Comparison of positional and rapid eye movement-dependent sleep apnea syndromes

AIM: We aimed to compare the clinical, epidemiological, and polysomnographic features of rapid eye movement (REM)-dependent obstructive sleep apnea syndrome (OSAS) and positional OSAS which are two separate clinical entities. METHODS: Between January 2014 and December 2015, at the Akdeniz University Medical Faculty Hospital, patients who were diagnosed REM-dependent and positional OSAS with polysomnography were retrospectively studied. RESULTS: In this study, 1727 patients were screened consecutively. Five hundred and eighty-four patients were included in the study. Of the patients, 24.6% (140) were diagnosed with REM-dependent OSAS and 75.4% (444) were diagnosed as positional OSAS. Female predominance was found in REM-dependent OSAS (P < 0.001). The mean total apnea–hypopnea index (AHI), non-REM AHI, and supine AHI in REM-dependent OSAS were 14.73, 9.24, and 17.73, respectively, and these values were significantly lower when compared with positional OSAS (P < 0.001). Patients diagnosed with REM-dependent OSAS had a statistically significant tendency to be overweight (P < 0.001). For REM-dependent OSAS, total pulse rate, supine pulse rate, and REM pulse rate were statistically higher than positional OSAS (P < 0.001). CONCLUSION: Positional OSAS is a clinical entity that is more common than REM-dependent OSAS. OSAS severity is higher in positional OSAS than REM-dependent OSAS. REM-dependent OSAS is observed more commonly in women

Pediatric Neutropenic Patients Care In Turkey

Objective: Infection is a common complication in children with malignancies. There is no consistent guidance for environmental infection control and isolation precautions for neutropenic patients (NP). There are differences between centers. The aim of this questionnaire study was to determine these differences in Turkey. Material and Methods: A multicenter-descriptive questionnaire was conducted on 36 centers from different geografical locations of Turkey. Bone marrow transplantation units were excluded. Each center was contacted at least three-times. Questionnaire was answered by two different doctors from each center. Results: Thirty-six centers including 20 (55.5%) University Hospitals, 12 (%33.3) Research Hospitals, three (8.3%) State Hospital and one Private University Hospital participated in this survey. 94.3% of the centers had a bed capacity of 50 beds and over. Twenty-one (58.3%) centers had pediatric infection ward that followed febrile NP. All centers had an infection control committee. 25% (9/36) of the centers always followed pediatric neutropenic fever patients in a single room. 66.6% (24/36) of the centers had toilet in all patients' room. The door features of patients' room included mostly (94.1%, 32/34) manually opened door. Ten (27.7%) centers had hepa filter system, five of them had positive-negative pressure room. Thirteen (38.2%, 13/34) centers prefered hickmann catheter for accessing a patient's central line. Training was given for catheteter care in all centers. Sixteen (44.4%) centers had determined policies about keeping toys in patient rooms. Visitor restrictions were performed in all centers. None of the centers allowed plants or flowers in hospital rooms. There was a neutropenic diet specific for pediatric NP provided in twenty-seven centers (75%). Conclusion: The prevention and control of infection contributes to the improvement of the prognosis of patients with hematological malignancies. Physicians must be aware of the infection risks and take precautions for infectious complications through the neutropenic period and standard protocols should be established and implemented for patients with hematological malignancies.WoSScopu

Türkiye’ de Pediatrik Nötropenik Hasta İzlemi

Objective: Infection is a common complication in children with malignancies. There is no consistent guidance for environmental infection control and isolation precautions for neutropenic patients (NP). There are differences between centers. the aim of this questionnaire study was to determine these differences in Turkey. Material and Methods: A multicenter-descriptive questionnaire was conducted on 36 centers from different geografical locations of Turkey. Bone marrow transplantation units were excluded. Each center was contacted at least three-times. Questionnaire was answered by two different doctors from each center. Results: Thirty-six centers including 20 (55.5%) University Hospitals, 12 (%33.3) Research Hospitals, three (8.3%) State Hospital and one Private University Hospital participated in this survey. 94.3% of the centers had a bed capacity of 50 beds and over. Twenty-one (58.3%) centers had pediatric infection ward that followed febrile NP. All centers had an infection control committee. 25% (9/36) of the centers always followed pediatric neutropenic fever patients in a single room. 66.6% (24/36) of the centers had toilet in all patients’ room. the door features of patients’ room included mostly (94.1%, 32/34) manually opened door. Ten (27.7%) centers had hepa filter system, five of them had positive-negative pressure room. Thirteen (38.2%, 13/34) centers prefered hickmann catheter for accessing a patient’s central line. Training was given for catheteter care in all centers. Sixteen (44.4%) centers had determined policies about keeping toys in patient rooms. Visitor restrictions were performed in all centers. None of the centers allowed plants or flowers in hospital rooms. There was a neutropenic diet specific for pediatric NP provided in twenty-seven centers (75%). Conclusion: the prevention and control of infection contributes to the improvement of the prognosis of patients with hematological malignancies. Physicians must be aware of the infection risks and take precautions for infectious complications through the neutropenic period and standard protocols should be established and implemented for patients with hematological malignancies.Giriş: Maligniteli hastaların tedavi sürecindeki en önemli komplikasyonlardan biri enfeksiyonlardır. Nötropenik hastalarda enfeksiyon kontrolü ve izolasyon önlemleri için merkezden merkeze değişen farklı uygulamalar mevcuttur. Anket çalışmasının amacı Türkiye’deki bu farklılıkları ve ihtiyaçları belirlemektir. Gereç ve Yöntemler: Çok merkezli tanımlayıcı çalışmaya Türkiye’nin farklı coğrafik bölgelerinden pediatrik nötropenik hasta takip eden 36 merkez dahil edildi. Kemik iliği transplantasyon üniteleri çalışmaya alınmadı. Her merkezle en az üç kez iletişime geçildi. Anketi her merkezden iki doktor yanıtladı. Anket kişisel, genel hasta bakımı ve nötropenik hasta bakımını içeren 64 sorudan oluşmaktaydı. Bulgular: Çalışmaya katılan merkezlerin 20 (%55.5)’si üniversite hastanesi, 12 (%33.3)’si eğitim araştırma hastanesi, 3 (%8.3)’ ü devlet hastanesi ve bir tanesi de özel üniversite hastanesi idi. Merkezlerin %94.3’ünün yatak kapasitesi 50 yatak ve üzerinde idi. Yirmi bir (%58) merkezin çocuk enfeksiyon hastalıkları servisi mevcuttu. Tüm merkezlerin enfeksiyon kontrol komitesi vardı. Merkezlerin %25 (n= 9)‘inde nötropenik ateş (NPA) tanısı alan çocuk hastalar tek kişilik odalarda izleniyordu. Tüm odalarda tuvalet bulunan merkez sayısı 24 (%66.6) idi. Hasta odalarının büyük çoğunluğunda elle açılıp kapanır kapı (%94.1) ve musluk (%97.1) mevcuttu. on (%27.7) merkezin oda havalandırması için hepa-filtreli sistemi vardı. Beşinde negatif basınçlı oda mevcuttu. on üç merkezde kateter olarak hickman kateter tercih edilmişti. Tüm merkezlerde kateter bakımı için eğitim verilmekte idi. Hiçbir merkezde hasta ziyaretine ve hastane odasında bitki veya çiçek bulundurmaya izin verilmemekteydi. Merkezlerin %45.7’sinde hastanede oyuncak bulundurma ile ilgili hastane politikası vardı. Sonuç: Sonuç olarak, nötropenik hastaları enfeksiyondan korumak için hastanelerde çeşitli yaklaşımlar uygulanmaktadır. Rehberler belirlenip bu rehberler ışığında hastane koşulları düzenlenmeli ve nötropenik hasta izlemi yapılmalıdır