Person: KELEBEK GİRGİN, NERMİN
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KELEBEK GİRGİN
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NERMİN
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Publication Incidence, characteristics and risk factors of delirium in the intensive care unit: An observational study(Wiley, 2022-01-03) ERBAY DALLI, ÖZNUR; KELEBEK GİRGİN, NERMİN; Girgin, Nermin Kelebek; Kahveci, Ferda; KAHVECİ, FERDA ŞÖHRET; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anestezi ve Reanimasyon Anabilim Dalı.; 0000-0003-2282-0846; 0000-0002-5882-1632; ABI-1236-2020Aims and Objective To investigate the incidence, characteristics and risk factors of delirium in the ICU. Background Identifying the risk factors of delirium is important for early detection and to prevent adverse consequences. Design An observational cohort study conducted according to STROBE Guidelines. Method The study was conducted with patients who stayed in ICU >= 24 h and were older than 18 years. Patients were assessed twice daily using the RASS and CAM-ICU until either discharge or death. Cumulative incidence was calculated. Demographic/clinical characteristics, length of stay and mortality were compared between patients with and without delirium. A logistic regression model was used to investigate risk factors. Results The incidence of delirium was 31.8% and hypoactive type was the most frequent (41.5%). The median onset of delirium was 3 days (IQR = 2) with a mean duration of 5.27 +/- 2.32 days. Patients with delirium were significantly older, had higher APACHE-II, SOFA and CPOT scores, higher blood urea levels, higher requirements for mechanical ventilation, sedation and physical restraints, longer stays in the ICU and higher mortality than those without delirium. The logistic regression analysis results revealed that a CPOT score >= 3 points (OR = 4.70, 95% CI: 1.05-20.93; p = .042), physical restraint (OR = 10.40, 95% CI: 2.75-39.27; p = .001) and ICU stay >= 7 days (OR = 7.26, 95% CI: 1.60-32.84; p = .010) were independent risk factors of delirium. Conclusions In this study, the incidence of delirium was high and associated with several factors. It is critical that delirium is considered by all members of the healthcare team, especially nurses, and that protocols are established for improvements. Relevance to the clinical practice Based on the results of this study, delirium could be decreased by preventing the presence of pain, prudent use of physical restraints and shortening the ICU stay.Publication Mixed fungal infection in early period after kidney transplantation: A case report(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2015-01-01) Işıktaş Sayılar, Emel; Ersoy, Alparslan; ERSOY, ALPARSLAN; Akalın, Halis; AKALIN, EMİN HALİS; Ayar, Yavuz; Girgin, Nermin Kelebek; KELEBEK GİRGİN, NERMİN; CEYLAN, İLKAY; DEMİR, UYGAR LEVENT; Ener, Beyza; ENER, BEYZA; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Nefroloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anestezi ve Reanimasyon Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Mikrobiyoloji Anabilim Dalı.; 0000-0003-4607-9220; 0000-0001-7530-1279; 0000-0003-3306-3107; AAU-8952-2020; AAH-5054-2021; O-9948-2015; AAH-7250-2019; GSE-0029-2022; AGF-0767-2022; AAG-8523-2021Invasive fungal infections have a rapid and frequently fatal course in patients with solid organ transplantations. Mostly Aspergillus spp., Mucorales spp., Candida spp. and Cryptococcus neoformans are causal pathogens for opportunistic infections. Aspergillus spp. and Mucorales spp. especially lead to invasive fungal infections at rhino-cerebral area; they show similar radiological and clinical signs and they lead to invasive fungal co-infections. In case of any doubt about invasive fungal infections, antifungal treatment should be initiated as soon as possible and immunosuppressive treatment should be considered. This case presentation is about a patient at 51 years of age who developed invasive rhino-cerebral mixed fungal infection in 4 weeks following renal transplant.Publication Is bispectral index monitoring reliable for determining sedation level in a tetanus patient?(Int Scientific Information, Inc, 2008-01-01) Girgin, Nermin Kelebek; KELEBEK GİRGİN, NERMİN; İşçimen, Remzi; İŞÇİMEN, REMZİ; Kutlay, Oya; Gurbet, Alp; GURBET, ALP; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anestezi ve Reanimasyon Anabilim Dalı.; 0000-0002-6503-8232; AAI-8104-2021; A-7994-2018; HKP-2533-2023; AAH-7250-2019Background: Tetanus is an infectious disease characterised by increased muscle rigidity, muscle spasms, and, in severe cases, cardiovascular instability secondary to autonomic dysfunction. Sedation is an important part of the treatment of tetanus. Clinical scoring systems, although simple and inexpensive, are often inadequate in evaluating the patient level of sedation in the intensive care unit (ICU). The bispectral index (BIS), a variable derived from the electroencephalography, could assess sedation in the ICU. In the present study, we aimed to present our experience on the application of BIS monitoring during treatment of a patient with tetanus.Case Report: A 69-year-old man was admitted to intensive care unit with a diagnosis of tetanus. The patient was intubated, and mechanical ventilation (MV) therapy with pressure support ventilation mode was administered. Dexmedetomidine, midazolam and morphine were administered for sedation and analgesia. Sedation was titrated to maintain a Ramsay Sedation Score (RSS) of 5 or greater. The RSS was assessed once a minute during the loading dose of dexmedetomidine and once an hour in the first day. On the following days, the RSS was recorded every 2 hours. When the RSS evaluation was applied, BIS values were also recorded simultaneously. On the 7th day, BIS monitoring could not be continued due to technical reasons. Sedation was monitored by RSS. A total number of 107 Ramsay score determinations and BIS values were obtained in the follow-up period. The patient underwent percutaneous tracheostomy on the 8th day. The patient was totally disconnected from MV on the 31st day and discharged from the hospital on the 33rd day.Conclusions: In this case, we thought that RSS is still a reliable method in monitoring the sedation level in tetanus. The BIS monitoring is inferior to and discordant with the standard monitoring of the RSS, largely to the painful muscle spasms and rigidity inherent in the pathophysiology of the disease. Moreover, if the sedative drug dosage is elevated according to BIS values, excessive sedation may occur in these patients.Publication Amitriptyline cardiac toxicity treated with hemoperfusion(Galenos Yayincilik, 2017-04-01) Girgin, Nermin Kelebek; KELEBEK GİRGİN, NERMİN; Ünlü, Nurdan; Çalışkan, Gülbahar; İşçimen, Remzi; İŞÇİMEN, REMZİ; Kahveci, Ferda; KAHVECİ, FERDA ŞÖHRET; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anestezi ve Reanimasyon Anabilim Dalı.; AAH-7250-2019; HKP-2533-2023; KFQ-1825-2024Tricyclic antidepressant intoxication is frequently encountered among children and adults due to widespread use of the drugs. Amitriptyline is among the major tricyclic antidepressants. It affects the cardiovascular, respiratory and central nervous system. In the treatment of amitriptyline intoxication, various treatments such as gastric lavage, activated charcoal, bicarbonate infusion, antiarrhythmic, and anticonvulsant drug usage were applied. Here, we reported a patient with severe amitriptyline intoxication who did not respond to these treatments but dramatically improved with hemoperfusion. A 33 year-old woman applied to the emergency service half an hour later ingesting 2000 mg of amitriptyline as a suicide attempt. On admission, her Glasgow coma scale (GCS) was 10, blood pressure was 100/60 mmHg, heart rate was 160 beats/min. Wide ORS and ventricular tachycardia was seen in the Electrocardiography (ECG) results. Having her GCS regressed to 7, she was intubated and admitted to intensive care unit after the initial treatments. Hemoperfusion was commenced within half an hour. While hemoperfusion was continuing, her ECG was seen to turn to sinus tachycardia. Her cardiovascular and neurological status returned to normal on the 2nd day and she was discharged from the intensive care unit on the 4th day. Besides hemoperfusion is not recommended due to high protein binding and large volume of distribution in classical treatment of amitriptyline overdose, current reports representing efficacy of hemoperfusion are also accumulating. After ingestion, tricyclic antidepressants are absorbed rapidly and reach to their effective concentration in the tissues, especially by the lung, the brain and the heart. Hence, hemoperfusion performed in early stage of ingestion is an effective treatment and in cases that do not respond to conventional therapies, it should be considered that this method can be used in the early period.Publication Sepsis episodes caused by pressure injuries in critical illness: A retrospective observational cohort study(Hmp, 2023-11-01) Kaya, Pınar Küçükdemirci; Kaya, Murad; Girgin, Nermin Kelebek; Kahveci, Ferda S.; Akalın, Emin Halis; İsçimen, Remzi; KÜÇÜKDEMİRCİ KAYA, PINAR; KAYA, MURAD; KELEBEK GİRGİN, NERMİN; KAHVECİ, FERDA ŞÖHRET; AKALIN, EMİN HALİS; İŞÇİMEN, REMZİ; Bursa Uludağ Üniversitesi/Tıp Fakültesi.; 0000-0002-8428-8245; 0000-0002-5882-1632; JGB-6637-2023; CYJ-4124-2022; DTU-3148-2022; IMY-6211-2023; AAU-8952-2020; DWL-9897-2022BACKGROUND: Critically -ill patients (CIPs) with pressure injuries (PIs) may develop bloodstream infections (BSIs). PURPOSE: To identify predisposing factors and discuss diagnosis and management of sepsis -related PIs in CIPs. METHODS: The records of CIPs in the intensive care unit (ICU) between January 1, 2014, and January 1, 2020, with PI with sepsis -diagnoses and with different site cultures that were positive concurrent with bloodstream -cultures were retrospectively reviewed. RESULTS: Ninety-one sepsis episodes were included in the study. Low albumin level ( U = 382.00, P = .006), renal failure (odds ratio [OR], 0.108 [95% CI, 0.015-0.783]; P = .025), and length of ICU stay ( U = 130.00, P < .001) were identified as risk factors of BSIs due to PIs. The probability of BSI during a sepsis episode was lower in CIPs with PIs with higher C -reactive protein levels ( U = 233.00, P < .001) and whose injury resulted from trauma or surgery (OR, 0.101 [95% CI, 0.016-0.626]; P = .014). The mortality was higher in CIPs with PI -induced BSIs (OR, 0.051 [95% CI, 0.008-0.309]; P = .001). CONCLUSIONS: Pressure injury -induced sepsis was associated with a high risk of 28 -day mortality. The findings suggest that CIPs with PI are at increased risk of BSIs if they have low albumin levels, renal -failure, and prolonged ICU stay during sepsis episodes.Publication Analysis of acute adult poisoning cases among patients admitted to the emergency department in Bursa, Turkey(Galenos Yayınevi, 2009-01-01) Demircan, Celaleddin; Kahveci, Ferda; Engindeniz, Zülfi; Kıyıcı, Murat; Girgin, Nermin Kelebek; Ercan, İlker; Tekce, Hikmet; Özdemir, Fatma; Özyurt, Gurayten; DEMİRCAN, CELALEDDİN; KAHVECİ, FERDA ŞÖHRET; Engindeniz, Zülfi; KIYICI, MURAT; KELEBEK GİRGİN, NERMİN; ERCAN, İLKER; Tekce, Hikmet; ÖZDEMİR, FATMA; Özyurt, Gurayten; Uludağ Üniversitesi/Tıp Fakültesi/Dahili Tıp Bilimleri Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Gastroenteroloji ve Hepatoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı.; 0000-0003-4820-2288; 0000-0003-1874-5097; 0000-0002-3208-6211; 0000-0002-2382-290X; HJZ-4470-2023; AAG-9356-2021; JBJ-5787-2023; AAI-4213-2021; AAH-7250-2019; ABF-2367-2020; JGP-4019-2023; JKS-7683-2023; JKO-9428-2023Purpose: The aim of this study was to define the epidemiological features such as age, sex, toxic substance, suicide, and mortality rates of the adult poisoning cases among patients admitted to the Emergency Department (ED) of Uludag University Medical Faculty Hospital.Materials and Methods: Records of acute adult poisoning cases at the ED within a one-year period (June 1, 2002 - May 31, 2003) were evaluated retrospectively. Data were compared to those of similar studies from Turkey and around the world.Results: In total 430 (1.96%) of 21,934 patients admitted to the ED during the study period suffered acute poisoning. Of these patients 259 (60.2%) were women and 171 (39.8%) were men and the mean age of the patients was 29.9. Patients were exposed to different types of toxic substances: drugs (47.4%), pesticides (10.7%), toxic gases (10%), corrosives (6.5%), alcohol (3.5%), food (15.8%), toxic substances of animal origin (3.0%), and others (3.0%). In all, 29.8% of the patients were admitted to hospital, 22.3% were transferred to other hospitals, and 47.9% were discharged from the ED, and the overall mortality rate was 1.2%. In addition, 54.9% of the poisonings were suicide attempts and within this group the women to men ratio was 2.2 and the most common toxic substance was a drug (85.2%).Conclusion: Our results were similar to those of previous studies from this country as acute poisonings are more common in women and younger ages, most of them were suicide attempts, and the mortality rate was low. Our transfer rate was high and this may necessitate the organization of short-term observation of these patients.Publication Bruised wound care(Galenos Yayincilik, 2007-02-01) Kelebek-Girgin, Nermin; KELEBEK GİRGİN, NERMİN; Kurhan-Erari, Gülhan; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anestezi ve Reanimasyon Anabilim Dalı.Publication Cerebral ischemia due to traumatic carotid artery dissection: Case report(Galenos Yayıncılık, 2012-12-01) Şener, Deniz Kamacı; Taşkapılıoğlu, Özlem; Girgin, Nermin Kelebek; Hakyemez, Bahattin; Bakar, Mustafa; Şener, Deniz Kamacı; Taşkapılıoğlu, Özlem; KELEBEK GİRGİN, NERMİN; HAKYEMEZ, BAHATTİN; BAKAR, HACI MUSTAFA; Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; 0000-0003-4436-3797; 0000-0002-3425-0740; IOZ-7564-2023; AAK-6623-2020; AAH-7250-2019; AAI-2318-2021; EKN-8251-2022Blunt injury to the neck region may lead to carotid artery dissection and cerebral ischemia. Blunt injury to carotid artery is not frequent but determination of the presence of trauma in the history of stroke patients will provide early diagnosis and treatment of them. In this article, a case with cerebral ischemia resulting from traumatic carotid artery dissection is presented and clinical findings, diagnostic procedures and choice of treatment are discussed in the light of the literature. Key Words: Carotid artery, dissection,Publication A retrospective evaluation of critically ill patients infected with H1N1 influenza A virus in Bursa, Turkey, during the 2009-2010 pandemic(Makerere Univ, 2015-01-01) Nermin, Kelebek Girgin; Remzi, İşçimen; Zeynep, Akoğul; İlker, Çimen; Meltem, Öner Torlar; Güven, Özkaya; Ferda, Kahveci; Halis, Akalın; KELEBEK GİRGİN, NERMİN; İŞÇİMEN, REMZİ; Akoğul, Zeynep; Çimen, İlker; Torlar, Meltem Öner; ÖZKAYA, GÜVEN; KAHVECİ, FERDA ŞÖHRET; AKALIN, EMİN HALİS; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Mikrobiyoloji ve Enfeksiyon Hastalıkları Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı.; AAH-7250-2019; FTV-1495-2022; EIE-4319-2022; JOR-4047-2023; FMO-2967-2022; EZV-3846-2022; CPT-2668-2022; EZJ-5901-2022Background: H1N1 influenza A virus infections were first reported in April 2009 and spread rapidly, resulting in mortality worldwide. The aim of this study was to evaluate patients with H1N1 infection treated in the intensive care unit (ICU) in Bursa, Turkey.Methods: Demographic characteristics, clinical features, and outcome relating to H1N1 infection were retrospectively analysed in patients treated in the ICU.Results: Twenty-three cases of H1N1 infection were treated in the ICU. The mean age of patients was 37 years range: (1782). Fifteen patients were female (65.2%). The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 19 range: (5-39). The most common symptoms were dyspnea (73.9%), fever (69.6%), and cough (60.9%). Mechanical ventilation was required for all patients. Oseltamivir and antibiotics were administered to all patients. Six (26.1%) patients died. APACHE II scores were higher in the deceased 28.5 range: [16-39] vs. 14 range: [5-28] in survivors; p = 0.013).Conclusion: When compared to the literature, the demographic, epidemiological, and clinical characteristics were similar in the cases we encountered. The mortality rate was high despite the use of appropriate treatment. We believe that the high mortality is related to higher APACHE II scores. The H1N1 virus should be considered in community acquired pneumonia, especially in younger patients presenting with severe pneumonia.Publication Reliability and validity of the Turkish version of pressure ulcer knowledge assessment tool-updated version (pukat 2.0)(Elsevier Sci Ltd, 2022-02-08) Yıldırım, Yasemin; Çalışkan, Gülbahar; Dallı, Öznur Erbay; ERBAY DALLI, ÖZNUR; Girgin, Nermin Kelebek; KELEBEK GİRGİN, NERMİN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anestezi ve Reanimasyon Anabilim Dalı.; 0000-0003-2282-0846; 0000-0002-5882-1632; ABI-1236-2020Objective: This study aimed to determine the reliability and validity of the Turkish version of the measurement tool developed and updated by Manderlier et al. to evaluate the nurses' evidence-based knowledge about pressure ulcers. Materials and methods: A methodological study design was used. The instrument was translated to Turkish and back-translated to English. A group of faculty members, including physicians and nurses who are experts in the subject area, evaluated the content validity of the tool with the Lawshe technique. A group of 240 nurses who met the inclusion criteria were reached, and then a pilot study was conducted with 35 nurses by using the testretest method to determine the invariance of the tool over time. The nurses in the pilot study were excluded from the overall sample, and the evaluations were performed with 205 nurses. Item difficulty index and discrimination index were used for the validity of the items since they were multiple-choice items; Kuder-Richardson 20 analysis was used to determine the internal consistency. Results: The translated and modified instrument demonstrated acceptable psychometric properties as follows: 1) overall content validity index was 0.90, 2) overall test-retest reliability was 0.83 (0.70-0.92 for the sub-themes), 3) item difficulty indexes were 35-75%, 4) discrimination indexes were 0.44-0.92, and 5) overall Cronbach's alfa for the internal consistency was 0.72. Conclusions: Similar to the earlier version, the Turkish version of PUKAT 2.0 was demonstrated to be a valid and reliable tool to evaluate the nurses' knowledge of evidence-based current information about pressure ulcers.
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