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Öğe Characteristics of Pediatric Forensic Cases Caused by Blunt General Body Trauma Evaluated in the Emergency Department: A Single Center Experience(2022) Demirel, Mustafa Enes; Akpinar, GulserenObjective: In this study we aimed to evaluate and analyse demographic features, presentations characteristics, and management approaches in paediatric forensic cases presenting to an emergency department.Materials and Methods: A total of 518 children aged between 0-18 years, who presented to the emergency department of hospital between 2011 and 2020 due to traffic accidents, falls and violence, were included. Demographic information such as age, gender, reason for admission, time of admission, diagnosis, body region of the injury, and consultation and treatment results were included in the study.Results: The median age was 12 years and 67.6% were boys. The median age was significantly lower in the patients who presented due to falls. The patients most presented to the emergency department in the summer months (August) and on Saturdays. The most diagnosis was in soft tissue injury (STI) (50.6%), followed by bone fracture / dislocation injury (42.1%). STI was higher in the violence group compared to others. The most injured body part was the head/neck region (37.8%). The most consulted department was neurosurgery (39.4%). The mortality rate was 4.4%.Conclusion: For emergency specialists, it is important to have sufficient information about demographic and clinical features of paediatric forensic patients for a more efficient physical examination and management.Öğe The Correlation of C-Reactive Protein/Albumin, Mii-1 and Mii-2 Indexes With Hospitalization and Mortality in Stanford Type A Aortic Dissection(2022) Demirel, Mustafa Enes; Korkmaz, Ufuk Turan Kürşat; Donmez, Ibrahim; Özçelik, Ayşenur; Korkmaz, AbdullahAim: In this study we aimed to investigate the relationship between C-Reactive Protein (CRP)/albumin ratio, MII-1 and MII-2 indexes in hospitalization and mortality due to aortic dissection. Material and Method: Patients who presented to our emergency department with a sudden-onset, sharp and stabbing chest pain and diagnosed with Stanford type A aortic dissection were included in the study. Patients’ demographics such as age and gender, hemogram parameters, ratios, indexes, hospitalization and mortality status were recorded. Demographic features, hemogram parameters, ratios and indexes were compared between the survivor and exitus patients. Results: A total of 71 patients who presented to the emergency department with sudden-onset stabbing chest pain and subsequently diagnosed with aortic dissection were included in this retrospective study. The median age of the patients was negatively correlated with albumin (r=-0.27, p=0.021), hemoglobin (r=-0.28, p=0.019). Hemoglobin values were significantly higher in male than in female patients. The median length of stay in the hospital was found as 10 (7-14) days. In the correlation analysis of the hemogram parameters, indexes and length of stay in the hospital; CRP and CRP/Albumin ratio were significantly correlated with length of stay in the hospital in positive direction. Conclusion: The results of this study point out a significant correlation between CRP, CRP/albumin ratio and length of stay in hospital. This information might be helpful in rapid decision making process for early diagnosis and treatment of the disease.Öğe Effects of fisetin on ethanol-induced rewarding properties in mice(Taylor & Francis Inc, 2024) Yalniz, Yasin; Yunusoglu, Oruc; Berkoz, Mehmet; Demirel, Mustafa EnesBackground: Alcohol use disorder (AUD) is a chronic relapsing disorder associated with compulsive drinking of alcohol. Natural flavonoid fisetin affects a variety of transmitter systems relevant to AUD, such as aminobutyric acid, N-methyl-D-aspartate, and dopamine, as well as peroxisome proliferator-activated receptors.Objectives: This study investigated fisetin's impact on the motivational properties of ethanol using conditioned place preference (CPP) in mice (n = 50). Methods: Mice were conditioned with ethanol (2 g/kg, i.p.) or saline on alternating days for 8 consecutive days and were given intragastric (i.g.) fisetin (10, 20, or 30 mg/kg, i.g.), 45 min before ethanol conditioning. During extinction, physiological saline was injected to the control and ethanol groups, and fisetin was administered to the fisetin groups. To evaluate the effect of fisetin on the reinstatement of ethanol-induced CPP, fisetin was given 45 min before a priming dose of ethanol (0.4 g/kg, i.p.; reinstatement test day). Results: Fisetin decreased the acquisition of ethanol-induced CPP (30 mg/kg, p < .05) and accelerated extinction (20 and 30 mg/kg, p < .05). Furthermore, fisetin attenuated reinstatement of ethanol-induced CPP (30 mg/kg, p < .05). Conclusions: Fisetin appears to diminish the rewarding properties of ethanol, as indicated by its inhibitory effect and facilitation of extinction in ethanol-induced CPP. These findings imply a potential therapeutic application of fisetin in preventing ethanol-seeking behavior, promoting extinction, and reducing the risk of relapse.Öğe Emergency service experience following the terrorist attack in Mogadishu, 14 October 2017, a scene of lay rescuer triage(W.B. Saunders, 2021) Demirel, Mustafa Enes; Ali, İbrahim Hussein; Boğan, MustafaBackground: A suicide bomber attack occurred in Somalia's capital city of Mogadishu on October 14, 2017. Over 500 people died, making it the third largest suicide bombing attack in world history. In this study, we aimed to share our experience and to discuss the importance of triage and prehospital care systems. Methods: These retrospective data included data from patients who suffered from severe explosions. Patient triage was performed using the START (Simple Triage and Rapid Treatment) triage algorithm at the entrance of the hospital. The patients included in the study were classified according to their age, sex, triage code, location of their major injury, department to which they were admitted, and discharge and/or exit status. Results: The patients included 188 (74.6%) males, and the mean age was 30.94 ± 12.23 years (range, 1–80 years). Eighty-six (34.1%) patients were marked with a red code indicating major injury, and 138 (54.8%) patients had superficial injuries. A total of 173 (68.7%) patients were managed in the emergency department (ED), and 7 (2.8%) patients died in the first 24 h. Multiple trauma injuries were detected in 43 (17.1%) patients, and 31 (12.3%) patients were admitted to the orthopedics department. Conclusion: Disaster management in a terrorist event requires rapid transport, appropriate triage, effective surgical approaches, and specific postoperative care. In this event, almost all patients were brought to the ED by lay rescuers. Appropriate triage algorithms for the public can be designed; for instance, green code: walking patient; yellow code: patient who is moving and asking for help; red code: unmoving or less mobile patient who is breathing; black code: nonbreathing patient.Öğe MANAGEMENT OF PEDIATRIC FALLS IN AN EMERGENCY DEPARTMENT: ANALYSIS OF 261 PEDIATRIC CASES(2021) Demirel, Mustafa Enes; Akpinar, GulserenObjective: Pediatric falls cause a significant burden for emergency departments and have negative patient outcomes such as prolonged length of stay and increased costs. The objective of this study was to evaluate results of the management of pediatric fall cases in an emergency department.Material and Methods: Pediatric patients who presented to our emergency department due to falling injury were evaluated and analyzed according to the demographic data, including age and gender, Glasgow Coma Scale, Injury Severity Score time of presentation, site of injury, diagnosis, department of consultation, department of hospitalization, length of stay and cost. After the initial management in the emergency department, patients were consulted and referred to other departments, if deemed necessary.Results: A total of 261 children were included in the study. Hospital admissions were most frequently made in summer, in August and on Saturdays. The children were most diagnosed by fractures followed by soft tissue trauma. The most injured body part was the head-neck region followed by extremities. The most frequently consulted departments included neurosurgery and orthopedics and traumatology. A total of 101 (38.7%) children were hospitalized. The median Injury Severity Score value of the patients was found as 3 and the median Glasgow Coma Scale value was found as 15 (8-15). The median treatment cost was found to be ?278.8. The median length of stay was found as 31 (interquartile range, 21-63.5) (interquartile range için 2 sayısal değer verilmeli) hours. A strong positive correlation was found between length of stay and costs (r=0.629, p<0.001).Conclusion: Pediatric age group fall injuries are common events that increase the workload of the emergency department and create a significant burden and cost for the health system and society. Our results show that, as expected, there is a very strong relationship between length of stay and treatment costs.Öğe Novel oral anticoagulants’ efficacy and safety in comparison to vitamin K antagonists and low molecular weight heparins(2023) Demirel, Mustafa Enes; Korkmaz, Ufuk Turan KürşatObjective: The last standard treatment for venous thromboembolism (VTE) is oral anticoagulation with a vitamin K antagonist. Treatment with a vitamin K antagonist requires frequent monitoring of the international normalized ratio (INR), and these drugs have several disadvantages. Direct oral anticoagulants are alternative drugs to oral antivitamin K anticoagulants. With safer ranges, novel oral anticoagulants (NOACs) have been accepted in guidelines as drugs of choice. This study aimed to retrospectively examine the outcomes of three new-generation anticoagulant drugs in a patient group. Methods: Two hundred eighteen adults were included in this retrospective cohort study. Patients are included in this study if they had been used any of these drugs in the past: Warfarin, low molecular weight heparin (LMWH), dabigatran, apixaban, and rivaroxaban. The study was conducted retrospectively for evaluating safety and effectiveness. Treatment charges for LMWH, warfarin, and NOAC were calculated based on info from the medical monitoring fee, approximate hospital transportation costs per INR measurement, and drug fees for 6 months. Results: In comparison with warfarin (n: 1, 1.4%), the risk of embolism recurrence was found higher with apixaban (n: 6, 20%, RR: 14.4, OR: 17.75, 95% CI: 2.03-154.99, p=0.002) and rivaroxaban (n: 6, 19.4%, RR: 13.94, OR: 17.04, 95% CI: 1.95-148.57, p=0.003) in patient groups. Conclusion: Compared to the literature, the rivaroxaban and apixaban groups had greater bleeding and recurrence risk in our study. This may be due to dietary habits and genetic factors.Öğe Predictive value of left ventricular diastolic parameters on type and severity of acute coronary syndrome(2020) Demirel, Mustafa Enes; Kama, Nuri Aydın; Tekten, Beliz Oztok; Çelik, Kaan; Çolak, TamerObjectives: Coronary artery disease is the most common cardiovascular disease and is associated with high rates of mortality and morbidity. The first impaired echocardiographic parameter in acute ischemia is diastolic function and systolic dysfunction occurs later. In our study, we aimed to evaluate the predictive value of left ventricular diastolic parameters on type and severity of acute coronary syndromes. Methods: The study was prospectively performed by including 60 patients, who applied to our hospital with complaints of chest pain. 12 –lead ECG was performed for all patients. In order to make diastolic function staging, echocardiography was performed by a cardiologist. After receiving a diagnosis, patients were assessed with statistical analyses regarding their echocardiographic results. Results: According to echocardiography results of patients included in the study, normal function was observed in 25 patients; impaired relaxation in 21; pseudonormal pattern in 7 and restrictive pattern in 7. According to the diagnosis of the patients, 26 patients were diagnosed with nonspecific chest pain. 27 patients were diagnosed as having NSTEMI and 7 patients were diagnosed as having STEMI. There was no correlation between the echocardiographic results of our patients and the diagnoses they have been received. Conclusion: Although diastolic parameters have many uses to evaluate diagnosis, prognosis and mortality of acute coronary syndromes, there was no significant difference between the groups in our study. The most likely reason for this is the inadequate number of patients in some groups.Öğe The role of platelet distribution width in the diagnosis of ischemic and hemorrhagic stroke(Bayrakol Medical Publisher, 2023) Demirel, Mustafa Enes; Özel, SinanAim: Current efforts to find diagnoses using simple and widely used indices of platelet activation have focused on the platelet activation caused by morphological changes, including both pseudopodia formation and spherical shape. The aim of this study was to evaluate the effect of PDW in differentiating ischemic and hemorrhagic stroke.Material and Methods: The study included a total of 333 patients, of which 269 had ischemic stroke and 64 had hemorrhagic stroke. Demographic data of the patients such as gender and age, National Institutes of Health Stroke Scale (NIHSS), Glasgow Coma Scale (GCS) and the modified Rankin score (mRs) were recorded. Complete blood count parameters were also recorded and compared between the patients with ischemic and hemorrhagic stroke.Results: The mean age of the patients was found to be 72.3 +/- 12.71 years in the ischemic stroke group and 69.27 +/- 14.39 years in the hemorrhagic group. The median neutrophil count was statistically significantly higher in the hemorrhagic stroke group (p=0.041). The median level of albumin was statistically significantly higher in the patients with hemorrhagic stroke (p=0.010). The median PDW value was determined to be statistically significantly higher at 14.9 (11.9-17.8) in the ischemic stroke group compared to 12.85 (11.33-17.03) in the hemorrhagic stroke group (p=0.009).Discussion: As the PDW level was statistically significantly lower in patients with hemorrhagic stroke than in patients with ischemic stroke, it may be of value in distinguishing these two forms of stroke. However, further comprehensive, multi-center studies are needed to better understand the role of PDW in ischemic and hemorrhagic stroke.Öğe Serum uric acid to HDL-cholesterol ratio could be promising predictor of atrioventricular nodal reentrant tachycardia(2023) Donmez, Ibrahim; Cosgun, Mehmet; Bayraktar, Muhammed Fatih; Korkmaz, Ufuk Turan Kursat; Demirel, Mustafa Enes; Acar, Emrah; Gunes, YilmazAim: Paroxysmal supraventricular tachycardia (PSVT), particularly atrioventricular nodal reentrant tachycardia (AVNRT), is a common arrhythmia with no associated structural heart disease. Inflammation has been implicated in the pathogenesis of arrhythmias. Uric acid to high density lipoprotein (HDL)-cholesterol ratio (UHR) is a novel inflammation marker that has been investigated in various conditions. This study aimed to explore the potential association between UHR and AVNRT. Materials and Methods: A total of 136 patients were included in the study, including 86 patients with AVNRT and 50 controls with normal electrophysiological study. All patients’ medical records were reviewed, and data were obtained retrospectively. We recorded baseline features, hematologic and biochemical markers, and determined the UHR value. Results: UHR (p=0.031) and uric acid (p<0.001) levels were significantly higher, while HDL cholesterol (p=0.031) levels were significantly lower in the AVNRT group. Neutrophil leukocyte ratio (NLR) was also higher in the AVNRT group (p=0.034). However, in multivariate analysis, only UHR emerged as an independent predictor for AVNRT (OR: 1.088; 95%CI: 1.022 – 1.159; p=0.008). ROC curve analysis suggested a UHR cut-off > 14.05 for predicting AVNRT with 56% sensitivity and 76% specificity. Conclusion: This study identifies UHR as a promising predictor for AVNRT, shedding light on the potential role of inflammation in the arrhythmia’s development. Utilizing UHR as a readily accessible marker in the evaluation of AVNRT patients may have clinical implications.Öğe Sol ventrikül diyastolik parametlerinin akut koroner sendrom tiplerini ve ciddiyetini öngörme değeri(Bolu Abant İzzet Baysal Üniversitesi, 2017) Demirel, Mustafa Enes; Kama, Nuri AydınAMAÇ Kalp damar sistemi ile ilgili hastalıklar gelişmiş ülkelerde önde gelen ölüm nedenlerindendir. Koroner arter hastalığı da kardiovasküler hastalıklar arasında en yaygın görülen olup yüksek oranda mortalite ve morbidite ile ilişkilidir. Yapılan bazı araştırmalarda koroner arter hastalığı 75 yaş altında görülmeye başlanmakta olup ilk kalp krizi yaşı erkeklerde 65.8 iken kadınlarda 70.4 bulunmuştur. Akut iskemide ilk olarak bozulan ekokardiyografik parametre diyastolik fonksiyon olup sistolik disfonksiyon daha sonra oluşmaktadır. Ekokardiyografide kendini segmenter duvar hareket bozukluğu olarak göstermektedir. Diyastolik fonksiyonlar standart tanısal kriterlere göre normal, bozulmuş relaksasyon, psödonormal ve restriktif patern olmak üzere 4 grupta sınıflandırılmıştır. Çalışmamızda, sol ventrikül diyastolik parametrelerinin, akut koroner sendrom ciddiyetini ve tiplerini öngörmesini değerlendirmeyi amaçladık. MATERYAL METOD Abant İzzet Baysal Üniversitesi Tıp Fakültesi bünyesinde Nisan 2016 – Ocak 2017 tarihleri arasında yerel etik kurul izni ile çalışmaya başlandı. Çalışmaya prospektif olarak hastanemize göğüs ağrısı ile başvuran 60 hasta aldık. Göğüs ağrısı ile başvuran hastaların biyokimya ve kardiyak enzimleri alındı. 12 kanallı EKG çekildi. Kardiyolog tarafından ekokardiyografi ile bakılarak diyastolik fonksiyon evrelemesi yapıldı. Tanısı konulan hastalar ile yapılan ekokardiyografi sonuçları istatistiksel olarak karşılaştırıldı. BULGULAR Çalışmaya alınan hastaların yapılan ekokardiyografisi sonucu 25 hasta normal fonksiyon , 21 hasta uzamış gevşeme evresinde, 7 şer hastada psödonormal ve restriktif paternde diyastolik disfonksiyon olarak evrelenmiştir. Bu hastaların 35 tanesi erkek 25 tanesi kadın hastaydı. Yaş ortalaması 59.9 ( ±13.4 ) idi Hastaların aldıkları tanıya göre 26 hastamız nonspesifik göğüs ağrısı tanısı almıştır. 27 hasta NSTEMİ diğer 7 hastamız ise STEMI tanısı almıştır. Hastalarımızın ekokardiyografik sonuçları ile aldıkları tanılar arasında bir korelasyon kurulamamıştır. SONUÇ Diyastolik parametreler akut koroner sendromların tanı, prognoz ve mortalitesini göstermede bir çok kullanım alanı olmasına rağmen bizim çalışmamızda gruplar arası bir fark bulunamamıştır. Bunun en muhtemel sebebi bazı gruplardaki hasta sayımızın yetersizliği olarak görülmektedir. Anahtar kelimeler : akut koroner sendrom , diyastolik fonksiyon, ekokardiyografiÖğe The way back home: The invisible burden of the emergency healthcare services(Public Library Science, 2024) Demirel, Mustafa Enes; Ozcelik, Aysenur; Bogan, Mustafa; Katipoglu, BurakAmbulance services around the world vary according to regional, cultural and socioeconomic conditions. Many countries apply different health policies locally. In Turkey, transportation from hospital to home has started to form an important part of ambulance services in recent years. The increase in the number of patients whose treatment has been completed and waiting to be referred may hinder the work of the emergency services. The aim of this study was to examine the costs, indications, and impact on workload of patients sent home by ambulance. Patients were divided into two groups according to the reasons for referral. The distance to home, transport time and cost were calculated according to the reasons for transport. Patients who were transferred to other clinics or hospitals by ambulance were excluded from the study. The findings showed that the hospital-to-home transfer rate during the study period was 11.4%. Although 9.7% of all cases transferred from our hospital to home were due to social indications, these cases accounted for 16.26% of the total costs. These results suggest that providing home transport services to selected patient groups for medical reasons should be seen as part of the treatment. However, the indications for home transport should not be exceeded and an additional burden should not be placed on the fragile health service.Öğe What is the role of intoxication cases in the intensive care workload during the pandemic period?(2021) Yüksek, Ahmet; Demirel, Mustafa Enes; Miniksar, Ökkeş HakanThe aim of our study is to examine intoxication cases treated in the intensive care unit during the covid-19 pandemic, to reveal the effect of these cases on the number of intensive care patients and their relationship with the pandemic period. The patient records of the pandemic period and the year before the pandemic were retrospectively reviewed. During the pandemic period, the ratio of intoxication cases to other intensive care patients treated in the same period decreased. Among the intoxication cases, the use of drugs for suicide was increased. The average age of intoxication cases and length of stay in the hospital increased. Although the covid-19 pandemic does not add an additional burden to the workload in intensive care, it has changed the demographics of intoxications.