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    Diagnostic values of proenkephalin and S100B protein in traumatic brain injury
    (Walter de Gruyter GmbH, 2017) Yalçın, Anıl; Baydın, Ahmet; Tuncel, Özgür Korhan; Erenler, Ali Kemal; Çokluk, Cengiz; Güzel, Murat; Tomak, Leman
    Background: The primary aim of this study was to investigate the diagnostic values of serum S100 calciumbinding protein B (S100B) and proenkephalin (P-ENK) levels in brain damage caused by traumatic brain injury (TBI). Methods: We prospectively collected serum blood samples of 58 adult patients admitted to our emergency department due to TBI. Serum S100B and P-ENK levels were measured and compared according to clinical findings and outcomes of the patients. Results: When patients with brain injury were compared to controls, statistical significance was determined in both S100B and P-ENK levels. According to the receiver operating characteristic (ROC) analysis, cut-off values for serum S100B and P-ENK levels for the differential diagnosis of patients with and without brain damage were found to be 785.944 ng/mL and 2.445 ng/mL, respectively. There was a statistical significance in both S100B and P-ENK levels when patients who were discharged and those who died were compared. Conclusions: Serum S100B and P-ENK levels are found to be elevated in patients with TBI when compared to controls. Additionally, serum levels of both markers are found to be elevated in patients with multiple lesions when compared to patients with a single lesion. Serum S100B and P-ENK levels may also be used as predictors of mortality in patients with TBI. © 2017 Walter de Gruyter GmbH, Berlin/Boston.
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    Effect of arteriovenous fistula and usage of arm with fistula on bone mineral density in hemodialysis patients
    (Taylor and Francis Ltd, 2016) Çağlıyan Türk, Ayla; Şahin, Füsun; Özkurt, Sultan; Tomak, Leman; Güray, Gürkan
    We aimed to determine the incidence of osteoporosis in hemodialysis patients, to evaluate the differences due to arteriovenous fistula on bone mineral density (BMD) and to investigate whether usage of arm with fistula has an effect on BMD. In this cross-sectional study, 96 patients with chronic renal disease undergone to dialysis were included. Place of fistula (radial and brachial) and dominant hand were recorded. All patients were asked to complete Likerts scale in order to determine the frequency of their usage of arm with fistula. Patients were assigned in two groups: age >51 and < 50 years. Age-matched control group included 60 subjects. BMD measurements were done on lumbar vertebra, femur and both forearms. BMD measurement of proximal femur and total radius were significantly lower in patients >50 years compared to healthy controls and bone density measurement of lumbar vertebra, proximal femur, 1/3 distal and total radius were significantly lower in patients < 50 years compared to healthy controls (p < 0.05). BMD measurement was significantly lower in arms with fistula, especially with radial fistula, compared to both arms without fistula and healthy controls (p < 0.05). When all patients were evaluated, BMD scores were lowering by increasing age, duration of dialysis and fistula and decreasing usage of arm with fistula. BMD in hemodialysis patients is lower than normal population. BMD of arm with fistula is lower than arm without fistula and healthy controls. Both radial and brachial fistula affect negatively ipsilateral BMD. Movement of arm with fistula has positive effects on BMD. © 2016 Taylor & Francis.
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    Outcomes of cardiopulmonary resuscitation in trauma patients in the Emergency Department
    (Verduci Editore, 2015) Erenler, Ali Kemal; Çelik, Selim; Baydın, Ahmet; Tomak, Leman; Koşargelir, Mehmet; Yastı, Ahmet Çınar
    OBJECTIVE: We aimed to determine our performance and factors effecting outcomes in cardiopulmonary resuscitation (CPR) for the patients with trauma in the Emergency Department (ED). PATIENTS AND METHODS: In a period of 5 years, file data of 136 consequtive adult trauma patients who have required CPR in our ED were collected, retrospectively. Patients were divided into subgroups according to years, mechanism of trauma, hour of the trauma, location of cardiac arrest, the period of the CPR, the rhythm during the onset of arrest, atropine use and ED specialist accompaniment. Patients were also divided into two subgroups as those who died in the ED and those who survived. RESULTS: The leading cause of trauma was motor vehicle accidents. The period between arrest and CPR was 0-5 minutes in 92 patients. Of these 92 patients 12 have survived and as the time prolonges, number of survivors tended to decrease. The most common rhythm determined shortly before cardiac arrest was asystole.When all patients with trauma requiring CPR were considered, overall rate of survival was found to be 9.5%. When an ED specialist accompanied, survival rate increased. According to the rates of survival, atropine was found to be useless. CONCLUSIONS: Our results revealed that, when performed in the leadership of an ED specialist, more successful outcomes may be obtained in CPR in trauma patients. We also determined that use of atropine does not contribute to survival rate. As CPR prolonges, the success rate falls.
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    Painful and painless shoulder Magnetic Resonance Imaging comparisons in hemodialysis patients and correlation with clinical findings
    (IOS Press, 2017) Çağlıyan Türk, Ayla; Fidan, Nurdan; Özcan, Oğuzhan; Özdemir, Ferda; Tomak, Leman; Özkurt, Sultan; Şahin, Füsun
    BACKGROUND: Shoulder pain is frequently observed in haemodialysis patients. OBJECTIVE: To compare haemodialysis patients with or without shoulder pain in terms of shoulder motion ranges, ?2 microglobulin levels and magnetic resonance imaging findings. METHODS: Forty-three patients undergoing dialysis were enrolled, of which 23 patients had explicit shoulder pain at night, which appeared during dialysis. Range of joint motion was evaluated. ?2 microglobulin value was recorded. MRI was used to evaluate rotator cuff tendons for thickness, homogeneity, integrity and presence of effusion. RESULTS: Ranges of motion were significantly lower in the painful shoulder group. Supraspinatus tendon thickness and the number of areas with effusion were higher in the painful group. There was a positive correlation between the ?2 microglobulin level and supraspinatus (r:0.352 p <0.05) and subscapular (r:0.454 p <0.05) tendon thicknesses. While effusion areas and pain (r:0.351 p < 0.05) showed positive correlation, there was a negative correlation between pain and shoulder motion ranges. CONCLUSIONS: Shoulder pain in dialysis patients can be related with tendon thickness and effusion.While the ?2 microglobulin level affects tendon thickness, it has no relation to pain and movement constraint. © 2017 - IOS Press and the authors.
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    Predictors of Crimean-Congo hemorrhagic fever in the Emergency Department
    (Verduci Editore, 2015) Erenler, Ali Kemal; Kulaksız, Fuat; Ülger, Hüseyin; Çapraz, Mustafa; Tomak, Leman; Baydın, Ahmet
    OBJECTIVE: Crimean-Congo hemorrhagic fever (CCHF) is an acute illness affecting multiple organ systems characterized by thrombocytopenia, and/or leukopenia, elevated levels of alanine aminotranferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and creatine kinase (CK) and it has a case-fatality of 8% to 80%. In this article, we aimed to determine the clinical and laboratory findings that predicts the disease on admission. PATIENTS AND METHODS:We retrospectively analyzed the medical data of the patients admitted to our emergency department (ED) due to tick bite. These patients were divided into two groups according to their transcriptase-polymerase chain reaction (RT-PCR) test results. Findings of PCR (+) (Group 1) and PCR (-) (Group 2) patients were compared. RESULTS: Epistaxis was found to be statistically significant clinical finding in Group 1. Also, while aspartate transaminase (AST) levels and potassium (K) level were significantly higher, platelet count and white blood count (WBC) were significantly lower in Group 1 when compared to Group 2. CONCLUSIONS: Predictors of CCHF in the ED are epistaxis, leukopenia, thrombocytopenia and elevated K and AST levels. In our study, the fatality rate of CCHF was found to be 21.6%.
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    Value of pulmonary vascular obstruction index for determining thrombolytic therapy
    (Carbone Editore di Alessandro Pennino, 2016) Güzel, Murat; Soylu, Ayşegül İdil; Salt, Ömer; Erenler, Ali Kemal; Tomak, Leman; Arslan Aksu, Esra; Atay, Erdi; Baydın, Ahmet
    Introduction: An index for Pulmonary Artery Computed Tomography Index Ratio (PACTOIR) may have important prognostic and therapeutic implications and as well as providing a standard to evaluate thrombolytic therapy response. The aim of this study was to determine whether PACTOIR predict the thrombolytic therapy in the treatment of pulmonary embolism (PE). Materials and methods: This retrospective study was conducted by reviewing charts of 52 patients (aged =18 years) who were admitted to our emergency department (ED) with initial diagnosis of pulmonary embolism and confirmed diagnosis of PE by Computed Tomography Pulmonary Angiography (CPTA). The patients were divided into two groups as follows: Group 1 (n=14) consisted of the patients who received thrombolytic therapy and Group 2 (n=38) consisted of the patients who did not receive thrombolytic therapy. PACTOIR was calculated in both groups to estimate thrombus load. We evaluated the effectiveness of thrombolytic therapy by comparing the levels of D-dimer and Troponin I. Results: Mean value for PACTOIR, D-dimer and Troponin I levels were 56.4 (%), 6.21 (mg/L) and 0.35 (?g/L) in Group 1 whereas they were 20.46 (%), 2.20 (mg/L) and 0.11 (?g/L) in Group 2, respectively. Significant difference was detected between Group 1 and Group 2 (p < 0.001). The sensitivity and specificity values were calculated as 92.9% and 89.5% for PACTOIR, whereas they were 85.7% and 78.9% for D-dimer, respectively. These values were found to be 78.6% and 65.8% for Troponin I, respectively. Conclusion: Based on our results, sensitivity to show PE severity and to determine thrombolytic therapy was significant when compared to D-dimer and Troponin I. In addition, we concluded that PACTOIR is the parameter with greatest sensitivity in determining the effectiveness of thrombolytic therapy.
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    Yeni nesil sentetik bir kannabinoid olan Bonzai’nin solunum sistemi üzerine etkileri
    (2017) Güzel, Murat; Yalçın, Anıl; Yavuz, Erdinç; Erenler, Ali Kemal; Tomak, Leman; Baydın, Ahmet
    Amaç: Bu çalışmada sentetik bir kannabinoid olan Bonzai’nin hastaların solunum parametreleri üzerine etkisini değerlendirdik. Gereç ve Yöntem: Aralık 2013 ile Aralık 2014 arasında Samsun Eğitim ve Araştırma Hastanesi Acil Servisi’nde takip edilen ve Bonzai kullanım öyküsü olan 52 hastanın tıbbi kayıtları retrospektif olarak incelendi. Hastalar ilaç alımından hastaneye başvuru arası geçen süre, semptomlar, vital bulgular, fizik muayene bulguları, arteriyel kan gazı analizi ve diğer laboratuvar testleri ile değerlendirildi. Bulgular: Ortalama hastaneye başvuru süresi 89.7±57.8 (Min. : 30; Max.:250) dakikaydı. En sık görülen semptomlar 23 hastada (44.2%) bozulmuş mental durum, 13 hastada (25.0%) ajitasyon, 12 hastada (23.0%) halüsinasyonlar, 8 hastada (15.4%) ataksi, 2 hastada (3.8%) bulantı ve kusmaydı. Bradipne tüm hastalarda mevcuttu. Bununla uyumlu olarak tüm hastaların kan gazı analizlerinde hiperkapni ve hipoksi saptandı. Ortalama parsiyel oksijen basıncı (PaO2), parsiyel karbondioksit basıncı (PaCO2) ve alveolar-arteriyel oksijen gradient (A-a O2) değerleri sırasıyla 67.6±29.8 mmHg, 50.4±8.6 mmHg ve 19.4±26.6 mmHg olarak bulundu. Hastaneye başvuru süresi ile kan gazı değerleri arasında istatiksel olarak ters bir ilişki saptandı (p=0,001). Sonuç: Sentetik bir kannabinoid Bonzai kullanım öyküsü ile acil servise başvuran hastalarda solunum depresyonu çok sıktır. Hastaların erken oksijenizasyon ve repiratuvar destek açısından değerlendirilmesi önemlidir