Obstructive Sleep Apnea in Ischemic Stroke patients

OBJECTIVE: To investigate the prevalence of obstructive sleep apnea in patients with ischemic stroke and to evaluate the effectiveness of nasal continuous positive airway pressure treatment. METHODS: Overnight polysomnography was performed by a computerized system in 19 subjects with ischemic stroke. Patients with an apnea-hypopnea index > 5 were considered to have obstructive sleep apnea. The appropriate level of continuous positive airway pressure for each patient was determined during an all-night continuous positive airway pressure determination study. Attended continuous positive airway pressure titration was performed with a continuous positive airway pressure auto-titrating device. RESULTS: Obstructive sleep apnea prevalence among patients with ischemic stroke was 73.7%. The minimum SaO2 was significantly lower, and the percent of total sleep time in the wake stage and stage 1 sleep was significantly longer in patients with obstructive sleep apnea. In two patients with severe obstructive sleep apnea, we observed a decrease in the apnea-hypopnea index, an increase in mean wake time, mean SaO2, and minimum SaO2, and alterations in sleep structures with continuous positive airway pressure treatment. CONCLUSION: As the diagnosis and treatment of obstructive sleep apnea is of particular importance in secondary stroke prevention, we suggest that the clinical assessment of obstructive sleep apnea be part of the evaluation of stroke patients in rehabilitation units, and early treatment should be started

Covid-19 The biggest threat of the 21st century in respectful memory of the warriors all over the world

Since the first case was diagnosed in China, the new coronavirus infection (COVID-19) has become the number one issue in the world and it seems to remain trend-topic for a long time. Until 17 April, it affected 210 countries, infected over 2 million people and caused approximately 150000 deaths. Although the course of the disease ranges from asymptomatic state to severe ARDS; the majority of patients reveal only mild symptoms. Though adults are the most commonly affected group; it can also be seen in newborns and elderly patients. Unfortunately, elderly patients are the most vulnerable group with higher mortality. Elderly patients, smokers and patients with comorbid conditions are most affected by the disease. In certain diagnostical tool is the real-time reverse transcription-polymerase chain reaction (real-time RT-PCR) test. However, it can be resulted in false-negative results and in this case the computed thorax tomography (CT) is one of the most important tools with high sensitivity. Besides the supportive treatment, most commonly used agents are immunomodulatory drugs such as plaquenil and azitromycin, and anti-virals including oseltamivir, ritonavir-lopinavir, favipiravir. Until a vaccine or a specific therapy invented, the most important intervention to control the disease is to fight against transmission. This is a real war and the doctors are the soldiers

The predictors of COVID-19 mortality in a nationwide cohort of Turkish patients

he COVID-19-related death rate varies between countries and is affected by various risk factors. This multi center registry study was designed to evaluate the mortality rate and the related risk factors in Turkey. We retrospectively evaluated 1500 adults with COVID-19 from 26 centers who were hospitalized between March 11 and July 31, 2020. In the study group, 1041 and 459 cases were diagnosed as definite and highly probable cases, respectively. There were 993 PCR-positive cases (66.2%). Among all cases, 1144 (76.3%) were diagnosed with non-severe pneumonia, whereas 212 (14.1%) had severe pneumonia. Death occurred in 67 patients, corre sponding to a mortality rate of 4.5% (95% CI:3.5–5.6). The univariate analysis demonstrated that various factors, including male sex, age ?65 years and the presence of dyspnea or confusion, malignity, chronic obstructive lung disease, interstitial lung disease, immunosuppressive conditions, severe pneumonia, multiorgan dysfunction, and sepsis, were positively associated with mortality. Favipiravir, hydroxychloroquine and azithromycin were not associated with survival. Following multivariate analysis, male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were found to be independent risk factors for mortality. Among the biomarkers, procalcitonin levels on the 3rd-5th days of admission showed the strongest associations with mortality (OR: 6.18; 1.6–23.93). This study demonstrated that the mortality rate in hospitalized patients in the early phase of the COVID-19 pandemic was a serious threat and that those patients with male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were at increased risk of mortality; therefore, such patients should be closely monitored

Evaluation of patients with fibrotic interstitial lung disease: Preliminary results from the Turk-UIP study

OBJECTIVE: Differential diagnosis of idiopathic pulmonary fibrosis (IPF) is important among fibrotic interstitial lung diseases (ILD). This study aimed to evaluate the rate of IPF in patients with fibrotic ILD and to determine the clinical-laboratory features of patients with and without IPF that would provide the differential diagnosis of IPF. MATERIAL AND METHODS: The study included the patients with the usual interstitial pneumonia (UIP) pattern or possible UIP pattern on thorax high-resolution computed tomography, and/or UIP pattern, probable UIP or possible UIP pattern at lung biopsy according to the 2011 ATS/ERSARS/ALAT guidelines. Demographics and clinical and radiological data of the patients were recorded. All data recorded by researchers was evaluated by radiology and the clinical decision board. RESULTS: A total of 336 patients (253 men, 83 women, age 65.8 +/- 9.0 years) were evaluated. Of the patients with sufficient data for diag-nosis (n=300), the diagnosis was IPF in 121 (40.3%), unclassified idiopathic interstitial pneumonia in 50 (16.7%), combined pulmonary fibrosis and emphysema (CPFE) in 40 (13.3%), and lung involvement of connective tissue disease (CTD) in 16 (5.3%). When 29 patients with definite IPF features were added to the patients with CPFE, the total number of IPF patients reached 150 (50%). Rate of male sex (p<0.001), smoking history (p<0.001), and the presence of clubbing (p=0.001) were significantly high in patients with IPE None of the women <50 years and none of the men <50 years of age without a smoking history were diagnosed with IPE Presence of at least 1 of the symptoms suggestive of CTD, erythrocyte sedimentation rate (ESR), and antinuclear antibody (FANA) positivity rates were significantly higher in the non-IPF group (p<0.001, p=0.029, p=0.009, respectively). CONCLUSION: The rate of IPF among patients with fibrotic ILD was 50%. In the differential diagnosis of IPF, sex, smoking habits, and the presence of clubbing are important. The presence of symptoms related to CTD, ESR elevation, and EANA positivity reduce the likelihood of IPF

A new approach in the diagnosis of upper airway resistance syndrome (UARS): PAP method.

Upper airway resistance syndrome (UARS) is characterized by repeated number of arousals at night, and excessive daytime sleepiness or somnolence (EDS). It is often missed in classical polysomnographic diagnostic approaches and misdiagnosed as simple snoring or idiopathic hypersomnia, thereby is often left untreated. We propose that positive airway pressure (PAP), which has shown to be effective against UARS, can be used as a diagnostic tool as well. The study designed to test whether patients with high titration pressures can be diagnosed for UARS, and whether this pressure can be used as the treatment pressure in UARS

Comparison of computerized and manual versions of the wisconsin card sorting test on schizophrenia and healthy samples

This study aims to examine whether there is an equivalence between the two different versions of Wisconsin Card Sorting Test (WCST) regarding psychometric properties on two distinct samples: individuals diagnosed with schizophrenia and those who are healthy. A total of 504 individuals were included in the study, 243 were diagnosed with schizophrenia, and 261 were healthy individuals. Both samples were separated into two subsamples, and the individuals in each separated group were administered either WCST-C (computerized) or WCST-M (manual) version of the test. We compared statistical measures of mean and variance with the data obtained from the two samples. We carried out analyses related to parallel forms reliability and equality of variances of the tests scores produced by parallel forms of the WCST. There was no significant difference between mean values of manual and computerized versions administered for each sample. However, the patterns of variances of the obtained scores were dissimilar. According to these findings, the two versions were found to be inequivalent regarding psychometric properties.This study aims to examine whether there is an equivalence between the two different versions of Wisconsin Card Sorting Test (WCST) regarding psychometric properties on two distinct samples: individuals diagnosed with schizophrenia and those who are healthy. A total of 504 individuals were included in the study, 243 were diagnosed with schizophrenia, and 261 were healthy individuals. Both samples were separated into two subsamples, and the individuals in each separated group were administered either WCST-C (computerized) or WCST-M (manual) version of the test. We compared statistical measures of mean and variance with the data obtained from the two samples. We carried out analyses related to parallel forms reliability and equality of variances of the tests scores produced by parallel forms of the WCST. There was no significant difference between mean values of manual and computerized versions administered for each sample. However, the patterns of variances of the obtained scores were dissimilar. According to these findings, the two versions were found to be inequivalent regarding psychometric properties.Bulent Ecevit Universit

Uykunun fonksiyonel sonuçları ölçeğinin (FOSQ) Türk toplumuna uyarlanması

Uyku anketinin fonksiyonel sonuçlarının Türk versiyonu (FOSQ.tr), obstrüktifuyku apne hipopne sendrorn (OUAHS)'lu hastalarda psikometrik özellikleri yönünden değerlendirildi. FOSQ testi önce Türkçe'ye çevrilip, sonra tekrar ingilizce'ye çevrildi. Psikometrik değerlendirme amacıyla, ardarda seçilmiş 73 hasta ile birlikte 73 kontrol olgusuna test uygulandı. Testlerin geçerlilik ve güvenilirlik çalışmaları yapıldı. FOSQ.tr'nin tümünde (a= 0.92) ve alt skalalarında (o= 0.76-0.80) Cronbach's alfa değerleri, anketin iç güvenilirliğinin tam olduğunu düşündürdü. FOSQ.tr'nin test, retest geçerliliği sosyal sonuçlardan farklı olarak, tüm skorlar (r= 0.7) ve alt skalalar için anlamlıydı (r= 0.5'den 0.8'e kadar, toplamda p< 0.01). FOSQ.tr Epworth uykululuk skalası ile korelasyon gösteriyordu; korelasyon katsayısı alt skalalar için r= -0.5'den-0.62'ye kadar (p< 0.05) ve tüm skor için r= 0.64 (p< 0.01) olarak değişiyordu. Diskriminant analiz sonucu FOSQ.tr'nin normal birey ile hastanın anlamlı derecede ayırt edilebileceğini göstermiştir (p< 0.03). Sonuç olarak, FOSQ.tr'nin psikometrik özellikleri davranışlarda gündüz aşırı uyku halinin etkilerinin saptanmasında geçerli ve güvenilir bir test olduğu gösterilmiştir.Turkish version of functional outcomes of sleep questionnaire (FOSQ.tr) was examined for its psychometric properties in patients with obstructive sleep apnoea hypopnoea syndrome (OSAHS). The FOSQ was translated into Turkish using a for-ward-backward translation. For the psychometric evaluation, 73 consecutive patients were selected along with 73 control subjects. Internal consistency, test-retest reliability, concurrent and discriminant validity were investigated. Values of Cronbach's alpha for the total FOSQ.tr (u= 0.92) and its subscales (a= 0.76-0.80) suggest that the questionnaire was consistent internally. Test-retest reliability of the FOSQ.tr was significant for the total score (r= 0.7) and the sub-scales apart from sodal outcome (r= 0.5 to 0.8, all p< 0.01). FOSQ.tr correlated moderately with Epworth sleepiness scale (ESS), with coefficients ranging from r= -0.5 to -0.62, (all p< 0.05) for the sub-scales, and r= -0.64 (p< 0.01) for total score. Discriminant analysis showed that FOSQ.tr could significantly distinguish the patients from normal subjects (p< 0.03). The psychometric properties of the FOSQ.tr suggest that it is a valid and reliable instrument for the assessment of the impact of disorders of excessive sleepiness on daily behaviour