Papers by Birdal Yıldırım
Dislipidemi ve koroner arter hastalıklarında Chlamydia pneumoniae
Cumhuriyet Üniv. Tıp Fak. Derg., 2003
Bratislava Medical Journal
OBJECTIVE: The lymphocyte-to-C-reactive protein ratio (LCRP) and Systemic Immune-Infl ammation In... more OBJECTIVE: The lymphocyte-to-C-reactive protein ratio (LCRP) and Systemic Immune-Infl ammation Index (SII) can successfully predict 28-day mortality rates with community-acquired pneumonia METHODS: This prospective study was conducted in 2018. Hospitalized patients underwent follow-up evaluations 28 days after admission. RESULTS: A total of 345 patients with CAP were enrolled in this study. All-cause mortality at the 28th day of follow-up was 13.6 %. There were statistically signifi cant results between the 2 groups (survivors and nonsurvivors), in terms of the LCRP, SII, PSI, and CURB-65 values. Moreover, the optimal LCRP cutoff for predicting 28-day mortality was determined to be 4, with 89 % sensitivity, 73 % specifi city. Based on the average SII>3551for predicting 28-day mortality, the sensitivity, specifi city was 63.8 %, 68.1 % respectively. When the value of the cutoff PSI was ≥130 points, the sensitivity, specifi city was 68 %, 65 %, respectively. Based on 3 points and above as the cutoff value of the CURB-65 score, the sensitivity, specifi city was 80 %, 68 %, respectively. ROC curve analysis revealed that the areas of LCRP, SII, PSI, and CURB-65 under the AUC in terms of 28day mortality were 0,820,0,737,681, and 0,773, respectively, CONCLUSIONS: LCRP and SII level are valuable for predicting the mortality rate among patients with CAP at ED admission
TAPSE: a novel prognostic marker in community-acquired pneumonia
Oxford Univ Press, 2016
Meandros Medical and Dental Journal
Amaç: Bu çalışmada hastanemizde yatarak tedavi gören toplum kökenli pnömoni (TKP) hastalarının pn... more Amaç: Bu çalışmada hastanemizde yatarak tedavi gören toplum kökenli pnömoni (TKP) hastalarının pnömoni şiddet skorları ve kan magnezyum (Mg) düzeyinin olguların mortalitesine etkisinin incelenmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışmamız, 2018 yılında hastanemizin acil servisinde TKP tanısı konulan ve servislere veya yoğun bakım ünitesine (YBÜ) yatırdığımız hastaları içeren retrospektif bir çalışmadır. Bulgular: Çalışmaya toplam 279 TKP hastası alındı. Takibin 28. gününde tüm nedenlere bağlı mortalite oranı %13,6 idi. Hastaları 28 günlük mortalite durumlarına göre yaşayanlar ve yaşamayanlar olarak iki gruba ayırdığımızda, gruplar arasında Mg düzeyi, pnömoni şiddet indeksi (PSİ) ve konfüzyon, üre, solunum sayısı, kan basıncı, <65 yaş (CURB-65) değeri arasında istatistiksel olarak anlamlı bir fark vardı. Ayrıca acil servise ilk başvuru anında alınan kan tetkikinde çalışılan Mg değeri için cutoff değerini 1,90mg/dL olarak aldığımızda 28 günlük mortalite tahmini için sensitivitesinin %71, spesifitesinin %73, doğruluk oranının %73 olduğu görüldü. Mg ve 28 günlük mortalite için çalışılan ROC analizinde eğri altında kalan alanın 0,778 olduğu tespit edildi. Yirmi sekiz günlük takip boyunca 28 hastanın öldüğü görüldü ve bu hastaların 27'sinin (%64,2) Mg düzeyi 1,90 mg/dL altındaydı. 28 günlük mortalite oranları için bağımsız prediktörlerin belirlenmesi amacıyla yapılan lojistik analizde Mg (1,90 mg/dL'den düşük), CURB-65, PSİ, vazopresör ihtiyacı ve YBÜ'de kalışın bağımsız prediktörler olduğu belirlendi. Sonuç: TKP hastalarında Mg seviyesi düştükçe ölüm oranları artmaktadır.
World Journal of Surgery, 2018
Background Preoperative nutritional status is considered to affect the short-term and long-term o... more Background Preoperative nutritional status is considered to affect the short-term and long-term outcomes of cancer patients. The clinical value of the controlling nutritional status (CONUT) score in elderly patients undergoing gastrectomy for gastric cancer remains unknown. Methods This study reviewed 211 elderly patients aged 75 years or over who underwent curative resection for gastric cancer from 2000 to 2015. Patients were grouped according to the preoperative CONUT score into those with normal nutrition (75 patients), light malnutrition (100 patients) and moderate or severe malnutrition (36 patients). The predictive value of the CONUT score for postoperative morbidity and survival was assessed. Results Impaired nutrition was associated with cardiovascular disease (P = 0.012) and chronic kidney disease (P = 0.014), and worsened malnutrition was linked to advanced age (P = 0.004), decreased body mass index (P = 0.008) and advanced disease stage (P = 0.01). Multivariate analysis showed the CONUT score as an independent predictor of procedure-unrelated infectious morbidity (odds ratio, 2.36; 95% confidence interval [CI], 0.99-5.40; P = 0.046). Patients with a higher CONUT score had significantly shorter overall survival in both stage I and stage II/III gastric cancer (P = 0.044 and P = 0.007, respectively) and reduced cancer-specific survival in stage II/III (P = 0.003) The CONUT score was a strong predictors of overall survival (hazard ratio [HR], 2.12; 95% CI, 1.18-3.69; P = 0.012) and cancer-specific survival (HR, 3.75; 95% CI, 1.30-10.43; P = 0.015) independent of disease stage. Conclusions The preoperative CONUT score is a simple and promising predictor of postoperative procedure-unrelated infectious morbidity and prognosis in elderly gastric cancer patients.
Is there a potential role for echocardiography in adult patients with community-acquired pneumonia ? A pilot study
The American Journal of Emergency Medicine, 2015
The role of echocardiography in adult patients with community-acquired pneumonia (CAP) has not be... more The role of echocardiography in adult patients with community-acquired pneumonia (CAP) has not been tested in a clinical trial. The aim of the study was to assess the cardiac changes secondary to CAP by echocardiography and to find out the correlation between echocardiographic findings and the severity of CAP. A total of 111 unselected consecutive adult patients hospitalized with CAP were enrolled. The control group consisted of 100 consecutive sex- and age-matched patients. The severity of CAP was evaluated with the pneumonia severity index and the CURB-65 (confusion, urea, respiratory rate, arterial blood pressure and age) score. Blood samples were taken and echocardiography was performed within the first 48 hours. White blood count, N-terminal pro-brain natriuretic peptide, and red blood cell distribution width were significantly higher in the CAP group compared with the control group. The 2 groups did not differ in terms of left and right ventricle ejection fraction, left atrial diameter, pulmonary artery systolic pressure, and left ventricular end-diastolic and end-systolic diameter. However, tricuspid annular plane systolic excursion (21.1 ± 4.3 vs 22.3 ± 4.1 mm; P = .04), aortic distensibility (2.5 ± 0.9 vs 3.5 ± 0.9 cm(2):dyne:10, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001), and aortic strain (5.8% ± 2% vs 6.5% ± 1.9%, P = .009) were significantly reduced in CAP group than in controls. The plasma concentration of N-terminal pro-brain natriuretic peptide correlated with aortic strain, aortic distensibility, tricuspid annular plane systolic excursion, pneumonia severity index score, and CURB-65 score. Tricuspid annular plane systolic excursion and elastic properties of aorta may play a role in the diagnosis and clinical assessment of CAP severity, which could potentially guide the development of new prognostic models.
Journal of Experimental and Clinical Medicine, 2021
Electrocardiography (ECG) is an auxiliary test applied for differential diagnosis of Pulmonary Th... more Electrocardiography (ECG) is an auxiliary test applied for differential diagnosis of Pulmonary Thromboembolism (PTE). However, its specificity is low, but it is more often used for differential diagnosis. Although there are some changes on ECG in PTE, ST elevation is not a finding that we expect to see. With this case report, we aimed to draw attention to the issue with the diagnosis of PTE in a patient with ST elevation in ECG. 52-year-old male patient presented to the emergency department with a complaint of convulsion after chest and back pain. During the examination in the emergency department, he had a convulsion and woke up on his own without entering a postictal phase. After that, he had a chest pain. For this reason, ECG was performed to the patient and revealed ST elevation in leads DI, AVL, V1-4. The results of the patient’s EEG and head computer tomography (CT) were normal, so coronary CT angiography was performed. And it was observed that the coronary arteries were paten...
Carbon Monoxide Intoxication Induced Atrial Fibrillation
Haseki Tıp Bülteni, 2012
Arquivos Brasileiros de Cardiologia, 2021
Fundamento: A prevalência e o significado da microalbuminúria não foram bem estudados em paciente... more Fundamento: A prevalência e o significado da microalbuminúria não foram bem estudados em pacientes com diferentes subtipos de insuficiência cardíaca. Objetivo: A prevalência e o significado da microalbuminúria não foram bem estudados em pacientes com diferentes subtipos de insuficiência cardíaca. Portanto, nosso objetivo foi investigar a frequência e o valor prognóstico da microalbuminúria em pacientes hospitalizados por insuficiência cardíaca aguda (ICA) com fração de ejeção preservada (ICFEp), fração de ejeção de faixa média (ICFEfm) e fração de ejeção reduzida (ICFEr). Métodos: Todos os pacientes adultos consecutivos encaminhados ao hospital devido a ICA entre junho de 2016 e junho de 2019 foram inscritos. A microalbuminúria é definida como o nível de albumina urinária para relação de creatinina (AURC) na faixa de 30-300 mg/g. A mortalidade hospitalar foi o critério de valoração deste estudo. Resultados: Dos 426 pacientes com ICA (idade média de 70,64 ± 10,03 anos, 53,3% do sexo feminino), 50% tinham ICFEr, 38,3% tinham ICFEp e 11,7% tinham ICFEfm na apresentação. A prevalência de microalbuminúria foi de 35,2%, 28,8% e 28,0% em ICFEr, ICFEp e ICFEfm, respectivamente. Um total de 19 (4,5%) pacientes morreram durante o curso intra-hospitalar, e a mortalidade intra-hospitalar foi maior em pacientes com ICFEr (6,6%) em comparação com pacientes com ICFEr (2,5%) e ICFEfm (2,0%). A análise multivariada mostrou que a presença de microalbuminúria previu mortalidade intra-hospitalar em pacientes com ICFEr e ICFEfm, mas não em ICFEp. Conclusão: Embora a microalbuminúria fosse comum em todos os subgrupos de pacientes com ICA, descobriu-se que ela prediz o prognóstico apenas em pacientes com ICFEr e ICFEfm.
The cientificWorldJOURNAL Research Article Comparison of Three Methods for the Estimation of Pineal Gland Volume Using Magnetic Resonance Imaging
Copyright © 2012 Niyazi Acer et al. This is an open access article distributed under the Creative... more Copyright © 2012 Niyazi Acer et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Pineal gland is a very important neuroendocrine organ with many physiological functions such as regulating circadian rhythm. Radiologically, the pineal gland volume is clinically important because it is usually difficult to distinguish small pineal tumors via magnetic resonance imaging (MRI). Although many studies have estimated the pineal gland volume using different techniques, to the best of our knowledge, there has so far been no stereological work done on this subject. The objective of the current paper was to determine the pineal gland volume using stereological methods and by the region of interest (ROI) on MRI. In this paper, the pineal gland volumes were calculated in a total of 62 subjects (36 females, 26 males) who were free ...
Hong Kong Journal of Emergency Medicine
Objective: We aimed to investigate the prevalence and prognostic value of malnutrition assessed b... more Objective: We aimed to investigate the prevalence and prognostic value of malnutrition assessed by Controlling Nutritional Status score in community-acquired pneumonia patients. Methods: All adult patients admitted to our emergency department and hospitalized for community-acquired pneumonia were prospectively followed-up until hospital discharge or death. Nutritional status was assessed with the Controlling Nutritional Status score, which is based on serum albumin levels, total cholesterol levels, and lymphocyte counts. The primary study endpoint was complicated hospital course defined as need for mechanical ventilation, mortality, or intensive care unit admission. Results: Three hundred and five patients (mean age 68.6 ± 11.2 years and 51.8% female) were enrolled, and 40 patients (13.1%) had complicated hospitalizations. Older patients, patients with more comorbidities, and patients with higher Controlling Nutritional Status scores on admission were tended to have a higher rate of...
Glucocorticoid Induced Hypokalemic Periodic Paralysis in Subclinical Hyperthyroidism: Case Report / Glukokortikoid Kullanımına Bağlı Hipokalemik Periyodik Paralizi Gelişen Subklinik Hipertiroidizm Olgusu
Thyrotoxic periodic paralysis (TPP), the most commonly seen disorder among Asian men, is characte... more Thyrotoxic periodic paralysis (TPP), the most commonly seen disorder among Asian men, is characterized by abrupt onset of hypokalemia and paralysis. The underlying hyperthyroidism is often subtle, which causes difficulty in early diagnosis. Factors such as high-carbohydrate eating habit, excessive exercise, use of steroid, and stress can precipitate a TPP attack. We, hereby, present a young Turkish man who developed acute paralysis after receiving intravenously applied dexamethasone for weever fish poisoning. His serum potassium level was 2.3 mmol/l. Moreover, he had subclinical hyperthyroidism and elevated serum creatinephosphokinase (CPK: 609 U/L) and hypophosphatemia (p:1.8 mg/dl). He had neither a loss of renal (24 h urinary potassium: 19.9 mmol) nor gastrointestinal potassium. His muscle strength and serum potassium were fully recovered after a small amount of potassium replacement. The patient was diagnosed as Steroid induced TPP in subclinical hyperthyroidism and was treated ...
Kış Sporları Yaralanmaları
Ozet Kis sporlari yayginligi her gecen gun artan spor faaliyetlerindendir ve yapan kisi sayisi ar... more Ozet Kis sporlari yayginligi her gecen gun artan spor faaliyetlerindendir ve yapan kisi sayisi arttikca yaralanmalar da sik gorulmektedir. Kis sporlarinda yaralanma profesyonel sporcularda daha fazladir ancak amator sporcularin yaralanmalari daha ciddi olmaktadir. Her yil milyonlarca kisinin yaptigi bu spor faaliyetlerinden yaralanmalardan korunmak cok onemlidir. Sporcularin koruyucu ve uygun ekipman kullanmalari, yaptiklari sporla ilgili kisa da olsa egitim almalari onem arz etmektedir. Alinacak basit davranissal onlemlerin koruyucu etkisi ve koruyucu ekipman kullanimi kazalarda yaralanmalarin azaltilmasi nedeniyle onemlidir. Anahtar kelimeler: Kis sporlari, Koruyucu ekipmanlar, Yaralanma Abstract Winter sports are a kind of sports activities, the prevalence of which is increasing day by day. As the number of people, who do winter sports, increases, injuries become more common. Injury in winter sports is seen in greater extent in the professional athletes, whereas, injuries of am...
Akut Apandisit ve Renal kolik ayırımında çok değerli laboratuvar markırları vardır
Spontaneous Spleen Rupture and Apixaban
Novel oral anticoagulants (NOACs) are now widely used. Spontaneous splenic rupture (SLR) is a rar... more Novel oral anticoagulants (NOACs) are now widely used. Spontaneous splenic rupture (SLR) is a rare condition. It is life-threatening, especially if not immediately recognized. Previous studies have shown an association between NOAC use and SLR. We report a case of a 53-year-old female patient who responded to cardiopulmonary resuscitation (CPR) after SLR. The patient, who had an external cardiac device for heart failure 13 months ago was admitted to our emergency department. She was unconscious, pale, hypotensive and had tachycardia. Free fluid was detected in the peritoneum by bedside ultrasonography. The patient was resuscitated for 20 minutes after arrest during the follow-up period. She was stabilized and computed tomography showed a large subcapsular splenic hematoma with active extravasation around the spleen, but persistent low urine output developed with hypotension despite resuscitation. She was taken to the operating room for splenectomy and abdominal washing. She was then...
Concurrent Pulmonary Embolism and Acute Myocard Infarction: A Case Report
Introduction: Pulmonary embolism and ST-elevation MI are both life threatening diseases. Although... more Introduction: Pulmonary embolism and ST-elevation MI are both life threatening diseases. Although rare, concomitant pulmonary embolism and myocardial infarction pose even greater risk. Here we aimed to report a case of ST-elevation acute coronary syndrome developing one hour after diagnosis of pulmonary embolism. Case-Report: A 48-year-old male patient with known coronary artery disease had admitted for chest pain and dyspnea. He had got deep vein thrombosis in 10 days prior to this presentation. There wasn’t ST elevation on his electrocardiogram. Pulmonary embolism was detected in the pulmonary CT angiography taken to the patient. The ECG was repeated after the patient, whose treatment was started, had new chest pain and sweating. The patient, whose ST elevation was detected in the inferior leads in the new ECG, was taking in to PCI. The patient, who had a stent in RCA, left the hospital voluntarily on the 3rd day of his admission to the coronary intensive care unit from where he w...
International Journal of Clinical Practice
This study aimed to investigate hemogram parameters and CRP that can be used in clinical practice... more This study aimed to investigate hemogram parameters and CRP that can be used in clinical practice to predict mortality in hospitalized patients with a diagnosis of COVID-19. Methods: This cohort study was conducted at University Hospital, which is a designated hospital for COVID-19 patients. Adult patients who were admitted to our hospital emergency department with suspected COVID-19 and who were hospitalized in our institution with a COVID-19 diagnosis were analysed. Results: There were 148 patients hospitalized with COVID-19. All-cause mortality of follow-up was 12.8%. There were statistically significant results between the 2 groups (survivors and nonsurvivors), which were classified based on hospital mortality rates, in terms of the lymphocyte to C-reactive protein ratio (LCRP), Systemic immune inflammation index (SII), , neutrophil-tolymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), CRP concentration and comorbid disease. In a Receiver operating characteristic (ROC)". curve analysis, LCRP, NLR, PLR, and SII Accepted Article This article is protected by copyright. All rights reserved area under the curve (AUC) for in-hospital mortality were 0.817, 0.816, 0.733 and, 0,742 respectively. Based on an LCRP value of 1 for in-hospital mortality, the sensitivity, and specificity rates were 100%, 86.8% respectively. Based on the average SII of 2699 for in-hospital mortality, the sensitivity, specificity, and accuracy rates were 68,4%, 77,5%, and 76,3%, respectively A total of 19 patients died during hospitalization. All of these patients had an LCRP level ≤ 1; 14 had an NLR level ≤ 10.8; 13 had a SII ≥ 2699 (Fisher's exact test, p = 0.000). Independent predictors of in-hospital mortality rates were LCRP < 1, PLR, SII ≥ 2699, white blood cell count, CRP, age, comorbidities, and ICU stay. Conclusions: We concluded that inflammatory parameters, such as LRCP, SII and NLR, were associated with disease severity and could be used as potentially important risk factors for COVID-19 progression.
High Flow Nasal Cannula is superior than CPAP in carbon monoxide poisoning
The American Journal of Emergency Medicine
Comparison of objective nutritional indexes for the prediction of in-hospital mortality among elderly patients with acute heart failure
European Journal of Emergency Medicine
Objectives: The association between objective nutritional indexes and prognosis in patients with ... more Objectives: The association between objective nutritional indexes and prognosis in patients with acute heart failure have not been well studied. Therefore, we aimed to compare the prognostic value of modified Glasgow prognostic score, prognostic nutritional index, controlling nutritional status score, and geriatric nutritional risk index for the prediction of in-hospital mortality in patients with acute heart failure. Methods: All consecutive elderly patients (aged ≥65 years) who had tests for C-reactive protein, total lymphocyte count, total cholesterol, and albumin levels at admission, and hospitalized due to acute heart failure were retrospectively included. The primary endpoint of the study was in-hospital mortality. We used a base model for the prediction of in-hospital mortality, including age, gender, log N-terminal pro-B-type natriuretic peptide, and the presence of coronary artery disease. We added each of the malnutrition scores, in turn, to the base model and used C-statistics to evaluate model discrimination in survival analysis. Results: A total of 628 patients were included, and 80 (12.7%) of the patients died during the hospital stay. Multivariate analysis showed that older age, prognostic nutritional index < 41.2, controlling nutritional status score > 5, geriatric nutritional risk index <92, and modified Glasgow prognostic score were independent predictors of in-hospital mortality. Among the malnutrition scores, geriatric nutritional risk index increased model performance most compared with base model. Conclusion: Though all objective nutritional indexes were associated with prognosis in elderly patients with acute heart failure, geriatric nutritional risk index was superior to other scores in predicting in-hospital mortality.
Evaluation of Nexus X-ray Rules in Blunt Thorax Trauma
Turkish Journal of Trauma and Emergency Surgery
BACKGROUND There is still no agreed radiographic rule for the evaluation of blunt thoracic trauma... more BACKGROUND There is still no agreed radiographic rule for the evaluation of blunt thoracic trauma. Emergency physicians want radiography according to their experience and examination findings. Various studies have been carried out on this subject and some of these studies have reached findings that can support the initial steps of the rules of radiography. One of them is the rule of Nexus thorax radiography rules. In this study, we aim to determine the accuracy of nexus thorax radiography rules. METHODS Our study was a prospective cohort study performed in the emergency department of our University Hospital. In this study, 690 patients were evaluated. RESULTS As a result of our study, we observed that patients were asked for more thoracic trauma because of chest pain, palpation tenderness in the thorax and sudden deceleration mechanism and pathology was found in approximately 25% of all imaging. The most common pathology we observed was rib fracture. Approximately 45% of the patients underwent thorax CT, and thorax CT was the most frequently requested for the detailed examination. When we evaluate the patients according to nexus thorax radiography rules, it was seen that the mechanism of sudden deceleration, intoxication and the disturbing, painful injury was more important than other parameters. The overall sensitivity and specificity of Nexus thorax radiographs were found to be 98% and 38%, respectively. CONCLUSION In the evaluation of blunt thoracic trauma, the rules of nexus thorax radiography are considered useful concerning pathological detection.
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Papers by Birdal Yıldırım