Person: AKOĞLU, HALDUN
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AKOĞLU
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HALDUN
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Publication Open Access Comparing the effects of different amounts of fluid treatments in addition to analgesia in patients admitted to the emergency department with renal colic: A randomized study(2022-01-01) ÖZPOLAT, ÇİĞDEM; SANRI, ERKMAN; AKOĞLU, HALDUN; DENİZBAŞI ALTINOK, ARZU; Celebi L., ÖZPOLAT Ç., Onur O., AKOĞLU H., SANRI E., DENİZBAŞI ALTINOK A.Objective: There are a limited number of studies examining the effect of fluid administration for acute pain relief in patients with renal colic. We aim to evaluate whether intravenous fluid of different amounts will make a difference regarding pain, in patients who presented to the emergency department (ED) with flank pain. Patients and Methods: This single-center, prospective, randomized clinical trial was performed at the ED of a university hospital. Subjects were randomly assigned to three groups. All received an intramuscular (IM) injection of 75 mg diclofenac sodium and 3 mg intravenous (IV) morphine. While group 1 did not receive extra treatment, group 2 received 100 cc /hr physiological serum (PS), and group 3 received 500 cc /hr PS. Pain was assessed by using the visual analogue scale (VAS) ruler for 6 hours. Results: A total of 201 patients were included. Mean age was 36.16 ± 9.85. At 60 min mean VAS scores were 3.55 ± 1.24 in the first group, 4.42 ± 1.87 in the second group and 5.02 ± 1.92 in the third group. In the group fluid not given, pain decrease was faster than others. At 240 min mean VAS scores were similar in all groups. Conclusion: This study indicates that IV fluids given to patients with renal colic pain was not effective in pain relief. Keywords: Renal colic, Analgesia, Intravenous fluid, Urolithiasis, VASPublication Open Access Diagnostic Accuracy of the Electrocardiography Criteria for Left Ventricular Hypertrophy (Cornell Voltage Criteria, Sokolow-Lyon Index, Romhilt-Estes, and Peguero-Lo Presti Criteria) Compared to Transthoracic Echocardiography(CUREUS INC, 2021-03-14) DENİZBAŞI ALTINOK, ARZU; Bayram, Nurseli; Akoglu, Haldun; Sanri, Erkman; Karacabey, Sinan; Efeoglu, Melis; Onur, Ozge; Denizbasi, ArzuObjective/Aim: We aimed to evaluate the diagnostic utility of the widely used left ventricular hypertrophy (LVH) electrocardiography (ECG) criteria (Cornell Voltage Criteria [CVC], Sokolow-Lyon Index [SLI], Romhilt-Estes [REC], and Peguero-Lo Presti [PLP] Criteria) compared with the left ventricular mass measured by echocardiography. Methods: In this prospective diagnostic accuracy study, we screened all consecutive adults (18 to 65 years) who presented to our academic emergency department (ED) with increased blood pressure (>= 130/85 mmHg) between January 2016 and January 2017, and we enrolled a convenience sample of 165 patients in our study. The attending emergency physician managed all patients as per their primary complaint. The consulting cardiologist performed a transthoracic echocardiogram (TTE) of the patient and calculated the left ventricular mass (LVM) according to the American Society of Echocardiography (ASE) formula. After completing the patient recruitment phase, researchers evaluated all ECGs and calculated scores for SLI, CVC, REC, and PLP. We used contingency tables to calculate the diagnostic utility metrics of all ECG criteria. Results: The prevalence of LVH by TTE was 31.5%. CVC, SLI, REC, and PLP criteria correctly identified (true positive rate) abnormal LVM in only 3.9%, 1.9%, 9.6%, and 19.2% of the patients, respectively. CVC, SLI, REC score and PLP criteria performed poorly with extremely low sensitivities (3.9%, 1.9%, 10%, 19.2%) and poor accuracies (67.3%, 64.9%, 57.7%, 69.7%). Conclusion: ECG voltage criteria's clinical utility in estimating LVM and LVH is low, and it should not be used for this purpose.Publication Open Access The utility of heart-type free fatty-acid binding-protein (HFABP) levels for differentiating acute ischemic stroke from stroke mimics(2023-01-01) AKOĞLU, HALDUN; SANRI, ERKMAN; KARACABEY, SİNAN; EFEOĞLU, MELİS; DENİZBAŞI ALTINOK, ARZU; Unal E., AKOĞLU H., SANRI E., KARACABEY S., EFEOĞLU SAÇAK M., Onur O., DENİZBAŞI ALTINOK A.Background: Heart-type fatty acid-binding protein (HFABP) is found in the myocardium, brain, and some organs and is rapidly released from damaged cells into the circulation in case of ischemia. Aims: We aimed to determine the diagnostic utility of HFABP levels in patients suggesting acute ischemic stroke (AIS). Methods: This study was a prospective, single-center, observational diagnostic accuracy study with a nested cohort design. The estimated sample size was 126 patients, with a 1:1 case and control ratio. We included all consecutive patients with a lateralizing symptom (motor or sensory) or finding suggesting AIS (139 patients) who presented to ED within 24 h of their symptom onset and collected plasma at admission to the ED. After further evaluations, 111 patients (79.8%) were diagnosed with AIS and 28 with other neurological diseases (stroke-mimics). Findings: In our study, the median HFABP levels of the cases and controls were 2.6 μg/ml and 2.2 μg/ml, respectively, without any statistically significant difference (p = 0.120). The diagnostic accuracy of HFABP for AIS was also insignificant at 0.60 (95% CI 0.51–0.68; p = 0.119). Discussion: Plasma HFABP level is not a marker that can differentiate AIS from other neurological pathologies in patients presenting to the ED, with findings suggesting AIS.Publication Open Access The Validity of Canadian Cervical Spine Rules and the Nexus Low Risk Criteria in Trauma Patients(2019-03-01) SANRI, ERKMAN; Bora KAYA;Erkman SANRI;Haldun AKOĞLU;Özlem GÜNEYSELBackground: The first decision rule developed to identify clinically significant injuries in blunt cervicaltrauma patients is National Emergency X-Radiography Utilisation Study (NEXUS). In the NEXUS study, thenegative predictive value (NPV) has been determined as 99.8%. Sensitivity of Canadian Cervical Spine Rules(CCR) was reported as 99.4%, specificity as 45.1% and NPV was reported as 100%. The objective of this studyis to determine the reliability and utility of NEXUS and CCR for Turkish patient population that has a risk ofcervical injury.Methods: This prospective observational study included 225 patients, all stable, conscious patients over 16years of age who had acute trauma and were brought to the hospital with ambulances or using their ownmeans and who had been injured by a mechanism that may cause cervical trauma, and without exclusioncriteria. The patients included in the study were then evaluated for NEXUS and CCR validity.Results: When CCR was evaluated as a whole, it was determined that all pathological cases were identifiedusing these rules. In terms of identifying the presence of pathological imaging finding the sensitivity of CCRwas 100% (95% CI % 56-100) and specificity was 3.2% (95% CI 1.4-6.7%). NEXUS's sensitivity was calculatedas 93% (95% CI 83-97) and specificity as 1.3%(95% CI 0.2-5.1).Conclusion: CCR and the NEXUS were determined to be useful in the emergency department for theexclusion of cervical pathologies. CCR were more reliable and useful when compared with the NEXUS.Publication Open Access Which is more effective for the treatment of Acute Migraine Attack: Dexketoprofen, Ibuprofen or Metoclopramide?(PROFESSIONAL MEDICAL PUBLICATIONS, 2018-04-05) SANRI, ERKMAN; Karacabey, Sinan; Sanri, Erkman; Yalcinli, Sercan; Akoglu, HaldunObjective: The aim of this study was head-to-head comparison of the efficacy and rate of adverse events of metoclopramide, ibuprofen and dexketoprofen for the acute treatment of migraine attack in the real-life conditions of a busy emergency department (ED). Methods: This was a prospective, observational, cross-sectional study. All patients who presented to the ED with a headache fulfilling the inclusion criteria were enrolled. All patients were treated by the attending emergency physicians in their daily routine. If an IV treatment in the ED was found indicated by the EP, they selected one of the options in the written departmental migraine treatment protocol. Results: During the study period, 54 patients met the inclusion criteria. The median change in the pain score was significantly different among treatment options (p<0.0001). The median pain score change at the end of the 30 minutes for treatment groups were 7.5 mm (IQR: 7.0-8.0), 5.0 mm (IQR: 4.75-7.0), and 7.0 mm (IQR: 6.0-7.25), respectively (p=0.0002). All three groups were found to be significantly different from each other in the post-hoc analysis. Conclusion: All drugs compared in this study are effective in the relief of migraine headache. However, IV dexketoprofen seems to be faster and more effective than metoclopramide and ibuprofen.Publication Open Access Comparison of ketamine/propofol (ketofol) and etomidate/fentanyl (etofen) combinations for procedural sedation and analgesia in the emergency department: An observational study(ELSEVIER SCIENCE BV, 2017-09) SANRI, ERKMAN; Sanri, Erkman; Karacabey, Sinan; Akoglu, Haldun; Kaya, Bora; Guneysel, OzlemObjectives: The primary aim of this study was to report the vital signs, hemodynamic parameters and pain scores of the patients who have received procedural sedation and analgesia (PSA) with either ketofol (combination of ketamine and propofol) or etofen (combination of etomidate and fentanyl) and compare the proportion of patients with airway or respiratory adverse events (AEs) requiring an intervention and calculate the relative risk of AEs with each combination. Methods: This study is a prospective observational study with survey analysis. All patients received procedural sedation and analgesia (PSA) with either ketofol (combination of ketamine and propofol) or etofen (combination of etomidate and fentanyl) were prospectively observed. Vital and hemodynamic parameters and pain scores of the patients were recorded by automated equipment and visual analog scale (VAS) charts. Results: 112 patients were enrolled, 55 received ketofol and 57 received etofen. All patients with a respiratory AE (n = 27) observed to receive a respiratory intervention. Respiratory AE rate and proportion of patient who required a respiratory intervention were significantly higher with ketofol (p = 0.0029). Overall AE rate, and rates of desaturation, emergence reaction were also significantly higher in ketofol group. Conclusion: Etofen is a promising combination for the PSA of adult patients with lower respiratory AE and intervention rates and with better hemodynamic profile. Copyright (C) 2017 The Emergency Medicine Association of Turkey. Production and hosting by Elsevier B.V. on behalf of the Owner.Publication Open Access Variables Affecting Mortality Among COVID-19 Patients With Lung Involvement Admitted to the Emergency Department(CUREUS INC, 2021-01-07) DENİZBAŞI ALTINOK, ARZU; Sacak, Melis Efeoglu; Karacabey, Sinan; Sanri, Erkman; Omercikoglu, Serhad; Unal, Emir; Onur, Ozge Ecmel; Akoglu, Haldun; Denizbasi, ArzuIntroduction: A cluster of atypical pneumonia cases in Wuhan, China, turned out to be a highly contagious disease, swept across most of the countries, and soon after was announced as a pandemic. Therefore we aimed to investigate the demographics and factors associated with the disease outcome. Methods: In this retrospective chart review, we screened patients admitted to the emergency department with severe acute respiratory infection due to coronavirus disease 2019 (COVID-19) between March 15, 2020 and April 30, 2020. Age, gender, symptoms, laboratory data, and radiology data were obtained, as well as outcomes and length of stay. Results: We identified 177 patients (54.8% male). Seventy-eight percent of the cases were admitted into wards whereas 22% of the cases were admitted into the intensive care unit (ICU). Twenty-five percent of the cases needed invasive mechanical ventilation during their hospital stay and median length of hospital slay until death or discharge was eight days (interquartile range (IQR) 5.0 - 16.0). Among 177 patients, overall inhospital mortality rate was 19.8% (n=35; male:female=18:17; p=0.6553). In-hospital mortality rates were statistically significantly higher in patients with higher age (64 vs. 74; p=0.0091), respiratory rate (RR) (28 vs. 36; p=0.0002), C-reactive protein (CRP) (54.7 vs. 104.0; p<0.0001), d-dimer (1.2 vs. 3.2; p<0.0001), ferritin (170 vs. 450.4; p<0.0001), fibrinogen (512 vs. 598; p=0.0349), international normalized ratio (INR) (1.1 vs. 1.3; p=0.0001), prothrombin time (PT) (14.8 vs. 17.4; p=0.0001), procalcitonin (0.1 vs. 0.3; p<0.0001), creatinine (0.9 vs. 1.1; p<0.0084), longer length of stay (LOS) (8.0 vs. 13.0; pl.0251) with lower oxygen saturation (sO(2)) (93.0% vs 87.5%; p<0.0001), diastolic blood pressure (DBP) (78 vs. 70; p=0.0039), lymphocyte (1.2 vs. 0.8; p=0.0136), and with positive polymerase chain reaction (PCR) results (28.6% vs. 12.8%; p=0.0118). Conclusion: Patients with older age, higher RR, lower sO(2) and DBP, higher creatinine, d-dimer, INR, CRP, procalcitonin, ferritin, and fibrinogen on initial admission were found to be less likely to survive COVID-19.Publication Open Access Effect of access block on emergency department crowding calculated by NEDOCS score(2024-08-01) ALTUN, MUSTAFA; KARACABEY, SİNAN; SANRI, ERKMAN; ONUR, ÖZGE ECMEL; DENİZBAŞI ALTINOK, ARZU; AKOĞLU, HALDUN; Altun M., Kudu E., Demir O., KARACABEY S., SANRI E., ONUR Ö. E., DENİZBAŞI ALTINOK A., AKOĞLU H.Objective: Emergency department (ED) crowding poses a significant challenge in healthcare systems globally, leading to delays in patient care and threatening public health and staff well-being. Access block, characterized by delays in admitting patients awaiting hospitalization, is a primary contributor to ED overcrowding. To address this issue, the National Emergency Department Overcrowding Study (NEDOCS) score provides an objective framework for assessing ED crowding severity. This study aims to evaluate the impact of access block on ED crowding using the NEDOCS score and to explore strategies for mitigating overcrowding through scenarios over a 39-day period. Methods: A single-center, prospective, observational study was conducted in an urban tertiary care referral center. The NEDOCS score was collected six times daily, including variables like total ED patients, ventilated patients, boarding patients, the longest waiting times, and durations of boarding patients. NEDOCS scores were recorded, and calculations were performed to assess the potential impact of eliminating access block in scenarios. Results: NEDOCS scores ranged from 62.4 to 315, with a mean of 146, indicating consistent overcrowding. Analysis categorized ED conditions into different levels, revealing that over 81.2% of the time, the ED was at least overcrowded. The longest boarding patient\"s waiting duration was identified as the primary contributor to NEDOCS (48.8%). Scenarios demonstrated a significant decrease in NEDOCS when access block was eliminated through timely admissions. Shorter boarding times during non-working hours suggest the potential mitigating effect of external factors on the access barrier. Additionally, daytime measurements were associated with lower patient admissions and shorter wait times for initial assessment. Conclusion: Although ED crowding is a multifactorial problem, our study has shown that access block contribute significantly to this problem. The study emphasizes that eliminating access block through timely admissions could substantially alleviate crowding, highlighting the importance of addressing this issue to enhance ED efficiency and overall healthcare delivery.