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    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, Sukru
    Background: 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.
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    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, Derya
    Background: 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.
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    Diagnostic value of tearing pain alone in aortic dissection
    (Mre Press, 2024) Senguldur, Erdinc; Selki, Kudret; Demir, Mehmet C.; Guldal, Hatice
    Severe and sudden chest or back pain that feels like tearing is the most common symptom of aortic dissection. This study aimed to investigate if chest or abdominal pain alone is a marker of aortic dissection and to determine its patient characteristics. This was a retrospective, single-center observational study. It was conducted in the emergency department (ED) of a tertiary university hospital in Turkey. During three years, patients admitted to the ED and underwent contrast-enhanced thoracic and abdominal computed tomography angiography (CTA) were detected through the hospital computer system. Patients with tearing chest or abdominal pain at admission were identified. Patients with and without aortic dissection were compared based on gender, triage code, comorbidity, aortic aneurysm, and one-month mortality. 76.3% (n = 730) out of 957 CTAs were performed due to complaints of tearing chest or abdominal pain. Aortic dissection was detected in 4.5% (n = 33) of patients with tearing pain. Pre-existing aortic aneurysm was statistically significantly higher in the dissection group (p <0.001). When the chest or abdominal pain and CTA findings regarding the presence of aortic dissection were compared, the sensitivity of tearing pain was 84.62%, and the specificity was 24.07%. The positive predictive value of tearing pain was 4.52%, and the negative predictive value was 97.36%. In conclusion, the negative predictive value of tearing pain for aortic dissection was approximately 97%. This severe pain raises the possibility of aortic dissection. However, aortic dissection is only detected in a small percentage of cases in CTAs performed immediately to confirm the diagnosis.
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    EMERGENCY MANAGEMENT AND NURSING CONSIDERATIONS OF CAROTID BLOWOUT SYNDROME
    (Elsevier Science Inc, 2024) Kudu, Emre; Ozdamar, Yasemin; Danis, Faruk; Demir, Mehmet C.; Ilhan, Bugra; Aksu, Nalan Metin
    Introduction: Carotid blowout syndrome is a rare but fatal complication often witnessed secondary to treating patients with head and neck cancer. It occurs when damage and necrosis lead to the carotid artery wall rupture. The symptoms encountered in these patients range from asymptomatic to cardiac arrest. Here, we present 5 cases of carotid blowout syndrome in the emergency department. Case Presentations: Patients demonstrated symptoms ranging from subtle bleeding to hemodynamic instability, highlighting the diverse nature of carotid blowout syndrome in this population. Notably, while all patients had a history of radiotherapy, some had additional risk factors for carotid blowout syndrome, including prior surgery (n = 2), malnutrition (n = 3), and tracheostomies (n = 2). Definitive diagnoses were established through clinical evaluation and computed tomography angiography. Immediate interventions included bleeding control, resuscitation, and consultations with relevant specialties. Four patients underwent interventional radiology procedures, and 1 patient received otolaryngology care. While 2 patients recovered completely, 1 died in the emergency department, and 1 in the intensive care unit. One patient's clinical course was complicated by a stroke. Conclusion: The approach to the carotid blowout syndrome patient includes complex steps that proceed in a multidisci- plinary manner, starting from triage until discharge. Emergency nurses play crucial roles at every stage. They should be aware of carotid blowout syndrome when evaluating patients with head and neck cancer presenting with bleeding. When treating these patients, emergency nurses should be ready for airway in- terventions, bleeding control, and massive transfusion protocol. In this context, the multifaceted approaches made by nurses contribute significantly to carotid blowout syndrome manage- ment in the emergency department.
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    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, Nevin
    Background: 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.
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    Impact of inter-visit duration on mortality in older adults who use emergency department frequently
    (Mre Press, 2024) Demir, Mehmet C.; Selki, Kudret; Senguldur, Erdinc
    The incidence of older adults presenting to the emergency department (ED) is increasing, and assessing their potential mortality risk for those returning frequently to the ED remains important. This study aims to evaluate the effects of frequent ED visits and the interval between these visits on the mortality of older adults.We retrospectively assessed the data of patients aged 65 years and above who frequently visited an academic ED in Turkey in 2021 and divided them into two groups: ED-frequent users (FUs) (4-7 visits) and ED-highly frequent users (HFUs) (>7 > 7 visits), following which we compared their characteristics, inter-visit duration, and 6-month mortality. The results indicated that out of the 2947 ED visits, 516 older adults were identified who visited the ED at least four times, averaging 5.7 visits per patient. HFUs constituted approximately 12% (n = 61)of the cohort. Further analysis revealed a significant increase in mortality associated with shorter inter-visit duration between ED visits (p p < 0.001). Specifically, visiting the ED at intervals shorter than 74 days was associated with a fourfold increase in mortality risk (odds ratio (OR): 3.84; 95% confidence interval (CI): 2.64-5.57; p < 0.001), which escalated to sixfold in patients with a history of recent hospitalization (OR: 5.87; 95% CI: 3.81-9.07; p < 0.001).The data indicated that most older adults with frequent ED visits had multiple comorbidities, and those who did not survive were significantly older. This study highlights the important need to acknowledge the increased mortality risk among older adults with frequent ED visits, with recent hospitalization and short inter- visit duration being contributing factors.
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    Platelet Indices' Usefulness in Determining whether Patients with COVID-19 Should be Treated as an Outpatient or Inpatient: a Retrospective study
    (Clin Lab Publ, 2021) Polat, Esra; Demir, Mehmet C.
    Background: Coronavirus disease 2019 (COVID-19) has affected the health system around the world. It is necessary to facilitate health care services with useful parameters in patient follow-up. In this study, we wanted to determine whether platelet indices can be used as an assistant parameter in the clinician's decision-making process regarding which of the patients diagnosed with COVID-19 should be treated by hospitalization. Methods: This retrospective study was performed in a secondary care hospital in Mugla, Turkey. Demographic information such as age, gender, and comorbidities of patients admitted to the emergency pandemic outpatient clinic within five months and diagnosed with COVID-19, as well as discharge, hospitalization, or intensive care needs (ICU), and thirty-day mortality were noted. Also, patients with platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), thrombocytocrit (PCT), MPV/PLT, MPV/PCT, PDW/PLT, PDW/PCT values for outpatient follow-up, hospitalization, intensive care unit need, and 30-day mortality relationships were examined. Results: A total of 93 patients diagnosed with COVID-19 were included in the study. It was observed that those with comorbidity had a statistically significant higher rate of hospitalization (p = 0.013). No statistically significant difference was found between outpatients and inpatients in terms of PLT, MPV, PDW, PCT, MPV/PLT, MPV/PCT, PDW/PLT, and PDW/PCT (p > 0.05 for each). Conclusions: Platelet indices such as PLT, MPV, PDW, PCT, MPV/PLT, MPV/PCT, PDW/PLT, and PDW/PCT are not useful parameters for the clinician to distinguish between outpatient and inpatient treatment of patients with COVID-19.