Browsing by Author "Korular, Didem"
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Item Clinical findings in the renal victims of a catastrophic disaster: the Marmara earthquake(Oxford Univ Press, 2002-11) Sever, Mehmet Şükrü; Erek, Ekrem; Vanholder, Raymond; Akoğlu, Emel; Ergin, Hülya Karadayı; Türkmen, Funda Muşerref; Korular, Didem; Yenicesu, Müjdat; Erbilgin, Dilaver; Hoeben, Heidi; Lameire, Norbert; Yavuz, Mahmut; Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı/Nefroloji Bilim Dalı.Background. The clinical course of acute renal failure (ARF) related to crush syndrome is very complex, because of co-existing surgical and/or medical complications. After the devastating Marmara earthquake that struck Turkey in August 1999, 639 patients were identified with nephrological problems, whose clinical findings have been the subject of this analysis. Methods. Specific questionnaires asking about 63 variables were sent to 35 reference hospitals that treated the victims. Clinical findings of the renal victims were analysed. Results. At admission, high fever was noted in 31.8% of the patients; the temperature of non-survivors was higher (P = 0.027). Mean blood pressure was higher in survivors (P = 0.004) and dialysed victims (P < 0.001). Most (61.4%) patients were oligo-anuric; oliguria lasted for 10.8 +/- 7.2 days. Thoracic and abdominal traumas were associated with a higher risk of mortality. 397 fasciotomies and 121 amputations were performed in 790 traumatized extremities. Fasciotomies were associated with sepsis (P < 0.001) and dialysis needs (P < 0.0001), while amputations were associated with mortality (P < 0.0001). Medical complications, which were associated with dialysis needs (P < 0.0001) and mortality (P < 0.0001), were observed in 51.5% of patients. In a multivariate analysis model of medical complications, disseminated intravascular coagulation (DIC) (P < 0.0001, OR = 5.81), and adult respiratory distress syndrome (ARDS) (P = 0.0001, OR = 4.53) were predictors of mortality. Conclusions. In the aftermath of catastrophic earthquakes, clinical findings of the renal victims can predict the final outcome. While fasciotomies indicate dialysis needs, extremity amputations, abdominal and thoracic traumas are associated with higher rates of mortality in addition to DIC and ARDS.Item The Marmara earthquake: Epidemiological analysis of the victims with nephrological problems(Elsevier Science Bv, 2001-09) Sever, Mehmet Şükrü; Erek, Ekrem; Vanholder, Raymond; Akoğlu, Emel; Ergin, Hülya; Tekçe, Mustafa; Korular, Didem; Tülbek, M. Yaşar; Keven, Kenan; Vlem, Bruno Van; Lameire, Norbert; Yavuz, Mahmut; Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı/Nefroloji Bilim Dalı.Background. Crush syndrome resulting from earthquakes is a major cause of morbidity and mortality, as seen during the catastrophic Marmara earthquake that struck Northwestern Turkey in August 1999. This report analyzes the epidemiological characteristics of the crush syndrome victims of this disaster. Methods. In order to analyze the nephrological problems caused by this earthquake, questionnaires were prepared within the first week of the disaster and sent to 35 reference hospitals that treated the victims. Data obtained by these questionnaires are the subject of this report. Results. Of the 5302 hospitalized patients in reference hospitals, 639 (12.0%) suffered from nephrological problems, and 477 (9.0%) needed dialysis support. Considering the patients with renal problems, there was not any significant difference in gender; however, the incidence of children younger than 10 years and the older population (older than 60 years of age) was significantly lower as compared with the resident population of the affected area (P < 0.001). Nonsurvivors were older (34.5 +/- 16.1 years) than survivors (31.2 +/- 14.4 years, P = 0.048), while no deaths were recorded under the age of 10. Most patients (70.1%) were admitted within the first three days after the earthquake, and the mortality rate among these victims was higher (17.7%) as compared with victims admitted thereafter (10.0%, P = 0.016). The average time period under the rubble was 11.7 +/- 14.3 hours, which was not significantly different between survivors and nonsurvivors, while the victims who required dialysis support spent shorter durations under the rubble, as compared with the ones who were not dialyzed at all (10.3 +/- 9.5 vs. 15.9 +/- 23.1 hours, P < 0.001). Conclusion. Victims of catastrophic earthquakes are characterized by a high incidence of renal problems and the need for dialysis support. The incidence of nephrological problems is lower in children, while the period of time under the rubble is not a prognostic indicator of survival.