Demographic and Clinical Characteristics of Migrant Patients Visiting the Emergency Department.

Introduction Disasters, war, violence, and famine have driven people to migrate in search of a better life, resulting in an increasing number of health issues related to migration. Turkiye has historically been a host country for migration due to its geopolitical location for economic and educational reasons, among other reasons. Migrants frequently visit emergency departments (EDs) regarding their chronic or acute diseases. Understanding the characteristics and admission diagnosis in EDs can help healthcare providers identify areas that require attention. This study aimed to determine the demographic characteristics and most frequent reasons for migrant patients visiting the ED. Methods This retrospective cross-sectional study was conducted in the ED of a tertiary hospital in Turkiye between January 1, 2021, and January 1, 2022. Sociodemographic data and diagnoses were obtained from the hospital information system and medical records. Migrant patients who visited the ED for any reason were included, while patients with inaccessible data, no diagnosis code, or missing information were excluded. Data were analyzed using descriptive statistical methods and compared using the Mann-Whitney U test, Student's t-test, and Chi-squared test. Results Out of 3865 migrant patients, 2186 (56.6%) were male, and the median age was 22 (17-27) years. Most patients (74.5%) were from the Middle East, and 16.6% were from Africa. The most common reasons for visiting the hospital were R00-99 "Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified" (45.6%); M00-99 "Diseases of the musculoskeletal system and connective tissue" (29.2%); and J00-99 "Diseases of the respiratory system" (23.1%). Among the African patients, 82.7% were students, while 85.4% of Middle Eastern patients were non-students. The number of visits differed significantly between regions, with Middle Easterners visiting more frequently than Africans and Europeans. Conclusion The majority of the patients were from the Middle East. Also, patients from the Middle East had more visits and a higher likelihood of being hospitalized than patients from other regions. The sociodemographic characteristics of migrant patients visiting ED and information about their diagnoses can help determine the profile of patients that emergency physicians are likely to encounter.

Predicting hospitalization by TAPSE/SPAP and the role of spironolactone in asymptomatic heart failure patients.

Aim: To appraise the prediction of tricuspid annular plane systolic excursion (TAPSE)/systolic pulmonary artery pressure (SPAP) with regard to hospitalization and the effect of spironolactone use. Materials & methods: A total of 245 patients were evaluated for the study. Patients were followed for 1 year and cardiovascular outcomes were determined. Results: It was determined that TAPSE/SPAP was an independent predictor of hospitalization. A 0.1-mmHg decrease in TAPSE/SPAP was associated with a 9% increase in relative risk. No event was observed above the 0.47 level. Negative correlation with TAPSE (uncoupling) began in the spironolactone group when SPAP was ≥43 and in nonusers when SPAP was 38 (Pearson's correlation coefficient: -,731 vs -,383; p < 0.001 vs p = 0.037). Conclusion: TAPSE/SPAP measurement may be useful in predicting 1-year hospitalization in asymptomatic heart failure patients. This ratio was also found to be higher in patients who used spironolactone.

The role of prognostic nutritional index in predicting amputation in patients with lower extremity peripheral artery disease.

Introduction: Lower-extremity peripheral artery disease (PAD) can lead to a wide spectrum of symptoms that can progress from claudication to amputation. The prognostic nutritional index (PNI), which is calculated using the levels of albumin and lymphocyte, is an accepted indicator of immunological and nutritional status. In this study, the association between nutritional status determined using the PNI, and extremity amputation in patients with lower-extremity PAD was investigated. Methods: Lower-extremity PAD patients who had been admitted to the cardiology clinic of the Diskapi Yildirim Beyazit Training & Research Hospital with stage 2b or higher claudication, and who were technically unsuitable for revascularization or underwent unsuccessful revascularization procedure were enrolled in this retrospective study. Patients were grouped according to whether or not limb amputation had been performed previously. Potential factors were tested to detect independent predictors for amputation with logistic regression analysis. Results: A study group was formed with 266 peripheral artery patients. The amputated group (39 patients) had a higher number of hypertensive (76.9% vs 57.7%; P = 0.032) and diabetic (92.3% vs 54.2%; P <0.001) patients than those in the non-amputated group (227 patients). The median PNI value of the amputated group was lower than that of the non-amputated group (31.8 vs 39.4; P <0.001). Multivariate logistic regression showed that the PNI (OR: 0.905, 95% CI: 0.859 - 0.954; P <0.001) was independently related with amputation. Conclusion: Immune-nutritional status based on PNI was independently associated with limb amputation in patients with lower-extremity PAD.

Comparison of atrial fibrillation predictors in patients with acute coronary syndrome using ticagrelor or clopidogrel

Background/aim: Ticagrelor is a drug widely used in patients with acute coronary syndromes (ACS) that specifically increases the plasma level of adenosine, which is likely to cause atrial fibrillation (AF). Therefore, in this study we aimed to investigate the electrocardiographic and echocardiographic predictors of AF development after P2Y12 receptor antagonists in ACS patients. Materials and methods: This cross-sectional study included 831 patients with ACS (486 [58.5%] with ST elevated myocardial infarction [STEMI] and 345 [41.5%] with non-ST elevated myocardial infarction [NSTEMI]). Patients were divided into ticagrelor (n = 410) and clopidogrel (n = 421) groups. P wave properties including P wave dispersion and atrial electromechanical conduction properties were measured as AF predictors with surface ECG and tissue Doppler imaging. Results: Baseline characteristics such as age, sex, heart rate, blood pressure, and laboratory parameters were almost the same in the ticagrelor and clopidogrel groups. The statistical analysis showed no significant difference in P wave dispersion (PWD) between ticagrelor and clopidogrel groups (40.98 ± 12 ms versus 40.06 ± 12 ms, P = 0.304). Subgroups analysis according to ACS types also showed no significant difference in PWD (NSTEMI: 41.16 ± 13.8 ms versus 40.76 ± 13.55 ms, P = 0.799; STEMI: 40.9 ± 12.62 ms versus 39.19 ± 11.18 ms, P = 0.132). In addition, we did not find significant difference in atrial electromechanical delay (EMD) with tissue Doppler imaging (interatrial EMD 24.11 ± 3.06 ms versus 24.46 ± 3.23 ms, P = 0.279). Conclusion: In conclusion, we did not find any difference in detailed electrocardiographic and echocardiographic parameters as AF predictors between ticagrelor and clopidogrel groups in patients with ACS