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Öğe 4-h mean lactate clearance as a good predictor of adverse outcome in acute cardiogenic pulmonary edema: a pilot study(Walter De Gruyter Gmbh, 2024) Vural, Abdussamed; Karapehlivan, Mahmut; Dolanbay, Turgut; Cumaoglu, Mustafa Oguz; Hatip, Ahmet Yunus; Cetinkaya, Yakup; Unalan, AdnanObjectives This pilot study aimed to evaluate the efficacy of the 4-h mean lactate clearance (LACclr) level as a predictive factor for in-hospital outcomes, 30-day mortality, and treatment success in patients with acute cardiogenic pulmonary edema (ACPE), a significant clinical form of acute heart failure (AHF).Methods A total of 44 patients diagnosed with acute pulmonary edema were included in the study. The patients were divided into two groups based on lactate levels and negative outcomes, and lactate and LACclr levels and negative outcomes were analyzed using statistical tests such as Fisher's exact test, Student's t-test, Mann-Whitney U test, and Receiver operating characteristic (ROC) analysis.Results The results indicated a statistically significant difference in the total hospitalization length of stay according to whether the patients had a negative outcome (intubation and in-hospital mortality) (p=0.033). Additionally, the area under the curve (AUC) value for 4-h mean LACclr was 0.795 in all patients, which was statistically significant in predicting 30-day mortality (p=0.033). The optimal cut-off value for the 4-h mean LACclr in predicting 30-day mortality was found to be 5.57 %, with 80 % sensitivity and 66.7 % specificity. The threshold to rule out 30-day mortality for all patients was 18.85 with 100 % sensitivity and 30.2 % specificity (AUC, 0.795 95 % CI [0.546-1.000], p=0.033).Conclusions These findings suggest that the 4-h LACclr level, calculated within 4 h of emergency department (ED) presentation, can be used as a predictive indicator for needing intubation, in-hospital mortality, and 30-day mortality and to identify patients at higher risk for adverse outcomes.Öğe Early and late adverse clinical outcomes of severe carbon monoxide intoxication: A cross-sectional retrospective study(Public Library Science, 2024) Vural, Abdussamed; Dolanbay, TurgutBackground Carbon monoxide (CO) results from incomplete combustion of carbon-based materials, causing symptoms such as headaches, dizziness, nausea, chest pain, confusion, and, in severe cases, unconsciousness. Normobaric oxygen therapy (NBOT) is the standard therapy, whereas hyperbaric oxygen therapy (HBOT) is recommended in severe cases of organ damage. This study examined the early and late adverse outcomes in patients with severe CO poisoning.Materials and methods This study analyzed severe cases of CO poisoning among patients admitted to the emergency department between January 2020 and May 2022. The demographic, clinical, and laboratory data of symptomatic individuals and those requiring HBOT were examined. The study recorded early outcomes, such as intubation and in-hospital mortality, and late outcomes, such as delayed neurological sequelae and 1-year mortality. Chi-square tests, Spearman's rho correlation tests, and logistic regression analyses were performed to identify factors affecting these outcomes.Results Patients who received HBOT showed a significant difference in delayed neurological sequelae (DNS) compared to those who received NBOT (p = 0.037). Significant differences were observed in the need for intubation, in-hospital mortality, and 1-year mortality between patients based on COHb levels, but no significant differences were found in DNS. The 1-year mortality probability was significantly influenced by COHb level (odds ratio = 1.159, 95% CI [1.056-1.273]). Patients receiving NBOT had a higher odds ratio for DNS risk than those receiving HBOT (odds ratio = 8.464, 95% [1.755-40.817], p = 0.008).Conclusion The study showed no differences in intubation, in-hospital mortality, and 1-year mortality rates between the HBOT and NBOT groups. However, significant differences in DNS suggest that treatment modalities have different effects on neurological outcomes. High COHb levels are associated with an increased risk of intubation, and mortality underscores the significance of monitoring COHb levels in clinical evaluations.Öğe Is Asymotomatic Low-Dose Carbonmonoxide Poisoning Harmless at Emergency Department Presentation?(Galenos Publ House, 2024) Dolanbay, Turgut; Vural, AbdussamedAim: Carbon monoxide (CO) poisoning is a common inhalation poisoning in emergency department (ED) admissions. In this study, we aimed to determine the negligible biochemical and electrocardiogram (ECG) pathological findings of this group of patients with CO poisoning and asymptomatic clinical cases with a CO level below 15% at first admission who are frequently discharged from the ED. Materials and Methods: A total of 68 patients who were exposed to CO poisoning who did not have any clinical complaints or symptoms at the first examination and whose carboxyhemoglobin (COHb) level was between 5% and 15% were included in the study. The group with a COHb level of 5-10% was considered to have a very low level, whereas the group with a COHb level of 10-15% was considered to have a low level. Among the laboratory findings at the time of admission, the COHb level measured at the time of admission to the ED, troponin a cardiac marker, potential of hydrogen and lactate measurements, and white blood cell (WBC) and neutrophil levels were recorded. ECG data were recorded. Results: With regard to COHb levels of low-dose and very low-dose CO poisoning, ECG parameters showed a significant difference, but not in heart rate (p=0.001) between the groups. Regression analysis was performed between ECG heart rate and COHb level, and the linear regression equation was found to be y=2.38x+58.32 (r2=0.68). 2 =0.68). Conclusion: It should be kept in mind that patients may sometimes present with low COHb levels at ED presentation. If patients have available ECGs, they should definitely be compared with their previous ECGs, and blood parameters, especially lactate, troponin, WBC, and neutrophil levels, should be evaluated. It should not be forgotten that tissue and organ damage can occur with low-dose poisoning.Öğe Ophthalmologic emergencies in pediatric patients aged 0–2 years(2024) Cumaoğlu, Mustafa Oğuz; Dolanbay, Turgut; Vural, Abdussamed; Bicer, Gamze Yıldırım; Özçelik, Mustafa; Altay, Mustafa CihanOphthalmologic emergencies (OE) in the pediatric age group are classified as traumatic or nontraumatic, potentially causing partial or total visual loss. These emergencies, which are significant contributors to acquired visual impairment or loss, hold a prominent position in emergency department visits globally. This retrospective study aimed to analyze the demographic, etiological, and clinical characteristics of patients aged 0–2 years who were brought to the Emergency Department (ED) with ophthalmologic emergencies and requested ophthalmologic consultation. Age (month), sex, complaint etiology, affected eye (right or left), diagnosis, examination findings, treatment, and clinical progression were analyzed. Of the patients, 26 who met the inclusion criteria were included in this study. The median age was 20 (14.75–24) months; 5 (19.2%) children were aged less than 1 year and 21 (80.8%) were aged more than 1 year. Three of the patients (11.5%) were refugees. When the cases were grouped as infective and noninfective eye emergencies, the diagnosis of conjunctivitis was statistically significant between refugee and nonrefugee children (p=0.032). Traumatic injuries were more common in children aged 13–24 months, which was statistically significant (p=0.029). Only a small proportion of children brought to emergency departments with ocular complaints actually have a genuine emergency necessitating consultation. Early pediatric patients, in particular, should undergo a more meticulous systemic examination. It is crucial to explore the presence of severe emergencies that could lead to vision loss, one of our most vital senses, in every patient.Öğe Pediatric Head Injuries Occur During the Play Childhood Period of 3-6 Years: A Sample from the South of Türkiye(2024) Cumaoglu, Mustafa Oguz; Vural, Abdussamed; Doğan, Mustafa; Yuruk, Burak; Özçelik, Mustafa; Sekme, SabriAim: Pediatric head traumas (HT) are of significant concern due to their potential for high mortality rates, which are influenced by the clinical progression of traumatic brain injury (TBI). HT poses a substantial risk of morbidity and mortality across all pediatric age groups, underscoring the importance of effective clinical management and follow-up procedures. The current study aims to evaluate the epidemiology, causes, and clinical outcomes of head injuries during childhood play between the ages of 3 and 6. Material and Method: Focused on pediatric patients aged 3-6 years who were admitted to the emergency department (ED) for HT, and required consultation from a neurosurgeon. Data collected included patients’ demographics, trauma etiology, cranial examination findings, laboratory results upon admission, cranial computed tomography findings, classification of TBI, treatment administered, and clinical progression. Results: The median Glasgow Coma Scale (GCS) scores were found to be significantly lower in the group with intraparenchymal injury compared to the group without intraparenchymal injury (p=0.008). The group with intraparenchymal injury exhibited a higher than expected occurrence of moderate TBI (p=0.012). Females exhibited significantly lower mean rank scores for age compared to males (p=0.032). Patients hospitalized for HT had significantly lower GCS scores than those discharged (p=0.001). There is a higher prevalence of moderate TBI than expected in the group of hospitalized patients (p=0.008). The mortality rate among hospitalized patients was 5.6%, with lower GCS scores and hyperglycemia upon admission significantly associated with fatalities (p=0.015, p=0.045). Conclusion: Identification and management of moderate TBI are imperative in children presenting to the ED with HT during early childhood play. Children with intraparenchymal injury should be hospitalized. Additionally, hyperglycemia in pediatric HT patients may signify high-energy trauma.Öğe Retrospective analysis of elderly poisoning cases admitted to emergency departments: A two-center study(2024) Vural, Abdussamed; Dolanbay, Turgut; Şahin, Levent; Özçelik, MustafaThis study aims to analyze demographic, clinical, and biochemical markers of geriatric individuals admitted to emergency clinics due to poisoning to develop preventive public health projects for poisoning prevention. This study was a two-center study. Patients were categorized into accidental, suicide, and misuse groups, and the patient’s clinical and laboratory data were compared. The study included individuals aged 65 and over admitted to hospital emergencies between June 1, 2021, and June 1, 2023. The mean age of the patients admitted with poisoning was 71.7±6.3 years, and the median was 70 (65-90). 69.2% (n=27) of the patients were female, and 30.8% (n=12) were male. Common causes included misuse and suicidal poisoning, drug ingestion, corrosive substance exposure, and pesticide poisoning, Antidepressants and analgesic drugs were the most common agents. There was a statistically significant difference between the mean age rank scores of patients categorized into 3 groups: accidental, suicidal, and misuse (H(3):11.186, p=0.004). The risk of being elderly in accidental poisoning and abuse (non- suicide) patients was 1.203 times that of suicide patients. In other words, it was 20% higher (odds ratio=1.203, CI 95% [1.001-1.446], p=0.049). The mean rank score of troponin values differed significantly between the groups (p=0.027). The study highlights the high rate of poisoning among the elderly, especially women, and suggests preventive public health projects, increased public awareness, and strengthened health policies to improve their quality of life.Öğe The effect of letrozole on liver function and some biochemical parameters in rats(2024) Dolanbay, Turgut; Makav, Mustafa; Vural, Abdussamed; Cumaoğlu, Mustafa Oğuz; Yuceer, Ömer; Başer, Lale; Metin, Hatice TetikLetrozole (LTZ), is an aromatase inhibitor, that has been widely used in a variety of diseases such as polycystic ovary syndrome, endometriosis, and breast cancer. LTZ is received via the oral route and metabolized in the liver. Therefore, LTZ may have toxic effects like other drugs metabolized in the liver. Based on this, our study aimed to investigate the effect of LTZ on liver function and biochemical parameters. For this purpose, 16 Wistar albino female rats were divided into two groups (n=8): Control and LTZ respectively. The rats in the letrozole group were administered with 2 mL/kg LTZ by oral gavage once a day for 21 days. The Control group received the vehicle once a day for 21 days. Blood samples were collected on the 22nd day of the experiment. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), lactate dehydrogenase (LDH), albumin (ALB), alkaline phosphatase (ALP), direct bilirubin and total bilirubin were measured. Biochemical analysis indicated that ALT, AST, LDH, ALP, and total bilirubin levels were significantly higher in the LTZ administrated group compared to the Control. ALB levels decreased in the LTZ group. In conclusion, it was determined that LTZ has toxic and detrimental effects on the liver. We suggested that long-term LTZ administrated patients should be under control against liver damage and may have liver supporting adjuvant therapies for robust liver functions.
