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 Comparison of predicting the severity of disease by clinical and radiological scoring systems in acute pancreatitis(2022-01-01) ÖZPOLAT, ÇİĞDEM; AKOĞLU, HALDUN; DENİZBAŞI ALTINOK, ARZU; Aktaş İ., Özpolat Ç., Demir H., Akoğlu E., Akoğlu H., Denizbaşı Altınok A.Aim: Acute pancreatitis (AP) is a frequent reason for patient presentation in emergency department. It is hard to assess objectively the grade of the disease due to a wide range of clinical signs in terms of determination the need for intensive care or surgical intervention. At this stage there is not a unique, unified scoring system that determines the severity of the disease. In this study we aimed to compare clinically used AP scoring systems; Ranson, BISAP and Balthazar (CTSI), SIRS to predict disease severity. Material and Methods: In this study, AP patients that were diagnosed by Atlanta criteria were analyzed retrospectively. The clinical, laboratory and radiological images and results of the patients were analyzed by using the "first 24 hours Ranson", "BISAP" and SIRS scores. The Balthazar scores were calculated from the CT reports retrospectively. Results: Age, respiratory rate and BUN values of the patients with mortality were significantly higher than the patients who survived, whereas diastolic blood pressure, systolic BP blood pressure, SO2 and amylase values of the patients with mortality were found to be significantly lower than the patients who survived. When the 6 month mortality prediction of prognostic scoring systems was examined, it was found that the BISAP score could catch 94% of mortality (95% CI: 0.88-0.97), and the SIRS score could predict mortality by 74.7% (95% CI: 0,66-0,82). Conclusion: Regarding the APs severity prediction, BISAP and SIRS scores were more sensitive and specific in terms of monthly and overall mortality in patientsPublication Open Access Determination of Pro-BNP and Troponin I Levels for ShortTerm Mortality Prediction in Ischemic Stroke Patients who did not Undergo Revascularization(2022-01-01) ÖZPOLAT, ÇİĞDEM; ONUR, ÖZGE ECMEL; DENİZBAŞI ALTINOK, ARZU; AKOĞLU, HALDUN; Aydın N., Özpolat Ç., Onur Ö. E. , Akoğlu H., Denizbaşı Altınok A.Introduction: Emergency departments (EDs) are the first place to start treatment for most stroke patients. Prognozing patients for planning and proper management of the therapies have an important place in approaching stroke patients. Many studies have been carried out with serum biomarkers especially in terms of prognosis stroke. Our objective, in this study, is to research short-term (14th day) mortality prediction of serum Troponin I (TnI) and pro-brain natriuretic peptide (BNP) levels. Methods: This was a prospective and observational prognostic test study. All consecutive patients admitted to the ED with the onset of symptoms in the past 24 h and diagnosed with the first episode of acute ischemic stroke were included in the study. A total of 121 subjects were included in the study. On admission, pro-BNP and TnI were collected from all subjects. On the 14th day of admission, patients were checked for mortality. Results: Of 121 patients, 14 (11.5%) had a mortal outcome at the end of the 14th day. The overall median pro-BNP level of all patients was 799.00 pg/ml (IQR: 220.00–2818.25). The median pro-BNP level of the non-survivor group was significantly higher than that of the survivor group (p:0.030). However, there was no significant difference between the TnI levels of the mortality groups. The optimal cutoff value of serum pro-BNP levels as an indicator of mortality on the 14th day was estimated to be 509 pg/ml (sensitivity: 85.7%, specificity: 49.5%, and AUC: 0.68 [95% CI, 0.59–0.769]). Discussion and Conclusion: Various biomarkers are investigated for prediction of mortality in ischemic stroke patient. According to our study, elevated pro-BNP values are associated with mortality. Further study with larger patient cohorts can be studied regarding the relationship between these threshold, in terms of predicting the mortality, in a more comprehensive study, as well as using subgroup and underlying conditions.Publication Open Access Diagnostic accuracy of the ECG criteria for left ventricular hypertrophy (cornell voltage criteria, sokolow-lyon index, romhilt-estes, and peguero-lo presti criteria) compared to transthoracic echocardiography(2021-03-01) AKOĞLU, HALDUN; ONUR, ÖZGE ECMEL; KARACABEY, SİNAN; EFEOĞLU, MELİS; DENİZBAŞI ALTINOK, ARZU; Akoğlu H., Onur Ö. E., Karacabey S., Efeoğlu Saçak M., Denizbaşı Altınok A.Objective/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], RomhiltEstes [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 Metadata only User's guide to sample size estimation in diagnostic accuracy studies(2022-10-01) AKOĞLU, HALDUN; AKOĞLU H.© 2022 Emergency Medicine Association of Turkey. All rights reserved.Sample size estimation is an overlooked concept and rarely reported in diagnostic accuracy studies, primarily because of the lack of information of clinical researchers on when and how they should estimate sample size. In this review, readers will find sample size estimation procedures for diagnostic tests with dichotomized outcomes, explained by clinically relevant examples in detail. We hope, with the help of practical tables and a free online calculator (https://turkjemergmed.com/calculator), researchers can estimate accurate sample sizes without a need to calculate from equations, and use this review as a practical guide to estimating sample size in diagnostic accuracy studies.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 Prediction of nipple involvement in breast cancer after neoadjuvant chemotherapy: Should we rely on breast MRI to preserve the nipple(2023-01-01) UĞURLU, MUSTAFA ÜMİT; BUĞDAYCI, ONUR; AKMERCAN, AHMET; KAYA, HANDAN; AKOĞLU, HALDUN; GÜLLÜOĞLU, MAHMUT BAHADIR; UĞURLU M. Ü., BUĞDAYCI O., AKMERCAN A., KAYA H., AKIN TELLİ T., AKOĞLU H., GÜLLÜOĞLU M. B.Background: Indications for nipple sparing mastectomy (NSM) is extending to post-neoadjuvant chemotherapy (NAC) setting. Eligibility for NSM with an optimum tumor-nipple distance (TND) after NAC is unclear. We examined predictive factors for nipple tumor involvement in patients undergoing total mastectomy following NAC. Methods: Clinical and pathological data from prospectively collected medical records of women with invasive breast carcinoma, who were undergone NAC and total mastectomy with sentinel lymph node biopsy and/or axillary lymph node dissection were analyzed. PreNAC and postNAC magnetic resonance imaging (MRI) views were examined and a cut-off TND value for predicting the negative nipple tumor status was determined. Results: Among 180 women, the final mastectomy specimen analysis revealed that 12 (7%) had nipple involvement as invasive carcinoma. Patients with nipple involvement had more postNAC multifocal/multicentric tumors (p: 0.03), larger tumors on preNAC and postNAC images (p: 0.002 and p 2mm) on preNAC and postNAC images (p < 0.001 and p: 0.01). The best likelihood ratios (LR) belonged to the postNAC positivity of the < 20 mm TND, with a + LR of 3.40, and − LR of 0.11 for nipple involvement. PreNAC positivity of the < 20 mm TND also had a similar − LR of 0.14. Conclusion: A TND-cut-off ≥ 2 cm on preNAC and postNAC MRI was shown to be highly predictive of negative nipple tumor involvement.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.