Background Onychomycosis has a high prevalance among immunocompromised patients such as diabetics... more Background Onychomycosis has a high prevalance among immunocompromised patients such as diabetics and hemodialysis patients. In the present study, we aimed to investigate the prevalence of onychomycosis among hemodialysis patients with and without diabetes mellitus, and to find out the factors likely to be associated with the development of onychomycosis among hemodialysis patients. Methods One hundred and nine hemodialysis patients were enrolled. Fifty-seven of hemodialysis patients had the diagnosis of diabetes mellitus. Nail scrapings were obtained from 76 patients who had dystrophic nail changes. Samples were examined with 20% potassium hydroxide solution and all of the samples were inoculated on Saboraud's dextrose agar, potateus dextrose agar and mycobiotic agar. Diagnosis of onychomycosis was based on the presence of both positive clinical signs and positive potassium hydroxide test. Results Onychomycosis was diagnosed in 26.6% of hemodialysis patients. Diabetes mellitus was present in 68.9% of patients with onychomycosis. Toenail scraping cultures were reported to be positive in 19.7% of patients with dystrophic nail changes. Logistic regression analysis revealed that the presence of diabetes mellitus and the mean duration of hemodialysis were the significant predictors associated with the development of onychomycosis. Conclusion The prevalence of dystrophic nail changes and onychomycosis is increased among hemodialysis patients. The dialysis duration and the presence of diabetes mellitus are the independent risk factors associated with the development of onychomycosis in uraemic patients.
Similar to the cases seen around the world, snakebite causes mortality and morbidity in Turkey. T... more Similar to the cases seen around the world, snakebite causes mortality and morbidity in Turkey. The venom of different types of snake in the region of Cukurova causes serious systemic and local tissue damage. We performed this prospective study on 45 patients who complained of snakebite. We grouped the patients according to their clinical presentations to facilitate treatment and follow-up period procedures. Whereas the patients with grade 1 envenomation did not receive any antivenom, grades 2 and 3 patients received 2.70 +/- 0.77 and 4.88 +/- 1.65 vials of antivenom, respectively. One of our patients had to undergo finger amputation but there were no deaths. Allergic reactions developed after antivenom therapy in 8 patients (17.8%). When we considered the cost and complications of the antivenom treatment, it was seen that low-dose antivenom treatment effectively treated the patients with venomous snakebite injuries in our region.
This presentation focused on a hyperactive child admitted to the emergency department because of ... more This presentation focused on a hyperactive child admitted to the emergency department because of ataxia and imbalance. It was later discovered that the child had been abused by his mother. In cases where there is conflict between the clinical findings, the patient and the family's history in a clinical state which cannot be explained satisfactorily by the medical staff, the need for taking the history again from other relatives whilst taking into account the parents' physiological well-being, is time well spent.
Nearly everyone is at risk of acute and chronic toxic exposure to hazardous substances in the amb... more Nearly everyone is at risk of acute and chronic toxic exposure to hazardous substances in the ambient environment. Morbidity and mortality following an overdose are reduced by intensive appropriate supportive therapy. A well-trained medical team is required for the administration of intensive clinical care, which includes enough equipment for monitoring the patient's status. In this paper we present a student who, after attending a dentist faculty, ingested 100 grams of pure inorganic mercury in order to commit suicide and was treated with forced diuresis, whole bowel irrigation, and D-penicillamine. The latter was found following 48 hours of therapy and only used for 4 days because of lack of availability of other antidotes for mercury in our city.
Hydatid disease is a parasitic infection caused by Echinococcus granulosus characterised by cyst ... more Hydatid disease is a parasitic infection caused by Echinococcus granulosus characterised by cyst formation in any organ, although the liver is the most commonly involved. Hydatid cysts can rupture either spontaneously or following trauma. Surgical treatment can be life-saving. This paper reports the atypical presentation of a young girl admitted to the emergency department. She presented with pain on her palms due to falling down a few steps. Because of the rebound tenderness on the right upper quadrant of her abdomen on physical examination, bedside ultrasonography was performed to identify the underlying cause, and promptly revealed a 62 x 72 mm lobular cyst on the right lobe of the liver with free fluid in the subcapsular area. Shortly afterwards, urticaria developed. Fluid resuscitation, methylprednisolone and diphenylhydramine were administered intravenously. Afterwards she was taken to the operation room for unroofing, drainage and capitonage. In conclusion, primary care and e...
Snakebite is one of the commonest causes of morbidity and mortality in tropical regions. This pap... more Snakebite is one of the commonest causes of morbidity and mortality in tropical regions. This paper focuses on the medical treatment of a patient who had been bitten by a snake on the vertex of his head. It was a severe envenomation with ensuing marked edema associated with coagulation abnormalities. Although the antivenin was extensively sought in various medical centers,
The Mount Sinai journal of medicine, New York, 2006
Methanol is a common component of gasoline, antifreeze, washer fluid, perfume, household cleaners... more Methanol is a common component of gasoline, antifreeze, washer fluid, perfume, household cleaners and various other industrial products. Acute methanol poisoning produces severe metabolic acidosis, serious neurologic sequelae and rarely imaging findings. In this paper, we describe a 35-year-old man with methanol intoxication who was in a comatose stage. Computed tomography (CT) showed widespread brain edema and hemorrhages localized in the supratentorial region of the temporal lobe, nearly 3 x 1 cm in a crescent shape, in the white matter surrounding the capsula externa and extending to the periventricular white matter and occipital lobes. Temporal lobe hemorrhage in our patient might also have been due to the effect of heparinization during hemodialysis, metabolic and lactic acidosis, or formate.
Colchicine is a highly active alkoloid with antiinflammatory properties. It is effective in gout,... more Colchicine is a highly active alkoloid with antiinflammatory properties. It is effective in gout, BehetÕs disease, familial Mediterranean fever, cirrhosisi and may be effective in scleroderma, sarcoidosis and skin disorders. Colchicine overdose is a rare but serious problem. Gastrointestinal distress is the earliest and most common manifestation and myelosuppression, cardiovascular collapse and respiratory failure are common life-threatenning side effects (1, 2). We report a patient with colchicine toxicity who developed pneumopericardium during his clinical course. Pneumopericardium has not been reported before and should be considered in the case of colchicine overdose.
Background: Serum S100B is found in the glial cells and is elevated with stroke. It can be used i... more Background: Serum S100B is found in the glial cells and is elevated with stroke. It can be used in the diagnostic and prognostic utility. However, the use of S100B in the emergency room is controversial. In our study, we wish to determine if the National Institutes of Health Stroke Scale (NIHSS) and Glasgow Coma Scale (GCS) have utility in predicting the acute and first month poststroke mortality and morbidity in emergency room patients, as measured by serum S100B and clinical evaluations.
Acetaminophen is an analgesic drug that is frequently used in suicide attempts. In this paper, we... more Acetaminophen is an analgesic drug that is frequently used in suicide attempts. In this paper, we report on a 17-year-old girl who was admitted to an emergency department 15 hours after taking acetaminophen pills in a suicide attempt. Her serum acetaminophen level was 73 mg/L on admission; she had elevated liver enzymes suggesting hepatic necrosis. She was started on N-acetyl cystein (NAC), and treated successfully with a fractionated plasma separation and absorption system.
Scorpions are nocturnal arthropods that inject their venom through the victims' skin hy stingers.... more Scorpions are nocturnal arthropods that inject their venom through the victims' skin hy stingers. By the envenomation, clinical manitestalions in a wide spectrum may occur, including pain at one side and death because of severe cardiopulmonary or neurological ahnormalities. Sometimes the victim cannot describe the insect or does not remember even being stung after the event. We present two cases of scorpion envenomation with different and rare clinical situations with a short review of the literature.
Little is known about snakebites during pregnancy and only a few cases have been reported in the ... more Little is known about snakebites during pregnancy and only a few cases have been reported in the literature. The fact that venomous snakebites during pregnancy result in high fetal wastage and may cause maternal mortality makes this an important, albeit, uncommonly encountered entity in emergency medicine. In this paper, we report on the successful treatment of three cases of snakebite in pregnancy. Human & Experimental Toxicology (2005) 24, 341 Á/345
Drugs containing 5-acetylsalicylic acid (5-ASA) have been commonly used for inflammatory bowel di... more Drugs containing 5-acetylsalicylic acid (5-ASA) have been commonly used for inflammatory bowel diseases for more than half a century, but no case about overdose of suppository form of mesalazine which was taken both orally and rectally has been reported in the related literature up to now. In the present case, a 20-year-old male patient who took 14.5 g of mesalazine rectally and orally for suicide purpose is discussed. He was an ulcerative colitis patient and depressed about his illness and routine life traffic. Although it was hard for him to take the suppository form orally because of its bad taste and structure, he took it with the help of water. In the patient's colonoscopy, diffuse hyperemia and edema extending from the anal channel to the proximal rectal mucosa and a 1.5 cm diameter ulcer expanding from anal channel through the rectum were identified. No pathology was found in the upper gastrointestinal endoscopy. Routine laboratory examination was performed and no abnormality was identified in the patient's total blood account, biochemical parameters and full-urine examination. In the control rectoscopy applied to the patient 15 days later, recovery of the ulcer was observed and he was discharged to be followed in the psychiatry clinic.
Crisis: The Journal of Crisis Intervention and Suicide Prevention, 2007
This study analyzed Turkish female adolescent-family relations, which is believed to be one of th... more This study analyzed Turkish female adolescent-family relations, which is believed to be one of the significant factors in female adolescents' suicide attempts, from a multidimensional perspective. The Parent-Adolescent Relationship Inventory, a multidimensional evaluation tool based on the behavioral family-system approach was used as a research tool. The inventory consists of the concepts and techniques of behavioral theory, family system theory, and cognitive theory in parent-adolescent' problems and conflicts. Based on these theories, the parent-adolescent relations inventory (PARQ), involves three main dimensions: problem solving and communication skills, cognitive/internalized beliefs, and functions and structures in family systems. There are two forms of the inventory, the adolescent form and the parent form. Only the adolescent form of PARQ, including 284 items, was used in this research. The inventory also consists of 16 subscales. It was adapted into Turkish by Eryüksel (1996). The subjects of the study were 52 female adolescents who had attempted suicide and were taken to the Emergency Department of The Faculty of Medicine in Cukurova University, and 52 normal female adolescents from two different secondary schools at the southern province in Turkey. The age range of the clinical and normal groups were 14-18 (x = 16). The results of the study revealed that the general stress level of female adolescents who attempted suicide is higher than those of normal groups. The examination of family structures of these female adolescents made it clear that mothers were the mediator between fathers and adolescents. It was also observed that both mothers and fathers shared many somatic concerns.
Management of intoxicated patients has many aspects in a wide spectrum, beginning with decontamin... more Management of intoxicated patients has many aspects in a wide spectrum, beginning with decontamination processes and basic supportive care. The most logical therapeutic approach is probably the specific antidotes, when available and/or applicable. On the other hand, many chemicals and drugs, can be removed from the body by means of hemodialysis or hemoperfusion while treating vital sign abnormalities and electrolyte and acid-base disturbances of the patient. In this paper, we describe 11 cases of intoxication, 6 with methyl alcohol, 3 with lithium, and 2 with salicylate, admitted to emergency department and treated with hemodialysis between January 1, 2002 and December 31, 2004. We review their medical charts and detailed demographic data, medical history, type of exposure, clinical and laboratory presentations, duration of hemodialysis performed, and the outcome.
Caustic products are responsible for the most serious cases of poisoning, which are always emerge... more Caustic products are responsible for the most serious cases of poisoning, which are always emergency cases. In this paper, we review demographic features and endoscopic results of the patients admitted to a university emergency department with a history of caustic substance ingestion between January 2000 and June 2003. Thirty-seven patients were included in this study. Twenty-one of the patients were female and 16 were male. The mean age of the patients was 30.9 +/- 14.7 years. The agents included sodium hypochlorite in 24 patients and hydrochloric acid in 13 patients. All the patients ingested these agents orally. The mean interval time of admission to emergency department after ingestion of caustic agent was 5.4 +/- 5.6 hours. Endoscopy was attempted in 37 patients. Endoscopic results were as follows: grade 0 in 8 (21.6%) patients, grade 1 in 17 (45.9%) patients, grade 2a in 5 (13.5%) patients, and grade 2b in 7 (18.9%) patients. We believe that early signs and symptoms after caustic substance ingestion are not consistent with the extent of damage, and endoscopy is the only reliable method to assess injury. It is important that efforts should be made to educate the public about the dangers of caustic substances so that their threat may be diminished.
Thyroid dysfunction is one of the serious consequences of an overdose of acetaminophen, aspirin, ... more Thyroid dysfunction is one of the serious consequences of an overdose of acetaminophen, aspirin, or nonsteroidal antiinflammatory drugs. The management of such consequences remains a medical challenge. A variety of thyroid abnormalities are common in clinical practice and can, in many cases, be accurately diagnosed and managed by the primary care physician. This case study covers an aspirin overdose causing thyroid storm that was treated successfully with hemodialysis.
Turkiye Klinikleri Journal of Medical Sciences, 2013
Ö ÖZ ZE ET T A Am ma aç ç: : Bu ça lış ma nın ama cı ka fa trav ma sı ne de niy le acil ser vi se... more Ö ÖZ ZE ET T A Am ma aç ç: : Bu ça lış ma nın ama cı ka fa trav ma sı ne de niy le acil ser vi se ge len/ge ti ri len ço cuk yaş gru bunda ki has ta la rın baş vu ru anın da ki S-100B pro te in dü zey le ri ile prog noz la rı ara sın da ki iliş ki yi in ce le mek ve S-100B pro te i ni nin ka fa trav ma sı nın şid de ti ni be lir le me de iyi bir be lir teç olup ol ma dı ğı nı araş tır maktır. G Ge e r re eç ç v ve e Y Yö ön n t te em m l le er r: : Çu ku ro va Üni ver si te si Tıp Fa kül te si Ço cuk Acil Tıp Bi ri mi' ne Ka sım 2005 ile Ağus tos 2006 ta rih le ri ara sın da baş vu ran 0-18 yaş gru bun da ki 75 ka fa trav ma lı has ta ile ay nı yaş gru bun -dan15 sağ lık lı ki şi ça lış ma ya dâhil edil di. Glas gow Ko ma Ska la sı (GKS) sko ru na gö re has ta lar, ha fif, or ta ve şid det li ka fa trav ma sı şek lin de grup lan dı. Has ta la rın, trav ma dan son ra ilk al tı sa at te ki S-100B dü zey leri ne ba kıl dı. S-100B dü zey le ri ile has ta la rın Ço cuk Trav ma Sko ru (ÇTS), Ye ni den Dü zen len miş Trav ma Sko ru (YDTS), Ha sar Şid de ti Sko ru [In jury Se ve rity Sco re (ISS)] ve Glas gow Son du rum Sko ru [Glas gow Out co me Sco re (GOS)] so nuç la rı ara sın da ki iliş ki in ce len di. B Bu ul l g gu u l la ar r: : GKS skor la rı kö tü olan has ta la rın S-100B dü zey le ri yük sek sap tan dı. Has ta la rın ISS, YDTS ve ÇTS skor la rı ile S-100B pro te in dü ze yi ara sın da an lam lı bir iliş ki sap tan dı (ISS için r=0,769, PTS için r=-0,821, YDTS için r=-0,833 ve her bi ri için p<0,001). S-100B pro te i nin sı nır de ğe ri 0,44 μg/L ola rak kul la nıl dı ğın da % 90 du yar lı lık ve %72,5 öz gül lük el de edilir ken, po zi tif kes ti ri ci de ğer %85,3 ve ne ga tif kes ti ri ci de ğer %85,3 bu lun du. Has ta la rın 3 ay son ra ki GOS de ğer le ri ile S-100B dü ze yi ara sın da da an lam lı de re ce de bir iliş ki sap tan dı. GOS de ğe ri 3 ve al tın da olan has ta la rın S-100B dü zey le ri da ha yük sek bu lun du (p<0,001). S So o n nu uç ç: : Ka fa trav ma lı has ta lar da baş lan gıç S-100B pro te i ni dü ze yi, be yin ha sa rı nın be lir len me sin de güç lü bir kes ti ri ci özel li ğe sa hip tir. Ek ola rak S-100B pro te i ni, ka fa ya ra lan ma sın dan son ra bi rin cil be yin ha sa rı nın cid di ye ti ve gi di şa tı hak kın da da önem li bir bil gi sağ la mak ta dır.
Anahtar Sözcükler: Acil, inme, mevsim , yaşlı hasta. GİRİŞ Yaşlı hastalarda vücudun çeşitli stres... more Anahtar Sözcükler: Acil, inme, mevsim , yaşlı hasta. GİRİŞ Yaşlı hastalarda vücudun çeşitli stres ve değişen koşullara adaptasyonu azalmakta, yaşlılar daha sık hastalanmakta, daha fazla kronik hastalık veya sorun ile yaşamak zorunda kalmakta, çoğu kez birkaç sağlık sorununu bir arada göğüslemeye çalışmakta, bütün bunların sonucunda da sağlık merkezlerine daha sık başvurmakta ve hastanelerde daha uzun süre kalmaktadırlar. Beklenen yaşam süresinin uzaması ve doğum hızının azalması ile, dünya nüfusu bir önceki elli yıla göre daha hızlı yaşlanmıştır. Yaşlı bireylerin sayısı 1998'de 580 milyon iken, 2050 yılında 1.97 milyara ulaşacağı hesaplanmaktadır. Gelişmekte olan ülkelerde yaşlı nüfusun artışı daha fazla olmaktadır. Önümüzdeki yıllarda dünyadaki 600 milyon yaşlı bireyin yaklaşık 2/3'ü gelişmekte olan ülkelerde olacaktır 9 . Dünyadaki tüm kültürel farklılıklara rağmen yaşlı sadece "65 yaşına ulaşan ve emekliye ayrılan kişi" olarak tanımlanmaktadır. Oysa modern ve uygar toplumların bu tanımlamayı artık gerçek anlamda mercek altına alması ve tartışması gerekmektedir. 20. yüzyıla ait bu değerlendirme çok yakın bir gelecekte anlamını yitirecektir 6 . Genel populasyonda tıbbın hedefi ve amacı "tedavi" iken, geriatrik populasyonda hedef, yaşlı insanların "yaşam kalitesini korumak"tır. Yaşlı hastanın değerlendirilmesi ve tedavisi yanında, yaşlıların sağlıklarının korunması da tüm uzmanlık dallarının
Background Onychomycosis has a high prevalance among immunocompromised patients such as diabetics... more Background Onychomycosis has a high prevalance among immunocompromised patients such as diabetics and hemodialysis patients. In the present study, we aimed to investigate the prevalence of onychomycosis among hemodialysis patients with and without diabetes mellitus, and to find out the factors likely to be associated with the development of onychomycosis among hemodialysis patients. Methods One hundred and nine hemodialysis patients were enrolled. Fifty-seven of hemodialysis patients had the diagnosis of diabetes mellitus. Nail scrapings were obtained from 76 patients who had dystrophic nail changes. Samples were examined with 20% potassium hydroxide solution and all of the samples were inoculated on Saboraud's dextrose agar, potateus dextrose agar and mycobiotic agar. Diagnosis of onychomycosis was based on the presence of both positive clinical signs and positive potassium hydroxide test. Results Onychomycosis was diagnosed in 26.6% of hemodialysis patients. Diabetes mellitus was present in 68.9% of patients with onychomycosis. Toenail scraping cultures were reported to be positive in 19.7% of patients with dystrophic nail changes. Logistic regression analysis revealed that the presence of diabetes mellitus and the mean duration of hemodialysis were the significant predictors associated with the development of onychomycosis. Conclusion The prevalence of dystrophic nail changes and onychomycosis is increased among hemodialysis patients. The dialysis duration and the presence of diabetes mellitus are the independent risk factors associated with the development of onychomycosis in uraemic patients.
Similar to the cases seen around the world, snakebite causes mortality and morbidity in Turkey. T... more Similar to the cases seen around the world, snakebite causes mortality and morbidity in Turkey. The venom of different types of snake in the region of Cukurova causes serious systemic and local tissue damage. We performed this prospective study on 45 patients who complained of snakebite. We grouped the patients according to their clinical presentations to facilitate treatment and follow-up period procedures. Whereas the patients with grade 1 envenomation did not receive any antivenom, grades 2 and 3 patients received 2.70 +/- 0.77 and 4.88 +/- 1.65 vials of antivenom, respectively. One of our patients had to undergo finger amputation but there were no deaths. Allergic reactions developed after antivenom therapy in 8 patients (17.8%). When we considered the cost and complications of the antivenom treatment, it was seen that low-dose antivenom treatment effectively treated the patients with venomous snakebite injuries in our region.
This presentation focused on a hyperactive child admitted to the emergency department because of ... more This presentation focused on a hyperactive child admitted to the emergency department because of ataxia and imbalance. It was later discovered that the child had been abused by his mother. In cases where there is conflict between the clinical findings, the patient and the family's history in a clinical state which cannot be explained satisfactorily by the medical staff, the need for taking the history again from other relatives whilst taking into account the parents' physiological well-being, is time well spent.
Nearly everyone is at risk of acute and chronic toxic exposure to hazardous substances in the amb... more Nearly everyone is at risk of acute and chronic toxic exposure to hazardous substances in the ambient environment. Morbidity and mortality following an overdose are reduced by intensive appropriate supportive therapy. A well-trained medical team is required for the administration of intensive clinical care, which includes enough equipment for monitoring the patient's status. In this paper we present a student who, after attending a dentist faculty, ingested 100 grams of pure inorganic mercury in order to commit suicide and was treated with forced diuresis, whole bowel irrigation, and D-penicillamine. The latter was found following 48 hours of therapy and only used for 4 days because of lack of availability of other antidotes for mercury in our city.
Hydatid disease is a parasitic infection caused by Echinococcus granulosus characterised by cyst ... more Hydatid disease is a parasitic infection caused by Echinococcus granulosus characterised by cyst formation in any organ, although the liver is the most commonly involved. Hydatid cysts can rupture either spontaneously or following trauma. Surgical treatment can be life-saving. This paper reports the atypical presentation of a young girl admitted to the emergency department. She presented with pain on her palms due to falling down a few steps. Because of the rebound tenderness on the right upper quadrant of her abdomen on physical examination, bedside ultrasonography was performed to identify the underlying cause, and promptly revealed a 62 x 72 mm lobular cyst on the right lobe of the liver with free fluid in the subcapsular area. Shortly afterwards, urticaria developed. Fluid resuscitation, methylprednisolone and diphenylhydramine were administered intravenously. Afterwards she was taken to the operation room for unroofing, drainage and capitonage. In conclusion, primary care and e...
Snakebite is one of the commonest causes of morbidity and mortality in tropical regions. This pap... more Snakebite is one of the commonest causes of morbidity and mortality in tropical regions. This paper focuses on the medical treatment of a patient who had been bitten by a snake on the vertex of his head. It was a severe envenomation with ensuing marked edema associated with coagulation abnormalities. Although the antivenin was extensively sought in various medical centers,
The Mount Sinai journal of medicine, New York, 2006
Methanol is a common component of gasoline, antifreeze, washer fluid, perfume, household cleaners... more Methanol is a common component of gasoline, antifreeze, washer fluid, perfume, household cleaners and various other industrial products. Acute methanol poisoning produces severe metabolic acidosis, serious neurologic sequelae and rarely imaging findings. In this paper, we describe a 35-year-old man with methanol intoxication who was in a comatose stage. Computed tomography (CT) showed widespread brain edema and hemorrhages localized in the supratentorial region of the temporal lobe, nearly 3 x 1 cm in a crescent shape, in the white matter surrounding the capsula externa and extending to the periventricular white matter and occipital lobes. Temporal lobe hemorrhage in our patient might also have been due to the effect of heparinization during hemodialysis, metabolic and lactic acidosis, or formate.
Colchicine is a highly active alkoloid with antiinflammatory properties. It is effective in gout,... more Colchicine is a highly active alkoloid with antiinflammatory properties. It is effective in gout, BehetÕs disease, familial Mediterranean fever, cirrhosisi and may be effective in scleroderma, sarcoidosis and skin disorders. Colchicine overdose is a rare but serious problem. Gastrointestinal distress is the earliest and most common manifestation and myelosuppression, cardiovascular collapse and respiratory failure are common life-threatenning side effects (1, 2). We report a patient with colchicine toxicity who developed pneumopericardium during his clinical course. Pneumopericardium has not been reported before and should be considered in the case of colchicine overdose.
Background: Serum S100B is found in the glial cells and is elevated with stroke. It can be used i... more Background: Serum S100B is found in the glial cells and is elevated with stroke. It can be used in the diagnostic and prognostic utility. However, the use of S100B in the emergency room is controversial. In our study, we wish to determine if the National Institutes of Health Stroke Scale (NIHSS) and Glasgow Coma Scale (GCS) have utility in predicting the acute and first month poststroke mortality and morbidity in emergency room patients, as measured by serum S100B and clinical evaluations.
Acetaminophen is an analgesic drug that is frequently used in suicide attempts. In this paper, we... more Acetaminophen is an analgesic drug that is frequently used in suicide attempts. In this paper, we report on a 17-year-old girl who was admitted to an emergency department 15 hours after taking acetaminophen pills in a suicide attempt. Her serum acetaminophen level was 73 mg/L on admission; she had elevated liver enzymes suggesting hepatic necrosis. She was started on N-acetyl cystein (NAC), and treated successfully with a fractionated plasma separation and absorption system.
Scorpions are nocturnal arthropods that inject their venom through the victims' skin hy stingers.... more Scorpions are nocturnal arthropods that inject their venom through the victims' skin hy stingers. By the envenomation, clinical manitestalions in a wide spectrum may occur, including pain at one side and death because of severe cardiopulmonary or neurological ahnormalities. Sometimes the victim cannot describe the insect or does not remember even being stung after the event. We present two cases of scorpion envenomation with different and rare clinical situations with a short review of the literature.
Little is known about snakebites during pregnancy and only a few cases have been reported in the ... more Little is known about snakebites during pregnancy and only a few cases have been reported in the literature. The fact that venomous snakebites during pregnancy result in high fetal wastage and may cause maternal mortality makes this an important, albeit, uncommonly encountered entity in emergency medicine. In this paper, we report on the successful treatment of three cases of snakebite in pregnancy. Human & Experimental Toxicology (2005) 24, 341 Á/345
Drugs containing 5-acetylsalicylic acid (5-ASA) have been commonly used for inflammatory bowel di... more Drugs containing 5-acetylsalicylic acid (5-ASA) have been commonly used for inflammatory bowel diseases for more than half a century, but no case about overdose of suppository form of mesalazine which was taken both orally and rectally has been reported in the related literature up to now. In the present case, a 20-year-old male patient who took 14.5 g of mesalazine rectally and orally for suicide purpose is discussed. He was an ulcerative colitis patient and depressed about his illness and routine life traffic. Although it was hard for him to take the suppository form orally because of its bad taste and structure, he took it with the help of water. In the patient's colonoscopy, diffuse hyperemia and edema extending from the anal channel to the proximal rectal mucosa and a 1.5 cm diameter ulcer expanding from anal channel through the rectum were identified. No pathology was found in the upper gastrointestinal endoscopy. Routine laboratory examination was performed and no abnormality was identified in the patient's total blood account, biochemical parameters and full-urine examination. In the control rectoscopy applied to the patient 15 days later, recovery of the ulcer was observed and he was discharged to be followed in the psychiatry clinic.
Crisis: The Journal of Crisis Intervention and Suicide Prevention, 2007
This study analyzed Turkish female adolescent-family relations, which is believed to be one of th... more This study analyzed Turkish female adolescent-family relations, which is believed to be one of the significant factors in female adolescents&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; suicide attempts, from a multidimensional perspective. The Parent-Adolescent Relationship Inventory, a multidimensional evaluation tool based on the behavioral family-system approach was used as a research tool. The inventory consists of the concepts and techniques of behavioral theory, family system theory, and cognitive theory in parent-adolescent&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; problems and conflicts. Based on these theories, the parent-adolescent relations inventory (PARQ), involves three main dimensions: problem solving and communication skills, cognitive/internalized beliefs, and functions and structures in family systems. There are two forms of the inventory, the adolescent form and the parent form. Only the adolescent form of PARQ, including 284 items, was used in this research. The inventory also consists of 16 subscales. It was adapted into Turkish by Eryüksel (1996). The subjects of the study were 52 female adolescents who had attempted suicide and were taken to the Emergency Department of The Faculty of Medicine in Cukurova University, and 52 normal female adolescents from two different secondary schools at the southern province in Turkey. The age range of the clinical and normal groups were 14-18 (x = 16). The results of the study revealed that the general stress level of female adolescents who attempted suicide is higher than those of normal groups. The examination of family structures of these female adolescents made it clear that mothers were the mediator between fathers and adolescents. It was also observed that both mothers and fathers shared many somatic concerns.
Management of intoxicated patients has many aspects in a wide spectrum, beginning with decontamin... more Management of intoxicated patients has many aspects in a wide spectrum, beginning with decontamination processes and basic supportive care. The most logical therapeutic approach is probably the specific antidotes, when available and/or applicable. On the other hand, many chemicals and drugs, can be removed from the body by means of hemodialysis or hemoperfusion while treating vital sign abnormalities and electrolyte and acid-base disturbances of the patient. In this paper, we describe 11 cases of intoxication, 6 with methyl alcohol, 3 with lithium, and 2 with salicylate, admitted to emergency department and treated with hemodialysis between January 1, 2002 and December 31, 2004. We review their medical charts and detailed demographic data, medical history, type of exposure, clinical and laboratory presentations, duration of hemodialysis performed, and the outcome.
Caustic products are responsible for the most serious cases of poisoning, which are always emerge... more Caustic products are responsible for the most serious cases of poisoning, which are always emergency cases. In this paper, we review demographic features and endoscopic results of the patients admitted to a university emergency department with a history of caustic substance ingestion between January 2000 and June 2003. Thirty-seven patients were included in this study. Twenty-one of the patients were female and 16 were male. The mean age of the patients was 30.9 +/- 14.7 years. The agents included sodium hypochlorite in 24 patients and hydrochloric acid in 13 patients. All the patients ingested these agents orally. The mean interval time of admission to emergency department after ingestion of caustic agent was 5.4 +/- 5.6 hours. Endoscopy was attempted in 37 patients. Endoscopic results were as follows: grade 0 in 8 (21.6%) patients, grade 1 in 17 (45.9%) patients, grade 2a in 5 (13.5%) patients, and grade 2b in 7 (18.9%) patients. We believe that early signs and symptoms after caustic substance ingestion are not consistent with the extent of damage, and endoscopy is the only reliable method to assess injury. It is important that efforts should be made to educate the public about the dangers of caustic substances so that their threat may be diminished.
Thyroid dysfunction is one of the serious consequences of an overdose of acetaminophen, aspirin, ... more Thyroid dysfunction is one of the serious consequences of an overdose of acetaminophen, aspirin, or nonsteroidal antiinflammatory drugs. The management of such consequences remains a medical challenge. A variety of thyroid abnormalities are common in clinical practice and can, in many cases, be accurately diagnosed and managed by the primary care physician. This case study covers an aspirin overdose causing thyroid storm that was treated successfully with hemodialysis.
Turkiye Klinikleri Journal of Medical Sciences, 2013
Ö ÖZ ZE ET T A Am ma aç ç: : Bu ça lış ma nın ama cı ka fa trav ma sı ne de niy le acil ser vi se... more Ö ÖZ ZE ET T A Am ma aç ç: : Bu ça lış ma nın ama cı ka fa trav ma sı ne de niy le acil ser vi se ge len/ge ti ri len ço cuk yaş gru bunda ki has ta la rın baş vu ru anın da ki S-100B pro te in dü zey le ri ile prog noz la rı ara sın da ki iliş ki yi in ce le mek ve S-100B pro te i ni nin ka fa trav ma sı nın şid de ti ni be lir le me de iyi bir be lir teç olup ol ma dı ğı nı araş tır maktır. G Ge e r re eç ç v ve e Y Yö ön n t te em m l le er r: : Çu ku ro va Üni ver si te si Tıp Fa kül te si Ço cuk Acil Tıp Bi ri mi' ne Ka sım 2005 ile Ağus tos 2006 ta rih le ri ara sın da baş vu ran 0-18 yaş gru bun da ki 75 ka fa trav ma lı has ta ile ay nı yaş gru bun -dan15 sağ lık lı ki şi ça lış ma ya dâhil edil di. Glas gow Ko ma Ska la sı (GKS) sko ru na gö re has ta lar, ha fif, or ta ve şid det li ka fa trav ma sı şek lin de grup lan dı. Has ta la rın, trav ma dan son ra ilk al tı sa at te ki S-100B dü zey leri ne ba kıl dı. S-100B dü zey le ri ile has ta la rın Ço cuk Trav ma Sko ru (ÇTS), Ye ni den Dü zen len miş Trav ma Sko ru (YDTS), Ha sar Şid de ti Sko ru [In jury Se ve rity Sco re (ISS)] ve Glas gow Son du rum Sko ru [Glas gow Out co me Sco re (GOS)] so nuç la rı ara sın da ki iliş ki in ce len di. B Bu ul l g gu u l la ar r: : GKS skor la rı kö tü olan has ta la rın S-100B dü zey le ri yük sek sap tan dı. Has ta la rın ISS, YDTS ve ÇTS skor la rı ile S-100B pro te in dü ze yi ara sın da an lam lı bir iliş ki sap tan dı (ISS için r=0,769, PTS için r=-0,821, YDTS için r=-0,833 ve her bi ri için p<0,001). S-100B pro te i nin sı nır de ğe ri 0,44 μg/L ola rak kul la nıl dı ğın da % 90 du yar lı lık ve %72,5 öz gül lük el de edilir ken, po zi tif kes ti ri ci de ğer %85,3 ve ne ga tif kes ti ri ci de ğer %85,3 bu lun du. Has ta la rın 3 ay son ra ki GOS de ğer le ri ile S-100B dü ze yi ara sın da da an lam lı de re ce de bir iliş ki sap tan dı. GOS de ğe ri 3 ve al tın da olan has ta la rın S-100B dü zey le ri da ha yük sek bu lun du (p<0,001). S So o n nu uç ç: : Ka fa trav ma lı has ta lar da baş lan gıç S-100B pro te i ni dü ze yi, be yin ha sa rı nın be lir len me sin de güç lü bir kes ti ri ci özel li ğe sa hip tir. Ek ola rak S-100B pro te i ni, ka fa ya ra lan ma sın dan son ra bi rin cil be yin ha sa rı nın cid di ye ti ve gi di şa tı hak kın da da önem li bir bil gi sağ la mak ta dır.
Anahtar Sözcükler: Acil, inme, mevsim , yaşlı hasta. GİRİŞ Yaşlı hastalarda vücudun çeşitli stres... more Anahtar Sözcükler: Acil, inme, mevsim , yaşlı hasta. GİRİŞ Yaşlı hastalarda vücudun çeşitli stres ve değişen koşullara adaptasyonu azalmakta, yaşlılar daha sık hastalanmakta, daha fazla kronik hastalık veya sorun ile yaşamak zorunda kalmakta, çoğu kez birkaç sağlık sorununu bir arada göğüslemeye çalışmakta, bütün bunların sonucunda da sağlık merkezlerine daha sık başvurmakta ve hastanelerde daha uzun süre kalmaktadırlar. Beklenen yaşam süresinin uzaması ve doğum hızının azalması ile, dünya nüfusu bir önceki elli yıla göre daha hızlı yaşlanmıştır. Yaşlı bireylerin sayısı 1998'de 580 milyon iken, 2050 yılında 1.97 milyara ulaşacağı hesaplanmaktadır. Gelişmekte olan ülkelerde yaşlı nüfusun artışı daha fazla olmaktadır. Önümüzdeki yıllarda dünyadaki 600 milyon yaşlı bireyin yaklaşık 2/3'ü gelişmekte olan ülkelerde olacaktır 9 . Dünyadaki tüm kültürel farklılıklara rağmen yaşlı sadece "65 yaşına ulaşan ve emekliye ayrılan kişi" olarak tanımlanmaktadır. Oysa modern ve uygar toplumların bu tanımlamayı artık gerçek anlamda mercek altına alması ve tartışması gerekmektedir. 20. yüzyıla ait bu değerlendirme çok yakın bir gelecekte anlamını yitirecektir 6 . Genel populasyonda tıbbın hedefi ve amacı "tedavi" iken, geriatrik populasyonda hedef, yaşlı insanların "yaşam kalitesini korumak"tır. Yaşlı hastanın değerlendirilmesi ve tedavisi yanında, yaşlıların sağlıklarının korunması da tüm uzmanlık dallarının
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