Diltiazem efficacy and CYP2D6 gene polymorphism in patients with atrial fibrillation with rapid ventricular response.

BACKGROUND: Diltiazem stands out as one of the front-line drugs administered in the emergency department to achieve acute rate control in patients suffering from atrial fibrillation with rapid Ventricular Response. One of the cytochrome enzymes involved in the metabolism of diltiazem is cytochrome P450 2D6 (CYP2D6). Interindividual differences can act on drug metabolism and thus drug efficacy due to the genetic polymorphism induced by the CYP2D6 enzyme. This study explores the association between the efficacy of diltiazem and the genetic polymorphism of CYP2D6 in patients with atrial fibrillation with rapid ventricular response. RESULTS: 87 out of 93 individuals with ventricular rate > 120 beats/min constituted the patient cohort. The patients were administered 0.25 mg/kg diltiazem intravenously. As a second dose, 0.35 mg/kg diltiazem was administered to patients who reportedly did not receive adequate drug efficacy. Heart rate control was considered to be achieved in patients whose heart rate fell below 110 beats/min and did not rise above 110 beats/min for 2 h. CYP2D6 *2, *3, *4 and *10 represent allele variants and *1 represents wild type (wt) allele. Achieving rate control after one or two doses of diltiazem in normal allele (wt/wt) carriers proved significantly higher than wt/*2, wt/*4 and wt/*10 heterozygous variant carriers. No significant difference was noted in wt/*3 heterozygous variant carriers. CONCLUSION: The presence of *2, *4 and *10 alleles was observed to significantly compromise the drug efficacy. *3 allele was found to bear no relation to the effect of diltiazem on achieving rate control.

The effect of surgical masks on vital signs and EtCO2 in patients on oxygen therapy.

BACKGROUND: There are conflicting data on the effects of masks on vital signs and end-tidal CO2 (EtCO2) values in the literature. AIMS: This study aims to evaluate the changes in the vital parameters and EtCO2 values of the patients who were administered oxygen through nasal cannula (NC) and simple oxygen mask (SOM) and wore surgical masks (SM) on top during their treatment. METHODS: The prospective, observational study was conducted from January 2021, over consecutive 30 days, in the emergency department of a tertiary-care university hospital. The vital signs and EtCO2 values of the subjects administered O2 were noted at the time of arrival and at the 30th and 120th minutes of treatment. Changes in vital signs and EtCO2 values were compared with regard to NC-SM and SOM-SM applications over a 120-min study period. RESULTS: Sixty-eight subjects were included in two groups (NC-SM [n = 49] and SOM-SM [n = 19]). At the 120th minute, a decrease in systolic and diastolic blood pressure, heart rate, and respiratory rate and an increase in oxygen saturation were observed in the group including all subjects. After decreasing slightly in the first 30 min, the EtCO2 value remained stable. CONCLUSIONS: NC-SM and SOM-SM applications do not affect adversely, and even seem to lead to recovery of, the vital signs and EtCO2 values during 120 min in subjects with acute complaints.

Investigation of Serum Angiotensin-Converting Enzyme (ACE) Concentration and ACE Gene Polymorphism in Patients With SARS-CoV-2 Pneumonia Admitted to the Emergency Department.

Background This study seeks to investigate the distribution of the angiotensin-converting enzyme (ACE) gene polymorphism and serum levels in patients with viral pneumonia and predict which polymorphism will lead to severe progression of the disease. Methodology The serum ACE levels and ACE gene polymorphisms were successfully evaluated with respect to subsequent viral pneumonia using records of 100 patients with viral pneumonia and 100 healthy controls. Results ACE serum concentration was statistically significantly elevated. ACE serum concentration with a cut-off value of ≥5,256.05 pg/mL had 85.3% sensitivity and 83.2% selectivity. In addition, patients with ACE genotype D/D were 0.08 times more likely to manifest severe lung involvement than those with I/I, and patients with the I/D genotype were 0.02 times more likely than their counterparts with I/I. The computed tomography findings of the patients revealed that ACE serum concentration was significantly effective in discriminating between mild and moderate-to-severe lung involvement. No significant difference was observed between the blood parameters and ACE genotype distributions. Conclusions I/D polymorphism likely affects the expression of the ACE gene and/or the function of the angiotensin I converting enzyme. The D/D genotype is associated with vessel wall thickness and higher blood pressure. Strong evidence was found between D/D and I/D genotypes in the patient cohort concerning genotypes and ACE serum concentration. Further analysis showed that ACE serum levels were more elevated in the D/D genotype compared to the I/D genotype in the patient cohort.

The Correlation Between Peroxisome Proliferator-Activated Receptor Alpha and Gamma Polymorphisms and Acute Coronary Syndrome.

OBJECTIVE: This study aims to evaluate the relationship between peroxisome proliferator-activated receptor (PPAR) alpha and gamma gene polymorphisms and acute coronary syndrome (ACS) clinically. SUBJECT AND METHODS: Peripheral blood samples were collected from a total of 200 people, including 100 acute coronary syndrome patients and 100 controls aged 19 to 93 years, admitted to the Pamukkale University Emergency Medicine Department. The healthy volunteers had no known chronic or acute diseases, no history of drug use, and no recent history of coronary artery disease (CAD). PPAR alpha L162V and PPAR gamma C161T gene polymorphic regions were detected using DNA sequencing analyses. In addition, data collected from the hemogram and biochemical parameters and comorbidities of the patients were statistically analyzed. RESULTS: PPAR gamma C161T polymorphisms were compared between groups. The CT heterozygous rate in the patient group (74%) was higher than in the control group (7%). The T allele was more common in the patient group (0.37) compared to the control group (0.03). When PPAR alpha L162V polymorphism was compared, VV homozygous individuals were %19 in the patient group and none in the control group. The V allele was found to be statistically higher in patients with ACS (p<0.01). CONCLUSION: The findings revealed that elevated PPAR alpha L162V and PPAR gamma C161T gene polymorphisms were associated with a progressive risk of ACS.

The impact of COVID-19 on social support perception and stress of prehospital care providers.

BACKGROUND: This study seeks to explore the impact of COVID-19 outbreak on the social support perception and acute stress disorder of prehospital care providers (PCPs) in the province of Denizli. METHODS: This descriptive and cross-sectional study was conducted between December 25, 2020 and January 25, 2021. Out of 510 ambulatory care staff constituting the study population, there were 287 PCPs (%56.2), including 13 physicians, 89 paramedics, 134 emergency medical technicians, and 51 individuals from other occupational groups (nurse, driver, cleaning staff, medical secretary) based at emergency health services. The data collection tools employed in the study include an introductory information form, Multidimensional Scale of Perceived Social Support (MSPSS), and National Stressful Events Survey Acute Stress Disorder Short Scale (NSESSS), which was organized as an online questionnaire. RESULTS: We analyzed the data from 287 PCPs that completed the form and scales. The mean score of the NSESSS was calculated as 1.53 ± 0.79. The PCPs who experienced health problems (1.85 ± 0.69), suffered from mental problems and received psychotherapy and medication (2.57 ± 0.57), encountered COVID-19 patients (1.58 ± 0.8), provided care for COVID-19 patients (1.59 ± 0.79), and took polymerase chain reaction (PCR) tests (1.68 ± 0.78) had higher acute stress symptom levels. The total mean score of MSPSS was calculated as 66.28 ± 17.22. Total MSPSS scores of the participants varied significantly in terms of age, marital status, taking a COVID-19 test, suffering from mental problems, status of encountering a COVID-19 patient, and workplace satisfaction (p < 0.05). CONCLUSIONS: The findings are suggestive of high perceptions of multidimensional social support and low acute stress symptom levels of the PCPs during the COVID-19 pandemic period.

Comparative evaluation of the effectiveness of intravenous paracetamol, dexketoprofen and ibuprofen in acute low back pain.

INTRODUCTION: Non-traumatic back pain constitutes roughly 5% of the admissions to emergency departments. This study seeks to compare the efficacy of intravenously administered paracetamol, dexketoprofen, and ibuprofen in patients with non-traumatic acute low back pain. METHODS: This study was designed as a randomized, double-blinded investigation and carried out at a tertiary hospital. 210 eligible patients without trauma who presented with low back pain were recruited for the study and randomized into paracetamol (n = 71), dexketoprofen (n = 70), and ibuprofen (n = 69) groups. The measurements at 0, 15, 30 and 60 min were noted down by using a 100 mm VAS, and the relevant comparisons were made. RESULTS: The VAS scores at 0 and 60 min in the paracetamol, dexketoprofen, and ibuprofen groups decreased on average by 40 mm, 42 mm, and 43 mm, respectively. The baseline and final pain scores of each drug group differed significantly (p < 0.05), though the between-group analysis revealed no significant difference (p > 0.05). CONCLUSION: Given the obtained data, we did not note a significant difference between intravenous paracetamol, dexketoprofen and ibuprofen with respect to pain efficacy in non-traumatic acute low back pain. Based on the patients' clinical conditions and histories, we concluded that the choice of medication might not change the efficacy of the treatment and patient comfort.

Investigation of electrorheological properties of biodegradable modified cellulose/corn oil suspensions.

Considerable scientific and industrial interest is currently being focused on a class of materials known as electrorheological (ER) fluids, which display remarkable rheological behaviour, being able to convert rapidly and repeatedly from a liquid to solid when an electric field (E) is applied or removed. In this study, biodegradable cellulose was modified and converted to their carboxyl salts. Modified cellulose is characterised by Fourier transform infrared (FTIR) spectroscopy, nuclear magnetic resonance (NMR) spectroscopy, energy dispersive spectroscopy (EDS), thermogravimetric analysis (TGA) and conductivity measurements. Suspensions of cellulose (C) and modified cellulose (MC) were prepared in insulated corn oil (CO). The effects of electric field strength, shear rate, shear stress, temperature, etc. of these suspensions onto ER activity were determined. Rheological measurements were carried out via a rotational rheometer with a high-voltage generator to investigate the effects of electric field strength and particle concentration on ER performance. The results show that the ER properties are enhanced by increasing the particle concentration and electric field strength. Also the cellulose-based ER fluids exhibit viscoelastic behaviour under an applied electric field due to the chain formation induced by electric polarization between particles.