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Öğe Acil servis çalışanların da el florasının nöbet süresince değişimi(Cumhuriyet Üniversitesi, 2017) Yurtbay, Sefa; Tekin, Yusuf KenanÇalışmamız Cumhuriyet Üniversitesi Tıp Fakültesi Hastanesi Acil servisimizde görev yapan hastane personelinden nöbet öncesi ve sonrası el kültürleri alınarak; nöbet süresince el florasın da değişiklik olup olmayacağı, ellerimizde patojen mikroorganizma olup olmadığı ortaya konulması amaçlanmıştır. Dünya Sağlık Örgütü' nün el hijyeni kılavuzuna göre hastane kaynaklı enfeksiyonlar; yılda milyonlarca hastayı etkilemektedir. Hastane enfeksiyonu uzun süre hastanede kalmaya maliyetin artmasına, hastalarda direnç gelişimine ve en önemlisi hastanın ölümüne sebebiyet vermektedir. Klinik personelin el hijyenine uyumu sayısız çalışmada hastane kaynaklı enfeksiyonların yayılımında önemli bir etken olduğunu ortaya koymuştur. Hastane kaynaklı dirençli mikroorganizmalarla oluşan enfeksiyonların %30-40'ı hastane personelinin elleriyle bulaşmaktadır. Bunun için mikropların yayılmasını önlemek, sağlık hizmetiyle ilişkili enfeksiyonu en aza çekmek için en iyi ve en etkili yöntem olan el yıkama; enfeksiyonların engellenmesine katkı sağlamıştır. Araştırmam da acil servis çalışanlarının el hijyeni endikasyonlarını bilmelerine rağmen, uyumları literatürdeki birçok çalışmayla uyumlu olarak düşük oranda bulundu. Eldiven ve el dezenfektanı kullanım alışkanlığının az olduğu görüldü. Çalışmamız Cumhuriyet Üniversitesi acil tıp kliniğinde görevli olan doktor, hemşire, acil tıp teknisyeni, taşıma ve temizlik personeli gibi toplamda 40 çalışanın el florasının nöbet süresince değişimini ve acil servisin genel kullanım alanları ile beraber özel müdahale alanlarından (RES, kırmızı alan) hava örneklemelerin de hangi mikroorganizmalarının olduğunu değerlendirmeyi planladık. Elde edilen sonuçlar ışığında yeşil ve sarı alanlarda daha çok üreme olduğu bu nedenle immünsüpresif hastaların bu alanlarda bakımlarının yapılmamasına özen gösterilmesi gerektiği düşünüldü. Ayrıca sağlık çalışanlarının ellerinde geçici flora olarak bulunan mikroorganizmaların çoğunun kalıcı flora haline geldiği ve bunların çok çeşitlilik gösterdikleri fakat hastane enfeksiyonuna neden olan dirençli mikroorganizmalara pek rastlanmadığı görüldü. El yıkama davranışı ile ilgili eksiklerin giderilmesi açısından personelin eğitimi, uyumun kontrolü ve geri bildirimin yapılmasının etkili olacağı ortaya çıktı.Öğe Change of hand flora during the shift in emergency servise staff(2018) Yurtbay, Sefa; Tekin, Yusuf Kenan; Korkmaz, İlhan; Güven, Mutlu Kukul Fatma; Demirtaş, ErdalObjective: We aimed to reveal the change in microorganisms in the hand flora during the working period from hospitalpersonnels in the emergency department of Cumhuriyet University by taking hand cultures before and after the workingperiod.Method: Our study was planned to evaluate the change of the hand flora and pre-shift and post-shift hand cultures from10 physicians, 13 nurses, 10 transport personnel in the emergency department of Cumhuriyet University. Also the microorganisms of air samples from special intervention areas (resuscitation, red area) as well as general use areas wereanalyzed.Results: We compared the washing status between pre (4,%11.1) and post-contact16 (44.4%) hand washing rate. Thevolunteers generally had washed their hands after the contact with the patient and the difference was statistically wassignificantly higher (p <0.05). there wasn’t any difference between the microorganisms samples that were reproduced onthe pre-shift right and left hand samples and post-shift right and left hand. According to the total count of samples takenfrom the left and right hand before shift in terms of the microorganism seen the difference was significiant (t=7,48;p=0,001).Conclusions: Although our participants knew the hand hygiene indications of emergency service workers, their harmonywas found to be low, consistent with many studies in the literature. It has been observed that the habit of using gloves andhand disinfectant was low also. Efficient strategies may be developed; improving institutional healthcare conditions,conducting educations at certain intervals, observing the practitioner and collecting feedback. However, it should be notedthat the most significant issue is that the significance in hand washing is ensured with changes in habits.Öğe Comparison of alvarado and ripasa scores in patients with acute appendicitis(Sivas Cumhuriyet University, 2020) Gökçe, Mine Esmer; Korkmaz, İlhan; Tekin, Yusuf; Yurtbay, Sefa; Demirtaş, Erdal; Özsoy, Orhan; Özbay, SedatObjective: Acute appendicitis management delays results in perforation and increases the morbidity and mortality. Studies have reported a 20% perforation rate, and 2-30% negative laparotomy whose diagnoses are made by symptoms and physical examination. By using anamnesis, clinical signs-symptoms and inflammatory parameters to reduce the diagnosis time, complications, and morbidity-mortality of AA, various scoring methods have been developed. The first scoring system defined for this purpose is Alvarado scoring system. The RIPASA scoring system was developed for patients in Asia. In this study, we aimed to determine which scoring is more suitable for our population by comparing Alvarado and RIPASA scoring methods in patients who underwent an appendectomy.Method: The Alvarado and RIPASA scores of each patient were calculated by the scoring system parameters after the 182 patient files were analyzed retrospectively. At cut-off value of 7.5 for RIPASA score and 7 for Alvarado score, patients were divided into high and low-risk groups. The positive predictive value, negative predictive value, sensitivity, and specificity were calculated and the two scoring systems' effectivity were compared with Chi-square and area under curve analysis.Results: According to the histological examination 42(23%) patients were not considered as acute appendicitis. RİPASA scoring systems high-risk group classification was better by predicting the acute appendicitis patients (p = 0.001, p <0.05). The area under the curve for RIPASA score calculated as 0.738 and this is statistically significant (p = 0.001; p <0.05). The result was better then the Alvarado AUC score (0,633). Alvarado scoring systems' negative predictive value was higher than the RİPASA score, respectively (58,14%, 32.56%).Conclusions: It is beneficial to use the RIPASA scoring system for patients in our region to reduce the rate of negative laparotomy and unnecessary surgical procedures in patients admitted to emergency services with the suspicion of acute appendicitis.Öğe Covid-19 Pandemisinin Acil Servis Yüküne Etkisi(2022) Çelik, Şimşek; Yurtbay, Sefa; Tekin, Yusuf Kenan; Korkmaz, Ilhan; Çelık, PelinGiriş: Pandemi döneminde acil servislere başvuran hasta sayısı ve profilinde değişiklikler olduğu görülmektedir. Bu araştırma, pandemi öncesi ve pandemi dönemindeki acil servise başvuran hasta yükünü incelemek, hastaların demografik özelliklerini ve başvuru şikayetlerini belirlemek amacıyla yapılmıştır. Gereç ve Yöntem: Acil Servise 1 Nisan 2019- 30 Nisan 2019 tarihleri arasında ve 1 Nisan- 30 Nisan 2020 tarihleri arasındaki hasta başvuruları geriye dönük olarak incelenmiştir. Hastaların demografik özellikleri ve acil servise başvuru şikayetleri değerlendirilmiştir. Bulgular: Acil servise başvuran hasta sayısı pandemi öncesi dönemde 36617 iken, pandemi döneminde ise 10907 olmuştur. Pandemi dönemi ve pandemi öncesi dönem karşılaştırıldığında; yeşil alanda takip edilen hasta, travma hastası, toplam yatan hasta, kardiyoloji servisine yatan hasta, nöroloji servisine yatan hasta, göğüs hastalıkları servisine yatan hasta ve ambulans ile acil servise başvuran hasta sayılarında pandemi döneminde önemli düzeyde azalma olduğu belirlenmiştir. Sonuç: Pandemi döneminde, pandemi öncesi döneme göre acil servisdeki toplam hasta sayısı ve alan hasta sayıları (yeşil, sarı) anlamlı oranda düşüş göstermiştir. Bu durum mortalite ve morbiditenin artmasına neden olabilir. Bu nedenle halkın hastaneye yatış gerektiren acil hastalıklar hakkında detaylı bir şekilde bilgilendirilmesi çok önemlidir.Öğe Eosinophil Cell Count Predicts Mortality in the Intensive Care Unit after Return of Spontaneous Circulation(Rambam Health Care Campus, 2022) Korkmaz, Ilhan; Tekin, Yusuf Kenan; Tekin, Gulacan; Demirtas, Erdal; Yurtbay, Sefa; Nur, NaimBackground: Eosinophils constitute 1%-5% of peripheral blood leukocytes, less in the presence of acute infections (referred to as eosinopenia). Studies indicate that eosinopenia can be used as a prognostic predictor for chronic obstructive pulmonary disease exacerbation, sepsis, or acute myocardial infarction disease. There are only a few studies about predicting mortality in emergency departments and intensive care units (ICUs). Prognostic studies about patients in ICUs are generally carried out using different scoring systems. We aimed to analyze if the eosinophil count can estimate the prognosis among non-traumatic patients who underwent cardiopulmonary resuscitation and were hospitalized in ICU thereafter. Methods: The data were evaluated of 865 non-traumatic adult patients (>18 years of age) who were admitted with cardiopulmonary arrest or developed cardiopulmonary arrest during clinical follow-ups. Admission venous blood sample tests, complete blood count, and biochemical laboratory results were recorded. Arterial blood gas results were also evaluated. The mean results of the recorded laboratory results were compared between the surviving and non-surviving patients groups. Results: There was a significant difference between the two groups in regard to platelet, eosinophil count, pH, PaO2, SaO(2), and HCO3- (P<0.001 for all). In the multiple linear regression analysis, eosinophil counts were found to be an independent factor (odds ratio=0.03, 95% confidence interval 0.33-0.56, P<0.001) associated with the mortality after cardiopulmonary resuscitation. Conclusion: Because admission eosinophil counts can be measured easily, they are inexpensive biomarkers that can be used for predicting the prognosis among the patients who have return of spontaneous circulation and are treated in ICUs.Öğe Evaluation of the Demographic and Laboratory Data of Patients Diagnosed with Crimean-Congo Hemorrhagic Fever in the Emergency Department and Their Relationship with Morbidity and Mortality(Emergency Medicine Physicians Assoc Turkey, 2021) Soylu, Umit; Demirtas, Erdal; Buyuktuna, Seyit Ali; Korkmaz, Ilhan; Tekin, Yusuf Kenan; Yurtbay, SefaAim: Crimean-Congo hemorrhagic fever (CCHF) is transmitted by infected ticks or through contaminated blood, tissue, and body fluids. Pathological laboratory results, such as thrombocytopenia, leukopenia, and anemia, along with biochemistry and coagulation parameters, can be used for its diagnosis and the determination of its prognosis. Materials and Methods: Data of patients over 17 years of age diagnosed with CCHF between 2013 and 2018 were reviewed retrospectively. The complete blood count, liver-renal enzymes, electrolytes, prothrombin time, activated partial thromboplastin time (aPTT), D-dimer values, fibrinogen values, and international normalized ratio (INR) were recorded and analyzed at admission. Results: Non-survivors had higher levels of alkaline phosphatase, alanine aminotransferase, amylase, aspartate aminotransferase (AST), blood urea nitrogen (BUN), direct bilirubin, gamma-glutamyl transferase, creatinine, potassium, total bilirubin and uric acid (p<0.05), whereas creatine kinase (CK), CK-MB, and calcium levels were lower (p<0.05). Non-survivors had higher levels of basophil, mean corpuscular hemoglobin concentration, mean corpuscular volume, neutrophil, nucleated red blood cells, platelet distribution width, and white blood cells (p<0.05). Conclusion: Evaluation of routine blood parameters of CCHF patients in the emergency room is a useful tool to accelerate recovery in intensive care and prevent delay in patient treatment. Platelet, aPTT, INR, BUN, and AST values are predictors for mortality.Öğe Frontal QRS-T angle as a predictive marker for myocardial damage in acute carbon monoxide poisoning(Sage Publications Ltd, 2021) Tekin, Yusuf K.; Tekin, Gulacan; Nur, Naim; Korkmaz, Ilhan; Yurtbay, SefaIntroduction The present study was undertaken to investigate the prognostic value of the frontal QRS-T angle associated with adverse cardiac outcomes in patients with carbon monoxide (CO) poisoning in early stages in the emergency department. Materials and methods The data of 212 patients with CO poisoning who were admitted to the ED between January 2010 and May 2020 were retrospectively analyzed. The frontal QRS-T angle was obtained from the automatic reports of the EKG device. Results Compared to patients without myocardial damage, among patients with myocardial damage, statistically high creatinine, creatine kinase MB, cardiac troponin I, and frontal QRS-T angle values were found (p < 0.001 for all parameters), while the saturation of arterial blood pH and arterial oxygen values were found to be lower (p = 0.002 and p < 0.001, respectively). The frontal QRS-T angle values were correlated with creatine kinase, creatine kinase-MB, cardiac troponin I, and oxygen saturation (SpO(2)) in arterial blood (r = 0. 232, p = 0.001; r = 0. 253, p = < 0.001; r = 0. 389, p = < 0.001; r = -0. 198, p = 0.004, respectively). The optimum cut-off value of the frontal QRS-T angle was found to be 44.5 (area under the curve: 0.901, 95% confidence interval: 0.814-0.988, sensitivity: 87%, specificity: 84%). Conclusions The frontal QRS-T angle, a simple and inexpensive parameter that can be easily obtained from 12-lead surface electrocardiography, can be used as an early indicator in the detection of myocardial damage in patients with CO poisoning.Öğe Glutamine-Driven Metabolic Adaptation to COVID-19 Infection(Springer India, 2023) Aydin, Huseyin; Tekin, Yusuf Kenan; Korkmaz, Ilhan; Tekin, Gulacan; Yurtbay, Sefa; Keles, Sami; Hekim, NezihBackground COVID-19 is known to be transmitted by direct contact, droplets or feces/orally. There are many factors which determines the clinical progression of the disease. Aminoacid disturbance in viral disease is shown in many studies. In this study we aimed to evaluate the change of aminoacid metabolism especially the aspartate, glutamine and glycine levels which have been associated with an immune defence effect in viral disease. Methods Blood samples from 35 volunteer patients with COVID-19, concretized diagnosis was made by oropharyngeal from nazofaringeal swab specimens and reverse transcriptase-polymerase chain reaction, and 35 control group were analyzed. The amino acid levels were measured with liquid chromatography-mass spectrometry technology. Two groups were compared by Kolmogorov-Smirnov analysis, Kruskal-Wallis and the Mann-Whitney U. The square test was used to evaluate the tests obtained by counting, and the error level was taken as 0.05. Results The average age of the patient and control group were 48.5 +/- 14.9 and 48.8 +/- 14.6 years respectively. The decrease in aspartate (p = 5.5 x 10(-9)) and glutamine levels (p = 9.0 x 10(-17)) were significiantly in COVID group, whereas Glycine (p = 0.243) increase was not significiant. Conclusions Metabolic pathways, are affected in rapidly dividing cells in viral diseases which are important for immun defence. We determined that aspartate, glutamine and glycine levels in Covid 19 patients were affected by the warburg effect, malate aspartate shuttle, glutaminolysis and pentose phosphate pathway. Enteral or parenteral administration of these plasma amino acid levels will correct the duration and pathophysiology of the patients' stay in hospital and intensive care.Öğe Response to the Letter: Mean Platelet Volume and Related Parameters May Not Contribute to the Diagnosis in Patients with Ascending Thoracic Aortic Aneurysm(Soc Brasil Cirurgia Cardiovasc, 2022) Tekin, Yusuf Kenan; Tekin, Gulacan; Korkmaz, Ilhan; Yurtbay, Sefa[Abstract Not Available]Öğe Serum TLR9 and NF-?B Biochemical Markers in Patients with Acute Pancreatitis on Admission(Hindawi Ltd, 2020) Demirtas, Erdal; Korkmaz, Ilhan; Cebecioglu, Kivanc; Ayan, Mustafa; Demirtas, Esin; Yurtbay, Sefa; Yildiz, SeymanurAim. The aim of this study was to investigate the serum TLR9 and NF-kappa B levels in patients for the diagnosis and prognostication of AP in the emergency department. Methods. In the current study, we looked at the TLR9 and NF-kappa B pathways in a cohort of 45 acute pancreatitis patients and compared them with the control group. We also divided the patient groups as mild-moderate or severe and compared the biomarker levels between the groups. Results. Of the patients with acute pancreatitis, 22 (49%) were male and 23 (51%) were female. The mean age of the patient group was 62 years, with a range of 25-95 years. The control group consisted of 19 (43.1%) male and 25 (56.9%) female patients. The serum TLR9 and NF-kappa B values were significantly higher than those of the control group [1104.44 +/- 339.20 vs. 702.08 +/- 203.94; p<0.001 and 8.04 +/- 1.76 vs. 4.76 +/- 1.13; p<0.001, respectively]. We found that TLR9 and NF-kappa B had a significant discriminative ability, while the cutoff value for TLR9 was 950.4, with a sensitivity of 73% and specificity of 93% (p<0.001), and the cutoff value for NF-kappa B was 6.32, with a sensitivity of 89% and specificity of 100% (p<0.001). Conclusion. We demonstrated that the TLR9 and NF-kappa B pathway is activated in acute pancreatitis and increases the inflammatory process. This may help to further understand the pathogenesis of disorder, diagnosis, and clinical severity. We proposed that blockage of these inflammatory pathways may play a role in the prevention of the disease progression and development of inflammatory complications.Öğe The significance of taurine for patients with Crimean-Congo hemorrhagic fever and COVID-19 diseases: a cross-sectional study(Walter De Gruyter Gmbh, 2025) Celik, Simsek; Aydin, Huseyin; Tekin, Yusuf Kenan; Ertemur, Zeynep; Korkmaz, Ilhan; Yurtbay, Sefa; Engin, AynurObjectives: In this study, we aimed to evaluate the change in taurine levels in two diseases [Crimean-Congo hemorrhagic fever (CCHF) and novel coronavirus disease (COVID-19)], which have a significant impact on public health as they frequently cause mortality and morbidity. Methods: This observational, cross-sectional study was conducted between September 15, 2023, and November 30, 2023, at the Emergency Department, Sivas Cumhuriyet University Faculty of Medicine. There were three groups in our study. These groups were 35 COVID-19 patients with confirmed diagnosis, 35 CCHF patients, and a control group consisting of 35 healthy volunteers who were similar to these patient groups in terms of age and gender. Plasma amino acid levels of taurine, beta-alanine, arginine, carnosine, cystine, histidine, lysine, and methionine were measured and compared in these three groups. Results: In the pairwise comparison of the groups, the increase in taurine plasma levels in CCHF (p<0.001) and COVID-19 (p=0.002) patients compared to the control group was statistically significant, whereas the difference between CCHF and COVID-19 patient groups was not significant (p=0.303). Multinomial logistic regression analysis revealed that taurine, beta-alanine, arginine, and lysine levels were significant predictors in differentiating patients with CCHF and COVID-19 from healthy individuals. Conclusions: We concluded that it may be important to determine taurine levels during the treatment and observation processes of these two diseases, which seriously affect public health. This study will contribute to a better understanding of the pathogenesis of the CCHF and COVID-19 diseases.Öğe Urea Cycle and Arginine Metabolic Changes in COVID-19 Patients(Galenos Publ House, 2023) Ozbay, Sedat; Aydin, Hueseyin; Korkmaz, Ilhan; Tekin, Yusuf Kenan; Tekin, Guelacan; Yurtbay, Sefa; Sargin, Ata BerkayAim: Metabolic changes begin after the invasion of an infectious microorganism and continue to develop as a series of interrelated events. Arginine is important in infectious diseases due to lymphocyte proliferation, nitricoxide production by macrophages, and the use of polyamides in the immune response. In this study, we aimed to examine the possible causes and consequences of urea cycle amino acid metabolism changes by comparing plasma arginine and urea cycle amino acid levels in Coronavirus disease-2019 (COVID-19) patients. Materials and Methods: In this cross-sectional study, we evaluated the urea cycle and arginine metabolic changes and compared the plasma aminoacid levels of 35 COVID-19 patients and a healthy control group (n=35). The patient was diagnosed by reverse transcriptase-polymerase chain reaction of oropharyngeal-nasofaringeal swab specimens. For statistical analyzes, Mann-Whitney U and chi-square tests were used. Results: The aminoacid plasma levels of argininosuccinate (1.03 mu mol/L, p=3.3x10-3), arginine (53.64 mu mol/L, p=1.1x10-3), aspartic acid (3.83 mu mol/L, p=5.5x10-9), citrulline (27.79 mu mol/L, p=3.3x10-5), glutamine (489.6 mu mol/L, p=9.0x10-17), lysine (206.4 mu mol/L, p=5.8x10-8), ornithine (129.5 mu mol/L, p=0.012), plasma levels and glutamine/glutamate (p=3.4x10-11), arg/ornithine (p=0.033), asp/argininosuccinate (p=0.011) ratios were decreased in the COVID-19 patient group compared to the healthy group. Conclusion: Arginine is significant in endothelial control, the urea cycle, and immune activation. Arginine deficiency in COVID-19 patients may cause disturbances in this biological process and its pathways. As indicated by many clinical trials, we believe that preventing a decrease in plasma arginine levels will prevent a poor prognosis of patients and metabolic pathway disturbances in the urea cycle.
