Ferhat Icme

Bio: Ferhat Icme is an academic researcher. The author has contributed to research in topics: Emergency department & Pulmonary embolism. The author has an hindex of 8, co-authored 65 publications receiving 231 citations.

The relation between oxidative stress parameters, ischemic stroke, and hemorrhagic stroke.

Abstract: Background/aim: The aims of this study were to investigate the significance of oxidative stress parameters in the pathogenesis of ischemic stroke and hemorrhagic stroke and to investigate their effects on stroke severity using the National Institutes of Health Stroke Scale (NIHSS). Materials and methods: A total of 92 patients, including 74 with ischemic stroke and 18 with hemorrhagic stroke, and 75 volunteers were enrolled in the study. Total oxidant status (TOS), total antioxidant status (TAS), paraoxonase, stimulating paraoxonase, arylesterase, and thiol levels were measured in both the patient and volunteer groups. NIHSS and oxidative stress index (OSI) scores were calculated. Results: TOS and OSI levels were significantly higher in the ischemia and hemorrhagic stroke groups than in the control group (P 0.05). Conclusion: Oxidative stress may play a role in the pathogenesis of both ischemic stroke and hemorrhagic stroke in terms of oxidants. We do not think that oxidative stress has any effect in determining stroke severity in either type of stroke.

The relationship between inferior vena cava diameter measured by bedside ultrasonography and central venous pressure value.

Abstract: Objective: We aimed to present inferior vena cava (IVC) diameter as a guiding method for detection of relationship between IVC diameter measured noninvasively with the help of ultrasonography (USG) and central venous pressure (CVP) and evaluation of patient’s intravascular volume status. Methods: Patients over the age of 18, to whom a central venous catheter was inserted to their subclavian vein or internal jugular vein were included in our study. IVC diameter measurements were recorded in millimeters following measurement by the same clinician with the help of USG both at the end-inspiratory and end-expiratory phase. CVP measurements were viewed on the monitor by means of piezoelectric transducer and recorded in mmHg. SPSS 18.0 package program was used for statistical analysis of data. Results: Forty five patients were included in the study. The patients had the diagnosis of malignancy (35.6%), sepsis (13.3%), pneumonia, asthma, chronic obstructive pulmonary disease (11.1%). 11 patients (24.4%) required mechanical ventilation while 34 (75.6%) patients had spontaneous respiration. In patients with spontaneous respiration, a significant relationship was found between IVC diameters measured by ultrasonography at the end of expiratory and inspiratory phases and measured CVP values at the same phases (for expiratory p = 0.002, for inspiratory p= 0.001). There was no statistically significant association between IVC diameters measured by ultrasonography at the end of expiration and inspiration and measured CVP values at the same phases in mechanically ventilated patients. Conclusions: IVC diameter measured by bedside ultrasonography can be used for determination of the intravascular volume status of the patients with spontaneous respiration.

The accuracy of mainstream end-tidal carbon dioxide levels to predict the severity of chronic obstructive pulmonary disease exacerbations presented to the ED.

Abstract: Introduction The end-tidal carbon dioxide (ETCO2) measurement was considered as an essential tool for the assessment of several conditions in emergency medicine. However, the diagnostic role of capnography in dyspneic patients still remains unclear. We aimed to analyze the alteration of the ETCO2 levels in chronic obstructive pulmonary disease (COPD) exacerbations and its role in the decision-making process. Methods All the individuals who were presented to the emergency department (ED) after COPD exacerbations were prospectively enrolled in the study. The patients were excluded if they refused to give informed consent, intubated after initial assessment, and had uncertain COPD diagnosis. The ETCO2 measurement using a mainstream capnometer was undertaken in the pretreatment and post-treatment period of COPD exacerbations. Results A total of 102 patients were enrolled in the study. Pre-ETCO2 and post-ETCO2 levels were positively correlated with arterial partial carbon dioxide pressure levels (r = 0.756, P Conclusion End-tidal carbon dioxide levels were higher in admitted patients when compared with discharged patients on arrival to the ED. ETCO2 measurement has very little contributions while evaluating patients with COPD exacerbation in the ED.

Effectiveness of therapeutic plasma exchange in patients with intermediate syndrome due to organophosphate intoxication.

Abstract: Objective We aimed to determine effectiveness of therapeutic plasma exchange (TPE) in patients with intermediate syndrome (IMS) due to organophosphate (OP) intoxication. Methods Patients diagnosed with IMS due to OP intoxication were included in this prospective study. Therapeutic plasma exchange procedure was performed with fresh frozen plasma as a replacement fluid via Fresenius-AS-TEC 204 device by Therapeutic Apheresis Unit to patients who developed IMS during follow-up. Samples were taken from patient's blood and waste plasma collected in the device before and after TPE procedure to be studied in laboratory for detection of organic phosphate and pseudocholinesterase (PChE) levels. In this study, SPSS 18.0 software package was used for statistical analysis of the data obtained. Level of statistical significance was taken as P Results Of all 17 patients, 4 (23.5%) were female, and 13 (76.5%) were male. A statistically significant decrease was detected in organic phosphate levels in the plasma of patients after TPE procedure (P = .012). A statistically significant increase was detected in PChE levels in the plasma of patients after TPE procedure (P = .014). Of 17 patients included in the study, 13 patients showed clinical improvement and were discharged after the TPE process. Conclusion In our study, it was observed that a significant decrease in the level of blood plasma OP and a significant increase in the level of PChE were achieved with TPE process in the early period of IMS due to OP poisoning. This study indicates that TPE is one of the effective treatment options for IMS due to OP intoxication.

The role of ultrasonography in the diagnosis of metacarpal fractures

Abstract: Introduction The aim of this study was to evaluate the efficiency of ultrasonography (USG) in identifying metacarpal bone fractures in patients admitted to the emergency department (ED) with hand injury. Materials and methods Patients who were admitted to a training and research hospital's ED during the study period with hand trauma and had suspected metacarpal fractures were included in the study. They were examined for metacarpal fracture by USG and x-ray. Hand radiographs reviewed by an emergency physician were considered to be the criterion standard diagnostic tool. Ultrasonography results were compared to x-ray results. Results Ninety-eight ultrasound examinations were performed on 96 adult patients who were enrolled in the study. The mean age of the patients was 30.1 ± 11.8 years; 79.2% of the patients were male. Right hand injury was observed in 69.4% of the cases. Forty metacarpal fractures were detected in 38 patients on x-ray. We found a sensitivity of 92.5% (95% confidence interval [CI], 78.5-98), a specificity of 98.28% (95% CI, 89.5-99.9), a positive predictive value of 97.37% (95% CI, 84.5-99.8), and a negative predictive value of 95% (95% CI, 85-98) for USG to detect metacarpal fractures when compared to x-ray imaging. Conclusions Under the light of these results, we suggest that USG may be an option for detecting metacarpal fractures and prevent unnecessary x-ray imaging examinations in patients presenting to the ED with hand trauma.

Bland-Altman analysis: A paradigm to understand correlation and agreement

Abstract: The rapid increase in the number of new laboratory methods has led to the necessity of reliable verification methods. Validation of a new measurement method for application to medical practice requires comparison with gold standard techniques. The Bland-Altman analysis is a frequently applied technique in studies that investigate the agreement between two methods of the same medical measurement. In this review, potential areas of usage of Bland-Altman analysis is elaborated from a clinical viewpoint, and possible pitfalls in study designs are discussed in statistical perspective.

The efficacy of sonographic measurement of inferior vena cava diameter as an estimate of central venous pressure

Abstract: Central venous pressure (CVP) and right atrial pressure (RAP) are important parameters in the complete hemodynamic assessment of a patient. Sonographic measurement of the inferior vena cava (IVC) diameter is a non-invasive method of estimating these parameters, but there are limited data summarizing its diagnostic accuracy across multiple studies. We performed a comprehensive review of the existing literature to examine the diagnostic accuracy and clinical utility of sonographic measurement of IVC diameter as a method for assessing CVP and RAP. We performed a systematic search using PubMed of clinical studies comparing sonographic evaluation of IVC diameter and collapsibility against gold standard measurements of CVP and RAP. We included clinical studies that were performed in adults, used current imaging techniques, and were published in English. Twenty one clinical studies were identified that compared sonographic assessment of IVC diameter with CVP and RAP and met all inclusion criteria. Despite substantial heterogeneity in measurement techniques and patient populations, most studies demonstrated moderate strength correlations between measurements of IVC diameter and collapsibility and CVP or RAP, but more favorable diagnostic accuracy using pre-specified cut points. Findings were inconsistent among mechanically ventilated patients, except in the absence of positive end-expiratory pressure. Sonographic measurement of IVC diameter and collapsibility is a valid method of estimating CVP and RAP. Given the ease, safety, and availability of this non-invasive technique, broader adoption and application of this method in clinical settings is warranted.

Violence against children...

Abstract: The purpose of the present study is to contribute to understanding violence in a family environment, especially in terms of childhood, and is formulated as a theoretical review of the theme. Based on book and article consultations, violence against children is looked at throughout history along with the protection of their rights. The application of disciplinary measures over time is approached, along with an understanding surrounding attitudes related to what can today be classified as abuse and violence against a child. Childhood was not always understood in the same manner it is today. The punishment, humiliation and even murder of children were tolerated over extended periods of history. Parents seem to have had supreme power over the life and death of their children. Changes in relation to this perception occurred mainly over the last few centuries. From then on, the relationship between parents and children became progressively permeated by more devoted attitudes, thus initiating significant changes that coincide with the scientific study of childhood. An important evolution is noted in terms of Law, in the sense of protecting children's rights, which had been recognized. However, it is shown that in spite of all the measures taken in terms of protection and a guarantee of rights, violence against children continues in our contemporary reality. [#] [K]