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Öğe Comparison of Intravenous Lipid Emulsion, Bicarbonate, and Glucagon Treatments in a Rabbit Model of Clomipramine Toxicity(Mre Press, 2020) Kara, Hasan; Bayir, Aysegul; Ak, Ahmet; Unlu, Ali; Kayis, Seyit AliBackground: This experimental study aimed to evaluate intravenous lipid emulsion, sodium bicarbonate, and glucagon as treatment options for the cardiotoxicity associated with clomipramine, a tricyclic antidepressant, and the antidotal effects of these drugs. Methods: In this experimental study, female and male New Zealand rabbits were divided into a sham group, a sodium bicarbonate treatment group, an intravenous lipid emulsion treatment group, and a glucagon treatment group. After the administration of a single dose of oral clomipramine (70 mg/kg), through an orogastric tube, vital parameters such as mean arterial pressure and oxygen saturation were measured, using a bedside monitor. Intoxication was established after the mean arterial pressure decreased to 40%-45%, within approximately 30-45 minutes. Treatments were administered after intoxication was established. Results: Although the mean arterial pressure values significantly changed over time in the sham and glucagon treatment groups, no significant changes were observed in the intravenous lipid emulsion and sodium bicarbonate treatment groups. Significant differences were observed among the values at 0 min compared with 30, 60, and 120 min in both the sham and the glucagon treatment groups. The clomipramine level changed significantly in all groups. Conclusion: Tricyclic antidepressant poisoning remains a difficult therapeutic challenge. Glucagon, a lipophilic drug, appears to be a promising candidate for the treatment of clomipramine-induced cardiotoxicity and should be considered early for the treatment of severe tricyclic antidepressant overdose.Öğe Red cell distribution width and neurological scoring systems in acute stroke patients(Dove Medical Press Ltd, 2015) Kara, Hasan; Degirmenci, Selim; Bayir, Aysegul; Ak, Ahmet; Akinci, Murat; Dogru, Ali; Akyurek, FikretObjectives: The purpose of the present study was to evaluate the association between the red blood cell distribution width (RDW) and the Glasgow Coma Scale (GCS), Canadian Neurological Scale (CNS), and National Institutes of Health Stroke Scale (NIHSS) scores in patients who had acute ischemic stroke. Methods: This prospective observational cohort study included 88 patients who have had acute ischemic stroke and a control group of 40 patients who were evaluated in the Emergency Department for disorders other than acute ischemic stroke. All subjects had RDW determined, and stroke patients had scoring with the GCS, CNS, and NIHSS scores. The GCS, CNS, and NIHSS scores of the patients were rated as mild, moderate, or severe and compared with RDW. Results: Stroke patients had significantly higher median RDW than control subjects. The median RDW values were significantly elevated in patients who had more severe rather than milder strokes rated with all three scoring systems (GCS, CNS, and NIHSS). The median RDW values were significantly elevated for patients who had moderate rather than mild strokes rated by GCS and CNS and for patients who had severe rather than mild strokes rated by NIHSS. The area under the receiver operating characteristic curve was 0.760 (95% confidence interval, 0.676-0.844). Separation of stroke patients and control groups was optimal with RDW 14% (sensitivity, 71.6%; specificity, 67.5%; accuracy, 70.3%). Conclusion: In stroke patients who have symptoms <24 hours, the RDW may be useful in predicting the severity and functional outcomes of the stroke.Öğe Role of ultrasound simulators in the training for Focused Assessment with Sonography for Trauma (FAST)(Turkish Assoc Trauma Emergency Surgery, 2021) Degirmenci, Selim; Kara, Hasan; Kayis, Seyit Ali; Ak, AhmetBACKGROUND: The present study aims to investigate the efficacy of ultrasound simulators in the training of the health staff working in the emergency department of a university hospital on Focused Assessment with Sonography for Trauma (FAST). METHODS: This study was conducted on emergency medicine residents, medical interns and paramedics of the emergency department of Selcuk University Medical Faculty, prospectively. The participants were given theoretical and practical training on FAST using the SonoSim (R) USG simulator. At the end of the training, all participants were requested to perform FAST for the pre-selected scenarios for five patients to find the ideal diagnostic window for each patient and declare the diagnosis. RESULTS: This study included 60 participants, including emergency medicine residents, medical interns and paramedics, each having 20 members. The rate of obtaining the correct image was 99.5%, and the rate of diagnosing correctly was 94% among resident physicians. For interns, these rates were 98.5% and 88%, respectively. For paramedics, the rates were 98% and 81.5%, respectively. CONCLUSION: It was observed that the theoretical knowledge level of the trainees did not affect the ability to obtain a correct image in the simulator. However, the skills of the trainees for correctly diagnosing via FAST were directly proportional to their theoretical knowledge levels. Our findings suggest that a short theoretical training followed by a simulator-guided practice would easily provide a sufficiency for FAST for the health workers.Öğe Termomekaniksel işlemin 17-4 ph paslanmaz çeliğin işlenebilirliğine etkisi(Karabük Üniversitesi, 2019) Ak, Ahmet; Demir, Halil; Tekaüt, İsmailBu çalışmada, 17-4 PH paslanmaz çeliği ASTM A564 standardında yaşlandırma işlemine tabii tutulup 36HRC, 40HRC ve 44HRC olmak üzere, her sertliği dört ayrı parametre ile tornalanıp, en iyi yüzey pürüzlülüğünün belirlenmesi ve takıma gelen yüklerin incelenmesidir. Öncelikle 17-4 PH paslanmaz çelik malzeme üzerinde, ASTM A564 standardı esas alınıp, çökelme sertleştirmesi (yaşlandırma) yöntemiyle sertliğinin değiştirilerek, 33 HRC malzemenin ilk sertliği olmak üzere 4 ayrı sertlik elde edilmiştir. Her sertlik için 4 ayrı kesme parametreleri kullanılarak CNC torna tezgahında tornalanmıştır. Tornalama işleminde Boehlerit DCMT kodlu elmas uç kullanılmıştır. Tornalama işleminde kesici takıma gelen yük ölçümü için 3 eksen Kistler marka yük ölçer kullanılmıştır. 33 HRC sertlikte 12 ön deney yapılmıştır. Ön deneyler sonucunda; yüzey pürüzlülüğüne bakılarak en uygun kesme hızı belirlenmiştir. Devamında sabit kesme hızı ile diğer 3 sertlikte deneylere devam edilmiştir. Tüm deneylerdeki yükler ve parçanın yüzey pürüzlülüğü incelenmiştir. Yapılan incelemeler sonucunda 33 HRC sertlik değerinde, 200m/dk kesme hızı ve 1mm kesme derinliğindeki kesme parametrelerinde yüzey pürüzlülüğünün en iyi olduğu gözlemlenmiştir. Ayrıca 44 HRC sertlik değerinde, yapılan deneylerde takıma gelen yüklerin en fazla olduğu belirlenmiştir.
