RESUMO
BACKGROUND: Diltiazem stands out as one of the front-line drugs administered in the emergency department to achieve acute rate control in patients suffering from atrial fibrillation with rapid Ventricular Response. One of the cytochrome enzymes involved in the metabolism of diltiazem is cytochrome P450 2D6 (CYP2D6). Interindividual differences can act on drug metabolism and thus drug efficacy due to the genetic polymorphism induced by the CYP2D6 enzyme. This study explores the association between the efficacy of diltiazem and the genetic polymorphism of CYP2D6 in patients with atrial fibrillation with rapid ventricular response. RESULTS: 87 out of 93 individuals with ventricular rate > 120 beats/min constituted the patient cohort. The patients were administered 0.25 mg/kg diltiazem intravenously. As a second dose, 0.35 mg/kg diltiazem was administered to patients who reportedly did not receive adequate drug efficacy. Heart rate control was considered to be achieved in patients whose heart rate fell below 110 beats/min and did not rise above 110 beats/min for 2 h. CYP2D6 *2, *3, *4 and *10 represent allele variants and *1 represents wild type (wt) allele. Achieving rate control after one or two doses of diltiazem in normal allele (wt/wt) carriers proved significantly higher than wt/*2, wt/*4 and wt/*10 heterozygous variant carriers. No significant difference was noted in wt/*3 heterozygous variant carriers. CONCLUSION: The presence of *2, *4 and *10 alleles was observed to significantly compromise the drug efficacy. *3 allele was found to bear no relation to the effect of diltiazem on achieving rate control.
RESUMO
BACKGROUND: This study seeks to explore the impact of COVID-19 outbreak on the social support perception and acute stress disorder of prehospital care providers (PCPs) in the province of Denizli. METHODS: This descriptive and cross-sectional study was conducted between December 25, 2020 and January 25, 2021. Out of 510 ambulatory care staff constituting the study population, there were 287 PCPs (%56.2), including 13 physicians, 89 paramedics, 134 emergency medical technicians, and 51 individuals from other occupational groups (nurse, driver, cleaning staff, medical secretary) based at emergency health services. The data collection tools employed in the study include an introductory information form, Multidimensional Scale of Perceived Social Support (MSPSS), and National Stressful Events Survey Acute Stress Disorder Short Scale (NSESSS), which was organized as an online questionnaire. RESULTS: We analyzed the data from 287 PCPs that completed the form and scales. The mean score of the NSESSS was calculated as 1.53 ± 0.79. The PCPs who experienced health problems (1.85 ± 0.69), suffered from mental problems and received psychotherapy and medication (2.57 ± 0.57), encountered COVID-19 patients (1.58 ± 0.8), provided care for COVID-19 patients (1.59 ± 0.79), and took polymerase chain reaction (PCR) tests (1.68 ± 0.78) had higher acute stress symptom levels. The total mean score of MSPSS was calculated as 66.28 ± 17.22. Total MSPSS scores of the participants varied significantly in terms of age, marital status, taking a COVID-19 test, suffering from mental problems, status of encountering a COVID-19 patient, and workplace satisfaction (p < 0.05). CONCLUSIONS: The findings are suggestive of high perceptions of multidimensional social support and low acute stress symptom levels of the PCPs during the COVID-19 pandemic period.