Amaç: Modern tıbbın bir parçası olarak kan ve kan ürünü transfüzyonu, 50 yılı aşkın bir süredir klinik kullanıma girmiştir. Acil servislerde kan transfüzyonları sıkça yapılmakta ve bu da ekstra iş yükü getirmektedir. Bu çalışmanın amacı, acil serviste yapılan kan ve kan ürünü transfüzyon oranlarını ve hastaların demografik özelliklerini ve acil servis işleyişine olan etkileri araştırmaktır.Yöntem: Bu çalışmada, acil serviste 2017 yılının ilk üç ayında kan ve kan ürünü verilen has-talar retrospektif olarak incelendi. Hastaların demografik özellikleri, kan ürününü hangi bölümün istediği, hangi kan ürünü verildiği, hastane hizmet bedeli kaydedildi. İstatistiksel analiz için SPSS for Windows 22.0 programı kullanıldı.Bulgular: Toplam, 356 hastanın %54,2’si kadın, %45,8’i erkekti. Ortalama yaş 60,60±19,77 olarak saptandı. En sık anemi (%49,2) tanısıyla transfüzyon yapıldığı görüldü. En sık eritrosit süspansiyonu (%84,8) kullanıldığı görüldü. Anemi tanısı ile transfüzyon yapılan hastaların taburculuk oranları yüksek (p=0,001) iken, GİS kanama ve travma nedenlilerde bu oran düşüktü (p=0,001). Genel cerrahi (p=0,001) ve dahiliye (p=0,031) tarafından istemi yapılan hastalarda hizmet bedeli yüksek olup, ortalama 289,36±36,65 Türk lirası saptandı.Sonuç: Uygun kan ve kan ürünü transfüzyonunun, acil servis yoğunluğunu, kalış sürelerini, hastane hizmet bedellerini, istem ile transfüzyon sayıları arasındaki uyumsuzluğu azaltaca-ğı düşünülmektedir. Acil servislerde transfüzyon kararı verilirken her açıdan dikkatli olunma-lıdır. Transfüzyon işlemleri hastalar için kar zarar dengesi gözeterek yapılmalıdır.
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Aim: This study aimed to investigate the prognostic value of lactate and red cell distribution width (RDW) parameters of patients admitted to emergency service and critical care unit (CCU).Materials and Methods: A total of 147 patients hospitalized in the CCU of Necmettin Erbakan University, Meram Faculty of Medicine, Department of Emergency Medicine, were included in the study. Vital signs, laboratory results, lactate, and RDW values of the patients were recorded. Acute Physiology and Chronic Health Evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores were calculated. Duration of hospitalization and intensive care unit stay and mortalities were recorded. Chi-square, Fisher's exact chi-square, and Student t tests were used for statistical analyzes, and Mann-Whitney U test was used for comparing nonparametric data that were not compatible with a normal distribution. P<0.05 were accepted as statistically significant. Spearman correlation analysis was used to assess whether a linear correlation existed between the parameters. Results: A statistically significant correlation was found between the duration of stay in the CCU for <7 days and total duration of hospitalization (p<0.001). Also, statistically significant correlations were observed between mortalities of 28 days and 3 months, APACHE II and SOFA scores, and mean lactate (for 24 h and during hospitalization) and RDW values (p<0.001, p<0.001, p<0.001, and p<0.05, respectively). Moreover, correlations were noted between APACHE II scores, lactate value during the first admission, and SOFA scores (p<0.001). Correlations were also observed between 48-h SOFA scores and RDW and lactate values (p<0.001). Conclusion: SOFA and APACHE II are the scoring systems used in practice. Efficiencies for mortality assessment of critical patients were confirmed. This study showed that lactate and RDW values, which were compatible with the scoring systems, could be used for assessing prognosis. Wider and more comprehensive studies that can assess scoring systems and lactate and RDW values together for prognostic identification are required to validate the findings.
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Aim: The aim was to evaluate the levels of serum pentraxin-3 (PTX-3) and neutrophil gelatinase-associated lipocalin (NGAL) and the efficiency of making a diagnosis and to estimate the prognosis in patients with chest pain.Materials and Methods: The study was conducted in the Necmettin Erbakan University Meram Medicine School Emergency Department. Patients who had chest pain and met the inclusion criteria were accepted. They were divided into the following groups: acute coronary syndrome (ACS), a diagnosis other than ACS (non-ACS), and control. The patients in theACS and non-ACS groups were divided into five sub-group -groups: ST Elevated Myocardial Infarction (STEMI) Non- ST Elevated Myocardial Infarction (NSTEMI), Unstable Angina Pectoris (USAP), stable angina, and pulmonary embolus. For all patients, serum PTX-3, serum NGAL, troponin I, and creatine kinase-MB fraction (CK-MB) levels were measured.Results: There were 199 patients in the ACS and non-ACS groups and 30 patientsin the control group. There was no significant difference among the study groups in terms of age and PTX-3 and NGAL levels. When comparing survival and non-survival in terms of in-hospital death, CK-MB and troponin I levels were significantly higher in the ACS and non-ACS groups than in the control groups, whereas there was no significant difference in terms of PTX-3 and NGAL levels.Conclusion: The results of our study demonstrated that PTX-3 and NGAL are not effective biomarkers in the differential diagnosis and the determination of in-hospital mortality in ACS. However, the limitations of the study should be considered. The results confirmed that CK-MB and Troponin I can be safely used in the differential diagnosis and the prediction of mortality.
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Demet ACAR, Mustafa GÜLPEMBE, Can Gökay YILDIZ, Emine Nur OZDAMAR, Kerem AÇIKGÖZ, Ahmet ÇAĞLAR,
BAŞAR CANDER
Demet ACAR, Mustafa GÜLPEMBE, Can Gökay YILDIZ, Emine Nur OZDAMAR, Kerem AÇIKGÖZ, Ahmet ÇAĞLAR,
... Devamını oku
Background/aim: We aim to determine the effects of low-dose atorvastatin treatment together with crush fluid resuscitation on renal functions and muscle enzyme levels in a rat model of crush syndrome. Materials and methods: The study involved female Wistar Albino rats weighing 250 300 g that were housed with free access to food and water. The crush model was obtained by compression. Rats were randomly divided into four groups: control (C) group, atorvastatin + crush fluid (ACF) group, crush fluid (CF) group, and hypertonic saline (%3) + mannitol + sodium bicarbonate (SM) group. Blood was obtained at 24, 48, and 72 h, and serum creatinine kinase, myoglobin, urea, creatinine, and lactate dehydrogenase levels were studied. Results: All parameters were statistically significantly higher in the control group than in the treatment groups at all hours. However, there was no statistically significant difference among treatment groups regarding any of the parameters. Conclusion: This is the first study determining the role of atorvastatin in the treatment of renal ischemia/reperfusion injury in a crush syndrome and rhabdomyolysis model setting. Larger studies with different atorvastatin doses are required to define the role of this drug in the treatment of renal ischemia/reperfusion injury during crush syndrome.
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Background/aim: This study aimed to evaluate oxidative stress markers of liver tissue in a mouse α-amanitin poisoning model with three different toxin levels. Materials and methods: The mice were randomly divided into Group 1 (control), Group 2 (0.2 mg/kg), Group 3 (0.6 mg/kg), and Group 4 (1.0 mg/kg). The toxin was injected intraperitoneally and 48 h of follow-up was performed before sacrifice. Results: Median superoxide dismutase activities of liver tissue in Groups 3 and 4 were significantly higher than in Group 1 (for both, P = 0.001). The catalase activity in Group 2 was significantly higher, but in Groups 3 and 4 it was significantly lower than in Group 1 (for all, P = 0.001). The glutathione peroxidase activities in Groups 2, 3, and 4 were significantly higher than in Group 1 (P = 0.006, P = 0.001, and P = 0.001, respectively). The malondialdehyde levels of Groups 3 and 4 were significantly higher than Group 1 (P = 0.015 and P = 0.003, respectively). The catalase activity had significant correlations with total antioxidant status and total oxidant status levels (r = 0.935 and r = 0.789, respectively; for both, P < 0.001). Conclusion: Our findings support a significant role for increased oxidative stress in α-amanitin-induced hepatotoxicity.
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Warfarin is an oral anticoagulant drug that prevents clotting, used in treating many diseases as well as prophylaxis. Despite its widespread use and efficacy, it may lead to a wide range ofadverse effects, mainly bleeding, due to its quite narrow therapeutic index and interaction withother medications. Most commonly, it may result in epistaxis, hematuria and subcutaneous hemorrhage. In addition, it is likely to cause bleeding in the gastrointestinal tract, soft tissues, and cerebral region. It is rare to develop intramural hematoma in the jejunum resulted from warfarintoxicity. Here, we present a case admitted to the emergency department with abdominal pain, anddiagnosed with intramural hematoma after physical examination, laboratory findings and imaging.Emergency physicians should consider intestinal hematoma as differential diagnosis in patientsusing warfarin and presenting with abdominal pain.
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Although post dural puncture headache is the most common complication of spinalanesthesia, subdural hematoma is a rare complication. The mortality would be high if untreated. Inthis case, a patient of 28 years old presented to our emergency department with headache after cesarean section performed with spinal anesthesia 20 days prior. She had received analgesic drugtreatment for post dural puncture headache. Despite treatment, she presented to our emergency department for unresolved headache. A subdural hematoma was detected using a brain computed tomography (CT) because of complaint of double vision accompanied by headache. For headacheoccurring after spinal anesthesia without response to medical therapy, subdural hematoma shouldbe considered.
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Aim: The purpose of this study was to examine changes in cardiac monitoring, electrocardiography (ECG), or cardiac enzymes and, specifically, changes in the TpTe interval and TpTe/QT ratio in patients who presented with electrical injuries. Materials and Methods: All patients aged over 18 years who had visited the Emergency Medicine Clinic between January 2011 and January 2014 because of electrical injuries and who were monitored for more than 24 h were included. Results: Seventy patients were included in the trial. ECG changes were present in 19 patients (27.1%) at various time points (0th, 6th, 12th, and 24th hour). The TpTe intervals of the patients at the time points were 64.5 (IQR: 21.25), 65 (IQR: 21.5), 64 (IQR: 20), and 64 (IQR: 20) ms, respectively, which were within the normal range. Although a statistical difference was present (p=0.033), superior analyses showed no significant difference among the groups. The TpTe/QT ratios of the patients were 0.18 (0.07), 0.18 (0.05), 0.18 (0.06), 0.18 (0.05), respectively, which were within the normal range (p=0.105). We compared the TpTe intervals and TpTe/QT ratios of patients with and without ECG changes and found that no statistically significant difference was present at all time points. Besides this, no difference in the TpTe intervals and TpTe/QT ratios was identified between the groups with elevated and non-elevated troponin levels. Conclusion: The use of TpTe intervals and TpTe/QT ratios may not be the correct approach for predicting potential rhythm disorders in electrical injuries. In addition, there is no association of the TpTe interval or the TpTe/QT ratio with ECG changes or troponin elevation caused by electrical injuries.
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Amaç: Brain Natriüretik Peptid (BNP) ventriküler miyositlerden duvar gerilimine yanıt olarak salınan protein yapılı belirteç olup son yıllarda kullanımı gittikçe artmaktadır. Akut kalp yetmezliğinde, sol ventrikül hastalıklarında akut dispnede kullanımı yaygınlaşmaktadır. Bu çalışmada amaç; aritmi tespit edilen hastalarda BNP düzeyi araştırılmıştır. Gereç ve Yöntemler: Bu çalışmaya Acil servisimize başvuran ve herhangi bir ritm bozukluğu olan hastalar dahil edildi. Hastalara yatak başı EKO yapıldı. Hastalar kalp yetmezliği olan ve kalp yetmezliği olmayan hastalar olarak iki grupta sınıflandırıldı. Hastalardan alınan 1 cc kan Etdalı tüpe alınarak N Terminal Prohormon Brain Natriüretik Peptid (NT pro BNP) bakıldı. Toplanan veriler önceden hazırlanan formlara kaydedildi. İstatistiksel analizler "SPSS for Windows 13.0'' programı yardımıyla yapıldı. Kalp yetmezliği olan hastalarda ortalama BNP düzeyi 25100±10955 pg/mL iken, kalp yetmezliği olmayan herhangi bir ritm bozukluğu olan hastaların ortalama BNP düzeyi 5767,61±6225 pg/mL olarak tespit edildi. Sonuç: BNP ve NTpro BNP akut kalp yetmezliğinin tanısında kullanılan önemli belirteçlerdir. Son yıllarda başka hastalıklarla ilgisi konusunda çalışmalar yaygınlaşmıştır. Bizim çalışmamızda kalp yetmezliği olan disritmili hastalarda yüksek tespit edilmesi yanında kalp yetmezliği olmayıp herhangi bir aritmi tespit edilen hastalarda da normal sınırların üstünde tespit edilmiştir.
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Background/aim: The purpose of this experimental study was to investigate the role of lipoprotein-associated phospholipase-A2 (LpPLA2 ) in the diagnosis of acute mesenteric ischemia (AMI) in the early stage. Materials and methods: Twenty-seven New Zealand rabbits were randomly divided into 3 groups in this study. Blood specimens were obtained from the groups at hours 0, 1, 3, and 6. Using the blood samples drawn from all groups, Lp-PLA2 and C-reactive protein (CRP) parameters were investigated. Results: There was a significant rise in the levels of both Lp-PLA2 and CRP starting at hour 1 (P < 0.05) (hour 1; Lp-PLA2 , P = 0.003) in the ischemia group. In the sham group, the levels of Lp-PLA2 and CRP started to rise at hour 3 (P < 0.05) (hour 3; Lp-PLA2 , P = 0.011). At hour 6 of ischemia, the area under the ROC curve was 100%, and the cut-off value of 63.91 ng/mL revealed a sensitivity of 88% and a specificity of 100% for Lp-PLA2 . Conclusion: These findings showed the role of serum Lp-PLA2 and CRP levels in the early diagnosis of AMI. Thus, further studies are needed to describe the role of Lp-PLA2 in the early diagnosis of AMI.
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