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Rationale: obstructive sleep apnea (OSA) may contribute to poor outcomes in adults with Coronavirus Disease 2019 (COVID-19). Objective: to determine the effect of OSA on clinical outcomes in patients with COVID-19. Methods: the current prospective observational study was conducted in three hospitals in Istanbul, Turkey from March 10 to June 22, 2020. The participants were categorized as modified high-risk (mHR), or low-risk (mLR)-OSA according to a modified version of the Berlin questionnaire. Snoring patterns (intensity and/or frequency), breathing pauses and morning/daytime sleepiness, without taking obesity and hypertension into account, were used in the regression models. Results: the primary outcome was clinical improvement defined as a decline of 2 categories from admission on a 7-category ordinal scale. Secondary outcomes included worsening (increase of 1 category), need for hospitalization, supplemental oxygen and intensive care. In total, 320 eligible patients were enrolled. According to the modified scoring, 70 (21.9%) had mHR-OSA. Among 242 patients requiring hospitalization, clinical improvement within 2 weeks occurred in 75.4 % of the mHR-OSA group compared to 88.4 % of the modified low-risk (mLR-OSA) group (P = 0.014). In multivariate regression analyses, mHR-OSA (adjusted OR 0.42; 95% CI 0.19-0.92) predicted the delayed clinical improvement. In the entire study population (n=320), mHR-OSA was associated with clinical worsening and need for supplemental oxygen. Snoring patterns, especially louder snoring, were significantly predicted delayed clinical improvement, worsening, need for hospitalization, supplemental oxygen, and intensive care. Conclusions: adults with mHR-OSA in our Covid-19 cohort had poorer clinical outcomes than those with mLR OSA independent of age, sex and comorbidities., NA

We aimed to analyze the association between body mass index and mortality in patients with coronavirus disease 2019 induced acute respiratory distress syndrome.In this retrospective cohort study, we analyzed 108 consecutive patients admitted in the intensive care unit for coronavirus disease 2019-induced lung disease in a single center between March 2020 and February 2021. Coronavirus disease 2019 infection was confirmed by real-time reverse transcription-polymerase chain reaction assay of nasal swabs or lower respiratory tract samples. Acute respiratory distress syndrome was defined using Berlin criteria. Acute respiratory distress syndrome severity was assessed with partial pressure of arterial oxygen/fraction of inspired oxygen ratio. We categorized patients according to the body mass index as underweight,18.5 kg/m2; normal weight, from 18.5 kg/m2 to25 kg/m2; overweight, from 25 kg/m2 to30 kg/m2; obese, ≥30 kg/m2. Clinical characteristics and mortality were compared among groups. Demographic and clinical data were collected from electronic medical records of the hospital system.The mean age was 67.3 ± 13.3 years. Study participants were predominantly males (66.7%). The mean BMI was 28.2 ± 5.6 kg/m2. There were 2 patients (2%), 28 (26%), 42 (39%), and 36 patients (33%) in the underweight, normal-weight, overweight, and obese groups, respectively. The hospital mortality was 40.7%. There was no association between body mass index and mortality (P = .09). In multivariate analysis, mortality was associated with the presence of cancer [odds ratio = 7.338 (1.636-32.914), P = .009], and time between diagnosis and intubation [odds ratio = 1.318 (1.150-1.509), P ≤ .001].Neither acute respiratory distress syndrome severity nor mortality was higher in patients with higher body mass index compared to the ones with normal body mass index.

Background The risk of muscle weakness is high in the survivors of acute respiratory distress syndrome with COVID-19 following discharge from intensive care unit. Aim To evaluate the effects of early rehabilitation program in intensive care unit in patients with acute respiratory distress syndrome secondary to COVID-19. Design Observational study. Setting Inpatient. Population Thirty-five patients with acute respiratory distress syndrome secondary to COVID-19 were enrolled. Methods This study was performed in an intensive care unit of a university hospital. Early rehabilitation program consisting of passive or active range of motion exercises and neuromuscular electrical stimulation in addition to standard intensive care (n=18) compared to standard intensive care (n=17). Primary outcome was hand grip strength following discharge. Results Rehab group had higher prevalence of chronic pulmonary diseases and neurologic diseases. There was no difference in hand grip or manual muscle strength following discharge between rehab and non-rehab groups. No adverse event was noted. CONCLUSIONS: The results did not support the beneficial effects of early rehabilitation in intensive care unit on improving muscle strength. More patients with pulmonary and neurologic diseases in rehab group might impede the impact of rehabilitation on outcomes. On the other hand, these comorbidities underline the role and need of rehabilitation. It is safe both for the patients and the health care workers when necessary precautions are taken. Clinical rehabilitation impact This study guide how to rehabilitate patients with acute respiratory distress syndrome with COVID-19 during intensive care unit in a safe way.

YÖK Tez No: 565774 Yarık dudak damak, genetik ve çevresel faktörlerin etkileşimi ya da prenatal dönemde gelişim sürecini etkileyecek bir teratojenin varlığı sebebiyle ortaya çıkabilecek konjenital bir anomalidir. Yarık damak anomalisine bağlı olarak tensör veli palatini ve levator veli palatine kasları yeterince kasılamamakta ve östaki tüpü görevini yerine getirememektedir. Östaki disfonksiyonundan kaynaklı orta kulak defisitleri ortaya çıkmaktadır. Kronik orta kulak problemleri ise uzun sürede işitsel işlemleme bozukluğuna sebep verebilmektedir. Çalışmamızda erken dönemde orta kulak problemlerine maruz kalan YDD tanılı adolesanların, işitsel temporal işlemleme ve konuşmayı anlama becerisi araştırılmıştır. Bilateral normal işitme eşiklerine ve bilateral tip A timpanograma sahip, 10-17 yaşları arasında, 30 YDD tanılı adolesan ve 30 normal gelişime sahip adolesan çalışmaya dahil edilmiştir. Tüm katılımcılara frekans patern, durasyon patern ve Türkçe Matrix testi uygulanmıştır. Frekans patern ve durasyon patern testlerinden elde edilen skorlar incelendiğinde, çalışma grubu, kontrol grubuna kıyasla daha düşük performans sergilemiştir. Matrix testinin sonuçları incelendiğinde, çalışma grubundan elde edilen sinyal gürültü oranları, kontrol grubundan elde edilen verilere göre daha yüksek bulunmuştur. Konuşmayı anlama skorları karşılaştırıldığında ise çalışma grubunun verileri kontrol grubuna kıyasla daha düşük performans sergilemiştir. Elde edilen sonuçlara göre, YDD tanılı popülasyonda, konjenital malformasyondan kaynaklı oluşabilecek orta kulak defisitlerinin sebep olacağı işitsel deprivasyonun, uzun dönemde işitsel işlemleme bozukluğu açısından risk faktörü olabileceği düşünülmektedir. Cleft lip palate is a congenital anomaly that may arise due to the interaction of genetic and environmental factors or the presence of a teratogen which may affect the development process in the prenatal period. Depending on the cleft palate malformation, the tensör veli palatine and levator veli palatine muscles are not sufficiently contracted and the eustachian tube cannot perform its function. Middle ear deficits occur due to eustachian dysfunction. Chronic middle ear problems can cause auditory processing disorders in a long term. In our study, we aimed to investigate auditory temporal processing and speech comprehension skills of adolescents which middle ear problems are exposed in early term. 30 CLP diagnosed adolescents and 30 normal developed adolescents which their ages are between 10-17 with bilateral normal hearing thresholds and bilateral type A tympanograms were included in the study. Both groups were assessed by the Matrix Test, Frequency Pattern and Duration Pattern tests. When the scores obtained from the frequency pattern and duration pattern tests were examined, the study group showed a lower performance than the control group. When the results of the Matrix test were examined, the signal noise ratios obtained from the study group were found to be higher than the control group. However, when speech comprehension scores were compared, the data of the study group showed lower performance than the control group. According to the results, it is thought that the auditory deprivation due to middle ear defisits caused by congenital malformations in the CLP population may be the risk factor for auditory processing disorder in the long term.

Serum free carnitine levels in five children (aged between 2.5 months and 4 years) with the findings of septic shock without disseminated intravascular coagulopathy and seven children (aged between 1.5 and 6.5 years) with the first attack of idiopathic status epilepticus were compared with those of eight healthy children (aged between 2.5 months and 5 years). Serum free carnitine levels showed a statistically significant decrease in the sepsis (mean 51.5 +/- 19 mg/L) and status epilepticus groups (mean 4.1 +/- 12.4 mg/L) (P = 0.006 and P = 0.001, respectively) when compared with the controls (mean 90.8 +/- 17.2 mg/L).