Evaluation of acute electrocardiographic changes while the use of intravenous 5 HT3 receptor antagonist and the use of oral NK-1 receptor antagonist combined with intravenous 5 HT3 receptor antagonist

Onkolojik tanılı hastalarda uygulanan i.v. kemoterapi sırasında görülen yan etkilerin başında bulantı ve kusma gelmektedir. Sistemik kemoterapi alan hastaların yaklaşık %70-80'inde bulantı ve/veya kusma gelişebilir ve hastanın beslenme, performans ve yaşam kalitesini etkileyebilir. Bulantı ve kusmanın engellenmesi veya en aza indirgenmesi açısından kullanılan anti emetik tedavi seçeneklerinden en yaygın olanları 5-HT3 reseptör antagonistleri ve NK-1 reseptör antagonistidir. İlaçların kalp ileti sistemi üzerine olan yan etkileri değerlendirilmesi açısından pratik olması ve invazif olmaması açısından EKG değerli bir tanı yöntemdir. EKG sayesinde QT dalgasındaki uzama ve QTc aralığı ölçümü ayrıca da Pdis ve QTdis değeri hesaplanması; aritmojenik etkileri olan ilaçların kardiyak repolarizasyon üzerine olan etkilerini doğru gösteren belirteçler saptanabilmektedir. Bu çalışmamızda kısa ve uzun etkili 5- HT3 reseptör antagonistlerinin akut dönemdeki elektrokardiyografik değişikliklerinin değerlendirilmesi ve bu ajanlarla beraber oral NK-1 reseptör antagonisti kullanımında oluşabilecek akut elektrokardiyografik değişikliklerin saptanması amaçlanmaktadır. Çalışmamızda granisetron alan hasta grubunda kalp hızında istatiksel olarak anlamlı bir düşüş izlendi. (p = 0.002) NK- 1 reseptör antagonistiyle beraber granisetron alan hastalarda kalp hızında, SBP ve DSP değerlerinde istatiksel anlamlı olarak bir düşüş izlendi (kalp hızı ve SBP için p < 0.001 ve DSP için p = 0.001). Ayrıca bu hastalarda QTcmax değerlerinde istatiksel anlamlı bir artış gözlemledi (p < 0.001). Palonosetron alan hastalarda kalp hızında istatiksel anlamlı bir düşüş izlendi (p < 0.001). Aprepitant ile beraber palonosetron alan hasta grubunda ise kalp hızında, SBP ve DSP değerlerinde istatiksel olarak anlamlı bir düşüş izlendi (Kalp hızı ve SBP için p < 0.001 ve DSP için p = 0.002). Gruplar kendi aralarında karşılaştırıldığında sadece granisetron alan hastalarda sadece palonosetron alan hastalara göre istatiksel anlamlı olarak SBP'de daha fazla düşüş olduğu görüldü (p=0.03); ayrıca da NK-1 reseptör antagonisti ile beraber palonosetron alan hastalarda SBP'de ve DSP'de sadece palonosetron alan hastalara göre istatiksel olarak anlamlı bir düşüş saptandı (p=0.001). Sonuç olarak; granisetron, aprepitant ile beraber granisetron, palonosetron ve aprepitant ile beraber palonosetron tedavilerinin aritmojenik bir etkileri gösterilememiştir.Nausea and vomiting are considered to be most unpleasant and distressing aspects of chemotherapy and radiotherapy for cancer patients. selective 5- HT3 receptor antagonists and NK-1 receptor antagonist for the prophylaxis and/or treatment of chemotherapy and radiotherapy-induced emesis have been an important advance in oncology. The 12-lead ECG is one of the noninvasive and practical safety measurements used in clinical trials to identify most of the drug-induced cardiac adverse effects [19]. In general,Pdis, QT interval prolongation, and QTdis, which are accurate predictors of effect of drug on cardiac repolarization, are used for measuring the arrhythmogenic potential of a drug. In this study, we aimed to determine the acute effects of granisetron, palonosetron and aprepitant on ECG parameters related to repolarization,heart rate, and systemic blood pressure. In our study group of patients receiving granisetron, a statistically significant decrease in heart rate was observed. (p = 0.002) NK-1 receptor antagonists together with granisetron in patients receiving heart rate, SBP and DSP values statistically significant decrease was observed (heart rate and SBP p < 0.001 and DSP p = 0.001). In addition, a statistically significant increase in the values observed in patients QTcmax (p < 0.001). Palonosetron is a statistically significant decrease in heart rate in patients receiving was observed (p < 0.001). In the group of patients receiving aprepitant with palonosetron in heart rate, a statistically significant decrease in SBP and DSP value was observed (heart rate and SBP p < 0.001 and p = 0.002 for DSP). The groups compared only granisetron in patients receiving palonosetron compared with those receiving only statistically significantly greater decrease in SBP was observed (p = 0.03); also with NK-1 receptor antagonist in patients with palonosetron palonosetron than patients receiving only statistically significant decrease in SBP and DSP was detected (p = 0.001). As a result; granisetron, aprepitant with granisetron, palonosetron, aprepitant and palonosetron arrhythmogenic effect of treatment could not be shown

The Association Between Neutrophil/Lymphocyte Ratio and Disease Activity in Rheumatoid Arthritis and Ankylosing Spondylitis.

Elevated neutrophil count is associated with poor prognosis and increased mortality in many conditions. Neutrophil to lymphocyte ratio (NLR) has emerged as a marker of inflammation in neoplastic and cardiovascular disorders. Herein, we investigated utility of this simple tool in rheumatoid arthritis (RA) and ankylosing spondylitis (AS)

The Association Between Neutrophil/Lymphocyte Ratio and Disease Activity in Rheumatoid Arthritis and Ankylosing Spondylitis

Background: Elevated neutrophil count is associated with poor prognosis and increased mortality in many conditions. Neutrophil to lymphocyte ratio (NLR) has emerged as a marker of inflammation in neoplastic and cardiovascular disorders. Herein, we investigated utility of this simple tool in rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Methods: The study consisted of 136 RA and 140 AS patients, along with 117 healthy control subjects. RA and AS activities were determined with Disease Activity Score (DAS) and Bath Ankylosing Spondylitis Disease Activity indices (BASDAI), respectively. The association between NLR and disease activity was analyzed. Results: Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and neutrophil counts were significantly higher in RA and AS patients compared to healthy controls. Similarly, NLR was higher compared to control subjects, both in RA (2.53 +/- 1.4 vs. 2.16 +/- 1.0, P = 0.019) and AS (2.43 +/- 1.4 vs. 2.16 +/- 1.0, P = 0.077). NLR correlated well with ESR and CRP, both in RA and AS. Moreover, NLR increased across worsening DAS28 activity groups (2.1 +/- 1.0 in patients with remission, 2.5 +/- 1.0 in low-moderate, 3.8 +/- 2.5 in high disease activity). However, no association was found between NLR and BASDAI. Conclusion: NLR is a cheap and readily available marker for the assessment of disease activity in RA. (C) 2015 Wiley Periodicals, Inc

Geriatrics education is associated with positive attitudes toward older people in internal medicine residents: A multicenter study

WOS: 000349695000012PubMed ID: 25532778Objective: The number of older people is growing fast in Turkey. In this context, internal medicine residents and specialists contact older people more frequently. Thus, healthcare providers' knowledge and attitudes toward older people is becoming more important. Studies that specifically investigate internal medicine residents' attitudes toward the elderly are scarce. We aimed to investigate the attitudes of internal medicine residents toward older people. Methods: This cross-sectional multicenter study was undertaken in the internal medicine clinics of six university state hospitals that provide education in geriatric care. All internal medicine residents working in these hospitals were invited to participate in this questionnaire study between March 2013 and December 2013. We recorded the participants' age, sex, duration of internal medicine residency, existence of relatives older than 65 years, history of geriatrics course in medical school, geriatrics rotation in internal medicine residency, and nursing home visits. Results: A total of 274 (82.3%) of the residents participated in this study, and 83.6% of them had positive attitudes toward older people. A geriatrics rotation during internal medicine residency was the only independent factor associated with positive attitudes toward the elderly in this multivariate analysis. A geriatrics course during medical school was associated with positive attitudes in the univariate analysis, but only tended to be so in the multivariate analysis. Conclusion: Geriatrics rotation during internal medicine residency was independently associated with positive attitudes toward older people. Generalization of geriatrics education in developing countries may translate into a better understanding and improved care for older patients. (C) 2015 Elsevier Ireland Ltd. All rights reserved

Geriatrics education is associated with positive attitudes toward older people in internal medicine residents: A multicenter study

Objective: The number of older people is growing fast in Turkey. In this context, internal medicine residents and specialists contact older people more frequently. Thus, healthcare providers' knowledge and attitudes toward older people is becoming more important. Studies that specifically investigate internal medicine residents' attitudes toward the elderly are scarce. We aimed to investigate the attitudes of internal medicine residents toward older people