1
|
Atis SK, Duyu M, Karakaya Z, Yilmaz A. Citrate anticoagulation and systemic heparin anticoagulation during continuous renal replacement therapy among critically-ill children. Pediatr Res 2024:10.1038/s41390-024-03163-x. [PMID: 38555381 DOI: 10.1038/s41390-024-03163-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/23/2024] [Accepted: 03/01/2024] [Indexed: 04/02/2024]
Abstract
BAKCGROUND The aim of this study was to evaluate the efficacy and safety of citrate versus heparin anticoagulation for CRRT in critically-ill children. METHODS This retrospective comparative cohort reviewed the clinical records of critically-ill children undergoing CRRT with either RCA or systemic heparin anticoagulation. The primary outcome measure was hemofilter survival time. Secondary outcomes included the comparison of complications and metabolic disorders. RESULTS A total of 131 patients (55 RCA and 76 systemic heparin) were included, in which a cumulative number of 280 hemofilters were used (115 in RCA with 5762 h total CRRT time, and 165 in systemic heparin with 6230 h total CRRT time). Hemofilter survival was significantly longer for RCA (51.0 h; IQR: 24-67 h) compared to systemic heparin (29.5 h; IQR, 17-48 h) (p = 0.002). Clotting-related hemofilter failure occurred in 9.6% of the RCA group compared to 19.6% in the systemic heparin group (p = 0.038). Citrate accumulation occurred in 4 (3.5%) of 115 RCA sessions. Hypocalcemia and metabolic alkalosis episodes were significantly more frequent in RCA recipients (35.7% vs 15.2%, p < 0.0001; 33.0% vs 19.4%, p = 0.009). CONCLUSION RCA is a safe and effective anticoagulation method for CRRT in critically-ill children and it prolongs hemofilter survival. IMPACT RCA is superior to systemic heparin for the prolongation of circuit survival (overall and for clotting-related loss) during CRRT. These data indicate that RCA can be used to maximize the effective delivery of CRRT in critically-ill patients admitted to the PICU. There are potential cost-saving implications from our results owing to benefits such as less circuit downtime and fewer circuit changes.
Collapse
Affiliation(s)
- Seyma Koksal Atis
- Department of Pediatrics, Istanbul Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey.
| | - Muhterem Duyu
- Pediatric Intensive Care Unit, Istanbul Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Zeynep Karakaya
- Department of Pediatrics, Istanbul Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Alev Yilmaz
- Department of Pediatrics, Division of Pediatric Nephrology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| |
Collapse
|
2
|
Karakaya Z, Boyraz M, Atis SK, Yuce S, Duyu M. Descriptive and Clinical Characteristics of Nonsurvivors in a Tertiary Pediatric Intensive Care Unit in Turkey: 6 Years of Experience. J Pediatr Intensive Care 2023. [DOI: 10.1055/s-0043-1764330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
AbstractThe objective of this study was to identify the characteristics of nonsurvivors in a pediatric intensive care unit (PICU) in Turkey. This is a retrospective analysis of patients who died in a tertiary PICU over a 6-year period from 2016 to 2021. Data were drawn from electronic medical records and resuscitation notes. Mode of death was categorized as failed cardiopulmonary resuscitation (F-CPR) or brain death. Among the 161 deaths, 136 nonsurvivors were included and 30.1% were younger than 1 year. Severe pneumonia, respiratory failure, and acute respiratory distress syndrome (ARDS) (31.6%) were the most common primary diagnoses. The most common mode of death was F-CPR (86.8%). More than half of the subjects had been admitted from pediatric emergency departments (58.1%), and more than half (53.7%) had died within 7 days in the PICU. Patients admitted from pediatric emergency departments had the lowest frequency of comorbidities (p < 0.001). Severe pneumonia, respiratory failure, and ARDS diagnoses were significantly more frequent in those who died after 7 days (p < 0.001), whereas septicemia, shock, and multiple organ dysfunction were more common among those who died within the first day of PICU admission (p < 0.001). It may be important to note that patients referred from wards are highly likely to have comorbidities, while those referred from pediatric emergency departments may be relatively younger. Additionally, patients with septicemia, shock, or multiple organ dysfunction were more likely to die earlier (within 7 days), especially compared with those with severe pneumonia, respiratory failure, or ARDS.
Collapse
Affiliation(s)
- Zeynep Karakaya
- Department of Pediatrics, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Merve Boyraz
- Department of Pediatrics, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Seyma Koksal Atis
- Department of Pediatrics, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Servet Yuce
- Department of Public Health, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Muhterem Duyu
- Pediatric Intensive Care Unit, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| |
Collapse
|
3
|
Yıldırım B, Karakaya Z, Acar E, Demir A, Gökçek K, Gökçek A, Doğan V, Biteker M. Controlling Nutritional Status Score Predicts In-Hospital Mortality in Acute Pulmonary Embolism. Med Princ Pract 2022; 31:439-444. [PMID: 35613540 PMCID: PMC9801349 DOI: 10.1159/000525240] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 05/09/2022] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE The association between the nutritional status and outcomes in pulmonary embolism is unclear. This study was aimed at examining the value of the Controlling Nutritional Status (CONUT) score in assessing malnutrition among acute pulmonary embolism patients. SUBJECT AND METHODS We retrospectively reviewed the records of adult patients with acute pulmonary embolism hospitalized through our ED. Demographic, clinical, and laboratory data on admission were recorded. Nutritional status was assessed with the CONUT score, which is calculated by the albumin, total cholesterol, and lymphocyte counts. The primary endpoint of the study was in-hospital mortality. RESULTS A total of 308 consecutive patients (mean age 68.2 ± 12.9 years, 53.9% female) were included, and 35 of the patients (11.4%) died during their in-hospital course. Multivariate analysis showed that a pulmonary embolism severity index >148 (OR 3.12, 95% CI: 1.65-8.81, p < 0.001), the presence of heart failure (1.25, 95% CI: 1.08-1.78, p = 0.03), and a CONUT score >4 (OR 1.39, 95% CI: 1.146-3.424, p = 0.015) were independent predictors of in-hospital mortality. CONCLUSION The present study indicates that the presence of malnutrition defined by the CONUT score predicts in-hospital mortality following acute pulmonary embolism.
Collapse
Affiliation(s)
- Birdal Yıldırım
- Department of Emergency Medicine, Muğla Sıtkı Koçman University, Kötekli, Turkey
| | - Zeynep Karakaya
- Department of Emergency Medicine, İzmir Katip Celebi University, İzmir, Turkey
- *Zeynep Karakaya,
| | - Ethem Acar
- Department of Emergency Medicine, Muğla Sıtkı Koçman University, Kötekli, Turkey
| | - Ahmet Demir
- Department of Emergency Medicine, Muğla Sıtkı Koçman University, Kötekli, Turkey
| | - Kemal Gökçek
- Department of Emergency Medicine, Muğla Sıtkı Koçman University, Kötekli, Turkey
| | - Aysel Gökçek
- Department of Cardiology, Muğla Sıtkı Koçman University, Kötekli, Turkey
| | - Volkan Doğan
- Department of Cardiology, Muğla Sıtkı Koçman University, Kötekli, Turkey
| | - Murat Biteker
- Department of Cardiology, Muğla Sıtkı Koçman University, Kötekli, Turkey
| |
Collapse
|
4
|
Duyu M, Karakaya Z, Yazici P, Yavuz S, Yersel NM, Tascilar MO, Firat N, Bozkurt O, Caglar Mocan Y. Comparison of chlorhexidine impregnated dressing and standard dressing for the prevention of central-line associated blood stream infection and colonization in critically ill pediatric patients: A randomized controlled trial. Pediatr Int 2022; 64:e15011. [PMID: 34610185 DOI: 10.1111/ped.15011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/02/2021] [Accepted: 08/17/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND The aim of this study was to compare chlorhexidine gluconate (CHG)-impregnated dressing and standard dressing with respect to the frequency of central-line-associated bloodstream infection (CLABSI), catheter-related bloodstream infection, primary bloodstream infection, and catheter colonization in critically ill pediatric patients with short-term central venous catheters. METHODS Children who were admitted to the pediatric intensive care unit of a tertiary institution between May 2018 and December 2019 and received placement of a short-term central venous catheter were included in this single-center randomized controlled trial. Patients were grouped according to the type of catheter fixation applied. RESULTS A total of 307 patients (151 CHG-impregnated dressing, 156 standard dressing), with 307 catheters (amounting to a collective total of 4,993 catheter days), were included in the study. The CHG-impregnated dressing did not significantly decrease the incidence of CLABSI (6.36 vs 7.59 per 1,000 catheter days; hazard ratio (HR): 0.93, P = 0.76), catheter related bloodstream infection (3.82 vs 4.18 per 1,000 catheter days; HR: 0.98; P = 0.98), and primary bloodstream infection (2.54 vs 3.42 catheter days; HR: 0.79; P = 0.67). The CHG-impregnated dressing significantly decreased the incidence of catheter colonization (3.82 vs 7.59 per 1,000 catheter days; HR: 0.40; P = 0.04). In both groups, the most frequent microorganisms isolated in CLABSI or catheter colonization were Gram-positive bacteria (the majority were coagulase-negative staphylococci). CONCLUSIONS The use of CHG-impregnated dressing does not decrease CLABSI incidence in critically ill pediatric patients but it significantly reduced catheter colonization. Coagulase-negative staphylococci were the most common microorganisms causing CLABSI or catheter colonization.
Collapse
Affiliation(s)
- Muhterem Duyu
- Department of Pediatrics, Pediatric Intensive Care Unit, Istanbul Medeniyet University Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Zeynep Karakaya
- Department of Pediatrics, Altınova District Hospital, Yalova, Turkey
| | - Pinar Yazici
- Department of Pediatrics, Health Sciences University Ankara Training and Research Hospital, Ankara, Turkey
| | - Senanur Yavuz
- Department of Pediatrics, Istanbul Medeniyet University Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Nihal Meryem Yersel
- Department of Pediatrics, Istanbul Medeniyet University Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | | | - Nazim Firat
- Department of Pediatrics, Istanbul Medeniyet University Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Ozlem Bozkurt
- Department of Pediatrics, Istanbul Medeniyet University Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Yasemin Caglar Mocan
- Department of Pediatrics, Health Sciences University Dr. Lutfi Kırdar City Hospital, Istanbul, Turkey
| |
Collapse
|
5
|
Bilgin S, Kayali A, Yamanoğlu A, Acar H, Karakaya Z, Topal F, Yüksel ES, Topal FE. The value of conventional manometry in the identification of normal esophageal manometry. Medicine (Baltimore) 2021; 100:e28395. [PMID: 34967374 PMCID: PMC8718173 DOI: 10.1097/md.0000000000028395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/23/2021] [Indexed: 01/05/2023] Open
Abstract
In the last decade, high-resolution esophageal manometry (HREM) is the main device for the management of dysphagia replacing conventional manometry (CM). Conventional manometry still seems to have some space to diagnose major motility disorders and differentiate normal from abnormal esophageal motility. The long term outcomes of patients with normal CM were analyzed in our study.Participants (patients with dysphagia and normal CM) took a questionnaire via a phone call in February 2021. Impact Dysphagia Questionnaire (IDQ) was used as an assessment tool.Only 55% (83/151) the individuals with previous normal manometric findings were reached via telephone. The group who have completed the survey was representative of the cohort. 66.2% of the participants were female (P = .40). The mean age was 57.21, mean weight was 70.69 kg, mean height was 163.74 cm and mean body mass index was 26.41. More than 40% of patients were completely asymptomatic at follow up, reflected by an IDQ score of 0. Only 28 out of 83 (33.7%) patients reported significant symptoms as reflected by an IDQ score greater than or equal to 7. The rest of responders admitted as having moderate to mild symptoms.HREM is a valid technique with comparable precision to CM. HREM measurements differ considerably to CM. The identification of normal motor function in CM is not likely a positive prognostic indicator and must be interpreted precautiously.
Collapse
Affiliation(s)
- Serkan Bilgin
- Department of Emergency, Izmir Katip Çelebi University, İzmir, Turkey
| | - Ahmet Kayali
- Department of Emergency, Izmir Katip Çelebi University, İzmir, Turkey
| | - Adnan Yamanoğlu
- Department of Emergency, Izmir Katip Çelebi University, İzmir, Turkey
| | - Hüseyin Acar
- Department of Emergency, Izmir Katip Çelebi University, İzmir, Turkey
| | - Zeynep Karakaya
- Department of Emergency, Izmir Katip Çelebi University, İzmir, Turkey
| | - Firdevs Topal
- Department of Gastroenterology, İzmir Katip Çelebi University, İzmir, Turkey
| | - Elif Saritaş Yüksel
- Department of Gastroenterology, İzmir Katip Çelebi University, İzmir, Turkey
| | - Fatih Esad Topal
- Department of Emergency, Izmir Katip Çelebi University, İzmir, Turkey
| |
Collapse
|
6
|
Duyu M, Karakaya Z. Viral etiology and outcome of severe lower respiratory tract infections among critically ill children admitted to the PICU. Med Intensiva 2021; 45:447-458. [PMID: 34717883 DOI: 10.1016/j.medine.2020.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 04/24/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the viral etiology of severe lower respiratory tract infections (LRTIs), their clinical significance and prognosis among critically ill children. DESIGN A prospective descriptive study was carried out. SETTING Pediatric Intensive Care Unit (PICU) of Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey. PATIENTS A total of 115 patients hospitalized in the PICU were evaluated for inclusion in the study. Children with underlying comorbidities and those who did not require mechanical ventilation were excluded. MAIN VARIABLES OF INTEREST Demographic, clinical, laboratory test and radiographic data were recorded. RESULTS A total of 63 patients were eligible for the study. The most common diagnosis was bronchiolitis (57.1%). Respiratory syncytial virus (RSV) was the most frequent causal virus (36.5%). The most common complication was acute respiratory distress syndrome (ARDS) (28.6%). Multiple viral infection was identified in 20.6% of the patients, the most common in this subgroup being rhinovirus. Patients with bocavirus infection had a higher likelihood of needing invasive mechanical ventilation (IMV) at presentation. Children who died were likely to be <12 months old, have ARDS, hepatitis, pneumomediastinum, multiple viral infection, and required IMV support with an increased duration of MV. Additionally, they were found to have a high Pediatric Risk of Mortality III score, Predicted Death Rate and increased need for inotropic support at admission. CONCLUSIONS Our study showed critically ill children with LRTI without known risk factors to have high mortality when aged <12 months, in the presence of multiple agents and when certain complications (ARDS, hepatitis) and X-ray findings were identified.
Collapse
Affiliation(s)
- M Duyu
- Istanbul Medeniyet University, Goztepe Training and Research Hospital, Pediatric Intensive Care Unit, Istanbul, Turkey.
| | - Z Karakaya
- Istanbul Medeniyet University, Goztepe Training and Research Hospital, Department of Pediatrics Istanbul, Turkey
| |
Collapse
|
7
|
Karakaya Z, Duyu M, Yersel MN. Oral mucosal mouthwash with chlorhexidine does not reduce the incidence of ventilator-associated pneumonia in critically ill children: A randomised controlled trial. Aust Crit Care 2021; 35:336-344. [PMID: 34376358 DOI: 10.1016/j.aucc.2021.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 05/24/2021] [Accepted: 06/11/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is one of the most frequently encountered causes of hospital-acquired infection and results in high morbidity among intubated patients. Few trials have investigated the efficacy of oral care with chlorhexidine (CHX) mouthwash for the prevention of VAP in the paediatric population. OBJECTIVES The objective of this study was to assess the efficacy of CHX mouthwash in the prevention of VAP and to determine risk factors for VAP in children aged 1 month to 18 years admitted to the paediatric intensive care unit (PICU). METHODS This was a prospective, randomised, controlled, double-blind trial performed in the PICU. Patients were randomised into two groups receiving CHX (0.12%) (n = 88) or placebo (0.9% NaCl) (n = 86) and were followed up for VAP development. The main outcome measures were incidence of VAP, duration of hospital stay, duration of PICU stay, duration of ventilation, mortality, and the characteristics of organisms isolated in cases with VAP. RESULTS No difference was observed in the incidence of VAP and the type and distribution of organisms in the two groups (p > 0.05). In the CHX and placebo groups, we identified 21 and 22 patients with VAP, respectively. Incidence per 1000 ventilation days was 29.5 events in the CHX group and 35.1 events in the placebo group. Gram-negative bacteria were most common (71.4% in CHX vs. 54.5% in placebo). The use of 0.12% CHX did not influence hospital stay, PICU stay, ventilation, and mortality (p > 0.05). Multivariate analysis identified duration of ventilation as the only independent risk factor for VAP (p = 0.001). CONCLUSION The use of 0.12% CHX did not reduce VAP frequency among critically ill children. The only factor that increased VAP frequency was longer duration on ventilation. It appears that low concentration of CHX is not effective for VAP prevention, especially in the presence of multiresistant bacteria. CLINICALTRIALS. GOV IDENTIFIER NCT04527276.
Collapse
Affiliation(s)
- Zeynep Karakaya
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Paediatrics, Turkey.
| | - Muhterem Duyu
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Paediatrics, Pediatric Intensive Care Unit, Istanbul, Turkey.
| | - Meryem Nihal Yersel
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Paediatrics, Pediatric Intensive Care Unit, Istanbul, Turkey.
| |
Collapse
|
8
|
Karakaya Z, Duyu M, Koksal Atis S. Anaphylactoid reaction during hemodiafiltration on AN69 membrane in a patient with atypical hemolytic uremic syndrome: A pediatric case report. Hemodial Int 2021; 26:E8-E11. [PMID: 34219382 DOI: 10.1111/hdi.12966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/25/2021] [Indexed: 11/28/2022]
Abstract
Reactions associated with hemodiafiltration can be life threatening if not recognized early in the course of dialysis. AN69 (acrylonitrile and sodium methallyl sulfonate copolymer) membrane-associated reactions during hemodialysis have been documented in adult patients receiving angiotensin converting enzyme inhibitors, which are thought to be triggered by the negative charge of the AN69 membrane. Here, we present a 5-month-old girl requiring continuous renal replacement therapy (CRRT) for acute kidney injury secondary to atypical hemolytic uremic syndrome who experienced acute cyanosis, angioedema, tachycardia, and impaired circulation during CRRT. After switching to a different type of hemofiltration membrane, her clinical findings improved and she was able to tolerate hemodialysis. We concluded that she had experienced an anaphylactoid reaction to the AN69 membrane. To our knowledge, this case is the first pediatric case report of AN69 membrane-associated anaphylactoid reaction.
Collapse
Affiliation(s)
- Zeynep Karakaya
- Department of Paediatrics, Altinova District State Hospital, Yalova, Turkey
| | - Muhterem Duyu
- Department of Paediatrics, Pediatric Intensive Care Unit, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Seyma Koksal Atis
- Department of Paediatrics, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
9
|
Payza U, Kayali A, Bilgin S, Karakaya Z, Esad Topal F. When is the right time to take an emergency surgery decision in Mechanical Intestinal Obstruction? Asian J Surg 2021; 44:854-859. [PMID: 33712329 DOI: 10.1016/j.asjsur.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/27/2021] [Accepted: 02/21/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND /Objective: Ischemia is a leading cause of morbidity in Mechanical Intestinal Obstruction (MIO) in which the timing of decisions of whether to proceed to surgical or conservative treatment is critical in emergency departments (ED). While advanced technological options are available, patients may be negatively affected by the application of contrast agents or radiation. The use of ultrasound is limited because of the air in the intestines does not allow a good field of vision. While biomarkers can be considered as a good alternative option at this point. In the present study we examine the effect of hemogram and blood gas parameters on early surgical decision-making in MIO patients. METHOD Involved in this observational prospective study were 264 patients diagnosed with MIO who presented to the Department of Emergency Medicine, Ataturk Research and Training Hospital, Katip Celebi University between February 2018 and February 2019. Contrast-enhanced tomography (CECT) and laboratory results of the patients were recorded. Pathology reports of the patients who underwent surgery were collected. Laboratory data were analyzed by comparing CECT and pathology reports. RESULTS In a ROC analysis of the laboratory values of the patients who were diagnosed with ileus, the sensitivity was calculated as 80% and the specificity was 57.7 in values above WBC>10.75 (109/L), 96.6%, and the specificity was 31.1% in N/L > 2.9. For intestinal ischemia, the cut-off values were WBC> 12.6 and N/L > 3.2, Lactate >2.8 mmol/L and B.E < -3.6 mmol/L. CONCLUSION Diagnoses of ileus are based on the results examinations and imaging methods. More data are needed to support decisions on the timing of surgery in ED. WBC, N/L, Lactate and Base Excess indicate an ischemic segment. When the parameters are evaluated together, they strongly support early surgical decision-making regarding the treatment of intestinal ischemia.
Collapse
Affiliation(s)
- Umut Payza
- Department of Emergency Medicine, Ataturk Research and Training Hospital, Katip Celebi University, İzmir, Turkey.
| | - Ahmet Kayali
- Department of Emergency Medicine, Ataturk Research and Training Hospital, Katip Celebi University, İzmir, Turkey.
| | - Serkan Bilgin
- Department of Emergency Medicine, Ataturk Research and Training Hospital, Katip Celebi University, İzmir, Turkey.
| | - Zeynep Karakaya
- Department of Emergency Medicine, Ataturk Research and Training Hospital, Katip Celebi University, İzmir, Turkey.
| | - Fatih Esad Topal
- Department of Emergency Medicine, Ataturk Research and Training Hospital, Katip Celebi University, İzmir, Turkey.
| |
Collapse
|
10
|
Duyu M, Yıldız S, Bulut İ, Karakaya Z, Buz A, Bozbeyoğlu G. Internal carotid artery dissection following blunt head trauma: a pediatric case report and review of the literature. Turk J Pediatr 2020; 62:1077-1087. [PMID: 33372448 DOI: 10.24953/turkjped.2020.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Internal carotid artery dissection (ICAD) is a rare but potentially devastating complication after trauma in the pediatric age group. The diagnosis of traumatic dissection is difficult and is usually recognized only when ischemic symptoms appear. We report a pediatric patient with ICAD due to blunt cerebrovascular injury (BCVI). CASE A 14-year-old boy suffered major trauma due to a motor vehicle accident. When the first aid team reached the accident site, he was intubated because of his low Glasgow Coma Score (GCS) and then transported to the nearest emergency department. Cranial computed tomography (CT) showed multiple fractures at the skull base and independent bone fragments in both carotid canals. On the 6th day; a brain magnetic resonance imaging (MRI) was performed to detect diffuse axonal injury. There was a loss of signal in the left internal carotid artery (LICA) tract but the limitation of diffusion was not associated with the same side, conversely there was a limitation of diffusion on the other side, affecting a very large area. CT angiography was performed in order to detect a filling defect and showed dissection in the LICA. The patient did not have any specific neurological symptoms associated with ICAD. Low-dose aspirin was utilized as anticoagulant therapy. On the 25th day of admission, the patient`s GCS was 14, neurologic examination showed no difference between the right and left sides. He was discharged on the 55th day of the accident and was walking without support. CONCLUSION Our patient was a rare case in pediatrics due to having a clinically silent form of ICAD. It is very difficult to diagnose ICAD dissection during the early phase in cases with BCVI accompanied by multiple trauma. Even in the absence of typical neurological deficit, the possible presence of ICAD should be explored in patients with cranial fractures encompassing the skull base.
Collapse
Affiliation(s)
- Muhterem Duyu
- Division of Pediatric Intensive Care Unit, İstanbul Medeniyet University, Göztepe Training and Education Hospital, İstanbul, Turkey
| | - Selin Yıldız
- Department of Pediatrics, İstanbul Medeniyet University, Göztepe Training and Education Hospital, İstanbul, Turkey
| | - İrem Bulut
- Department of Pediatrics, İstanbul Medeniyet University, Göztepe Training and Education Hospital, İstanbul, Turkey
| | - Zeynep Karakaya
- Department of Pediatrics, İstanbul Medeniyet University, Göztepe Training and Education Hospital, İstanbul, Turkey
| | - Ayşenur Buz
- Department of Radiology, İstanbul Medeniyet University, Göztepe Training and Education Hospital, İstanbul, Turkey
| | - Gülçin Bozbeyoğlu
- Department of Radiology, İstanbul Medeniyet University, Göztepe Training and Education Hospital, İstanbul, Turkey
| |
Collapse
|
11
|
Abstract
BACKGROUND There is close association between asthma and cardiovascular functions as both diseases share common inflammatory pathways. The current study was aimed at investigating the risk factors, associated with endothelial and cardiac functions in children with newly-diagnosed mild-persistent asthma. METHODS A total of 33 steroid-naive asthmatic children [median(interquartile-range); 9.1 years(7.8-13.5)] and 16 healthy controls [11.5 years(9.9-13.6)] were included. Their demographic, clinical and laboratory findings were recorded. Carotid Artery intima-media thickness (CIMT), stiffness, distensibility and strain were measured as atheroclerosis markers. Conventional and tissue Doppler imaging was performed to evaluate ventricular function. RESULTS The patients with asthma had higher CIMT and stiffness and lower strain and distensibility compared to controls (p < 0.001 for all). There was a significant correlation between the duration of asthmatic symptoms and subclinical-atherosclerosis as well as peripheral eosinophil count (p < 0.001, p < 0.05). The patients had lower tricuspid-annular-plane-systolic-excursion (TAPSE), ejection time, and higher isovolumetric relaxation time (IRT), isovolumetric contraction time (ICT), and left ventricle myocardial performance index (LVMPI) than the control subjects (p < 0.001 for all). A positive correlation was also observed between the duration of asthmatic-symptoms and cardiac-function parameters. CONCLUSION Children with mild persistent asthma had subclinical atherosclerosis and ventricular dysfunction even in the early stage of disease. Symptom duration was closely associated with both subclinical atherosclerosis and ventricular dysfunction. Myocardial performance index was abnormal in the asthmatic children when assessed by tissue Doppler Imaging even though they had normal ejection fraction in conventional echocardiography. Future prospective studies with larger sample sizes are needed to confirm these findings and to assess the possible protective effect of ICSs in the prevention of subclinical atherosclerosis.
Collapse
Affiliation(s)
- Zeynep Karakaya
- Department of Pediatrics, Istanbul Medeniyet University Medical Faculty, İstanbul, Turkey
| | - Özlem Cavkaytar
- Department of Pediatric Allergy and Immunology, Istanbul Medeniyet University Medical Faculty, İstanbul, Turkey
| | - Öykü Tosun
- Department of Pediatric Cardiology, Istanbul Medeniyet University Medical Faculty, İstanbul, Turkey
| | - Mustafa Arga
- Department of Pediatric Allergy and Immunology, Istanbul Medeniyet University Medical Faculty, İstanbul, Turkey
| |
Collapse
|
12
|
Özdemir E, Karakaya Z, Karaca M, Topal F, Payza U. Recurrent diclofenac-induced acute myocardial infarction: An interesting case with wandering ST-segment elevation. HONG KONG J EMERG ME 2020. [DOI: 10.1177/1024907919845526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Allergic acute myocardial infarction with ST-segment elevation is rare, and vasoconstrictor mediators released from mast cells are responsible for its pathogenesis. Several medications have been reported to lead to acute myocardial infarction with ST-segment elevation, as a part of systemic allergic reactions and this entity is known as Kounis syndrome (KS). Case presentation: We presented a patient with recurrent KS who had no allergic reactions, except coronary spasm after parenteral diclofenac administration. First, she experienced anterior myocardial infarction with ST-segment elevation after administration of diclofenac 2 years ago. The second presentation was acute inferior-posterior myocardial infarction with ST-segment elevation with atrioventricular complete block leading to cardiogenic shock. She had no significant coronary stenosis responsible for each myocardial infarction with ST-segment elevation. However, she had a catheter-induced coronary spasm of non-dominant right coronary artery. She was considered to have a recurrent allergic myocardial infarction with ST-segment elevation due to parenteral diclofenac usage and treated with a calcium antagonist, statin, and dual antiplatelet agent. Discussion: KS can manifest as same as acute coronary syndrome. All drugs or any allergen can cause this event.KS had three variants but In all three conditions, treatment is antithrombotic or vasodilatator regime. Conclusion: As atherosclerosis events on coronary, allergic coronary events also may recurs. However, unlike the literature, our case is differentiated by recurrence of similar events in different coronary vessels.
Collapse
Affiliation(s)
- Emre Özdemir
- Cardiology Clinic, Ataturk Education and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Zeynep Karakaya
- Emergency Clinic, Ataturk Education and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Mustafa Karaca
- Cardiology Clinic, Ataturk Education and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Fatih Topal
- Emergency Clinic, Ataturk Education and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Umut Payza
- Emergency Clinic, Ataturk Education and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| |
Collapse
|
13
|
Ozkaya E, Topal FE, Bulut T, Gursoy M, Ozuysal M, Karakaya Z. Evaluation of an artificial intelligence system for diagnosing scaphoid fracture on direct radiography. Eur J Trauma Emerg Surg 2020; 48:585-592. [DOI: 10.1007/s00068-020-01468-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/21/2020] [Indexed: 11/30/2022]
|
14
|
Duyu M, Mocan Çağlar Y, Karakaya Z, Usta Aslan M, Yılmaz S, Ören Leblebici AN, Doğan Bektaş A, Bahar M, Yersel MN. Comparison of arterial CO 2 estimation by end-tidal and transcutaneous CO 2 measurements in intubated children and variability with subject related factors. J Clin Monit Comput 2020; 35:101-111. [PMID: 32720231 PMCID: PMC7384390 DOI: 10.1007/s10877-020-00569-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 07/22/2020] [Indexed: 02/06/2023]
Abstract
Transcutaneous PCO2 (PTCCO2) and end-tidal PCO2 (PETCO2) measurement methods serve as alternatives to arterial PCO2 (PaCO2), providing continuous non-invasive monitoring. The objective of this study was to evaluate the PTCCO2 and PETCO2 methods with actual PaCO2 levels, and to assess the variability of measurements in relation to subject-related factors, such as skin and subcutaneous adipose tissue thickness and presence of pulmonary diseases. PTCCO2, PETCO2 and PaCO2 were measured at the same time in intubated pediatric subjects. Subjects' demographic characteristics, clinical features, laboratory parameters, skin and subcutaneous adipose tissue thickness were identified. The study was carried out on 102 subjects with a total of 1118 values for each method. In patients with non-pulmonary disease, the mean difference between PTCCO2 and PaCO2 was - 0.29 mmHg (± 6.05), while it was 0.44 mmHg (± 6.83) bias between PETCO2 and PaCO2. In those with pulmonary diseases, the mean difference between PTCCO2 and PaCO2 was - 1.27 mmHg (± 8.32), while it was - 4.65 mmHg (± 9.01) between PETCO2 and PaCO2. Multiple linear regression demonstrated that increased subcutaneous adipose tissue thickness, core body temperature and inotropic index were related with higher PTCCO2 values relative to the actual PCO2 values. Other factors, such as skin tissue thickness, presence of pulmonary disease, measurement location and measurement times were non-significant. The PTCCO2 method has higher reliability than the PETCO2 method, and PTCCO2 measurements are not influenced by most subject-related factors; however, core body temperature, inotropic index and subcutaneous adipose tissue thickness can lead to significant differences in PCO2 measurement.
Collapse
Affiliation(s)
- Muhterem Duyu
- Department of Pediatrics, Pediatric Intensive Care Unit, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey.
| | - Yasemin Mocan Çağlar
- Department of Pediatrics, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Zeynep Karakaya
- Department of Pediatrics, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Mine Usta Aslan
- Department of Radiology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Seyhan Yılmaz
- Department of Pediatrics, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Aslı Nur Ören Leblebici
- Department of Pediatrics, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Anıl Doğan Bektaş
- Department of Pediatrics, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Meral Bahar
- Department of Pediatrics, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Meryem Nihal Yersel
- Department of Pediatrics, Pediatric Intensive Care Unit, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
15
|
Duyu M, Karakaya Z. VIRAL ETIOLOGY AND OUTCOME OF SEVERE LOWER RESPIRATORY TRACT INFECTIONS AMONG CRITICALLY ILL CHILDREN ADMITTED TO THE PICU. Med Intensiva 2020; 45:S0210-5691(20)30164-9. [PMID: 32405129 PMCID: PMC7218367 DOI: 10.1016/j.medin.2020.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 04/24/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the viral etiology of severe lower respiratory tract infections (LRTIs), their clinical significance and prognosis among critically ill children. DESIGN A prospective descriptive study was carried out. SETTING Pediatric Intensive Care Unit (PICU) of Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey. PATIENTS A total of 115 patients hospitalized in the PICU were evaluated for inclusion in the study. Children with underlying comorbidities and those who did not require mechanical ventilation were excluded. MAIN VARIABLES OF INTEREST Demographic, clinical, laboratory test and radiographic data were recorded. RESULTS A total of 63 patients were eligible for the study. The most common diagnosis was bronchiolitis (57.1%). Respiratory syncytial virus (RSV) was the most frequent causal virus (36.5%). The most common complication was acute respiratory distress syndrome (ARDS) (28.6%). Multiple viral infection was identified in 20.6% of the patients, the most common in this subgroup being rhinovirus. Patients with bocavirus infection had a higher likelihood of needing invasive mechanical ventilation (IMV) at presentation. Children who died were likely to be < 12 months old, have ARDS, hepatitis, pneumomediastinum, multiple viral infection, and required IMV support with an increased duration of MV. Additionally, they were found to have a high Pediatric Risk of Mortality III score, Predicted Death Rate and increased need for inotropic support at admission. CONCLUSIONS Our study showed critically ill children with LRTI without known risk factors to have high mortality when aged < 12 months, in the presence of multiple agents and when certain complications (ARDS, hepatitis) and X-ray findings were identified.
Collapse
Affiliation(s)
- M. Duyu
- Istanbul Medeniyet University, Goztepe Training and Research Hospital, Pediatric Intensive Care Unit, Istanbul, Turkey
| | - Z. Karakaya
- Istanbul Medeniyet University, Goztepe Training and Research Hospital, Department of Pediatrics Istanbul, Turkey
| |
Collapse
|
16
|
Topal FE, Bilgin S, Yamanoglu A, Karakaya Z, Payza U, Akyol PY, Aslan C, Aksun M. The Feasibility of the Ultrasound-Guided Femoral Nerve Block Procedure with Low-Dose Local Anesthetic in Intracapsular and Extracapsular Hip Fractures. J Emerg Med 2020; 58:553-561. [PMID: 32070647 DOI: 10.1016/j.jemermed.2019.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 12/25/2019] [Accepted: 12/25/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The local anesthetic dosages used in the current literature in regional applications of local anesthetics are frequently high for surgical purposes, and there are no sufficient dosage studies for emergency department (ED) management. OBJECTIVES The aim of this study was to determine the success of lower local anesthetic dosages capable of reducing costs and excessive exposure to drugs in pain control in patients with femoral neck fractures (FNFs) in the ED. METHODS Patients ≥65 years of age with FNFs and reporting Wong-Baker Pain Rating Scales scores ≥8 were included in this prospective, interventional study. Patients underwent ultrasound-guided regional femoral block with 5 mL 2% prilocaine. Pain scores before the procedure and at 30 min and 2 h postprocedure were compared with the Friedman test and Wilcoxon test with Bonferroni correction. RESULTS Forty patients, 20 with intracapsular and 20 with extracapsular FNFs, were enrolled. The initial pain scores of patients with both intra- and extracapsular fractures were 8 (range 8-10). A statistically significant 50% decrease in pain scores was observed in both groups 30 min after the regional block procedure (p < 0.001). A statistically significant 75% decrease in pain scores was observed in both groups 2 h after the regional block procedure (p < 0.001). No statistically significant difference was determined in the change in 30-min and 2-h pain scores between the groups. CONCLUSIONS The administration of 5 mL 2% prilocaine for pain control in FNFs in elderly patients in the ED can reduce systemic analgesic requirements by establishing effective analgesia in both intracapsular and extracapsular fractures.
Collapse
Affiliation(s)
- Fatih Esad Topal
- Department of Emergency Medicine, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Serkan Bilgin
- Department of Emergency Medicine, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Adnan Yamanoglu
- Department of Emergency Medicine, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Zeynep Karakaya
- Department of Emergency Medicine, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Umut Payza
- Department of Emergency Medicine, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Pınar Yesim Akyol
- Department of Emergency Medicine, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Cihan Aslan
- Department of Orthopaedics and Traumatology, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Murat Aksun
- Department of Anesthesiology, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| |
Collapse
|
17
|
Bilgin S, Topal FE, Yamanoğlu A, Payza U, Karakaya Z, Akyol PY, Tahtaci R, Topal F. Effect of Changes in Intravascular Volume on Inferior Vena Cava and Aorta Diameters and the Caval/Aorta Index in Healthy Volunteers. J Ultrasound Med 2020; 39:231-238. [PMID: 31283047 DOI: 10.1002/jum.15093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 06/17/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Although inferior vena cava diameter (IVCD) measurement can be useful as a noninvasive method for monitoring the volume status, the benefit of abdominal aorta diameter (AAD) measurement is unclear. The purpose of this study was to determine the value of the combined use of the IVCD and AAD in blood loss monitoring. METHODS This prospective observational study was conducted at the blood donor center of a training and research hospital. Standard blood donation criteria were followed during volunteer enrollment. Vital signs and ultrasound IVCD and AAD measurements were obtained before and after blood donation and after fluid resuscitation with 500 mL of 0.9% sodium chloride. Measurements before and after blood donation and after fluid resuscitation were compared by the paired t and Wilcoxon matched-pair tests. RESULTS Thirty-nine volunteers were included in the study. With 500 mL of blood loss, percent changes in the shock index (SI; mean ± SD, 7% ± 6%), IVCD (6% ± 2%), and caval/aorta index (IVCD/AAD; 6.1% ± 3%) were similar and were higher (P < .001 for all parameters) than the changes in the pulse rate (3% ± 4%), AAD (0.5% ± 1.5%), systolic blood pressure (3% ± 4%), and diastolic blood pressure (2% ± 7%). Although IVCD and SI values changed significantly (P < .001 for both) after 500 mL of 0.9% sodium chloride resuscitation, no significant change was observed in the IVCD/AAD (P = .059). CONCLUSIONS The IVCD/AAD, SI, and IVCD may have similar success rates in diagnosing early blood loss. Additionally, the SI and IVCD may be superior to the IVCD/AAD in bleeding patients requiring simultaneous fluid resuscitation.
Collapse
Affiliation(s)
- Serkan Bilgin
- Departments of Emergency Medicine, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Fatih Esad Topal
- Departments of Emergency Medicine, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Adnan Yamanoğlu
- Departments of Emergency Medicine, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Umut Payza
- Departments of Emergency Medicine, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Zeynep Karakaya
- Departments of Emergency Medicine, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Pınar Yesim Akyol
- Departments of Emergency Medicine, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Rezan Tahtaci
- Departments of Emergency Medicine, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Firdes Topal
- Departments of Gastroenterology, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| |
Collapse
|
18
|
Topal FE, Karakaya Z, Akyol PY, Payza U, Çalışkan M, Topal F, Aksun S, Erdoğan S, Neşelioğlu S. ST elevasyonlu akut koroner sendromlu hastalarda artmış tiyol/disülfid oranı. Cukurova Medical Journal 2019. [DOI: 10.17826/cumj.527542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
19
|
Abstract
INTRODUCTION Geriatric patients are subject to traumas more frequently due to age-related physiopathological changes. The objective of the study was to evaluate the demographic properties of geriatric patients who presented with trauma to the emergency department in addition to establishing the course of the diagnosis and treatment. MATERIAL AND METHODS Nine hundred and twelve geriatric patients who presented with trauma to the emergency department during one year were included in this retrospective study. Cause of the presentation, demographic properties, diseases, medications, sites of trauma, departments of consultations, departments that the patients were admitted to, discharge, mortality and morbidity rates were obtained from the folders of the subjects. The subjects were assigned to age groups 65-79 years old and over 80 years old. RESULTS 60.4% (n = 551) of the 912 subjects were female, 39.6% (n = 361) were male and the mean age of the subjects was 77.16 (65-100). Falls were the most common cause (80.3%) of traumas, and the most frequently affected parts of the body were the extremities. The over 80 group was the most frequently consulted group (p = 0.01) and women were admitted more often to the hospital (p = 0.03). Of the patients who presented with trauma, 28.9% (n = 264) were hospitalized and 2% (n = 18) died. The most common causes of death of patients were femur fractures and intracranial hemorrhages. CONCLUSIONS Due to high mortality and morbidity, this geriatric patient group deserves a multidisciplinary approach beginning with the emergency departments.
Collapse
Affiliation(s)
- Gülbahar Söz
- Emergency Medicine Department, Izmir Çiğli Region Hospital, Izmir, Turkey
| | - Zeynep Karakaya
- Emergency Medicine Department, Izmir Atatürk Education and Research Hospital, Katip Çelebi University, Izmir, Turkey
| |
Collapse
|
20
|
Karakaya Z, Saritas A, Yeşim Akyol P, Esad Topal F, Payza U, Bilgin S. Evaluation of Chronic Subdural Hematoma Volume Calculated via Cavalieri’s Principle. Konuralp Tıp Dergisi 2019. [DOI: 10.18521/ktd.469173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
21
|
Akyol PY, Karakaya Z, Topal FE, Payza U, Kuday Kaykısız E. Simplified Pulmonary Embolism Severity Index in Predicting Mortality in ED. Konuralp Tıp Dergisi 2019. [DOI: 10.18521/ktd.511525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
22
|
Karakaya Z, Akyol PY, Topal F, Esad F, Aykaç MC. Akut pankreatitte prokalsitonin düzeyinin mortalite üzerine etkisi. Cukurova Medical Journal 2018. [DOI: 10.17826/cumj.333679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
23
|
Urnal R, Akyol PY, Karakaya Z, Payza U, Topal FE, Kaykisiz EK. The effect of neutrophil/lymphocyte ratio on 1-year mortality in pulmonary embolism diagnosed patients. Biomed Res 2018. [DOI: 10.4066/biomedicalresearch.29-18-137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
24
|
Topal F, Payza U, Topal F, Karakaya Z, Tahtaci R, Bilgin S. Is P2/MS score valuable for prediction in HBV-related variceal bleeding? J Acute Dis 2018. [DOI: 10.4103/2221-6189.241017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
25
|
Ugur Goktas M, Akyol PY, Karakaya Z, Payza U, Topal FE. Evaluation of white blood cell and neutrophil/lymphocyte ratio in acute coronary syndrome patients admitted to emergency department. Biomed Res 2018. [DOI: 10.4066/biomedicalresearch.29-18-136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
26
|
Alp MB, Karakaya Z, Yavaş GC, Akyol PY, Topal FE, Payza U, Bilgin S. Analysis of Patients Who Applied to Our Clinic with Aortic Dissection: A Five-year Experience. meandros 2017. [DOI: 10.4274/meandros.08379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
27
|
Karakaya Z, Ünlüer EE, Ersan A. Deadly right flank pain: inferior vena cava spontaneous rupture. Am J Emerg Med 2016; 34:2050.e1-2050.e3. [DOI: 10.1016/j.ajem.2016.02.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 02/21/2016] [Indexed: 10/22/2022] Open
|
28
|
Ozdinc S, Oz G, Ozdemir C, Kilic I, Karakaya Z, Bal A, Koken T, Solak O. Melatonin: is it an effective antioxidant for pulmonary contusion? J Surg Res 2016; 204:445-451. [DOI: 10.1016/j.jss.2016.05.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 03/31/2016] [Accepted: 05/11/2016] [Indexed: 12/21/2022]
|
29
|
Poyrazoglu HH, Avsar MK, Demir S, Karakaya Z, Güler T, Tor F. Atrial septal defect closure: comparison of vertical axillary minithoracotomy and median sternotomy. Korean J Thorac Cardiovasc Surg 2013; 46:340-5. [PMID: 24175268 PMCID: PMC3810555 DOI: 10.5090/kjtcs.2013.46.5.340] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 01/26/2013] [Accepted: 03/29/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study aims to evaluate whether or not the method of right vertical axillary minithoracotomy (RVAM) is preferable to and as reliable as conventional sternotomy surgery, and also assesses its cosmetic results. METHODS Thirty-three patients (7 males, 26 females) with atrial septal defect were admitted to the Cardiovascular Surgery Clinic of Cukurova University from December 2005 until January 2010. The patients' ages ranged from 3 to 22. Patients who underwent vertical axillary minithracotomy were assigned to group I, and those undergoing conventional sternotomy, to group II. Group I and group II were compared with regard to the preoperative, perioperative and postoperative variables. Group I included 12 females and 4 males with an average age of 16.5±9.7. Group II comprised 14 female and 3 male patients with an average age of 18.5±9.8 showing similar features and pathologies. The cases were in Class I-II according to the New York Heart Association (NYHA) Classification, and patients with other cardiac and systemic problems were not included in the study. The ratio of the systemic blood flow to the pulmonary blood flow (Qp/Qs) was 1.8±0.2. The average pulmonary artery pressure was 35±10 mmHg. Following the diagnosis, performing elective surgery was planned. RESULTS No significant difference was detected in the average time of the patients' extraportal circulation, cross-clamp and surgery (p>0.05). In the early postoperative period of the cases, the duration of mechanical ventilator support, the drainage volume in the first 24 hours, and the hospitalization time in the intensive care unit were similar (p>0.05). Postoperative pains were evaluated together with narcotic analgesics taken intravenously or orally. While 7 cases (43.7%) in group I needed postoperative analgesics, 12 cases (70.6%) in group II needed them. No mortality or major morbidity has occurred in the patients. The incision style and sizes in all of the patients undergoing RVAM were preserved as they were at the beginning. Furthermore, the patients of group I were mobilized more quickly than the patients of group II. The patients of group I were quite pleased with the psychological and cosmetic results. No residual defects have been found in the early postoperative period and after the end of the follow-up periods. All of the patients achieved functional capacity per NYHA. No deformation of breast growth has been detected during 18 months of follow-up for the group I patients, who underwent RVAM. CONCLUSION To conclude, the repair of atrial septal defect by RVAM, apart from the limited working zone for the surgeon in these pathologies as compared to sternotomymay be considered in terms of the outcomes, and early and late complications. And this has accounted for less need of analgesics and better cosmetic results in recent years.
Collapse
|
30
|
Demir Ş, Selçuk M, Tosu AR, Karakaya Z, Yüksekdağ V. The Prognostic Value of Neopterin Concentration in Patients with Advanced Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
31
|
Demir S, Karakaya Z, Sagay S. A rare cause of dyspnoea: the LEOPARD syndrome. J PAK MED ASSOC 2013; 63:527-529. [PMID: 23905457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The LEOPARD syndrome is a rare hereditary disorder in Asian countries. This syndrome involves complex malformations and other features. Though the LEOPARD syndrome is rare, diagnosis is important since it can be related with serious cardiac ailments. Patients must be followed up regularly in order to reduce the risk of sudden death which is the most severe complication. The study presents the case of a 23-year-old woman who had dyspnoea on daily exercises. She had multiple lentigines, cardiac anomalies (apical hypertrophic cardiomyopathy, left ventricular hypertrophy and pulmonary stenosis), ocular hypertelorism and abnormal electrocardiographic findings. Based on the findings, the patient was diagnosed with the LEOPARD syndrome.
Collapse
|
32
|
Demir S, Tufenk M, Karakaya Z, Akilli R, Kanadas M. The treatment of heart failure-related symptoms with ivabradine in a case with peripartum cardiomyopathy. Int Cardiovasc Res J 2013; 7:33-6. [PMID: 24757617 PMCID: PMC3987426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 01/03/2013] [Accepted: 02/02/2013] [Indexed: 11/30/2022] Open
Abstract
Peripartum cardiomyopathy is a form of dilated cardiomyopathy that is defined as deterioration in cardiac function presenting typically between the last month of pregnancy and up to five months postpartum. As with other forms of dilated cardiomyopathy, PPCM involves systolic dysfunction of the heart with a decrease of the left ventricular ejection fraction with associated congestive heart failure. In heart failure sinus tachycardia is a poor prognostic factor and the common symptom. In this paper, we presented a case treated with ivabradine which provided additional benefit in patient with acute heart failure.
Collapse
Affiliation(s)
- Serafettin Demir
- Department of Cardiology, Adana State Hospital, Adana, Turkey,Corresponding author: Serafettin Demir, Adana State Hospital, Department of Cardiology, Karata Street, 01270, Adana, Turkey. Tel/fax: +90-5336271991, E-mail:
| | - Mucahit Tufenk
- Department of Cardiology, Kiziltepe State Hospital, Mardin, Turkey
| | - Zeynep Karakaya
- Department of Emergency Medicine, Adana State Hospital, Adana, Turkey
| | - Rabia Akilli
- Department of Cardiology, School of Medicine, Cukurova University, Adana, Turkey
| | - Mehmet Kanadas
- Department of Cardiology, School of Medicine, Cukurova University, Adana, Turkey
| |
Collapse
|
33
|
Karakaya Z, Gökel Y, Açikalin A, Karakaya O. [Evaluation of the process and effectiveness of consultation system in the Department of Emergency Medicine]. ULUS TRAVMA ACIL CER 2009; 15:210-216. [PMID: 19562540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Triage, consultations, and radiological and laboratory test processes have different effects on the total waiting time in the emergency department (ED). Under these circumstances, the importance of the consultation system process and effectiveness of consultation becomes very clear. Our aim in this study was to verify the process of the consultation system. METHODS This prospective and defining study was performed with 276 patients admitted to the ED. A total of 342 consultations were requested. These patients were classified as very urgent, urgent and non-urgent according to their problems, and a survey form was completed by the ED resident. RESULTS The most frequently requested consultation was to the Department of Internal Medicine (72%). Mean time for reply to the consultation was 29+/-43 minutes. The earliest reply to the consultation was from Cardiology while the latest responders were the general surgeons. Timeline for replying to the consultation was shorter depending on the urgency of the case. CONCLUSION In our study, we determined that the most important factor for the effectiveness of consultation was the definition of the urgency of the patients by the residents in the ED. Since the number of patients admitting to the ED will continue to increase in the future, more detailed prospective studies are needed about the efficiency of consultation in the ED.
Collapse
Affiliation(s)
- Zeynep Karakaya
- Department of Emergency Medicine, Cukurova University, Faculty of Medicine, Adana.
| | | | | | | |
Collapse
|