Publications by authors named "Ramazan Güven"

24 Publications

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Supraventricular arrhythmia in mitral valve prolapse : Predictive value of P-wave dispersion and atrial conduction time.

Herz 2021 Apr 21. Epub 2021 Apr 21.

Emergency Medicine Department, SBU Kanuni Sultan Suleyman Training and Research Hospita, Istanbul, Turkey.

Background: The incidence of supraventricular arrhythmia (SVA) is high in patients with mitral valve prolapse (MVP). The purpose of our study was to determine the role of parameters showing atrial conduction heterogeneity such as P‑wave dispersion (PWD) and atrial electromechanical delay (AEMD) in predicting the development of SVA in MVP patients.

Methods: A total of 76 patients with MVP (56 female, 20 male) were included in the study. The patients were divided into two groups according to the presence or absence of SVA: 36 patients were allocated to the non-SVA group and 40 patients to the SVA group. Heart rate variability (HRV), PWD, and AEMD values were determined and compared.

Results: The PWD was found to be higher in the SVA group. Interatrial EMD was 32.00 ms (25.00-35.00) in patients with SVA while it was 18.00 ms in patients without SVA (11.00-23.75); the intra-atrial EMD was 17.0 ms (10.00-20.00) in patients with SVA whereas it was 10.00 ms (4.00-14.00) in patients without SVA. Lower HRV was found in the SVA group.

Conclusion: In the SVA group, PWD and AEMD were increased while HRV values were decreased. Noninvasive parameters may help predict the presence and incidence of SVA during the follow-up of this group of patients.
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http://dx.doi.org/10.1007/s00059-021-05034-1DOI Listing
April 2021

Clinical Features of the 60 Years and Older Patients Infected with 2019 Novel Coronavirus: Can We Predict Mortality Earlier?

Gerontology 2021 Mar 30:1-8. Epub 2021 Mar 30.

Department of Emergency Medicine, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.

Introduction: The novel coronavirus (COVID-19), which has affected over 100 countries in a short while, progresses more mortally in elderly patients with comorbidities. In this study, we examined the epidemiological, clinical, and laboratory characteristics of the patients aged 60 and over who had been infected with COVID-19.

Methods: The data of the patients admitted to the hospital within 1 month from May 8, 2020 onwards and hospitalized for COVID-19 pneumonia were obtained from the hospital medical records, and the epidemiological, clinical, and laboratory parameters of the patients during the admission to the emergency department were examined. Patients were divided into 2 groups regarding the criteria of having in-hospital mortality (mortality group) and being discharged with full recovery (survivor group). The factors, which could have an impact on the mortality, were investigated using a univariate and multivariate logistic regression analysis.

Results: This retrospective study included 113 patients aged 60 years and older, with a confirmed diagnosis of COVID-19 pneumonia. The mean age of the patients was 70.7 ± 7.9, and 64.6% (n = 73) of them were male. The mortality rate was 19.4% (n = 22). Among the comorbid illnesses, only renal failure was significant in the mortality group (p = 0.04). A CURB-65score ≥3 or pneumonia severity index (PSI) class ≥4 manifested a remarkable discrimination ability to predict 30-day mortality (p < 0.001). When the laboratory parameters were considered, the value of neutrophil to lymphocyte ratio (NLR) was significant in predicting mortality in univariate and multivariate analysis (odds ratio [OR] = 1.11; 95% confidence interval [95% CI], 1.03-1.21; p = 0.006, and OR = 1.51; 95% CI, 1.11-2.39; p = 0.044, respectively).

Conclusion: In our study, NLR was determined to be an independent marker to predict in-hospital mortality among patients with COVID-19. PSI and CURB-65 revealed a considerably precise prognostic accuracy for the patients with COVID-19 in our study as well. Moreover, thanks to that NLR results in a very short time, it can enable the clinician to predict mortality before the scoring systems are calculated and hasten the management of the patients in the chaotic environment of the emergency room.
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http://dx.doi.org/10.1159/000514481DOI Listing
March 2021

Do Clothing Labels Play a Role for Weight Estimation in Pediatric Emergencies? A Prospective, Cross-Sectional Study.

Prehosp Disaster Med 2021 Feb 26:1-6. Epub 2021 Feb 26.

Department of Emergency Medicine, Kanuni Sultan Suleyman Education and Research Hospital University of Health Science, İstanbul, Turkey.

Introduction: The aim of this study was to investigate the usability of the age value listed on the labels on children's clothes in the age-based weight estimation method recommended by the Pediatric Advanced Life Support (PALS) guidelines.

Material-method: This prospective, cross-sectional study was organized in Antalya Training and Research Hospital Emergency Department. Children aged between 1-12 years were included in the study. The weight measurements of the children were obtained based on the age-related criteria on the labels of their clothes. The estimated values were compared with the real values of the cases measured on the scale.

Results: One-thousand ninety-four cases were included, the mean age of cases in age-based measurements was 6.25 years, which was 6.5 years in label-based measurements. Average weights measured 25.75kg according to age-based measurements, 26.5kg according to label-based measurements, and 26.0kg on the scales, and showed no statistical difference (P <.0001). It was estimated that 741 (67.7%) of age-based measurements and 775 (70.8%) of label-based measurements were within (±)10% values within the normal measurement limits and no significant difference was measured.

Conclusion: In the emergency department and prehospital setting, children with an unknown age and that need resuscitation and interventional procedures for stabilization, and have no time for weight estimation, checking the age on clothing label (ACL) instead of the actual age (AA) can be safely used for the age-dependent weight calculation formula recommended by the PALS guide.
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http://dx.doi.org/10.1017/S1049023X21000194DOI Listing
February 2021

Increased Intima-Media Thickness of the Ascending Aorta May Predict Neurological Complications Associated with TAVI.

J Stroke Cerebrovasc Dis 2021 May 23;30(5):105665. Epub 2021 Feb 23.

Antalya Training and Research Hospital, Cardiology Department, University of Health Sciences, Antalya, Turkey.

Objectives: Neurological complications associated with transcatheter aortic valve implantation (TAVI) are important due to its morbidity and mortality risks. The purpose of this study was to investigate the importance of the features of the aortic valve and ascending aorta to predict the neurological complications associated with TAVI.

Methods: The patients for whom the heart team decided to perform TAVI were included in the study. In order to assess possible neurological complications, cerebral diffusionweighted magnetic resonance imaging(MRI) was performed pre- and post-operatively. The diameter of the patients' aortic root and ascending aorta, aortic valve scores, intima media thickness of the ascending aorta were measured from their transesophageal echocardiography records.

Results: A total of 108 patients constituted the study population. 31 patients were found to develop a new lesion (MR+) detected on MRI after TAVI, while 76 patients did not have any new lesions (MR-). The groups did not have any significant differences in their aortic valve features and scores. However, AA-IMT was found to be higher in the MR+ group (1.8mm [1.6-2.3] vs 1.4mm [1.2-1.8] interquartile range). The multivariate logistic regression analysis conducted to detect new lesions revealed that AA-IMT led to a significantly increased risk.

Conclusion: The features of the ascending are more important than the demographic characteristics of patients and features of the native valve in predicting new lesions on MRI scans and thus neurological events after TAVI.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2021.105665DOI Listing
May 2021

Safety and efficacy of hydroxychloroquine in 152 outpatients with confirmed COVID-19: A pilot observational study.

Am J Emerg Med 2021 Feb 11;40:41-46. Epub 2020 Dec 11.

University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey.

Purpose: We investigated the efficacy and safety of hydroxychloroquine for empirical treatment of outpatients with confirmed COVID-19.

Methods: In this prospective, single-center study, we enrolled ambulatory outpatients with COVID-19 confirmed by a molecular method who received hydroxychloroquine. The patients were divided into low- and moderate-risk groups based on the Tisdale risk score for drug-associated QT prolongation, and the QT interval was corrected for heart rate using the Bazett formula (QTc). The QTc interval was measured by electrocardiography both pretreatment (QTc1) and 4 h after the administration of hydroxychloroquine (QTc2). The difference between the QTc1 and QTc2 intervals was defined as the ΔQTc. The QTc1 and QTc2 intervals and ΔQTc values were compared between the two risk groups.

Results: The median and interquartile range (IQR) age of the patients was 47.0 (36.2-62) years, and there were 78 men and 74 women. The median (IQR) QTc1 interval lengthened from 425.0 (407.2-425.0) to 430.0 (QTc2; 412.0-443.0) milliseconds (ms). However, this was not considered an increased risk of ventricular tachycardia associated with a prolonged QTc interval requiring drug discontinuation, because none of the patients had a ΔQTc of >60 ms or a QTc2 of >500 ms. Moreover, the median (quartiles; minimum-maximum) ΔQTc value was higher in patients in the moderate-risk group than those in the low-risk group (10.0 [-4.0-18.0; -75.0-51.0] vs. 7.0 [-10.5-23.5; -53.0-59.0 ms]) (p = 0.996). Clinical improvement was noted in 91.4% of the patients, the exceptions being 13 patients who presented with non-serious adverse drug reactions or who had severe COVID-19 and were hospitalized. Adverse effects related to hydroxychloroquine were non-serious and occurred in 52.8% (n = 80) of the patients.

Conclusions: Our findings show that hydroxychloroquine is safe for COVID-19 and not associated with a risk of ventricular arrhythmia due to drug-induced QTc interval prolongation. Additionally, hydroxychloroquine was well tolerated, and there were no drug-related non-serious adverse events leading to treatment discontinuation in the majority of patients who were stable and did not require hospitalization.
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http://dx.doi.org/10.1016/j.ajem.2020.12.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7836768PMC
February 2021

Critical pancreatitis management associated with hypertriglyceridemia in pregnancy in emergency service.

Am J Emerg Med 2020 07 25;38(7):1516. Epub 2020 Mar 25.

University of Health Medicine Kanuni Sultan Süleyman Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey.

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http://dx.doi.org/10.1016/j.ajem.2020.03.037DOI Listing
July 2020

Critical pancreatitis management associated with hypertriglyceridemia in pregnancy in emergency service.

Am J Emerg Med 2020 09 15;38(9):1994.e1-1994.e2. Epub 2019 Nov 15.

University of Health Medicine Kanuni Sultan Süleyman Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey.

Because of the variable clinical features of acute pancreatitis, it is difficult to make a differential diagnosis in patients presenting with abdominal pain in emergency departments. Acute pancreatitis due to severe hypertriglyceridemia during pregnancy is rare but due to the increased risk of maternal and fetal mortality, diagnosis and treatment options should be known and should be performed in the emergency department, which is the first admission site. In this case report, we present a 20-year-old woman with 19 weeks pregnant who presented to the emergency department with abdominal pain and whose biochemistry parameters were high enough to give lipemic stimulation was hospitalized in the emergency ıntensıve care unit (EICU) in the emergency department and lipid apheresis treatment was planned successfully. Lipid apheresis treatment in patients with resistant hypertriglyceridemia in the emergency department should become an easy, safe and effective option with the use of an emergency intensive care unit.
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http://dx.doi.org/10.1016/j.ajem.2019.158488DOI Listing
September 2020

Evaluating Stable Chronic Obstructive Pulmonary Disease by Ultrasound.

Emerg Med Int 2019 15;2019:5361620. Epub 2019 Sep 15.

Department of Chest Diseases, Ufuk University Medical Faculty, Dr Ridvan Ege Education and Research Hospital, Ankara, Turkey.

Background And Aim: The purpose of the study was to evaluate the relationship between COPD severity and the diaphragmatic function measured by point-of-care US in patients with stable COPD.

Method: A total of 61 patients with COPD and 40 healthy subjects who had been admitted to Ufuk University Hospital between December 2018 and May 2019 were enrolled. Point-of-care US was performed, and lung silhouette and anterior, right, and left hemidiaphragm method in M-mode were used to evaluate the diaphragm.

Results: The point-of-care US measurements, lung silhouette method right (Lung Sil R), lung silhouette method left (Lung Sil L), right hemidiaphragm US method in B-mode (Ant B-Mode R), and right hemidiaphragm US method in M-mode (Ant M-Mode R), were significantly different among groups ( < 0.001 for each). FEV1 was strongly correlated with Lung Sil R, Lung Sil L, Ant B-Mode R, and Ant M-Mode R ( = 0.963, < 0.001;  = 0.956, < 0.001;  = 0.953, < 0.001; and  = 0.917, and < 0.001, respectively). Negative correlations were detected between the number of exacerbations per year and Lung Sil R and the number of exacerbations per year and Ant M-Mode R ( = -0.599, < 0.001 and  = -0.587, and < 0.001, respectively).

Conclusion: In this study, FEV1 and annual number of exacerbations turned out to be strongly correlated US findings. The use of US in COPD patients could help to support clinical decision, but further clinical studies are necessary to confirm those findings.
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http://dx.doi.org/10.1155/2019/5361620DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6766158PMC
September 2019

Aspartate-aminotransferase to platelet ratio index score for predicting HELLP syndrome.

Am J Emerg Med 2020 03 12;38(3):459-462. Epub 2019 Feb 12.

Department of Emergency Medicine, Kanuni Sultan Suleyman Education and Research Hospital University of Health Science, İstanbul, Turkey.

Introduction: HELLP (hemolysis, elevated liver enzyme levels, low platelet counts)-syndrome is a rare but dramatic pregnancy-related illness. The difficult part of this syndrome is the lack of standardised diagnostic criterias and tests to be used to predict it. The aim of this study is determining the role of APRI score in the diagnosis of HELLP syndrome.

Material And Methods: In this cross sectional, retrospective study, patients with HELLP syndrome as case group and age-matched healthy pregnants at the similar pregnancy trimester as control group were included between January 12,017 and May 31, 2018. Data including sex, age, laboratory values, prognosis were recorded from the computerized system of the hospital. The p-value <0.05 was considered statistically significant.

Results: 40 patients with HELLP syndrome and 124 age-matched healthy pregnants included in the study. There was a statistically significant difference between control group and HELLP patients in terms of the mean urinary protein, platelet count, ALT, AST, creatinin, D dimer levels and also the mean APRI score. In the multivariate regression analysis, APRI score was found a better predictor than AST and both were in a good significant in predicting HELLP. On the ROC curve in order to distinguish the patients with HELLP from the control group for AST and APRI score, the sensitivity was found to be 71.7% and 82.6%, specificity to be 91.2% and 87.6% respectively. Maternal mortality rate of HELLP syndrome was 10%.

Conclusion: We concluded that the APRI score was robustly predicted HELLP syndrome than AST alone in this study. Further studies are needed to support our data with prospective, multicentre, larger patient groups.
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http://dx.doi.org/10.1016/j.ajem.2019.02.014DOI Listing
March 2020

Examination of References in Rosen's Emergency Medicine Text Book, 8 Edition; an Observational Study.

Authors:
Ramazan Güven

Emerg (Tehran) 2018 16;6(1):e37. Epub 2018 Jun 16.

Department of Emergency Medicine, Bitlis State Hospital, Bitlis, Turkey.

Introduction: This study aims to analyze the references that the authors and editors used during the writing of Rosen's Emergency Medicine, 8th edition.

Methods: 15,209 references, which were used in 197 chapters of Rosen's Emergency Medicine, 8 edition, were examined regarding the distribution of countries, journals, publication year, and the department of the affiliation of the first author.

Results: A total of 63.1% (n = 9591) of the references were led by authors from the United States (US). US-based journals were mostly used, and Annals of Emergency Medicine was the journal from which the references were most frequently extracted, with a percentage of 5.2% (n = 756). The studies conducted by emergency physicians have increased in recent years, and emergency physicians, with a percentage of 17.8% (n = 351), were the leading authors of studies conducted between 2010 and 2013, which were cited in the references of Rosen's Emergency Medicine, 8th edition.

Conclusion: US-based studies make up a significantly bigger portion of the references used in Rosen's Emergency Medicine, 8 edition. If Europe and other countries give due importance to emergency medicine, they will have the capability to produce studies that can be used as references in textbooks as much as the US.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6036535PMC
June 2018

Neutrophil Count as a Predictor of Critical Coronary Artery Stenosis in Young Patients.

Iran J Public Health 2018 May;47(5):765-767

Dept. of Emergency Medicine, Antalya Training and Research Hospital, Antalya, Turkey.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6005979PMC
May 2018

A Rare Case of Foreign Body in Stomach: Dental Mouth Mirror.

Iran J Public Health 2018 Feb;47(2):295-296

Dept. of General Director, Bitlis State Hospital, Bitlis, Turkey.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5810395PMC
February 2018

The association between apelin gene polymorphism and coronary artery disease in young patients with acute obstructive coronary syndrome.

Turk Kardiyol Dern Ars 2017 Sep;45(6):520-526

Department of Emergency Medicine, Bitlis State Hospital, Bitlis, Turkey.

Objective: The purpose of this study was to evaluate the association between V103V, 6140AG, TGA-Stop-TAA Stop, and 6016CA polymorphisms of the apelin (APLN) gene detected for the first time among young patients with acute coronary syndrome (ACS) and coronary artery disease (CAD).

Methods: This was a prospective cross-sectional study. The study population was divided into 2 groups. The first group included 132 patients who were found to have critical lesions in their coronary arteries, while the control group consisted of 41 patients who were found to have normal coronary arteries or non-critical atherosclerotic lesions.

Results: Among the gene polymorphisms, V103V was found to be more common in the critical CAD patients with the GG genotype compared with the control group (67.4% vs. 46.3%). On the other hand, the GT genotype was more common in the control group (53.7% vs. 32.6%). Univariate and multivariate logistic regression analysis revealed that the GG genotype of V103V was an independent predictor for the presence of critical CAD (odds ratio: 2.397; 95% confidence interval, 1.174-4.892; p=0.016).

Conclusion: In cases of V103V polymorphism of the APLN gene, patients with the GG genotype were at a greater risk for the presence of atherosclerotic critical lesions compared with the control group.
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http://dx.doi.org/10.5543/tkda.2017.95849DOI Listing
September 2017

Assessment of the association between the personality traits of young patients with acute coronary syndrome and the severity of coronary artery disease.

Turk Kardiyol Dern Ars 2017 Sep;45(6):514-519

Department of Cardiology, Antalya Training and Research Hospital, Antalya, Turkey.

Objective: The role of psychosocial risk factors is becoming increasingly important in the etiology of acute coronary syndrome (ACS). The purpose of this study was to assess an association between the personality types of young patients with ACS and the prevalence and severity of coronary artery disease (CAD).

Methods: Patients younger than 45 years of age who presented with ACS and who underwent coronary angiography in the period from 2012 to 2016 were included in the study. The coronary angiography records of the patients were examined and their Gensini score (GS) was calculated; GS ≥20 was considered to be severe CAD. The Eysenck Personality Questionnaire-Revised Short Form scales were used to measure psychoticism, extraversion, lying, and neuroticism.

Results: A total of 139 patients were included in the study. The median psychoticism score of patients with GS <20 was found to be significantly higher than that of patients with GS ≥20 [1.0 (25th and 75th percentile: 0.0-2.0) vs. 1.0 (25th and 75th percentile: 0.0-1.0); p=0.015]. The median psychoticism score was 1.0 (25th and 75th percentile: 1.0-2.0) in the unstable angina pectoris group, 0.5 (25th and 75th percentile: 0.0-1.0) in the ST segment elevation myocardial infarction group, and 1.0 (25th and 75th percentile: 0.0-1.0) in the non-ST segment elevation myocardial infarction group (p=0.004).

Conclusion: The presence of psychoticism characteristics in patients who present with ACS is associated with less severe CAD.
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http://dx.doi.org/10.5543/tkda.2017.32379DOI Listing
September 2017

Is neutrophyl to lymphocyte ratio really a useful marker for all grades of degenerative aortic stenosis?

Turk Kardiyol Dern Ars 2017 Sep;45(6):506-513

Department of Cardiology, Antalya Training and Research Hospital, Antalya, Turkey.

Objective: Inflammatory processes play an important role in cardiac valve calcification and ossification. The aim of this study was to investigate the relationship between the neutrophil-lymphocyte ratio (NLR) and degenerative aortic stenosis (AS).

Methods: A total of 220 patients with AS and 158 healthy individuals who were a control group were included in the study. The NLR was calculated by dividing the number of neutrophils by number of lymphocytes in peripheral blood samples.

Results: The study group consisted of 220 AS patients (mild/ moderate group: n=110; severe group: n=110) and 157 healthy controls. Both the mild/moderate AS group (p<0.001) and the severe AS group (p<0.001) had a significantly higher NLR compared with the control group. The NLR in the severe AS group was significantly higher than that of the mild/moderate AS group (p<0.001). The groups were similar with respect to other baseline characteristics. A receiver operating characteristic curve analysis yielded a strong predictive ability of NLR for the presence of AS (Area under the curve=0.930; 95% CI [confidence interval], 0.898-0.963; p<0.001). A cut-off value of 2.310 for NLR had a sensitivity and specificity of 80.4% and 92.4%, respectively, for the presence of AS. In multivariate logistic regression analysis, NLR (Odds ratio: 43.8; 95% CI, 14.7-130.7) was the only independent predictor of AS.

Conclusion: The discriminative performance of NLR for AS is high. NLR is strongly and independently associated with AS.
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http://dx.doi.org/10.5543/tkda.2017.32389DOI Listing
September 2017

Assessment of left ventricular function with tissue Doppler echocardiography and of B-type natriuretic peptide levels in patients undergoing transcatheter aortic valve implantation.

Rev Port Cardiol 2017 May 9;36(5):377-383. Epub 2017 May 9.

Mus State Hospital, Department of Emergency Medicine, Antalya, Turkey.

Introduction: Transcatheter aortic valve implantation (TAVI) is an emerging minimally invasive treatment modality in high surgical risk or inoperable patients.

Aim: The aim of this study was to ascertain the effect of TAVI on left ventricular (LV) systolic and diastolic function and serum B-type natriuretic peptide (BNP) levels in high surgical risk or inoperable patients with severe aortic stenosis.

Methods: Fifty-five patients were included in our retrospective study. LV systolic and diastolic function was assessed with conventional and tissue Doppler imaging (TDI) prior to and after TAVI. Additionally, BNP was measured 24 h before and three months after the procedure. Echocardiographic controls were performed at one, three and six months and one year and mean values were taken. At the end of the study, LV systolic and diastolic function, serum BNP levels and New York Heart Association functional capacity were assessed and compared to baseline parameters.

Results: The TAVI procedure was successful in all patients. In-hospital mortality was 1.8% (one patient). There was a substantial improvement in LV function and functional capacity at follow-up. In addition, a statistically significant decrease was detected in serum BNP levels post-TAVI (median 380 pg/ml [176.6-929.3] vs. 215 pg/ml [96.0-383.0], p=0.0001). Only one patient required a permanent pacemaker (1.8%) and there was no mortality after TAVI during follow-up. There were significant increases in LV ejection fraction and aortic valve area (51.0±13.1% vs. 58.4±9.1%, p<0.001, and 0.6±0.1 cm vs. 2.1±0.2 cm, p=0.0001, respectively). At the end of the study, conventional Doppler echocardiography revealed improvement in diastolic function, with an increase in mitral E wave, a decrease in mitral A wave and an increase in E/A ratio. Deceleration time and isovolumetric relaxation time were shortened and myocardial performance (Tei) index decreased. TDI showed an increase in systolic myocardial velocity (Sm) and early diastolic velocity (Em). Septal mitral annular Sm and Em were increased, whereas MPI was reduced.

Conclusion: We found that LV structural changes and diastolic dysfunction occur in patients with severe aortic stenosis and that TAVI is able to reverse these abnormalities, which we demonstrated by both conventional echocardiography and TDI. In addition, serum BNP levels were decreased after TAVI.
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http://dx.doi.org/10.1016/j.repc.2016.10.008DOI Listing
May 2017

The Relationship between Vitamin D and Coronary Artery Ectasia in Subjects with a Normal C-Reactive Protein Level.

Korean Circ J 2017 Mar 13;47(2):231-237. Epub 2017 Mar 13.

Department of Cardiology, Antalya Education and Research Hospital, Antalya, Turkey.

Background And Objectives: Vitamin D is generally known to be closely related to inflammation. The effects of vitamin D on coronary artery disease (CAD) are not fully explained. Nowadays, coronary artery ectasia (CAE) cases are common and are regarded as being a kind of CAD. We aimed to investigate, in a case-control study, the relationship between vitamin D and CAE without an associated inflammatory process.

Subjects And Methods: This study population included 201 patients (CAE group, 121 males; mean age, 61.2±6.4 years) with isolated CAE; and 197 healthy individuals (control group, 119 males; mean age, 62.4±5.8 years), comprising the control group, who had normal coronary arteries. These participants concurrently underwent routine biochemical tests, tests for inflammatory markers, and tests for 25-OH vitamin D in whole-blood draws. These parameters were compared.

Results: There are no statistical significance differences among the groups for basic clinical characteristics (p>0.05). Inflammatory markers were recorded and compared to exclude any inflammatory process. All of them were similar, and no statistical significance difference was found. The average parathyroid hormone (PTH) level of patients was higher than the average PTH level in controls (41.8±15.1 pg/mL vs. 19.1±5.81 pg/mL; p<0.001). Also, the average 25-OH vitamin D level of patients was lower than the average 25-OH vitamin D level of controls (14.5±6.3 ng/mL vs. 24.6±9.3 ng/mL; p<0.001). In receiver operating characteristic curve analysis, the observed cut-off value for vitamin D between the control group and patients was 10.8 and 85.6% sensitivity and 75.2% specificity (area under the curve: 0.854, 95% confidence interval: 0.678-0.863).

Conclusion: We found that there is an association between vitamin D and CAE in patients who had no inflammatory processes. Our study may provide evidence for the role of vitamin D as a non-inflammatory factor in the pathophysiology of CAE.
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http://dx.doi.org/10.4070/kcj.2016.0198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5378030PMC
March 2017

Effect of Focused Bedside Ultrasonography in Hypotensive Patients on the Clinical Decision of Emergency Physicians.

Emerg Med Int 2017 5;2017:6248687. Epub 2017 Mar 5.

Department of Emergency Medicine, Antalya Training and Research Hospital, Antalya, Turkey.

We assessed the effect of focused point of care ultrasound (POCUS) used for critical nontraumatic hypotensive patients presenting to the emergency department of our hospital on the clinical decisions of the physicians and whether it led to the modification of the treatment modality. This prospective clinical study was conducted at the Emergency Department of Antalya Training and Research Hospital. Nontraumatic patients aged 18 and older who presented to our emergency department and whose systolic blood pressure was <100 mmHg or shock index (heart rate/systolic blood pressure) was >1 were included in the study. While the most probable preliminary diagnosis established by the physician before POCUS was consistent with the definitive diagnosis in 60.6% ( = 109) of 180 patients included in the study, it was consistent with the definitive diagnosis in 85.0% ( = 153) of the patients after POCUS ( < 0.001). POCUS performed for critical hypotensive patients presenting to the emergency department is an appropriate diagnostic tool that can be used to enable the physicians to make the accurate preliminary diagnosis and start the appropriate treatment in a short time.
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http://dx.doi.org/10.1155/2017/6248687DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5357513PMC
March 2017

Relationship between mean platelet volume and ischemic stroke in patients with patent foramen ovale.

Turk Kardiyol Dern Ars 2017 Jan;45(1):9-15

Department of Cardiology, Antalya Training and Research Hospital, Antalya, Turkey.

Objective: Patent foramen ovale (PFO) is commonly encountered in patients with cryptogenic stroke. Mean platelet volume (MPV), an indicator of platelet reactivity, has been reported in recent trials to be higher in patients with PFO than in normal population. The aim of this study was to investigate whether there is a difference in MPV between patients with PFO and stroke or transient ischemic attack (TIA) and that of patients with asymptomatic PFO.

Methods: Patients with PFO who were younger than 55 years of age were enrolled in this retrospective study. Hemogram parameters of patients with ischemic stroke or TIA (symptomatic group) were obtained during hospitalization once they had stable clinical status.

Results: Total of 108 patients, 51 of whom were symptomatic, were included in the study. MPV was determined to be higher in symptomatic group compared with asymptomatic group (median 10.0 fl [25th-75th percentile: 9.0-11.0] vs median 8.56 fl [25th-75th percentile: 8.0-9.0], respectively; p<0.001,. Cut-off point of 9.0 fl for MPV had 70% sensitivity and 86% specificity in predicting symptomatic PFO patients.

Conclusion: MPV is higher in symptomatic than in asymptomatic PFO patients. This finding may be a subsidiary risk factor to identify patients with PFO and high risk of cardioembolic stroke.
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http://dx.doi.org/10.5543/tkda.2016.17971DOI Listing
January 2017

Thrombolytic therapy delay is independent predictor of mortality in acute pulmonary embolism at emergency service.

Kaohsiung J Med Sci 2016 Nov 1;32(11):572-578. Epub 2016 Nov 1.

Department of Emergency Medicine, Antalya Education and Research Hospital, Antalya, Turkey.

Acute pulmonary embolism (PE) carries a high risk of morbidity and mortality. Delays in diagnosis or therapy may result in sudden, fatal deterioration; therefore, rapid diagnosis and an appropriate therapeutic approach are needed. We aimed to investigate the effect of delaying thrombolytic administration on the mortality rate in a suspected PE. We retrospectively analyzed 49 consecutive patients who were aged 18 years or older and received thrombolysis for a high-risk PE without a major contraindication. All patients were classified according to the time of onset of the thrombolytic therapy. Patients experiencing cardiopulmonary arrest were analyzed from the time of admission to thrombolytic administration with 10-minute cutoff values. Data were analyzed by a regression analysis and a receiver operating characteristic (ROC) analysis for significant and independent associated risk factors and in-hospital mortality. Mortality was seen in 17 of the 49 cases. Thirteen of these had received thrombolytic therapy 1 hour after their emergency department (ED) admission. Among all cases, the mortality rate was 35%. The ROC analysis indicated that a > 97-second delayed thrombolytic administration time was associated with mortality with 53% sensitivity and 91% specificity (area under the curve, 0.803; 95% confidence interval, 0.668-0.938). In the logistic regression, a 5-minute delay in thrombolytic therapy (beta = 1.342; 95% confidence interval, 1.818-2.231; p = 0.001) was associated with in-hospital mortality in the multivariable model. No major bleeding complications were seen in PE survivors. We conclude that early onset thrombolytic therapy in the ED for high-risk and hemodynamically worsening patients appears safe and life-saving.
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http://dx.doi.org/10.1016/j.kjms.2016.09.004DOI Listing
November 2016

Treatment of a patient in hemorrhagic shock due to leech bite with tranexamic acid.

Authors:
Ramazan Güven

Am J Emerg Med 2016 Nov 12;34(11):2253.e3-2253.e4. Epub 2016 May 12.

Department of Emergency Medicine, Bitlis State Hospital, Bitlis, Turkey. Electronic address:

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http://dx.doi.org/10.1016/j.ajem.2016.05.021DOI Listing
November 2016

Right-sided electrocardiogram usage in acute pulmonary embolism.

Am J Emerg Med 2016 Aug 16;34(8):1437-41. Epub 2016 Apr 16.

Emergency Medicine Service, Bitlis State Hospital, Bitlis, Turkey.

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http://dx.doi.org/10.1016/j.ajem.2016.04.025DOI Listing
August 2016

Point-of-care ultrasonography for the management of shoulder dislocation in ED.

Am J Emerg Med 2016 May 16;34(5):866-70. Epub 2016 Feb 16.

Akdeniz University Medical Faculty, Department of Emergency Medicine, Antalya, Turkey. Electronic address:

Objective: Point-of-care ultrasonography (POCUS) is an easily available and noninvasive tool without radiation exposure that is also gaining a broad range of use in emergency departments. The aim of this study is to evaluate the value of POCUS in the diagnosis of shoulder dislocation by comparing with plain radiography.

Methods: This prospective observational study with a convenience sampling was conducted in emergency departments of 2 hospitals. Patients older than 15 years with possible shoulder dislocation during the physical examination composed the study population. All the study patients underwent POCUS evaluation to detect a shoulder dislocation or fracture before radiography, and the POCUS procedure was also achieved after the reduction attempt.

Results: A total of 103 patients were enrolled in the study. The mean age of study subjects was 33.9±15 years, and 80.6% (n=83) of them were male. The sensitivity and specificity of POCUS in identifying dislocation were 100% (95% confidence interval [CI], 96%-100%) and 100% (95% CI, 48%-100%), respectively. POCUS also confirmed reduction in 93 of 94 patients with a specificity of 100% (95% CI, 96%-100%). POCUS has a sensitivity of 100% (95% CI, 63%-100%) for excluding a shoulder fracture but a specificity of 84.2% (95% CI, 75%-91%).

Conclusion: Point-of-care ultrasonography is an effective tool to either rule in or rule out shoulder dislocation in the emergency setting. Furthermore, it is a robust sensitive tool for excluding fractures but with false-positive results.
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http://dx.doi.org/10.1016/j.ajem.2016.02.006DOI Listing
May 2016

The Diagnostic Value of Oxidative/Antioxidative Balance Parameters in Venous Thromboembolism.

Clin Lab 2015 ;61(7):769-75

Background: The aim of this study is to observe the association between venous thromboembolism (VTE) and oxidative stress and to see if there is a diagnostic value in the oxidative/antioxidative balance parameters like total oxidant status (TOS), total antioxidant status (TAS), paraoxonase-(PON1), and arylesterase (ARE) enzyme activities in this specific disease.

Methods: Sixty-nine patients with deep vein thrombosis and/or pulmonary embolism and 40 control subjects were included in the study. Oxidative stress index, total oxidant status, and antioxidant status were examined in addition to the PON1 and ARE enzyme activities in both groups.

Results: Serum PON1 and ARE activities were significantly lower in the VTE patients, whereas total oxidant status was higher in patients compared to the controls.

Conclusions: This preliminary study showed that oxidative/antioxidative balance shifted towards the oxidative status in venous thromboembolism. ROC analysis results suggested that the parameters used in this study were not good enough to be used in the diagnosis of VTE.
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September 2015