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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 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
