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Öğe A retrospective clinical trial on nasal bone fractures admitted to a level three emergency room(Annals of Medical Research, 2020) Çayır, Serkan; Mutlu, Hüseyin; Sert, Ekrem TahaAim: The anatomical location and protruding structure of the nasal bone can easily lead to fracture as a result of trauma. The high incidence rates have emphasized that the causes, treatments, and complications of these fractures should be investigated. The purpose of this study is to investigate our treatment modalities and complications by reviewing the current information about such fractures. Material and Methods: A total of 582 patients presented with nasal bone fractures between January 2014 and December 2019 were retrospectively analyzed. Examination findings, patient records, and radiological examinations of fractures were analyzed in detail. Results: The age of the patients was between 2 and 83 years (mean age: 33.9 ± 6.11 years). The study included 451 (77.5%) males and 131 (22.5%) females. The most common etiologic factor was assault (35.7%). The most common postoperative complications included deformity (53 patients; 9.1%), nasal congestion (41 patients; 7.1%), and smell disorders (5 patients; 0.9%), with the complications increased with the severity of fracture. Conclusion: Reduction procedures are successfully performed within the first 2 weeks following nasal fractures, and if there is a suspicion of causing deformity in patients under observation, necessary surgical interventions should be performed.Öğe Acil servisimize başvuran hastaların 5 yıllık analizi(Muğla Sıtkı Koçman Üniversitesi, 2021) Sert, Ekrem Taha; Mutlu, Hüseyin; Yeşildağ, Kerim; Kokulu, Kamil; Sarıtaş, AyhanAcil servise başvuran kritik hastalıkların özelliklerinin bilinmesi, en kısa sürede tanı alması ve doğru tedavilerinin başlamasında hayati öneme sahiptir Çalışmamızda acil servise başvuran hastaların demografik ve klinik özelliklerini incelemeyi amaçladık. Ocak 2015 ile Aralık 2019 tarihleri arasında hastanemiz üçüncü basamak acil servisine başvuran tüm erişkin ve çocuk hastalar retrospektif olarak değerlendirildi. Hastaların demografik özellikleri, hastalık tanıları ve yıllara göre başvuru oranları değerlendirildi. Acile servise beş yıl içerisinde başvuran hasta sayısı 2.254.302 olarak tespit edildi. Hastaların %50.9’u erkek ve %49.1’i kadındı ve yaş gruplarına göre başvuru sıklığı değerlendirildiğinden yoğun grubun %26.73 ile 10 yaş ve altı olduğu görüldü. En çok başvuru %51 ile 16:00-24:00 saatleri arasında idi. Hastaların en sık solunum sistemi problemleri(%24,71) ile acile başvurduğu tespit edildi. Acil servise başvuran hastaların %2.24’ü ilgili bölümlere, %0.77’sinin ise yoğun bakım ünitesine yatırıldığı tespit edildi. Acil servislere başvuru oranının yüksek olması beraberinde aşırı hasta yoğunluğuna neden olmaktadır. Acil servise başvuran hasta profilinin belirlenmesi, verilecek hizmet sunumu ve hasta bakım kalitenin artırılmasında faydalı olacaktır.Öğe An effective treatment option for pain caused by urolithiasis: A randomised-controlled trial of local active warming with heat-patch(Blackwell Publishing Ltd, 2021) Mutlu, Hüseyin; Ertaş, Kasım; Kokulu, Kamil; Sert, Ekrem Taha; Diri, Mehmet Akif; Gül, MuratBackground: There is growing interest in physical medicine treatment options for renal colic. In this study, we aimed to determine whether or not heat-patch treatment with no drug was effective in relieving renal colic. Methods: For this purpose, patients who were diagnosed with renal colic in the emergency department were randomised to have either heat-patch or sham treatment. The Visual Analogue Scale (VAS) scores of renal colic, body temperature (Btemp), and sub-patch skin temperature (Stemp) values were measured at 0, 15, 30, 45, and 60 minutes. In addition, the salvage treatment needs of the groups were compared. Results: The average age of the study group was 30.5 ± 8.3 years and that of the sham group was 31.0 ± 8.2 years (P =.75). According to the baseline VAS score of the patients, 15, 30, 45, and 60 minutes VAS scores significantly decreased in the heat-patch group (P <.001). The Btemp values did not differ significantly between the heat-patch and sham groups. In addition, no statistically significant difference was found between the two groups in terms of Stemp values at 0 and 15 minutes (P =.39 and P =.10, respectively). However, there was a significant difference in the heat-patch group in terms of Stemp values at 30, 45, and 60 minutes compared with the sham group (P <.001). The salvage treatment rates for the heat-patch and sham groups were 11.5% and 31.4%, respectively (P =.01). Conclusion: As non-pharmaceutical treatment, the heat-patch has been shown to be a possible candidate for pain relief in patients with urolithiasis. Further research should concentrate on multicentre and large scale randomised studies.Öğe Anxiety level in pre-hospital emergency medical services personnel during coronavirus disease-2019 pandemic(Emergency Medicine Physicians Association, 2021) Mutlu, Hüseyin; Sert, Ekrem Taha; Kokulu, Kamil; Sarıtaş, AyhanAim: This study aimed to determine the anxiety level in pre-hospital emergency medical services personnel (PHEMSPs) and investigate the factors that potentially affect the anxiety level during the pandemic. Materials and Methods: This cross-sectional survey was conducted with PHEMSPs during the Coronavirus Disease-2019 (COVID-19) pandemic. A 60-item survey, including socio-demographic characteristics, anxiety-related demographic factors, and State-Trait Anxiety Inventory (STAI) scale scores was used. Results: Among 586 PHEMSPs participating in the study, 50.5% were female, with median age of 30 years. The mean STAI-S value was 42.2, and the median STAI-T value was 48. The anxiety levels of female PHEMSPs (STAI-S=51 and STAI-T=44.14) were higher than male (STAI-S=44 and, STAI-T=40.26). The anxiety level of patients with chronic diseases (STAI-S=56 and, STAI-T=45.77) was significantly higher than those without chronic diseases. State anxiety scores in married individuals (STAI-S=49) were higher than those unmarried individuals. Conclusion: Clearly, people who provide this service should be psychologically healthy to efficiently provide healthcare for the benefit of the people. All types of media assume a great responsibility in reducing the unrest or anxiety that may occur in humans, especially because of their potential to reach many parts of the society.Öğe Argyrophilic nucleolar organizer regions as a promising biomarker for the detection of brain hypoxia levels caused by different doses of carbon monoxide poisoning(Academia Nacional de Medicina de México, 2021) Yeşildağ, Kerim; Kokulu, Kamil; Mutlu, Hüseyin; Eröz, Recep; Taha Sert, Ekrem; Sarıtaş, AyhanThe purpose of the study is to investigate whether there is any relationship between mean argyrophilic nucleolar organizing regions (AgNOR) number and total AgNOR area/total nuclear area (TAA/TNA) ratio and the levels of brain hypoxia after exposure to different acute doses of carbon monoxide (CO) gas. Methods: Each experimental group was exposed to CO gas (concentrations of 1,000, 3,000 and 5,000 ppm). Then, the rats were anesthetized, and blood samples were taken from the right jugular vein for carboxyhemoglobin levels detection. The rats were sacrificed on seventh day. AgNOR staining was applied to brain tissues. TAA/TNA and mean AgNOR number were detected for each nucleus. Results: Significant differences were detected among the all groups for TAA/TNA ratio, mean AgNOR number and carboxyhemoglobin level. According to double comparison of groups, the differences between control and 1000ppm, control and 3000ppm, control and 5000ppm and 1000 and 5000ppm were significant for TAA/TNA ratio. When mean AgNOR number to be considered, significant differences were detected between control and 1000ppm, control and 3000ppm, control and 5000ppm and 1000 and 3000ppm. Conclusion: AgNOR proteins may be used for early detection of the duration, intensity and damage of brain injury caused by CO intoxication. Thus, effective treatment strategies for the prevention of hypoxic conditions may be developed.Öğe Bir Eğitim ve Araştırma Hastanesinde sağlık çalışanlarına yönelik şiddetin değerlendirilmesi: kesitsel bir çalışma(Türkiye Klinikleri Yayınevi, 2022) Bahadır, Yılmaz, Emel; Yüksel, Arzu; Mutlu, HüseyinDünya Sağlık Örgütüne göre sağlık çalışanlarının %8- 38’i kariyerlerinin bir noktasında fiziksel şiddete maruz kalmaktadır. Bu nedenle bu çalışmada, sağlık çalışanlarına yönelik şiddetin, özelliklerinin ve sonuçlarının tanımlanması amaçlanmıştır. Gereç ve Yöntemler: Kesitsel türdeki araştırmanın örneklemini, bir eğitim ve araştırma hastanesinde çalışmakta olan 317 sağlık personeli oluşturmuştur. Veriler, araştırmacılar tarafından hazırlanan anket formu ile toplanmıştır. Verilerin değerlendirilmesinde sayı, yüzde, ortalama ve standart sapma gibi tanımlayıcı istatistikler ile ki-kare analizi kullanılmıştır. Bulgular: Araştırmaya katılan sağlık personelinin yaş ortalaması 33,01±8,07 olup %61,8’i kadın, %63,4’ü evli, %56,4’ü hemşire, %27,8’i doktor ve %56,5’i lisans mezunudur. Sağlık çalışanlarının %58,4’ü şiddete maruz kalmıştır. Şiddete maruz kalanların %57,8’i hemşire, %26,5’i doktor ve %15,7’si acil tıp teknisyenidir. Şiddete maruz kalan sağlık personelinin %41,8’inin çalışma verimi azalmış, %33,2’si mesleği bırakmak istemiş, %30,7’sinin sosyal yaşamı ve ilişkileri bozulmuştur. Şiddet gören ve görmeyen sağlık personeli cinsiyet, medeni durum, meslekte çalışma süresi ve şu an bulundukları kurumda çalışma süresi gibi özellikler açısından farklılık göstermiştir (p<0,05). Sonuç: Sağlık çalışanlarının yarısından fazlasının şiddete maruz kaldığı ve şiddetin en çok sözel şiddet olarak yaşandığı belirlenmiştir. Şiddete uğrayanların yaklaşık yarısı beyaz kod bildiriminde bulunduklarını beyan etmiştir. Sağlık çalışanlarının bildirimde bulunma ve hukuki olarak haklarını arama konusunda desteklenmeleri gerekmektedir. Ayrıca sağlıkta şiddet konusunda hukuki yaptırımların ivedilikle gözden geçirilmesi önemlidir.Öğe ChatGPT and pediatric advanced life support: A performance evaluation(Elsevier Ireland Ltd, 2024) Kokulu, Kamil; Demirtaş, Mehmet Semih; Sert, Ekrem T.; Mutlu, HüseyinThe development of artificial intelligence (AI) tools, such as large language models (LLMs), holds significant promise for enhancing patient care and medical education. ChatGPT (Chat Generative Pre-trained Transformer), an LLM developed by OpenAI utilizing the GPT-4 architecture, currently demonstrates the highest level of medical domain knowledge among its peers.1 While ChatGPT’s performance has been assessed in various medical examinations,2,3 its capabilities in pediatric resuscitation and advanced life support remain unexplored. This study aimed to evaluate the clinical reasoning ability of ChatGPT by testing its performance on the American Heart Association (AHA) Pediatric Advanced Life Support (PALS) exam.Öğe Clinical predictors of delayed neurological sequelae in charcoal-burning carbon monoxide poisoning(W.B. Saunders, 2021) Sert, Ekrem Taha; Kokulu, Kamil; Mutlu, HüseyinBackground: The main objective of the treatment of acute carbon monoxide (CO) poisoning is to prevent delayed neurological sequelae (DNS). However, today there is still no objective screening tool to identify patients at high risk of developing DNS. The aim of this study was to identify clinical factors that could predict DNS after acute charcoal-burning CO poisoning. Methods: This prospective observational study was conducted from September 1, 2019 to August 31, 2020 in a single academic medical center. Patients older than 18 years of age suffering from charcoal-burning CO poisoning were included in the study. After acute recovery, patients were followed up for six weeks to investigate for DNS development. The clinical predictors of DNS were determined using a multivariate logistic regression model. Results: Of the 217 patients—113 males (52.1%), median age 37.0 (27.5–51.5) years—included, 49 (22.6%) developed DNS. The multivariate logistic regression analysis revealed the independent predictors of DNS as a lower initial Glasgow Coma Scale (GCS) score (adjusted odds ratio (AOR): 0.73, 95% confidence interval (CI): 0.62–0.87), a longer duration of CO exposure (AOR: 2.18, 95% CI: 1.65–2.88), and the presence of acute brain lesions with high signal intensity on diffusion-weighted imaging (AOR: 5.22, 95% CI: 1.50–18.08). The created multivariate regression model predicted DNS development with high accuracy (area under the curve: 0.93, 95% CI: 0.89–0.97). Conclusion: A low initial GCS score, longer exposure to CO and abnormal findings on diffusion-weighted magnetic resonance imaging can assist in the early identification of patients at high risk of DNS development.Öğe Comparison of the effect of two different intravenous methylprednisolone doses on the occurrence time of biphasic reaction(İnönü Üniversitesi, 2021) Sert, Ekrem Taha; Kokulu, Kamil; Mutlu, Hüseyin; Parlak, İsmailThe aim of this study is to determine the effect of two different doses of methylprednisolone administered in our emergency department (ED) on the elapsed time in biphasic or recurrent anaphylaxis cases. Materials and Methods: The patients with anaphylaxis admitted to the ED were retrospectively analyzed. A total of 82 patients who received methylprednisolone in combination with epinephrine in the ED due to anaphylaxis and who developed biphasic reaction within 48 h after discharge were included in the study. The patients were classified into two groups according to the dose of methylprednisolone administered: 80 mg (Group 1, low-dose) and 120 mg (Group 2, high-dose). The effect of different doses of methylprednisolone on the development time of biphasic reaction was evaluated. Results: Two different doses of IV methylprednisolone administered in the ED did not affect the development time of biphasic reaction (p = 0.24). The biphasic reaction development times were 335 (IQR, 212–950) min in the low-dose group and 520 (IQR, 265– 1150) min in the high-dose group. The earliest development time of biphasic reaction was 125 min (low-dose group) and the latest development time was 2270 min (high-dose group). The relationship between dose and biphasic reaction development times was evaluated using Kaplan–Meier curve. No significant difference was observed between the two groups (p = 0.28). Upon comparing the symptoms in patients’ second admission to the ED due to biphasic reaction, no statistically significant difference was observed in patient symptoms with respect to the dose administered (p > 0.05). Conclusions: Corticosteroids are often used in ED, although there is no definitive evidence that they prevent biphasic reactions. The administration of two different doses of methylprednisolone has no effect on biphasic reaction development time.Öğe Comparison of the incidence of recovery agitation with two different doses of ketamine in procedural sedation: A randomized clinical trial(John Wiley and Sons Inc, 2025) Türkücü, Çağrı; Parlak, İsmet; Kokulu, Kamil; Sert, Ekrem T.; Mutlu, HüseyinThe objective was to compare the incidence of recovery agitation and efficacy of two different intravenous (IV) doses of ketamine (0.5 mg/kg vs. 1 mg/kg) in adult patients who presented to the emergency department (ED) requiring procedural sedation with ketamine. Methods: This randomized, prospective clinical trial included patients aged 18–75 years who required procedural sedation with ketamine in the ED. Patients were randomized to receive IV ketamine at either 0.5 mg/kg (low dose) or 1 mg/kg (high dose). The primary outcome was the incidence of recovery agitation, assessed by the Richmond Agitation–Sedation Scale (RASS) at 5, 15, and 30 min following the procedure, in both dosage groups. Secondary outcomes included overall efficacy, sedation duration, and changes in vital signs. Results: A total of 108 patients were enrolled in the study, 54 in each group. The median (IQR) RASS scores at 5, 15, and 30 min were −4 (−5 to −4), −1 (−1.3 to 0), and 0 (−1 to 0.5), respectively, in the low-dose group and −4 (−5 to −4), −1 (−3 to 0), and 0 (0 to 0), respectively, in the high-dose group. The incidence of recovery agitation was similar between the low- and high-dose groups (difference 1.9%, 95% confidence interval [CI] −14.8% to 18.4%). No significant difference was observed in sedation duration between the two groups (difference 0%, 95% CI −3.0% to 4.0%). While no additional ketamine was required in the high-dose group, four patients (7.4%) in the low-dose group required an additional half-dose (difference 7.4%, 95% CI −2.3% to 18.7%). Changes in vital signs were similar between the two groups. Conclusions: There was no significant difference in recovery agitation, sedation duration, and changes in vital signs between 0.5 and 1 mg/kg IV ketamine for procedural sedation in the ED.Öğe Demographic and Injury Characteristics of Patients Injured in a Hailstorm(Cambridge University Press, 2025) Kokulu, Kamil; Sert, Ekrem Taha; Özdemir, Serdar; Mutlu, Hüseyin; Altunok, İbrahimThe aim of this study was to describe the demographic characteristics, injury characteristics, and outcomes of individuals sustaining injuries during a hailstorm in Istanbul, Turkey. Methods: In this study, the medical records of 76 patients who presented to the emergency department (ED) of a tertiary hospital after incurring injuries due to hailstorms were retrospectively reviewed. Analyses were performed to identify hailstorm-associated injury profiles, injury mechanisms, patient demographics, and ED resource use. Results: Of the 76 patients, 42 (55.3%) were male and 34 (44.7%) were female, with the ages of the patients ranging from five to 79 years. Of the patients, 93.4% presented to the ED within the first eight hours after a hailstorm. The most common injury mechanisms were the direct impact of hailstones on the body surface (36.8%) and slips and falls during escape (35.6%). The most frequently injured anatomical areas were skin (60.5%), head (44.7%), and extremities (16.7%). Significant injuries occurred in only 11.8% of the patients, of whom three were treated surgically and one died. The most common injuries were soft tissue and minor head injuries. Conclusions: Severe hailstorms often strike suddenly and can be difficult to predict. In response, EDs must handle a large number of injured patients in the aftermath of a hailstorm. It is important to remember that hailstorms, like other natural disasters, can cause serious injuries.Öğe Determination of the Cricothyroid Membrane Height by Age and Sex and Optimal Tracheal Tube Size(John Wiley and Sons Inc, 2024) Kokulu, Kamil; Alkan, Ender; Sert, Ekrem T.; Mutlu, Hüseyin; Türkücü, Çağrı; Akar, Emin H.The primary aim of this study was to determine the average cricothyroid membrane (CTM) height in healthy volunteers, and the secondary aim was to determine the hypothetical success rate for emergency cricothyrotomy with a tracheal tube with an 8.0 mm outer diameter. Methods: This study included healthy volunteers aged 18 years and older. The participants' clinical characteristics were recorded, and their CTM height was measured using ultrasound, with their necks placed sequentially in the neutral and extension positions. The relationship between the CTM height and sex, age, height, weight, body mass index, and sternomental distance was evaluated using linear regression analysis. An equation that could estimate the height of the CTM was obtained with the parameters found significant in this analysis. Results: Of the 340 participants, 208 (61.2%) were male. The mean (SD) height of the CTM in the extension position was 9.60 (1.54) mm, and it was significantly shorter in the women than in the men (8.72 [1.19] mm vs. 10.16 [1.48] mm, p < 0.001). Among the participants of short stature, the CTM was significantly shorter, regardless of sex. The hypothetical success rate for emergency cricothyrotomy was 93.3% for the males and 73.5% for the females. The equation for estimating the height of the CTM in the extension position was determined as ?4.36 + 5.27 × height (m) + 0.32 × sternomental distance (cm). Conclusions: Since the CTM height may differ according to age, sex, and height, cricothyrotomy sets should be available in various outer diameters.Öğe Diagnostic role of serum testican and ubiquitin levels in patients with head trauma(Pharmamed Mado Ltd, 2024) Yazıcı, Ramiz; Basa Kalafat, Ayşe Fethiye; Mutlu, Hüseyin; Sarı, Eyüp; Kalafat, Utku Murat; Atik, Dilek; Cander, BaşarWe aimed to determine if testican-1 and ubiquitin can serve as early indicators for diagnosing worsening clinical course (presence of intraparenchymal pathology) and mortality in patients with moderate traumatic brain injury (TBI).In this study, we conducted an observational and prospective study in the Emergency Department (ED) of a tertiary care hospital. The department admitted an average of 25,000 patients per month between October 2020 and March 2021. We focused on patients over 18 years old with moderate traumatic brain injury (Glasgow coma score (GCS): 9–13). We compared the prognostic values of blood testican and ubiquitin levels with Receiver Operating Characteristic (ROC) analysis for intracranial pathologies resulting from head trauma. Additionally, we used logistic regression analysis to compare the effectiveness of these markers in diagnosing intraparenchymal injury. The study included a total of 89 patients, with 45 in the case group (moderate TBI) and 44 in the healthy control group. It was found that levels of ubiquitin and testican levels were significantly higher in patients with intraparenchymal pathology (p = 0.048, p = 0.046, respectively). The cut-off point for detecting intraparenchymal pathology was 161.3 pg/mL for testican (Area under curve (AUC): 0.810; min: 0.654; max: 0.965, p = 0.002) and 44.42 ng/mL for Ubiquitin (AUC: 0.863; min: 0.727; max: 1.000, p < 0.001). High testican-1 and ubiquitin levels were independent markers for intraparenchymal pathology in moderate head trauma.Öğe Diagnostic value of lateral ankle radiography in achilles tendon rupture(SAGE Publications Ltd, 2023) Kokulu, Kamil; Altunok, İbrahim; Sert, Ekrem Taha; Özdemir, Serdar; Mutlu, Hüseyin; Akça, Hatice ŞeymaAchilles tendon rupture (ATR) is a common sports injury, but approximately 20% of acute ATR cases are misdiagnosed as ankle sprains at first presentation. This study aimed to investigate the diagnostic value of lateral ankle radiography in the diagnosis of acute ATR. Methods: This was a retrospective case-control study in which the lateral ankle radiographs of patients who presented to the emergency department between January 1, 2015 and December 31, 2019 were examined. The study included a total of 154 patients with acute ATR, who underwent lateral ankle radiography at the presentation and were surgically or magnetic resonance imaging (MRI) confirmed to have ATR in our hospital. The lateral ankle radiographs of the patients were examined by 2 clinicians blinded to clinical data for the following 3 findings: Kager’s fat pad sign, tibio-first metatarsal angle, and tibiocalcaneal angle. The same procedure was repeated for 308 controls who underwent lateral ankle radiography and were diagnosed with ankle sprain.Öğe Effect of serum netrin-1 levels on diagnosis and prognosis in patients admitted to the emergency service for acute coronary syndrome(Cureus, 2020) Mutlu, Hüseyin; Akıllı, Nazire; Cander, Başar; Köylü, Öznur; Gül, Murat; Köylü, RamazanBackground Netrin-1 is a recently discovered diagnostic biomarker that indicates atherosclerosis, angiogenesis, and ischemia-reperfusion damage. There arc no human studies about Netrin-1 in acute coronary syndrome (ACS). The purpose of the present study was to investigate Netrin-1 levels in the early diagnosis and successful reperfusion of ACS. Method The study was conducted with 188 patients diagnosed with ACS and 50 healthy subjects at the emergency unit in a prospective design. Blood samples were collected from the patient group at initial admission and after angiography. The control group consisted of healthy adult subjects without any disease. Netrin-1 levels were studied in both groups. Results The Netrin-1 levels of the patient group at the time of admission were found to be higher than of the control group (p<0.001). In the patient group, netrin-1 levels measured at initial admission (1.53 +/- 0.19) and after angiography (1.49 +/- 0.19) were determined to be statistically significant (p:0.049). In the patient group, where the Thrombolysis in Myocardial Infarction (TIMI) 3 flow was established after angiography, netrin-1 levels were detected to be low (p:0.039). Netrin-1 levels obtained at the time of admission were determined to be significantly different in the Global Registry of Acute Coronary Events (GRACE) moderate and high-risk groups in comparison to the low-risk group (p:0.017). Conclusion Netrin-1 was shown to increase in the early diagnosis of ACS and to decrease in patients for whom reperfusion was established after angiography. Therefore, Netrin-1 can be an important biomarker as an indicator of diagnosis and successful reperfusion in ACS.Öğe Effectiveness of clinical risk factors in the detection of central pathology in patients with isolated vertigo(Elsevier Inc., 2021) Sert, Ekrem Taha; Çayır, Serkan; Mutlu, Hüseyin; Kokulu, KamilBackground: There is no clinical guidance for the indications of neuroimaging in patients with isolated vertigo. The differential diagnosis of isolated vertigo can be challenging for emergency physicians. Objective: The aim of this study was to identify the risk factors that increase the likelihood of detecting a central pathology in patients who present with isolated vertigo and in whom peripheral vertigo is considered. Methods: Patients imaged using neuroimaging, including diffusion-weighted magnetic resonance imaging (DW-MRI) with head computed tomography (CT), for isolated vertigo over a 3-year period were identified retrospectively. The patients were divided into two groups—a positive neuroimaging group and a negative neuroimaging group—according to the abnormal lesions in the head CT and DW-MRI results. We reviewed the medical records to identify presenting symptoms and signs, vascular risk factors, history of vertigo, medical comorbidities, and diagnostic imaging results (i.e., head CT and DW-MRI). Results: Two hundred and seventy-nine patients were included: 231 in the negative neuroimaging group (82.8%) and 48 in the positive neuroimaging group (17.2%). Univariate and multivariate logistic regression analyses were performed. It was found in the regression analysis that being 65 years or older (odds ratio [OR] 2.53; 95% confidence interval [CI] 1.29–4.96; p = 0.006), having two or more vascular risk factors (OR 2.45; 95% CI 1.10–5.46; p = 0.028), and not responding to the treatment (OR 2.57; 95% CI 1.08–6.14; p = 0.033) increased the likelihood of detecting a pathology in neuroimaging. Conclusions: We suggest that patients unresponsive to ED treatment, 65 years or older, and with two or more vascular risk factors, should alert physicians for central causes and increase the yield of neuroimaging.Öğe Effects of Clinical Frailty Scale Score on Adverse Outcomes and Length of Emergency Department Stay Before Intensive Care Unit Admission(Elsevier, 2024) Sert, Ekrem Taha; Kokulu, Kamil; Mutlu, Hüseyin; Yortanlı, Betül ÇiğdemBackground: Older adults living with frailty who require treatment in hospitals are increasingly seen in emergency departments (EDs). Objective: This study investigated the effects of frailty severity according to the Clinical Frailty Scale (CFS) on adverse outcomes and length of stay in the ED before intensive care unit (ICU) admission. Methods: We conducted this prospective observational study with patients 65 years or older and admitted to the ICU from March 1, 2021 to December 31, 2022. We divided the patients into four groups according to their CFS scores. We determined the effects of frailty severity on length of ED stay and clinical outcomes using logistic regression analysis. Results: Of the 920 patients included in the study, 25.4% were nonfrail, 26.2% had mild frailty, 25.9% had moderate frailty, and 22.5% had severe frailty. In the regression analysis, compared with those who were nonfrail, the length of ED stay was significantly longer for those with moderate frailty (odds ratio [OR] 2.13; 95% confidence interval [CI] 1.63-2.90) or severe frailty (OR 3.32; 95% CI 1.92-3.87), but the result was not significant for those with mild frailty (OR 1.65; 95% CI 1.21-2.45). ICU mortality was significantly higher among patients with mild, moderate, or severe frailty than among those who were nonfrail. Conclusions: We found CFS score to be a predictor of length of ED stay and adverse outcomes. Accordingly, CFS evaluation can provide an idea of the length of ED stay and the likelihood of adverse outcomes.Öğe Effects of workload and distance traveled on psychological resilience and values among emergency healthcare workers(TUBITAK, 2025) Yazıcı, Ramiz; Bala, Efe Demir; Basa Kalafat, Ayşe Fethiye; Sarı, Eyüp; Mutlu, Hüseyin; Güner, Hakan; Kaya, Hilmi; Tapkan, Rabia Birsen; Kalafat, Utku Murat; Doğan, SerkanEmergency medical services (EMS) personnel face significant challenges in their daily work, which can lead to burnout and affect their mental well-being. This study aimed to investigate how workload and distance traveled, as specific aspects of EMS work, influence the psychological resilience and values of EMS personnel. The Connor–Davidson Resilience Scale (CD-RISC) and Spiritual and Humanistic Value Scale (SHVS) were utilized to assess psychological resilience and values, respectively. Materials and methods: A cross-sectional study was conducted among EMS personnel in Ankara, Türkiye, utilizing a questionnaire survey distributed between 23 and 30 May 2024. The study was approved by the Medical Research Scientific and Ethical Evaluation Board of Ankara Bilkent City Hospital. A total of 293 EMS personnel participated after providing informed consent and approval. The participants were categorized into 3 groups based on their case/distance ratio. We used the CD-RISC and SHVS to compare psychological resilience and values between the groups. Results: Significant differences were observed according to various sociodemographic and work-related variables among the participating EMS personnel. Younger personnel tended to handle more cases, while older personnel traveled longer distances on average (p < 0.001). Education level and experience also influenced workload allocation, with less experienced individuals and those with lower education levels handling more cases (p < 0.001). No significant differences were found in CD-RISC and SHVS scores between the considered groups; however, we identified significant differences based on sex (p = 0.005) for the CD-RISC and based on age (p < 0.05) and experience (p < 0.05) for the SHVS. Conclusion: This study highlights the complex relationship among workload, sociodemographic factors, and psychological resilience/ values in EMS personnel. Older, more experienced personnel tended to exhibit higher resilience and values scores, suggesting greater adaptation and satisfaction. Understanding these dynamics can aid in developing targeted interventions to prevent burnout and promote the well-being of EMS personnel.Öğe Etiological characteristics and management of patients with epistaxis in Aksaray(Annals of Medical Research (Ann Med Res), 2020) Çayır, Serkan; Mutlu, Hüseyin; Sert, Ekrem TahaAim: Epistaxis is a common condition in humans, particularly in patients with hypertension, and is one of the most common presenting symptoms in ear, nose, and throat emergency consultation. The present study aimed to examine the treatment and hospitalization characteristics of the patients who presented with epistaxis in Aksaray city and to propose an optimized and updated protocol. Material and Methods: The present study retrospectively evaluated 758 patients who presented with epistaxis to the Training and Research Hospital in Aksaray between January 2016 and February 2020. The patients were analyzed in terms of age, sex, seasonal characteristics, hospitalization rates, pathogenesis of epistaxis, sites of bleeding, and treatments. Results: The study included 349 females (46.1%) and 409 males (53.9%); mean patient age was 60.9 ± 9.3 years (range: 3–89 years). The most common comorbidity was hypertension (47.3%), and the most common site of bleeding was the anterior region including the Kiesselbach’s plexus (88.2%). Nasal packing (58.5%) and electrocauterization (29.9%) were performed in most cases. The treatment success was defined as no instance of re-visit by the patients to the hospital due to nasal bleeding within 24 h after the procedure; the treatment was successful in 698 patients (92.1%). Conclusion: Most cases of epistaxis are successfully treated using endoscopic electrocauterization on an outpatient basis. Hospitalization is indicated if surgical intervention, posterior packing, or embolization is required and if deterioration of general condition is observed. The present study proposes an updated protocol optimized for the management of epistaxis.Öğe Impact of chronic medical conditions on mortality in geriatric trauma, 10-year analysis of a single centre in Turkey(Taylor & Francis, 2022) Çağlar, Ahmet; Sert, Ekrem Taha; Mutlu, HüseyinBackground The healthy and active lifestyle adopted by the elderly as a result of improvements in the standards of living may lead to an increase in the risk of injury. Comorbidities increase the risk of posttraumatic complications and mortality. The aim of this study was to investigate the impact of chronic medical conditions (CMCs) on the risk of mortality in geriatric trauma patients. Methods All geriatric trauma patients admitted to emergency department over a 10-year period were retrospectively analysed. Patients were stratified by baseline characteristics, injury severity score (ISS), presence of CMCs, and in-hospital mortality. Multivariate logistic regression was used to determine variables significantly associated with in-hospital mortality. Results 9455 patients included in the study. The median age was 74 (10) years and 57% of them were female. The presence of >= 1 CMC and >= 2 CMCs increased the risk of mortality 5.64 and 2.38 times respectively in mild traumas and 2.67 and 2.59 times respectively in moderate traumas. Age, ISS and penetrating traumas had a significant impact on the risk of mortality in all ISS groups. In severe traumas, only renal disease had an impact on the risk of mortality (OR = 2.58, 95%CI = 1.03-6.43, p = 0.042). All other CMCs, >= 1 CMC, and >= 2 CMCs had no impact on the risk of mortality. Conclusion The presence of CMCs in elderly patients with mild and moderate injuries increases the risk of mortality. Such patients should be diagnosed and treated more quickly and aggressively during the prehospital process and in the hospital.
