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        Maximal Exercise-Corrected QT as a Predictor of Coronary Artery Disease: Comparison of Simpler Heart Rate Corrections

        Aydın Akyuz,Seref Alpsoy,Dursun Cayan Akkoyun,Hasan Degirmenci,Niyazi Guler 대한심장학회 2013 Korean Circulation Journal Vol.43 No.10

        Background and Objectives: The relationship between QT prolongation and myocardial ischemia is widely known. Due to the limited value of ST depression, we aimed to evaluate, by using four simpler heart rate corrections (Bazett, Framingham, Fridericia and Hodges), the value of maximal exercise-QTc prolongation in the diagnosis of coronary artery disease (CAD) presence and severity. Subjects and Methods: We enrolled 234 subjects (mean age 57.3±9 years, 143 men) who had undergone exercise testing and coronary angiography due to a suspicion of CAD in the study. Evaluating CAD severity with Gensini scoring, the CAD group (n=122) and controls with non-CAD were compared in terms of corrected QT duration at maximal exercise. Results: Age, gender, hypertension, dyslipidemia, smoking, exercise duration, resting, and peak heart rate were similar between the two groups (all p>0.05). The CAD group had higher raw QT values than the controls {268 (169-438) vs. 240 (168-348), p<0.001}. Although Fra-mingham QTc of ≥350 ms and Fridericia QTc of ≥340 ms were seen to be useful for the diagnosis of CAD, there was no additive diagnostic value of exercise QTc in addition to ST depression. Maximal exercise-QTc Bazett (r=0.163, p=0.01), Framingham (r=0.239, p=0.001), and Fri-dericia (r=0.206, p=0.001) equations were weakly positively correlated with Gensini scoring. Conclusion: The patients with CAD have longer QTc intervals at peak heart rates during exercise. This finding provides insufficient evid-ence to support routine incorporation of QTc at peak heart rates into exercise test interpretation.

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        Effects of Stevia rebaudiana (Bertoni) Extract and N-Nitro-l-Arginine on Renal Function and Ultrastructure of Kidney Cells in Experimental Type 2 Diabetes

        Cansu Ozbayer,Hulyam Kurt,Suna Kalender,Hilmi Ozden,Hasan V. Gunes,Ayse Basaran,Ecir A. Cakmak,Kismet Civi,Yusuf Kalender,Irfan Degirmenci 한국식품영양과학회 2011 Journal of medicinal food Vol.14 No.10

        Diabetes is the leading cause of chronic renal failure. Our purpose was to determine the effects of N-nitro-l-arginine (l-NNA) and an extract of Stevia rebaudiana (Bertoni) (SrB) leaves on renal function in streptozotocin-nicotinamide (STZ-NA)–induced diabetic rats. Rats were divided into seven groups. Three of these groups were controls. Diabetes was induced by STZ-NA in the other four. Diabetic rats were treated with SrB (200 mg/kg), _L-NNA (100 mg/kg), or SrB + _L-NNA for 15 days after 5–8 weeks of diabetes. At the end of the experiments, urine and blood samples were collected from the rats, and kidney tissue samples were collected with the animals under ether anesthesia. Renal filtration changes were determined by measuring urine pH, urine volume, and serum and urine creatinine. Nitric oxide synthase (NOS) activity was measured in kidney homogenates. Alterations in kidney ultrastructure were determined by electron microscopy, and histological changes were examined by hematoxylin and eosin staining. No statistical differences were observed in urine creatinine or creatinine clearance. Even so, we observed higher NOS activity in SrB-treated diabetic rats. SrB-treated diabetic rats had less mitochondrial swelling and vacuolization in thin kidney sections than other diabetic groups. The control groups showed normal histological structure, whereas in the diabetic groups, membrane thickening, tubular epithelial cells, and cellular degeneration were observed. Thus, SrB has beneficial effects on diabetes compared with _L-NNA. Our results support the validity of SrB for the management of diabetes as well as diabetes-induced renal disorders.

      • Medication Errors in Chemotherapy Preparation and Administration: a Survey Conducted among Oncology Nurses in Turkey

        Ulas, Arife,Silay, Kamile,Akinci, Sema,Dede, Didem Sener,Akinci, Muhammed Bulent,Sendur, Mehmet Ali Nahit,Cubukcu, Erdem,Coskun, Hasan Senol,Degirmenci, Mustafa,Utkan, Gungor,Ozdemir, Nuriye,Isikdogan Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.5

        Background: Medication errors in oncology may cause severe clinical problems due to low therapeutic indices and high toxicity of chemotherapeutic agents. We aimed to investigate unintentional medication errors and underlying factors during chemotherapy preparation and administration based on a systematic survey conducted to reflect oncology nurses experience. Materials and Methods: This study was conducted in 18 adult chemotherapy units with volunteer participation of 206 nurses. A survey developed by primary investigators and medication errors (MAEs) defined preventable errors during prescription of medication, ordering, preparation or administration. The survey consisted of 4 parts: demographic features of nurses; workload of chemotherapy units; errors and their estimated monthly number during chemotherapy preparation and administration; and evaluation of the possible factors responsible from ME. The survey was conducted by face to face interview and data analyses were performed with descriptive statistics. Chi-square or Fisher exact tests were used for a comparative analysis of categorical data. Results: Some 83.4% of the 210 nurses reported one or more than one error during chemotherapy preparation and administration. Prescribing or ordering wrong doses by physicians (65.7%) and noncompliance with administration sequences during chemotherapy administration (50.5%) were the most common errors. The most common estimated average monthly error was not following the administration sequence of the chemotherapeutic agents (4.1 times/month, range 1-20). The most important underlying reasons for medication errors were heavy workload (49.7%) and insufficient number of staff (36.5%). Conclusions: Our findings suggest that the probability of medication error is very high during chemotherapy preparation and administration, the most common involving prescribing and ordering errors. Further studies must address the strategies to minimize medication error in chemotherapy receiving patients, determine sufficient protective measures and establishing multistep control mechanisms.

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