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Hasdemir C.,Ege University | Ulucan C.,Ege University | Yavuzgil O.,Ege University | Yuksel A.,Kent Hospital | And 8 more authors.
Journal of Cardiovascular Electrophysiology | Year: 2011

Idiopathic Ventricular Arrhythmias and Cardiomyopathy. Introduction: Idiopathic ventricular arrhythmias in the form of monomorphic premature ventricular contractions (PVC) and/or ventricular tachycardia (VT) can cause tachycardia-induced cardiomyopathy (TICMP). The aim of this study was to determine the incidence, clinical and electrophysiologic characteristics, and the predictors of TICMP in patients with idiopathic ventricular arrhythmias. Methods: Study population consisted of 249 consecutive patients (148 F/101 M, 45 ± 20 y/o) with frequent PVCs and/or VT. All patients underwent transthoracic echocardiography and 24-hour Holter monitoring. TICMP was defined as left ventricular ejection fraction (LVEF) of ≤50% in the absence of any detectable underlying heart disease and improvement of LVEF a ̂ 15% following effective treatment of index ventricular arrhythmia. Results: Seventeen (6.8%) patients had TICMP. Patients with TICMP compared to patients with preserved LVEF were more likely to be male (65% vs 39%, P = 0.043) and asymptomatic (29% vs 9%, P = 0.018), and were more likely to have higher PVC burden (29.4 ± 9.2 vs 8.1 ± 7.4, P < 0.001), persistence of PVCs throughout the day (65% vs 22%, P = 0.001), and repetitive monomorphic VT (24% vs 0.9%, P < 0.001). PVC burden of 16% by ROC curve analysis best separated the patients with TICMP compared to patients with preserved LVEF (sensitivity 100%, specificity 87%, area under curve 0.96). Conclusions: TICMP was relatively common (∼1 in every 15 patients) in our study population. The predictors of TICMP were male gender, absence of symptoms, PVC burden of ≥16%, persistence of PVCs throughout the day, and the presence of repetitive monomorphic VT. (J Cardiovasc Electrophysiol, Vol. 22, pp. 663-668, June 2011) © 2011 Wiley Periodicals, Inc. Source

Pawasauskas J.,University of Rhode Island | Stevens B.,Liberty Drug and Surgical | Youssef R.,University of Rhode Island | Kelley M.,Kent Hospital
American Journal of Health-System Pharmacy | Year: 2014

Purpose. Results of a study to determine the established risk factors most closely associated with the use of naloxone to reverse adverse effects of opioid analgesia in a hospital population are presented. Methods. In a retrospective case - control study at a community hospital, pharmacy dispensing records were used to identify 65 cases over a one-year period that involved the use of naloxone for the treatment of oversedation or respiratory depression and met the other inclusion criteria; another 65 patients who received opioid analgesia during the same period but did not require naloxone were identified as controls. The influence of demographics and clinical variables on the likelihood of naloxone use was analyzed by linear regression and chisquare testing. Results. Patients in the naloxone group had an average of 5 risk factors for opioid-induced oversedation or respiratory depression, compared with an average of 3.3 risk factors in the control group (p < 0.001). Five factors were significantly associated with naloxone use: comorbid renal disease (odds ratio [OR], 6.034; 95% confidence interval [CI], 2.565-14.195), cardiac disease (OR, 5.829; 95% CI, 2.687-12.642), respiratory disease (OR, 3.600; 95% CI, 1.742-7.441), concurrent use of central nervous system-sedating medication (OR, 4.750; 95% CI, 1.949-11.578), and positive smoking status (OR, 4.7421; 95% CI, 2.114-9.256). Conclusion. Hospitalized patients on general medical units who required naloxone to reverse opioid-induced oversedation or respiratory depression had significantly more risk factors than matched patients who did not require naloxone. Copyright © 2014 American Society of Health-System Pharmacists Inc. All rights reserved. Source

Hasdemir C.,Ege University | Vuran O.,Ege University | Yuksel A.,Kent Hospital | Yavuzgil O.,Ege University
PACE - Pacing and Clinical Electrophysiology | Year: 2013

We present a case of 38-year-old woman with stress cardiomyopathy presenting to the emergency department with a 1-week history of recurrent syncope due to sustained polymorphic ventricular tachycardia. ©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc. Source

Donofrio J.C.,Kent Hospital | Weiner S.G.,Tufts University
Journal of Emergency Medicine | Year: 2013

Background Urinary tract infection (UTI) is a common emergency department (ED) complaint and self-diagnosis may be possible. Objective The objective was to compare female patient self-diagnosis compared with emergency physician (EP) diagnosis of UTI. Methods This was a prospective cohort study in a single urban ED. Women aged 18-64 years with a chief complaint of UTI, urinary frequency, or dysuria who presented to an urban academic ED were enrolled in a convenience sample fashion. Patients completed a written four-question survey by an ED greeter before triage. Charts of respondents were reviewed for demographic, laboratory, and EP diagnosis. Results Fifty women were enrolled; 100% of patients who were approached participated in the study. Mean age was 33.7 years (standard deviation 13.8). Forty-three patients (86%) had a history of UTI. Forty-one patients (82%) thought they had a UTI on the index visit. Thirty patients (60%) preferred to buy over-the-counter antibiotics for their symptoms instead of seeing a doctor. Fifteen patients (30%) identified a specific antibiotic they would take. Of the 41 patients who thought they had a UTI, 25 (61%) were given that diagnosis. Of the 30 patients who would have preferred over-the-counter antibiotics, 20 (67%) were actually prescribed them. Agreement between EP and women's final impressions was low (κ = 0.11). Conclusions There was poor agreement between EP diagnosis and self-diagnosis of UTI. In our ED population, women should be encouraged to seek medical attention to confirm the diagnosis. Copyright © 2013 Elsevier Inc. Printed in the USA. All rights reserved. Source

Kurt S.,Tepecik Training and Research Hospital | Toz E.,Tepecik Training and Research Hospital | Canda M.T.,Kent Hospital | Sahin C.,Tepecik Training and Research Hospital | Tasyurt A.,Tepecik Training and Research Hospital
European Journal of Obstetrics Gynecology and Reproductive Biology | Year: 2015

Objective: To investigate the relationship between two connective tissue pathologies: striae and pelvic organ prolapse (POP). Study design: Four hundred and eighty-eight women who had undergone gynaecological surgery were divided into two groups. The study group (n = 244) consisted of symptomatic patients with POP, and the control group (n = 244) consisted of cases who underwent surgery for benign gynaecological conditions without evidence of POP. The groups were compared in terms of the presence, intensity and severity of striae, as well as their general characteristics. Results: The presence of striae (p = 0.001), number of striae (p = 0.001) and Davey score (p = 0.00001) were significantly higher in the study group, and the absence of striae was more common in the control group (p = 0.00001). According to multivariate analysis, the presence of striae, an increased number of striae (>15) and a Davey score >2 increased the risk of POP 1.29 fold (p = 0.03, 95% confidence interval [CI] 1.14-1.35), 1.19 fold (p = 0.04, 95% CI 1.14-1.25) and 2.51 fold (p = 0.01, 95% CI 1.66-3.78), respectively. Conclusion: Striae may serve as a promising marker for POP. In particular, women who develop striae should be cautious about their risk for developing POP in the future, and should be informed about preventive methods for POP. © 2014 Elsevier Ireland Ltd. All rights reserved. Source

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