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Öğe Acute aortic dissection: unusual presentations(Elsevier Science Bv, 2009) Guven, Fatma Mutlu Kukul; Korkmaz, Ilhan; Dogan, Zeki; Doles, Kenan Ahmet; Eren, Sevki HakanMortality rate in aortic dissection increases to 50% in the first 48 hours due to delayed diagnosis and treatment. These patients generally admit to emergency department with acute onset sharp pain on sternum or interscapular region. They also can admit with syncope, cerebrovascular disease, myocardial infarction, hemiparesis-hemiplegy, disphagy and flank pain. Hypertension, connective tissue diseases, congenital aortic stenosis or bicuspid aortic valve and positive family history generally present in the etiologies of aortic dissections. Laboratory results without radiological data are inreliable and controversial in diagnosing of aortic dissections among the patients with atypical symptoms. In this study; we aimed to review and discuss literature information about the aortic dissections with three cases that admitted to Cumhuriyet University Medicine Faculty Emergency Department with atypical complaints.Öğe Analysis of 264 Patients with Stab and Gunshot Wounds in Abdominal and Thoracic Regions(DRUNPP-SARAJEVO, 2010) Korkmaz, Ilhan; Karadayi, Sule; Guven, Fatma Mutlu Kukul; Eren, Sevki Hakan; Sahin, Ekber; Nadir, Aydin; Beydilli, Inan; Kaptanoglu, MelihIntroduction: Penetrating traumas are life-threatening situations which can be encountered in emergency services. In this study, epidemiological data, treatment approaches and the results pertaining to penetrant abdominal and/or thoracic injuries, which occured due to gunshot or stab wounds, are evalauted retrospectively. Material-method: Two hundred and sixty four patients who admitted to emergency department with penetrating thoracic and/or abdominal trauma between 2002 and2009 were retrospectively analyzed. Patients were divided into 3 groups according to their shock indexes including Low risk (<= 0.5), medium risk (> 0.5-<= 1) and high risk (> 1) groups. Results: The study group included 244 male (92.4%) and 20(7.6%) female participants. Age distribution of the groups was as follows; 58 (22.0%) patients were in the 0-19 years group, 139 patients (52.6%) were in the 20-40 years group and 67 patients (25.4%) were over 40 years. Two hundred and fifteen injuries (81.4%) were caused by stab wounds and 49 (18.6%) were due to gunshots. When the patients were evaluated considering the injury site, isolated thoracic trauma was seen in 93 patients (35.3%) and isolated abdominal injuries were found in 74 patients (28.0%). The most common organ injuries among the patients who underwent laparotomy (n=73) were as follows; bowel injury in 28 patients (38.3%), stomach injuries in 20 patients (27.4%) and liver-spleen injuries in 17 patients (23.28 %). Of 189 patients with thoracic trauma, 17 patients (8.9 %) had hemothorax, 44 (23.28 %) had pneumothorax, 46 (24.33 %) had hemopneumothorax and 2 patients (1.05 %) had pulmonary contusion. Seven patients (2.65 %) died. Two patients were considered as exitus in the initial examination. Two of the 5 exitus cases had shock index ranging within the medium risk group and 3 were in the high-risk group. Conclusion: It must be considered that penetrating trauma patients with medium or high shock index have a higher mortality rate. Therefore, those patients must be closely monitored and the health services should be improved for immediately and appropriately transferring them.Öğe Analysis of patients with upper gastrointestinal bleeding: a study from Anatolian, Turkey Seasonal Distribution of Gastrointestinal Bleeding(DRUNPP-SARAJEVO, 2012) Korkmaz, Ilhan; Eren, Sevki Hakan; Guven, Fatma Mutlu Kukul; Beydilli, Inan; Yildirim, Birdal; Oguzturk, HakanThe aim of our study was to analyze if we have a seasonal or circadian distribution of acute upper gastrointestinal bleeding (AUGIB) patients, and to evaluate the laboratory and demographic risk factors on mortality rates. We scanned all of the files of the patients who had been diagnosed with AUGIB, for a ten year period. Datas' about seasonal distribution, circadian rhythm, admission hemoglobin, blood urea nitrogen and demographic variables were extracted from the charts. We didn't observed a seasonal distribution for AUGIB inspite of we excluded the drug effect by analyzing its seasonal distribution. Also our patients were admitted mostly nights which was compatible with the literature. Whereas our admission rate between 24 and 06 hour period was low. Admission low hemoglobin level, impaired blood urea nitrogen and creatinine level, and patients with advanced age has a higher mortality rate (p=0.03, p=0.003, p=0.02, p=0.001 respectively). Climatic factors effect on the seasonal distribution among AUGIB patients is not observed. Other risk factors (mental-physical) should also be evaluated. Low hemoglobin level, impaired renal functions and advanced age are bad risk factors for prognosis.Öğe Analysis of the patients admitted to emergency department due to urogenital trauma and investigation of factors that affect mortality(ELSEVIER SCIENCE BV, 2017) Sozen, Semih; Celik, Simsek; Akpinar, Cafer; Guven, Fatma Mutlu Kukul; Yel, Cihat; Kavalci, Cemil; Salt, OmerObjective: To determine the general characteristics of urogenital trauma, and the factors that impact on mortality. Methods: Patients who were over 18 years of age admitted to the emergency service with urogenital injury between 1 January 2010 and 31 December 2014 were evaluated retrospectively. Age, gender, type of trauma, injured urogenital organs, vital parameters, additional organ injuries and mortality rate were investigated. Categorical variables were compared by using Chi-square test and comparing to groups data were performed with the Mann-Whitney and Kruskal-Wallis tests. P < 0.05 was considered statistically significant. Results: The median age of 174 patients was 35 years (interquartile range: 22), and 150 patients (86.2%) were males. It was determined that the incidence of urogenital trauma increased in August and September. The kidney was the most frequently injured organ (41.4%) and the most common cause of injury was traffic accidents (49.4%). Mean arterial pressure and revised trauma score were the lowest while pulse rate was the highest in renal trauma patients (P < 0.05). Mean arterial pressure, revised trauma score and respiratory rate were low in mortal group while pulse rate and Glasgow coma scale scores were significantly higher (P < 0.05). Conclusions: It is determined that the most common injured organs in trauma patients are kidneys and bladder and also no single factor is effective on mortality.Öğe Anaphylaxis Due to Sublingual Captopril in Emergency Service(Aves, 2010) Eren, Sevki Hakan; Korkmaz, Ilhan; Guven, Fatma Mutlu Kukul; Doles, Kenan AhmetAnaphylaxis is a severe systemic hypersensitivity reaction characterized by multisystem involvement, which may include hypotension and airway compromise. Histamine especially, a mediator which is released from basophil or mast cells, has a great importance in the clinical state. As the condition can be fatal within a few minutes, it must be kept in mind and all clinicians must be aware of it. Especially in emergency departments, where many drugs are used, anaphlaxis can be frequently seen and all emergency department doctors must familiar with the treatment. We present a case of anaphylaxis that occurred following sublingual captopril for treatment of hypertension. We felt that it would be benefi cial to remind clinicians of sublingual captopril anaphlaxis although it is rarely seenÖğe Baseline characteristics and the association between hyponatraemia and pulmonary embolism prognosis(PAKISTAN MEDICAL ASSOC, 2013) Korkmaz, Ilhan; Guven, Fatma Mutlu Kukul; Eren, Sevki Hakan; Beydilli, Inan; Yildirim, Birdal; Aktas, Can; Alagozlu, HakanObjective: To evaluate the effect of hyponatraemia on pulmonary thromboembolism mortality rates. Methods: The retrospective study was conducted at the Cumhuriyet University Medicine Faculty's Emergency Department, and involved the analysis of records related to all patients who were diagnosed with acute pulmonary thromboembolism between January 2005 and June 2011. Diagnoses were confirmed by pulmonary angiography, multi-slice computed tomography or high-probablity ventilation/perfusion scintigraphy. All patients (n=260) were over 16 years of age. SPSS 14 was used for statistical analysis. Results: Plasma sodium level, platelet count and hospitalisation time were significiantly lower among those who died (n=16; 6.29) (p<0.005, p<0.035, p<0.035). Pearson correlation analysis found a negative correlation between plasma sodium level and C-reactive protein, white blood cells and pulmonary artery pressure (r=-0.238, p<0.001; r=-0.222, p<0.001; r=-0.444, p<0.018 respectively). A positive correlation was found between plasma sodium level and hospitalisation time (r=0.130; p<0.039). Conclusion: While mortality rates in hyponatraemic pulmonary thromboembolism patients increases, low plasma sodium is an easy parameter that should be kept in mind for the prognosis of pulmonary thromboembolism disease.Öğe C-type natriuretic peptide is associated with the severity of Crimean-Congo hemorrhagic fever(ELSEVIER SCI LTD, 2012) Turkdogan, Kenan Ahmet; Zorlu, Ali; Engin, Aynur; Guven, Fatma Mutlu Kukul; Polat, Muhammed Mirhan; Turgut, Okan Onur; Yilmaz, Mehmet BirhanBackground: Crimean-Congo hemorrhagic fever (CCHF) is characterized by vascular dysfunction, indicating the involvement of endothelial cells. C-type natriuretic peptide (CNP) plays a critical role in the coordination of vascular tone and is associated with the prognosis in critically ill patients such as those with sepsis and septic shock. We investigated whether CNP is related to the severity of CCHF. Methods: Forty-eight consecutive patients with a laboratory confirmed diagnosis of CCHF and 40 age-sex-matched healthy volunteers as the control group were prospectively enrolled into the study. CCHF patients were classified according to the disease severity into a non-severe group (n = 28) and a severe group (n = 20). Results: The CNP levels were detected to be 0.43 (0.4-0.7) ng/ml in the control group, 0.87 (0.7-1.0) ng/ml in the non-severe CCFH group, and 1.27 (0.8-1.7) ng/ml in the severe CCHF group. According to the receiver operating characteristics curve analysis, the optimal cut-off value of CNP to predict disease severity was >1.22 ng/ml, with 89.3% specificity and 55% sensitivity. CNP >1.22 ng/ml, lactate dehydrogenase >480 IU/l, and aspartate aminotransferase >202 IU/l were found to have prognostic significance in the univariate analysis. In the multivariate logistic regression analysis by forward stepwise method, CNP >1.22 ng/ml (odds ratio 8.336, p = 0.016) and lactate dehydrogenase > 480 IU/l (odds ratio 16.206, p = 0.002) remained associated with disease severity after adjustment for confounding variables. Conclusions: CNP measurement could help in the risk stratification of patients with CCHF. (C) 2012 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.Öğe Carbon Monoxide Intoxication Induced Atrial Fibrillation(Galenos Yayincilik, 2012) Korkmaz, Ilhan; Eren, Sevki Hakan; Guven, Fatma Mutlu Kukul; Turkdogan, Ahmet; Beydilli, Inan; Yildirim, BirdalCarbon monoxide (CO) is a colorless, odorless gas which is a leading cause of accidental deaths during winter months. Its toxic effect occurs by binding to hemoglobin or directly at cellular level. Electrocardiographic findings due to CO intoxication are STsegment changes, premature contractions, sinus tachycardia, bundle blocks and atrial fibrillation (AF). We report a 33-year-old man who presented with AF due to CO poisoning. The patient was treated with anti-ischemic drugs and oxygen therapy.Öğe The Clinical Significiance of Multimarker Index for Early Diagnosis Among the Patients Admitted to the Emergency Department with Suspected Stroke(AVES YAYINCILIK, 2011) Korkmaz, Ilhan; Eren, Sevki Hakan; Guven, Fatma Mutlu Kukul; Segmen, HaticeObjective: Cerebrovascular diseases have a high rate in emergency services. We investigated the value of MMX in plasma for early diagnosis among the patients with suspected cerebrovascular disease and the correlation between the emergency, triage and neurology physician diagnoses. Material and Methods: It is a prospective study carried out with 83 patients. Pre-prepared forms were filled with the data about the patients. Samples of 1cc venous blood were measured for MMX and the results classified as normal or pathologic. The correlation between the results and physician diagnosis was investigated. Results: 44 (53%) of 83 patients were male, 39 (47%) were female. The average age was 69.1 (37-90) years. Neurology physician diagnosis, accepted as the gold standard, was compared with the triage, emergency physician diagnosis and MMX results by ROC curve analysis, and the difference was not significiant (p>0.05). When the diagnoses of the emergency physician were compared with the MMX results, the compatiblity for definite and probable strokes were 100% and 92.1%. The rates for triage physician were 100% and 96.4%. Conclusion: As a result of this study we can say that the stroke probablity is high if MMX is high in patients with suspected cerebrovascular disease, but more studies with large population groups are needed for specifity assessment.Öğe Cost analysis of different venues for treating suicide cases presented to the Emergency Department(SCIENTIFIC PUBLISHERS INDIA, 2014) Guven, Fatma Mutlu Kukul; Turkdogan, Kenan Ahmet; Duman, Ali; Akpinar, Orhan; Kapci, Mucahit; Sonmez, Ertan; Coskun, Abuzer; Akpinar, Hatice; Sogut, Ozgur; Korkmaz, IlhanPatients presented with poisoning-related suicide attempts is one of the most problematic cases of the emergency services. The most important reason for this being the failure to decide the department of the hospital in which these patients should be admitted to, following consultation. The objective of this study is to emphasize the cost-lowering effect of treatment and follow-up of such suicide cases in Emergency Departments (ED) instead of intensive care units. A total of 791 adult patients with suicidal attempts were retrospectively examined and their clinical and demographic data were included. In addition, the costs of their treatment in the ED, Intensive Care Unit (ICU) and Psychiatric Clinic between 01/01/2007 and 31/12/2011were compared. When patients were classified by their month of birth it was found that patients who born in January had the maximum tendency to commit suicide (n:227, 28.7%), while those born in December were the least to do so (n: 30, 3.8%). Of all the patients, 122 (15.4%) were followed-up in Anesthesia Intensive Care (AIC), 639 (80.8%) in the Emergency Department Observation Unit and 30 (3.8%) in the Psychiatric Clinic. When costs of the patients who could receive the same medical treatment in case of necessity were compared; mean cost of the patients were found to be $ 665.44 for the patients treated in AIC, $ 204.09 for patients treated in EDs and $ 186.85 for those received treatments in the psychiatric clinic. We defined that it would be profitable if the intoxication cases were followed-up in the ED observation units and that ED's could be used more effectively than ICUs.Öğe Diagnostic criteria in Crimean Congo haemorrhagic fever disease and cost analysis(ACADEMIC JOURNALS, 2010) Eren, Sevki Hakan; Korkmaz, Iihan; Guven, Fatma Mutlu Kukul; Aktas, Can; Ay, DidemIn recent years, Crimean Congo haemorrhagic fever disease (CCHF) has created a serious health problem in our country. The disease takes place among haemorrhagic viral diseases. This study was made with CCHF diagnosed patients accepted in emergency services to determine the diagnostic criteria and cost effectivness for CCHF. CCHF patients who were accepted in our emergency service between 2004 and 2008 were analyzed retrospectively. Sensitivity, specificity, positive predictive and negative predictive value was calculated only for the patients who had 5 pathological laboratory parameters together (thromobcytopenia, high LDH, AST, ALT and CPK), and cost effectiveness analysis was made. During the five-year period, 687 patients had been evaluated. Significant pathologic results were established for alanine amino transferase (ALT), aspartate amino transferase (AST), creatine phosphokinase (CPK) enzymes, platelet counts and lactate dehydrogenase (LDH). Fatigue, fever, bleeding, gastro intestinal symptoms and diffuse pain were the symptoms seen according to their frequencies. The patients were frequently admitted in July. Mortality, costs per patient and emergency service's crowdedness can be reduced by rapid diagnosis which can easily be made with a brief history of the patient's occupation, physical examination and mentioned laboratory results sensitivity, specificity, positive predictive and negative predictive value.Öğe The epidemiological and prognostic importance of the aVR lead among patients with and without ST segment elevation(BAYCINAR MEDICAL PUBL-BAYCINAR TIBBI YAYINCILIK, 2011) Coskun, Abuzer; Eren, Sevki Hakan; Korkmaz, Ilhan; Guven, Fatma Mutlu KukulBackground: Patients with ST segment elevation in the aVR lead were divided into major and minor groups and compared with respect to blood lipid levels, admission glucose levels, angiography results and prognosis. Methods: The clinical data of the study was obtained by a retrospective review of the charts of 887 patients (550 males, 337 females) with aVR elevation, who were admitted to our emergency department between January 2004 and December 2008 with chest pain and hospitalized in the cardiology ward. The patients were divided into minor (group 1; 0.5-1 mm) and major (group 2; >1 mm) groups according to the ST segment elevation in aVR and compared with respect to age, gender, emergency room arrival time, blood glucose level, lipid profile, ejection fraction (EF), angiography results, Gensini score, and mortality rates. Results: Group 2 had a significant correlation with male gender, increased Gensini score, low EF, high blood glucose level, number of myocardial infarction patients with ST segment elevation, three-vessel disease and high mortality (p<0.05). Group 2 patients also had a worse prognosis. Conclusion: Early revascularization and/or medical treatment may be effective in the prognosis of patients with acute coronary syndrome diagnosis and a 1-mm or higher ST segment elevation in the aVR lead.Öğe Evaluation of the child trauma cases applied to our university hospital department of emergency(AVES, 2011) Dogan, Zeki; Guven, Fatma Mutlu Kukul; Cankorkmaz, Levent; Korkmaz, Ilhan; Coskun, Abuzer; Doles, Kenan AhmetAim: Trauma is the major mortality cause in pediatric patients living in developed countries. The aim of this study was to evaluate the child trauma cases who were admitted to our emergency unit. Material and Method: Study data was obtained as a result of a retrospective review of the files of child trauma cases admitted to our emergency department between January 2006-December 2007. The child trauma cases were evaluated in terms of age, sex, application time, type of trauma, injury type, radiological findings and hospitalization rates. Results: Within age range 0-16 years, accessed records of 1293 trauma cases that admitted to the emergency deparment were 69% male, 31% female. Most of the applications were in August. Among the causes of injury, at the primary ordinal were falling down/crash into the flat. Out of vehicle traffic accidents were the fastest group who admitted to the emergency department. Within overall trauma types, rate of trauma exposure with 43.8% was the highest in 2-6 ages. In the exposed areas of injury, head zone with 42% took part in the first ordinal. Conclusions: In this study; we wanted to draw attention to the problem of trauma highlighting some features of pediatric injuries in our country. (Turk Arch Ped 2011; 46: 164-7)Öğe Hypothermia Evaluation, Diagnosis and Treatment(Aves, 2009) Eren, Sevki Hakan; Korkmaz, Ilhan; Dogan, Kasim; Guven, Fatma Mutlu KukulBody temperature below 35 degrees C is defined as hypothermia. It is classified as mild, moderate and severe. While the standard thermometers can not measure the core temperature below 35 degrees C, thermometers with intravezical, rectal or esophageal probes must be used to determine the core temperature in hypothermic patients. Although hypothermia is seen in cold climates; it can be seen because of environmental conditions, like drowning, too. Also inadequate clothing and hypothermia background can facilitate hypothermia in patients. The common causes for hypothermia are dermatological disease, drug adverse effects, iatrogenic causes, neurological disease, neuromuscular insufficiency, sepsis and metabolic condition of the patient. Resistance to cold in the peoples is not well developed while they are warm-blooded. Especially homeless, psychiatric and lonely elderly people can be affected by hypothermia easily. Although the main heat loss of the body is by radiation; conduction, convection and evaporation take place too. Coordination and consciousness deficiencies are the main symptoms. Nevertheless clinical signs vary according to the hypothermia state. The basic treatment principles resemble each other in mild, moderate and severe hypothermia. These are; reducing of the heat loss, warming of the body with internal and external ways, supplying the main energy and fluid demands for patient metabolism. The defibrillation techniques, resuscitation time and the drugs which are used are different in hypothermic cardiopulmonary resuscitation than normal cardiopulmonary resuscitation. The main systems which are damaged from hypothermia are cardiovascular and central nervous system. That's why early and true diagnosis and aggressive treatment has a great importance for surviving.Öğe METHANOL POISONING IN THREE CASES: DIAGNOSIS AND TREATMENT IN EMERGENCY DEPARTMENT(Istanbul Univ, Faculty Medicine, Publishing Office, 2012) Guven, Fatma Mutlu Kukul; Turkdogan, Kenan Ahmet; Eren, Sevki Hakan; Aydin, Huseyin; Korkmaz, Ilhan; Coskun, AbuzerMethanol is a very poisonous substance that is used as an industrial solvent and automotive antifreeze. Toxic dose is between 20-250 ml and causes neurological symptoms such as headache, cerebral edema and putamen necrosis within the first 12 to 14 hours. Central nervous system and visual cortex are the main areas which are damaged by methanol poisoning. Methyl alcohol is not toxic until its toxic metabolites turn into formic acid. Formic acid is especially responsible for the clinical findings. Serum half-life of methanol is 14 to 20 hours in mild and 24 to 30 hours in severe toxicity. Gastric lavage, fomepizole, ethanol and hemodialysis are used in the treatment. In this study, we aimed to review and discuss information from literature about the treatment and monitoring of methanol poisoning in three cases followed at emergency department.Öğe QUAIL CONSUMPTION CAN BE HARMFUL(ELSEVIER SCIENCE INC, 2011) Korkmaz, Ilhan; Guven, Fatma Mutlu Kukul; Eren, Sevki Hakan; Dogan, ZekiBackground: Intoxication due to quail consumption is rarely seen. Such a toxicological syndrome (also called coturnism) occurs during the migration of quails from north to south, when they consume hemlock seeds. The clinical symptoms and laboratory results are indicative of acute rhabdomyolysis. Objectives: Acute rhabdomyolysis has a wide range of etiologies. Coturnism is a rare cause of acute rhabdomyolysis that can be lethal due to renal failure and shock. To avoid severe complications, coturnism may be considered if the history is appropriate. Case Report: We report four cases of coturnism from quail consumption; the patients were admitted with some combination of symptoms including muscle tenderness, extremity pain, nausea, and vomiting. They were treated with vigorous isotonic crystalloid hydration and urine alkalinization. Consequently, the laboratory results returned to normal ranges and the clinical symptoms disappeared. Conclusion: Although coturnism is a rarely seen toxicological syndrome that causes rhabdomyolysis, we present this case to increase awareness that it may present with symptoms of muscle tenderness, extremity pain, nausea, and vomiting after quail consumption. (C) 2011 Elsevier Inc.Öğe The role of heparan sulphate in pathogenesis of Crimean-Congo hemorrhagic fever disease(MALARIA RESEARCH CENTRE, INDIAN COUNCIL MEDICAL RESEARCH-ICMR, 2013) Guven, Fatma Mutlu Kukul; Aydin, Huseyin; Kaya, Ali; Engin, Aynur; Celik, V. Kenan; Korkmaz, Ilhan; Atli, Bahri; Icagasioglu, DilaraBackground & objectives: Crimean-Congo hemorrhagic fever (CCHF) is a viral infection typically transmitted by tick bite. This study is to define the level of heparan sulphate (HS) in serum/urine since HS may play a role in the pathogenesis of hemorrhagic events in the patients with CCHF. Methods: In this study, the patient group consisted of 79 cases with a positive diagnosis of CCHF according to PCR/ELISA outcome among the patients referred to Cumhuriyet University, School of Medicine in 2010. A total of 81 volunteers who had not any viral or metabolic disease were enrolled as the control group. The blood samples were centrifuged, and the serum and urine samples obtained were stored at -80 degrees C until they were studied. Then, these samples were simultaneously dissolved, and HS level was spectrophotometrically measured using glycosaminoglycans specific 1-9, dimethyl-methylene blue (DMMB) stain. Results: A statistically significant increase in the HSserum values was found both in the individuals under and above 16 yr old in the patient groups compared to the controls (p <0.05). Also there was a statistically significant increase in the urine levels of HS in the cases >16 yr old compared to the controls (p <0.05). Interpretations & conclusion: Increase of the serum/urine levels of HS was though to be due to vascular endothelium damage and to liver injury as well as vascular endothelium damage in the patients who died. Further, comprehensive studies are needed to demonstrate whether the serum/urine levels of HS are correlated to liver and vascular endothelium damage and prognosis of the disease.Öğe Serum Paraoxonase, Arylesterase, and Glutathione-S-Transferase Activities and Oxidative Stress Levels in Patients with Mushroom Poisoning(HOSPITAL CLINICAS, UNIV SAO PAULO, 2018) Eren, Sevki Hakan; Korkmaz, Ilhan; Guven, Fatma Mutlu Kukul; Tekin, Yusuf Kenan; Ozdemir, LeventOBJECTIVES: Consumption of toxic species of mushrooms may have detrimental effects and increase oxidative stress. Paraoxonase, arylesterase and glutathione-S-transferase are antioxidants that resist oxidative stress. In this study, we analyzed the changes in these enzymes during intoxication due to mushrooms. METHODS: The study enrolled 49 adult patients with a diagnosis of mushroom poisoning according to clinical findings and 49 healthy volunteers as the control group. The patients with mild clinical findings were hospitalized due to the possibility that the patient had also eaten the mushrooms and due to clinical findings in the late period, which could be fatal. Paraoxonase, arylesterase, and glutathione-S-transferase concentrations, as well as total antioxidant and oxidant status, were determined in the 49 patients and 49 healthy volunteers by taking blood samples in the emergency department. RESULTS: While paraoxonase, arylesterase, and total antioxidant status were significantly decreased in the patient group (p<0.05), glutathione-S-transferase, total oxidant status and the oxidative stress index were significantly higher (p < 0.05). There was a positive correlation between the hospitalization time and the oxidative stress index (r=0.752, p < 0.001), whereas a negative correlation was found with glutathione-S-transferase (r=-0.420, p=0.003). CONCLUSION: We observed a significant decrease in paraoxonase and arylesterase and an increase in glutathione-S-transferase and oxidative stress indexes in patients with mushroom poisoning, indicating that these patients had an oxidative status. In particular, a low total antioxidant status and high oxidative stress index may gain importance in terms of the assessment of hospitalization duration.Öğe Usefulness of admission matrix metalloproteinase 9 as a predictor of early mortality after cardiopulmonary resuscitation in cardiac arrest patients(W B SAUNDERS CO-ELSEVIER INC, 2012) Turkdogan, Kenan Ahmet; Zorlu, Ali; Guven, Fatma Mutlu Kukul; Ekinozu, Ismail; Eryigit, Umut; Yilmaz, Mehmet BirhanBackground: Matrix metalloproteinases (MMPs) have a central role in disease progression after ischemia-reperfusion injury. However, its prognostic significance in cardiac arrest (CA) patients having cardiopulmonary resuscitation (CPR) is unknown. The aim of this study was to investigate the relation between admission MMP-9 level and early mortality in CA patients. Methods: A total of 96 in-hospital or out-of-hospital CA patients and 40 age-and sex-matched healthy volunteers as the control group were evaluated prospectively. The patients were classified according to the CPR response into a successful group (n = 46) and a failed group (n = 50). Results: The MMP-9 levels were detected to be 56.9 +/- 4.3, 69.5 +/- 7.4, and 92.7 +/- 10.1 ng/mL in the control group, the successful CPR group (acute responders), and the failed CPR group, respectively (P < .001 for the 2 comparisons). The MMP-9 level on admission, presence of asystole, mean CA duration, out-of-hospital CPR, sodium and potassium levels, and arterial pH were found to have prognostic significance in univariate analysis. In addition, MMP-9 levels were correlated with age, troponin level, and oxygen saturation. In multivariate logistic regression analysis with forward stepwise method, only MMP-9 level on admission (odds ratio, 1.504; P < .001) and mean CA duration before CPR (odds ratio, 1.257; P = .019) remained associated with post-CPR early mortality after adjustment of other potential confounders. In addition, optimal cutoff value of MMP-9 to predict failed CPR was found as greater than 82 ng/mL, with 88% sensitivity and 97.8% specificity. Conclusions: High MMP-9 levels were associated with worse clinical and laboratory parameters, and it seems that MMP-9 helps risk stratification in CA patients. (C) 2012 Elsevier Inc. All rights reserved.Öğe Usefulness of Admission Red Cell Distribution Width as a Predictor of Early Mortality in Patients With Acute Pulmonary Embolism(EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC, 2012) Zorlu, Ali; Bektasoglu, Gokhan; Guven, Fatma Mutlu Kukul; Dogan, Omer Tamer; Gucuk, Esra; Ege, Meltem Refiker; Altay, Hakan; Cinar, Ziynet; Tandogan, Izzet; Yilmaz, Mehmet BirhanRed cell distribution width (RDW) is strongly associated with prognosis in cardiopulmonary disorders such as coronary artery disease, acute myocardial infarction, acute and chronic heart failure, and pulmonary hypertension. However, its prognostic significance in acute pulmonary embolism (PE) is unknown. The aim of this study was to investigate the relation between admission RDW and early mortality in patients with acute PE. One hundred sixty-five patients with confirmed acute PE were included. Patients with previous treatment for anemia, malignancy, or chronic liver disease, those with dialysis treatment for chronic renal failure, and those who received erythrocyte suspension for any reason were excluded. A total of 136 consecutive patients with acute PE were evaluated prospectively. According to receiver-operating characteristic curve analysis, the optimal cut-off value of RDW to predict early mortality was >14.6%, with 95.2% sensitivity and 53% specificity. Patients were categorized prospectively as having unchanged (group 1) or increased (group 2) RDW on the basis of a cut-off value of 14.6%. The mean age of patients was 63 +/- 15 years. The mean follow-up duration was 11 +/- 7 days, and 21 patients died. Among these 21 patients, 1 (1.6%) was in group 1 and 20 (27%) were in group 2 (p <0.001). Increased RDW >14.6% on admission, age, presence of shock, heart rate, oxygen saturation, and creatinine level were found to have prognostic significance in univariate Cox proportional-hazards analysis. Only increased RDW >14.6% on admission (hazard ratio 15.465, p.= 0.012) and the presence of shock (hazard ratio 9.354, p <0.001) remained associated with increased risk for acute PE-related early mortality in a multivariate Cox proportional-hazards model. In conclusion, high RDW was associated with worse hemodynamic parameters, and RDW seems to aid in the risk stratification of patients with acute PE. (C) 2012 Elsevier Inc. All rights reserved. (Am J Cardiol 2012;109:128-134)
