Triple rule-out computed tomography angiography:Evaluation of acute chest pain in COVID-19 patients in the emergency department

BACKGROUND The aim of this study was to define clinical evidence supporting that triple ruleout computed tomography angiography(TRO CTA)is a comprehensive and feasible diagnostic tool in patients with novel coronavirus disease 2019(COVID-19)who were admitted to the emergency department(ED)for acute chest pain.Optimizing diagnostic imaging strategies in COVID-19 related thromboembolic events,will help for rapid and noninvasive diagnoses and results will be effective for patients and healthcare systems in all aspects.AIM To define clinical evidence supporting that TRO CTA is a comprehensive and feasible diagnostic tool in COVID-19 patients who were admitted to the ED for acute chest pain,and to assess outcomes of optimizing diagnostic imaging strategies,particularly TRO CTA use,in COVID-19 related thromboembolic events.METHODS TRO CTA images were evaluated for the presence of coronary artery disease,pulmonary thromboembolism(PTE),or acute aortic syndromes.Statistical analyses were used for evaluation of significant association between the variables.A two tailed P-value<0.05 was considered statistically significant.RESULTS Fifty-three patients were included into the study.In 31 patients(65.9%),there was not any pathology,while PTE was diagnosed in 11 patients.There was no significant relationship between the rates of pathology on CTA and history of hypertension.On the other hand,the diabetes mellitus rate was much higher in the acute coronary syndrome group,particularly in the PTE group(8/31=25.8%vs 6/16=37.5%,P=0.001).The rate of dyslipidemia was significantly higher in the group with pathology on CTA while compared to those without pathology apart from imaging findings of the pneumonia group(62.5%vs 38.7%,P<0.001).Smoking history rates were similar in the groups.Platelets,D-dimer,fibrinogen,C-reactive protein,and erythrocyte sedimentation rate values were higher in COVID-19 cases with additional pathologies.CONCLUSION TRO CTA is an effective imaging method in evaluation of all thoracic vascular systems at once and gives accurate results in COVID-19 patients.

Neutrophil-to-lymphocyte ratio in occlusive vascular diseases： the literature review of the past 10 years

BACKGROUND: This study aims to evaluate the results of studies investigating neutrophilto-lymphocyte ratio(NLR) and to identify the prognostic and diagnostic value of NLR in occlusive vascular diseases.METHODS: With the aim of identifying the studies related to NLR, a search was performed on http://www.ncbi.nlm.nih.gov/pubmed by using the key words "neutrophil lymphocyte ratio" between January 2005 and December 2014. All of the original articles were evaluated according to date of publications, countries, clinics and topics. Studies about occlusive vascular diseases were evaluated according to their qualifications, review methods and results. SPSS for Windows 16.0 was used in data analysis and data were expressed as mean, standard deviation and percentage.RESULTS: A total of 735 original research articles were investigated. The number of publications have shown a regular logarithmic increase over the years. Thirty-two percent of all publications were performed by clinics in Turkey and 56.4% were performed by general-oncological surgery and cardiology clinics. A total of 107 publications were identified to be about occlusive vascular diseases, 80.3% of these publications were found to be prognostic and 19.6% to be diagnostic, 82.2% of them were found to be planned as retrospective and 17.7% as prospective. In 95.3% of prognostic publications, there was a positive correlation between high NLR values at admission and poor prognosis. In 95.3% of diagnostic publications high NLR values at admission were identifi ed to be signifi cant diagnostically.CONCLUSION: Elevated neutrophil-to-lymphocyte ratio at admission, could be used as a diagnostic and/or prognostic parameter in occlusive vascular diseases.

Cardiometabolic effects of breastfeeding on infants of diabetic mothers

BACKGROUND Breast milk is the best and principal nutritional source for neonates and infants.It may protect infants against many metabolic diseases,predominantly obesity and type 2 diabetes.Diabetes mellitus(DM)is a chronic metabolic and microvascular disease that affects all the body systems and all ages from intrauterine life to late adulthood.Breastfeeding protects against infant mortality and diseases,such as necrotizing enterocolitis,diarrhoea,respiratory infections,viral and bacterial infection,eczema,allergic rhinitis,asthma,food allergies,malocclusion,dental caries,Crohn's disease,and ulcerative colitis.It also protects against obesity and insulin resistance and increases intelligence and mental development.Gestational diabetes has short and long-term impacts on infants of diabetic mothers(IDM).Breast milk composition changes in mothers with gestational diabetes.AIM To investigate the beneficial or detrimental effects of breastfeeding on the cardiometabolic health of IDM and their mothers.METHODS We performed a database search on different engines and a thorough literature review and included 121 research published in English between January 2000 and December 15,2022,in this review.RESULTS Most of the literature agreed on the beneficial effects of breast milk for both the mother and the infant in the short and long terms.Breastfeeding protects mothers with gestational diabetes against obesity and type 2 DM.Despite some evidence of the protective effects of breastfeeding on IDM in the short and long term,the evidence is not strong enough due to the presence of many confounding factors and a lack of sufficient studies.CONCLUSION We need more comprehensive research to prove these effects.Despite many obstacles that may enface mothers with gestational diabetes to start and maintain breastfeeding,every effort should be made to encourage them to breastfeed.

COVID-19 vaccination and associated factors in Turkish healthcare workers practicing chest medicine

Objective: To evaluate the COVID-19 vaccination status and related characteristics of Turkish healthcare workers practicing chest medicine.Methods: A cross-sectional online survey was conducted among the Turkish Thoracic Society members. The survey was started on May 17, 2021, and kept open for seven weeks. The 39-item survey included the COVID-19 vaccination status and demographic, clinical, and occupational characteristics. Results: Of 378 healthcare workers participated in the survey, 354(93.7%) reported receiving at least one dose of the COVID-19 vaccine. A total of 323(91.2%) healthcare workers received CoronaVac vs. BioNTech/Pfizer in 31(8.8%). In the CoronaVac group, 77(23.8%) contracted COVID-19 when not fully vaccinated, and 13(4.0%) when fully vaccinated;however, 16(51.6%) healthcare workers in the BioNTech/Pfizer group got COVID-19 when not fully vaccinated, but any fully vaccinated participants did not contract COVID-19(P=0.003). Regarding vaccine dosing, 328(86.8%) were fully vaccinated, while 50(13.2%) were not. Multiple regression analysis for being a non-fully vaccinated healthcare worker demonstrated a significant relationship with having any SARS-CoV-2 infection history(adjusted OR 9.57, 95% CI 3.93-23.26, P<0.001) and being a non-physician healthcare worker(adjusted OR 5.86, 95% CI 2.11-16.26, P=0.001), but a significant negative relationship with full-time working at the time of survey(adjusted OR 0.13, 95% CI 0.03-0.56, P=0.006). Conclusions: Although a majority of healthcare workers were fully vaccinated, occupational and non-occupational characteristics were related to being non-fully vaccinated. Active surveillance regarding the COVID-19 vaccination in healthcare workers is necessary to address specific parameters as barriers to vaccination.

Pathological and immunohistochemical findings of lungs,heart,liver,and kidneys,and unexpected findings of fungi and parasites in lungs of deceased COVID-19 patients:A case series

Objective:To define histopathologic and immunohistochemical features of the lungs,heart,liver,and kidneys in patients who died from coronavirus disease 2019(COVID-19),and to determine the presence of SARS-CoV-2 in all tissues,as well as the presence of fungi and parasites in lung tissues.Methods:This retrospective case study was conducted in the intensive care units of Dokuz Eylül University Hospital,and patients(≥18 years)who died due to COVID-19 between October 2020 and April 2021 were included.The biopsy samples of the patient’s lung,heart,liver,and kidney tissues were studied.Results:In the study,we enrolled 12 patients(mean age:70 years;50%male).Alveolar epithelial cell damage and diffuse alveolar damage were predominant in lung tissues.Lobular lymphocyte infiltration,centrilobular sinusoidal dilatation,and microvesicular steatosis in the liver,together with pigmented cast,non-isometric vacuolar degeneration,and capillary plugging in the kidneys,were commonly found among the patients.SARS-CoV-2 nucleocapsid protein antibodies were detected in three lung and two kidney tissues,and so did angiotensin-converting enzyme 2 receptor positivity in one lung and more than half of the kidney tissues.The RT-PCR tests were positive in three lungs and one kidney tissue.After DNA isolation from lung tissues,Pneumocystis jirovecii was detected in nine patients,Aspergillus fumigatus in two,Microsporidia in three,and Cryptosporidium in two.Conclusions:SARS-CoV-2 is a multisystemic disease.Fungi and parasites should be investigated in critically ill COVID-19 patients prescribed corticosteroids.

Clinical characteristics and outcomes of nosocomial COVID-19 in Turkey:A retrospective multicenter study

Objective:To identify the clinical characteristics and outcomes of hospital-acquired SARS-CoV-2 infection during the vaccination period nationwide in Turkey.Methods:COVID-19 patients followed in the pandemic services across Turkey between January 1,2021,and March 31,2022 were investigated retrospectively.Nosocomial COVID-19 was defined as a patient neither diagnosed with COVID-19 nor suspected COVID-19 at the hospital admission and was confirmed COVID-19≥5 days after hospital admission.The primary outcome of this study was in-hospital mortality;demographic features and vaccination status was compared between survivors and non-survivors.Results:During the study period,15573 COVID-19 patients were followed in 18 centers and 543(3.5%)patients were nosocomial COVID-19.Most patients with nosocomial COVID-19(80.4%)were transferred from medical wards.162(29.8%)of the patients with nosocomial COVID-19 admitted to the intensive care unit due to disease severity and 138(25.4%)of the patients died during hospital stay.Advanced age(≥65 years)and number of comorbid diseases(≥2)was found to be associated with mortality in nosocomial COVID-19(OR 1.74,95%CI 1.11-2.74 and OR 1.60,95%CI 1.02-2.56,respectively).Vaccination was associated with survival in nosocomial COVID-19(OR 0.25,95%CI 0.16-0.38).Conclusions:Patients with nosocomial COVID-19 had increased admission to intensive care units and higher mortality rate.Vaccination can decrease the in-hospital mortality rate.

Metabolomic changes in children with autism

BACKGROUND Autism spectrum disorder(ASD)is a neurodevelopmental condition characterized by deficits in social communication and repetitive behaviors.Metabolomic profiling has emerged as a valuable tool for understanding the underlying metabolic dysregulations associated with ASD.AIM To comprehensively explore metabolomic changes in children with ASD,integrating findings from various research articles,reviews,systematic reviews,meta-analyses,case reports,editorials,and a book chapter.METHODS A systematic search was conducted in electronic databases,including PubMed,PubMed Central,Cochrane Library,Embase,Web of Science,CINAHL,Scopus,LISA,and NLM catalog up until January 2024.Inclusion criteria encompassed research articles(83),review articles(145),meta-analyses(6),systematic reviews(6),case reports(2),editorials(2),and a book chapter(1)related to metabolomic changes in children with ASD.Exclusion criteria were applied to ensure the relevance and quality of included studies.RESULTS The systematic review identified specific metabolites and metabolic pathways showing consistent differences in children with ASD compared to typically developing individuals.These metabolic biomarkers may serve as objective measures to support clinical assessments,improve diagnostic accuracy,and inform personalized treatment approaches.Metabolomic profiling also offers insights into the metabolic alterations associated with comorbid conditions commonly observed in individuals with ASD.CONCLUSION Integration of metabolomic changes in children with ASD holds promise for enhancing diagnostic accuracy,guiding personalized treatment approaches,monitoring treatment response,and improving outcomes.Further research is needed to validate findings,establish standardized protocols,and overcome technical challenges in metabolomic analysis.By advancing our understanding of metabolic dysregulations in ASD,clinicians can improve the lives of affected individuals and their families.

Clinical and hemodynamic profiles of elderly patients with pulmonary arterial hypertension： a single center, prospective study

Backgrounds Pulmonary arterial hypertension （PAH） was previously considered an illness that affects mostly the young, but now it is also increasingly recognized in the elderly. The aim of this study was to compare the features of elderly versus younger patients diagnosed with PAH, and to define the prognostic factors which affect their long-term survival. Methods In this prospective, single center study, the clinical, echocardiographic, hemodynamic characteristics, and the outcomes of younger （18-65 years） and elderly （〉 65 years） patients with definitive diagnosis of precapillary PAIl were compared. Results A total of 119 patients were analyzed in this study; 43 were elderly （mean age： 71.5 ± 5.5 years）, while 76 were non-elderly （mean age 44.5 ±15.2 years）. During the mean follow-up duration of 26.8 ±25.0 months, 43 deaths occurred, 17 of which were among the elderly group, with 28 among non-elderly group. Comparison of baseline parameters showed that 6 min walking distance, hemoglobin levels, pulmonary artery pressures and pulmonary vascular resistance were significantly lower; and estimated glomerular filtration rate, body mass index, E/e＇ and pulmonary capillary wedge pressure were significantly higher in the elderly group than in the younger group. Survival analysis demonstrated that the independent predictors of death were tricuspid plane annular systolic excursion （TAPSE; HR： 1.272, 95% CI： 1.079-1.499, P = 0.004） and uric acid （HR： 1.291, 95% CI： 1.042-1.600, P = 0.019） in the elderly group. In contrast, in the non-elderly group, higher brain natriuretic peptide （HR： 1.002, 95% CI： 1.001-1.004, P 〈 0.001） and higher right atrial pressure （HR： 1.128, 95% CI： 1.026-1.241, P = 0.013） values were the only parameters associated with mortality. Conclusions Our data suggest that elderly PAH patients have a unique clinical and hemodynamic profile, with totally different prognostic markers compared to younger PAH patients.

Aspartate transferase-to-platelet ratio index-plus: A new simplified model for predicting the risk of mortality among patients with COVID-19

BACKGROUND Coronavirus disease 2019(COVID-19)has a spectrum of clinical syndromes with serious involvement of the lung and frequent effection of the liver and hemostatic system.Blood biomarkers are affordable,rapid,objective,and useful in the evaluation and prognostication of COVID-19 patients.AIM To investigate the association between aspartate transferase-to-platelet ratio index(APRI)and in-hospital mortality to develop a COVID-19 mortality prediction model.METHODS A multicenter cohort study with a retrospective design was conducted.Medical records of all consecutive adult patients admitted to Al-Azhar University Hospital(Assiut,Egypt)and Chest Hospital(Assiut,Egypt)with confirmed COVID-19 from July 1,2020 to October 1,2020,were retrieved and analyzed.The patient cohort was classified into the following two categories based on the APRI:(1)COVID-19 presenting with APRI≤0.5;and(2)COVID-19 presenting with APRI(>0.5 and≤1.5).The association between APRI and all-cause in-hospital mortality was analyzed,and the new model was developed through logistic regression analyses.RESULTS Of the 353 patients who satisfied the inclusion criteria,10%were admitted to the intensive care unit(n=36)and 7%died during the hospital stay(n=25).The median age was 40 years and 50.7%were male.On admission,49%had aspartate transferase-dominant liver injury.On admission,APRI(>0.5 and≤1.5)was independently associated with all-cause in-hospital mortality in unadjusted regression analysis and after adjustment for age and sex;after stepwise adjustment for several clinically relevant confounders,APRI was still significantly associated with all-cause inhospital mortality.On admission,APRI(>0.5 and≤1.5)increased the odds of mortality by fivetimes(P<0.006).From these results,we developed a new predictive model,the APRI-plus,which includes the four predictors of age,aspartate transferase,platelets,and serum ferritin.Performance for mortality was very good,with an area under the receiver operating curve of 0.90.CONCLUSION APRI-plus is an accurate and simplified prediction model for mortality among patients with COVID-19 and is associated with in-hospital mortality,independent of other relevant predictors.

Prognostic Values of PET/CT Findings and Tumor/Patient Characteristics with Non-Small Cell Lung Cancer

Background/Aim: Although numerous prognostic factors have been described for non-small cell lung cancer (NSCLC), there is still a requirement for better and non-invasive markers. FDG-PET is a non invasive diagnostic tool that is being used increasingly in the diagnosis of lung cancer. This study evaluates the prognostic values of PET/CT defined SUV measurements and other patient/tumor characteristics in newly diagnosed stage IIIB and IV NSCLC. Method: This ret- rospective study included 111 patients admitted between 2005 and 2006 with stage IIIB and IV NSCLC, whose diag- noses were verified with biopsy and staging performed with PET/CT. The prognostic values of standart uptake values (SUV) of the primary lesion on PET/CT, and other patient/tumor characteristics were analyzed using survival analysis. Results: SUV was found to be unrelated with survival. Only the presence of distant metastasis, type of metastasis (bone, brain, or the contralateral lung) and the type of radiotherapy used (curative or palliative) were found to be related to survival. SUV values in epidermoid carcinoma were found to be significantly higher compared to adenocarcinoma (16.15 ± 7.18 and 12.32 ± 5.52, respectively, p = 0.021).Conclusion: Our findings do not support that SUV of the pri- mary lesion in inoperable NSCLC has a prognostic value with respect to survival. This condition may be explained by the inclusion of significantly advanced NSCLC patients who are known to have a low survival and a high mortality, and also the relatively small sampling size.

Effects of COVID-19 on children with autism

The coronavirus disease 2019(COVID-19)pandemic affects all countries and populations worldwide,significantly impacting people with autism with a high risk of morbidity and mortality due to COVID-19.Approximately 25%of children with autism have an asymptomatic or symptomatic immune deficiency or dysfunction.In addition,they frequently have various comorbid conditions that increase the severity of COVID-19.In addition,severe COVID-19 during pregnancy may increase the risk of autism in the offspring.Furthermore,severe acute respiratory syndrome coronavirus 2 could target human nervous system tissues due to its neurotrophic effects.The COVID-19 pandemic intensely impacts many patients and families in the autism community,especially the complex management of autism-associated disorders during the complete lockdown.During the complete lockdown,children with autism had difficulties coping with the change in their routine,lack of access to special education services,limited physical space available,and problems related to food and sleep.Additionally,children with autism or intellectual disabilities are more liable to be abused by others during the pandemic when the standard community supports are no longer functioning to protect them.Early detection and vaccination of children with autism against COVID-19 are highly indicated.They should be prioritized for testing,vaccination,and proper management of COVID-19 and other infectious diseases.In this review,we discuss the various effects of COVID-19 on children with autism,the difficulties they face,the increased risk of infection during pregnancy,how to alleviate the impact of COVID-19,and how to correct the inequalities in children with autism.

Role of serological rapid antibody test in the management of possible COVID-19 cases

Although the detection of viral particles by reverse transcription polymerase chain reaction(RT-PCR)is the gold standard diagnostic test for coronavirus disease 2019(COVID-19),the false-negative results constitute a big challenge.AIM To examine a group of patients diagnosed and treated as possible COVID-19 pneumonia whose multiple nasopharyngeal swab samples were negative for severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)by RT-PCR but then serological immunoglobulin M/immunoglobulin G(IgM/IgG)antibody against SARS-CoV-2 were detected by rapid antibody test.METHODS Eighty possible COVID-19 patients who had at least two negative consecutive COVID-19 RT-PCR test and were subjected to serological rapid antibody test were evaluated in this study.RESULTS The specific serological total IgM/IgG antibody against SARS-CoV-2 was detected in twenty-two patients.The mean age of this patient group was 63.2±13.1-yearsold with a male/female ratio of 11/11.Cough was the most common symptom(90.9%).The most common presenting chest computed tomography findings were bilateral ground glass opacities(77.2%)and alveolar consolidations(50.1%).The mean duration of time from appearance of first symptoms to hospital admission,to hospital admission,to treatment duration and to serological positivity were 8.6 d,11.2 d,7.9 d,and 24 d,respectively.Compared with reference laboratory values,serologically positive patients have shown increased levels of acute phase reactants,such as C-reactive protein,ferritin,and procalcitonin and higher inflammatory markers,such as erythrocyte sedimentation rate,lactate dehydrogenase enzyme,and fibrin end-products,such as D-dimer.A left shift on white blood cell differential was observed with increased neutrophil counts and decreased lymphocytes.CONCLUSION Our study demonstrated the feasibility of a COVID-19 diagnosis based on rapid antibody test in the cases of patients whose RT-PCR samples were negative.Detection of antibodies against SARS-CoV-2 with rapid antibody test should be included in the diagnostic algorithm in patients with possible COVID-19 pneumonia.

A cross-sectional study of post-COVID syndrome at a tertiary care center in Turkey

Objective:To investigate long-term symptoms after acute COVID-19,the link between symptoms and respiratory function,radiological changes in the post-COVID period,and risk factors for post-COVID syndrome.Methods:In this cross-sectional study,123 participants who were admitted within the first 3 months were categorized as group 1,and those who applied after 3 months were categorized as group 2.According to thoracic imaging and pulmonary function tests,patients were split into 3 groups as mild,moderate and severe.Results:At least one symptom was present in 91.9%and 61.8%in acute and post-COVID period,respectively.Pulmonary function tests were normal in 60(70.6%)in the first three months,and 30(78.9%)in 91-days to 1-year period after acute COVID-19 infection.After 3 months,22.4%of chest X-rays and 7.9%of computerized tomography revealed progression.Patients who developed acute complications(OR 9.91,95%CI 1.93-50.87),had 2 or more symptoms at admission(OR 7.73,95%CI 2.56-23.33),had 1%to 14%CT involvement(OR 3.05,95%CI 1.06-8.79),or had 50%or more CT involvement(OR 14.68,95%CI 1.24-172.55)had a higher risk of developing post-COVID syndrome.Conclusions:COVID-19 symptoms can last for long time.Severity of symptoms,acute complications,and the extent of radiological involvement may all contribute to elevated risk of post-COVID syndrome.As a result,patients with COVID-19 should be checked for long-term clinical difficulties on regular basis.

Effects of intraocular rifampicin on retinal ganglion cell structure:a stereological and histopathological study

AIM:To determine the histopathological changes of rifampicin applied intravitreally on retinal ganglion cells by means of stereological and histopathological methods.METHODS:For this study twenty-four New Zealand adult rabbits were divided into four groups(n=6 for each group).50μg/0.1mL(group 1),100μg/0.1mL(group 2),150μg/0.1mL(group 3) and 200μg/0.1mL(group 4),rifampicin were injected into the vitreous of the right eyes of animals,their left eyes were used as control(group 5).After the 28thday of application,animals were anesthetised with xylazine(8mg/kg,IM) and then their eyes were enucleated immediately.Patterns were taken away and eyes were prepared for both stereological and electromicroscopic observation.RESULTS:Depending on the high dose of rifampicin,some histopathological changes such as cytoplasmic dilatation and damaged membrane were observed on the electromicroscopic level.Using quantitative examination,which was done at the light microscopic level,it was shown that the number of neurons decreased linearly as rifampicin dose increased when compared with the control group.CONCLUSION:Based on these findings,low-dose rifampicin(50μg/0.1mL) may be useful for treatment of the ocular diseases.

Hemoptysis developing soon after use of sildenafil:an observation on two cases

Dear Sir, Our group from Pamukkale University Hospital would like to present an observation on hemoptysis that was probably associated with sildenafil usage in two patients. Since hemoptysis occurred immediately the drug was taken and has not recurred following the discontinuation of the drug. We think that after eliminating other risk factors, sildenafil might be a probable cause of transient hemoptysis.

Stenting for the Management of Posttracheostomy Tracheomalacia: Case Report

In patients who undergo prolonged endotracheal intubation, tracheostomy is performed to prevent the tracheal and laryngeal trauma which may be caused by the intubation tube. In this report, a patient who was intubated after a cerebrovascular embolism and required a tracheostomy for 6 months due to decannulation problems is presented. The patient subsequently developed a tracheomalacia. A stent was inserted and seen to provide functional support. Upon removal of the stent, the tracheomalacia improved. Although surgical therapy is claimed to provide higher success rate, stenting may also be a viable option for the management of tracheomalacia and improve the quality of life in patients with good general condition.

Relation between the Severity of Obstructive Sleep Apnea and the Severity of Type 2 Diabetes Mellitus and Hypertension

Background: Obstructive sleep apnea syndrome (OSAS) may promote hyperglycemia, insulin resistance, and hypertension (HTN). Purpose: To evaluate if there is a relationship between the severity of OSA and the severity of type 2 diabetes mellitus (T2DM) and HTN in our patients, aiming to understand and optimize the control for comorbidities. Materials and Methods: Patients referred for polysomnography (PSG) were retrospectively recruited during the period from October 2017 to August 2020. A STOP-BANG questionnaire formed eight questions was used to assess the risk of OSAS. We divided the patients into two groups;group 1, who have snoring without T2DM, and group 2, who have snoring with T2DM. PSG was completed for all subjects and data were collected for each patient including apnoea hypopnea index (AHI), mean arterial oxygen saturation (SaO2), and Nadir SaO2 recorded during PSG. Anthropometric data, medical history, and medications for T2DM (for group 2) and HTN and HbA1c were collected (for group 2). AHI was used to evaluate the severity of OSA and its relation to T2DM and HTN. Results: The study included 300 patients who met the inclusion criteria with mean age of 49.9 ± 13.6 years. The majority of subjects (56.3%) were males and the mean body mass index (BMI) was 38.0 ± 8.4 kg/m2. Forty-two percent had HTN and 32.7% had T2DM. OSA was diagnosed in 209 patients (69.7%). OSA was more detected among those with increased age, increased BMI, and those with HTN and T2DM. The severity of both HTN and T2DM was significantly higher among patients with OSA. Conclusions: There is a relation between OSA and T2DM and HTN. The risk of OSA is higher among patients with uncontrolled T2DM and HTN. OSA should be suspected in subjects with obesity, especially with uncontrolled HTN and T2DM.

Unusual Cause of Stridor in an Adult Man, Selective Immunoglobulin A Deficiency

The common causes of stridor in adults are abscesses or swelling of the upper airway, tumors, paralysis, or malfunction of vocal cords. Tracheitis due to immunoglobulin deficiency may be a rare explanation for stridor in adults, although occasionally reported in children. We report an adult man having stridor secondary to isolated immunoglobulin A deficiency. We did an in-depth review of the literature to seek out no reported cases of stridor thanks to immunoglobulin deficiency in adults. This case underlines the very fact that a standard symptom like stridor rarely occurs thanks to uncommon causes. This case is exclusive because it reports the presence of stridor associated with isolated immunoglobulin A deficiency in an adult patient. The explanation for the stridor was an intraluminal narrowing of the upper part of the extrathoracic trachea.

Echocardiographic Measurement of Pulmonary Arterial Pressure in Patients with Sarcoidosis

Introduction: Pulmonary hypertension (PH) is a significant complication and is poor prognostic factor for sarcoidosis. We evaluated various tests of diagnosis and treatment as well as the associations between PH and value of six-minute walk test (6 MWT) in sarcoidosis patients. Methods: This study was conducted with fifty patients with sarcoidosis. We grouped patients according to echocardiography. Results: PH prevalence in sarcoidosis was found to be 10%. In cases with likely PH, FEV1%, FVC%, MMF% was found to be lower. Although DLCO was less than 80% in the group of likely PH and over 80% in the other, there were no statistical differences between two groups. Mean value of FVC/DLCO ratio was 1.1 ± 0.38 in group of likely PH. There was no significant difference between groups. Mean distance of 6 MWT was 464 ± 105 m in all cases. There were no statistical differences between two groups in 6 MWT. Significant desaturation with exercise was observed in cases with PH (p = 0.007). Conclusion: In all stages, patients who have longer disease duration and abnormal pulmonary function tests, should be examined about PH. Patients should undergo 6 MWT and presence of desaturation after 6 MWT, even without hypoxemia, should be looked after and dealt with accordingly.

Chest ultrasound in neonates:What neonatologists should know

For many years,ultrasound was thought to have no indications in pulmonary imaging because lungs are filled with air,creating no acoustic mismatch,as encountered by ultrasound wave beam.Lung ultrasound(LUS)was started in adult critical care settings to detect pleural effusion and acquired more indications over time.In the neonatal intensive care unit(NICU),the use of chest ultrasound has gained more attention during the last two decades.Being a radiation-free,bedside,rapid,and handy tool,LUS started to replace chest X-rays in NICU.Using LUS depends upon understanding the nature of normal lungs and the changes induced by different diseases.With the help of LUS,an experienced neonatologist can detect many of the respiratory problems so fast that interventional therapy can be introduced as early as possible.LUS can diagnose pleural effusion,pneumothorax,pneumonia,transient tachypnoea of the newborn,respiratory distress syndrome,pulmonary atelectasis,meconium aspiration syndrome,bronchopulmonary dysplasia,and some other disorders with very high accuracy.LUS will be helpful in initial diagnosis,follow-up,and predicting the need for further procedures such as mechanical ventilation,diuretic therapy,surfactant therapy,etc.There are some limitations to using LUS in some respiratory disorders such as bullae,interstitial emphysema,and other conditions.This review will highlight the importance of LUS,its uses,and limitations.