Bahadir Taslidere

Introduction: Ultrasonography, a radiological method that has been used in the medical field for diagnostic and therapeutic purposes for a long time, employs sound frequencies. This study aims to examine the use of ultrasonography among emergency medicine residents, investigate the frequency of its usage over the years, and provide recommendations.Material and Method: In our study, emergency medicine residents currently training at ministry of health training and research hospitals or city hospitals and university hospitals were included. Those who passed the specialty exam were excluded from the study. A comprehensive survey was developed, recording questions regarding the residents' gender, training center, year of residency, availability of ultrasound (USG) equipment in the emergency department, adequacy of the equipment for current diagnoses, USG training, changes in frequency of use after training, frequency of USG use overall, frequency of USG use in resuscitation, for FAST examination, for detecting wall motion abnormalities in myocardial infarction, for measuring optic nerve sheath diameter, for diagnosing deep vein thrombosis (DVT), for the BLUE Protocol, and for diagnosing testicular torsion.Results: In the study, a total of 190 emergency medicine residents participated, comprising 116 males and 74 females. Among them, 112 were undergoing training at university hospitals, while 78 were at ministry of health training and research hospitals or city hospitals. The distribution of participants based on years of residency showed 47 in the 0-12 month range, 45 in the 12-24 month range, 40 in the 24-36 month range, 31 in the 36-48 month range, and 27 with more than 48 months of current residency. Regarding ultrasound (USG) equipment, 94.7% of participants reported that their training emergency department had at least one USG device. However, 39% of participants felt that these devices were not sufficient for making diagnoses. Two-thirds (67.7%) of participants indicated they had received USG training, and a significant majority (62.9%) reported an increase in the frequency of USG use after receiving training.Conclusion: In our study, we found that emergency medicine residents training at university hospitals used USG devices more frequently across various types of USG compared to those training at EAH-city hospitals. Additionally, we believe that replacing all devices at the centers with state-of-the-art technology that aids in diagnosis will increase the frequency of use and, over time, reduce examination costs and diagnosis times.

Rapid risk stratification is crucial in managing upper gastrointestinal bleeding (UGIB). This study evaluated the prognostic value of the age‐adjusted shock index (ASI), blood urea nitrogen (BUN)/haemoglobin ratio and BUN/platelet ratio for predicting adverse clinical outcomes. This single‐centre retrospective observational cohort study included 204 adult patients (age ≥ 18 years) presenting to the emergency department with UGIB between 1 January 2022 and 31 December 2022. Patients with oesophageal variceal bleeding, lower gastrointestinal sources, trauma, pregnancy, malignancy, prior diagnosis at another institution or incomplete data were excluded. Receiver operating characteristic (ROC) curve analysis was the primary statistical method used to determine prognostic performance. Among the 204 included patients, the intensive care unit (ICU) admission rate was 14%, and the in‐hospital mortality rate was 5.4%. ROC curve analyses for in‐hospital mortality revealed statistically significant predictive capabilities across all evaluated parameters. The BUN/haemoglobin ratio demonstrated an area under the curve (AUC) of 0.779 at an optimal cut‐off of > 8.45, yielding a high negative predictive value (NPV) of 97.26%. The BUN/platelet ratio produced an AUC of 0.747 at a cut‐off of > 0.17, with an NPV of 98.32%. Additionally, the ASI achieved an AUC of 0.780 at an optimal cut‐off of > 61.72 and an NPV of 98.03%. The ASI, BUN/haemoglobin and BUN/platelet ratios are rapid, inexpensive and easily calculable parameters upon admission. Their notably high NPVs make them effective complementary tools to established scoring systems, aiding clinicians in safely identifying low‐risk patients who can be managed in the general ward rather than the ICU.

This study aims to compare emergency physicians’ performance with that of general-purpose large language models (LLMs), such as ChatGPT and Gemini, for pneumothorax (PTX) detection on chest radiographs (CXRs). This single-center, retrospective study of adults was conducted between January 2015 and February 2025 and included 265 PTX cases and 267 non-PTX controls. Exclusions included diagnoses made only by computed tomography, absence of CXR, initial treatment at another center, or incomplete data. Thirteen emergency physicians independently and blindly reviewed CXRs and recorded a binary decision. ChatGPT and Gemini evaluated the same images with a standardized yes/no prompt, with memory cleared between cases to prevent carryover. The primary outcome was LLM diagnostic performance for PTX, while the secondary outcome compared LLMs with physicians. ChatGPT and Gemini exhibited distinct diagnostic performance profiles for PTX detection on CXRs. Gemini demonstrated a sensitivity of 52.5%, whereas ChatGPT demonstrated a sensitivity of 44.5%. Conversely, ChatGPT achieved a specificity of 95.5% and an overall accuracy of 70.1%, while Gemini demonstrated a specificity of 79.0% and an accuracy of 65.8%. Agreement with the reference standard was moderate for ChatGPT, with a kappa value of 0.401, and fair for Gemini, with a kappa value of 0.315. Increasing case difficulty was associated with a reduction in diagnostic accuracy for both models, with correlation coefficients of − 0.438 for ChatGPT and − 0.274 for Gemini. For contextual clinical comparison, emergency physicians demonstrated a sensitivity of 64.5%, a specificity of 99.6%, and an overall accuracy of 82.1%. This study demonstrates model-specific differences in PTX detection by general-purpose AI systems, with Gemini showing higher sensitivity and ChatGPT showing superior specificity and accuracy, both declining with increasing case difficulty. Physician performance remained higher, but was secondary for context. Despite their accessibility and low cost, these models should be considered only adjunctive tools until task-specific optimization and clinical validation are achieved.

Cardiogenic pulmonary edema (CPE) is a serious condition that can result in impaired gas exchange and acute respiratory failure, often leading to high mortality. Diuretics are considered to be the cornerstone of CPE treatment. The doses of furosemide should be individualized according to the patient status and response. Lung ultrasonography has emerged as a reliable bedside tool for diagnosing and monitoring pulmonary congestion. By considering the extent of extravascular lung water and the inferior vena cava (IVC) size, clinicians can obtain objective data to guide them in determining the appropriate level of diuresis for the safe and effective treatment of pulmonary edema. However, data on the use of structured ultrasound protocols, such as the Reverse-FALLS protocol, to guide and monitor diuretic therapy in the emergency department are limited. This prospective, single-center observational study was conducted between April 1 and June 30, 2023, in an emergency department. Adult patients diagnosed with acute CPE were included. Bedside lung ultrasonography and IVC measurements were performed using the Reverse-FALLS protocol before and after intravenous loop diuretic therapy. The number of B-lines in 4 lung regions and IVC diameter changes were recorded. The primary outcome was the change in B-line counts following diuretic treatment. Secondary outcomes included IVC diameter changes and clinical outcomes. A total of 40 patients (mean age 73.7 ± 12.7 years; 65% female) were included. After diuretic therapy, 82.5% of patients demonstrated a significant reduction in B-lines on lung ultrasonography. B-line counts decreased significantly in all lung regions (right upper P = .005, right lower P = .013, left upper P < .001, left lower P < .001). The mean interval between ultrasound assessments was 6.2 ± 3.4 hours. Changes in IVC diameter were not statistically significant ( P = .061). Higher brain natriuretic peptide levels were significantly associated with worse clinical outcomes ( P = .021). Bedside lung ultrasonography using the Reverse-FALLS protocol effectively demonstrated a reduction in pulmonary congestion following diuretic therapy in patients with CPE. Monitoring B-line changes may allow individualized diuretic management without significant intravascular volume depletion, supporting the clinical utility of ultrasound-guided treatment in the emergency department.

Objectives: This study primarily aimed to evaluate the association of EDACS and GRACE scores with angiographically significant coronary lesions in patients presenting with NSTEMI. The secondary objective was to assess their relationship with 30-day mortality. Methods: This retrospective single-center study included adults diagnosed with NSTEMI between January 2022 and December 2024. Demographic and clinical characteristics, GRACE and EDACS scores, angiographic findings, and 30-day mortality were obtained from electronic hospital records. Significant coronary lesions were defined as ≥70 % stenosis or the need for stent placement. Statistical analyses included Mann–Whitney U, Chi-square, logistic regression, and ROC analyses. Results: Among 332 patients, both GRACE and EDACS scores were significantly higher in non-survivors. GRACE high-risk classification was strongly associated with mortality, whilst EDACS (≥16) showed a non-significant trend. EDACS demonstrated superior discriminatory ability for significant coronary lesions, whereas GRACE was more closely associated with mortality risk. An EDACS cut-off >12.5 yielded 87.7 % sensitivity and 40.0 % specificity. Logistic regression identified male sex, hypercholesterolaemia, EDACS ≥16, and systolic blood pressure as independent predictors of significant lesions. Conclusions: GRACE predicted mortality, whereas EDACS better identified significant coronary lesions; combined use showed marginal improvement in model fit but did not significantly enhance discriminatory performance.

Background/Aims: Acute pancreatitis is a life-threatening disease associated with significant in-hospital mortality, particularly when complications occur. However, there is little data for long-term all-cause mortality of acute pancreatitis and its relation to etiology. Thus, in this study, both short- and very long-term all-cause mortality after acute pancreatitis were sought. Materials and Methods: Patients admitted with acute pancreatitis to the Bezmialem Vakıf University Hospital from 2012 to 2023 were retrospectively investigated. Demographic and laboratory values were obtained from hospital records. All-cause mortality was assessed using the national death notification system. Results: A total of 689 patients were included in the final analysis. The median follow-up duration was 86 months (range: 0-154 months). The mean age of the study population was 54.3 ± 16.9 years, and 384 individuals (55.7%) were women. The overall in-hospital mortality rate was 2.8%, while 1-year all-cause mortality was 5.4%. Age, diabetes mellitus, and development of in-hospital complications were independent predictors of all-cause long-term mortality. In terms of etiology, alcoholic and hypertriglyceridemia-induced acute pancreatitis had higher in-hospital mortality rates; however, over the long term, alcoholic pancreatitis yielded the worst prognosis. The first year after discharge showed the highest mortality that is most likely associated with in-hospital complications and disease severity. Conclusion: This study sheds light on modern-era mortality rates of acute pancreatitis. Age, diabetes, and in-hospital complication development had a significant impact on long-term survival. Although underrepresented in this cohort, alcoholic pancreatitis had the highest long-term all-cause mortality and clearly represents an issue that deserves to be investigated. Cite this article as: Keskin EB, Taşlıdere B, Kiremitçi S, Köker İH, Toluk Ö, Şentürk H. Long-term all-cause mortality after acute pancreatitis: median 7-year follow-up. Turk J Gastroenterol. 2025;36(12):858-865.

Anaphylaxis is a life-threatening allergic reaction requiring rapid diagnosis and treatment, with epinephrine being the first-line treatment to manage symptoms and prevent complications. This study aims to increase awareness by evaluating anaphylaxis cases in the emergency department to guide patients and physicians in managing the condition. This retrospective study, conducted at Bezmialem Vakıf University Hospital between 2018 and 2022, evaluated adult anaphylaxis patients using the National Institute of Allergy and Infectious Disease 2021 guideline. Patients' demographic and clinical data were analyzed, with ethics committee approval obtained for the study. Of the 77 patients studied, 9 required IV epinephrine treatment. More than half of the patients were started on epinephrine within 1 hour of exposure to the allergen. And the only person who was arrested had more than 1 hour to reach epinephrine treatment. When diagnosing anaphylaxis, we should not hesitate to start adrenaline and switch to IV infusion, and we should get the patient to the necessary care and treatment as soon as possible.

Introduction: Gastrointestinal system (GIS) bleeding is one of the most common reasons for emergency department visits. The aim of this study is to investigate the impact of base excess, lactate, and alactic base excess—parameters that can be quickly assessed through blood gas analysis—on predicting the clinical outcome in patients presenting to the emergency department with GIS bleeding. Materials and Methods: The study was retrospective and conducted at a single center from January 1 to December 31, 2022. The collected data included age, gender, blood gas (lactate and base excess), and outcomes (discharge, intensive care, and death). Results and Conclusions: The study included 205 patients (135 males and 70 females). Deceased individuals had a lower average base excess and higher lactate levels. There were no significant differences in ward admission based on alactic base excess status. A base excess cutoff value of ≥ −0.65 was used to predict ward admission, yielding a sensitivity of 57.71%, specificity of 63.33%, PPV of 90.18%, and negative predictive value of 20.43%. According to the data obtained in our study, we observed that a lactate cutoff value ≥ 2.07 could be effective in predicting ICU admission for patients. We also found that a base excess cutoff value ≥ −0.65 could be effective in predicting admission to the ward. The mean base excess was lower in patients who resulted in death compared to survivors, while the mean lactate level was higher. However, no significant result was found regarding alactic base excess.