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Öğe Acute myocarditis mimicking acute myocardial infarction associated with pandemic 2009 (H1N1) influenza A virus(2011) Erden, Ismail; Erden, Emine Çakcak; Özhan, Hakan; Basar, CengizThe prevalence of myocardial involvement in influenza infection ranges from 0% to 11% depending on the diagnostic criteria used to define myocarditis. Whether such an association holds for the novel influenza A strain, pandemic-2009-H1N1, remains unknown. The clinical presentation of myocarditis varies and often mimics myocardial infarction. Although history, physical examination, laboratory data points, and electrocardiogram are helpful in distinguishing myocarditis from myocardial infarction, differential diagnosis can sometimes be difficult. Here, we present the first known report of acute myocarditis mimicking acute myocardial infarction associated with the pandemic influenza A virus (H1N1) infection. © 2011 Via Medica.Öğe Effect of dipping status on QRS morphology in patients with hypertension(2010) Erden, Ismail; Erden, Emine Cakcak; Özhan, Hakan; Yalçin, Subhan; Basar, Cengiz; Aydin, MesutBACKGROUND: Prolongation of the QRS complex on the surface electrocardiogram (ECG) has been shown to be predictive of cardiovascular outcomes in selected populations. A 'nondipper' blood pressure (BP) profile is currently regarded as a risk factor in its own right for cardiovascular events and target organ damage. The predictive value of ECG parameters in hypertensives with nondipper profile has not been established. MethodS: A total of 750 consecutive patients with hypertension who had been evaluated with ambulatory BP monitoring were screened for this study. One hundred and thirty-six patients who had fulfilled the inclusion and exclusion criteria were included in the final analysis. Dipper and nondipper patterns were detected and the maximum QRS duration (QRSd) measured on a 12-lead ECG was recorded. RESULTS: There were 70 nondipper and 66 dipper hypertensives. There was no significant difference between the two groups regarding the daytime systolic and diastolic mean BPs, number of medications taken, and the proportion of each class of antihypertensive medications. Other variables were similar between the two groups. QRSd was significantly higher in nondippers than dippers (P=0.006). Correlation analysis revealed that the systolic BP fall at night was inversely and significantly related with QRSd (r=-0.482, P<0.001). Regression analysis further showed that the systolic BP fall at night and age were independent correlates of QRSd. Conclusion: QRSd on the standard-surface 12-lead ECG was increased in patients with nondipper pattern and furthermore the systolic BP fall at night was independent correlate of QRSd in patients with hypertension. Copyright © 2010 Lippincott Williams & Wilkins.Öğe Efficacy of olmesartan therapy on fibrinolytic capacity in patients with hypertension(2011) Bulur, Serkan; Ozhan, Hakan; Erden, Ismail; Alemdar, Recai; Aydin, Mesut; Caglar, Onur; Basar, CengizThe efficacy of olmesartan on fibrinolytic capacity has not been studied yet. Therefore, the aim of the present study was to investigate the efficacy of olmesartan on hemostatic/fibrinolytic status by measuring plasma level of plasminogen activator inhibitor-1 (PAI-1) and soluble thrombomodulin levels in patients with hypertension. Forty-two consecutive, newly diagnosed (25 women and 17 men with a mean age of 48 ± 8 years) patients with untreated essential hypertension were included in the study. Olmesartan medoxomil (20 mg/day) was started and the patients were followed up for 6 months. Baseline biochemical variables, thrombomodulin, and PAI-1 levels were compared with the levels of these variables measured at the end of the 6-month follow-up period. After 6 months of treatment with olmesartan medoxomil, there was a significant reduction in systolic and diastolic blood pressure (from 159.5 ± 10.9 to 134.6 ± 12.7 mmHg and from 98.0 ± 6.3 to 83.9 ± 7.0 mmHg, respectively). Mean plasma PAI-1 and thrombomodulin levels were also significantly decreased (59.73 ± 41.91 vs. 48.60 ± 33.65 ng/ml, P = 0.001 and 8.09 ± 2.29 vs. 6.92 ± 1.42 ?g/l, P < 0.001, respectively). Olmesartan medoxomil decreased plasma PAI-1 and thrombomodulin levels after 6 months of therapy, indicating a favorable effect on fibrinolytic capacity in patients with essential hypertension. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.Öğe ENOXAPARIN INDUCED MASSIVE RECTUS SHEATH HEMATOMA(Istanbul Univ, Faculty Medicine, Publishing Office, 2012) Basar, Cengiz; Ozhan, Hakan; Caglar, Sabri Onur; Yalcin, Subhan; Aslantas, Yusuf; Ekinozu, IsmailRectus sheath hematoma is an uncommon complication of anticoagulation that generally presents as sudden onset of abdominal pain. Enoxaparin; a widely used low molecular weight heparin in acute coronary syndrome may rarely cause about abdominal wall hematoma. This complication is potentially fatal and needs prompt recognition and treatment. We report here a case of rectus sheath hematoma due to enoxaparin with the diagnosis of acute coronary syndrome. The potential diagnostic and treatment modalities were discussed in the light of the literature .Öğe Mean platelet volume in patients with non-alcoholic fatty liver disease(2010) Ozhan, Hakan; Aydin, Mesut; Yazici, Mehmet; Yazgan, Omer; Basar, Cengiz; Gungor, Adem; Onder, ElifMean platelet volume (MPV) is an indictor of platelet activation. Platelet activation and aggregation are central processes in the pathophysiology of coronary heart disease. Non-alcoholic fatty liver disease (NAFLD) is present up to onethird of the general population and the majority of patients with cardio-metabolic risk factors such as abdominal obesity, type 2 diabetes and other components of the metabolic syndrome (MS). The aim of the current study was to investigate the MPV in patients who had NAFLD. MPV values of the patients with NAFLD and of the patients without fatty liver disease were compared. NAFLD patients had significantly higher body mass index compared to the control cases. Among biochemical variables, fasting plasma glucose and triglyceride were significantly higher in the NAFLD group. NAFLD cases also had lower platelet count and higher MPV (10.43 ± 1.14 vs. 9.09 ± 1.25; p < 0.001, respectively). MPV was positively correlated with AST (r: 0.186, p < 0.042), ALT level (r: 0.279; p 0.002) and the presence of NAFLD (0.492; p < 0.001) but negatively correlated with platelet number (r: -0.26; p 0.004) and creatinine (r: -0.255; p 0.005). In logistic regression analysis (age, gender, NAFLD, body mass index, high-density lipid (HDL) cholesterol, systolic and diastolic blood pressure, triglyceride and fasting plasma glucose were used as covariates) only NAFLD was found to be the independent predictor of MPV (Odds Ratio (OR) 21.98) [95% confidence interval (CI): 2.404-201.048; p: 0.006]. We have shown for the first time in the literature that, patients with NAFLD have higher MPV. It may have prognostic value in NAFLD patients indicating a possible cardiovascular disease (CVD) risk increase. © 2010 Informa UK Ltd.Öğe OUTCOME OF PRIMARY PERCUTANEOUS INTERVENTION IN PATIENTS WITH INFARCT RELATED CORONARY ARTERY ECTASIA(Elsevier Ireland Ltd, 2010) Erden, Ismail; Ordu, Serkan; Alemdar, Recai; Aydin, Mesut; Ozhan, Hakan; Yazici, Mehmet; Basar, CengizÖğe Pioglitazone improves ventricular diastolic function in patients with diabetes mellitus: A tissue Doppler study(Acta Cardiologica, 2010) Ordu, Serkan; Ozhan, Hakan; Alemdar, Recai; Aydin, Mesut; Basar, Cengiz; Caglar, Onur; Yazici, MehmetObjective - Pioglitazone treatment in type 2 diabetes mellitus produced significant improvements in glycaemic control, plasma lipids, blood pressure and inflammation. The aim of this study was to investigate the effect of pioglitazone on systolic and diastolic function in diabetic patients. Methods and results - Forty-nine diabetic patients were included in the study.The patients had never received thiazolidinedione therapy before. Clinical and echocardiographic variables were measured. 30 mg pioglitazone were administered. The patients were followed up for six months and all the measurements were re-evaluated for comparison. Body mass index (BMI) significantly increased after treatment. Fasting glucose, HbA1c and systolic blood pressure decreased. Insulin resistance improved and the HOMA-IR index decreased after pioglitazone treatment. Mean aortic diameter, left atrial systolic and diastolic volumes significantly decreased after therapy. Among diastolic function variables mitral E wave, E/A, ejection time and pulmonary vein peak reverse flow velocity (PVA) significantly increased whereas isovolumetric relaxation time (IVRT), isovolumetric contraction time (IVCT), deceleration time, E/E' and pulmonary vein late systolic flow (PVS2) decreased after pioglitazone therapy. Among tissue Doppler variables early (E) ventricular inflow velocities measured from the tricuspid lateral annulus, the mitral septal and lateral annulus, the anterior, inferior and posterior free wall significantly increased. Late (A) ventricular inflow velocities measured from the anterior, inferior free wall and the mitral septal annulus also increased. Conclusion - Pioglitazone treatment in type 2 diabetes mellitus produced significant improvements in measures of glycaemic control and diastolic ventricular function.Öğe Poor-quality sleep score is an independent predictor of nondipping hypertension(Lippincott Williams and Wilkins, 2010) Erden, Ismail; Erden, Emine Cakcak; Özhan, Hakan; Basar, Cengiz; Aydin, Mesut; Dumlu, Talha; Alemdar, Recaiobjective: We aimed to investigate whether there was any association between the nondipping status and sleep quality in relatively young patients with an initial diagnosis of hypertension. METHODS: One hundred and thirty-three consecutive patients, diagnosed to have stage 1 hypertension by their primary physicians, were referred to our study. Patients with a history of use of any antihypertensive medication were excluded. Eligible patients underwent the Pittsburgh Sleep Quality Index (PSQI) survey, which has an established role in evaluating sleep disturbances. All patients underwent ambulatory blood pressure monitoring. RESULTS: There were 71 nondipper patients (mean age 44.3±5.3 years, 33 male/38 female) and 62 dipper hypertensive patients (mean age 43.3±6.3 years, 27 male/35 female). The PSQI scores, globally, were significantly higher in the nondippers compared with the dippers. It was noticed that all the components of the PSQI (sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, use of sleep medication, and daytime dysfunction) were significantly higher in the nondippers. Correlation analysis showed that systolic blood pressure fall at night was inversely and significantly related with the PSQI (r=-0.46, P<0.001). Logistic regression analysis showed that the PSQI score is an independent determinant for nondipping hypertension (HT) {odds ratio=0.842 [95% confidence interval (CI)=0.748-0.947; P=0.004]}. CONCLUSION: We showed that poor sleep quality was related with a nondipping pattern, and furthermore, it was an independent predictor of nondipping in newly diagnosed stage 1 hypertensive patients. © Lippincott Williams & Wilkins.Öğe The prognostic value of mean platelet volume in decompensated heart failure(2011) Kandis, Hayati; Ozhan, Hakan; Ordu, Serkan; Erden, Ismail; Caglar, Onur; Basar, Cengiz; Yalcin, SubhanBackground: Congestive heart failure (CHF) is a major public health problem that is related to substantial morbidity, impaired quality of life and diminished survival. Mean platelet volume (MPV) is an indicator of platelet activation. Aim: To investigate whether there is a difference of MPV in patients with decompensated and stable heart failure (SHF), and test the prognostic value of MPV in decompensated heart failure (DHF). Methods: 136 consecutive patients with DHF were enrolled. 71 with SHF were also enrolled for comparison. Patients were followed up for a mean of 18±12 months. The primary endpoint was death from any cause. Clinical characteristics of patients with DHF who died during follow-up were compared with the those of the survivors. Results: MPV was significantly higher in DHF group than in the SHF group. 71 patients died during the follow-up period (18±12 months). Comparison with survivors revealed that mortality was associated with age, systolic blood pressure, pulmonary artery pressure, serum creatinine, urea and MPV. MPV was determined as an independent risk factor for mortality (OR 1.553, 95% CI 1.024 to 2.354, p=0.038). Receiver operating characteristic analysis showed that MPV level on admission was a predictor of mortality (area under the curve (AUC) for in-hospital mortality was 0.716 (95% CI 0.632 to 0.789, p=0.003) and AUC for 6-month mortality was 0.815 (95% CI 0.74 to 0.877, p<0.001), respectively). Conclusion: MPV is increased in patients with DHF. Also, MPV on admission is an independent predictor of in-hospital mortality and 6-month mortality.
