Afsin Emre Kayipmaz

Knowledge levels regarding crimean-congo hemorrhagic Fever among emergency healthcare workers in an endemic region.

Background In this study, we aimed to determine knowledge levels regarding Crimean-Congo hemorrhagic fever (CCHF) among emergency healthcare workers (HCWs) in an endemic region. Methods A questionnaire form consisting of questions about CCHF was applied to the participants. Results The mean age was 29.6 ± 6.5 years (range 19 - 45). Fifty-four (49.5%) participants were physicians, 39 (35.8%) were nurses and 16 (14.7%) were paramedics. All of the participants were aware of CCHF, and 48 (44%) of them had previously followed CCHF patients. Rates of the use of protective equipment (masks and gloves) during interventions for patients who were admitted to the emergency service with active hemorrhage were 100% among paramedics, 76.9% among nurses and 61.1% among physicians (P = 0.003). Among 86 (78.9%) HCWs who believed that their knowledge regarding CCHF was adequate, 62 (56.9%) declared that they would prefer not to care for patients with CCHF (P = 0.608). Conclusions The use of techniques to prevent transmission of this disease, including gloves, face masks, face visors and box coats, should be explained to emergency room HCWs, and encouragement should be provided for using these techniques.

Relationship of Meteorological and Air Pollution Parameters with Pneumonia in Elderly Patients

Background and Purpose In this study, we aimed to evaluate the relationship between pneumonia and meteorological parameters (temperature, humidity, precipitation, airborne particles, sulfur dioxide (SO2), carbon monoxide (CO), nitrogen dioxide (NO2), nitrite oxide (NO), and nitric oxide (NOX)) in patients with the diagnosis of pneumonia in the emergency department. Methods Our study was performed retrospectively with patients over 65 years of age who were diagnosed with pneumonia. The meteorological variables in the days of diagnosing pneumonia were compared with the meteorological variables in the days without diagnosis of pneumonia. The sociodemographic characteristics, complete blood count of the patients, and meteorological parameters (temperature, humidity, precipitation, airborne particles, SO2, CO, NO2, NO, and NOX) were investigated. Results When the temperature was high and low, the number of days consulted due to pneumonia was related to low air temperature (p < 0.05). During the periods when PM 10, NO, NO2, NOX, and CO levels were high, the number of days referred for pneumonia was increased (p < 0.05). Conclusion As a result, climatic (temperature, humidity, pressure levels, rain, etc.) and environmental factors (airborne particles, CO, NO, and NOX) were found to be effective in the number of patients admitted to the hospital due to pneumonia.

The Duration of Fasting in Ramadan Affects the Admissions to Emergency Department

Aim: One of the ways that Muslims worship in Ramadan is by fasting. People who are fasting may prefer to receive health services in the period between iftar and pre-dawn meal owing to the concern that their fasting may be interrupted with the medical interventions to be administered. For this reason, the workload of emergency departments that serve for continuous 24 h may increase in Ramadan. We have not encountered any study analyzing the comparison of emergency visits in the seasons when the period between iftar and pre-dawn is the shortest and longest. We aimed to compare the characteristics of visits to the adult emergency department between those in the year 2016 that included the longest fasting time and those in the year 2000 that included the shortest fasting time.

Dental Girişim Esnasında Yutulan İmplant Anahtarı

A 65 year-old-man was admitted to our emergency department after the ingestion of a cover screw driver during a dental procedure. A plain abdominal x-ray revealed the ingested foreign body. As he had no active symptoms, an emergency colonoscopy was not planned, and he was discharged with the recommendation of visual selfinspection of stools and returning for a control physical examination. Three days later, the patient had still no complaints. A control x-ray showed that the cover screw driver was now at the level of caecum. The patient was discharged with no additional intervention. The ingestion or inhalation of foreign bodies can occur during dental procedures due to patientor physician-related factors. Emergency physicians should be aware of the management of such cases.

Demographics, Management Strategies, and Problems in ST-Elevation Myocardial Infarction from the Standpoint of Emergency Medicine Specialists: A Survey-Based Study from Seven Geographical Regions of Turkey

Background This study aimed to explore the ST segment elevation myocardial infarction (STEMI) management practices of emergency medicine specialists working in various healthcare institutions of seven different geographical regions of Turkey, and to examine the characteristics of STEMI presentation and patient admissions in these regions. Methods We included 225 emergency medicine specialists working in all geographical regions of Turkey. We e-mailed them a 20-item questionnaire comprising questions related to their STEMI management practices and characteristics of STEMI presentation and patient admissions. Results The regions were not significantly different with respect to primary percutaneous coronary intervention (PCI) resources (p = 0.286). Sixty six point two percent (66.2%) of emergency specialists stated that patients presented to emergency within 2 hours of symptom onset. Forty three point six percent (43.6%) of them contacted cardiology department within 10 minutes and 47.1% within 30 minutes. In addition, 68.3% of the participants improved themselves through various educational activities. The Southeastern Anatolian region had the longest time from symptom onset to emergency department admission and the least favorable hospital admission properties, not originating from physicians or 112 emergency healthcare services. Conclusion Seventy point seven percent (70.7%) of the emergency specialists working in all geographical regions of Turkey comply with the latest guidelines and current knowledge about STEMI care; they also try to improve themselves, and receive adequate support from 112 emergency healthcare services and cardiologists. While inter-regional gaps between the number of primary PCI capable centers and quality of STEMI care progressively narrow, there are still issues to address, such as delayed patient presentation after symptoms onset and difficulties in patient admission.

Atrial Fibrillation at a Very Young Age

Atrial fibrillation is the most common rhythm disturbance in general population. We present a 19-year-old man who was admitted to emergency department with progressive weakness, intermittent nausea, vomiting, and palpitations for 1-2 hours. He stated that he had palpitations for the first time. His past history was notable for venlafaxine use for panic disorder. He was diagnosed with AF with rapid ventricular rate and admitted to coronary care unit. Medical cardioversion with amiodarone was attempted and normal sinus rhythm was restored. He had no additional problems during hospital stay and was discharged on anticoagulant therapy (warfarin sodium). Atrial fibrillation should be born in mind in cases presenting to emergency department with palpitations, chest pain, syncope, or weakness in order to provide early diagnosis and treatment for this important disorder causing many complications.

THE ANALYSIS OF CARBON MONOXIDE POISONING CASES PRESENTED TO THE EMERGENCY DEPARTMENT OF A UNIVERSITY HOSPITAL

Introduction : Carbon monoxide poisoning is one of the most leading poisoning causing death through worldwide, although its exact incidence is yet to be determined. Carbon monoxide is a colorless and odorless gas that binds to hemoglobin and cellular oxidative enzymes with a higher affinity than oxygen, causing tissue hypoxia. Hypoxia of heart and nervous system cells leads to neuropsychiatric and cardiological signs and symptoms. In this study, we aimed to investigate the demographic characteristics of the carbon monoxide poisonings occurring in patients presenting to the emergency department. We also aimed to determine the clinical characteristics, and the factors affecting the mortality. Material and Methods : We retrospectively reviewed the demographic and clinical characteristics of 1013 patients who admitted to our adult emergency department and were diagnosed with carbon monoxide poisoning for a period of two years. We recorded and analyzed age, gender, season of presentation, hospital admission rate, sources of poisoning, symptoms at admission, mortality rate, and carboxyhemoglobin and cardiac Troponin-I levels. Results : The mean age of the study population was 36.2±16.2 years. 70.5% of the patients were admitted in winter seasons. 66.1% of the patients’ poisoning source was water heater and stove. The most frequent symptoms were nausea, headache, and dizziness. On multilogistic regression analysis the death rate was significantly correlated with age and cardiac Troponin I level. Conclusion : Our results indicate that accidental carbon monoxide poisonings continue to be an important public health problem in regions with cold winter seasons. We believe that intensifying efforts for public education and efficient control of resources of poisoning are the key steps to prevent carbon monoxide poisonings.

Notes on patient compensation system suggestion.

We have read with great interest the letter to the editor entitled “An alternative malpractice system suggestion for Turkey: Patient compensation system” by Olcay et al. (1) that was published in Anatolian J Cardiol 2015; 15: 775-6. It is our opinion that the patient compensation system (PCS) that was proposed to prevent healthcare staff burnout, defensive medical practices, and increased healthcare expenditures at first appears convenient in general terms. According to our previous study in which judicial issues experienced by emergency physicians were examined, we determined that 57.8% of emergency physicians were complained to patient communication units and 14.2% of them were sued for medical malpractice. Furthermore, we observed that clinical decisions of 41.5% of emergency physicians were affected by previously experienced judicial and administrative inquiries (2). With respect to these studies, we believe that some legal points need to be considered while designing PCS, which is deemed beneficial to conduct healthcare services. First, PCS cannot alter the physicians’ responsibilities within the context of penal law and disciplinary law. It would be useful to mention that such a compensation system cannot concern the physicians’ penal and administrative/disciplinary responsibilities but can concern their civil (pecuniary) responsibilities. Moreover, regarding the scope of PCS, it would be appropriate to clarify the compensation matter of “moral damages” alongside “material damages”, arising from malpractice. Besides, it appears that the PCS board would comprise healthcare professionals and is projected to function as part of PCS has been designed as a relatively autonomous “administrative” board. The organization, powers, and activities of such a board should be regulated by the “law” in accordance with the Principle of Legality of the Administration that is provided by Article 123 of the Constitution. Legislative regulations concerning the compensation board must comply with the constitutional principles and rules. In this context, because the board authorized to pay compensation would not be regarded as a “judicial organ” and its decisions as “judicial decisions”; it would not be legally possible for this board to be organized and authorized in a manner that it would replace “courts”/“judicial review”, even for merely a specific field. This system can be expected to form a facultative alternative rather than a compulsory substitution to a judicial review. What needs to be currently stressed is that judicial review cannot be excluded against the board’s decisions. Hence, according to Article 125 of the Constitution stating that “Recourse to judicial review shall be available against all actions and acts of administration.”, it will be clearly unconstitutional to enact that decisions of a compensation board, considered to be “administrative”, would be definitive and cannot be sued. Moreover, composing additional regulations should be considered for the time limit to bring actions, such as providing that application to the board shall stop the time limit. Furthermore, Article 129 of the Constitution, which states “Compensation suits concerning damages arising from faults committed by public servants and other public officials while exercising their duties shall be filed only against the administration in accordance with the procedure and conditions prescribed by law, as long as the compensation is recoursed to them.” should be considered while making legislative regulations with respect to the pecuniary liability of physicians who have a “public official” status. As it can be observed, an array of legislative regulations and amendments are required to realize PCS. However, in that case, it is clear that such a system would be completely different from the one proposed and would deviate from its original goals when the abovementioned points are to be considered. Moreover, this subject has some other dimensions that may lead to some professional and legal issues that require careful attention. In conclusion, PCS may initially make sense by providing hope of minimizing actions for compensation resulting from malpractice; however, the authors of this study regard it as a proposal that is not so easy to implement in the short term because the “conciliation procedure”, with which PCS has some similarities and that had been promulgated in 2011 (3) concerning the compensation for damages arising from the health practices, was abrogated in 2014 (4).

Investigation on legal problems encountered by emergency medicine physicians in Turkey.

Background Medicine is a profession that carries certain risks. One risky area of practice is the emergency department. Emergency physicians diagnose and treat a high volume of patients, and are also responsible for preparing reports for forensic cases. In this study, we aim to investigate emergency physicians’ legal-administrative problems and reveal their level of understanding on forensic cases. Methods An electronic questionnaire form was prepared after the approval of an ethical committee. This form was sent to the residents, specialists and academicians of emergency medicine by e-mail. The physicians were asked to fill out the form online. All the gathered data was analyzed. Descriptive statistics were presented as frequency percentages with mean and standard deviation. Chi-square tests were used to compare the groups. Correlation between number of complaint cases and age, sex, career, institution, and duration of service in emergency department were investigated. p<0.05 was considered statistically significant. Results 294 physicians participated in the questionnaire. According to the questionnaire, 170 of the physicians were reported to the patient communication units due to medical malpractice. Mean number of compliant reports was 3.20±3.5. 29 of the physicians received administrative penalties. 42 of the physicians were judged in the court for medical malpractice. 1 physician was fined 5000 Turkish Liras as a result of these judgments. Conclusion We found that the number of complaint reports is negatively correlated with duration of service in emergency medicine and age. There was a significant difference between number of complaint reports and career (p<0.05). The physicians’ level of awareness on forensic cases was found to be insufficient. Lack of legislation knowledge may be an important cause of complaint reports concerning emergency physicians, who have a high load of patients. Thus, we think that increasing the frequency of post-graduate education sessions and periodical reviews might be beneficial.

Retrospective Analysis of Indication of Bone Scintigraphy Performed in Our Clinic

DOI: 10.4328/JCAM.2051 Received: 11.09.2013 Accepted: 28.09.2013 Printed: 01.05.2015 J Clin Anal Med 2015;6(3): 324-6 Corresponding Author: Füsun Aydoğan, Mustafa Kemal Üniversitesi Tıp Fakültesi, Nükleer Tıp A.D. Hatay, Türkiye. T.: +905056579710 E-Mail: drfusunay@yahoo.com Özet Amaç: Kemik sintigrafisi sık kullanılan radyonüklid görüntüleme yöntemlerindendir ve birçok hastalığın tanı ve takibinde başarıyla kullanılmaktadır. Çalışmamızın amacı kliniğimizde yapılan kemik sintigrafisi çekimlerinin endikasyonlarını ve çekim protokollerini belirlemektir. Gereç ve Yöntem: Çalışmaya Aralık 2011 ve Haziran 2013 tarihleri arasında kliniğimizde kemik sintigrafisi çekimi yapılan 252 hasta (132 erkek, 120 kadın) dahil edildi. Hastaların yaş ortalaması 50.1±20.2 idi (yaş aralığı 6-84). Sintigrafik protokoller hastalığın çeşidine göre geç statik tüm vücut görüntüleme ve üç fazlı kemik sintigrafisi olmak üzere iki şekilde yapıldı. Çekim endikasyonları ve sintigrafik protokoller tesbit edildi. Bulgular: 102 hastaya (% 40,5) metastatik kemik hastalıklarının tanı ve takibi amacıyla, 57 hastaya (% 22,6) ortopedik uygulamalar amacıyla, 29 hastaya (% 11,5) primer kemik tümörlerinin tanı ve takibi amacıyla, 17 hastaya (% 6,7) osteomyelit tanısı amacıyla, 12 hastaya (% 4,8) protez enfeksiyonu ve gevşemesi ayrıcı tanısının yapılması amacıyla, 14 hastaya (% 5,6) greft canlılığının araştırılması amacıyla, 9 hastaya (% 3,6) romatoid artrit-sakroileit gibi romatolojik hastalıklar nedeniyle, 4 hastaya (% 1,6) osteoporoz-vertebralarda patolojik kırık araştırılması amacıyla, 2 hastaya (% 0,8) metabolik kemik hastalığı nedeniyle, 5 hastaya (% 1,98) otitis eksterna tanısı amacıyla ve 1 hastaya (% 0,4) sedimantasyon-CRP yüksekliği gibi nedenlerden dolayı malignite şüphesi nedeniyle kemik sintigrafisi çekimi yapıldı. Hastaların 136’sına (% 54) geç statik tüm vücut görüntüleme, 116’sına (% 46) ise üç fazlı görüntüleme protokolü uygulandı. Tartışma: Kemik sintigrafisinin en sık kullanıldığı alan metastatik kemik hastalıklarının tanı ve takibidir. Bunu ortopedik uygulamalar, primer kemik tümörlerinin tanı-takibi ve osteomyelit tanısı gibi nedenler takip etmektedir.