Search

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., (© 2023. The Author(s).)

Objectives: The endocannabinoid system (ECS) is a critical important neuromodulatory system that interacts with many neurohormonal and neurotransmitter systems in the brain. It plays a pivotal role in emotional responses and mood regulation. The ECS is related with psychotic disorders, depression, anxiety and autism. In this study, we aimed to investigate whether there is any relationship between endocannabinoid and N-acylethanolamine levels with bipolar disorder., Methods: Seventy-nine patients with bipolar disorder diagnosis, who are in the euthymic period, were included in the study. Clinical characteristics, symptoms and serum endocannabinoid and N-acylethanolamine levels were compared. Endocannabinoid and N-acylethanolamine levels were evaluated using liquid chromatography-tandem mass spectrometry., Results: In total of 79 patients, 44 (55.69%) were females and 35 (44.30%) were males. The mean age of the patients was 42.40 ± 1.10 years. Palmitoylethanolamide (PEA) levels were higher and oleoylethanolamide and 2-arachidonyl glycerol levels were lower in patients who had at least one depressive episode during their life-time illness than in patients who had no depressive episode while arachidonyl ethanolamide levels were unchanged., Conclusions: PEA levels were correlated with the history and frequency of depressive episodes and the history of depressive symptoms in patients with bipolar disorder.

Background: There are conflicting data on the effects of masks on vital signs and end-tidal CO 2 (EtCO 2 ) values in the literature., Aims: This study aims to evaluate the changes in the vital parameters and EtCO 2 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 EtCO 2 values of the subjects administered O 2 were noted at the time of arrival and at the 30th and 120th minutes of treatment. Changes in vital signs and EtCO 2 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 EtCO 2 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 EtCO 2 values during 120 min in subjects with acute complaints., (© 2022. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

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., Competing Interests: Conflict of interest The authors have no conflict of interest to declare. Conflict of interest statement The authors declare that they have no conflicts of interests., (Copyright © 2022 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.)

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., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Goren et al.)

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., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Kemanci et al.)

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., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflicts of interests., (Copyright © 2022 Elsevier Inc. All rights reserved.)