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    Analysis of Recurrent İleus Admissions to an Emergency Department
    (2023) Ozel, Mehmet; Çetinkaya, Remzi; Alpar, Suleyman; Araç, Songul
    Objective: Ileus is a common surgical emergency and tends to recur like other gastrointestinal tract pathologies. Recurrent episodes of ileus cause morbidity and mortality. The aim of this study was to evaluate the clinical characteristics, outcomes, and laboratory parameters of patients who presented with initial and recurrent episodes of ileus. Method: A retrospective observational study at a tertiary care hospital examined adult patients (≥18 years) diagnosed with ileus in the emergency department from January 2018 to March 2021. Results: This study was performed on 393 ileus patients in the emergency department. Of the patients, 312 (79.4%) were in the initial admission group and 81 (20.6%) were in the recurrent admission group. 144 patients (36.6%) were found to have comorbid diseases and the rate of comorbid patients in the initial group (23.7%, n=74) was significantly lower than in the recurrent group (50.7%, n=41) (p<0.001). Among 337 patients (85.8%) who were followed up on the ward and 56 patients (14.2%) who were followed up in the intensive care unit, the rate of follow-up in the intensive care unit was significantly higher for the initial group (16%, n=50) than for the recurrent group (7.4%, n=6) (p=0.048). In-hospital mortality was 11.5%, and there was no significant difference between the groups (p=0.776). WBC, CRP, CRP/albumin, and RDW/albumin ratios were lower in recurrent admissions, and a statistically significant difference was found between the groups (p=0.034, p<0.001, p=0.001, p=0.013, respectively). Conclusion: In managing patients with recurrent ileus episodes, clinicians may benefit from the findings of this study.
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    Factors influencing recurrent emergency department visits for mild acute respiratory tract infections caused by the influenza virus
    (Peerj Inc, 2023) Tatliparmak, Ali Cankut; Alpar, Suleyman; Yilmaz, Sarper
    Background. Seasonal viral outbreaks, exemplified by influenza A and B viruses, lead to spikes in emergency department (ED) visits, straining healthcare facilities. Addressing ED overcrowding has become paramount due to its implications for patient care and healthcare operations. Recurrent visits among influenza patients remain an underexplored aspect, necessitating investigation into factors influencing such revisits.Methods. Conducted within a tertiary care university hospital, this study adopts an observational retrospective cohort design. The study included adult patients with acute respiratory symptoms diagnosed with influenza using rapid antigen testing. The cohort was divided into single and recurrent ED visitors based on revisits within 10 days of initial discharge. A comparative analysis was performed, evaluating demographics, laboratory parameters, and clinical process data between recurrent visitors and single visitors.Results. Among 218 patients, 36.2% (n = 139) experienced recurrent ED visits. Age and gender disparities were not significant. Antibiotics were prescribed for 55.5% (n = 121) and antivirals for 92.7% (n = 202) of patients, with no notable influence on recurrence. Recurrent visitors exhibited lower monocyte counts, hemoglobin levels, higher PDW and P-LCR percentages, and increased anemia prevalence (p = 0.036, p = 0.01, p = 0.004, p = 0.029, p = 0.017, respectively). C-reactive protein (CRP) levels did not significantly affect recurrence.Conclusion. This study highlights the pressing concern of recurrent ED visits among mild influenza patients, magnifying the challenges of ED overcrowding. The observed notable prescription rates of antibiotics and antivirals underscore the intricate land-scape of influenza management. Diminished monocyte counts, hemoglobin levels, and altered platelet parameters signify potential markers for identifying patients at risk of recurrent visits.
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    Managing Hemiballismus Hemichorea Caused by Hyperglycemia in an Emergency Department
    (2023) Alpar, Suleyman; Yılmaz, Sarper
    Chorea, which is a common kind of uncontrollable movement disease, chorea is caused by dysfunctional neural networks that connect the basal ganglia with the frontal cortex. If a patient complains of chorea, a complete medical history is required to rule out other possible causes, including infection with group A beta-hemolytic streptococcus, a history of drug use, as well as the patient’s age at start and course (acute or insidious). Static chorea may be caused by structural or chemical injury to the basal ganglia or by benign hereditary chorea, both of which are associated with neurodegenerative illnesses. It is also necessary to conduct a neurological examination that includes an evaluation of the distribution and features of chorea. Non-ketotic hyperglycemia is a common cause of acute chorea. In addition to hemichorea, hyperglycemia may also produce chorea that is widespread. Patients with hyperglycemia that fit the normal description have been shown to have an unusual symptom of uncontrolled high hyperglycemia: hyperglycemia-induced hemiballismus hemichorea (HIHH). Even if all patients present with abnormal, hyperglycemic non-ketotic chorea, the differential diagnosis should be considered. Dopamine blockers, tetrabenazine, and topiramate are used to treat HIHH patients who do not respond to hyperglycemia treatment.
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    A shortcut for preparing doses of positive inotropic drug infusions in emergency patient management-fast inotrope bag (FiB) coefficient''
    (Mre Press, 2023) Alpar, Suleyman; Yilmaz, Sarper; Ak, Rohat
    The most basic rule for the management of patients in the emergency departments (EDs) and critical & intensive units (ICUs) are quick decision and quick order medication. For this reason, calculator applications are a necessary part of EDs in order to calculate some drug doses quickly. With the simple formula we discovered, it will be much easier to place an order for the 4 most frequently used drugs of the EDs (dopamine, dobutamine, norepinephrine, epinephrine). We recommend this simple and fast calculation method to all EDs and ICUs with fast inotrope bag (FiB) coefficient. This coefficient has been developed especially for simple pump devices or dosing devices that do not use ready-made inotropic drug bags and that, if needed, first control the preparation of the solution and then the hourly infusion of the prepared solution. These devices are used only because the amount of solution to be given to the patient per hour can be monitored. Taking advantage of this coefficient, the inotrope needed by the patient can be administered easily and quickly with only the patient's weight information, and the initial dose corresponds to the dose range recommended by the guidelines for inotropes.