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Öğe Acil Serviste Çocuklarda Düşme Olgularının Yönetimi: 261 Çocuk Olgunun Analizi(Kırıkkale Üniversitesi, 2021) Demirel, Mustafa Enes; Akpinar, GuleserAmaç: Çocuklarda düşme, acil servisler üzerinde önemli bir yük oluşturmakta ve hastanede kalış süresinde uzama ile artan maliyetler gibi olumsuz sonuçlara neden olabilmektedir. Bu çalışmanın amacı, bir acil serviste çocuklarda düşme olgularının yönetim sonuçlarının değerlendirilmesidir.Gereç ve Yöntemler: Düşme kaynaklı yaralanma nedeniyle acil servisimize başvuran pediatrik hastalar; yaş ve cinsiyet gibi demografik veriler, Glasgow Koma Skalası, Injury Severity Score skorları, başvuru zamanları, yaralanma bölgesi, tanı, konsülte edilen bölüm, yatış verilen bölüm, hastanede kalış süresi ve maliyetler açısından değerlendirilmiş ve analiz edilmiştir. Acil servisteki ilk yönetim sonrasında gerekli görülen hastalar diğer bölümlerle konsülte edilerek sevk edilmiştir.Bulgular: Çalışmaya 261 çocuk dahil edildi. Başvurular en sık yaz mevsiminde, Ağustos ayında ve Cumartesi günleri yapılmıştır. Çocuklarda en sık konulan tanılar kırık ve yumuşak doku hasarıdır. En sık yaralanan vücut bölgeleri baş-boyun bölgesi ve ekstremitelerdir. En sık konsültasyon yapılan bölümler beyin ve sinir cerrahisi ile ortopedi ve travmatolojidir. Toplam 101 çocuğa (%38.7) yatış verilmiştir. Hastaların medyan Injury Severity Score değeri 3 ve medyan Glasgow Koma Skalası değeri 15 (8-15) olarak bulunmuştur. Medyan tedavi maliyeti 278.8? olarak saptanmıştır. Medyan hastanede kalış süresi 31 (çeyrekler arası aralık, 21-63.5) (çeyrekler arası aralık için 2 sayısal değer verilmeli) saattir. Hastanede kalış süresi ile maliyetler arasında güçlü bir pozitif ilişki saptanmıştır (r=0.629, p<0.001).Sonuç: Çocuk yaş grubu düşmeye bağlı yaralanmalar, acil servisin iş yükünü artıran, sağlık sistemi ve toplum için önemli bir yük oluşturan ve maliyeti artıran yaygın olaylardır. Elde ettiğimiz sonuçlar, beklendiği gibi kalış süresi ile tedavi maliyetleri arasında çok güçlü bir ilişki olduğunu göstermektedir.Öğe Characteristics of pediatric injuries due to road traffic accidents and their effects on mortality(Selçuk BAŞAK, 2021) Akpinar, GuleserBackgroundAim: Road traffic accident (RTA)-related injuries may cause morbidity and mortality in childhood. We aimed to investigate these injuries in terms of affected body regions, time of the accident, gender, and age, determine the factors affecting mortality, and evaluate the casualties' demographic features and discharge status. Methods: This retrospective cohort study included patients aged under 18 years who were victims of RTAs and presented to the emergency department of our tertiary university hospital between 01/01/2015 and 31/12/2019. Patients' age, gender, time, and mechanism of the accident, affected body region, type of injury, and clinical outcomes were recorded and analyzed. Results: A total of 137 pediatric patients met the inclusion criteria, among which 95 (67.2%) were males, and 42 (32.8%) were females. Five of the six patients who died were males. RTAs most occurred in summer (45.3%), in August (17.5%) and on Saturdays (25.5%). Among the affected systems, extremity injuries ranked first (36.5%), and head traumas ranked second (30.7%). Conclusion: In our study, presentations with out of vehicle traffic accidents (OVTAs) (motorcycle, bicycle, agricultural vehicle, or pedestrian) were more common (75.1%). Pediatric RTAs caused many injuries, especially extremity traumas, which were more serious in children under 15 years of age. In these patients, intracranial hemorrhage, rib fractures, and liver lacerations were evaluated as more severe injuries. Because of the limited number of the cases, we could not investigate the effects of traffic accidents on child mortality.Öğe Comparison of Clinical, Laboratory and Demographic Characteristics of Patients Diagnosed with COVID-19 as Symptomatic and Atypical Symptoms(Clin Lab Publ, 2021) Akpinar, Guleser; Demir, Mehmet C.; Sultanoglu, Hasan; Unlu, Elif N.; Oksuz, SukruBackground: Clinical findings of COVID-19 have been observed with a wide spectrum ranging from asymptomatic disease and mild upper respiratory tract infection to severe viral pneumonia resulting in mortality. While clinical symptoms present in some COVID-19 patients, others have been incidentally identified. The objective of this study was to examine the clinical and laboratory features of patients diagnosed with COVID-19 who were symptomatic or had atypical symptoms and to make a contribution to the literature. Methods: Patients with the likelihood of having COVID-19 pneumonia were evaluated with RT-PCR samples, other laboratory tests, and chest computed tomography. Results: There were significant differences between these groups in terms of age, dyspnea, saturation, and comor-bidities including hypertension [HT] in 19 patients, cerebrovascular events [CVE] that were classified as other diseases in two patients (intracranial mass in one patient and Alzheimer's disease in one patient), and CRP and platelet counts (PLT) among the laboratory parameters (for all p < 0.05). Conclusions: Atypical symptoms have increased due to the progression of the outbreak. Infected people with atypical symptoms can act as sources of the infection. Therefore, the epidemiological history of these patients should be sought in detail, and individuals with atypical symptoms in society should be identified as soon as possible in order to control the spreading of the disease.Öğe The Demographic Analysis of the Probable COVID-19 Cases in Terms of RT-PCR Results and Age(Clin Lab Publ, 2021) Akpinar, Guleser; Demir, Mehmet C.; Sultanoglu, Hasan; Sonmez, Feruza T.; Karaman, Kivanc; Keskin, Banu H.; Guclu, DeryaBackground: Despite global prevention and quarantine efforts, the incidence of COVID-19 disease continues to increase. As a possible cause, our aim was to investigate which parameters increase the sensitivity or protection against COVID-19 between RT-PCR positive and RT-PCR negative cases in patients admitted to the emergency department. Methods: In the pandemic process, patients admitted to the hospital with suspicion of COVID-19 were evaluated retrospectively. RT-PCR test was divided into + (for Group 1) and - (Group 2). The gender, age, clinical information, application symptoms, and comorbidity data of the patients were evaluated. Results: One hundred and sixty-seven cases were evaluated in the study. Group 1: 88 cases, M/F ratio: 46/42 and average age 48 +/- 17.3 years, Group 2: 79 cases, M/F ratio was approximately 3/2, and the average age was 48.3 +/- 19.4 years. When the groups were compared in terms of symptoms, fever, cough, weakness, and headache were prominent in Group 1, whereas the contact was significantly higher in Group 2 (p < 0.05). Among the comorbid diseases, only COPD showed a significant difference between the groups, and it was found significantly higher in Group 2 (p < 0.05). Conclusions: Cough, headache, and fever were found valuable in the detection of cases. Attention should be paid to contact isolation to circumvent the pandemic process with less damage. Having chronic diseases, especially COPD, increases the risk of infection with SARS-CoV-2. Close monitoring and control of chronic diseases can positively change the course of COVID-19.Öğe Endogenous Carboxyhemoglobin Concentrations in Predicting Prognosis of Patients with COVID-19 Pneumonia(Clin Lab Publ, 2021) Demir, Mehmet C.; Akpinar, Guleser; Sultanoglu, Hasan; Yildiz-Gulhan, Pinar; Caliskan, Emel; Guclu, Derya; Ince, NevinBackground: The coronavirus disease 2019 (COVID-19) outbreak has caused great difficulties in providing healthcare services worldwide. Accurate and useful indicators are needed for the effective use of resources. Carbon monoxide (CO) is also produced endogenously without exogenous exposure. Studies confirm that endogenous CO increases in conditions such as pneumonia, sepsis, and trauma. This study aimed to compare patients diagnosed with COVID-19 pneumonia and healthy people to reveal whether endogenous carboxyhemoglobin (COHb) levels differ. It was also to determine whether it could be a helpful indicator for the clinician in predicting disease severity in combating the COVID-19 pandemic. Methods: The study included 72 patients admitted to the hospital during the COVID-19 pandemic and diagnosed with COVID-19 pneumonia and a control group of 75 healthy people. The research data was collected retrospectively in a tertiary emergency department. The patients' demographic data, pneumonia severity index (PSI) score, CURB-65 score, 30-day mortality, hospitalization, need for mechanical ventilation (MV), and COHb levels were recorded. Results: While the COHb level was 0.9% (min-max, 0.1 - 4.0) in patients with COVID-19 pneumonia, it was 1% (min-max, 0.1 - 2.6) in the control group. No significant difference was found between the patients and the control group in terms of COHb levels (p = 0.341). Also, there was no correlation between COHb levels and PSI and CURB-65 scores. No significant difference was detected between COHb levels and patients diagnosed with COVID-19 pneumonia in terms of mortality, need for MV, or hospitalization (p > 0.05). Conclusions: We concluded that COHb levels alone could not be used to diagnose COVID-19 pneumonia or predict disease severity. Besides, in COVID-19 pneumonia, the COHb level was not a useful indicator of mortality, need for MV, or hospitalization decision. Further studies are needed to find useful indicators to assist clinicians in their decision-making process in tackling the COVID-19 pandemic.Öğe Evaluation of the effect of patient position in the management of chronic heart failure patients presenting with dyspnea(Selçuk BAŞAK, 2021) Akpinar, Guleser; Topacoglu, HakanBackground/Aim: One of the pathomechanisms of congestive heart failure is inadequate cardiac load, and one of the physiological ways to reduce cardiac load is to decrease venous return. Based on this mechanism, we aimed to reduce venous return and alleviate cardiac load in patients by drooping their legs. In this study, we aimed to evaluate the impact of leg position on patients' comfort and treatment, emphasize that patient position is valuable enough to be included in the treatment algorithm, and determine the effects of the patient sitting with legs hanging down position in an armchair (sitting position), or upright with the straight knees position on a stretcher with the stretcher’s head at 90°C (high Fowler's position) on the patient's perception of dyspnea in chronic heart failure (CHF). Methods: Patients over 18 years of age, followed-up with CHF diagnosis who presented to the emergency department (ED) with dyspnea were included in this case control study. The participants were divided into high Fowler's and sitting groups. According to the Visual Analog Scale (VAS) scoring, patients were asked to point to the severity of dyspnea. Patients’ vital signs, 30-day mortality, and VAS scores were recorded at the 0th, 15th, 30th, and 60th minutes. Results: A total of seventy-four patients were included in the study. Thirty-eight patients in the high Fowler’s group, and thirty-six patients in the sitting group were treated. VAS started to decrease significantly at 15 minutes in sitting position. Although baseline VAS scores were higher at sitting than at the high Fowler’s position, the end of the 60th minute VAS scores and respiratory rate were significantly lower in the sitting group (P=0.016, and P=0.008, respectively). The mortality rate was significantly higher in the high Fowler’s group (P=0.028). Conclusions: We concluded that patient position plays a vital role in patients' perception of dyspnea and mortality in the acute treatment of CHF patients presenting with dyspnea. Perception of dyspnea disappears earlier, and mortality is lower in the sitting position.Öğe Pediatric firearm injuries: A 5 year single-center experience(Bayrakol Medical Publisher, 2020) Akpinar, Guleser; Demir, Mehmet CihatAim: Firearm-related injuries are causes of severe morbidity and mortality among pediatric injuries. An average number of pediatric firearm violence incidents for the USA is about 20 000 annually. In this study, we aimed to evaluate firearm injuries in the pediatric population. We aimed to contribute to national data on firearm violence characteristics. Material and Method: In total, eleven patients admitted to the emergency department during a 5-year period with firearm injury were evaluated. The Glasgow Coma Scale (GCS), Injury Severity Score (ISS), injured body part, consulting knowledge, hospital stay duration, and the healing and mortality rates of the patients were described. Results: The majority of the victims were male (n=8, 72.7%), the average age was 12.7 years, the average GC and IS scores at the presentation were 14.6 and 27.45, respectively. The cause of rime was not reported in a significant number of the cases (n8, 72.7%), and extremities were the most wounded area. No mortality was reported in the study. Discussion: Firearm injuries are one of the common medicolegal issues. Because of violence in society, children may frequently be subjected to firearm injuries during incidents of crossfire, peer violence, and family conflicts. To date, there is limited information on short-term clinical outcomes and resource utilization in pediatric patients who sustain a firearm injury. Firearm-related injury is a life-threatening emergency that contributes to 0.3% of the total pediatric mortality in childhood for our country. Evaluation of firearm violence characteristics will lead to a better understanding of the incidences and will aid in establishing preventive policies.
