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Öğe Assessment of sphenoid sinus related anatomic variations with computed tomography(AFRICAN FIELD EPIDEMIOLOGY NETWORK-AFENET, 2017) Turkdogan, Figen Tunali; Turkdogan, Kenan Ahmet; Dogan, Murat; Atalar, Mehmet HaydarIntroduction: Frequent and broad application of endoscopic sinus surgery (ESS) in parallel with experience makes it imperative to know the anatomy and the existing pathology very well before surgery. This study examines the association between anomalies in the sphenoid sinus area in paranasal sinuses computed tomography (PNS-CT) and pathological findings and determines variations of sphenoid sinus. Methods: A total of 200 cases (100 women, 100 men) who had PNS-CT in the emergency and radiology polyclinics within the period of one year were included in this study. Bone tissue anomalies and soft tissue pathologies were assessed in the CT. Results: Pterygoid process was found in 36.75% of our cases, anterior clinoid pneumatization was found in 21.25%; vidian canal in 34.25%, foramen rotundum in 17.5% and ICA in 12.75% had protrusion into the sphenoid sinus; 8.25% were found to have onodi cell, 11.25% were found to have multiple septation, 16.75% were found to have mucosal thickening and 2.5% were found to have retention cyst. Conclusion: The importance of PNS-CT in terms of determining anatomic variations before ESC and predicting possible complications during surgery has been emphasized once more. In our study, as sphenoid sinus pneumatization increased, the projection of neighbouring vein and nerve structures into the sinus was found to increase as well.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 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 Detection of neutrophil-lymphocyte ratio as a serum marker associated with inflammations by acute carbon monoxide poisoning(ELSEVIER SCIENCE BV, 2015) Karabacak, Mustafa; Turkdogan, Kenan Ahmet; Coskun, Abuzer; Akpinar, Orhan; Duman, Ali; Kapci, Mucahit; Eren, Sevki Hakan; Karabacak, PinarObjective: To investigate neutrophil-lymphocyte ratio (NLR), which is an indicator of systemic inflammation, in patients with carbon monoxide (CO) poisoning. Methods: We included 528 patients (275 women) who presented with a diagnosis of CO poisoning between June 2009 and March 2014. Control group was composed of 54 patients (24 women). Platelet count and mean platelet volume level were significantly higher in the CO poisoning group. Results: White blood cell level (9.8 +/- 3.3 vs. 8.6 +/- 2.9 x 10(3)/mL, respectively; P = 0.01), neutrophil count (6.00 +/- 2.29 vs. 4.43 +/- 2.04 x 10(3)/mL, respectively; P < 0.01) and NLR (3.01 +/- 2.34 vs. 2.23 +/- 1.27, respectively; P = 0.02) were significantly higher in CO poisoning group. Conclusions: The increase of NLR may indicate the progression of fatal complications due to CO poisoning.Öğe Impact of C/EBP homologous protein in the diagnosis of acute pancreatitis.(SCIENTIFIC PUBLISHERS INDIA, 2015) Yigit, Mehmet; Turkdogan, Kenan Ahmet; Uysal, Emin; Sogut, Ozgur; Eren, Sevki Hakan; Yigit, Eda; Celik, Veysel KenanSerum levels of amylase and lipase are the most widely used biochemical indicators of pancreatic inflammation. They are the basic markers used when making a diagnosis of pancreatitis. However, they are not necessarily the gold standard since the specificity and sensitivity of high amylase and lipase levels are low. The purpose of this study was to show the predictive value of C/EBP homologous protein in diagnosing acute pancreatitis. Thirty-two cases of acute pancreatitis that were admitted to the Department of Emergency Medicine of the Bezmialem Vakif University between November 2013 and July 2014 were analyzed. The diagnosis of acute pancreatitis was made based on characteristic signs and symptoms, increased serum enzyme levels, and abnormal findings on diagnostic imaging. When compared with the control group, the serum C/EBP homologous protein levels were found to be significantly increased with routine diagnostic methods in cases of acute pancreatitis. During the process of pancreatic inflammation, the level of C/EBP homologous protein increased independently in the etiopathogenesis of acute pancreatitis.Öğe Increased gamma-glutamyl transferase levels predict early mortality in patients with acute pulmonary embolism(W B SAUNDERS CO-ELSEVIER INC, 2012) Zorlu, Ali; Yucel, Hasan; Bektasoglu, Gokhan; Turkdogan, Kenan Ahmet; Eryigit, Umut; Sarikaya, Savas; Ege, Meltem Refiker; Tandogan, Izzet; Yilmaz, Mehmet BirhanBackground: Increased gamma-glutamyl transferase (GGT) level is associated with increased oxidative stress, all-cause mortality, the development of cardiovascular disease, and metabolic syndrome. However, its role in acute pulmonary embolism (PE) is unknown. In this study, we aimed to investigate the relationship between GGT and early mortality in patients with acute PE. Methods: A total of 127 consecutive patients with confirmed PE were evaluated. The optimal cutoff value of GGT to predict early mortality was measured as more than 55 IU/L with 94.4% sensitivity and 66.1% specificity. Patients with acute PE were categorized prospectively as having no increased (group I) or increased (group II) GGT based on a cutoff value. Results: Of these 127 patients, 18 patients (14.2%) died during follow-up. Among these 18 patients, 1 (1.4%) patient was in group I, and 17 (30.9%) patients were in group II (P < .001). gamma-Glutamyl transferase level on admission, presence of shock, heart rate, oxygen saturation, right ventricular dilatation/hypokinesia, main pulmonary artery involvement, troponin I, alanine aminotransferase, alkaline phosphatase, and creatinine levels were found to have prognostic significance in univariate analysis. In the multivariate Cox proportional hazards model, GGT level on admission (hazard ratio [HR], 1.015; P = .017), presence of shock (HR, 15.124; P = .005), age (HR, 1.107; P = .010), and heart rate (HR, 1.101; P = .032) remained associated with an increased risk of acute PE-related early mortality after the adjustment of other potential confounders. Conclusions: We have shown that a high GGT level is associated with worse hemodynamic parameters, and it seems that GGT helps risk stratification in patients with acute PE. (C) 2012 Elsevier Inc. All rights reserved.Öğe Infection Diseases in Geriatric Patients Who Admitted to Emergency Department(DERMAN MEDICAL PUBL, 2015) Akpinar, Orhan; Turkdogan, Kenan Ahmet; Sen, Munevver; Duman, Ali; Karabacak, MustafaAim: In this study, it was aimed to investigate infectious disease frequency, most admission compliant, consultation type, the outpatient and hospitalization rates in geriatric patients who admitted to emergency department. Material and Method: Identification study was applied with computer based patient registration scan in 65 years or older patients who admitted to emergency department between 01.01.2011-31.12.2011. Results: Data of 115185 patients were evaluated for one year period. Geriatric patients were consist with amount of 1467 (12.7%) of total admission. Diagnosed patients number was 310 (21.2%) in this age group according to the ICD -10 coding on infectious diseases. One hundred and sixty eight (5.4%) of 310 patients were hospitalized. Eighty nine of these patients were hospitalized at infectious disease and clinical microbiology clinic, seventy nine patients were hospitalized at other clinics. Discussion: It is known that elders are at higher risk for infections and diseases are more common due to the cellular immune deficiency. Therefore, immediate treatment should be applied with rapid diagnose in elderly infections.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 Ratio of neutrophil to lymphocyte Counts in Crimean Congo Hemorrhagic Fever(DERMAN MEDICAL PUBL, 2016) Turkdogan, Kenan Ahmet; Eren, Sevki Hakan; Coskun, Abuzer; Engin, Aynur; Sonmez, Ertan; Civelek, CemilThe implementation of new markers of bacterial and viral infection into clinical practice is hindered by their costs. In this study we assessed the potential use of the neutrophil to lymphocyte count ratio (NLCR) in crimean conga hemorraghic fever (CCHF). NLCR values were measured in total 104 patients with CCHF with 77 patients in whom bleeding was observed and 27 patients without bleeding observed and in 61 healthy adults. NLCR values of patients were measured in the first and 3rd days in which the patients admitted to the hospital. Median NLCR value was found as 4.02 in the patient group on the 1st day and 2.02 on the 3rd day, while this value was 4.10 in the healthy adults. NLCR values of the 3rd day were found as 1.16 (0.05-3.401 in the patients with bleeding and 2.32 (0.35-19.45) in the patients without bleeding (p<0.01). NLCR value seems to be a marker guiding in determination of the clinical course and treatment from the 3rd day of the contact with ticks.Öğe RED CELL DISTRIBUTION WIDTH IN CARBON MONOXIDE POISONING: RELATIONSHIP WITH MARKERS OF INEFFECTIVE ERYTHROPOIESIS, INFLAMMATION(CARBONE EDITORE, 2014) Turkdogan, Kenan Ahmet; Eren, Sevki Hakan; Sogut, Ozgur; Karabacak, Mustafa; Yigit, Mehmet; Gulen, Bedia; Coskun, Abuzer; Karabacak, PinarAims: Carbon monoxide (CO) poisoning is very common. Although it causes death in some cases, the pathophysiologic mechanisms that generate these fatal complications are still not fully understood. No study has directly focused on the indicators of severe complications resulting from CO poisoning; therefore, we investigated red cell distribution width (RDW), which is an indicator of systemic inflammation in patients with CO poisoning. Methods: A total of 429 patients (207 males and 222 females) who experienced CO poisoning between July 2009 and February 2013 were examined. Results: The control group comprised 23 males and 16 females (a total of 39 patients). The RDW level was significantly higher in the CO poisoning group; this increase may indicate the progression of anisocytosis due to CO poisoning. The white blood cell (WBC) level (9.9 +/- 3.4 vs 8.5 +/- 2.9 x 103/mL, respectively; p = 0.01), hemoglobin (13.7 +/- 1.7 vs 12.9 +/- 1.1 g/dl, respectively; p < 0.01) and MCHC (34.2 +/- 1.1 vs 35.1 +/- 1.6, respectively; p < 0.01) were critically higher in the group with CO poisoning. Conclusions: Our data suggest that the hypoxia in patients subjected to CO exposure resulted in significantly elevated red cell distribution width levels. The increasead red cell distribution width levels on admission may indicate the onset of complications due to CO exposure in patients without anemia.Öğe Red cell distribution width in carbon monoxide poisoning: Relationship with markers of ineffective erythropoiesis, inflammation(Acta Medica Mediterranea, 2014) Turkdogan, Kenan Ahmet; Eren, Sevki Hakan; Sogut, Ozgur; Karabacak, Mustafa; Yigit, Mehmet; Gülen, Bedia; Coskun, AbuzerAims: Carbon monoxide (CO) poisoning is very common. Although it causes death in some cases, the pathophysiologic mechanisms that generate these fatal complications are still not fully understood. No study has directly focused on the indicators of severe complications resulting from CO poisoning; therefore, we investigated red cell distribution width (RDW), which is an indicator of systemic inflammation in patients with CO poisoning. Methods: A total of 429 patients (207 males and 222 females) who experienced CO poisoning between July 2009 and February 2013 were examined. Results: The control group comprised 23 males and 16 females (a total of 39 patients). The RDW level was significantly higher in the CO poisoning group; this increase may indicate the progression of anisocytosis due to CO poisoning. The white blood cell (WBC) level (9.9 ± 3.4 vs 8.5 ± 2.9 ? 103/mL, respectively; p = 0.01), hemoglobin (13.7 ± 1.7 vs 12.9 ± 1.1 g/dl, respectively; p < 0.01) and MCHC (34.2 ± 1.1 vs 35.1 ± 1.6, respectively; p < 0.01) were critically higher in the group with CO poisoning. Conclusions: Our data suggest that the hypoxia in patients subjected to CO exposure resulted in significantly elevated red cell distribution width levels. The increasead red cell distribution width levels on admission may indicate the onset of complications due to CO exposure in patients without anemia.Öğe The relationship between D-dimer level and the development of atrial fibrillation in patients with systolic heart failure(SPRINGER, 2012) Zorlu, Ali; Akkaya, Emre; Altay, Hakan; Bektasoglu, Gokhan; Turkdogan, Kenan Ahmet; Sincer, Isa; Vuruskan, Ertan; Cinar, Ziynet; Tandogan, Izzet; Yilmaz, Mehmet BirhanHeart failure (HF) is one of the most common and leading cause of death worldwide. Clinical trials provide evidence that the development of atrial fibrillation (AF) is a marker of poor prognosis in patients with HF. Furthermore, elevated D-dimer level is associated with increased cardiovascular mortality independent of AF in HF patients. We investigated whether plasma D-dimer levels in patients with hospitalized systolic HF could predict development of AF. A total of 150 consecutive patients with sinus rhythm who admitted to the emergency department with hospitalized systolic HF were evaluated. All hospitalized patients were obtained D-dimer levels within the first 24 h following admission. Atrial fibrillation developed in 31 (20.7%) patients during follow-up period of 6.3 +/- A 5 months. Patients who developed atrial fibrillation had significantly increased levels of D-dimer [608 (339-1,022) ng/ml versus 1,100 (608-2,599) ng/ml, P = 0.001]. Optimal cut-off level of D-dimer to predict development of AF was found to be > 792 ng/ml. D-dimer > 792 ng/ml, right ventricular dilatation, age, systolic pulmonary pressure, left atrium size, moderate to severe tricuspid regurgitation, and beta blocker usage were found to have prognostic significance in univariate analysis. In multivariate Cox proportional-hazards model, D-dimer levels > 792 ng/ml (HR = 3.019, P = 0.006), and right ventricular dilatation (HR = 8.676, P = 0.003) were associated with an increased risk of new-onset AF. In conclusion, D-dimer could predict development of AF in patients with hospitalized systolic HF.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 The VKORC1 gene homozygous polymorphism is markedly higher in Crimean Congo Hemorrhagic Fever patients.(SCIENTIFIC PUBLISHERS INDIA, 2013) Turkdogan, Kenan Ahmet; Karabacak, Mustafa; Akpinar, Orhan; Karahan, Oguz; Guven, Fatma Mutlu Kukul; Engin, Aynur; Turkdogan, Figen TunaliIn Crimean-Congo Hemorrhagic Fever (CCHF), the main target of the virus is endothelial cells, monocytes and hepatocytes. The virus in these cells leads to the development of capillary vessels dysfunction, which induces clinical and pathological changes during the disease. Increase in capillary permeability and coagulation dysfunction constitute a tendency to bleed. In the current study, we aimed to investigate the relationship between VKORC1 and bleeding tendency in CCHF. Forty-eight consecutive patients with a laboratory-confirmed diagnosis of CCHF were treated with blood products, and 37 healthy volunteers as the control group were prospectively enrolled into the study. The DNA was obtained from each sample using PCR amplification method, and VKORC1 1639 G>A gene polymorphisms were scanned in the DNA samples. In CCHF group of patients with bleeding VKORC1 gene were analyzed. Normal genotype was detected in 5 (22.7%) patients, homozygote mutation was detected in 2 (9.1%) patients and heterozygote mutation was detected in 15 (68.2%) patients, respectively. Furthermore, the G allele frequency was statistically higher in study group (51 [53%] vs. 27 [36%]) (p<0.005). It seems to be that VKORC1 gene A allele frequencies saliently higher in CCHF. This might be associated with increased bleeding risk in CCHF. Analyzing of VKORC1 gene polymorphisms could help in the risk stratification of patients with CCHF.
