Tüm uyarılara rağmen acil servisten ayrılmak isteyen hastalar geriye dönük olarak incelendive özellikle hastaların acil serviste kalma süreleri değerlendirilmesi amaçlandı. YÖNTEM: Aralık 2012 -Mart 2013 tarihleri arasında devlet hastanesi acil servisine gelen ve muayene, tetkik ve gözlem aşamalarının herhangi bir kısmında, kendisine her türlü tıbbi risk ve ihtimaller anlatılmasına rağmen imza atarak hastaneden ayrılan hastalar geriye dönük olarak incelendi. Sayısal değişkenler ortalama±Standart deviasyon (Minimum değer, Maksimum değer) Median değer olarak belirtildi. Kategorik değişkenler sayı ve yüzde olarak sonuçlandırıldı. BULGULAR: Beş aylık dönemde hastanemiz acil servisinden, tüm tıbbi risklerin açıklanmasına rağmen kendi isteğiyle hastaneden yarılan 18 yaş ve üzeri 52 bayan (% 58,43) ve 37 erkek (% 41,57) olmak üzere toplam 89 hasta dâhil edildi. 89 hastanın 10'u (%11,20) başka bir merkeze gitmek istedi, 16 hasta (% 17,98) ise hastaneye yatması önerilmesine rağmen yatış yapmayı kabul etmedi. 63 hasta ise (%70,82) acil serviste tanı, tedavi ve takibi kabul etmemiş ve acil servisten ayrılmıştır. Hastaların tamamının acil serviste kalış süreleri ortalama olarak 163,65±135,2 (Min: 6 Max: 698) dakika idi. İntoksikasyon, karın ağrısı ve göğüs ağrısı ile takip edilen hastalar ortalama süreden fazla takip edilmişken travma nedeniyle acil servise gelen hastaların acil serviste bekleme süreleri daha az olmuştur. Hastaların hastaneye geliş saatine göre de hastanede kaldıkları toplam süreleri değişmekte ve saat 21 den sonra gelen hastalar daha uzun süre hastanede kalmış ve sonrasında ayrılmıştır SONUÇ: Acil servislerden ayrılmak isteyen hastaların o anda neden ayrılmak istedikleri özenle sorgulanmalı ve acil servislerin mevcut imkânları, hekimlerin tecrübeleri doğrultusunda hastanın sorunları değerlendirilerek çözüm önerileri geliştirilmelidir.
Background: Poisoning with carbon monoxide occurs occasionally worldwide, and the gold diagnostic standard is to measure carboxyhemoglobin level in the blood. This study investigated the correlation between carboxyhemoglobin and the end-tidal carbon dioxide levels in 50 patients with carbon monoxide poisoning. Methods: We recruited 50 volunteer patients who had been admitted to the Emergency Services of Istanbul Medipol University Hospital between January 2017 and January 2018. They had been diagnosed with carbon monoxide poisoning unrelated to fire accidents. The arterial and venous blood gases, and other blood and clinical parameters were also measured. The patients’ end-tidal carbon dioxide levels were measured from the nose and mouth air, using a Capnostream 20p bedside monitor. Pearson’s correlation analyses were performed and the results were compared with the end-tidal carbon dioxide, carboxyhemoglobin and oxygen saturation in the arterial and venous blood samples. Results: The Mean±SD age was 33.98±10.89 years. The Mean±SD arterial and venous carboxyhemoglobin values were 18.05±7.10 and 12.11±9.67, respectively. There were no statistically significant differences between the oxygen saturation, and the arterial and venous blood levels of carboxyhemoglobin (P=0.870, P=0.950), respectively. Also, no statistically significant correlations were found between the end-tidal carbon dioxide, and the arterial and venous carboxyhemoglobin levels (P=0.529, P=0.601), respectively. Conclusion: The results from the blood analyses demonstrated that there was no statistically significant difference between the end-tidal carbon dioxide and the carboxyhemoglobin levels in these patients who had been earlier diagnosed with carbon monoxide poisoning, unrelated to fire accidents.
Bone marrow aspirate for morphology and cytogenetics and qualitative reverse transcriptase polimerase chain reaction on peripheral blood cells is mandatory for the diagnosis of chronic myeloid leukemia (CML). Bone marrow biopsy and fluorescence in situ hybridisation may be necessary in selected patients. Performing other tests and diagnostic procedures depends on characteristics of the individual patient. Although flow cytometry is an essential tool in the diagnosis and monitoring of many hematological malignancies, it has a limited role in CML. In this study, we evaluated the CD45 side scatter results of our CML patients at diagnosis and during follow up. Totally 56 CML patients (22 female and 34 male) in chronic phase treated with imatinib were included. Patients were also evaluated after 8 (3-19) months follow up. Complete blood cound parameters and CD45/SSC results of the patients at diagnosis and follow up were evaluated retrospectively. The Wilcoxon T test was used to compare the means between the two groups. p<0.05 was considered statistically significant. All of them had decreased leukocyte and platelet counts. There was no difference in hemoglobin value. Comparison of CD45/SSC results at diagnosis and follow up revealed a decrease in granulocyte and blast percentages, and an increase in lymphocyte, monocyte, normoblast percentages. Complete blood counts and CD45/SSC results were not different when we divided patients into 2 groups according to being MMR positive or MMR negative. Survival of MMR positive and negative patients were also found similar. According to the results of our study, we were unable to suggest using CD45/SSC as a routine diagnostic and/or follow up tool. However, there were limitations of our study such as the limited number of patients, the variance between the time of MMR evaluation and the evaluation at only one time point. The results may change in larger studies with serial CD45/SSC analysis and with different tyrosine kinase inhibitors.
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