Burak Katipoğlu

Background/Objectives: Epidemic infectious diseases remain a persistent global threat, but whether declining outbreak frequency translates into reduced mortality is unclear. This gap is critical for emergency care systems, where timely intervention determines survival. This study aims to characterize global epidemic trends and to assess whether reductions in outbreak frequency have been accompanied by reductions in epidemic mortality. Methods: We performed a retrospective global analysis of epidemic infectious disease events recorded in the Emergency Events Database (EM-DAT) from 2000 to 2025, following the STROBE reporting guideline. Data on disease type, geographic distribution, deaths, and affected populations were extracted. Completeness of mortality and affected-population reporting was quantified by region and disease type. Crude mortality ratios (CMRs) were compared across regions and pathogens using Kruskal–Wallis tests, and temporal trends were assessed with Mann–Kendall analysis and Sen’s slope estimation. Results: We identified 893 epidemic events across 131 countries, resulting in 125,262 deaths and over 12.7 million affected individuals. Mortality data were available for 773 events (86.6%), with completeness ranging from 92.0% in Africa to 23.5% in Europe. Burden was overwhelmingly concentrated in sub-Saharan Africa, which accounted for 80.2% of deaths. Cholera was the most frequent pathogen, while Ebola showed extreme lethality (CMR 42.71%). Despite a significant decline in annual epidemic frequency (τ = −0.668, p < 0.001), the greater part of which preceded the COVID-19 pandemic, neither annual mortality (τ = −0.237, p = 0.094) nor the annual mortality ratio (τ = −0.114, p = 0.427) showed a commensurate decline. Marked heterogeneity across regions and diseases underscores the dominant role of healthcare system capacity. Conclusions: Global progress in reducing epidemic frequency has not been matched by gains in survival. The persistence of high mortality in regions with constrained emergency care capacity highlights a critical failure in translating outbreak control into lives saved. Strengthening emergency care systems, improving access to timely treatment, and addressing structural inequities are essential. Fewer epidemics are not enough; fewer deaths when they occur is what is needed.

Acute cholecystitis is a common inflammatory condition encountered in emergency departments (EDs), with severity varying widely among patients. Rapid risk stratification and appropriate management are critical in preventing complications and mortality. This study aimed to evaluate the association between the acute-phase reactant index (APhRI) and disease severity, and to investigate the potential prognostic value of APhRI in clinical decision-making. We conducted a single-center, retrospective observational study of adult patients diagnosed with acute cholecystitis in a tertiary ED between January 2024 and January 2025. APhRI was calculated as (C-reactive protein [CRP] × procalcitonin [PCT])/ albumin. Patients were stratified according to the Tokyo Guidelines 2018 (TG18). Statistical analyses included chi-square/Fisher exact tests, t -test/Mann–Whitney U test, receiver operating characteristic curve analysis, and DeLong test. A total of 547 patients were included. According to TG18, 28.7% were classified as moderate-to-severe acute cholecystitis. APhRI levels were significantly higher in these patients. The area under the curve of APhRI for predicting severity was 0.687, superior to CRP (0.673), PCT (0.567), and albumin (0.618) ( P < .05 for all). Higher APhRI values were also observed in patients requiring surgery ( P = .008) or interventional radiology ( P < .001), and positively correlated with hospital stay (ρ = 0.327, P < .001). APhRI appears to be a practical and useful biomarker not only for predicting severity in acute cholecystitis but also for supporting early triage and treatment decisions in the ED.

Background/Objectives: Accurate and timely triage is essential for optimizing clinical outcomes and resource allocation in emergency departments (EDs). The Peripheral Perfusion Index (PPI), a non-invasive and objective parameter derived from pulse oximetry, may offer added value in early risk stratification. This study aimed to analyze the correlation between the PPI measured at triage and at Emergency Severity Index (ESI) levels, as well as to determine if the PPI may function as a predictive tool to facilitate early risk identification before patient disposition. Methods: In this prospective cross-sectional study, adult ambulatory patients presenting to a tertiary care ED were enrolled. At triage, PPI and standard vital signs were recorded, and patients were classified using the five-level ESI system. The diagnostic performance of PPI and ESI in predicting ED discharge was assessed using receiver operating characteristic (ROC) curve analysis, with comparative evaluation performed via DeLong’s test. Results: Lower PPI values were consistently associated with higher ESI acuity levels and more intensive care requirements. Patients who were discharged had significantly higher median PPI values (4.0) compared to those admitted to wards (2.1) or intensive care units (1.9). PPI also distinguished survivors from non-survivors (median PPI: 3.60 vs. 1.15). ROC analysis showed that the PPI demonstrated a good discriminative capacity for forecasting ED discharge, equal to the efficacy of ESI (AUC: 0.926 vs. 0.903; p < 0.001). Conclusions: The PPI could improve post-triage risk classification and enhance current triage techniques like ESI, especially in cases of unclear or borderline presentations, but further validation in prospective trials is required.

Aims: The COVID-19 pandemic has impacted the entire world; however, certain individuals and groups have been affected more significantly or are at a higher risk. Among these groups are medical workers, who face unique challenges. In addition to the physical consequences of the pandemic, there have been notable psychological effects. This study aims to examine the prevalence of emotional disorders in healthcare personnel working in COVID-19 services and polyclinics, as well as in their first-degree relatives. Methods: This study was conducted in 2022 on COVID-19 Service Personnel at Ufuk University Hospital and their firstdegree relatives. It included doctors, nurses, and auxiliary medical personnel who worked in either COVID-19 services or polyclinics, along with their non-medical first-degree relatives. In total, 375 participants were surveyed. The survey consisted of three sections: socio-demographic information, the short symptom inventory, and the short form for Burnout scale. The Mann-Whitney U test and the Kruskal-Wallis test were utilized for data analysis, with a p-value of

Background/Objectives: Pediatric cardiac arrest poses considerable obstacles, with survival rates markedly inferior to those of adults. Effective chest compressions are essential for enhancing outcomes; nevertheless, the ideal rescuer attitude is still ambiguous. This study sought to compare the efficacy of lateral (LAT) and over-the-head (OTH) chest compression techniques in pediatric cardiopulmonary resuscitation (CPR) and to ascertain whether OTH presents a viable alternative to the conventional LAT method by assessing compression quality, rescuer fatigue, and ergonomics. Methods: A randomized crossover simulation study was conducted in a high-fidelity medical simulation facility. Thirty-five medical students executed 2 min cycles of chest compressions with both LAT and OTH techniques, interspersed with a 15 min rest period between sessions. Results: OTH showed a tendency for enhanced overall performance (72.94 vs. 64.46; p = 0.08), while the differences lacked statistical significance. The compression rate was somewhat elevated with OTH (116.94 compared to 114.57; p = 0.31). We assessed LAT as somewhat less challenging (4.37 vs. 3.91; p = 0.17) and found less fatigue (4.83 vs. 4.40; p = 0.24). Male rescuers and individuals with elevated BMI attained larger compression depths. Age was negatively connected with the ease and efficiency of compressions. Conclusions: Although no statistically significant differences were detected, OTH demonstrated potential for enhanced performance. The anthropometrics of rescuers affected the quality of CPR, highlighting the necessity for tailored training methods. Future investigations should examine the long-term viability of OTH in clinical and pre-hospital environments.

Attenuation values in computed tomography (CT) are used as a diagnostic aid in certain clinical conditions. In our study, we investigated the effectiveness of attenuation values, obtained through the noninvasive method of CT, in determining the type of pleural effusions in the emergency department. Patients who presented to the emergency department with a diagnosis of pleural effusion and underwent thoracentesis within 48 hours between January 1, 2023, and January 1, 2024, were included in the study. Exclusion criteria were patients under 18 years of age, those without CT imaging, those presenting due to trauma, those with >48 hours between CT and thoracentesis, patients with chest tubes, a history of thoracic surgery/intervention within the last month, or incomplete data. Attenuation values measured on CT were compared with pleural fluid samples interpreted according to Light criteria. A total of 207 patients were evaluated. The mean age in the exudate group (66.00 ± 15.63) was significantly lower than in the transudate group (72.98 ± 10.38) (P < .001). The prevalence of malignancy was significantly higher in the exudate group (34.0%) compared to the transudate group (4.4%) (P < .001). Heart failure was more common in the transudate group (31.1%) (P = .041). The mean Hounsfield unit (HU) value was 16.64 ± 8.04 in the exudate group and 12.22 ± 7.01 in the transudate group, with a statistically significant difference between the groups (P = .001, 95% confidence interval [CI]: 1.79–7.05). At the cutoff point of 14.2, sensitivity was 62.73%, specificity was 75.00%, and the Youden index reached its highest value at 0.377. The area under the curve was 0.710 (95% CI: 0.626–0.794, P < .001), and the positive predictive value at the 14.2 cutoff point was 90.18%. In conclusion, our study demonstrated that the use of CT attenuation in managing pleural effusions in the emergency department can accurately detect exudative effusions as a noninvasive method. However, HU values should be evaluated alongside clinical parameters, and the varying cutoff values reported in different studies suggest that this method may not be sufficient on its own. In the emergency department setting, the use of the HU scale could improve patient management by avoiding complications associated with invasive procedures like diagnostic thoracentesis.

Objectives: Teaching more people high-quality CPR through more efficient training methods can improve the rates and quality of Cardiopulmonary resuscitation (CPR) in cases of out-of-hospital cardiac arrest and help save more lives. In this study, we aimed to provide online Basic Life Support (BLS) training to football coaches who are in close contact with the risk group, and to examine the effectiveness of the training, to what extent they retained basic life support knowledge after completing the training program, and to determine the time of booster training. Methods: Online BLS training was provided to football coaches. Pre- and post-tests were administered to measure the effectiveness of online BLS training. A retention test was administered to one group after 3 months and to one group after 6 months to evaluate the permanence of the training. Results: Knowledge gain was significant immediately after the BLS course. There was no difference between the two groups in the post-training test results. Overall level of knowledge decreased significantly after three and six months. While there was a 5-point decrease in the retention test performed after three months, a 12-point reduction after six months. Conclusions: There is no clear answer yet regarding the time and frequency of booster training. Rather than single training, the most effective approach will be to integrate booster content with short training videos at intervals of 3-6 months. Online BLS training videos can serve as an alternative.

Background: The role of Cystatin C (CysC) in the diagnosis and prognosis of cardiovascular disease, particularly acute coronary syndrome (ACS), is increasingly significant. The goal of this meta-analysis was to assess the diagnostic and prognostic value of CysC in patients with ACS, as well as its association with major adverse cardiovascular events (MACE), defined as mortality, myocardial infarction, heart failure, and stroke. Methods: The present study is a systematic review and meta-analysis. Using PubMed, Web of Science, Cochrane Library, and Embase, a literature review of cohort and case control studies reporting MACE and using the terms ACS and Cystatin C was conducted, excluding studies published after August 1, 2024. the meta-analysis using a random effects model. Results: CysC concentrations were significantly higher in patients with ACS compared to controls [mean difference (MD) = 0.36, p < 0.001], and in acute myocardial infarction (AMI) vs. unstable angina (MD = 0.18, p < 0.001). No significant differences were observed between ST elevation myocardial infarction (STEMI) and Non-ST elevation myocardial infarction (NSTEMI). Patients with MACE had higher CysC levels than those without (MD = 0.25, p < 0.001). Hospital survivors had lower CysC levels compared to those who died (MD = −0.25, p < 0.001). Higher CysC concentrations were associated with increased risks of MACE, cardiac death, overall mortality, myocardial reinfarction, and stroke, both during hospitalization and beyond. Conclusions: CysC is a promising biomarker for both diagnosis and prognosis in patients with ACS, especially in the context of predicting MACE, mortality and heart failure risk. The use of CysC may improve risk stratification and support therapeutic decision-making in clinical practice. Keywords: cystatin C biomarker prognosis diagnosis ACS acute coronary syndrome meta-analysis

Introduction: Despite significant medical and technological advancements, cardiac arrest remains a critical public health concern due to its persistently high mortality and morbidity rates. Consequently, research on cardiopulmonary resuscitation (CPR) is of significant importance. Materials and Methods: This study presents a bibliometric analysis of the 100 most‐cited articles in the field of CPR identified using the Scopus database without time restrictions. Analyses were conducted using VOSviewer and Bibliometrix software. Original research articles published in English were included. Results: The study revealed contributions from 798 distinct authors across 18 journals, with citation counts ranging from 218 least‐cited articles to 1194 most‐cited articles. The most recent article was published in 2020, and the most frequently used keywords were “CPR” and “heart arrest.” In addition, 20% of the analyzed articles were funded by military organizations. Conclusion: This analysis highlights the significant contributions of emergency medicine researchers and the notable development of CPR literature, particularly between the late 1990s and the early 2000s. While the most‐cited studies originated from journals with high H‐indices, the citation frequency of these articles showed a consistent decline over time. Furthermore, impactful articles in this field were predominantly published in general medical journals rather than in specialized emergency medicine journals. This study provides a foundational resource for researchers, especially early career academicians, seeking to engage in CPR‐related research.