group 2 in terms of age, gender and dislocation side (P values: 0.484, 0.570, 0.251, respectively). Inferior dislocations were more common in Group 1 (n=7/77) compared to Group 2 (n=1/42), and a statistically significant difference was found (p=0.009). Group 2 cases (n=19/42) were found to be more common in the spring than group 1 (n=17/77) (p=0.012). Additional injuries were detected in 8.4% of the cases (n=10/119), 8 of them were in group 1 and 2 of them were in group 2, and there was no statistically significant difference between the groups in terms of additional injury (p=0.491). 11.8% (n=14) of the cases were hospitalized by orthopedics for surgery (open reduction) or closed reduction under general anesthesia. Surgical treatment (open reduction) was applied in 23.8% (n=10/42) in Group 2, and 5.2% (n=4/77) in Group 1, and a statistically significant difference was found between the groups ( p= 0.005). Conclusion: It was found that surgical treatment was preferred more frequently on recurrent dislocations compared to primary dislocations. Therefore, we recommend that cases with a history of primary dislocation should take precautions for trauma during active periods of social life.
Diyarbakır'da Bir Bomba Patlaması: Klinik Bulgular ve Acil Servis Yönetimi
(2016) Zengin, Yılmaz; Orak, Murat; İçer, Mustafa; Durgun, Hasan Mansur; Üstündağ, Mehmet Üstündağ; Ekinci, Mustafa; Arı, Baran
Amaç: Bu çalışmada bir bombalı saldırı sonrasında acil servis yönetimi, hastaların klinik bulguları ve mortalite analizi sunulmuştur Yöntemler: Diyarbakır Dicle Üniversitesi Hastanesi Acil servisi'ne 5 Haziran 2015 tarihindeki patlama sonrası gelen hastalar retrospektif incelendi. Yaş, cinsiyet, triaj, sistem yaralanmaları, hipotansiyon, kan transfüzyonu, entübasyon, yoğun bakıma yatış, cerrahi tedavi, ampütasyon, travma skorları[Glasgow Coma Skalası (GCS) Skoru, Revize Trauma Skoru (RTS), Yaralanma Şiddet Skoru (Injury Severity Skoru -ISS), Travma Skoru-Yaralanma Şiddet Skoru (TRISS), Şok İndeksi ] incelendi. Acil servis yönetimi ve mortalite üzerine etkili faktörler analiz edildi. Bulgular: Yaşayanların yaş ortalaması 29,64±12,88 yıl ve ölenlerin yaş ortalaması 36±19,98 yıl idi. GCS, ISS, shock index mortaliteyi etkileyen faktörlerdi (p<=0,05). Resüsitasyon odasına alınan yaralılar, hipotansiyon, kan transfüzyonu, entübasyon, yoğun bakımda tedavi, cerrahi tedavi ve ampütasyon yapılması mortalite ile ilişkiliydi (p<0,05). Sonuç: Bir bombalama eyleminin ardından acil servislerde hızlı ve etkili bir triaj sistemi uygulanmalıdır. Açık alanda gerçekleşen bombalı patlamalarda en yaygın yaralanma alt ekstremite yaralanmaları olup mortalite en sık alt uzuv ampütasyonları ile ilişkilidir.
EFFECTS OF SLEEP QUALITY, INCOME LEVEL AND COMORBID CONDITIONS ON QUALITY OF LIFE IN A TURKISH ELDERLY POPULATION: A MULTICENTRE STUDY
(2015) Selçuk, Engin Burak; Gürbüz, Hüseyin; Zengin, Yılmaz; Durgun, Hasan Mansur; Yeşil, Yusuf; Güllü, Mehmet Nezir; İçer, Mustafa
Giriş: Bu çalışmanın amacı Türk geriatrik popülasyonda uyku kalitesi, gelir durumu ve komorbiditeleri yaşam kalitesine etkisini araştırmaktır.Gereç ve Yöntem: Çalışma İç Hastalıkları ve Geriatri polikliniklerine ayaktan başvuran, 65 yaşüstü 1030 hastayı içeren çok merkezli bir çalışmadır. Hastalarla yapılan yüzyüze görüşme yoluyla Pittsburgh Uyku Kalitesi ve Yaşam Kalitesi Kısa Form (Short Form-36) testleri yapıldı. Görüşmede ayrıca hastaların demografik özellikleri kaydedildi.Bulgular: Uyku kalitesi düşük olan hastaların ortalama yaşam kalitesi subskala skorları (Zindelik skoru hariç) anlamlı olarak daha düşüktü (p<0,001). Çoklu kronik hastalığı olanların yaşamkalitesi 3 parametrede (Fiziksel fonksiyon, Mental sağlık, Ağrı) anlamlı olarak daha düşüktü (sırasıyla p=0,04; p=0,04; p=0,01). İlave olarak gelir durumu iyi olanlarda Fiziksel fonksiyon, Mentalsağlık, Ağrı subskala skor ortalamaları anlamlı olarak daha yüksekti (p=0,01).Sonuç: Çalışma düşük uyku kalitesi, çoklu kronik hastalık varlığı ve düşük gelir durumununyaşam kalitesine olumsuz etkisini ortaya koymuştur
Erişkin Still Hastalığı: Olgu Sunumu
(Acil Tıp Uzmanları Derneği, 2014) Gündüz, Ercan; Güllü, Mehmet Nezir; Zengin, Yılmaz; Dursun, Recep; İçer, Mustafa; Özhasenekler, Ayhan; Karakoç, Yenal
Introduction: Adult-onset Still’s disease (ASD) is a systemic inflammatory disease of unknown etiology and pathogenesis. ASD, one of the most important causes of fever of unknown origin, is diagnosed after ruling out infection, malignancy, and rheumatologic diseases. It may also present with fever alone, without typical skin rash and articular manifestations. Case Report: There are no pathognomonic laboratory findings in ASD. In this paper, we report a case that presented to the emergency department with fever, malaise, and joint pain for 5 days and was subsequently diagnosed with ASD. Conclusion: In patients with prolonged fever combined with musculoskeletal symptoms and macular rash, the differential diagnosis should include ASD. Timely diagnosis and treatment of the disease can prevent complications and lead to a favorable prognosis
Evaluation of pregnant patients admitted to the emergency department with suicide attempt
(Modestum Publishing Ltd., 2015) Zengin, Yılmaz; Gündüz, Ercan; Dursun, Recep; İçer, Mustafa; Durgun, Hasan Mansur; Kara, Ertuğrul; Gündüzalp, Ahmet; Güloğlu, Cahfer
Objective: In the pregnancy period, the incidence of suicide attempt is lower compared to other life-periods. However, according to the recent studies, suicide attempts may lead life-threatening consequences in high-risk pregnant women. The aim of this study is to compare pregnant patients admitted to the emergency department for suicide attempt in terms of their sociodemographic and clinical properties and suicide attempt methods. Methods: In this study, 56 patients admitted to the emergency department of university for suicide attempt between January 1, 2009, and December 31, 2014, were included and they were classified according to suicide attempt methods into 2 groups as violent ones. Group 1 included violent methods as hanging, jumping, shooting and Group 2 included non-violent method as drugs. The study was a retrospective cross-sectional study. The sociodemographic, psychiatric and clinical properties of the patients were identified by patient registry system and patient files, and inter-group differences were compared. Results: In this study, 15 (26.7%) patients in the violent suicide attempt group, and 41 (73.3%) patients in the non-violent suicide attempt group, totally 56 patients were included. In the non-violent suicide attempt group, cigarette smoking, suicide attempt due to boredom, and live birth was significantly higher as compared to violent group; hospitalization period and fetal death was lower (p=0.04; p=0.006; p=0.004; p=0.004, respectively). Conclusion: Most of our pregnant suicide attempt patients are in the non-violent group, however, violent suicide attempt increased hospitalization period and fetal mortality significantly. J Clin Exp Invest 2015; 6 (2): 115- 120.
Factors affecting amputations in patients with diabetic foot ulcer referring to the emergency units
(Dicle Üniversitesi Tıp Fakültesi, 2017) İçer, Mustafa; Durgun, Hasan Mansur
Objective: Diabetic foot is the most common cause of lower extremity amputations. The aim of the present study was to investigate the clinical characteristics of and factors affecting amputation in patients with diabetic foot ulcer referring to the emergency units. Methods: The present study was performed based on retrospective review of medical files of 58 patients who were referred to the Emergency Unit of Dicle University, Faculty of Medicine between June 2010 and October 2016 due to diabetic foot ulcer. Results: Of 58 patients included in this study, 31 (53.4%) were men and 27 (46.6%) were women. The mean age was 61.43±11.584 (range: 41 to 85) years. Extremity amputation was not performed in 34 patients (58.6%), while 24 (41.4%) underwent an amputation. Factors affecting extremity amputation were found to be disease duration, presence of coronary artery disease, duration of hospital stay, and presence of osteomyelitis. Among laboratory findings, factors affecting extremity amputation were albumin, hemoglobin, leukocytes, neutrophil, neutrophil/lymphocyte ratio, hemoglobin A1c, and elevated erythrocyte sedimentation rate. The Wagner-Meggitt Classification of Grade 4, University of Texas Classification of stage D and Grade 3 also had significant effects on amputation. (p<0.05) Conclusion: Our study results suggest that together with classification systems, comorbidities, albumin levels, hemoglobin A1c levels, sedimentation rate, and complete blood count results play a key role in predicting the amputation requirement in patients with diabetic foot ulcers referring to the emergency units.
FACTORS AFFECTING MORTALITY IN GERIATRICPATIENTS WITH HEAD TRAUMA
(2016) Üstünda, Mehmet; Şen, Abdullah; Dursun, Recep; Orak, Murat; İçer, Mustafa; Güloğlu, Cahfer; Durgun, Hasan Mansur
Girifl:Yaşlılıkla birlikte vücut anatomisinde ve fizyolojisinde değişiklikler olur. Buna bağlı trav-maya karşı cevap yetenekleri değişmekte buda travmaya bağlı morbidite ve mortaliteyi arttırmak-tadır.Geriatrik yaş grubundaki kafa travmalı hastalarda prognoza ve mortaliteye etki eden faktör-leri tespit etmeyi amaçladık.Gereç ve Yöntem:Üç yıllık sürede kafa travması sebebiyle başvurmuş olan 65 yaş ve üstü1060 hasta incelendi. Hasta verileri cinsiyet, yaş, travmanın oluş şekli, Glasgow Koma Skalası, Re-vize Travma Skoru, kraniyal fizik muayene bulguları, kafa kemiklerindeki kırık lokalizasyonu, kra-niyal patoloji, ek organ yaralanması, yaşam ve ölüm durumu idi.Bulgular:Çalışmaya alınan 1060 geriatrik kafa travmalı hastanın 500'ü (%47) erkek, 560'>(%53) bayandı. Hastaların 1005'i (%94.8) yaşadı. Hastaların 55'i (%5.20) öldü. Ölen hastaların37'si (%67.3) erkek, 18'i (%32.7) kadındı. En çok başvuru toplamda 513 hasta ile 65-75 yaş ola-rak tanımlanan erken yaşlılık grubundaydı. Travma oluş sebeplerine göre en sık basit düşme var-dı.65 yaş ve üzeri tüm hasta gruplarında erkek cinsiyette olmanın mortalite için bir risk faktörü ol-duğu görüldü. Bilgisayarl> tomografi görüntülerine göre intrakraniyal kanama, kontüzyon, suba-raknoid hemoraji, epidural hematom, subdural hematom ve intrakraniyal ödem mortaliteyi arttı-ran bulgulardı.Sonuç:Geriatrik kafa travmarında erkek cinsiyet ve kraniyak patolojiler yüksek mortalite ileilişkilidir.
Glutamine provides effective protection against deltamethrin-induced acute hepatotoxicity in rats but not against nephrotoxicity
(International Scientific Literature Inc., 2015) Gündüz, Ercan; Ülger, Burak Veli; İbiloğlu, İbrahim; Ekinci, Aysun; Dursun, Recep; Zengin, Yılmaz; İçer, Mustafa; Uslukaya, Ömer; Ekinci, Cenap; Güloğlu, Cahfer
Background: The aim of this study was to investigate the protective effects of L-glutamine (GLN) against liver and kidney injury caused by acute toxicity of deltamethrin (DLM). Material/Methods: Thirty-two rats were indiscriminately separated into 4 groups with 8 rats each: control group (distilled water; 10 ml/kg, perorally[p.o.]), DLM group (35 mg/kg p.o. one dose.), GLN group (1.5 gr/kg, p.o. single dose.) and DLM (35 mg/kg p.o. one dose.) + GLN group (1.5 gr/kg, p.o. one dose after 4 hours.). Testing for total antioxidant status (TAS), total oxidant status (TOS), interleukin-1 beta (IL-1?), tumor necrosis factor-alpha (TNF-?), and interleukin-6 (IL-6) analyses were performed on tissue samples, and alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), urea, and creatinine were analyzed on serum samples. Liver and kidney samples were histopathologically analyzed. Results: The TOS level in liver was significantly higher in the DLM group than in the control group, and the level in DLM+GLN group was considerably lower than in the DLM group. The TAS level in the DLM+GLN group was considerably higher than in the control and DLM groups. The TAS level in kidney tissues was considerably lower in the DLM group than in controls, but was similar to other groups. Histopathological analyses of liver tissues established a significant difference between DLM and DLM+GLN groups in terms of grade 2 hepatic injury. However, no significant difference was found between DLM and DLM+GLN groups in terms of kidney injury. Conclusions: Glutamine leads to significant improvement in deltamethrin-induced acute hepatotoxicity in terms of histopathologic results, tissue oxidative stress parameters, and serum liver function marker enzymes.
Santral venöz kateter (SVK) malpozisyonlarında kolay ve hızlı tanı: Posterior-anterior (PA) akciğer grafisi: 3 Olgu sunumu
(2010) İçer, Mustafa; Üstündağ, Mehmet; Orak, Murat; Özhasaneker, Ayhan; Gökhan, Şervan
Santral venöz kateter (SVK) uygulamaları, son yıllarda acil servis ve yoğun bakım ünitelerinde ilaç ve kan ürünleri infüzyonu, santral venöz basınç izlemi, acil diyaliz erişim yolu, parenteral nütrisyon, kemoterapi ilaçlarının infüzyonu, uzun süre takibi gereken ve geniş bir damar yolu gereksinimi olan komplike olgularda sıkça kullanılan çok önemli, küçük cerrahi girişimdir. Kullanım sıklığının artması ile birlikte gelişebilecek komplikasyonlardan SVK malpozisyonunun erken dönemde fark edilebilmesi amacıyla posterior-anterior (PA) akciğer grafisinin önemini belirtmeyi amaçladık.
Socio-demographic and clinical factors related to mortality among the geriatric suicide attempters admitted to the emergency department
(Dicle Üniversitesi Tıp Fakültesi, 2015) Zengin, Yılmaz; Gündüz, Ercan; İçer, Mustafa; Dursun, Recep; Durgun, Hasan Mansur; Gürbüz, Hüseyin; Demir, Süleyman; Kuyumcu, Mahir
Objective: The ratio of elderly people in Turkey is rapidly growing. Accordingly, psychiatric problems and suicidality among elderly people are growing concerns. In this study, we aimed to investigate the socio-demographic characteristics of older people who attempted suicide by drug and to identify risk factors affecting mortality. Methods: Patients who were over 65 years old and admitted to the emergency department of a university hospital due to drug-related suicide attempt between January 1, 2004 and December 30, 2014, were included into this retrospective cross-sectional study. Relationship between suicide attempt and mortality was investigated in regard to socio-demographic and clinical factors. Patients were divided into two groups according to whether they survived or died. Results: Of the 107 patients included in the study, 68.2% were female and 31.8% were male; 34 6% were married. Common reasons for suicide attempt were depression (34.6%) and domestic violence (30.8%). Analgesics (33.6%) were the most common drugs used in suicide attempts. The analysis of the factors related to suicide attempt and mortality revealed that significant factors were loneliness, being widowed, being retired, having adjustment disorder and anxiety disorder. Conclusion: Loneliness, being widowed, being retired, adjustment disorder, and anxiety disorder were found as the risk factors affecting mortality in geriatric suicide attempts.
Toxic epidermal necrolysis secondary to ceftriaxone use: A case report
(Dicle Üniversitesi Tıp Fakültesi, 2015) İçer, Mustafa; Zengin, Yılmaz; Gündüz, Ercan; Durgun, Hasan Mansur; Orak, Murat; Üstündağ, Mehmet; Güloğlu, Cahfer
Toxic epidermal necrolysis (TEN) is a rare, life-threatening condition that is usually associated with medication use and characterized by separation of epidermis and dermis and a scalded skin appearance. A 71-year-old man presented to emergency department with fever, malaise, and hyperemic skin eruptions and bullae. Skin lesions covered more than 70% of total body surface area. Nikolsky sign was positive. He had been begun ceftriaxone for pneumonia before. TEN was considered as the initial diagnosis; the medication he used was stopped, appropriate supportive treatment was begun, and the patient was admitted to intensive care unit. He was discharged on 8th day after skin epithelization occurred. Toxic epidermal necrolysis is a highly fatal syndrome, in which early diagnosis, stopping the offensive drug, and administering appropriate supportive treatment are important components of the management.
Vital indicators in predicting burn mortality: A comparison of shock indices and burn shock indices
(Turkiye Klinikleri, 2023) İçer, Mustafa; Gündüz, Ercan; Güloğlu, Cahfer; Erbatur, Serkan; Polat, Dicle; Özkan, Halime; Bayrak, Tuğçe; Ülgüt, Şilan Göger
Background/aim: In many studies, shock indices have proven to be good tools for predicting mortality. In the present study, burn shock index (BSI), percentage of total body surface area burned (TBSA%) multiplied by shock index; burn modified shock index (BMSI), TBSA% multiplied by modified shock index; burn age shock index (BASI), TBSA% multiplied by age shock index; burn rivers shock index (BrSI), TBSA% multiplied by rivers shock index; burn rivers shock index multiplied by Glasgow Coma Scale score (BrSIG) were examined in burn patients. We defined these burn shock indices for the first time. This study aimed to evaluate the effectiveness of shock indices and burn shock indices in predicting mortality in burn patients. Materials and methods: This study examines retrospectively of burn patients admitted to the emergency department of Dicle University Hospital between January 2010 and December 2022. The patients’ vital signs were obtained at the time of presentation to the emergency department, and shock indices were calculated. The effectiveness of shock indices in predicting mortality was compared. Results: A total of 2445 patients were included in the study. Of the patients, 1793 were pediatric, and 652 were adults. BSI (AUC: 0.872, 95% confidence interval (CI): 0.812–0.931, p ˂ 0.001) had the highest area under the curve (AUC) value in predicting mortality in children. The optimal cut-off value for BSI in children was 21.79 and its was sensitivity 83.05%, specificity 79.64%, positive predictive value (PPV) 12.19%, negative predictive value (NPV) 99.28%. In adults, BASI had the highest value of AUC (AUC: 0.936, 95% CI: 0.887–0.984, p ˂ 0.001). The optimal cut-off value for BASI in adults was 62.5 and its sensitivity was 86.49%, specificity was 91.71%, PPV was 38.55%, and NPV was 99.12%. Conclusion: Shock indices are easy to calculate and effective in predicting mortality in burn patients admitted to the emergency department. Among the shock indices in the study, BSI was the best in predicting mortality in children, and BASI was the best in adults.
Yüksekten düşen travma hastalarının demografik verileri ile morbidite ve mortaliteye etkili faktörler (2005-2008 yılları arasındaki 2252 vakalık seri) (Retrospektif Çalışma
(2015) İçer, Mustafa; Güloğlu, Cahfer
Bu çalışmadaki amacımız yüksekten düşme ile gelen travma hastalarının demografik yapısını saptamak, mortalite ve morbiditeye etkili faktürleri incelemektir. Bu çalışmamızda Ocak 2005 ile Aralık 2008 tarihleri arasında Güneydoğu Anadolu bölgesinde Dicle Üniversitesi Hastanesi Acil Servisinde tedavi edilen 2252 yüksekten düşme ile gelen travmalı hastaya ait veriler geriye dönük olarak analiz edildi. Olgularda düşmenin olduğu ay, yaş, cinsiyet, düşme nedeni, düşme yeri, düşme zemini, entübasyon, hipotansiyon, taşikardi, baş boyun, göğüs, karın, pelvis ve ekstremite yaralanması, başvuru süresi, hastanede kalış süresi, GKS, İSS, RTS, GOS incelendi. Hastalar düşme yüksekliğine göre yedi gruba ayrıldı. Bu gruplar ve mortalitede yukarıdaki parametreler incelendi. Çalışmaya alınan 2252 yüksekten düşme ile gelen travma hastasının 1435 (%63,7)’i erkek,817 (%36,3)’i kadındı. Hastaların 2131 (%94,6)’i yaşadı. Hastaların 121 (%5,4)’i öldü. Hastaların yaş ortalaması 16,305±19,5462’idi. Yaş dağılımı en küçük 1 ay, en büyük 95 yıldı. Haziran, Temmuz, Ağustos, Eylül aylarında gelen hastalar 1238 hasta olup, tüm hastaların %54,9’uydu. Düşme zeminine göre 493 hasta yumuşak zemine 1759 hasta sert zemine düşmüştü. Düşme yerine göre hastalar incelendiğinde 1056 hasta ile damdan düşmeler hastaların %46,9’unu oluşturuyordu. 1-5 m’den (grup 2-3-4) düşen hastalar 1665 hasta olup tüm hastaların %73,9’unu oluşturuyordu. Hastalar sistem yaralanmasına göre incelendiğinde 594 hasta ile kafa travması ilk sıradaydı. Mortalite oranı %5,4’tü. Yaş, intihar, düşme yüksekliği, düşme zemini, damdan düşme, balkondan-pencereden düşme,inşaattan düşme,diğer yerlerden düşme, kafa travması, göğüs travması, batın travması, kot frakrürü, hemotoraks, pnomotoraks, akciğer kontüzyonu, hemopnomotoraks,batın içi serbest mayi, nörolojik defisit, serebral ödem, kranium fraktürü, EDH, SDH, SAK, İKH, serebral kontüzyon, pnomosefalus, RTS,GOS, ISS, GKS mortalite üzerine etkisi anlamlı bulundu(hepsinin P<0,05). Multivarite analiz sonucunda; SAK, hemopnomotoraks ve GOS mortaliteyi etkileyen bağımsız değişkenler olarak bulundu. Sonuç olarak dikkatsizlik, tedbirsizlik veya ihmal sonucu meydana gelen ve büyük çoğunluğu çocukluk çağında görülen yüksekten düşme olgularının, alınacak koruyucu önlemler ve ailelerin bu konuda bilinçlendirilmesi ile azaltılabileceği düşünüldü.

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