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Öğe Çocukluk çağı apandisit olgularında laboratuvar testlerinin analizi(2016) Cesur, Özkan; Benli, Ali Ramazan; Koyuncu, MuratAmaç: Bu çalışmada akut ve perfore apandisit olgularında tanısal metotların değerinin analiz edilmesi amaçlandı. Yöntem: Ocak 2013 - Aralık 2013 tarihleri arasında Karabük Üniversitesi (KBÜ) Karabük Eğitim ve Araştırma Hastanesi Çocuk Cerrahi servisine apandisit şüphesi ile yatırılan ve apendektomi yapılan 97 hastanın dosyaları retrospektif incelendi. Demografik verileri, laboratuvar ve histopatolojik sonuçları değerlendirildi. Veriler SPSS 12.0 programında analiz edildi. Bulgular: Hastaların yaş ortalaması 11±3.36 idi. K/E oranı 1/1.4 olarak saptanmıştır. Histopatolojik incelemede hastaların %37.2'si (n=36) akut fokal apandisit, %34.1'i (n=33) süpüratif apandisit, %17.8'i (n=17) gangrenöz-perfore apandisit, %9.8'i (n=10) lenfoid hiperplazi, %1.1'i (n=1) kronik apandisit olarak tanımlanmıştır. Süpüratif ve gangrenöz-perfore form apandisitlerde diğer tiplere göre total lökosit sayısı (WBC), nötrofil oranı (NR) ve C-reaktif protein (CRP) değerleri istatistiksel olarak anlamlı yüksek bulunmuştur (p<0.05). Hastaların laboratuvar incelemeleri sonucunda WBC sayısı, NR ve CRP'nin duyarlılık, özgüllük, pozitif tanımlama, negatif tanımlama ve doğruluk oranları belirlenmiştir. Bu oranlar sırasıyla WBC için %65, %60, %96, %92 %65, NR için %55, %60, %96, %94 %56 ve CRP için %50, %80, %92, %98 %52 olarak bulunmuştur. WBC sayısı, NR ve CRP bir arada değerlendirildiğinde ise%84, %60, %97, %84 %83 olarak anlamlı düzeyde yüksek bulunmuştur. Sonuç: Total lökosit sayısı düzeylerinde anlamlı artışın tanısal kesinliği artırmadığı ancak komplike apandisit olguları ilgili olabileceği görüldü. WBC, NR ve CRP'nin ayrı ayrı bağımsız belirleyiciler olmadığı gibi seçiciliklerinin de yeterli olmadığı tespit edildi. Sonuç olarak; WBC düzeyi, NR ve CRP'nin birlikte değerlendirilmesinin komplike apandisit olgularına yaklaşımda daha faydalı olacağı düşünülmektedirÖğe Effect of Coenzyme Q10 on Acute Pulmonary Damage Following the Experimental Thoracic Trauma(Derman Medical Publ, 2015) Koyuncu, Murat; Avsarogullari, Omer Levent; Duman, Ali; Deniz, Kemal; Saraymen, Recep; Ozkan, Seda; Durukan, PolatAim: Pulmonary contusion negatively affects prognosis in the case of damages following a trauma. Objective of this experimental study performed in Turkey was to evaluate effects of coenzyme Q10 on primary and secondary damages of pulmonary contusion following experimental thoracic blunt trauma using biochemical and histopathological parameters. Material and Method: A total of 56 Wistar Albino female rats with a mean weight of 205 45 g were included in this study. Rats were randomly divided into seven groups with each group having eight rats. A trauma device which consisted of a fixed platform, and an aluminium tube was prepared. Rats were administered 2.45 J of chest impact energy in order to generate pulmonary contusion. Control and Study groups were named according to the sacrificed time. No process (trauma and/or medication) was performed in the sham group, while only trauma was induced in the controls. On the other hand, after induced trauma. intraperitoneal Q10 (0.-24.-48. hours) was administered to study group. Rats were sacrificed at the end of the after trauma 24, 48 and 72 hours. and their blood and lung tissue samples were analyzed. Results: No significant difference was found between sham and Study-72 groups in terms of high-sensitivity C-reactive protein. On the histopathological examination, no significant difference was found between study and control groups. While no significant difference was found between the sham and study groups, significant difference was observed between sham and control groups. Discussion: Coenzyme Q10, an antioxidant agent, can be used as an antioxidant agent in order to reduce the secondary damage in blunt thoracic trauma.Öğe The effect of ferritin, vitamin B12 and folic acid on pregnancy outcomes(E-Century Publishing Corp, 2016) Kalem, Pinar; Benli, Ali Ramazan; Koroglu, Mustafa; Benli, Neriman Cetin; Koyuncu, Murat; Cesur, Ozkan; Dane, Pakizer Banu KilicogluPurpose: A reduction occurs in levels of some minerals and vitamins due to physiological adaptation during pregnancy, and this situation causes anemia in pregnancy. The aim of the present study was to evaluate the effect of ferritin, vitamin B12 and folate levels on outcomes of pregnancy in 3rd trimester pregnant women. Materials and Methods: This retrospective study included a total of 72 pregnant women in the third trimester of pregnancy. Vitamin and mineral analyses of the patients were applied. Patients were questioned in respect of whether or not iron and vitamin supplements were taken during pregnancy, the mode of delivery and the history of postpartum problems in infant. Results: As the number of children increased, so an increase was seen in the incidence of anemia. Of the mothers of newborns with medical problems, 60% had anemia. There was no statistically significant difference in the mean birth weight according to the presence or absence of maternal anemia. Anemia in pregnant women is defined as hemoglobin level below 11.0 g/dL in the first and third trimester and below 10.5 g/dL in the second trimester. No significant difference was determined in anemia status according to the mode of delivery. No difference in anemia was detected in infants, regardless of whether or not their mothers took vitamin and mineral supplements. Conclusion: Anemia in the third trimester has no effect on the mode or time of delivery, weight and general condition of the newborn. To decide the effect of anemia on the outcome of pregnancy, further studies with more participants are needed.Öğe EFFECTS OF DRUG USE ON THE DEVELOPMENT OF DIABETIC KETOACIDOSIS(Carbone Editore, 2015) Koyuncu, Murat; Ozturk, Derya; Altinbilek, Ertugrul; Yapar, Nikola; Karakisa, Halit; Kavalci, Cemil; Ikizceli, IbrahimIntroduction: Diabetic Ketoacidosis (DKA) is a condition in which the body must use adipose and protein deposits as intracellular energy sources due to a lack of insulin. In the current study, we aimed to investigate the effects of drug use on the development of DKA and on clinical parameters in patients who presented to the Emergency Department (ED) with the diagnosis of DKA. Materials and methods: This study was retrospectively conducted in Sisli Etfal Training and Research Hospital between October 1, 2011 and March 31, 2013. The following parameters were recorder for each patient: age, gender, complaints, history of drug use, cause of DKA, pH, HCO3 levels, time spent in the ED, treatment outcomes and hospitalization durations. Results: The mean age of the patients was 42.61 +/- 8.6 years, and 58% (n=43) of them were female. 20.3% (n=15) of the patients were drug free. 63.5% (n=47) of the patients were followed up with in the ward, 12 (16.5%) were followed up with in the ED and 20% (n=15) were followed up with in the intensive care unit (ICU). The mean duration of stay in the ED was 15 hours, and the mean hospitalization time was 10 days. The mortality rate was 2.7%(n=2). When the effects of the drug use on DKA were examined, there were no statistically significant differences between the patients in terms of acidosis condition, mortality, clinic of hospitalization and durations of follow-up and treatment (p>0.05). The most important factor causing ketoacidosis was the presence of infection (40.5%, n=30), while the most common symptom was nausea/vomiting (51.4%, n=38). Conclusion: We observed that in patients with DKA, drug use does not affect mortality and morbidity.Öğe Hyperglycaemia in the emergency department: stress hyperglycaemia or diabetes mellitus.(Allied Acad, 2017) Koyuncu, Murat; Koyuncu, Sumeyra; Biberoglu, Serap; Benli, Ali Ramazan; Koyuncu, Serhat; Atli, Bahri; Kostekc, Senol KadirStress Hyperglycaemia (SH) evolving especially in the acute period of diseases and in post-traumatic patients is appeared in many diabetic and non-diabetic patients. Patients with undiagnosed diabetes mellitus may also present with complications of diabetes, with 5% fatal courses. The aim of this study was to determine the incidence of diabetes mellitus in patients who applied to Emergency Department (ED) for various reasons. The files of the patients were retrospectively examined. The patients were divided into the following groups: Group 0: No prior diagnosis of diabetes. Group 1: Stress hyperglycaemia. Group 2: Diabetes mellitus. Group 3: The patients had not been diagnosed with diabetes mellitus before visiting the emergency department, and they were not taking any treatment for diabetes. Group 4: Newly diagnosed diabetes mellitus. Group 2 had the highest number of patients (64.4%), followed by Group 3 (10.4%), Group 4 (4.3%), and Group 0 (4.1%). The highest average blood glucose values were found in Group 2 (258.00), followed by Group 3 (230.00), and Group 4 (237.00). Undiagnosed patients with diabetes mellitus risk can apply with complications, and this not only threatens the lives of these patients but also dramatically reduces their quality of their life. It should be considered that there could be diabetes mellitus patients, as well as stress hyperglycaemia patients, with a high blood sugar level, in the emergency department. Thus, we believe that patients diagnosed with a high blood sugar level should be advised to attend their family practices and/or a polyclinic for disease monitoring, with follow-up in an endocrine unit.Öğe Knowledge, attitude and behaviours of hospital staff with regard to the occupational health and safety(2016) Benli, Ali Ramazan; Özenver, Fatma; Sürmen, Sevilay; Kayıs, Seyit Ali; Koyuncu, Murat; Sunay, DidemGiriş: İş sağlığı ve güvenliğinin temel amacı, çalışanların sağlıklarını korumak, güvenli ve sağlıklı bir ortamda çalışmalarını sağlamaktır. Bu araştırmada, hastane çalışanlarının iş sağlığı ve güvenliği ile ilgili bilgi, tutum ve davranışlarını değerlendirmek amaçlanmıştır. Yöntem: Kesitsel tipteki araştırmanın evreni, Karabük Eğitim ve Araştırma Hastanesi çalışanlarından oluşturulmuştur. Katılımcıların demografik bilgilerini, kişisel koruyucu donanım (KKD) kullanımını, iş sağlığı ve güvenliği eğitimlerini ve uğradıkları iş kazalarını saptamak amacıyla, 4 bölüm ve 23 sorudan oluşan anket formu, 01.05.201531.05.2015 tarihleri arasında, çalışmaya katılmayı kabul eden çalışanlarla yüz, yüze görüşmelerle doldurulmuştur. Değişkenlere ait frekans ve yüzdesel dağılımların yanında, değişkenler arasındaki ilişki ki-kare analizi ile değerlendirilmiştir. Bulgular: Çalışma evreni, çalışmanın yapıldığı dönemde Karabük Eğitim ve Araştırma Hastanesinde, hizmet veren 1489 personel içinde direk hastayla temas eden 910 kişi ve staj yapan 140 öğrenciden oluşturulmuştur. Toplam 1050 kişiden, 532'si (%50.6) kişi çalışmaya katılmayı kabul etti. Çalışma grubunun %44,9'u hemşirelerden oluşmaktaydı, % 45,5'i servislerde çalışmakta idi. Katılımcıların %88,9'u çalıştığı birimde hangi KKD'leri kullanması gerektiğini bilmekteydi, %93,6'sı KKD kullanımın gerekli olduğunu, %93,6'sı KKD'lerin ulaşılabilir ortamda bulunduğunu, %84'ü KKD'leri kullanılması gereken yer ve zamanlarda kullandığını belirtmiştir. KKD'leri kullanmayanların %52,8'i iş yerindeki yoğunluktan dolayı kullanmadıklarını belirtmişlerdir. Katılımcıların %94,1'i İSG kanunu ile ilgili eğitim verilmesinin gerekli olduğunu belirtmişlerdir. Katılımcılardan %33,1'i iş kazası geçirmiş olup, sadece %32,4'ü bildirim yaptığını belirtmiştir. En sık karşılaşılan iş kazası, kesicidelici alet yaralanması olarak tespit edilmiştir (%68,8). İş kazası geçirenlerin %36,9'u, kazaların nedeni olarak çalışanın güvenli olmayan davranışını göstermiştir. İş kazalarının, en sık servislerde (p=0,0001) ve hemşirelerde (p=0,001) olduğunu göstermektedir. Hemşirelerin iş kazasını bildirme oranları daha fazlaydı (p=0,04). Sonuç: Katılımcıların, iş kazasından korunma yöntemleri konusunda bilgili olmalarına rağmen, sahip oldukları bilginin uygulama ve davranışa yansımadığı görülmüştür. Bu da eğitim sisteminin sadece bilgi veren durumdan çıkartılıp, tutum ve beceri odaklı olarak değiştirilmesi gerekliliğini göstermektedirÖğe Mushroom Poisoning in a Metropolitan Hospital(Emergency Medicine Physicians Assoc Turkey, 2014) Koyuncu, Murat; Ozturk, Derya; Benli, Ali Ramazan; Altinbilek, Ertugrul; Sahin, Harun; Serin, Mehmet; Ikizceli, IbrahimObjective: We aimed to investigate suspected cases of mushroom poisoning that were admitted to the emergency department of a metropolitan education and research hospital. Material and Methods: Suspicious cases of mushroom poisoning and determined mushroom poisoning patients were investigated in the medical records of patients who were older than 18 years old in 1 year. We examined patient's demographic information, admission date, complaints, time of complaint starting, and clinical and laboratory findings. Treatments and results were evaluated. Results: We analyzed 74 patients who were diagnosed with mushroom poisoning. The most common complaints of the patients were nausea and vomiting. Increases in the number of admission were observed in November and December. A total of 25 patients were externed from emergency medicine, and 39 patients were hospitalized. 5 patients treatment with hemodialysis and both of them died. Conclusion: Mushroom poisoning is known to vary according to seasonal distribution, type of mushroom, geographic shape, and climate of the region. Therefore, emergency physicians should investigate the characteristics and ecology of the region and the geographic shape, so that provision services can facility the emergency departments principles working and organizated. The importance of regional characteristics is lost in a metropolitan hospital.Öğe Mushroom poisoning in a metropolitan hospital(2014) Koyuncu, Murat; Öztürk, Derya; Benli, Ali Ramazan; Altınbılek, Ertuğrul; Şahin, Harun; Serin, Mehmet; Ikızcelı, İbrahimObjective: We aimed to investigate suspected cases of mushroom poisoning that were admitted to the emergency department of a metropolitan education and research hospital. Material and Methods: Suspicious cases of mushroom poisoning and determined mushroom poisoning patients were investigated in the medical records of patients who were older than 18 years old in 1 year. We examined patient's demographic information, admission date, complaints, time of complaint starting, and clinical and laboratory findings. Treatments and results were evaluated.Results: We analyzed 74 patients who were diagnosed with mushroom poisoning. The most common complaints of the patients were nausea and vomiting. İncreases in the number of admission were observed in November and December. A total of 25 patients were externed from emergency medicine, and 39 patients were hospitalized. 5 patients treatment with hemodialysis and both of them died.Conclusion: Mushroom poisoning is known to vary according to seasonal distribution, type of mushroom, geographic shape, and climate of the region. Therefore, emergency physicians should investigate the characteristics and ecology of the region and the geographic shape, so that provision services can facility the emergency departments principles working and organizated. The importance of regional characteristics is lost in a metropolitan hospital.Öğe Role of Computed Tomography Severity Index in Acute Diagnosis and Follow-up of Acute Pancreatitis(Derman Medical Publ, 2017) Biberoglu, Serap; Koyuncu, Murat; Ozturk, Derya; Toksoz, Ahmet Cevdet; Cakmakci, Emin; Cakmak, Fatih; Ikizceli, IbrahimWe aimed to identify the role that computed tomography (CT) plays in the emergency services and during treatmentin the process of establishing an early diagnosis of acute pancreatitis and detecting potential complications that can emerge. Material and Method: Seventy-six patients who presented to a Training and Research Hospital's Emergency Department and diagnosed with acute pancreatitis (AP) were included in the study. Patients' files were evaluated retrospectively and their CT severity index (CTSI) values were obtained using Balthazar classification. Results: There was no significant difference between the ratio of patients with and without ultrasonographic features and patients whose CTSI was 3 and above. The ratio of being in the intensive care unit was significantly higher in patients with CTSI scores of 3-6 when compared to those with CTSI scores of 0-2. Two patients who died had CTSI scores in the range of 7-10. Discussion: CT plays an important role in the diagnosis of AP and the follow-up of patients diagnosed with the disease. Thus, CT can be an important parameter in the prediction of complications, as well as a preferred method for predicting the morbidity and mortality of patients diagnosed with AP.Öğe Splenic Infarction as a Rare Cause of Chest Pain(Aves, 2015) Koyuncu, Murat; Kostekci, Senol Kadir; Ozturk, Derya; Altinbilek, Ertugrul; Okay, Meryem; Ekinci, NihatThis report reviews literature on splenic infarction. It also describes the case of a 27-year-old female who was bedridden because of a muscular disease and who was admitted to the emergency department with chest pain. She experienced continuous squeezing and compressing pain, which originated from the lower left hemithorax and radiated to the left axilla. A splenic infarct was detected after 24 h follow-up in the emergency room. Emergency physicians should keep in mind that chest pain originating from the lower left thorax and radiating to the left shoulder can be a sign of splenic infarction.Öğe Splenic infarction as a rare cause of chest pain(2015) Koyuncu, Murat; Köstekçı, Senol Kadir; Öztürk, Derya; Altınbılek, Ertuğrul; Okay, Meryem; Ekıncı, NihatThis report reviews literature on splenic infarction. It also describes the case of a 27-year-old female who was bedridden because of a muscular disease and who was admitted to the emergency department with chest pain. She experienced continuous squeezing and compressing pain, which originated from the lower left hemithorax and radiated to the left axilla. A splenic infarct was detected after 24 h follow-up in the emergency room. Emergency physicians should keep in mind that chest pain originating from the lower left thorax and radiating to the left shoulder can be a sign of splenic infarctionÖğe Successful application of acute cardiopulmonary resuscitation(Wolters Kluwer Medknow Publications, 2015) Ozturk, Derya; Altinbilek, Ertugrul; Koyuncu, Murat; Sonmez, Bedriye Muge; Caltili, Cilem; Ikizceli, Ibrahim; Kavalci, CemilObjective: To compare the quality and correct the deficiencies of cardiopulmonary resuscitation (CPR) procedures performed in patients who developed cardiopulmonary arrest before or after Emergency Department admission. Methods: This study was conducted on patients who were applied CPR at Sisli Etfal Training and Research and Research Hospital, Emergency Department between 01 January 2012 and 31 December 2012. Chi-square and Mann-Whitney U test were used to compare the patients' data. The study data were analyzed in SPSS 18.0 software package. A P value less than 0.05 was considered statistically significant. Results: A total of 155 patients who were applied CPR were included in the analysis. Among the study patients, seventy eight (50.3%) were brought to Emergency Department after developing cardiopulmonary arrest while 77 (49.7%) developed cardiopulmonary arrest at Emergency Department. The mean age of the study population was (66 +/- 16) years and 64% of the patients were male. The initial rhythms of the CPR-applied patients were different (P < 0.05). There were no significant differences between the groups with respect to the treatment protocols or CPR responses (P > 0.05). The CPR response time was longer in ED (P < 0.05). The survival rate was lower in the trauma patients who developed cardiopulmonary arrest at ED (P < 0.05). Conclusions: The scientific data obtained in this study suggest that an early response and therapy improves outcomes in CPR procedure.Öğe When should cardiopulmonary resuscitation be stopped: opinions of the emergency medicine physicians in turkey(2015) Koyuncu, Murat; Duman, Ali; Öztürk, Derya; İpekçi, Afsin; Altınbilek, Ertuğrul; Topal, Fatih Esad; Türkdoğan, Kenan AhmetWe aimed to define point of view of the Emergency Medicine Physicians (EMPs) working in emergency services in Turkey about the duration of cardiopulmonary resuscitation (CPR) and to determine whether a standardization could be developed for CPR duration in the light of this information. After approval of the ethics committee, a survey form was prepared using Google Document and internet access address was sent to 1.404 EMPs via mail. A total of 428 persons responded the survey and 426 appropriate responses were assessed. Of the EMPs, 64.2% suggested that the persons who perform and/or manage CPR must make the decision for the duration. The participants stated that CPR time should be longer at younger ages and shorten with aging and that duration of CPR must be shorter in patients with the end-stage. The decision for 'Do Not Attempt Resuscitation (DNAR)' can not be made in our country. Legal studies must be conducted for law, regulations and notification in order to made decision for DNAR only in terminal stage patients. Therefore there must not be a law, regulation or CPR guide including exact duration for CPR
