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Publication Open Access Comparison of analgesic consumption of hemophilic and non-hemophilic patients in knee arthroplasty(Turkish Assoc Trauma Emergency Surgery, 2022) Canbolat, Nur; Dinc, Tugce; Koltka, Kemalettin; Zulfikar, Bulent; Koc, Basak; Buget, Mehmet I.; N/A; Kılıçoğlu, Önder; Faculty Member; School of Medicine; N/ABACKGROUND: Hemophilia is a rare hereditary bleeding disorder that develops as a result of factor VIII or IX deficiency. Long-term complications of hemophilia such as arthropathy, synovitis, and arthritis can lead to the development of recurrent chronic pain. Pain is therefore a critical aspect of hemophilia. The gold standard treatment for end-stage hemophilic knee arthropathy is total knee arthroplasty (TKA). The hypothesis of this study was that after knee replacement surgeries that cause severe post-operative pain, hemophilia patients with chronic analgesic consumption may experience higher levels of pain than non-hemophilic patients, and use more opioid and non-opioid drugs. METHODS: This retrospective study included 82 patients who were hemophilic and non-hemophilic TKA patients operated under general anesthesia. Seventy-three patients were evaluated and divided into two groups according to the diagnosis of hemophilia: 36 patients were investigated in the hemophilic group and 37 patients in the non-hemophilic group. RESULTS: Post-operative tramadol consumption (p=0.002) and pethidine consumption (p=0.003) were significantly higher in the group hemophilia. The length of stay in the hospital was also significantly longer in the hemophilic group (p=0.0001). CONCLUSION: In the light of these informations, we think that acute post-operative pain management of hemophilia patients should be planned as personalized, multimodal preventive, and pre-emptive analgesia.Publication Open Access Effects of short-term hyperoxic ventilation on lung, kidney, heart, and liver in a rat model: a biochemical evaluation(Kare Yayıncılık, 2021) Aksu, Uğur; Ulugöl, Halim; Sungur, Mukadder Orhan; Vardar, Kübra; Şentürk, Mert; Toraman, Fevzi; Şentürk, Evren; Faculty Member; School of Medicine; 48359Background: despite studies on the adverse effects of hyperoxia, its use is still recommended by the World Health Organization. The aim of this study was to test the possible harmful effects of hyperoxia on the lung, kidney, heart, and liver in a rat mechanical ventilation model. Methods: male Wistar rats were randomly assigned into two groups (n=6/group): Normoxic (FiO(2): 0.3) or hyperoxic (FiO(2): 1.0) ventilation for 4 h. The injury was evaluated in bronchoalveolar lavage (BAL), blood, lung, liver, kidney, and heart was evaluated in terms of cell surface integrity, extracellular matrix (sialic acid, syndecan-1), osmotic stress (free hemoglobin), and redox homeostasis-lipid peroxidaation (malondialdehyde). BAL and wet/dry weight ratio were also evaluated for cellular permeability. Results: four hours of hyperoxic ventilation did not lead to significant changes in (1) sialic acid, syndecan-1, (2) malondialdehyde levels and wet/dry weight ratio in liver, kidney, heart, and lung compared to normoxic ventilation. Conclusion: mechanical ventilation with hyperoxia seems to have almost similar effects compared to ventilation with normoxia. However, the long term effect of hyperoxia should be evaluated. / Amaç: hiperoksinin olumsuz etkileri üzerine yapılan çalışmalara rağmen, Dünya Sağlık Örgütü (WHO) hiperoksinin kullanımını önermektedir. Bu çalışmanın amacı sıçan mekanik ventilasyon modelinde hiperoksinin akciğer, böbrek, kalp ve karaciğer üzerindeki olası olumsuz etkilerini test etmektedir. Gereç ve yöntem: erkek Wistar sıçanlar dört saat boyunca normoksik (FiO2: 0.3) veya hiperoksik (FiO2: 1.0) ventile edilerek iki gruba (n=6/grup) ayrıldı. Hasar hücre yüzey bütünlüğü, ekstraselüler matriks (sialik asit, sindekan-1), ozmotik stres (serbest hemoglobin) ve redoks homeostazisi-lipit peroksidasyonu (malondialdehit) açısından bronkoalveolar lavaj, kan, akciğer, böbrek, kalp ve karaciğer örneklerinde değerlendirildi. Ayrıca bronkoalveolar lavaj ve ıslak/kuru ağırlık oranı ile hücre geçirgenliği değerlendirildi. Bulgular: dört saatlik hiperoksik ventilasyon sialik asit, sindekan-1, malondialdehit düzeylerinde ve organların ıslak kuru ağırlıklarında anlamlı bir değişikliğe neden olmadı. Tartışma: hiperoksik ventilasyonun normoksik ventilasyona benzer bir etki gösterdiği görülmektedir. Ancak, hiperoksinin uzun vadeli etkileri değerlendirilmelidir.Publication Open Access Environment, global climate change, and cardiopulmonary health(American Thoracic Society (ATS), 2017) Bauer, Alison K.; Abdalati, Waleed; Carlsten, Christopher; Pinkerton, Kent E.; Thurston, George D.; Balmes, John R.; Takaro, Tim K.; N/A; Bayram, Hasan; Faculty Member; School of Medicine; 4890Publication Open Access Endoscopic and surgical management of iatrogenic biliary tract injuries(Kare Yayıncılık, 2020) Acar, Turan; Acar, Nihan; Güngör, Feyyaz; Gür, Özlem; Çamyar, Hakan; Haıyanlı, Mehmet; Dilek, Osman Nuri; Alper, Emrah; Faculty Member; School of MedicineBackground: Iatrogenic biliary tract injury (BTI) is a rare complication but has high risks of morbidity and mortality when it is not early noticed. Although the treatment varies depending on the size of injury and the time until the injury is noticed, endoscopic and percutaneous interventions are usually sufficient. However, it should be remembered that these interventions may cause major complications in the following years, such as biliary stricture, recurrent episodes of cholangitis and even cirrhosis. In this paper, we aimed to present our approach to BTI following cholecystectomy and our treatment management in the light of the literature. Methods: the medical records of 105 patients who were treated for BTI between January 2015 and July 2019 were evaluated retrospectively. The majority of the patients consisted of the patients who underwent cholecystectomy at an external medical center and were referred to our clinic due to biliary leakage (BL). Patients were grouped according to Strasberg classification determined by the place of leakage. Results: among 105 patients included in this study, 55 were male, and 50 were female. Mean age was 55.2 ±16.26 years (range, 21– 93 years). According to Strasberg classification, type A, B, C, D and E injuries were detected in 57, 1, 3, 29 and 15 patients, respectively. Eighty-five patients were successfully treated with endoscopic and percutaneous interventions, while 20 patients underwent surgery. Conclusion: in all patients with suspected BTI, a detailed screening and appropriate treatment provide a significant decline in morbidity and mortality. Therefore, early diagnosis is very important for both early and late outcomes. / Amaç: iyatrojenik safra yolu yaralanmalarını, nadir görülen bir komplikasyon olup erken tanınmadığında yüksek morbidite ve mortaliteye neden olur. Tedavisi, yaralanma boyutu ve yaralanmanın fark edilmesine dek geçen süreye göre değişmekle birlikte, çoğunlukla endoskopik ve perkütan girişimler yeterli olmaktadır. Fakat bu tedaviler sonrasında ilerleyen yıllarda biliyer striktür, tekrarlayan kolanjit atakları ve hatta siroz gibi majör komplikasyonlara neden olabileceği unutulmamalıdır. Bu yazımızda postkolesistektomi biliyer kaçaklara yaklaşımımızı ve literatür eşliğinde tedavi yönetimini sunmayı amaçladık. Gereç ve yöntem: Ocak 2015–Temmuz 2019 tarihleri arasında biliyer kaçak nedeniyle tedavi ettiğimiz 105 hastanın dosyası geriye dönük olarak değerlendirildi. Hastaların çoğunluğunu, dış merkezde kolesistektomi geçirip, biliyer kaçak saptanması üzerine kliniğimize sevk edilenler oluşturmakta idi. Hastalar kaçak yeri ve miktarına göre belirlenen Strasberg sınıflandırmasına göre gruplandırıldı. Bulgular: çalışmaya alınan 105 hastanın 55’i erkek, 50’si kadın olup ortalama yaş 55.2±16.26 yıl (21–93 yıl) idi. Strasberg sınıflamasına göre; 57 hastada tip A, 1 hastada tip B, 3 hastada tip C, 29 hastada tip D ve 15 hastada tip E yaralanma mevcut idi. Seksen beş hasta endoskopik ve girişimsel radyolojik yöntemlerle başarı ile tedavi edilirken, 20 hastaya cerrahi girişim yapıldı.Tartışma: biliyer kaçaktan şüphelenilen her hastada, ayrıntılı tarama ve uygun tedavi morbidite ve mortalitede önemli bir düşüş sağlar. Bu sebeple, erken tanı hem erken hem de geç dönem sonuçlar açısından çok önemlidir.Publication Open Access Nosocomial infections and associated risk factors in geriatric patients in the intensive care unit(Aves, 2016) İnci, Ayşe; Karabay, Ayşegül; Demiraran, Yavuz; N/A; Erus, Suat; Faculty Member; School of MedicineAim: The elderly population increases worldwide. The purpose of this study was to evaluate nosocomial infections (NI) detected in geriatric patients and to determine the risk factors leading to their development. Materials and Methods: Patients monitored in our hospital's Intensive Care Unit (ICU) were evaluated daily by intensive care and infectious disease specialists, including surveillance by our Infection Control Committee. We included the patients aged >= 65 years who were monitored in the adult ICU between January and December 2014, using the methods of retrospective file screening and computer record review. Patients were classified into two groups: patients with and without NI. Results: In total, 222 (38.07%) patients were >= 65 years old. 44 NI events were detected in 27 patients. Groups were compared with respect to age; sex; presence of mechanic ventilation (MV), central venous catheterization (CVC), cerebrovascular disease, chronic obstructive disease, diabetes mellitus; and mortality. The presence of MV, CVC, and mortality were seen to be significantly higher in patients with NI compared with those without. The most common NIs found were sepsis and pneumonia. The most common infectious agent was Acinetobacter. Conclusion: NIs observed in hospital ICUs are common, but largely preventable, conditions. A systematic approach and well-disciplined empiric therapy are very important. Our study revealed that the mortality rate is high in elderly patients who develop NI, and NI is more commonly seen in patients who undergo invasive interventions. We believe that using invasive interventions as little as possible in this group may improve their treatment success and outcome.Publication Open Access The diagnostic value of irisin in patients with acute abdominal pain: a preliminary study(Kare Yayıncılık, 2018) Yeniocak, Selman; Karcıoğlu, Özgür; Kalkan, Asım; Saraç, Fatma; Keklikkıran, Zehra Zeynep; Gümüş, Alper; Koldaş, Macit; Korkut, Semih; N/A; Karadana, Gökçe Akgül; Doctor; School of MedicineBackground: the aim of this study was to investigate the prognostic value of irisin by examining the serum level of this smooth muscle protein in patients presenting at the emergency department (ED) with acute abdominal pain. Methods: this research was performed as a single-center, prospective, cross-sectional study. In all, 213 adult patients presenting at the ED with acute abdominal pain and 140 healthy controls were enrolled. The serum irisin level was correlated with the leukocyte, C-reactive protein, amylase, and creatine kinase values. The irisin level was compared between groups of those who were admitted or discharged, and those who received surgical or medical treatment. Results: the mean irisin level of the 213 patients and the 140 controls was 6.81 +/- 3.17 mcg/mL vs. 5.69 +/- 2.08 mcg/mL. The mean irisin value of the hospitalized patients (7.98 +/- 3.1 1 mcg/mL) was significantly higher than that of the discharged patient group (6.38 +/- 3.09 mcg/mL) and the controls (control vs. discharged: p=0.202; control vs. hospitalized: p<0.001; discharged vs. hospitalized: p=0.001). When compared with that of the control group, the irisin level was significantly higher in patients with gall bladder diseases, urolithiasis, and acute appendicitis (p=0.001, p=0.007, p=0.007). Conclusion: the serum irisin level in patients with abdominal pain may serve as a guide in diagnostic decision-making and determining the prognosis for cases of acute abdominal pain involving luminal obstruction in tubular intra-abdominal organs.Publication Open Access Serum cortisol level as a useful predictor of surgical disease in patients with acute abdominal pain(Pharmamed Mado Doo, 2019) Dikme, Özgür; N/A; Dikme, Özlem; Faculty Member; School of MedicineIntroduction: the immediate aim should be to identify potentially resuscitative acute abdominal pain that requires prompt investigation or early surgical intervention. We aimed to evaluate whether serum cortisol levels differentiate surgical and non-surgical disease in patients with acute abdominal pain. Materials and methods: in this prospective cross-sectional study, the primary end-point was defined as differences in serum cortisol levels between surgically and non-surgically treated patients with non-traumatic acute abdominal pain. The secondary end-point was to compare the cortisol levels with defined complete blood count (CRC) parameters in those groups. Results: one hundred eleven patients with acute abdominal pain were included in the study. Three most frequent diagnoses were nonspecific abdominal pain, acute appendicitis and dyspeptic complaints. Thirty patients were hospitalized and 22 of them were operated. The median cortisol level was 23.13 mu g/dl in surgically treated patients and 13.94 mu g/dl in non-surgically treated patients (p<0.001). The area under the ROC curve using cortisol to detect surgical disease was 0.750 (95% CI, 0.659-0.827) and the accuracy of cortisol to detect surgical disease was not inferior to defined CRC parameters. A cortisol value of 17.98 mu g/dl had a sensitivity of 67.4% and a specificity of 77.3% for surgical disease. Conclusion: operated patients had higher serum cortisol levels. High serum cortisol levels may indicate surgical disease at the early stage on admission in ED patients with acute abdominal pain and may be used as a marker in the prediction of acute surgical abdomen.Publication Open Access Demographic and clinical characteristics among Turkish homeless patients presenting to the emergency department(Elsevier, 2017) Gökmen, Necati; Barış, İbrahim; Öçmen, Elvan; Yılmaz, Osman; Günerli, Ali; Karadana, Gökçe Akgül; Doctor; Koç University HospitalObjective: Since the homeless are at greater risk of encountering health problems than the general population, the reasons for and incidence of their presentations to emergency departments also vary. The purpose of this study was to determine the sociodemographic and clinical characteristics of Turkish homeless patients who brought to the emergency department by ambulance. Materials and methods: The records of homeless adult patients brought to the ED by 112 emergency service ambulance teams over a 1-year period from January to December, 2014, were examined retrospectively.Results: Thirty-six (21.56%) of the homeless patients enrolled in the study presented due to trauma, and 131 (78.44%) due to non-traumatic causes. One hundred thirty-seven (82.04%) of the total patient group were male. The mean age of the non-trauma patients was 47.3 +/- 15.2 years (range, 18-81 years), and the mean age of the trauma patients was 36.9 +/- 14.4 years (range, 18-63 years). The most common reason for presentation among patients prese nting to the emergency department for non-trauma reasons was clouded consciousness (n = 39, 23.35%), followed by general impaired condition (n = 26, 15.57%), respiratory difficulty (n = 25 14.97%) and abdominal pain (n = 21, 12.57%). The most common reason for presentation among trauma cases was traffic accidents (n = 13, 7.78%), followed by sharp implement injury (n = 9, 5.39%). Four (2.4%) homeless patients died in the emergency department, three (%1.8) homeless patients discharged from the emergency department, and the remaining 160 (95.8%) were admitted to the hospital. Conclusion: Homeless patients may present to the emergency department due to traumatic or non-traumatic causes. Admission levels are high among these patients, who may have many acute and chronic problems, and appropriate precautions must be taken in the management of these subjects in the emergency department. Copyright (C) 2017 The Emergency Medicine Association of Turkey. Production and hosting by Elsevier B.V. on behalf of the Owner. This is an open access article under the CC BY-NC-ND license.Publication Open Access The predictive value of biochemical parameters in evaluating patients with abdominal trauma: the new scoring system(Elsevier, 2017) Ersel, Murat; Akarca, Funda Karbek; Kıyan, Güçlü Selahattin; Can, Özge; Musalar, Ekrem; Koç University HospitalAim: The aim of this study was to investigate the contribution of non-invasively and rapidly obtained biochemical parameter results to the diagnosis and follow-up of intraabdominal injuries in multitrauma patients. Material and Methods: A total of 2604 multitrauma patients who were treated following their referral to our emergency department between January 2009 and January 2012 were retrospectively reviewed. A logistic regression analysis was used in the risk assessment. Results: Statistically significant associations between intraabdominal injury and certain biochemical variables measured at the time of the referral were determined. These variables were hemoglobin <= 9.99 g/dL [odds ratio (OR): 6.25, 95% CI: 2.86-13.52, p < 0.0001], serum alanine amino transferase (ALT) >= 100 IU/L (OR: 34.45, 95% CI: 21.76-54.54, p < 0.0001), and serum lipase >= 61 U/L (OR: 10.44, 95% CI: 6.56-16.49, p < 0.0001). The pretest probability score was determined for each patient by adding the scores that were obtained from each factor. ROC curve analysis was performed to determine the diagnostic value of the pretest probability score for detecting intra-abdominal injury (area = 0.88; p < 0.0001). Conclusion: The results of our study demonstrated that biochemical parameters may contribute to the diagnosis and follow-up of intraabdominal injuries in multitrauma patients. In particular, ALT, AST, CK and myoglobin were found to have higher ORs than low hemoglobin. After these parameters are tested in larger scale studies in conjunction with the gold standard multislice abdominal CT, they may be used for establishing scores to evaluate the severity of abdominal injuries. Copyright (C) 2016 The Emergency Medicine Association of Turkey.Publication Open Access Serum cortisol as a predictor of major adverse pulmonary event in emergency department acutely dyspneic patients(Hindawi, 2018) Dikme, Özgür; Dikme, Özlem; Faculty Member; Koç University HospitalCortisol is a steroid hormone released from the adrenal glands in response to stressful conditions. Elevated cortisol levels have been described in stress, but it is unclear whether these are associated with adverse outcomes. In this study, we assess whether cortisol levels drawn in patients presenting with dyspnea to the ED were a predictor of major adverse pulmonary event (MAPE). In 87 patients presenting with dyspnea to the ED, cortisol levels were determined. Patients were then assessed to determine the following MAPE: endotracheal intubation (ETI) in the ED, admission to the intensive care unit (ICU), and in-hospital all-cause mortality. Forty-four patients (50.6%) were female and 33 (37.9%) were diagnosed with heart failure. Cortisol levels in patients with and without MAPE were 34.3 mu g/dL and 23.8 mu g/dL, respectively (p<0.001). Also, cortisol levels were found higher in patients intubated in the ED than nonintubated patients (54.2 mu g/dL vs 25.7 mu g/dL, p<0.001), higher in patients admitted to the ICU (38.7 mu g/dL vs 24 mu g/dL, p<0.001), and higher in patients who died in hospital (50 mu g/dL vs 24.3 mu g/dL, p<0.001). The area under the ROC curve using cortisol to detect any component of MAPE-ETI or ICU admission or in-hospital all-cause mortality-was 0.76 (95% CI, 0.65-0.84). A cortisol value of 31.4 mu g/dL had sensitivity of 70.8% and specificity of 79.4% for predicting MAPE. Patients in the MAPE group had higher serum cortisol levels than those without any MAPE. Cortisol may be used as a marker to predict MAPE in nontraumatic acutely dyspneic adult patients on ED admission.