Kronik Koroner Sendromlar

ÖZETKronik koroner sendrom (KKS) genellikle egzersiz, duygusal veya başka tip streslerle tetiklenen, tekrarlayabilen, ancak kendiliğinden de gelişebilen,iskemiveya hipoksi ileilişkili, geridönüşümlü mi- yokardihtiyaç/sunum dengesizliğiataklarışeklinde tanımlanır. KKS tanısınıdesteklemekiçin birçok non-invaziv kardiyakincelemeden yararlanılır. Buincelemeler KKS’danşüphelenilen hastalardaiskemitanısınıdoğrulamak, tetikleyicifaktörleribelirlemek veya dışlamak, hastalıklailişkiliriskiölçmek, te- davinin etkinliğinideğerlendirmek veyaileritedavikararlarıverebilmek amacıyla kullanılabilir. KKS’danşüphelenilen hastalarda temel tetkikler; standart biyokimyasal laboratuvar testleri,istirahat elektrokardiyogramı(EKG),istirahat ekokardiyografisive seçilmişhastalarda ambulatuar EKGizlemi ile göğüs röntgendir. Ayrıca stres testlerive koroner görüntüleme gibiözgül kardiyakincelemeleri içe- ren kapsamlıtetkiklerden yararlanılır. Bu tetkiklerin uygun kullanımıve seçimi, yakınmalarınşiddetine, hastanın olumsuz kardiyak olaylar açısından riskine, hastanın tercihlerine ve eşlik eden hastalıkları ile yaşam kalitesine göre yapılır. Ayrıca test seçerken maliyet-etkinlik oranıgözönüne alınmalı, tanıve te- davinin yönlendirilmesine katkıda bulunmayacakincelemelerden kaçınılmalıdır.Anahtar Kelimeler:Kronik koroner sendrom;iskemi; noninvaziv; stres; görüntülem

Halk Sağlığı ve COVID-19

ÖZETKardiyovasküler hastalıklar, yeni koronavirüs hastalığı (COVID-19) için hem risk faktörü olarak hem de hastalığın bir sonucu olarak karşımıza çıkabilmektedir. Bu nedenle kardiyak görüntüleme hastalığın ayırıcı tanısında, kardiyak komplikasyonların saptanmasında ve tedavisinin yönlendirilmesinde önemlidir. Ekokardiyografi, kolay ulaşılabilmesi ve yatak başında hızlı bir şekilde uygulanabilmesi nedeniyle COVID-19 hastalarında önemli ve tercih edilen bir kardiyak görüntüleme yöntemidir. Ancak ekokardiyografik görüntüleme COVID-19 hastalarında, hastayla yakın temas gerektirmesi nedeniyle hem sağlık çalışanları için önemli risk oluşturmakta, hem de direkt ve indirekt yollarla hastalığın yayılımına yol açabilmektedir. Bu nedenle COVID-19 pandemisi döneminde hastadan hekime ve hekimden hastaya kontaminasyon riskini en aza indirmek için görüntüleme işleminin gerekliliği dikkatlice değerlendirilmeli ve gereksiz işlemlerden sakınılmalıdır. Sağlık çalışanları hastalığın yayılmasını önlemek için gerekli tedbirlere en üst düzeyde uymalı ve uygun kişisel koruyucu ekipman kullanmalıdır. Bu yazıda ekokardiyografinin hasta yönetimine nasıl kılavuzluk edebileceği ve kimlere nasıl uygulanması gerektiği konusu gözden geçirilmektedir.Anahtar Kelimeler: COVID-19; ekokardiyografi; transözofageal ekokardiyograf

The evaluation of ecology-based tourism potential in coastal villages in accordance with landscape values and user demands: the Bursa-Mudanya-Kumyaka case

Ecology-based tourism, which is integrated with nature, developed in environmentally conscious areas and enriched by different cultures, has become more important in the direction of extending tourism throughout the year. While the landscape values of the area are important functions for tourism activities to be carried out in natural characteristics, the preferences of the users are also important. Ecology-based tourism, which develops in connection with the concepts of intacteness, the protection-use balance and sustainability, and the demands and expectations of tourists, constitute the basis of our study. For this purpose, the study was carried out in Kumyaka, a small coastal neighborhood (village) of the county of Mudanya in the province Bursa, Turkey with important natural, historical and cultural assets. Fieldwork, field analysis, literature search, interviews with tourists coming to the field, interviews with the day trippers and survey work were conducted in the study. While evaluating the ecology-based tourism potential of the area, the demands and expectations of tourists have been taken into account together with the available area data. According to the results of the survey, tourists are mostly interested in having the most scenic value and quietness when choosing the area. The types of tourism that tourists most wanted to experience in the field were 42.38% culture tourism and 32.32% nature tourism. As a result of tourists' demands and expectations, the tourism activities to be carried out in accordance with the possibilities of the area were examined and ecology based planning proposals and holistic planning approaches were developed

Association between Multiplate-measured aspirin resistance and vitamin D deficiency in stable coronary artery disease.

INTRODUCTION: Insufficient inhibition of platelets in patients with atherosclerosis despite antiplatelet therapy leads to important clinical consequences. The present study evaluated the role of vitamin D (VD) deficiency in aspirin resistance (AR) in patients with stable coronary artery disease (CAD) treated with aspirin. MATERIAL AND METHODS: This study included 70 patients with stable CAD who had been using 100 mg aspirin for at least seven days. Serum 25-hydroxyvitamin D [25-(OH)D] concentration was measured and patients with 25-(OH)D level 30 U. RESULTS: AUC was > 30 U in 15 (21%) patients and these patients were considered AR. The mean 25-(OH)D level was 18.7 ±12.2 ng/ml in all patients. Forty-five (64%) patients were VD deficient. The rate of AR was higher in the VD deficient group than the sufficient group (29% vs. 8%, p = 0.041). The mean AUC was higher in the VD deficient group than the sufficient group (30.2 ±29.1 vs. 15.3 ±13.1 U; p = 0.018). In ROC analysis 25-(OH)D level < 19.25 ng/dl predicted AR with 86.7% sensitivity, 61.8% specificity (AUC = 0.696, 95% CI: 0.551–0.840, p = 0.021). CONCLUSIONS: In the current study, an association was found between VD deficiency and AR in patients with stable CAD. VD supplementation may reduce platelet aggregation and overcome AR

High- Risk Factors Associated with Inferior Alveolar Nerve Injury Following Removal of the Third Molars: A Preliminary Study

PURPOSE: This study aims to determine the incidence of inferior alveolar nerve (IAN) injury following the extraction of the lower third molars (LTMs) and to identify the demographic, radiographic, and intra-operative risk factors associated with this complication. MATERIALS amp; METHODS: Fifty LTMs from 47 patients were included in this prospective clinical study. Demographic data and intra-operative parameters including operation time, bone removal and duration, excessive bleeding and IAN exposure were recorded. Bone retention, anatomical position of LTMs (Pell amp;Gregory and Winter classification) and 5 radiographic criteria proposed by Rood and Shehab were evaluated on panoramic images, whereas the distance between roots and the inferior alveolar canal (IAC), the cortication status of IAC, and the buccolingual position of IAC were examined on CBCT images. Chi-square test was used to compare the presence of IAN injury with variables. A p-value lt; 0.05 was considered as statistically significant. RESULTS: The incidence of temporary IAN injury was 6% among study population. No permanent IAN injury was observed. Excessive bleeding (p=0.007), IAN exposure (p=0.007), the lingual position of IAC (p=0.035) and dumbbell-shaped IAC (p=0.002) were found to be associated with increased risk of temporary IAN injury. CONCLUSION: Identification of high-risk factors is essential for predicting the risk of IAN injury, and determining the most convenient treatment plan for each case. Further studies with larger study samples are needed both to confirm the risk factors that are proposed in the present study and to identify the other potential ones