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Öğe An Aortic Abscess Associated with Psoas Abscess: A Case Report(Emergency Medicine Physicians Assoc Turkey, 2023) Selki, Kudret; Demir, Mehmet Cihat; Bogan, MustafaIn this article, we report a case in which a psoas abscess opened into the aneurysmatic abdominal aorta, and abscess formation was observed in the aortic lumen containing a stent. A 57-year-old male patient presented to the emergency department with a complaint of abdominal pain. During the abdominal examination of the patient, tenderness and defense were detected in the right lower quadrant. Contrast-enhanced computed tomography (CT) angiography of the abdominal aorta was ordered because the patient had a history of previous stenting and right lower quadrant deficiency. In the right iliopsoas muscle, there was an increase in size suggestive of abscess formation with air densities. The diameter of the ascending aorta was 44 mm. At the level of the descending thoracic aortic bifurcation, an aneurysmatic appearance was noted in a segment of approximately 140 mm extending to the proximities of both main iliac arteries, and USG showed air in the wall in the aneurysmatic section and mural wall thickening with thrombus. In this case, although the abscess eroded the aneurysmatic aortic wall, acute bleeding did not develop due to the presence of a stent. We wanted to share the rare image on computed tomography (massive air-fluid level around the stent in the aortic lumen), especially in our case with the medical literature.Öğe Applicability of 3.0 T MRI images in the estimation of full age based on shoulder joint ossification: Single-centre study(Elsevier Ireland Ltd, 2020) Altinsoy, Hasan Baki; Gurses, Murat Serdar; Bogan, Mustafa; Unlu, Nisa ElifSkeletal maturity is evaluated by many radiological methods for forensic age estimation. Direct radiography and computed tomography lead to a rise in ethical concerns due to radiation exposure. Therefore, magnetic resonance imaging (MRI) has currently been used in recent studies. In this study, the ossification stage of the shoulder joint was determined retrospectively in 178 male and 109 female individuals in the age group 12 to 30 years using 3.0 T MRI. All the images were evaluated with T1-weighted turbo spin echo (T1 TSE) sequence and T1 fast low angle shot two-dimensional sequence (T1 FL2D). The combined staging method, which was defined by Kellinghaus et al. and Schmeling et al., was used. The infra- and inter-observer agreement levels were very good (kappa and kappa(w)). There were no significant age differences between males and females in all stages. In most of the stages, the ossification of the proximal humeral epiphyses occurred earlier in females than in males. Stage 4 did not occur in either of the sexes before the 18th birthday as the youngest patients in this stage was at 19 and 18 years of age in males and females, respectively. We concluded that evaluating the ossification of the proximal humeral epiphysis with MRI imaging for forensic age estimation may be beneficial. Evaluating the same anatomical structure with different MRI sequences may be useful for accurate staging diagnosis.Öğe Effect of parental pressure on emergency physicians for computerized tomography imaging request in children with head trauma(W B Saunders Co-Elsevier Inc, 2021) Bogan, Mustafa; Sabak, Mustafa; Oktay, Murat; Gumusboga, Hasan; Aykol, EmineBackground: Both minor and major head traumas constitute an important proportion of childhood emergency admissions. In this study, the findings of cranial computed tomography (CCT) scans performed as a result of the parental pressure were evaluated. Methods: The frequency and findings of CCT scans performed as a result of parental pressure were examined in a separate subgroup. Results: A total of 227 patients were included in the study; 158 (69.9%) patients had undergone CCT scans; a pathological finding was detected in 24 (10.6%) of these patients and undergone a consultation by the neurosurgeon (most common finding was isolated linear fracture; n = 12; 50%). The patients undergoing CCT scans were divided in two subgroups: the PECARN group [n = 123 (77.8%)] and the Parental pressure group [n = 33 (22.2%)]. Conclusion: One third of the parents of children who presented to the emergency department with head trauma and had no indication for CCT according to PECARN rules insisted on CCT imaging, and none of these cases showed ciTBI, surgical operation, or mortality. None of the patients in the parental pressure group had a history of surgical intervention or mortality within one month after discharge. (c) 2020 Elsevier Inc. All rights reserved.Öğe The effects of desert dust storms, air pollution, and temperature on morbidity due to spontaneous abortions and toxemia of pregnancy: 5-year analysis(Springer, 2021) Bogan, Mustafa; Al, Behcet; Kul, Seval; Zengin, Suat; Oktay, Murat; Sabak, Mustafa; Bayram, HasanEpidemiological studies have suggested an association between particulate air pollution, increased temperatures, and morbidity related to pregnancy outcomes. However, the roles of desert dust storms and climatological factors have not been fully addressed. The objectives of the present study were to investigate the association between desert dust storms, particulate matter with a diameter <= 10 mu m (PM10), daily temperatures, and toxemia of pregnancy and spontaneous abortion in Gaziantep, South East Turkey. The study was conducted retrospectively at emergency department of two hospitals in Gaziantep city. Data from January 1, 2009, to March 31, 2014, were collected. Patients, who were diagnosed with toxemia of pregnancy and spontaneous abortion by radiological imaging modalities, were included in the study. Daily temperature ranges, mean temperature values, humidity, pressure, wind speed, daily PM10 levels, and records of dust storms were collected. A generalized additive regression model was designed to assess variable effects on toxemia of pregnancy and spontaneous abortion, while adjusting for possible confounding factors. Our findings demonstrated that presence of dust storms was positively associated with the toxemia of pregnancy both in outpatient admissions (OR=1.543 95% CI=1.186-2.009) and inpatient hospitalizations (OR=1.534; 95% CI=1.162-2.027). However, neither PM10 nor maximum temperature showed a marked association with spontaneous abortion or toxemia of pregnancy in our study population. Our findings suggest that desert dust storms may have an impact on the risk for adverse pregnancy outcomes such as toxemia of pregnancy. Health authorities should take necessary measures to protect pregnant women against detrimental effects of these storms.Öğe Evaluation of the diagnostic value of platelet indices in pediatric acute appendicitis(Sage Publications Ltd, 2020) Oktay, M. Murat; Bogan, Mustafa; Colak, Selcan Turker; Sabak, Mustafa; Gumusboga, Hasan; Eren, Sevki HakanObjective Abdominal examination findings in pediatric acute appendicitis (AA) significantly vary by age. Therefore, grading systems have been developed for diagnosing pediatric appendicitis, and laboratory and radiological findings have an important role in this diagnosis. However, there is a need to develop new parameters for diagnosing AA. This study aimed to investigate the diagnostic value of platelet indices in AA. Methods This retrospective, observational study included 207 pediatric patients who were admitted to the Emergency Department and operated on for AA. The patients were divided into three groups on the basis of their surgical and histopathological findings (non-AA, uncomplicated AA, and complicated AA). Results There was no significant difference in the mean platelet volume/platelet count (MPV/PC) ratio among the groups. The white blood cell (WBC) count and the MPV/PC ratio showed a significant negative relationship (r = -0.239). The specificity for MPV was 61.8% and the sensitivity was 68.8%. Receiver operating curve analysis of WBC and MPV showed significance for diagnosing AA. Conclusion There is a negative, but weak, relationship between the WBC count and the MPV/PC ratio. However, the MPV/PC ratio could be a useful parameter for diagnosing pediatric AA according to receiver operating curve analysis.Öğe Impact of desert dust storms, PM10 levels and daily temperature on mortality and emergency department visits due to stroke(Frontiers Media Sa, 2023) Oktay, M. Murat; Al, Behcet; Bogan, Mustafa; Kul, Seval; Gumusboga, Hasan; Bayram, HasanObjective: It is known that the inhalation of air pollutants adversely affects human health. These air pollutants originated from natural sources such as desert storms or human activities including traffic, power generating, domestic heating, etc. This study aimed to investigate the impacts of desert dust storms, particulate matter <= 10 mu m (PM10) and daily maximum temperature (MT) on mortality and emergency department (ED) visits due to stroke in the city of Gaziantep, Southeast Turkey. Method: The data on mortality and ED visits due to stroke were retrospectively recruited from January 1, 2009, to March 31, 2014, in Gaziantep City Centre. Results: PM10 levels did not affect ED visits or mortality due to stroke; however, MT increased both ED visits [adjusted odds ratio (OR) = 1.002, 95% confidence interval (CI) = 1.001-1.003] and mortality (OR = 1.006, 95% CI = 0.997-1.014) due to stroke in women. The presence of desert storms increased ED visits due to stroke in the total population (OR = 1.219, 95% CI = 1.199-1.240), and all subgroups. It was observed that desert dust storms did not have an increasing effect on mortality. Conclusion: Our findings suggest that MT and desert dust storms can induce morbidity and mortality due to stroke.Öğe Pagophagia-Induced Hyponatremia: An Unusual Case(Knowledge E, 2023) Akbaba, Aydanur; Bogan, Mustafa; Karakecili, Ceren; Bogan, Fatma; Sultanoglu, HasanHyponatremia occurs when the serum sodium level is below 135 mmol/L. The symptoms include nausea, vomiting, confusion, headache, cardiorespiratory symptoms, profound somnolence or coma, and seizures are observed. Iron deficiency anemia can also cause pagophagia, a Pica subspecies. Although it has been emphasized that electrolyte disturbance may develop due to pagophagia, only a dearth of cases was reported. A 59-year-old male patient was brought to the emergency department with complaints of incoherent speech that started at night, disorientated movements (such as fluttering and climbing), insomnia, restlessness, and confusion. In 2017, he experienced hyponatremia due to pagophagia and a salt-free diet. At the index episode of hyponatremia, he experienced confusion, drowsiness, and sleepiness. It was learned that the patient enjoyed these symptoms.For this purpose, the patient made a habit of eating a completely salt-free diet and consumed plenty of water. Although pagophagia is considered to cause hyponatremia because it causes excessive water intake, there are not enough cases reported. It is to be noted that people develop habits or addiction to things they like.Öğe Retrospective study on suicide attempts among psychiatric emergencies admitted to the emergency department of a Regional hospital in Turkey(Springer, 2024) Bogan, Mustafa; Bekircan, Esra; Bogan, Fatma; Kara, Neslihan; Kara, Ali CanIntroductionThe aim of this study was to determine the sociodemographic characteristics of psychiatric emergencies presenting to emergency departments (ED), the provisional diagnoses and reasons for consultation by emergency physicians, and to determine the rate of suicide attempts among patients presenting to emergency departments for psychiatric emergencies.MethodsThe records of all patients aged 18 years and older admitted to the emergency department of the Department of Emergency Medicine, a tertiary hospital, with either a pre-existing psychiatric diagnosis or a new psychiatric provisional diagnosis made by emergency physicians between January 2020 and December 2023 were reviewed.ResultsAccording to the data obtained in the study, it was determined that the most common provisional diagnoses made by emergency physicians in psychiatric emergencies were suicide attempts (41.88%), agitation (21.94%), schizophrenia (8.44%), psychosis (7.91%) and manic attack (6.54%). It was found that 49.3% of psychiatric emergencies resulted in discharge and 25.5% resulted in hospitalisation. Among the provisional diagnoses, depression, mutism and sleep disorders were most commonly associated with refusal of treatment, while depression and suicide were the most common reasons for hospitalisation. Among psychiatric emergency patients who attempted suicide, medication, sharp objects and chemicals were the most common substances ingested.DiscussionIn this study, it was determined that a great portion of the emergency psychiatric cases admitted to the emergency department consisted of patients who attempted suicide. However, due to the crowdedness and fast pace of emergency departments, it is understood that in psychiatric emergencies, epidemiological profile data are missing in the files of the cases and detailed medical history cannot be obtained from the patients We think that recording better data of patient who admitted a psychiatric condition to the emergency department will provide better information about the patients in future visits and improve the care to be provided. Psychiatrists and psychiatric nurses recommend the implementation of emergency department-based rehabilitation programs for these patients. Psychiatric emergencies presenting to emergency departments should not be overlooked in terms of suicide risk.Psychiatric emergencies who have attempted suicide should be closely followed at frequent intervals.Emergency department staff should be educated about psychiatric emergencies and suicide risk.Öğe Smartphone evaluation of postero-anterior chest x-rays: An inter-observer study(W B Saunders Co-Elsevier Inc, 2021) Bogan, Mustafa; Altinsoy, Hasan Baki; Karadag, MehmetBackground: Posterior-anterior chest x-ray (PA-CXR) is among the most commonly used imaging methods in the diagnosis both in the emergency departments (ED) and the other clinics. The aim of the present study was to evaluate the diagnostic reliability of PA-CXRs sent via a smartphone. Methods: This study was conducted as an inter-observer study. PA-CXRs were photographed with a smartphone and they were sent to two separate participants (emergency medicine specialists one with 4 years experience and another with 3) via the WhatsApp application. And the participants evaluated to these images on their mobile phone. Results: A poor concordance was determined in a ratio of 3/8 and good concordance was detected in a ratio of 3/8 between the two participants (p < 0.05). It was observed that only the mediastinum assessments could be an alternative to the gold standard (p < 0.01). Conclusion: We may conclude that the assessments done via a smartphone (photographing and sharing) may not be reliable. (C) 2020 Elsevier Inc. All rights reserved.Öğe Using Smartphone to Evaluate Cranial Computed Tomography Videos: An Inter-Observer Study(Duzce Univ, Fac Medicine, 2022) Naldemir, Ibrahim Feyyaz; Karaman, Ahmet Kursat; Altinsoy, Hasan Baki; Bogan, Mustafa; Karadag, MehmetObjective: Many clinicians receive Cranial Computed Tomography (CCT) images or videos by their smartphone. The aim of this study was to evaluate the reliability of the CCT videos that are shared through smartphone in the diagnosis. Methods: The CCT videos that were sent via WhatsApp were examined in 9 sections: soft tissue, bone structure, parenchyma, ventricle, vascular structures, middle ear, orbits, sinuses and the extra axial space. Results: The CCT videos were analyzed in 9 sections; there was a perfect agreement among specialists in one of these sections, good agreement in 6 and poor agreement in 2. When compared with the gold standard, it was shown that 5 out of 9 sections could be an alternative to the gold standard. Conclusions: It may be thought that evaluation of the CCT videos can be obtained with messenger applications such as WhatsApp, which is a cheap, fast and common application. But this study shows that diagnostic images and videos shared through the smartphone by a messenger application can not be an alternative to standard evaluations.Öğe 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.
