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Acute Pancreatitis and Splenic Vein Thrombosis due to Hypertriglyceridemia
(Hindawi Ltd, 2015) Gunduz, Ercan; Dursun, Recep; Icer, Mustafa; Zengin, Yilmaz; Guloglu, Cahfer
Acute pancreatitis (AP) is a condition characterised by the activation of the normally inactive digestive enzymes due to an etiological factor and digestion of the pancreatic tissues, resulting in extensive inflammation and leading to local, regional, and systemic complications in the organism. It may vary from the mild edematous to the hemorrhagic and severely necrotising form. The most common causes are biliary stones and alcohol abuse. In this case study, we would like to present a patient with AP due to hypertriglyceridemia (HPTG), which is a rare cause of pancreatitis, and splenic vein thrombosis, which is a rare complication of pancreatitis.
AFFECTING FACTORS ON EARLY MORTALITY IN ELDERLY PATIENTS DIAGNOSED WITH PULMONARY EMBOLISM IN EMERGENCY DEPARTMENT
(Gunes Kitabevi Ltd Sti, 2015) Zengin, Yilmaz; Gunduz, Ercan; Dursun, Recep; Icer, Mustafa; Durgun, Hasan Mansur; Taylan, Mahsuk; Guloglu, Cahfer
Introduction: The ratio of elderly people in Turkey is rapidly growing. It is known that pulmonary embolism and venous thrombolysis incidence increases with age. Despite the major advances in pulmonary embolism diagnosis and treatment, pulmonary embolism leads to higher mortality rates in the elderly. In the present study, evaluation of socio-demographic and clinical characteristics of elderly patients diagnosed with pulmonary embolism in the emergency department and determination of factors that affect early mortality have been targeted in order to decrease mortality. Materials and Method: Between January 1, 2009, and September 30, 2014, patients who were 65 years of age and older who had been admitted through the emergency department with suspected pulmonary embolism and whose pulmonary embolism diagnosis was finalized via computerized tomographic pulmonary angiography. Results: In the study, 87 (61.8%) were female and 52 (38.2%) were male. Thirteen patients (9.4%) died during the follow-up period. The analysis of the relationship between pulmonary embolism in elderly patients and early mortality revealed that there is a statistical correlation among immobility, syncope, tachycardia, hypotension, elevated Troponin-T, coronary arterial disease, cerebrovascular disease, pulmonary embolism with massive dimension, bilateral pulmonary embolism, Wells-likely pulmonary embolism, and modified Geneva-likely pulmonary embolism were statistically related factors(p values, respectively, were 0.002; 0.033; 0.000; 0.000; 0.000; 0.037; 0.011; 0.000; 0.030; 0.023; 0.018). Conclusion: Immobility, syncope, tachycardia, hypotension, elevated Troponin T, coronary arterial disease, cerebrovascular disease, pulmonary embolism with massive dimension, bilateral pulmonary embolism, Wells-likely pulmonary embolism, and modified Geneva-likely pulmonary embolism were determined as effective risk factors affecting the early mortality of elderly patients with pulmonary embolism.
Analysis of amitriptyline overdose in emergency medicine
(B M J Publishing Group, 2011) Guloglu, Cahfer; Orak, Murat; Ustundag, Mehmet; Altunci, Yusuf Ali
Introduction Amitriptyline is a tricyclic antidepressant. In general, toxicity effects develop within 30 min of overdose and peak from 2 h to 6 h. Anticholinergic effects predominate in cases of low dose ingestion. In cases of high dose ingestion, marked depression of the central nervous system is coupled with cardiotoxicity, seizures and hypotension. Patients and methods Amitriptyline-intoxicated patients admitted to the emergency department (ED) of Dicle University Hospital were evaluated between January 2005 and April 2007. Social and demographic status, clinical and laboratory findings, treatments and outcomes were recorded. Age, sex, marital status, time of hospital admission, consciousness levels, ECG findings, requirement for respiratory support, follow-up periods and antidepressant overdose risk assessment (ADORA) criteria were analysed using SPSS software. Results A total of 110 cases of overdose by amitriptyline was evaluated. Suicide attempts by amitriptyline overdose in adult single women were the commonest finding. The commonest symptoms seen during initial examinations were sinus tachycardia (66.3%), altered mental state (78.1%) and hypotension (7.3%). Mechanical ventilatory support was required in 9.1% of cases. Most patients (n = 76, 69.1%) were treated in the ED (p = 0.001). 60 (54.5%) patients were discharged from the ED within 24 h after admission (p < 0.0001). Conclusion Most of the patients were young single women. Altered mental state and tachycardia were the commonest symptoms. The initial symptoms of amytriptyline overdose patients may be life threatening, but effective supportive treatments were helpful. There was high correlation between ADORA criteria and the dose ingested.
The Analysis of Generalized Tonic Clonic Seizures Associated Injuries in Emergency Department
(Elsevier Science Bv, 2010) Altunci, Yusuf Ali; Gokhan, Servan; Ustundag, Mehmet; Orak, Murat; Ozhasenekler, Ayhan; Guloglu, Cahfer
Objectives: Persons with epilepsy are believed to be at greater risk of incurring accidental injury than those without seizures. During generalized seizures the individual is unable to utilize protective reflexes during falls and may consequently suffer head, orthopedic, or soft tissue injury. Our aim is to evaluate the spectrum of trauma in epilepsy patients presenting to our emergency department as a result of generalized tonic-clonic seizure (GTCS). Methods: We retrospectively reviewed patient records collected between January 2004 and December 2007 at the Emergency Department of Dicle University Medical School. All patients aged 15 years or more with epilepsy and trauma due to generalized tonic clonic seizures were included in the study. Records were analyzed for age, gender, type of injury, sufficiency of anti-epileptic medication, and mortality. Results: The average age of the 51 patients included in the study was 26.02 +/- 9.86 years, range 15-52 years. Thirty-three patients (64.7%) were male; the male female ratio was 1.83. Soft tissue injuries were the most common injury (26 instances). Head trauma, cuts, dental and tongue injuries were less common. Blood levels of anti-epileptic medication were in the therapeutic range in 9 (17.6%) patients, while 42 (82.4%) had sub therapeutic levels for effective treatment. Four (7.8%) of the patients died. The trauma in 2 mortalities involved burns; remaining deaths were associated with submersion injury and fall (subarachnoidal hemorrhage). Conclusions: There was no significant association between sub therapeutic levels of anti-epileptic medication and mortality.
Anticholinergic Toxicity Related to the Use of Datura Innoxia
(Aves, 2017) Basturk, Mustafa; Icer, Mustafa; Guloglu, Cahfer; Ertekin, Selcuk; Dogan, Serkan
Introduction: The incorrect use of the flowers, leaves, and seeds of some plants by members of the general public can give rise to serious toxicities. Datura innoxia (DI), also known as pipe grass or weed wizard, is frequently used for the treatment of asthma and cough and to alleviate cramps. However, DI is also a hallucinogenic, with tremendous potential for abuse and can cause anticholinergic toxicity, and serious and fatal complications, such as coma, respiratory failure, and death, have been reported. Case Report: We present the cases of two women (21 years old and 41 years old) who were admitted to the emergency department with findings of anticholinergic toxicity, including mydriasis, agitation, and delirium, after taking DI. The patients' pupils were widely dilated. Gastric decontamination and administration of activated charcoal, IV fluids, and midazolam/diazepam were performed. The patients' general conditions were recovered except for mydriasis. However, after 1 week, the diameter of the patients' pupils returned to normal. Conclusion: The unconscious misuse of some plants can cause fatal anticholinergic toxicity. Such toxicity though has rarely been reported with DI. When plants known to cause toxicity are usually endemic, clinicians should be alert to potential anticholinergic toxicity in patients who present with anticholinergic symptoms in these endemic areas.
Clinical importance of ultrasonographic pelvic fluid in pediatric patients with blunt abdominal trauma
(Turkish Assoc Trauma Emergency Surgery, 2010) Orak, Murat; Ustundag, Mehmet; Guloglu, Cahfer; Gokdemir, Mehmet Tahir; Erdogan, Mehmet Oezguer; Al, Behcet
BACKGROUND The aim of this study was to evaluate the significance of the ultrasonographic finding of pelvic fluid as a predictor of organ injury in pediatric patients with blunt abdominal trauma. METHODS We reviewed retrospectively the medical records of 85 consecutive pediatric patients who admitted to the Emergency Department of Dicle University from January 2008 to December 2008 with blunt abdominal trauma. Age, gender, mechanism of injury, isolated injuries, surgical interventions, hospitalization, and mortality were evaluated according to the location of fluid. RESULTS A total of 85 pediatric patients (63 male, 22 female; mean age: 7.88 +/- 3.403 years) with blunt abdominal trauma were included in the present study. Forty percent of the patients had intraperitoneal fluid, while 60% had pelvic fluid. The majority (35.3%) of patients applied due to falling from height. The difference between the mechanism of the injuries and location and presence of the fluid was not statistically significant (p>0.05). Twenty-nine patients had solid organ injuries. Splenic injuries showed the highest association with intraperitoneal fluid (p<0.001). Of the patients, 15.3% underwent exploratory laparotomy and 44.7% required blood transfusion. The presence of intraperitoneal fluid statistically increased the probability of the exploratory laparotomy and necessity of blood transfusion (p<0.001). Mortality rate was 4.8%. CONCLUSION In ultrasound examination, it was determined that the probability of solid organ injury was lower in the presence of pelvic fluid, while it was higher in the presence of intraperitoneal fluid outside the pelvis.
COVID-19 Sürecinde Acil Servis, Hasta Değerlendirme ve Yönetimi
(2021) Türk, Mehmet; Guloglu, Cahfer; Dursun, Recep
Covid-19 pandemisi sırasında acil servisler hastane ve yerel bakımın ön saflarında yer almaktadır. Hem şüpheli COVID-19 vakalarını belirlemek ve yönetmek hem de diğer tıbbi acil durumları teşhis etmeye ve tedavi etmeye devam etmek için kritik öneme sahiptirler. Sonuç olarak, değişen ihtiyaçları karşılamak için acil servislerin yeniden gözden geçirilmesi gerekmektedir. Bu makalemizde COVID-19 pandemisi sırasında acil servis organizasyonu ve hasta yönetimi süreçlerine odaklanmayı amaçladık.
Demographic Analysis of Complications of Warfarin Treatment and Factors Affecting Mortality
(Aves, 2013) Orak, Murat; Dursun, Recep; Ustundag, Mehmet; Ozhasenekler, Ayhan; Durgun, Hasan Mansur; Guloglu, Cahfer
Objective: This study investigated the demographic analysis of complications of warfarin therapy and the factors affecting mortality. Material and Methods: The digital medical records of patients who applied to our Emergency Clinic with warfarin overdose between September 2007 and September 2010 were retrieved and patient files were assessed retrospectively. Cases were classified into two groups in terms of INR level and hemorrhagic complications; patients with an INR level greater than 3.5 and a hemorrhagic complication, and patients with an INR level greater than 3.5 and no hemorrhagic complication. Furthermore, cases with a hemorrhagic complication were divided into two subgroups as those who died and those who survived. Results: The study enrolled 151 cases presenting to our emergency clinic with warfarin overdose. Among these, 50.3% (n = 76) were males and 49.7% (n = 75) were females. Mean age was 60.80 +/- 16.11 years. There was no significant difference between the groups in terms of sex and age. Hemorrhagic complication was present in 66.89% (n = 101) while absent in 33.11% (n = 50). PT and INR levels were significantly higher in patients with hemorrhage compared to those without (for PT 90.98 +/- 26.52 vs. 55.51 +/- 12.70, respectively; p < 0.001; for INR 8.97 +/- 11.29 vs. 4.63 +/- 0.68, respectively; p = 0.042). In patients with a hemorrhagic complication who died, the PT level was significantly higher, and hematocrit and platelet levels were significantly lower than those of patients who survived a hemorrhagic complication (p < 0.001, p = 0.033, and p = 0.009, respectively). Conclusion: Education in warfarin use, regular follow-ups, self-monitorization, and increased distribution of home-type coagulometry devices will decrease the frequency of complications.
The effect of body mass index on trauma severity and prognosis in trauma patients
(Turkish Assoc Trauma Emergency Surgery, 2016) Durgun, Hasan Mansur; Dursun, Recep; Zengin, Yilmaz; Ozhasenekler, Ayhan; Orak, Murat; Ustundag, Mehmet; Guloglu, Cahfer
BACKGROUND: As in the rest of the world, the prevalence of obesity in Turkey has been increasing in recent years and has become a major public health issue. Although many trials have been conducted to study the effects of obesity on internal diseases, there are few studies investigating the effects of obesity on prognosis of trauma patients. The present study analyzed the effects of body mass index (BMI) on trauma severity and prognosis in trauma patients. METHODS: This study was prospectively conducted with trauma patients older than 15 years of age who presented at the Dicle University Faculty of Medicine emergency medicine department trauma unit between June I, 2013 and May 31, 2014. Patients were grouped into high-energy trauma and low-energy trauma groups based on trauma severity. In addition, 4 groups were made according to BMI value (kg/m(2)). Group I was defined as BMI <25 (normal weight). Group II patients had BMI of 25-29.9 (overweight). Group III had BMI of 30-34.9 (obese), and Group IV was made up of patients with BMI >= 35 (morbidly obese). RESULTS: Comparison of whole patient population for inter-group differences showed significant differences between rate of head injury, thoracic injury, extremity injury, multitrauma, clinic admission rate, and mortality rate (p<0.001). No significant difference was observed between groups in abdominal injury rate (p=0.347). CONCLUSION: Clinic admission rate, length of intensive care unit stay, mortality rate, multitrauma rate, and injury severity score increased in proportion to greater BMI.
The Effective Factors in Emergency Department Observation on Hospitalization Requirement and Mortality in Blunt Trauma Patients
(Emergency Medicine Physicians Assoc Turkey, 2010) Altunci, Yusuf Ali; Aldemir, Mustafa; Guloglu, Cahfer; Ustundag, Mehmet; Orak, Murat
Objective: Today, despite social and economic development, trauma is the most important public health problem for all countries. Our aim is to retrospectively overview patients with blunt multi trauma who applied to our emergency department within their treatment period in the emergency department or other surgical departments and evaluate the factors which were effective for hospitalization and mortality. Materials and Methods: In our study we evaluated 226, patients over 15 years of age who applied to Dicle University Emergency Department between January 2006 and January 2008 due to blunt multi trauma such as motor vehicle crash, fall etc. retrospectively according to their definitive medical records. For statistical analysis, we divided our patients into two groups: treated in emergency department (n=105), treated in surgical departments (n=121). Results: Of our 226 patients 71.7% (n=162) were male and 28.3% (n=64) were female. Nineteen (8.4%) of trauma patients died. The average age for all patients was 35.9 +/- 15.882 (15-94). Blood transfusion requirement effected transfer of patients to surgical department (p=0.00). Between our groups, alanin transaminase, aspartate transaminase, hematocrit and white blood cells were submitted for statistical analysis (p>0.05). Injury Severity Score (ISS) and Abbreviated Injury Scale (AIS) were available for group 2 patients scientifically (p<0.05). Conclusion: Multivariate analysis showed that high white blood cell levels (OR=1.0, CI=1.00+1.00, P<0,01), high AIS score (OR=4.17, CI=2.34+7.43, P=0,00) and blood transfusion requirement (OR=0.042, CI=0.005+0.33, P<0,01) were effective factors for hospitalization.
Effects of suicide methods and demographic data on mortality in patients presented with suicide attempts to the emergency department
(Elsevier Science Bv, 2009) Guloglu, Cahfer; Gokhan, Servan; Ustundag, Mehmet; Orak, Murat
Objective: The aim of this study was to evaluate the relation between demographic properties, suicide methods and mortality in patients presented with suicide attempt to the emergency department (ED). Methods: The patient charts presented with suicide attempt to ED of Dicle University between 01.01.2003 and 31.12.2007 were evaluated retrospectively. Age, gender, social and demographic features, suicide methods, period from attempt to admission and mortality were recorded.. Results: One thousand and eighty one patients were included into the study. Nine hundred and one (70.4%) patients were female and 380 (29.6%) were male. Mean age was 23.36(i-7.53). Eight hundred and fifty five (66.7%) attempted suicide by taking drugs, 337 (% 26.3) by taking insecticides, 33 (% 2.6) by hanging, 19 (1.5%) by gunshots, 13 (1%) by jumping and 24 (1.9%) by ingesting corrosive solvents, Nine hundred fourty six (73.9%) patients were admitted from the city centers and 335 (% 26.1) were from rural areas. Five hundred seventy seven (45%) were married, 704 (55%) were single. Twon hundred ninety three (22.9%) had been working, 988 (77.1%) were unemployed. The mortality rate was 5.78% (n=74) cases. The mortality rates were significantly higher in patients with female gender, suicide with insecticide ingestion, hanging, gunshot and jumping. Conclusions: Suicide is an important public health problem that concerns patients, relatives and society. Preventing mortality from suicide, social and demographic characteristics should be regarded by a multidisciplinary approach.
Elevated Troponin Levels in Acute Exacerbation of COPD
(Emergency Medicine Physicians Assoc Turkey, 2013) Erdogan, Mehmet Ozgr; Guloglu, Cahfer; Orak, Murat; Ustundag, Mehmet; Senyigit, Abdurrahman
Objective: To investigate the correlation between serum troponin elevation and vital signs, arterial blood gases, length of stay, prognosis in patients admitted to the emergency department with an exacerbation of chronic obstructive pulmonary disease. Material and Methods: This prospective study was performed on 100 COPD patients admitted to the Dicle University Hospital Emergency Department between January 2008 and June 2008. Ki square test was used for univariate analyses of categorical variables, Mann-Whitney U Test was used for continuous variables. Results: In our study, 11% of patients were in the elevated sTnI group. Elevation of sTnI had no statistical relation with vital signs, electrocardiographic datas or arterial blood gases. Elevation of sTnI had no statistical relation with length of stay (p=0.863), ICU admission (p=0.619) or mortality (p=0.061). Conclusion: High sTnI in COPD patients has no predictive value for length of stay, ICU admission and prognosis.
Factors affecting mortality caused by falls from height
(Turkish Assoc Trauma Emergency Surgery, 2013) Icer, Mustafa; Guloglu, Cahfer; Orak, Murat; Ustundag, Mehmet
BACKGROUND: Falls from height are among the most common trauma cases presenting to emergency departments and often cause mortality and morbidity. In the present study, we aimed to determine the factors that effectively reduce mortality caused by falls from height. METHODS: Data from 2252 trauma patients who presented to Dicle University Emergency Service between January 2005 and December 2008 due to falling from height in the Southeastern Anatolia region were retrospectively analyzed. We analyzed the parameters that are considered to have a positive effect on mortality, which included the following: month of fall; age; gender; etiology; place of fall; type of ground on which the patient fell; height of fall; intubation; hypotension; tachycardia; neck, head, thoracal, abdominal, pelvic, and extremity injuries; Glasgow Coma Score (GCS); Injury Severity Score (ISS); and Revised Trauma Score (RTS). RESULTS: There were 1435 males (63.7%) and 817 females (36.3%) included in the study. Two thousand thirty-one (94.6%) patients survived the fall while 121(5.4%) died. The mean age of the surviving patients was 15.55 +/- 18.60 years, while the patients who died had a mean age of 29.59 +/- 28.93 years. The mean height of the fall of the survivors' was 3.09 meters, and the mean height of the fall for those that died was 6.61 +/- 5.73 meters (p<0.001). CONCLUSION: The mean fatal height of the fall in falls from height is 6.61 m. Age, attempted suicide, height of fall, type of ground on which the patient fell, place of fall, and head, thoracic, and abdominal trauma are the primary factors affecting mortality caused by falls from height.
Factors Affecting Mortality in Endosulfan Ingestion With Suicidal Intent
(Aves, 2010) Orak, Murat; Ustundag, Mehmet; Ozhasenekler, Ayhan; Altunci, Yusuf Ali; Guloglu, Cahfer; Tamam, Yusuf
Objective: Most pesticides containing Endosulfan have either been restricted or prohibited due to the fact that they remain active longer in nature, and have a long half-life and mid-level toxicity in the body. Acute or chronic exposure to Endosulfan, which may be life-threatening or at times fatal, has rarely been reported. Our aim was to analyze the aff ective factors of endosulfan toxicity on clinical fi ndings and mortality cases. Materials and Methods: In the study, all patients who called upon the emergency service due to suicidal endosulfan ingestion were retrospectively analyzed. Twenty-seven patients over the age of 15 years with defi nite proof that they used medicine containing an endosulfan substance were included into the study. Results: The average age of our patients was 26.56 +/- 13.6 years (15-68). The number of male patients was 10 (37.1%), while that of female patients was 17 (62.9%). There were 17 patients (62.9%) who presented with nausea and vomiting complaints, 12 (44.4%) patients with seizure, and 15 (55.5%) with loss of consciousness. The 5 patients who died had loss of consciousness and seizure, and required mechanical ventilation support during seizure and follow-up. In the surviving group, however, loss of consciousness was detected in 10 patients, seizure during follow-up in 5, and ventilation support was required in 5 patients. Conclusion: Loss of consciousness following suicidal endosulfan ingestion, seizure on arrival and/ or during follow-up and need for mechanical ventilation support were the factors which aff ected mortality.
FACTORS AFFECTING MORTALITY IN PATIENTS WITH GUNSHOT INJURIES
(Marmara Univ, Fac Medicine, 2009) Eris, Savas; Orak, Murat; Al, Behcet; Guloglu, Cahfer; Aldemir, Mustafa
Objective: We planned this study in order to determine the factors affecting mortality in patients with gunshot injuries in more than one organ. Methods: We retrospectively reviewed the hospital records of 714 patients admitted to the Emergency Department of Dicle University, between January 2000 and December 2004. The factors that we considered would affect mortality such as age, sex, attempts suicide, long barrelled gun injuries, pellet injuries, contact/near contact shot, delayed admission time, presence of serious anemia and shock during admission, more than four entrance wounds, injury areas, serious cranial, thorax and abdominal injuries, vascular injuries in the extremities, administration of multiple transfusion, and trauma scores as GCS, RTS, PATI were analyzed. Results: As a result of unvaried statistical analyses, we determined that suicide attempts (p= 0.001), presence of serious anemia (p= 0.001) and shock (p= 0.001) during admission, presence of serious cranial (p= 0.001), thorax (p= 0.001) and abdominal (p= 0.001) injury, femoral artery injury (p= 0.001), multiple blood transfusion (p= 0.009),, GCS 0-7, GCS 8-12 (p= 0.001) and low RTS (p= 0.001) were significant factors affecting mortality. Conclusion: Multivariate analysis showed that serious anemia during admission, serious cranial injury, serious abdominal injury and low RTS were independently significant in predicting mortality (p< 0.05).
Factors Associated with Morbidity and Mortality in Patients with Mechanical Bowel Obstruction
(Emergency Medicine Physicians Assoc Turkey, 2012) Halis, Nurkal; Sogut, Ozgur; Guloglu, Cahfer; Ozgonul, Abdullah; Gokdemir, Mehmet Tahir; Durgun, Hasan Mansur
Objective: The aim of this study was to investigate the factors affecting morbidity and mortality by evaluating the demographical, etiological and clinical characteristics of patients with mechanical bowel obstruction. Materials and Methods: Data for 171 mechanical bowel obstruction patients were evaluated retrospectively. The patients were assessed in mortality (n=21), morbidity (n=55) and recovery (n=95) groups. Results: Of the patients, 70% were men; and 27.4% were =55 years of age. While gender had no impact on mortality and morbidity, age did. Adhesion was observed to be the leading cause (45.6%) of mechanical bowel obstruction, followed by incarcerated hernia in 17.5%. Intestinal necrosis was associated with mortality but not with morbidity. Late presentation and multiple concomitant diseases had no impact on mortality but were associated with morbidity. The presence of a concomitant disease and leukocytosis or leukopenia had a significant impact on both mortality and morbidity. Conclusion: Older age and presence of a concomitant disease, leukocytosis or leukopenia were established to be associated with mortality and morbidity. Late presentation and multiple concomitant diseases were associated only with morbidity. The presence of intestinal necrosis was associated only with mortality. Establishing the risk factors well will be beneficial in lowering the incidences of morbidity and mortality.
Factors Influencing Mortality in Pediatric Trauma Patients
(Emergency Medicine Physicians Assoc Turkey, 2012) Tas, Mahmut; Guloglu, Cahfer; Orak, Murat; Ustundag, Mehmet; Aldemir, Mustafa
Objective: In our study, we aimed to research the factors we thought might be affect mortality in a pediatric age group (0-15 y) with multiple trauma. Materials and Methods: In our study of 1658 pediatric patients suffering from falling events, burns, cutting and perforating instrument injuries, gunshot injuries and vehicle accidents admitted to Dicle University. hospital ED between March 2003 and December 2006 were analyzed and included to the study consecutively. The patients were divided in two groups, the patients who survived were in group 1, and the patients who died were in group 2. Results: Of the 1658 patients, 70.5% (n= 1169) were male, 29.5% (n=489) were female and 107 patient died (6.46 %). Mean age was 6.75+-0.397 in group 2 (who died) and 7.00+-0.99 in group 1, (survived). Low RTS score (OR (odds ratio)= 1.565, CI=1.297-1.889, p<0.05). Falling down from height OR=0.637, CI=0.408- 0.995, p<0.05), postulated admission (OR=2.035 CI=1.267-3.267, p<0.05) and medical treatment (OR=0.451, CI=0.273-0.744, p<0.05) were found to be the effective factors in pediatric patients with multiple trauma. Conclusion: The falling events, abdominal and thoracic trauma with low ISS, RTS, TRISS and postulated admission to ED are the factors that affect the mortality in pediatric trauma patients.
Factors that effect on complication development while inserting central venous catheter
(Elsevier Science Bv, 2006) Orak, Murat; Ustundag, Mehmet; Guloglu, Cahfer; Aldemir, Mustafa; Dogan, Halil
Objectives: Knowledge of factors that effect the development of complications while inserting a central venous catheter can lead to interventions which can lead to decreased rates of complications. In this study we evaluate the factors that effect the development of complications during central venous catheter insertion. Materials and Methods: 325 patients (179 males (% 55.1), 146 females (% 44.9)) who had central venous catheters inserted in Dicle University hospital emergency department between June 2005 and May 2006 were enrolled in this study. The effect of age, gender, reason for central venous catheter insertion, diameter of the catheter, the initial insertion site, the number of attempts for inserting the catheter, the time of day when the catheterwas inserted and the level of training of the physician on development of complications was studies. Chisquare test was used for categorical variables and the t test for continuous variables in statistical analysis. Results: Complications developed in 12% (n=39) patients. Of patients with complications, 56.4% (n=22) were male and 43.6% (n=17) female. No significant statistical relationship was detected between complication development and age, gender, reason of central venous catheter insertion, diameter of the catheter, the insertionsite, the time of day when the catheter was inserted, or the level of training of the physician (p>0.05). Patients in whom the initial insertion site was infraclavicular (42.6%) had a statistically significant higher rate of complications (p=0.036). Patients who had three or more attempts for catheterization (26.5%) also had statistically significant increase in the rate of complications (p<0.0001). Conclusion: The infraclavicular approach and three or more attempts at CVP catheter insertion arerelated to complicationst.
Lethal toxicity of propafenone in a case of suicidal attempt
(Elsevier Science Bv, 2007) Ustundag, Mehmet; Orak, Murat; Guloglu, Cahfer; Ozhasenekler, Ayhan; Durgun, Hasan Mansur
Propafenone is a well-established IC class antiarrhythmic drug widely used in the treatment of a variety of supraventricular and ventricular tachyarrhythmias. Propafenone has been widely used in clinical practice in recent years. As a class IC antiarrhythmic agent it may show a significant proarrhythmogenic effect even at therapeutic doses. Toxic effects of high doses including fatal outcome have been sporadically described in the literature. Fatal course is usually associated with cardiac conduction abnormalities with progression to asystole or electromechanical dissociation. Since a specific treatment is not available and resuscitation techniques may be of limited value, early diagnosis and primary detoxication are essential. In this study, we present one case of suicidal attempt acute toxicity 7500 mg of propafenone that proceeded mortal and review the literature on this subject.
Mortal postpartum neuroleptic malignant syndrome
(Elsevier Science Bv, 2006) Ustundag, Mehmet; Orak, Murat; Guloglu, Cahfer; Dogan, Halil; Uysal, Emin
Neuroleptic malignant syndrome is a serious side effect caused by antipsychotic medications. Neuroleptic malignant syndrome is believed to be triggered by neuroleptic blockade of dopaminergic receptors located in the hypothalamus and basal ganglia. The incidence of neuroleptic malignant syndrome with conventional antipsychotic agents has been reported to vary from 0.02-2.44%. Manifestations of this syndrome include severe muscle rigidity and high temperature with any of the following symptoms: dysphagia, tremor, incontinence, changes in the level of consciousness, ranging from confusion to coma, mutism, tachycardia, elevated or labile blood pressure, leukocytosis and laboratory evidence of muscle injury characterized by elevated creatinine-phosphokinase (CPK). In this study, we present a case of postpartum neuroleptic malignant syndrome which ended in the death of the patient, and review the literature.

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