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Öğe Investigation of Vitamin B12 Deficiency in Patients with Acute Coronary Syndrome and its Relationship with Gensini Score(Clin Lab Publ, 2022) Polat, Esra; Demir, Mehmet Cihat; Küçükdemirci, ÖmerBackground: Vitamin B12 deficiency is not an independent risk factor for cardiovascular disease. However, anemia due to vitamin B12 deficiency and also hyperhomocysteinemia are among the cardiovascular risk factors. The study aimed to determine the frequency of vitamin B12 deficiency in patients with acute coronary syndrome. We also aimed to ascertain whether there is a significant difference between obstructive coronary artery disease presence and its severity in patients with and without vitamin B12 deficiency using the Gensini score. Methods: Patients who underwent coronary angiography due to acute coronary syndrome between June 1, 2018, and November 30, 2019, and whose vitamin B12 levels were measured were retrospectively analyzed. Coronary angiography results of the patients were evaluated with the Gensini scoring system. Results: Anemia was observed in 32.6% (n = 135) of the patients who underwent coronary angiography with a diagnosis of acute coronary syndrome, and vitamin B12 deficiency was observed in 14.7% (n = 61). The median age was 69 years in anemic patients and 68 years in those with Vitamin B12 deficiency and was significantly higher than patients without anemia and vitamin B12 deficiency (p < 0.001 and p = 0.038, respectively). There was no statistically significant differences between the patients' Gensini scores with or without Vitamin B12 deficiency (p = 0.554). Conclusions: We concluded that anemia and vitamin B12 deficiency were higher in elderly patients with acute coronary syndrome. We found no significant difference when the Gensini score was used to evaluate obstructive coronary artery disease presence and its severity according to anemia and vitamin B12 deficiency. Investigating vitamin B12 levels in elderly patients with acute coronary syndrome should not be ignored.Öğe ntravenous Diltiazem or Metoprolol Administration in the Emergency Department for Acute Rate Control of Atrial Fibrillation Patients with Rapid Ventricular Response with Unknown Ejection Fraction(2021) Demir, Mehmet Cihat; Doğan, Muharrem; Polat, Esra; Akpinar, Gulserenim: Atrial fibrillation (AF) is the most widespread persistent cardiac arrhythmia in adults.There is no standard procedure applied in AF patients with rapid ventricular response withunknown ejection fraction (EF) in the emergency department. This study aimed to comparethe effectiveness and side effects of diltiazem and metoprolol treatments without knowing theEF in AF patients with rapid ventricular response in the emergency department.Material and Methods: Patients with a ventricular response ?110/min were selected as havingAF with rapid ventricular response. The patients first received 25 mg intravenous diltiazem asa rate control drug were compared with those first received 5 mg metoprolol. A total of 50patients whose EF were not registered before the admission date and was measured after beingconsulted for cardiology following acute rate control in emergency department were includedin this study.Results: For the first drug treatment, diltiazem was given to 56% (n=28) of the patients andmetoprolol to 44% (n=22). Moreover, 44% (n=22) of the patients needed a second druginfusion. The proportion of patients received diltiazem in those with preserved EF wassignificantly higher than those with reduced EF (p=0.032). No statistically significantdifference was found between the rates of needing a second administration based on the EF(p=0.157).Conclusion: Diltiazem was found to reduce heart rate earlier than metoprolol. While updatingthe guidelines for drug selection in acute rate control of AF with rapid ventricular response,rural emergency departments, where EF measurement cannot be achieved, should also beconsidered.Öğe Pain management in ST-segment elevation myocardial infarction: an observational analysis(MediHealth Academy Yayıncılık, 2022) Polat, Esra; Yüce, Elif İlkay; Dondurmacı, Engin; Demir, Mehmet CihatAim: ST-segment elevation myocardial infarction (STEMI) is one of the most severe forms of pain. However, the guidelines give quite a few places for pain control in STEMI and, do not offer strong recommendations on this issue. This study aimed to reveal which medications are given to STEMI patients for pain control until they arrive at the catheter laboratory, in which situations they are used, and the frequency of use. Material and Method: A total of 272 consecutive STEMI patients were prospectively collected. Medications were administered to the patients until they arrived at the angiography laboratory; vital signs, comorbidities, referral status, infarction types, the time between the onset of pain and the admission to the emergency department, and the door-balloon time were also noted. The patients’ pain characteristics and intensity were evaluated. Results: It was observed that 96.3% of the patients presented with chest pain. The pain of diabetic patients was severe according to the visual analog scale (VAS) score (p=0.023). It was witnessed that 9.92% of the patients were administered drugs for analgesic purposes. The most commonly administered medication was paracetamol. It was noticed that morphine was used frequently after paracetamol. Medication administration for analgesia was more common in referred patients (p=0.040). Conclusion: Physicians behave timidly in their clinical practice in pain control of STEMI and move away from the guideline. In terms of comfort and hemodynamic stabilization of the patients, it will be beneficial for the applications in the field to give more place to the treatments for pain control in the guidelines.Öğe Platelet Indices' Usefulness in Determining whether Patients with COVID-19 Should be Treated as an Outpatient or Inpatient: a Retrospective study(Clin Lab Publ, 2021) Polat, Esra; Demir, Mehmet C.Background: Coronavirus disease 2019 (COVID-19) has affected the health system around the world. It is necessary to facilitate health care services with useful parameters in patient follow-up. In this study, we wanted to determine whether platelet indices can be used as an assistant parameter in the clinician's decision-making process regarding which of the patients diagnosed with COVID-19 should be treated by hospitalization. Methods: This retrospective study was performed in a secondary care hospital in Mugla, Turkey. Demographic information such as age, gender, and comorbidities of patients admitted to the emergency pandemic outpatient clinic within five months and diagnosed with COVID-19, as well as discharge, hospitalization, or intensive care needs (ICU), and thirty-day mortality were noted. Also, patients with platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), thrombocytocrit (PCT), MPV/PLT, MPV/PCT, PDW/PLT, PDW/PCT values for outpatient follow-up, hospitalization, intensive care unit need, and 30-day mortality relationships were examined. Results: A total of 93 patients diagnosed with COVID-19 were included in the study. It was observed that those with comorbidity had a statistically significant higher rate of hospitalization (p = 0.013). No statistically significant difference was found between outpatients and inpatients in terms of PLT, MPV, PDW, PCT, MPV/PLT, MPV/PCT, PDW/PLT, and PDW/PCT (p > 0.05 for each). Conclusions: Platelet indices such as PLT, MPV, PDW, PCT, MPV/PLT, MPV/PCT, PDW/PLT, and PDW/PCT are not useful parameters for the clinician to distinguish between outpatient and inpatient treatment of patients with COVID-19.Öğe ST-Elevasyonlu Miyokard Enfarktüsü Tatil Dinler mi?(Bolu Abant İzzet Baysal Üniversitesi, 2022) Polat, Esra; Demir, Mehmet CihatAmaç: Türkiye’nin yerli ve yabancı turist bakımından en gözde beldelerinden olan Fethiye ilçesinde ST elevasyonlu miyokard infarktüsü tanısı alan hastalarının epidemiyolojik inceleme çalışmasıdır. Kateter laboratuarı olmayan, en yakın kateter laboratuarına 2 saat mesafede olan bir tatil yöresi için STEMI açısından riskli olabilecek olan ve dikkat edilmesi gerekecek turist grubunu belirleyebilmek amaçlandı.Gereç ve Yöntemler: Bu çalışma retrospektif bir çalışmadır. 01.06.2021-01.10.2021 tarihleri arasında yaz tatil döneminde 1’i devlet 2’si özel hastane olmak üzere ilçedeki tüm hastanelerde STEMI tanısı alan hastalar incelendi. Hastaların en sık MI geçirme tarih, gün, saat dilimleri incelendi. Hastalar yerli halk ve turist olmak üzere demografik özellikleri, komorbiditeleri karşılaştırıldı.Bulgular: Toplam 331 adet STEMI hastası olduğu saptandı. Hastaların %76,7 (n=254)’si yerleşik Türk, %1,8 (n=6) yerleşik yabancı, %19,3 (n=64) Yerli turist ve %2,1 (n=7) yabancı turist idi. Yerleşik halkın yaş ortalaması turist grubuna göre istatistiksel anlamlı olarak daha yüksek izlenmiştir (64,15 vs 57,83, [p=0,01]). Komorbidite olarak sadece hipertansiyon ile istatistiksel olarak anlamlı bir farklılık saptanmıştır (p=0,034).Sonuç: Turist grubunda ST elevasyonlu MI açısından yerli halktan farklı özellikle dikkat edilmesi gereken spesifik bir hasta grubu yoktur. İnsan ömrünün uzaması ile sağlık problemleri olan yaşlı turistlerle daha sık karşılaşılacağı gözönünde bulundurularak, tatil bölgelerinde özellikle STEMI gibi acil müdahale edilmesi gereken durumlar için katater laboratuarına erişimin daha da kolaylaşması için çabalar devam etmelidir.
