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Öğe Development of pacemaker lead thrombosis in a patient with atrial fibrillation during apixaban treatment(Tehran Heart Center, 2019) Adar, A.; Önalan, O.; Cakan, F.Apixaban was introduced in clinical use for nonvalvular atrial fibrillation as an alternative to warfarin. There is a dearth of information regarding apixaban use in patients suffering from atrial fibrillation with intracardiac foreign bodies such as pacemaker leads. In this report, we describe a 72-year-old female patient with a complaint of weakness in both legs of a few days’ duration. She was detected to have a thrombus over the pacemaker lead and inside the left atrial appendage during apixaban treatment. After the discontinuation of apixaban and the commencement of warfarin, the thrombus was resolved. Our case is the first report to show that apixaban treatment (5 mg, twice daily) may not prevent the development of pacemaker lead thrombosis in patients with atrial fibrillation. © 2019, Tehran Heart Center. All rights reserved.Öğe The effects of intermittent fasting on nighttime blood pressure levels(Ondokuz Mayis Universitesi, 2022) Yilmaz, Yücel, A.H.; Adar, A.; Korkut, B.; Kalem, P.; Inci, H.; Adahan, D.Hypertension, a preventable disease with a high prevalence, is frequently seen in obese patients with cardiovascular risk factors. Our study aimed to investigate the effect of an intermittent fasting regimen on nighttime blood pressure levels. Patients who applied to Karabuk University Faculty of Medicine Training and Research Hospital Cardiology and Family Medicine Polyclinic between January and March 2021 and were followed up for 24 hours on an outpatient basis were included in this self-controlled interventional study. Patients underwent a second 24-hour Holter blood pressure follow-up after one month of diet, and the results were compared. The study was conducted with 30 subjects who adhered to a one-month intermittent fasting regimen. 63.3% of the patients were male, and the mean age was 54.60 ± 9.71 years. One month later, 13 patients whose nighttime blood pressure improved were assigned to Group 1 and 17 patients to Group 2. There was no important variance between the groups in terms of gender, age, height, waist circumference and BMI (p=0.609, p=0.105 and p=0.087, in order of). Mean VA and BSA were considerably lower in Group 2 (p=0.027 and p=0.045, in order of). HT duration was longer in Group 1 (p=0.001). There was no important variance between the groups in terms of smoking, alcohol use, average daily sleep time, salt intake awareness and exercise habits. The rate of snacking habits in Group 2 was statistically considerably higher (p=0.033). Intermittent fasting may be beneficial in preventing nocturnal hypertension. © 2022 Ondokuz Mayis Universitesi. All rights reserved.Öğe Extensive, Idiopathic, Recurrent, Spontaneous Coronary Artery Dissection Healed With Medical Treatment(Duzce University Medical School, 2021) Akbay, E.; Önalan, O.; Adar, A.; Çakan, F.Spontaneous coronary artery dissection is a rare cause of sudden cardiac death and acute coronary syndrome, and mainly affects young female. Treatment of this condition depends on the clinical features, hemodynamic and angiographic findings of the patient, but due to the rarity of the disease, guideline support was insufficient until the last period. Depending on the condition of the patient and the coronary blood flow, medical observation, percutaneous coronary intervention or coronary artery bypass graft surgery are used in the treatment. We present a young female patient who underwent emergency coronary artery bypass graft surgery after spontaneous left main coronary artery dissection four years ago and was recently diagnosed with extensive spontaneous coronary artery dissection in her right coronary artery. After the diagnosis, the patient was given medical treatment and recovered completely. © 2021, Duzce University Medical School. All rights reserved.Öğe Fragmented QRS is associated with subclinical left ventricular dysfunction in patients with chronic kidney disease(Acta Cardiologica, 2014) Adar, A.; Kiris, A.; Ulusoy, S.; Özkan, G.; Bektas, H.; Okutucu, S.; Onalan, O.Objective: We aimed to investigate the association of fragmented QRS (fQRS) with subclinical left ventricular (LV) dysfunction in patients with chronic kidney disease (CKD). Methods and results: Patients with CKD who had a normal LV ejection fraction (? 50%) were enrolled. The tissue Doppler-derived Tei index was measured for all patients. A Tei index of ? 0.5 was considered abnormal. Subclinical LV dysfunction was defined as the presence of an abnormal Tei index in the absence of impaired LV ejection fraction (< 50%). The fQRS was defined as the presence of an additional R wave (R') or notching of R or S wave or the presence of fragmentation in two contiguous ECG leads. The study group consisted of 82 patients (45 male, mean age 54 ± 14 years). Overall, prevalence of fQRS was 60% among CKD patients who had a preserved LV ejection fraction. Of these, 52 (63%) had an abnormal (? 0.5) and 30 (37%) a normal Tei index (< 0.5). The prevalence of fQRS was significantly higher in patients with an abnormal Tei index than in patients with a normal Tei index (71% vs. 40%, P = 0.006). Patients with an abnormal Tei index had a lower E/A ratio as compared to patients with a normal Tei index (P = 0.03). Groups were similar with respect to all other variables. In multivariate logistic regression analysis, the presence of fQRS was independently associated (OR 3.52, 95% CI 1.28-9.64) with the presence of an abnormal Tei index after adjustment for potential confounders. Conclusion: Fragmented QRS is independently associated with subclinical LV dysfunction in patients with CKD and normal ejection fraction.Öğe Reply(S. Karger AG, 2016) Onalan, O.; Adar, A.; Kiris, A.; Bülbül, Y.; Bektas, H.; Acat, M.; Casim, H.[No abstract available]Öğe A strong clue on chest radiography for metabolic syndrome in patients with obstructive sleep apnea: Aortic arch calcification(Duzce University Medical School, 2019) Adar, A.; Önalan, O.; Casim, H.; Çakan, F.; Köktürk, U.; Çetin, E.; Özçalik, E.Aim: Obstructive sleep apnea (OSA) is associated with increased atherosclerosis and metabolic syndrome (MetS). Vascular calcification plays a pivotal role in the development of atherosclerosis. However, data regarding vascular calcification and MetS is insufficient. The aim of the present study was to investigate the association between MetS and aortic arch calcification in patients with OSA. Material and Methods: Patients who underwent an overnight polysomnography and diagnosed with OSA were enrolled into the study. Patients were classified into two groups based on the presence of MetS. Two examiners who were unaware of the results of polysomnographic assessment reviewed the chest radiograms. Results: A total of 314 patients with OSA were included in the study. 33.1% of the patients were female and mean age was 51.2±10.9. Of these, 43.6% had mild OSA, 30.9% had moderate OSA, and 25.5% had severe OSA. Aortic arch calcification was detected in 56.4% (n=177) and MetS was detected in 58.6% (n=184) of the patients. Prevalence of aortic arch calcification was higher in patients with MetS than in those without MetS (p<0.001). By multiple logistic regression analysis found that body mass index (1.148, 95% CI, 1.089-1.210), apnea hypnea index (1.039, 95% CI, 1.016-1.062), and aortic arch calcification (4.986, 95% CI, 2.887-8.610) were found to be predictors of MetS. Conclusion: Aortic arch calcification seen in chest radiography is strongly associated with MetS in patients with OSA. Aortic arch calcification may be an alerting finding for clinicians regarding the development of MetS in patients with OSA. © 2019, Duzce University Medical School. All rights reserved.Öğe An unusual case of asymptomatic diffuse alveolar hemorrhage related to amiodarone induced INR elevation(Ondokuz Mayis Universitesi, 2019) Adar, A.; Onalan, O.; Cakan, F.Pulmonary adverse effects of amiodarone are among the important causesof morbidity. Such effects may rarely manifest as diffuse alveolar hemorrhage. Another important amiodarone-induced adverse effect is hepatotoxicity. Hepatotoxicity mostly presents as asymptomatic elevation of the liver enzymes. To the best of our knowledge, in amiodarone-induced hepatotoxicity, AST and ALT elevations are well known; however, there are no clear data regarding the high International Normalized Ratio (INR) levels in such a condition. In the present report, we describe the case of a patient under management with chronic low-dose amiodarone, who was admitted to the emergency department for lingual hematoma. During the assessment for bleeding diathesis, the INR was found to be 8.59. After excluding all other possible causes for the high INR level, amiodarone was suggested to be the cause. Since there were diffuse infiltrations on chest x-ray, the patient underwent thorax tomography. Asymptomatic diffuse alveolar hemorrhage secondary to INR elevation was considered. This patient is the first case who had amiodarone-induced INR elevation, and as a consequence, developed asymptomatic diffuse alveolar hemorrhage. © 2019 OMUÖğe A very rare complication of sublingual captopril(Ondokuz Mayis Universitesi, 2019) Adar, A.; Onalan, O.; Aktas, H.; Ertugrul, S.; Cakan, F.Captopril inhibits angiotensin-converting enzyme and it is the most used sublingual drug in emergency departments to decrease blood pressure. Sublingual captopril is safe, effective and useful in treating hypertensive urgency. However, it is known that captopril has fewer systemic and dermatologic side effects such as headache, weakness and oral ulcers, oral pemphigus, consecutively. No data is available about captopril induced oral mucositis. Herein, we present a 50-year-old hypertensive woman who uses sublingual captopril frequently and suffers from recurrent, reversible and painful oral mucositis that thought to be caused by sublingual captopril. © 2019 OMU
