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    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, Ömer
    Background: 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.
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    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, Gulseren
    im: 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.
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    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.