Browsing by Author "Özdemir, IH"

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    Reply to Letter to the Editor: How Does SARS-CoV-2 Fragment the QRS?
    Özdemir, IH; Özlek, B; Özlek, E; Özen, MB; Gündüz, R; Çetin, N
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    Comparison of anti-factorXa assay and rotational thromboelastogram in evaluating the efficacy of enoxaparine treatment in patients with acute coronary syndrome without ST-segment elevation
    Gündüz, R; Yildiz, BS; Özdemir, IH; Özen, MB; Çetin, N; Yavuzgil, O
    Purpose: The aim of this study was to compare anti-factor Xa assay and tromboelastogram in evaluation of efficacy of enoxaparin in patients with acute coronary syndrome without ST-segment elevation. Materials and Methods: Twenty-five patients with acute coronary syndrome were involved. Two blood samples were taken on admission and 4 hours after the subcutaneous injection of third dose of 1mg/kg enoxaparin to the patients. AntiFXa, tromboelastogram, activated coagulation time were calculated. Results: A non-significant increase in activated coagulation time was observed after the injection of enoxaparin. After injection enoxaparin thromboelastography parameters changed maximum amplitude(MA) increased (MA basal 65.4 +/- 11.9 after 63.4 +/- 7.8), R time increased (from 5 +/- 1.7 to 8.4 +/- 4.6,), K time increased (from 1.89 +/- 1.06 to 2.56 +/- 1.4), angle increased (from 66.34 +/- 5.6 to 57.9 +/- 11.4). AntiFXa increased. (from 0.122 +/- 0.06 to 0.501 +/- 0.359). Conclusion: Tromboelastography method can be used in assessment of efficacy of enoxaparin in patients with acute coronary syndrome without ST-Segment elevation.
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    Comparison of Access Site Complications After Early or Late Sheath Removal in Patients with PCI, Regardless of ACT Levels
    Özyurtlu, F; Özdemir, IH; Çetin, N; Yavuz, V
    Background: Despite the lack of supporting data, many clinics perform sheath removal 4-6 hours after femoral percutaneous coronary intervention to reduce the risk of possible access site complications. This study aims to examine the effects of sheath removal immediately after the procedure on access site complications and patient comfort. Methods: This prospective study included 349 patients who underwent percutaneous coronary intervention via the femoral site and 6 French guiding catheters. The sheath in the early group was removed immediately after the procedure without checking the activated clotting time levels but after 4 hours in the late group. Access site complications were recorded and patient comfort was evaluated using the Visual Analog Scale. Results: Patients were divided into 2 groups: patients in the early removal group (n = 171) and in the late removal group (n = 178). There was no statistically significant difference between the 2 groups in terms of access site complications. Three patients in the early removal group and 4 patients in the late removal group developed a hematoma. Six patients in the early removal group and 10 patients in the late removal group showed ecchymosis. The Visual Analog Scale score was statistically significantly lower in the early removal group compared with that in the late removal group [2 (1-3) vs. 3 (2-4), P < .001]. Conclusion: This study shows that immediate sheath removal is safe and more comfortable for patients with percutaneous coronary intervention who received weight-adjusted dose of heparin, regardless of the percutaneous coronary intervention levels after the procedure.
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    Peripheral polyneuropathy in patients receiving long-term statin therapy
    Özdemir, IH; Copkiran, Ö; Tikiz, H; Tikiz, C
    Objective: Peripheral neuropathy is an important potential side effect of statin use. This study was an investigation of the incidence of peripheral neuropathy in patients taking atorvastatin or rosuvastatin for hypercholesterolemia and the relationship to the dose and duration of the treatment. Methods: In all, 50 patients using a statin treatment and 50 healthy controls matched for age and gender who had never taken a statin were included in the study. Polyneuropathy was assessed with a neurological examination and electroneuromyography (ENMG). Results: While no polyneuropathy was detected in the control group, polyneuropathy was seen in 33 (66%) of the patients in the statin group (p<0.01). There was no significant difference between the 2 statin groups in the results of the neurological examination or the ENMG findings regarding the incidence of polyneuropathy (p=0.288 and p=0.720, respectively). Neuropathy was observed in a neurological examination performed within the first year in 50% of the rosuvastatin users and 18% of those taking atorvastatin. The severity of the polyneuropathy increased with the duration of the treatment in the atorvastatin group (p=0.030). Conclusion: This study revealed an increased risk of peripheral neuropathy with long-term statin use (>1 year). Electrodiagnostic changes have been detected in motor and sensory nerves in nerve conduction studies of patients on long-term statin treatment. The assessment of neurological symptoms, like tingling, numbness, pain and tremor in the hands and feet, and unsteadiness during walking associated with peripheral neuropathy may be useful in the follow-up of the patients on long-term statin treatment. Early detection of peripheral neuropathy and changing hypercholesterolemia treatment may prevent permanent nerve damage.
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    Prognostic implication of uncontrolled hypertension in hospitalized patients with COVID-19
    Özdemir, IH; Özlek, B; Özen, MB; Gündüz, R; Çetin, N
    Objective: In this study, we aimed to investigate the effect of hypertension (HT) and antihypertensive treatment on prognosis, which is one of the cardiovascular risk factors affecting the prognosis of COVID-19. Methods: We included 117 patients diagnosed with COVID-19 by nasopharyngeal polymerase chain reaction (PCR). The patients were divided into a hypertensive group and a control group. Biochemical, complete blood count and imaging data of the patients were recorded. Mortality of patients with and without HT was evaluated. The effect of antihypertensive therapy on mortality was evaluated. Results: In thorax CT, ground glass opacity and pneumonic consolidation were found statistically significantly higher in the hypertensive group (p <0,001). Hospital stay duration (days) of the patients were significantly longer in the hypertensive group and need for intensive care unit was statistically higher in the hypertensive group (p <0,001). Mortality of hypertensive patients was higher than of those without hypertension (p <0,001). There was no statistically significant difference in mortality in antihypertensive treatment groups (p = 0,801). Conclusion: Hypertension is an important risk factor that increases mortality in COVID-19 patients. Uncontrolled hypertension was common in most patients. Inflammatory parameters are higher especially in patients with uncontrolled hypertension. Patients with uncontrolled hypertension have a higher risk of mortality. There is no data to suggesting that the use of ACEI/ARB worsens prognosis. High blood pressure on admission to the hospital is important and the patient's current antihypertensive therapy should not be discontinued.
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    Comparison of Framingham risk score and atherogenic indices as a predictor of atherosclerosis in patients with myocardial bridge in left anterior descending artery
    Çetin, N; Özlek, B; Özdemir, IH; Yildiz, BS; Yavuz, V; Tikiz, H
    Background Myocardial bridge (MB) is generally considered as a benign condition, but it may trigger atherosclerosis, especially in the adjacent proximal coronary artery segment. In this study, we aimed to investigate whether the Framingham risk score (FRS) or atherogenic indices are risk factors for coronary atherosclerosis in patients with MB in the left anterior descending coronary artery (LAD). Methods We performed a retrospective study evaluating 155 patients who have MB in LAD. The patients were evaluated in two groups according to the presence of atherosclerosis (74 patients in atherosclerotic group vs. 81 patients in non-atherosclerotic group). Baseline characteristics, FRS and atherogenic indices were reviewed between groups. Significant independent risk factors for coronary atherosclerosis were investigated by logistic regression analysis. Results Patients in atherosclerotic group were significantly older (58.15 +/- 10.04 vs. 50.22 +/- 9.27 years, p < .001) and 74.3% of the patients were male. While the mean FRS in the atherosclerotic group was 21.20 +/- 8.81, it was 12.79 +/- 8.61 in the non-atherosclerotic group (p < .001). Among the atherogenic indices, only LDL-c/HDL-c ratio was significantly higher in the atherosclerotic group (3.49 +/- 1.2 vs. 3.11 +/- 0.98, p:.033). Multivariable analysis showed that age (OR: 1.08, 95% CI 1.03-1.13, p < .001) and FRS (OR: 1.06, 95% CI 1.01-1.11, p:.012) were independently associated with the presence of atherosclerotic lesion. Conclusions FRS is an easily applicable predictor in clinical practice that indicates the presence of coronary atherosclerosis in patients with MB in LAD.
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    Prognostic value of C-reactive protein/albumin ratio in hypertensive COVID-19 patients
    Özdemir, IH; Özlek, B; Özen, MB; Gündüz, R; Çetin, N; Özlek, E; Yildiz, BS; Bilge, AR
    Objectives The aim of this study was to investigate the relationship between the C-reactive protein/albumin ratio and the prognosis of hypertensive COVID-19 patients. Methods It was designed as a single center retrospective study. PCR positive COVID-19 patients who were followed up in the intensive care unit (ICU) and received antihypertensive treatment were included in the study. The patients were divided into two groups as survivor and non-survivor. C-reactive protein/albumin (CAR) ratios of the patients were compared. The cut-off value was determined as a mortality predictor. The effect of CAR on mortality was evaluated using Logistic Regression analysis. Results 281 patients were included in the study. Groups consisted of 135 (non-survivor) and 146 (survivor) patients. CAR was significantly higher in the non-survivor group (p<0.001). The area under the ROC curve for CAR for mortality was 0.807, with sensitivity of 0.71 and specificity of 0.71. The cut-off value for CAR was calculated as 56.62. In logistic regression analysis, CAR increases mortality 4.9 times compared to the cut-off value. Conclusion CAR is a powerful and independent prognostic marker for predicting mortality and disease progression in hypertensive COVID-19 patients.
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    Hydroxychloroquine/azithromycin treatment, QT interval and ventricular arrhythmias in hospitalised patients with COVID-19
    Özdemir, IH; Özlek, B; Özen, MB; Gündüz, R; Çetin, N; Bilge, AR
    Background Hydroxychloroquine (HCQ) and azithromycin (AZM) are widely used in off-label treatment of novel coronavirus disease (COVID-19). However, cardiac safety of these drugs is still controversial in COVID-19. Therefore, we aimed to evaluate association of HCQ or HCQ + AZM treatment regimens, corrected QT (QTc) interval and malignant ventricular arrhythmias in hospitalized patients. Methods This is a single-center, retrospective and observational study. All data were extracted from the electronic medical records. The initial and post-treatment mean QTc intervals were calculated and compared in patients with HCQ alone or HCQ + AZM therapy. Associated factors with QTc prolongation, the incidence of ventricular arrhythmia during treatment and in-hospital mortality because of ventricular arrhythmias were evaluated. Results Our cohort comprised 101 hospitalized COVID-19 patients (mean age of 49.60 +/- 18 years, 54.4% men). HCQ + AZM combination therapy group (n = 56) was more likely to have comorbidities. After 5-days treatment, 19 (18.8%) patients had QTc prolongation, and significant increase in the QTc interval was observed in both two groups (P < .001). However, HCQ + AZM combination group had significantly higher Delta QTc compared to HCQ group (22.5 +/- 18.4 vs 7.5 +/- 15.3 ms, P < .001). All of 101 patients completed the 5-days treatment without interruption. Also, no malignant ventricular arrhythmia or death secondary to ventricular arrhythmia occurred during the treatment in both groups. Conclusions The present study revealed that although HCQ + AZM treatment was independently associated with QTc prolongation, none of patients experienced malignant ventricular arrhythmia or death during treatment. Further prospective studies are needed to determine the exact implications of these drugs on arrhythmias in patients with COVID-19.
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    Type 1 Kounis Syndrome Induced by Inactivated SARS-COV-2 Vaccine
    Özdemir, IH; Özlek, B; Özen, MB; Gündüz, R; Bayturan, Ö
    Background Vaccination is the most important way out of the novel coronavirus disease 2019 (COVID-19) pandemic. Vaccination practices have started in different countries for community immunity. In this process, health authorities in different countries have preferred different type of COVID-19 vaccines. Inactivated COVID-19 vaccine is one of these options and has been administered to more than 7 million people in Turkey. Inactivated vaccines are generally considered safe. Kounis syndrome (KS) is a rare clinical condition defined as the co-existence of acute coronary syndromes and allergic reactions. Case Report We present the case of a 41-year-old woman with no cardiovascular risk factors who was admitted at our emergency department with flushing, palpitation, dyspnea, and chest pain 15 min after the first dose of inactivated CoronaVac (Sinovac Life Sciences, Beijing, China). Electrocardiogram (ECG) showed V4-6 T wave inversion, and echocardiography revealed left ventricular wall motion abnormalities. Troponin-I level on arrival was elevated. Coronary angiography showed no sign of coronary atherosclerosis. She was diagnosed with type 1 KS. The patient's symptoms resolved and she was discharged from hospital in a good condition. Why Should an Emergency Physician Be Aware of This? To the best of our knowledge, this is the first case of allergic myocardial infarction secondary to inactivated coronavirus vaccine. This case demonstrates that KS can occur after inactivated virus vaccine against COVID-19. Although the risk of severe allergic reaction after administration of CoronaVac seems to be very low, people who developed chest pain after vaccine administration should be followed by ECG and troponin measurements. (C) 2021 Elsevier Inc. All rights reserved.
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    The effects of perioperative goal-directed therapy on acute kidney injury after cardiac surgery in the early period
    Özdemir, I; Ozturk, T; Amanvermez, D; Yildirim, F; Sengel, A; Özdemir, IH
    Background: This study aims to investigate the effects of goal directed fluid therapy on the development of acute kidney injury in the perioperative period in patients undergoing cardiopulmonary bypass.Methods: Between November 2019 and May 2021, a total of 60 patients (46 males, 14 females; mean age: 62.5 +/- 9.6 years; range, 44 to 76 years) who were scheduled for elective coronary artery bypass grafting or valve surgery under cardiopulmonary bypass were included in the study. The patients were divided into two groups as the study group (Group S, n=30) and control group (Group C, n=30). The patients in Group C were treated with standard therapy, while the patients in Group S were treated with goal-directed fluid therapy. The Kidney Disease: Improving Global Outcomes (KDIGO) classification and renal biomarkers were used for the evaluation of acute kidney injury.Results: Acute kidney injury rates were similar in both groups (30%). Postoperative fluid requirement, intra-, and postoperative erythrocyte suspension requirements were significantly lower in Group S than Group C (p=0.002, p=0.02, and p=0.002, respectively). Cystatin-C was lower in Group S (p<0.002). The kidney injury molecule-1, glomerular filtration rate, and creatinine levels were similar in both groups. The length of hospital stay was longer in Group C than Group S (p<0.001).Conclusion: Although goal-directed fluid therapy does not change the incidence of acute kidney injury in patients undergoing cardiac surgery, it can significantly decrease Cystatin-C levels. Goal-directed fluid therapy can also decrease fluid and erythrocyte requirements with shorter length of hospital stay.
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    THE PREDICTORS OF IN-HOSPITAL MORTALITY IN HYPERTENSIVE ELDERLY INTENSIVE CARE UNIT PATIENTS WITH CORONAVIRUS DISEASE 2019
    Çetin, N; Özdemir, IH
    Introduction: Advanced age is an important prognostic indicator for the mortality of coronavirus disease 2019, especially in patients over 65. Patients with chronic underlying conditions such as hypertension showed the worst outcomes. This study aimed to identify predictors of mortality in elderly hypertensive patients hospitalized in intensive care units.Materials and Methods: Demographic, clinical, treatment, and laboratory data were extracted from electronic medical records and compared between survivors and non-survivors. Univariate and multivariate logistic regression methods were used to explore the indicators of in-hospital mortality.Results: One hundred and ninety-eight patients with a median age of 75 years (65-94 years) were included in this study, of whom 95 were discharged from the intensive care units, and 103 died. Shortness of breath [hazard ratio (HR): 1.65, 95% confidence interval (CI): 1.04-2.61, p: 0.034], C-reactive protein (CRP)/albumin ratio (>51.32) (HR: 1.83, 95% CI: 1.12-2.97, p: 0.015), serum creatinine (>1.62 mg/dl) (HR: 2.04, 95% CI: 1.13-3.33, p: 0.001), aspartate transaminase (>34 u/l) (HR: 1.99, 95% CI: 1.28-3.09, p: 0.002), D-dimer (>781 ng/ml) (HR: 1.59, 95% CI: 1.04-2.43, p: 0.031), leukocyte (>12,000 acute accent 103/mu l) (HR: 1.68, 95% CI: 1.09-2.59, p: 0.018) and lymphocyte count, (<= 660 acute accent 103/mu l) (HR: 1.76, 95% CI: 1.17-2.63, p: 0.006) were independent predictors for mortality in elderly hypertensive patients.Conclusion: Using these predictors with cut-off values can identify patients at risk of death and needing aggressive intervention earlier in the disease course.
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    Permanent atrial fibrillation portends poor outcomes in hospitalized patients with COVID-19: A retrospective observational study
    Özdemir, IH; Özlek, B; Çetin, N
    Background: Data specifically addressed to whether atrial fibrillation (AF) would contribute to increasing the risk for severe forms of novel coronavirus disease (COVID-19) or worse prognosis remain unclear. Hence, we sought to assess the association of permanent AF with in-hospital outcomes in patients with COVID-19. Methods: This was a single-centered, retrospective, observational study including consecutive hospitalized patients with COVID-19. The primary outcome for the study was defined as all cause in-hospital mortality. Clinical characteristics and outcomes of patients with AF were compared to patients without AF. Results: Three hundred and fifty hospitalized COVID-19 patients (median age of 55 years, 55.4% men) were enrolled. Of them 40 (11.4%) had AF. Patients with AF were older; were more likely to have co-morbidities, abnormal chest radiography findings and deteriorated laboratory parameters such as D-dimer, troponin, albumin, urea. In-hospital mortality was higher in patients with AF compared to patients without AF (32.5% vs. 13.5%, log-rank p = 0.002, RR 2.40). The number of patients who needed intensive care unit (55% vs. 31%, p = 0.002) and invasive mechanical ventilation (35% vs 15.2%, p = 0.002) were also higher in the AF group. In addition, length of in-hospital stay was longer in patients with AF (median 8 vs. 7 days, p = 0.008). After adjustment for age and co-morbidities, multivariable analyses revealed that AF (HR: 2.426, 95% CI: 1.089-5.405, p = 0.032) was independently associated with in-hospital death. Conclusions: AF was seen with together markers of severe COVID-19, and the presence of AF was an independent predictor of in-hospital mortality in patients with COVID-19. (c) 2021 Elsevier Inc. All rights reserved.
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    Safety of once-or twice-daily dosing of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with nonvalvular atrial fibrillation: A NOAC-TR study
    Emren, SV; Zoghi, M; Berilgen, R; Özdemir, IH; Çelik, O; Çetin, N; Enhos, A; Köseoglu, C; Akyüz, A; Dogan, V; Levent, F; Dereli, Y; Dogan, T; Basaran, Ö; Karaca, I; Karaca, Ö; Otlu, YÖ; Özmen, Ç; Cosar, S; Sümerkan, M; Gürsul, E; Inci, S; Onrat, E; Ergene, O
    Once-daily dosing of non-vitamin K antagonist oral anticoagulants (NOACs) may increase patient adherence to treatment but may also be associated with a higher risk of bleeding. In this study, we investigated the adherence to once-or twice-daily dosing of NOACs and the risk of bleeding in nonvalvular atrial fibrillation (NVAF) patients. This multicenter cross-sectional study, conducted between 1 September 2015 and 28 February 2016, included 2214 patients receiving NOACs for at least 3 months, due to NVAF. Patients receiving once-daily or twice-daily NOAC doses were 1: 1 propensity score matched for baseline demographic characteristics and the presence of other diseases. The medication adherence was assessed by the 8-item Morisky Medication Adherence Scale. Risk factors were investigated in relation to minor and major bleeding. The mean age of patients was 71 +/- 10 years, and 53% of the patients were women. The medication adherence was lower in patients receiving twice-daily NOAC doses compared to once-daily-dose group (47% versus 53%, p = 0.001), and there was no difference between the groups in terms of minor (15% versus 16%, p = 0.292) and major bleeding (3% versus 3%, p = 0.796). Independent risk factors for bleeding were non-adherence to medication (OR: 1.62, 95% CI: 1.23-2.14, p = 0.001), presence of 3 or more other diseases (OR: 10.3, 95% CI: 5.3-20.3, p < 0.001), and HAS-BLED (Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile INR, Elderly, Drugs or alcohol) score (OR: 4.84, 95% CI: 4.04-5.8, p < 0.001). In summary, the once-daily dose of NOACs was associated with increased patient adherence to medication, while it was not associated with bleeding complications.