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Öğe Akut aort diseksiyonu tanısında kullanılabilecek kan parametreleri(2024) Bildik, Büşra; Yilmaz, Gökhan; Atis, Seref Emre; Çekmen, BoraAmaç: Akut aort diseksiyonu yüksek mortalite ve morbiditeye sahip bir hastalıktır. Oldukça geniş semptomlara neden olması sebebiyle tanısı sıklıkla atlanmakta veya akut koroner sendom, gastrointestinal hastalıkları veya serebrovasküler hastalıklarla karıştırılabilmektedir. Çalışmamızda, aort diseksiyonu tanısı alan hastalarda bakılan kan parametrelerinin tanıyı belirlemedeki etkinliğini saptamayı hedefledik. Yöntemler: Çalışmamız retrospektif, kesitsel bir çalışma olarak planlandı. Çalışmamıza üçüncü basamak bir acil servise göğüs ağrısı şikâyeti ile başvuran ve aort diseksiyonundan şüphe edilip, bilgisayarlı toraks ve abdomen anjiografisi (BTAA) çekilen hastalar dâhil edildi. Çalışmaya alınan hastalar iki gruba ayrıldı ve BTAA raporunda aort diseksiyonu saptanıp saptanmamasına göre aort diseksiyonu olanlar “hasta grubu” ve aort diseksiyonu saptanmayanlar ise “kontrol grubu” olarak belirlendi. Hastalara ait yaş, cinsiyet gibi demografik verilerle birlikte, tam kan parametreleri (lökosit, lenfosit, nötrofil, platelet sayıları), C-reaktif protein (CRP), kreatinin değerleri kaydedildi. Bulgular: Çalışmaya 64 hasta dâhil edildi. Çalışmaya alınan hastaların yaş ortalaması 61,48±14,49 olarak saptandı. Hastalar ve kontrol grubu karşılaştırıldığında, aort diseksiyonu olan grubun yaş ortalaması 56,96±10,37, kontrol grubun ise 64,20±15,98 olarak saptandı. Aort diseksiyonu olan grubun yaş ortalaması kontrol grubuna göre istatistiksel olarak anlamlı bir şekilde daha düşüktü (p=0,032). Aort diseksiyonu olan grubun platelet sayısı 199 109/L [162-260], kontrol grubunun ise 260 109/L [348-223] olarak saptandı (p=0,003). Platelet değeri için yapılan ROC analizinde, değer 199 109/L olarak alındığında, aort diseksiyonu için duyarlılık %50,0 (pozitif prediktif değeri =2,5), özgüllük %80,0 (negatif prediktif değeri =0,63) olarak belirlendi (AUC= 0,725 [0,597-0,853], p=0,003). Sonuç: Platelet sayısı ve yaş, aort diseksiyonu tanısında bağımsız risk faktörleridir. Düşük platelet sayısı seviyeleri aort diseksiyonu tanısını destekler.Öğe Chest compression quality during CPR of potential contagious patients wearing personal protection equipment(W B Saunders Co-Elsevier Inc, 2022) Cekmen, Bora; Bildik, Busra; Bozan, Oner; Atis, Seref Emre; Koksal, Mustafa; Uzuncu, Halil Berkay; Akilli, Nazire BelginAim of the study: In this study we aimed to investigate whether changing rescuers wearing N95 masks every 1 min instead of the standard CPR change over time of 2 min would make a difference in effective chest compressions. Methods: This study was a randomized controlled mannequin study. Participants were selected from healthcare staff. They were divided into two groups of two people in each group. The scenario was implemented on CPR mannequin representing patient with asystolic arrest, that measured compression depth, compression rate, recoil, and correct hand position. Two different scenarios were prepared. In Scenario 1, the rescuers were asked to change chest compression after 1 min. In Scenario 2, standard CPR was applied. The participants' vital parameters, mean compression rate, correct compression rate/ratio, total number of compressions, compression depth, correct recoil/ratio, correct hand position/ratio, mean no-flow time, and total CPR time were recorded. Results: The study hence included 14 teams each for scenarios, with a total of 56 participants. In each scenario. 14 participants were physicians and 14 participants were women. Although there was no difference in the first minute of the cycles starting from the fourth cycle, a statistically significant difference was observed in the second minute in all cycles except the fifth cycle. Conclusion: Changing the rescuer every 1 min instead of every 2 min while performing CPR with full PPE may prevent the decrease in compression quality that may occur as the resuscitation time gets longer. (C) 2021 Published by Elsevier Inc.Öğe CLINICAL FINDINGS AND PROGNOSIS OF HOSPITALIZED ELDERLY COVID-19 PATIENTS(Turkish Geriatrics Soc, 2021) Bozan, Oner; Atis, Seref Emre; Cekmen, Bora; Kocer, Mehmet Taylan; Koca, Yayunelim; Karaaslan, Edip Burak; Senturk, MucahitBackground: SARS-CoV-2 has caused an outbreak all over the World. Age is the most important factor for mortality. However, it is not known exactly why SARS-CoV-2 infections are more severe and fatal in the elderly population. We examined the clinical course and the causes of increasing mortality in all hospitalized patients diagnosed with COVID-19 over 65 years of age. Methods: Hospitalized elderly patients diagnosed with COVID-19 were examined in this retrospective observational study. The blood results, length of stay, comorbid diseases, admission symptoms, clinical results and demographic data of the patients were recorded. It was examined whether there was a significant difference between surviving and non-surviving patients in terms of comorbid diseases and symptoms. The effects of these parameters on the 30-day mortality alone were investigated. Results: A total of 263 patients (125 males) were included in the study. Cough (53.2%) followed by dyspnea (35.7%) were the two most common symptoms. There was no statistically significant difference age or sex distribution between survivor and nonsurvivor patients. Patients with dyspnea had a significantly lower survival rate compared to patients who did not have dyspnea at presentation and patients who have chronic obstructive pulmonary disease and cerebrovascular disease were associated with a significantly increased risk of mortality Conclusions: It has been shown that there is a significant increase in the risk of mortality in COVID-19 patients with chronic obstructive pulmonary disease and cerebrovascular diseases. Additionally, Dyspnea, as an admission symptom, were found to have an effect on mortality and clinical outcomes in our study.Öğe Do we feel safe and confident about workplace violence in the emergency departments?(W B Saunders Co-Elsevier Inc, 2022) Bildik, Busra; Atis, Seref Emre; Cekmen, Bora; Dorter, MelisStudy objective: This study aimed to determine the relationship of safety and safety perception of physicians working in emergency departments with socio-demographic characteristics and working conditions. Method: The study included physicians who work in the emergency department. An online questionnaire with two sections was used to collect data. The first section comprised 11 questions about the socio-demographic characteristics and working conditions. The second section comprised the Safety and Confidence Scale for Health Professionals (SCSHP) that assessed how safe physicians felt and how confident they were in the face of violence. Results: A total of 402 participants were included in the study. The median score of the participants with less than one year of work experience was significantly lower than the other subgroups (p < 0.001). There was no signif-icant difference in the SCSHP score among other subgroups. The median SCSHP score of the male participants was higher than that of the female participants (p < 0.001). The median score of married participants was significantly higher than that of unmarried participants (p = 0.007). However, other characteristics didn't have a significant effect on SCSHP scores (p > 0.05). When the relationship between the working title and SCSHP score was examined, significant differences were found between faculty members and specialist doctors vs general practitioners (p = 0.005, 0.001, respectively), whereas no significant difference was found in SCSHP scores among other subgroups (p > 0.0125). Conclusion: Among physicians working in the emergency department, those with less work experience, female physicians, and those who are unmarried feel less safe and confident about workplace violence.(c) 2022 Elsevier Inc. All rights reserved.Öğe Effectiveness of the Full Outline of UnResponsiveness Score in Patients With Acute Ischemic Stroke(Springernature, 2022) Atis, Seref Emre; Bozan, Oner; Ferhatlar, Mehmet Esat; Kalkan, AsimBackground Predicting the mortality and prognosis of patients with stroke is one of the commonly studied topics. Various scoring systems have been used in this regard. One of them is the Full Outline of UnResponsiveness (FOUR) score. In this study, we aimed to investigate the utility of the FOUR scores in terms of their ability to predict hospital stay duration and mortality in patients who were diagnosed with ischemic stroke upon their admission to the emergency department. Methods Our study is a prospective observational study. Patients who were admitted to the emergency department of a tertiary hospital and diagnosed with ischemic stroke between August 1, 2020, and August 1, 2021, were included in the study. The inclusion criteria were as follows: being over the age of 18, being diagnosed with ischemic stroke, having symptoms that started within the last 48 hours, and patient consent approved by the patients themselves or their relatives. The patients were divided into two groups according to the FOUR scores (FOUR score = 16 and FOUR score < 16). Patients' demographic information, vital parameters, symptoms, time to admission, comorbidities, laboratory parameters, length of hospitalization, mortality, and Glasgow Coma Scale (GCS), FOUR, and National Institutes of Health Stroke Scale (NIHSS) scores were recorded. Results A total of 79 patients were included in the current study, of which 47 (59.5%) were male. The patients included in the present study had a mean age of 66 +/- 13 years. When the two groups of patients with a FOUR score of 16 and a FOUR score of below 16 were compared, the mean platelet count was found to be 248 +/- 70 x 103/L in the former group and 170 +/- 84 x 103/L in the latter (p = 0.004). Sixty-five (91.5%) of the patients in the group with a FOUR score of 16 and three (37.5%) of the patients in the group with a FOUR score of less than 16 stayed for more than six hours in the hospital (p < 0.001). When the patients were evaluated for intensive care unit (ICU) admission rates, five (62.5%) patients with a FOUR score of <16 were admitted to the ICU. This rate was 2.8% (n = 2) in the group of patients with a FOUR score of 16 and was found to be significantly lower (p < 0.001). Conclusion The FOUR score was found to be useful in predicting the ICU admission rate of patients with ischemic stroke. It has also been shown that the admission time was shorter in patients with a lower FOUR score, and platelet counts were also lower in this group.Öğe Evaluation of the relationship between Hemoglobin, Albumin, Lymphocyte, Platelet (HALP) score and treatment modality and mortality in patients with ileus(Turkish Assoc Trauma Emergency Surgery, 2023) Bildik, Busra; Cekmen, Bora; Atis, Seref Emre; Gunaydin, Yahya Kemal; Dorter, MelisBACKGROUND: Ileus is a clinical condition defined as obstruction of the intestines and develops as a result of a mechanical obstruction or paralytic etiologies. Small bowel obstructions are primarily referred to as surgical conditions, but conservative treatment is one of the treatment protocols of choice in some of patients. The aim of the present study was to evaluate the effectiveness of hemoglobin, albumin, lymphocyte, and platelet (HALP) score in determining the conservative versus surgical treatment decision, mortality, and length of hospitalization and demonstrate its superiority over other parameters thought to be associated with inflammation in patients with ileus.METHODS: Patients with a diagnosis of ileus were included in the study. Age, gender, comorbidities, selected treatment modality (conservative or surgical), length of hospitalization, and in-hospital mortality were determined and recorded. White blood cell, hemoglobin, platelet, neutrophil, lymphocyte, neutrophil, lymphocyte, urea, creatinine, aspartate aminotransferase (AST), bilirubin, albumin, and C-reactive protein (CRP) levels from biochemistry parameters were recorded. HALP score was calculated and the relationship with mortality, length of hospitalization, and conservative versus surgical treatment decision was analyzed.RESULTS: A total of 286 patients were included in the study. Conservative treatment was used in 245 (85.7%) patients. Mortality was not observed in 262 (91.6%) patients, 24 (8.4%) of the patients were died. HALP score was significantly higher in surviving patients (p=0.045). The median albumin value of the surviving patients was lower than that of the patients who died (p<0.001). The patients with mortality had significantly higher age, urea, creatinine, AST, and CRP values than those without (p=0.002, p<0.001, p<0.001, p<0.001, p<0.001, and p=0.001, respectively). HALP score of patients with conservative treatment was significantly higher (p=0.003) than those who underwent surgical treatment. Lymphocyte value was significantly higher in patients followed up with conservative treatment (p=0.027). Age, urea, creatinine, and CRP scores were higher in patients who underwent surgery (p=0.007, p<0.001, 0.003, and p<0.001, respectively). HALP score demonstrated that sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio values for a HALP score of 28 were 50.6%, 78.0%, 2.3, and 0.63 for predicting conservative treatment (AUC 0.645 [95% confidence interval =0.556-0.735]; p=0.003).CONCLUSION: The HALP score is an important scoring system that may be useful in determining mortality and treatment modality in patients with ileus. We believe that HALP score will contribute positively to the management of patients with a diagnosis of ileus, both in reducing mortality and in determining the appropriate treatment modality.Öğe Factors predicting hyperimmune response in COVID-19 patients presenting to the emergency department(Bayrakol Medical Publisher, 2022) Atis, Seref Emre; Uguz, MustafaAim: The aim of this study is to determine the predictive parameters that can be used in the early determination of hyperimmune response syndrome in the Emergency Department. Material and Methods: This is a cross-sectional, retrospective study. Patients over the age of 18 who were admitted to the emergency department with a pre-diagnosis of COVID-19, and who were admitted to the intensive care unit were included in the study. Demographic data and laboratory findings were obtained from the hospital information system and patient files. Patients' thoracic computerized tomography images were classified into two groups. The classic involvement includes bilateral basal ground-glass opacities, crazy paving, reverse halo, per lobular pattern, and peripheral consolidation. All other images were included as non-classic COVID-19 involvement. Results: A total of 202 patients were included. Hyperimmune response development was detected in 74 (36.6%) patients. When laboratory values were examined, ferritin and ALT values were found to be higher, WBC and lymphocyte values were found to be lower in patients who developed a hyperimmune response (p<0.01, p<0.01, p=0.038 and p=0.004, respectively). In the logistic regression analysis of the values that can be effective in the development of the hyperimmune response, classic imaging had a statistically significant effect (Odds ratio 0.449 [95% confidence interval, CI = 0.244-0.827], non-classic vs classic[reference]). No statistically significant effect was found in the analysis of other values. Discussion: Classical chest tomography findings can be useful as a preliminary parameter in the development of hyperimmune response.Öğe Gender disparity in medicine and where are we now in emergency medicine?(W B Saunders Co-Elsevier Inc, 2022) Atis, Seref Emre; Bozan, Oner; Bildik, Busra; Cekmen, Bora; Mistik, YusufBackground: Studies show that although the presence of women in the medical field has risen, there is a lesser representation of women within editorial boards of journals. Studies on this subject have mostly been carried out related to the medical field of the researcher. It is not known what position the emergency medicine department is in this regard compared to other departments. We aimed to investigate whether gender disparity exists within the editors and editorial board members of medical journals, especially in those related to emergency medicine. Methods: In the present cross-sectional study, we searched medical journals using the Scimago Journal/Country Rank journal system for comparison. The websites of the journals included in the study were searched, and gender data of the editor and editorial board, associate editors, consultant editors, and section editors for each journal were obtained. Results: The total number of journals examined in this study was 276. The median percentage of female editorial board members (20.8%; 50-100) was lower in emergency medicine journals compared to other branches of medicine (31%; 0-100) (p < .001). The median percentage of female editorial board members and editors was also lower in the emergency medicine field (20.6%; 0-50) (p <.001) than in other branches of medicine. The percentage of female editorial board members of emergency medicine journals was 19.5% with the third-lowest ranking among 26 branches. When both the editors and editorial board members were considered, the highest female percentage was found in pediatrics (50.7%) followed by geriatric medicine (43.4%). Conclusion: There is a significant gender disparity within editors and editorial board members in emergency medicine journals. The proportion of women within the editorial board was found to be lower in emergency medicine journals among all the journals included in the study.Öğe Healthcare workers' sleep quality after COVID-19 infection: A cross-sectional study(Wiley, 2021) Bozan, Oner; Atis, Seref Emre; Cekmen, Bora; Senturk, Mucahit; Kalkan, AsimIntroduction The COVID-19 pandemic not only affected physical health but also caused high levels of mental health problems including sleep disturbances, depression and post-traumatic stress symptoms. The aim of this study was to examine the sleep parameters of healthcare workers before COVID-19 infection and after recovery. Materials and Methods Healthcare workers who were infected with COVID-19 and whose treatment was completed at least 30 days ago were included in the study. A web-based cross-sectional survey was conducted on the participants. Results The median PSQI score increased significantly after COVID-19 infection (7.0) compared with the level before COVID-19 infection (5.0). The increases in median scores for subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, use of sleeping medication and daytime dysfunction were all significant. Conclusion Sleep quality decreased during the convalescence period from COVID-19 infection as compared with the pre-COVID-19 period.Öğe Intestinal Obstruction Following Ingestion of Alginate Dental Impression Material(Mre Press, 2021) Cekmen, Bora; Atis, Seref Emre; Bozan, Oner; Kaya, NeseIntroduction: No medical intervention is required for emergency department applications resulting from foreign body ingestion. Patients who need intervention are generally with complications such as obstruction, perforation or fistula. Alginate is a non-toxic and non-irritant substance that is elastic in the form of a paste preserving its elasticity under heat, which is used as a printing material for measuring the teeth in dental prosthesis applications. A case of ileus developing as a result of ingestion of alginate impression has been presented. Case report: A 74-year-old male patient presented to our emergency department due to abdominal pain nausea and vomiting. He described periumbilical pain and stated that he felt mild swelling. He had vomit one time and the content of vomit was what he had eaten. On physical examination, his abdomen was slightly distended, bowel sounds had increased slightly on auscultation and there was mild periumbilical tenderness with palpation, with no defence or rebound. On the abdominal CT evaluation, a homogeneous, lobulated, hyperintense foreign body image was detected in the distal ileus and distension in the small bowel loops proximal to the foreign body was interpreted. After general surgery consultation, distal ileal resection was performed and pink, homogenous, slightly soft charactered object was extrected. Later this object was understood to be alginate impression. Conclusion: Elderly patients in particular, ileus may occur due to foreign body associated with dental interventions, and in such cases, patients may need surgical intervention.Öğe A new biomarker in the differential diagnosis of epileptic seizure: Neurogranin(W B Saunders Co-Elsevier Inc, 2022) Kalkan, Asim; Demirel, Ahmet; Atis, Seref Emre; Karaaslan, Edip Burak; Ferhatlar, Mehmet Esat; Senturk, MucahitAim: The aim of this study was to determine the level of serum NGRN in epilepsy patients presenting at the Emergency Department with complaints of an epileptic seizure, and to thus evaluate the utility of this biomarker in the differentiation of epilepsy and PNES patients from each other. Material methods: The study included patients aged >18 years who had experienced an epileptic seizure or were experiencing an epileptic seizure proven with EEG. All patients with brain disease of structural or infectious cause were excluded from the study (dementia, stroke, intracranial mass, meningitis, encephalitis, Creutzfeldt-Jacobs disease, abscess, etc). Patients were also excluded if they had traumatic brain injury or a severe systemic disease such as sepsis, which was thought to impair brain blood flow. The control group was formed of completely healthy volunteers. Results: Evaluation was made of a total of 49 patients, comprising 19 (38.78%) males and 30 (61.22%) females, and a control group of 53 healthy volunteers comprising 28 (52.83%) males and 25 (47.17%) females. The serum neurogranin value was median 184.16 ng/dl (range: 110.1-1172.98) in the patient group and 97.90 ng/dl (range: 73.71-282. 11) in the control group. The serum neurogranin value was determined to be statistically significantly higher in the patient group than in the control group (p < 0.005). Conclusion: The differential diagnosis of ES from PNES remains a challenging situation for emergency service physicians. Based on the findings of this study, it can be said that the serum NRGN level is high in patients who have experienced an epileptic seizure. Therefore, this new biomarker can be considered for use in the differential diagnosis of epileptic seizure and PNES. (c) 2022 Elsevier Inc. All rights reserved.Öğe Pseudoulnar Palsy Due to Ischemic Stroke; Case Report(Emergency Medicine Physicians Assoc Turkey, 2021) Atis, Seref Emre; Bozan, Oner; Cekmen, BoraIsolated motor nerve paresis can occur due to central nervous system lesions. This condition is extremely rare, they are often misdiagnosed as a peripheral nerve lesion. 83-year-old male, applied to our hospital with 4th and 5th digit weakness. Neuroimaging revealed cortical-subcortical diffusion restriction in the medial gyrus of the precentral gyrus. The patient was diagnosed as ischemic stroke. In this article, we presented a case of ischemic stroke that mimics ulnar nerve paresis and be easily overlooked.Öğe A rare complication of Covid-19: Spontaneous pneumothorax following pneumomediastinum; case report(W B Saunders Co-Elsevier Inc, 2021) Bozan, Oner; Atis, Seref Emre; Cekmen, Bora[No abstract available]Öğe Relationship of the crp/albumin ratio and the systemic immune-inflammation index with forrest classification in patients with gastrointestinal bleeding(2022) Bozan, Öner; Atis, Seref EmreAim: The present study aimed to investigate CRP/albumin ratio and the systemic immune-inflammation index (SII) and Forrest classification in patients who presented to the emergency department with acute upper gastrointestinal (GI) bleeding. Materials and Method: Patients over 18 years of age who presented to the emergency department of our hospital with melena, hematemesis, and hematochezia and were diagnosed with upper GI bleeding via esophagoduodenoscopy were included in the study. Esophagoduodenoscopy results, and accordingly, the Forrest classifications, together with complete blood count, including hemoglobin, platelet, and neutrophil values, as well as demographic characteristics were recorded. SII (calculated by multiplying the platelet count with neutrophil count and dividing the value obtained by the lymphocyte count [platelet (P)×neutrophil (N)/lymphocyte (L)]) and CRP/albumin ratio was calculated. Results: No statistically significant difference was observed among the Forrest classification groups in terms of the median SII values as well as median CRP/albumin ratios. However, a statistically significant difference in median CRP/albumin ratios was observed among the dichotomized Forrest classification groups. Conclusion: The SII is not a reliable parameter either predicts GI bleeding or the Forrest classification in patients with upper GI bleeding. The CRP/albumin ratio might be a poor predictor of bleeding; however, it can not predict the Forrest classification.Öğe The role of neutrophil-albumin ratio in the diagnosis of acute appendicitis and its efficacy in predicting perforation(Turkish Assoc Trauma Emergency Surgery, 2023) Cekmen, Bora; Bildik, Busra; Atis, Seref Emre; Guven, HuseyinBACKGROUND: Acute appendicitis (AA) is one of the most common causes of abdominal pain in patients presenting to the emergency department with abdominal pain, and despite developments in radiological imaging for its diagnosis, researchers are still in pursuit of a simpler, cheaper, and safer biomarker. Our study investigated the usability of the neutrophil-albumin ratio, a biomarker that predicts prognosis in cases with severe inflammation, in diagnosing AA and anticipating perforation. METHODS: Our study is a retrospective and cross-sectional study. The study was conducted with patients who presented to the emergency department between January 2018 and December 2020 and were hospitalized with a preliminary diagnosis of AA. The cases were first divided into two groups as Not appendicitis and AA, and then the patients with AA were divided into two subgroups as Perforated and Non-perforated. The demographic data of the patients, their symptoms, physical examination findings, and the decision-making process for surgery were noted. The neutrophil count and albumin levels detected in the blood samples obtained at the time of admission to the emergency department were noted. Afterward, the neutrophil-albumin ratio (NAR) was calculated and the cutoff level was determined to predict the diagnosis of AA and the development of perforation. RESULTS: The rate of complaints of pain in the periumbilical region was significantly higher in the patient group without AA compared to the patients in the AA group (70.6% and 40.3%, p=0.034). Although the leukocyte count, neutrophil count and percentage, and NAR were significantly higher in the AA group, the lymphocyte count was found to be significantly lower (p=0.005). However, no significant correlation was found between the NAR and the development of perforation (p=0.697). CONCLUSION: The NAR is useful for the diagnosis of AA. Nevertheless, it is not a sufficient biomarker for detecting perforation.Öğe The Role of Relative Troponin Change in Predicting Clinical Outcome and Critical Stenosis in Patients with Chest Pain(Galenos Publ House, 2022) Atis, Seref Emre; Koseoglu, Zikret; Cekmen, Bora; Bozan, Oner; Karcioglu, OzgurAim: Dynamic changes in troponin levels have been shown to be effective indicators of acute injury and useful for distinguishing acute injuries from chronic injuries. This study investigates the role of the change in troponin I (TnI) values in the prediction of acute myocardial infarction (AMI) and its relationship with the findings of percutaneous coronary angiographies. Materials and Methods: The patients included here were divided into two groups: a group of patients with AMI and a group of patients without AMI. The patients diagnosed with AMI were subsequently divided into two subgroups as those with and without critical stenosis. The relative troponin change in these patients was calculated as the percentage of the difference between the first and second troponin measurements; the second measurement was taken two hours later after admission. Results: The receiver operating curve analysis revealed that increases of more than 83.18% in Delta TnI were significant predictors of AMI and critical stenosis [sensitivity 45.24%, specificity 89.67%, area under the curve (AUC)=0.698 (95% confidence interval (CI): 0.639-0.752, p=0.001), sensitivity 56.00%, specificity 87.92%, AUC value of 0.681 (95% CI: 0.620-0.738, p<0.001), respectively]. Conclusion: The Delta TnI value is a useful marker with high negative and positive predictive values for detecting AMI in patients admitted with chest pain. It can be beneficial as an adjunctive tool to predict the critical lesion, in conjunction with percutaneous angiography.Öğe Utility of non-invasive synchronized intermittent mandatory ventilation in acute cardiogenic pulmonary edema(W B Saunders Co-Elsevier Inc, 2022) Cekmen, Bora; Bildik, Busra; Bozan, Oner; Atis, Seref Emre; Dogan, Serkan; Kocak, Abdullah OsmanBackgrounds: Acute cardiogenic pulmonary edema (ACPE), one of the outcomes of acute heart failure (AHF), is a common reason in a critical condition with respiratory distress. Non-invasive synchronized intermittent manda-tory ventilation(nSIMV) mode, which includes inspiratory pressure in addition to positive end expiratory pres-sure with/without pressure support provided in the non-invasive continuous positive airway pressure plus/ pressure support(nCPAP/PS) mode can be effective in hypercarbia and the associated changes in consciousness. This study aimed to demonstrate the efficacy of nSIMV in ACPE. Methods: Patients who presented with clinical acute respiratory failure and were admitted to the critical care unit of the emergency department with the diagnosis of ACPE were included. Patients were placed on non-invasive mechanical ventilators with an oronasal mask under the nCPAP/PS and nSIMV modes. Pulse and respiratory rate, systolic and diastolic blood pressure and Glasgow Coma Scores(GCS), HACOR(heart rate, acidosis, con-sciousness, oxygenation and respiratory rate) scores, pH, PaCO2, PaO2/FiO2 and lactate at the time of admission and at 30 and 60 min were evaluated. Results: Twenty-two patients were recruited, nCPAP/PS mode was 10 and nSIMV mode was 12. Although there was no statistically significant difference between the two groups in terms of the change in the relevant param-eters from admission to 60 min, the decreases in PaCO2 and lactate levels (31.4% vs. 21.2%, p = 0.383; 68.8% vs. 47.1%, p = 0.224; respectively) and the increase in PaO2 and PaO2/FiO2 values (34% vs. 14.2%, p = 0.710 and 132.1% vs. 52.7%, p = 0.073; respectively) were higher in the nSIMV group. Conclusion: The nSIMV mode is as effective as the nCPAP/PS mode in the treatment of patients with ACPE. We be-lieve that the nSIMV mode can be preferable, particularly in patients with hypercarbia who have relatively lower GCS and oxygenation.(c) 2022 Elsevier Inc. All rights reserved.
