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Yayın Do the patients referred to the emergency department really deserve an urgent medical intervention?(2019) Akgün, Feride SinemAim: In this study, it was aimed to evaluate the urgency of the patients considering their referral complaints indicated by 112 ambulance service crew and their anamnesis obtained in the emergency department (ED) as well. The evaluation was performed according to the World Health Organization (WHO) - 32 - Emergency Parameters (EP).Material and Methods:This retrospective study was carried out examining the data of all patients brought to our hospital’s ED by the 112-ambulance service between the dates January 05, 2017 and October 31, 2017. Qualitative and quantitative evaluations are based on the WHO-32-EP.Results: Findings: The age of the emergency patients was found to be statistically higher than that of non-emergency patients (p= 0.024). It was observed that 171 patients evaluated according to their referral complaints were not in an urgent condition and that 109 patients evaluated according to their anamnesis obtained in the ED were not in an urgent condition as well. When the relationship between the complaints of the patients at the moment of the referral to the ED by 112 ambulance crew, and their anamnesis obtained in the ED, it was found that 24.6% (n = 99) of these patients were not in an urgent condition. Most of the complaints reported by 112 ambulance crew were not found in the WHO-32-EP (n=170).Conclusion: Awareness-raising training may be useful for 112 ambulance service crews that provide on-site emergency medical care so that they can make accurate decisions about diagnosis and perform accurate initial intervention as well.Yayın Evaluation of neutrophil-to-lymphocyte ratio as a marker of inflammatory response in spondylodiscitis(2018) Doğan, Mustafa; Karaarslan, Numan; Çalışkan, Tezcan; Yılmaz, İbrahim; Ateş, Özkan; Akgün, Feride Sinem; Bilir, BülentAim: Spondylodiscitis, if not diagnosed on time, can cause morbidity or mortality at high rates. This study was carried out with the aim of testing the hypothesis that “neutrophil-to-lymphocyte ratio can be used” especially in cases where it is difficult to diagnose spondylodiscitis.Material and Methods: This study involved 24 patients admitted to the State Hospital of Ministry of Health and Namik Kemal University for spondylodiscitis between January2014 and June2017. After excluding the cases that did not meet the inclusion criteria (n=6), the remaining cases (n=24) were referred to as the study group. A control group was created from healthy volunteers (n=24) who applied for routine physical checkups at the clinic between the same dates and who were similar in terms of age, sex, and body mass index to the study group. Hemogram parameters of the cases in both groups; white blood cell, C-reactive protein, erythrocyte sedimentation rate, and neutrophil-to-lymphocyte ratio were statistically compared.Results: Patients in the spondylodiscitis group, compared to healthy volunteers had statistically significant neutrophil-to-lymphocyte ratio value.Conclusion: Especially in cases where the diagnosis of spondylodiscitis is not assured, the neutrophil-to-lymphocyte ratio parameter, which is less costly than other diagnostic methods and the analysis results of which can be obtained in a shorter time, may be used to support clinical diagnosis.Yayın Evaluation of the admitted forensic cases to the emergency department(2019) Akgün, Feride SinemForensic cases, whereas non-natural factors cause physical or behavioral damages, are mostly seen in the emergency departments (ED) of the hospitals. In this study, we aimed to contribute to the forensic records of our country by examining the demographic characteristics of the forensic cases who were admitted to our ED. Hospital records and forensic reports of the patients who were admitted to ED and accepted as forensic cases between 2014-2017 were retrospectively scanned, and evaluated. Age, gender, the reason for admission and results of the patients were examined. Data were recorded, and statistical analyzes were performed via SPSS v.16.0. A total of 824 forensic cases were admitted to the ED during the study period, and 61% (n = 503) were male. The mean age of the patients was 32,73 ± 15,65 years. Traffic accidents (n = 289; 35%) and occupational accidents (n = 208; 25.2%) were the most common causes of forensic case admissions. While 79.5% (n = 655) of the patients were discharged from the ED, 14.7% (n = 121) were hospitalized while 0.7% (n = 6) of the cases could not be saved despite all interventions. Traffic accidents and occupational accidents are among the most frequent forensic cases in our country, and it should be highlighted that these causes are preventable injuries. At the same time, while the rate of violence and sexual assault has been high all over the world, the reason that our study has no case admissions due to sexual assault and violence should be investigated.Yayın Evaluation of the effect of apixaban on the primary intact intervertebral disc cell cultures(2019) Şimşek, Abdullah Talha; Özbek, Hanefi; Şirin, Duygu Yaşar; Yılmaz, İbrahim; Ateş, Özkan; Akgün, Feride Sinem; Kaplan, NecatiAim: Apixaban is a frequently preferred pharmacological agent in clinics to prevent deep vein thrombosis and pulmonary embolism.Such new oral anticoagulants may cause hemorrhage’s in tissues and/or organs or may cause gastrointestinal symptoms withoutbleeding. It is also reported in the literature that it may lead to mental disorders, unwanted disorders in the urinary tract and skeletalmuscle system. However, when the literature is examined, there are no studies, which are of high-evidential value, evaluating theefficacy of apixaban on healthy, intact intervertebral disc tissue, and matrix-like structures. In this pharmaco-molecular study, itwas aimed to investigate the effects of a new oral anticoagulant agent containing the active ingredient apixaban on the intactintervertebral disc tissue cells, extracellular matrix (ECM) structure and to evaluate its positive and / or negative effects on geneexpressions of cartilage oligo matrix protein (COMP), chondroadherin (CHAD), and Matrix Metalloproteinase (MMP)s.Material and Methods: The primary cell cultures were prepared from the intact tissues of the patients with the traumatic intervertebraldisc herniation. Apixaban was administered to the cultures and molecular analyses were performed for 21 days. The data obtainedfrom the apixaban-administered and non-apixaban-administered samples were evaluated statistically and the significance valuewas accepted as P <0.05.Results: The changes were observed in the cell proliferation and the expressions of the mentioned genes in the apixabanadministered group. The suppression of COMP value and the increase in MMP-13 value may be indicative of the development ofmatrix degeneration in the apixaban-administered group, compared to the non-drug-administered control group.Conclusion: The selectivity is one of the most important features of the drugs. However, it should not be forgotten that no drug willonly produce the desired effect.Yayın Gebelik ve meme kanseri: olgu sunumu(Maltepe Üniversitesi, 2014) Akgün, Feride Sinem; Sezgin, Gülbüz; Kaya, Fatih Öner; Deveci, Uğur; Yener, Arzu Neşe; Çelik, Aygen; Manukyan, Manuk Norayık; Türken, Orhan; Deveci, UğurMeme kanseri gebelik sırasında nadir görülür ancak gebelikte en sık görülen kanserdir. Gebelikte ve laktasyon döneminde oluşan memelerdeki hassasiyet ve büyüme nedeni ile bu dönemde ortaya çıkan bir kitle ve dolayısı ile meme kanserinin tanısı gecikebilir. Kadın doğum, genel cerrahi ve onkoloji kliniklerinin birlikte takip etmeleri gereken bir patolojidir. Gebelikle ilgili meme kanseri terimi, gebelik sırasında ya da gebeliği takiben 1 yıl içinde görülen meme kanserlerini kapsamaktadır. Gebelik ve laktasyonda olan fizyolojik değişiklikler nedeniyle fizik muayene bu hastalarda klinisyen için problem oluşturabilir. Bu dönemde kitle saptanırsa ultrasonografi ve ince iğne aspirasyon biyopsisi yapılarak kitle araştırılmalıdır. Gebelikte meme kanseri tanısı ileri evrelerde konulmaktadır. 25 Yaşında G3P2 olan hasta son gebeliğinin yedinci ayında sağ memesinde gittikçe büyüyen kitle nedeniyle hastaneye başvurmuş. Yapılan meme ultrasonografisinde sağ memede BIRADS 5 kriterlerine uyan kitle tespit edilmiş ve yapılan biyopsi sonucuna göre invaziv duktal karsinom tanısı almıştır. Öncelikle kadın doğum uzmanı görüşü alınıp genel cerrahi tarafından sağ modifiye radikal mastektomi ve aksiller diseksiyon uygulandı. Operasyon sonrası medikal onkoloji ve kadın doğum uzmanlarının takibine alınan hasta 33. gebelik haftasında sezeryanla doğum yaptı ve adjuvan kemoterapi programına alındı.Yayın Gebelikte mide kanseri: olgu sunumu(Maltepe Üniversitesi, 2014) Akgün, Feride Sinem; Kaya, Fatih Öner; Sezgin, Gülbüz; Deveci, Uğur; Yener, Neşe; İlter, Erdin; Manukyan, Manuk Norayık; Türken, Orhan; Deveci, UğurGebelik sırasında mide kanseri oldukça nadir görülmektedir. Gebeliğe bağlı bulantı, kusma ve abdominal ağrı gibi gastrointestinal semptomlar hastalığın tanısını güçleştir¬mektedir. Tanı konduğunda ise hasta ileri evre tümör olarak karşımıza çıkmaktadır ve prognozu olumsuz yönde etkilemektedir. Mide kanserinde erken tanı ve tedavi sağ kalım oranını artırmaktadır. Gebelik sırasında tanı ve tedavisi oldukça güç olan mide kanserinin tedavisinde kadın doğum, genel cerrahi ve medikal onkoloji kliniklerinin ortak çalışmasıyla başarılı sonuçlar alınabilir. Bu çalışmada gebeliğinde hiçbir gastrointestinal şikayeti olmadığı halde ileri evre mide kanseri tespit edilen 39 yaşında bayan hasta sunulmuştur. Hastanın özgeçmişinde 5 yıl önce meme kanseri nedeniyle tedavi gördüğü öğrenildi. Postoperatif dönemde yapılan tetkik ve tedaviler sonrasında tedaviye tam yanıt alındı.Yayın Investigation of the effect of dipyrone on cells isolated from intervertebral disc tissue(Spandidos Publ Ltd, 2019) Akgün, Feride Sinem; Sirin, Duygu Yasar; Yılmaz, Ibrahim; Karaarslan, Numan; Özbek, Hanefi; Simsek, Abdullah Talha; Kaya, Yasin EmreThe present study aimed to evaluate the effects of dipyrone, an indispensable analgesic, anti-pyretic and anti-spasmodic used in emergency departments, on nucleus pulposus and annulus fibrosus cells in vitro. After surgical biopsy, primary cell cultures were prepared from intact intervertebral disc tissues. Dipyrone was administered to the cultures in the experimental groups except for the control group. The data obtained were statistically evaluated. The proliferation was identified to be suppressed via MTT analysis. The gene expression profile of the intervertebral disc cells in the dipyrone-treated groups was significantly changed. The expression of chondroadherin, cartilage oligo matrix protein, interleukin-1 beta and metalloproteinase (MMP)-19 genes were decreased, but MMP-13 and MMP-7 genes expressions were increased, as determined via reverse transcription-quantitative PCR. AO/PI staining revealed that no apoptotic or other type of cell death was detectable after administration of dipyrone does not mean that the drug is innocuous. The occurrence of cellular senescence and/or the halt of cell proliferation may also be important mechanisms underlying the adverse inhibitory effects of dipyrone. Therefore, prior to administering dipyrone in clinical practice, all possible adverse effects of this drug should be considered.Yayın Is r202 q polymorphism related with some atypical inflammatory clinical situations?(İzmir Hastanelerine Yardım ve Bilimsel Araştırmaları Teşvik Derneği, 2019) Akgün, Feride Sinem; Dabak, Reşat; Kaya, Fatih Öner; Sezgin, Gülbüz; Akduman Alaşehir, Elçin; Uygur Bayramiçli, Oya; Nalbant, SelimObjective: To date, especially alterations of genes on exon 10 have beenconsidered in Mediterranean fever (MEFV), but it is not clear whether all thesealterations are disease-causing mutations. This study aims to evaluate theclinical features of the patients with R202Q alteration.Materials and methods: Patients admitted to the emergency department andinternal medicine clinic and diagnosed as Familial Mediterranean Fever (FMF)were included in the study. The medical records of patients with MEFV genemutations were reviewed retrospectively.Results: Total 25 patients with R202Q mutations were obtained. 14 patientshad a classical AAA phenotype with fever and abdominal pain: 10 patients withM694V mutation, and 4 with other mutations. None of the patients with singleR202Q mutation were with the classical FMF phenotype. Patients with singleR202Q mutation showed atypical inflammatory phenotype (4 pericarditis, 1pleurisy, 1 arthritis, 1 psoriatic arthritis). On the other hand, patients withclassical FMF phenotype and with R202Q mutation were with higher colchicineneed and proteinuria.Conclusion: According to our results, R202Q mutation may create a tendencyto inflammation or augment the existing inflammation. However, prospectivecomprehensive studies are needed to further investigate the relationship ofR202Q and clinical findings and severity of the disease.Yayın Systematic Evaluation of Desmopressin Administered to Patients with Aneurysmal Subarachnoid Hemorrhage in the Light of the Literature(Turkish Neurosurgical Soc, 2020) Karaarslan, Numan; Yılmaz, Ibrahim; Akgün, Feride Sinem; Caliskan, Tezcan; Özbek, Hanefi; Ates, ÖzkanAIM: To discuss the management of patients with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) developing after subarachnoid hemorrhage, in a comparative manner in the light of the literature. MATERIAL and METHODS: Without country or language restrictions, articles with high evidential value found in electronic databases were compared to our patients' data. RESULTS: After the literature review, three articles were included for systematic evaluation. Desmopressin was administered to the patients for the treatment of hyponatremia, volume contraction, and negative sodium balance caused by SIADH. However, it was not used for preventing re-bleeding. CONCLUSION: To prevent the development of this complication (SIADH), the use of desmopressin, an analogue of vasopressin, is important in routine clinical practice.
