Objective: We aimed to investigate whether fragmented QRS (fQRS) is associated with subclinical left ventricular (LV) dysfunction in patients with obstructive sleep apnea (OSA). Subjects and Methods: A total of 141 patients with OSA who had normal LV ejection fraction (LVEF) were included in the study. The fQRS was defined as the presence of an additional R wave, notching of R or S wave or the presence of fragmentation in 2 contiguous electrocardiography (ECG) leads. Subclinical LV dysfunction was defined as the presence of a tissue Doppler-derived Tei index of ≥0.5 in the absence of impaired LVEF (<50%) as assessed by transthoracic echocardiography. Results: Of the 141 patients, 71 (50.4%) had subclinical LV dysfunction. Overall, the prevalence of the fQRS was 61% (86/141). Patients with fQRS had significantly higher Tei indices than those without fQRS [median 0.66, interquartile range (IQR) 0.39 vs. median 0.40, IQR 0.15, p < 0.001]. The presence of fQRS on ECG predicted subclinical LV dysfunction in univariate logistic regression analysis [odds ratio (OR) 6.69, 95% confidence interval (CI) 3.10-14.43]. The association remained significant after adjusting for all potential confounders (OR 4.59, 95% CI 1.94-10.87). Conclusion: fQRS on ECG was an independent predictor of subclinical LV dysfunction in patients with OSA. This simple tool might help to identify OSA patients who could be at risk for developing overt cardiac dysfunction.

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Pneumonia remains an important cause of morbidity and mortality among infectious diseases. Streptococcus pneumoniae and viruses are the most common cause of pneumonia. Candidiasis in such patients has been associated with haemodialysis, fungal colonization, exposure to broad-spectrum antibiotics, intensive care unit (ICU) hospitalization, and immunocompromised patients. The most common cause of infection is C. albicans. The case presented here is of a 66-year-old male patient diagnosed with C. glabrata. The patient suffered from chronic obstructive pulmonary disease.

SUMMARY Moxifloxacin related thrombocytopenia: A case report

Objective: Obstructive sleep apnoea (OSA) has been linked with many forms of cardiovascular diseases. Aortic knob width (AKW) has increasingly been presented as a marker of diagnosis and prognosis of atherosclerotic coronary artery disease. We sought to determine whether AKW has an association with sleep apnoea syndrome in patients referred to sleep testing in order to provide baseline information for future studies on general population. Methods: A total of 363 patients were included in this retrospective study. The capacity of AKW indexed by patients' height in predicting the presence of severe OSA was analysed using receiver operating characteristics curve analysis. The association of OSA severity with AKW indexed by height was tested with two separate models of ANCOVA (analysis of variance). Results: Area under the curve for estimating severe OSA with AKW was 0.67 (95% CI, 0.60 to 0.73, P < 0.001). A cut-off value of 21.42 mm/m provided a sensitivity of 62.6% and a specificity of 70.7% for severe OSA. In both ANCOVA models, the association of OSA severity on AKW indexed by height was significant and the effect size was moderate (P < 0.001, partial eta squared: 0.09 and 0.05). Conclusions: Aortic knob width indexed by height has a significant association with the severity of OSA; however, the association is significantly influenced by gender and age. K E Y W O R D Saortic knob width, apnoea-hypopnea index, chest, obstructive sleep apnoea