Fatma Mutlu Kukul Güven

Usefulness of Admission Red Cell Distribution Width as a Predictor of Early Mortality in Patients With Acute Pulmonary Embolism

Red 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.

Mushroom poisoning: retrospective analysis of 294 cases

OBJECTIVE The objective of this study was to present special clinical and laboratory features of 294 cases of mushroom poisoning. MATERIALS AND METHODS In this retrospective study, 294 patients admitted to the Pediatric and Adult Emergency, Internal Medicine and ICU Departments of Cumhuriyet University Hospital were investigated. RESULTS Of 294 patients between the ages of 3 and 72 (28.97 ± 19.32), 173 were female, 121 were male and 90 were under the age of 16 years. One hundred seventy-three patients (58.8%) had consumed the mushrooms in the early summer. The onset of mushroom toxicity symptoms was divided into early (within 6 h after ingestion) and delayed (6 h to 20 d). Two hundred eighty-eight patients (97.9%) and six (2.1%) patients had early and delayed toxicity symptoms, respectively. The onset of symptoms was within two hours for 101 patients (34.3%). The most common first-noticed symptoms were in the gastrointestinal system. The patients were discharged within one to ten days. Three patients suffering from poisoning caused by wild mushrooms died from fulminant hepatic failure. CONCLUSION Education of the public about the consumption of mushrooms and education of health personnel working in health centers regarding early treatment and transfer to hospitals with appropriate facilities are important for decreasing the mortality.

C-type natriuretic peptide is associated with the severity of Crimean-Congo hemorrhagic fever

BACKGROUND 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.

Quail consumption can be harmful.

BACKGROUND 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.

The Relationship Between Oxidative Stress, Paraoxanase and Injury Severity in Blunt Trauma Patients

1 İlhan Korkmaz1, Hüseyin Aydın2, Şevki Hakan Eren3, Fatma Mutlu Kukul Güven4, Birdal Yıldırım5, İnan Beydilli6, Mehmet Eren7, 1Cumhuriyet Üniversitesi Tıp Fakültesi Acil Tıp A.D., 2Cumhuriyet Üniversitesi Tıp Fakültesi Klinik Biyokimya Laboratuarı, 3Cumhuriyet Üniversitesi Tıp Fakültesi Acil Tıp A.D., 4Cumhuriyet Üniversitesi Tıp Fakültesi Acil Tıp A.D., Sivas, 5Muğla Devlet Hastanesi Acil Servis, Muğla, 6Antalya Eğitim Araştırma Hastanesi Acil Servis, Antalya, 7Atatürk Eğitim Araştırma Hastanesi Ortopedi ve Travmatoloji, Ankara, Türkiye Travma Hastalarında Paraoksanaz / Paraoxanase Levels in Trauma Patients The Relationship Between Oxidative Stress, Paraoxanase and Injury Severity in Blunt Trauma Patients

Acil Servis Çalışanların da El Florasının Nöbet Süresince Değişimi

Ozet: Acil Servis Calisanlarin da El Florasinin Nobet Suresince Degisimi Amac: Calismamiz Cumhuriyet Universitesi Tip Fakultesi Hastanesi Acil servisimizde gorev yapan hastane personelinden nobet oncesi ve sonrasi el kulturleri alinarak; nobet suresince el florasinda degisiklik olup olmayacagi, ellerimizde patojen mikroorganizma olup olmadigi ortaya konulmasi amaclanmistir. Materyal ve metod: Calismamiz, Cumhuriyet Universitesi acil servisinde gorev yapan 10 hekim, 13 hemsire, 10 tasima ve 7 temizlik personelinin nobet oncesi ve sonrasi her 2 ellerinden kulturleri alinarak el floralarindaki degisimleri degerlendirilmek uzere planlanmistir. Ayrica, ozel mudahale alanlarindaki (resusitasyon, kirmizi alan) hava numunelerindeki mikro organizmalar analiz edildi. Tartisma: Temas oncesi (4,%11.1) ve temas sonrasi (16,%44.4) el yikama durumu karsilastirildiginda farklilik istatiksel acidan onemli bulunmustur. (p<0,05) Nobet oncesinde alinan sag ve sol el ornekleri ile nobet sonrasi alinan sag ve sol el orneklerinde uretilen mikroorganizmalar arasinda herhangi bir fark bulunmadi. nobet oncesinde alinan sag ve sol el orneklemeleri, uretilen mikroorganizmalarin toplam sayilari acisindan karsilastirildiginda fark anlamli olarak bulunmustur. (t = 7,48; p = 0,001). Sonuc: Calismamizdaki sonu c lari genel olarak degerlendirecek olursak hastanede el yikama sikligi ve suresinin uluslararasi kilavuzlar ve belirtilen sinirlara yakin oldugu fakat temas o ncesi ve sonrasi el y ikama aliskanliginin beklenen duzeyde olmadigi saptandi . El y ikama davranisi ile ilgili eksiklerin giderilmesi acisindan personelin egitimi, uyumun kontrolu ve geri bildirimin yapilmasinin etkili olacagi ortaya cikmistir. Yapilan hava o rneklemeleri degerlendirildiginde tanimlanan bakteri c esitliligi acisindan alanlarda farklilik olmadigi ve bunlarin normal hava ortaminda bulunan mikroorganizmalar olduklari tespit edilmis oldu. U reme sayilari acisindan hasta bakiminin daha fazla oldugu yesil alanda ve sari alanlarda daha c ok ureme oldugu ortaya cikti. Anahtar Sozcukler: El hijyeni, Hastane kaynakli enfeksiyon kontrolu, El yikama, Saglik calisani, Metisiline rezistans staphyloccus aerius

METHANOL POISONING IN THREE CASES: DIAGNOSIS AND TREATMENT IN EMERGENCY DEPARTMENT

ABSTRACT Methanol 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. Key words: Methanol poisoning, emergency, blurred vision, hemodialysis

Analyses of The Risc Factors for Atrial Fibrillation Among the Patients Who were Admitted to Emergency Service

1 Ethem Arisoy1, İlhan Korkmaz2, Şevki Hakan Eren3, Fatma Mutlu Kukul Güven4, Mehmet Birhan Yilmaz5, İnan Beydilli6, Birdal Yıldırım7 1Zonguldak Devlet Hastanesi Acil Servis, Zonguldak, 2Cumhuriyet ÜniversitesiTıp Fakültesi Acil Servis, Sivas, 3Cumhuriyet Üniversitesi Tıp Fakültesi Acil Servis, Sivas, 4Cumhuriyet Üniversitesi Tıp Fakültesi Acil Servis, Sivas, 5Cumhuriyet Üniversitesi Tıp Fakültesi Kardiyoloji A.D, Sivas, 6Kayseri Eğitim Araştırma Hastanesi Kayseri, 7Muğla Devlet Hastanesi Muğla, Türkiye Atrial Fibrillation / Atrial Fibrilasyon Analyses of the Risc Factors for Atrial Fibrillation Among the Patients Who were Admitted to Emergency Service

Kronik obstruktif akciğer hastalığı akut alevlenmeli hastalarda prokalsitonin ve diğer akut faz belirteçleri

Objectives: The aim of this study was to investigate the correlation between procalcitonin and other acute phase reactants, and also analyze their relationship with clinical situation in chronic obstructive pulmonary disease (COPD) acute exacerbations. Materials and methods: The study was made with 122 acute COPD exacerbated patients, who were admitted to emergency service. Patients with below 0.25 ng/ml PCT value included Group 1, and the patients with PCT values ≥ 0.25 ng/ml Group 2. Serum procalcitonin levels, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) values and white blood cell (WBC) counts were measured. Also, patients hospitalization time and mortality rates were recorded and compared with PCT. Results: Patients were divided in 3 groups according to their clinical diagnosis; Pneumonia (n=27), MycoplasmaChlamydia pneumonia (n=11) and the patients with only COPD exacerbation(n=84). Mean PCT values according to the groups were 9.47 ± 8.1 ng/ml, 0.41 ± 0.2 ng/ ml, and 0.21 ± 0.05 ng/ml respectively. The relationship between PCT with CRP and white blood cell has been found between significiant (p=0.001, p=0.005 respec tively), whereas the relationship between PCT and ESR was nonsignificant (p=0.55). Procalcitonin and CRP had a positive correlation with the hospitalization time (p=0.034, p=0.022 respectively). The mean ± standard error of PCT for the patients who died was 28.3 ± 27.5 ng/ml, and the difference between patients who died or were discharged was statistically significant (p= 0.012). Conclusion: PCT can be a useful indicator for morbidity and prognosis in COPD patients.