This study aimed at the assessment of the clinical approach to atrial fibrillation (AF) in the older population and the consistency with the guidelines based on the records of the multicenter, prospective AFTER (Atrial Fibrillation in Turkey: Epidemiologic Registry) study.2242 consecutive patients admitted to the Cardiology Outpatient Clinics of 17 different tertiary Health Care Centers with at least one AF attack determined on electrocardiographic examination, were included in the study. Among the patients included in the study, 631 individuals aged 75 years and older were analyzed.The mean age of the patients was determined as 80.3±4.2 years. The most frequent type of AF in geriatric population was the persistent-permanent type with a percentage of 88%. 60% of the patients with AF were female. Hypertension was the most common co-morbidity in patients with AF (76%). While in 16% of patients a history of stroke, transient ischemic attack or systemic thromboembolism was present, a history of bleeding was present in 14% of the patients. 37% of the patients were on warfarin treatment and 60% of the patients were on aspirin treatment. In 38% of the patients who were on oral anticoagulant treatment, INR level was in the effective range.The rate of anticoagulant use in the elderly with AF was 37% and considering the reason of this situation was the medication not being prescribed by the physician, one should pay more attention particularly in the field of treatment.
Ozet Deferipronun agranulositoz yapma potansiyeli mevcuttur. Iskenderun Devlet Hastanesi Kalitsal Kan Hastaliklari Merkezi ve Mustafa Kemal Universitesi Tip Fakultesi Hematoloji Servisince takip edilen talasemi major hastalarinin kayitlari incelendi. Onsekiz vaka desferoksamin, bes vaka deferipron ve 21 vaka her ikisini de kullanmaktaydi. Tedavinin ilk yilinda deferipron kullanan 26 hastadan ucunde (%11.5) agranulositoz gelisti. Bu oran, onceki yayinlarda belirtilen agranulositoz gorulme orani olan %0.5-1 ile karsilastirildiginda, arada istatistiksel olarak anlamli bir farkin mevcut oldugu goruldu (p<0.01). Hafif notropeni hicbir vakada gorulmedi ve bu oran da anlamli sekilde dusuktu (%0.0’a karsilik %8.5, p<0.01). Agranulositoz gorulen vakalarin ucu hem desferoksamin hem de deferipron kullanmaktaydi ve vakalarin bir tanesi bayandi. Ayrica, agranulositoz gorulen vakalarin ikisi splenektomiliydi ve hicbir vakada antiHCV pozitifligi tespit edilmedi. Sonuc olarak, kalitimsal faktorler ve desferoksamin ile birlikte kullanimin, deferiprona bagli agranulositoz icin onemli risk faktorleri oldugu ve bayan cinsiyet, gecirilmis splenektomi veya hepatit enfeksiyonlarinin getirdigi risklerin dusuk olabilecegi dusunuldu. Anahtar kelimeler: Talasemi major, artmis demir yuku, desferoksamin, deferipron, ICL 670
A 62-year-old male patient with no known cardiovascular disease was admitted to the emergency department with abdominal pain and dizziness.Electrocardiogram showed complete atrioventricular block with 50 beats per minute (Figure 1A).The patient was transferred to the coronary care unit.On physical examination, his left-arm blood pressure was 90/60 mmHg, whereas the right-arm blood pressure could not be measured.Electrocardiogram showed spontaneous return to sinus rhythm (Figure 1B).On physical examination, a grade 3/6 diastolic heart murmur was heard at the aortic area.Chest X-Ray showed enlarged mediastinum (Figure 1C).Transthoracic echocardiography revealed ascending aorta dilatation (53 mm) with an intimal flap, suggesting acute aortic dissection (Figure 1D).Color Doppler imaging showed moderate aortic regurgitation.Transesophageal echocardiography showed the dissection flap beginning above the aortic valves extending into the descending aorta (Figure 1E).Contrastenhanced computed tomography revealed aortic dissection, starting 1 cm above the aortic cusps and extending distal to the renal arteries (Stanford type A; Figures 1F,G).The patient was immediately transferred to the operating room.The aortic dissection was resected and reapproximated using Dacron tube graft (Figure 1H).Subsequently, the patient recovered well from the surgery and was discharged on postoperative day 7.