Role and limitations of high-flow nasal oxygen therapy in COVID-19 patients: An observational study.

Background: The management of acute respiratory failure in COVID-19 patients and the role and limitations of high-flow nasal oxygen therapy (HFNOT) remain unclear. Aim: This study aimed to investigate the effect of HFNOT, identify the characteristics of patients who will benefit from therapy, and determine monitoring strategies to decide on endotracheal intubation for patients with COVID-19. Patients and Methods: We conducted a prospective observational study of COVID-19 patients who were admitted to the intensive care unit (ICU) and required HFNOT for at least 2 days between 20 March 2020 and 20 June 2020. The exclusion criteria were a severe respiratory failure, reduced levels of consciousness, combination with other noninvasive ventilation strategies, and exhaustion. The patients were followed up until ICU discharge. The primary outcome was the proportion of patients with COVID-19 who were successfully weaned from HFNOT, whereas failure comprised intubation or death on HFNOT. Results: Thirty-five subjects (24 males, mean-age: 61.62, standard deviation: 14.9 yr.) were included in the study. A total of 20/35 (57.1%) subjects survived to discharge. C-reactive-protein (CRP) and interleukin-6 (IL-6) levels were significantly increased in the treatment failure group (CRP; effect size (r):0.35, P: 0.037, IL-6; r: 0.37, P: 0.03). Although there was a difference between repeated measures of partial-pressure-of-oxygen/fraction-of-inspired-oxygen (PaO2/FiO2:P/F) rates (partial-eta-squared (ηp2):0.79, P < 0.001), no difference was found between carbon dioxide levels (ηp2:0.29, p: 0.44). There was also no difference between ROX (ratio-of-oxygen-saturation/FiO2 to respiratory-rate) rates (Kendall's W: 0.33 P = 0.310). Conclusion: In COVID-19 patients with mild-to-moderate dyspnea and hypoxemia who are nonresponsive to conventional-oxygen-therapies, the initial approach may involve the use of HFNOT. In this study, patient monitoring could be performed with ROX and P/F ratios, and the effectiveness of the treatment could be decided by looking at these rates in the second hour. Prolongation of the period and awake prone positioning did not improve the outcome.

A new method for evaluation of the autonomic nervous system in patients with idiopathic hyperhidrosis: systolic blood pressure and heart rate recovery after graded exercise.

BACKGROUND: Idiopathic hyperhidrosis (IH) is characterized by excessive and uncontrolled production of sweat, mainly localized to the soles, palms, axillae and craniofacial area. Although IH is a disease concerning the autonomic nervous system, it is not clear yet whether this dysfunction is local or systemic. OBJECTIVE: To evaluate the autonomic control of cardiovascular system by measuring values of heart rate recovery (HRR) and systolic blood pressure recovery (SBPR) obtained at various time intervals after maximal graded exercise treadmill testing in patients with IH compared with controls. METHODS: The study population comprised 36 patients with IH (20 men, 16 women; mean age 25 ± 7 years) and 36 healthy controls (HCs) (12 men, 24 women; mean age 27 ± 5 years). All patients were selected from young, nonobese and healthy sedentary individuals. RESULTS: Peak HR values reached in patients with IH were significantly higher compared with the HC group (P < 0.001). The obtained HRR values at minutes 3, 4 and 5 were significantly lower in the IH than the HC group [57 ± 16 vs. 64 ± 9 (P = 0.03); 61 ± 14 vs. 68 ± 9 (P = 0.03); 64 ± 12 vs. 70 ± 7 (P < 0.01)]. In addition, calculated mean values for SBPR1 and SBPR2 were > 1 in patients with IH (1.04 ± 0.15 vs. 0.98 ± 0.08 and 1.0 ± 0.12 vs. 0.94 ± 0.06, respectively) and these were statistically significant compared with the HC group (P = 0.04 and P = 0.03, respectively). CONCLUSIONS: The significantly impaired SBPR and decreased HRR values we observed in patients with IH may indicate that the autonomic dysfunction in IH is a systemic disorder with cardiovascular effects, rather than a merely local disease. Both HRR and SBPR values may provide additional information about predicting adverse cardiovascular events in the future even in apparently healthy young patients with IH.

The effects of psychiatric treatment on depression, anxiety, quality of life, and sexual dysfunction in patients with inflammatory bowel disease.

OBJECTIVE: Depression and anxiety are common disorders in inflammatory bowel disease (IBD). Our aim is to prospectively determine the effect of psychiatric treatment on scores for depression, anxiety, quality of life (QoL), and sexual dysfunction in an outpatient population diagnosed with IBD and also anxiety and/or depression disorder. PATIENTS AND METHODS: Patients who scored higher than the cutoff point on the Hospital Anxiety Depression Scale were referred for further structured psychiatric evaluation and determination of the need for psychiatric drug treatment. Patients who underwent drug therapy completed Short Form-36 (SF-36) and the Arizona Sexual Experience Scale at baseline and after 6 months of follow-up. RESULTS: Major depressive disorder and generalized anxiety disorder were the most common diagnoses. After 6 months, 47 patients had completely adhered to drug treatment (group A), whereas 20 were nonadherent (group B). In group A, all domains of SF-36, Arizona Sexual Experience Scale, depression/anxiety scores, and Crohn's disease activity index were statistically improved after treatment when compared with the baseline. In group B, the three domains of SF-36, platelet count, and mean corpuscular volume were worse between baseline and at 6 months. CONCLUSION: In IBD patients having any psychiatric disorder, 6 months of antidepressant drug treatment is associated with an improvement in depression, anxiety, QoL, and sexual functioning scores, as well as an improvement in Crohn's disease activity index. On the other hand, insufficient psychiatric treatment seems to be related to a poor QoL.

Circulating adhesion molecules and arterial stiffness.

AIM: VCAM-1 and ICAM-1 are two important members of the immunoglobulin gene superfamily of adhesion molecules, and their potential role as biomarkers of diagnosis, severity and prognosis of cardiovascular disease has been investigated in a number of clinical studies. The aim of the present study was to determine the relationship between circulating ICAM-1 and VCAM-1 levels and aortic stiffness in patients referred for echocardiographic examination. METHODS: Aortic distensibility was determined by echocardiography using systolic and diastolic aortic diameters in 63 consecutive patients referred for echocardiography. Venous samples were collected in the morning after a 12-hour overnight fast, and serum concentrations of ICAM-1 and VCAM-1 were measured using commercial enzyme immunoassay kits. RESULTS: Data of a total of 63 participants (mean age 55.6 ± 10.5 years, 31 male) were included in the study. Circulating levels of adhesion molecules were VCAM-1: 12.604 ± 3.904 ng/ml and ICAM-1: 45.417 ± 31.429 ng/ml. We were unable to demonstrate any correlation between indices of aortic stiffness and VCAM-1 and ICAM-1 levels. CONCLUSION: The role of soluble adhesion molecules in cardiovascular disease has not been fully established and clinical studies show inconsistent results. Our results indicate that levels of circulating adhesion molecules cannot be used as markers of aortic stiffness in patients.

Impaired systolic blood pressure recovery and heart rate recovery after graded exercise in patients with metabolic syndrome.

The aim of this study was to evaluate and compare systolic blood pressure recovery and heart rate recovery (HRR) values obtained at various time intervals after maximal graded exercise treadmill testing between patients with metabolic syndrome (MS) and the controls without MS. To our knowledge, this is the first study indicating systolic blood pressure recovery (SBPR) impairment and its relations to HRR and other variables in this group of patients. The study population included 110 patients with MS (67 men, 43 women; mean age: 46 ±â€Š9 years) and 110 control subjects who did not meet the criteria for MS (58 men, 52 women; mean age: 44 ± 10 years). All patients were selected from nonobese, apparently healthy sedentary individuals who had the ability to perform maximum exercise testing. SBPR was assessed by calculating the ratio of systolic blood pressure (SBP) obtained in the third minute of the recovery period to either the peak-exercise SBP or the SBP in the first minute of the recovery period after graded exercise testing. HRR values were calculated by subtracting the HR at the first, second, third, fourth, and fifth minutes of the recovery period from the HR reached at peak exercise. There was no significant difference found between the 2 groups with respect to age and sex distribution. As expected, patients with MS had higher waist circumference, fasting plasma glucose and serum triglyceride, and lower high-density lipoprotein cholesterol compared with control subjects. All HRR values calculated in the first, second, third, fourth, and fifth minutes were significantly detected lower in the MS group compared with the control group (HRR 1st: 32 ± 10 vs 36 ± 11; P = 0.009; HRR 2nd: 47 ± 10 vs 51 ± 11; P = 0.02; HRR 3rd: 53 ± 11 vs 58 ± 12; P = 0.001; HRR 4th: 57 ± 11 vs 64 ± 12; P < 0.001; HRR 5th: 60 ± 16 vs 69 ± 15; P < 0.001). In addition, calculated mean values for SBPR1 and SBPR2 were >1 in patients with MS (1.01 ±â€Š0.2 vs 0.91 ± 0.1 and 1.01 ± 0.1 vs 0.94 ± 0.1) and these were statistically significant compared with the control group (P < 0.001 and P = 0.002, respectively). The existence of MS was found to be the only parameter that was independently and positively related to SBPR values in the study population. Our findings suggest that only the existence of MS itself, not the presence of any MS components, is independently associated with SBPRs. We are of the opinion that significantly impaired SBPR values, in addition to the decreased HRR values observed in this group of patients, such as those with MS, may especially help identify patients with potentially increased cardiovascular risk despite normal exercise stress testing findings.

Coronary subclavian steal syndrome: a case-based review.

Internal mammary artery (IMA) grafts have been shown to be superior to saphenous vein grafts in terms of rare atherosclerotic involvement, biochemical and physical qualities, and long-term patency rates. The IMA originates from the subclavian artery, just distal to the vertebral artery, and an occlusion or a hemodynamically significant stenosis proximal to the IMA ostium would cause a pressure drop distally and a reversal of flow from the coronary arteries to the IMA in patients with this graft. This condition is referred to as "coronary subclavian steal syndrome" (CSSS). In most cases, the cause of this syndrome is atherosclerotic disease; however, other causes of subclavian artery stenosis (SAS) have the potential to lead to CSSS. Patients with CSSS present with the symptoms of myocardial ischemia due to coronary steal, vertebrobasilar insufficiency, or limb ischemia. Discrepancy in the blood pressure (BP) measurements in two arms should warn the clinician of SAS. A diminished pulse or the bruit of jet flow on the lesion side can be noticed. Doppler ultrasonography, computed tomography angiography, and magnetic resonance angiography are safe and accurate noninvasive modes of diagnosis. Treatment can be surgical or percutaneous.

Effects of coronary artery bypass grafting surgery on retinal vascular caliber, ocular pulse amplitude and retinal thickness measurements.

AIM: The retina and ocular vasculature are vulnerable to alterations in systemic hemodynamics, such as in open heart surgeries. Our aim was to investigate retinal vascular caliber (RVC), ocular pulse amplitude (OPA), peripapillary retinal nerve fiber layer (RNFL) and macular thickness in coronary artery bypass grafting (CABG) surgery patients. METHODS: Twenty-six patients who had a history of CABG surgery and 26 age-sex-matched healthy participants were recruited for this prospective, cross-sectional and comparative study. The RVC, peripapillary RNFL and macular thickness measurements were taken with spectral-domain optical coherence tomography. The OPA, a surrogate of pulsatile ocular blood flow, was measured with the Pascal dynamic contour tonometer. RESULTS: There were no statistically significant differences between the CABG surgery patients and the controls with regard to RVC, OPA, peripapillary RNFL thickness and macular thickness measurements (p>0.05). CONCLUSIONS: CABG surgery does not affect retinal structures and pulsatile ocular blood flow in the long-term follow-up.

Clinical and electrophysiological characteristics of the patients with relatively slow atrioventricular nodal reentrant tachycardia.

OBJECTIVE: The aim of this study is to retrospectively investigate clinical and electrophysiologic characteristics of typical AVNRT with relatively slow tachycardia rates below the average value compared to faster ones, in patients without structural heart disease. METHODS: The present study retrospectively included a total of 1,150 patients receiving successful slow-pathway radio frequency ablation for typical slow-fast AVNRT. Patients were divided into two groups according to their tachycardia cycle length: group I included 1,018 patients with tachycardia cycle length < 400 msn and group II included 132 patients with cycle length > 400 msn. Patients with another form of arrhythmia other than typical AVNRT, the existence of structural heart disease, preexisting prolonged PR interval, history of clinically documented AF, and reasons capable of causing AF were accepted as exclusion criterias. RESULTS: The patients in group II were older than those in group 1 (p=0.039), and male ratio was significantly higher in group II compared to group I (p=0.02). Wenckebach cycle length and AV node antegrade effective refractory period values before the RF ablation were significantly higher in group II compared to group I (p=0.0001 and 0.01, respectively). Right atrium effective refractory period values in both pre- and post-ablation period were significantly higher in group I compared to group II (p=0.0001 and 0.004, respectively). The existence of atrial vulnerability before ablation was significantly higher in group II compared to group I (p=0.007); however, there was no difference between the two groups in terms of atrial vulnerability after the ablation. In addition, while the ratio of anterior location as an ablation site near the His-bundle region was significantly higher in group II, the ratio of posterior location was significantly higher in group I (p=0.0001 for both). CONCLUSION: Our experience demonstrates that clinical and electrophysiologic characteristics of AVNRT patients with relatively slower tachycardia rates were quite different compared to the faster AVNRT cases.

The association between coronary flow rate and impaired heart rate recovery in patients with metabolic syndrome: A preliminary report.

BACKGROUND: The aim of this study is to evaluate heart rate recovery (HRR) and association between coronary flow rate and HRR in patients with metabolic syndrome (MS) who had morphologically normal coronary angiogram. METHODS: Study population included 43 patients with MS and 37 control subjects without MS. All patients were selected from individuals who had recently undergone coronary angiography in our hospital and were diagnosed as having angiographically normal coronary arteries. Exercise stress test results obtained prior to coronary angiography were evaluated for calculating HRR and other parameters. In addition, coronary flow was objectively evaluated for each major coronary artery in each subject using TIMI frame count method. RESULTS: All HRR values calculated were detected significantly lower in MS group compared to controls (HRR first: 32 ± 9 vs. 37 ± 10; p = 0.01, second: 46 ± 11 vs. 52 ± 11; p = 0.03, third: 51 ± 12 vs. 59 ± 12; p = 0.00, fourth: 54 ± 13 vs. 61 ± 2; p = 0.02). TIMI frame counts for each major epicardial coronary artery and mean TIMI frame count were also found to be significantly higher in MS group compared to controls (left anterior descending artery:51 ± 24 vs. 39 ± 15; p = 0.009, left circumflex artery: 32 ± 11 vs. 24 ± 7; p = 0.001, right coronary artery: 33 ± 14 vs. 24 ± 10; p = 0.003, mean TIMI frame count: 38 ± 15 vs. 29 ± 9;p = 0.002). Additionally, significant negative correlations were also detected between HRR first minute and coronary TIMI frame count values in patients with MS. None of MS parameters did not affect HRR values, however mean TIMI frame count independently associated with HRR first minute (p = 0.04) in patients with MS. CONCLUSIONS: Impaired coronary blood flow occurring in MS might be a clue of autonomic dysfunction in addition to previously known endothelial dysfunction.

The Relationship between Farmers' Perceptions and Animal Welfare Standards in Sheep Farms.

In this study, we investigated the relationship between welfare standards in sheep farms and farmers' perceptions of factors affecting animal welfare. We developed a scale of 34 items to measure farmers' perceptions of animal welfare. We examined the relationships among variables in farmers' characteristics, our observations, and farmers' expressed perceptions through a t test, variance analysis and correlation analysis. Results of the research suggested that higher welfare standards for sheep exist on farms run by farmers who have a higher perception level of animal welfare. These farmers believed that personnel and shelter conditions were more effective than veterinary inspection, feeding and other factors in terms of animal welfare. In addition, we detected a significant relationship between the farmers' perceptions and their gender, educational level, whether they enjoyed their work, or whether they applied the custom of religious sacrifice. Our results showed that emotional and cognitive factors related to farmers' perceptions may offer opportunities for progress in the domain of animal welfare.

Ventilation rates in large commercial layer hen houses with two-year continuous monitoring.

1. Ventilation controls the indoor environment and is critical for poultry production and welfare. Ventilation is also crucial for assessing aerial pollutant emissions from the poultry industry. Published ventilation data for commercial layer houses have been limited, and are mostly based on short-term studies, mainly because monitoring airflow from large numbers of fans is technically challenging. 2. A two-year continuous ventilation monitoring trial was conducted at two commercial manure belt houses (A and B), each with 250 000 layers and 88 130-cm exhaust fans. All the fans were individually monitored with fan rotational speed sensors or vibration sensors. Differential static pressures across the house walls were also measured. Three fan performance assessment methods were applied periodically to determine fan degradations. Fan models were developed to calculate house ventilations. 3. A total of 693 and 678 complete data days, each containing >16 h of valid ventilation data, were obtained in houses A and B, respectively. The two-year mean ventilation rates of houses A and B were 2·08 and 2·10 m(3) h(-1) hen(-1), corresponding to static pressures of -36·5 and -48·9 Pa, respectively. For monthly mean ventilation, the maximum rates were 4·87 and 5·01 m(3) h(-1) hen(-1) in July 2008, and the minimum were 0·59 and 0·81 m(3) h(-1) hen(-1) in February 2008, for houses A and B, respectively. 4. The two-year mean ventilation rates were similar to those from a survey in Germany and a 6-month study in Indiana, USA, but were much lower than the 8·4 and 6·2 m(3) h(-1) hen(-1) from a study in Italy. The minimum monthly mean ventilation rates were similar to the data obtained in winter in Canada, but were lower than the minimum ventilation suggested in the literature. The lower static pressure in house B required more ventilation energy input. The two houses, although identical, demonstrated differences in indoor environment controls that represented potential to increase ventilation energy efficiency, and reduce carbon footprints and operational costs.

Aortic pressures, stiffness and left ventricular function in coronary slow flow phenomenon.

BACKGROUND: Coronary slow flow (CSF) phenomenon is characterized by delayed opacification of coronary vessels in a normal coronary angiogram. Although clinical and pathological features have been previously described, the underlying pathophysiology has not been fully elucidated. In this study, we aimed to evaluate central aortic pressure, aortic stiffness and left ventricular (LV) function in patients with coronary slow flow. METHOD AND RESULTS: The study population consisted of 154 patients who underwent coronary angiography because of typical and quasi-typical symptoms of angina. 81 patients with angiographically proven CSF and 73 cases with normal coronary flow pattern with similar risk profiles were enrolled in the study. Aortic pressures and indexes of elastic properties were evaluated using invasive methods. Aortic pulse pressure (mm Hg) and pulsality index of patients with CSF were found to be significantly higher than those of controls (60.8 ± 13.8 vs. 53.7 ± 14.5, p = 0.002; 0.84 ± 0.22 vs. 0.67 ± 0.18, p = 0.0001, respectively). LV Doppler parameters were deteriorated in patients with CSF. Aortic fractional pulse pressure and pulsality index were significantly correlated with the mean TIMI frame count and LV diastolic parameters in correlation analysis. CONCLUSION: The present findings allow us to conclude that impaired aortic elasticity in patients with CSF may also be responsible for the impaired LV diastolic parameters.

Screening for G71R mutation of the UDP-glucuronosyltransferase 1 (UGT1A1) gene in neonates with pathologic and prolonged hyperbilirubinemia in Turkey.

OBJECTIVE: Whether the G71R mutation contributes to the high incidence of neonatal indirect hyperbilirubinemia in Turkey remains unknown. In this study we screened for G71R mutation of the UGT1A1 gene in prolonged and pathological hyperbilirubinemia with unexplained etiology in newborns in Turkey. METHOD: In this study, we screened the G71R mutation of the UGT1A1 gene in 70 Turkish newborn infants: 23 infants with pathologic hyperbilirubinemia, 24 infants with prolonged hyperbilirubinemia and 23 infants without pathologic and prolonged hyperbilirubinemia. Mutations were detected by non-radioactive dye terminator cycle sequencing. RESULTS: In these seventy infants enrolled in this study, there were 62 with G/G (88.5 %), 8 with G/R (11.5%), and none with R/R. Two (8.7%) infants in the pathologic jaundice group and 5 (20.8 %) infants in the prolonged indirect hyperbilirubinemia, one (4.3%) infant in the control group had G/R genotype. Although G/R mutation is higher in the prolonged indirect hyperbilirubinemia group, genotypic distributions among the three groups were not statistically significant. The allele frequency of the G71R mutation was found 4.3%, 10.4%, and 2.2% in the pathologic jaundice group, in the prolonged indirect hyperbilirubinemia group, and in the control group respectively. When we compared the peak serum total bilirubin concentrations of neonates according to their genotypes, the peak bilirubin concentration was higher in G/R genotype than G/G genotype. CONCLUSIONS: G71R mutation of UGT1A1 gene is also present in Turkish population and the presence of this mutation is associated with otherwise unexplained pathological or prolonged neonatal hyperbilirubinemia in a Turkish population.

The microbial colonisation of mobile phone used by healthcare staffs.

Mobile phones are dispensable accessories in social life and normally they are not cleaned properly. Therefore, they serve as a reservoir of bacteria and may cause nosocomial infections in hospitals. The purpose of this study was to investigate microbiological colonization of mobile phones used by healthcare staffs. The study was carried out collecting swab samples with Cary-Blair transport medium from mobile phones of attending healthcare staffs from different departments of three hospitals in March, 2008. All collected samples were inoculated in 5% sheep blood agar, eosin-methylene blue agar and Sabouraud Dextrose agar. Isolated bacteria were identified using by classic technique and Vitec2 (Biomerieux, France) full automated bacteria identification system. Growth was observed in 65 of collected 106 samples, corresponding to 61.3%. The most frequent bacteria were Staphylococcus epidermidis followed by Staphylococcus aureus, Bacillus sp., Corynebacterium sp. and Escherichia coli, respectively. In conclusion, bacteria were colonized on mobile phones frequently and mobile phones may become reservoir of microorganism for nosocomial infections.

Congenital lymphoedema, bronchiectasis and seizure: case report.

A 10-year-old girl with facial anomalies, mental retardation, peripheral lymphoedema, convulsions, cerebral cortical dysgenetic changes, bronchiectasis and chronic sinusitis is presented. She had features of both yellow nail syndrome and Hennekam syndrome. We think that our case might be a new congenital lymphoedema syndrome or an intermediate form between these syndromes.

The value of admission glycosylated hemoglobin level in patients with acute myocardial infarction.

BACKGROUND: Glycosylated hemoglobin (HbA1c) level on admission is a prognostic factor for mortality in patients with and without diabetes after myocardial infarction. In the present study, the authors examined the relationship between admission HbA1c level and myocardial perfusion abnormalities in patients with acute myocardial infarction. METHODS: One hundred consecutive patients with acute myocardial infarction who were treated with thrombolytic therapy were included in the present prospective study. Blood glucose and HbA1c levels of all patients were measured within 3 h of admission. Patients were divided into three groups according to HbA1c level: 4.5% to 6.4% (n=25), 6.5% to 8.5% (n=28) and higher than 8.5% (n=47). All patients then underwent exercise thallium-201 imaging and coronary angiography to determine ischemic scores and the number of diseased coronary arteries four weeks after admission. RESULTS: Seven patients died within the four-week follow-up period. There was a significant relationship between admission HbA1c level and mortality (P=0.009). Furthermore, there was a significant relationship between HbA1c level and total ischemic scores in patients with acute myocardial infarction (r=0.482; P=0.001). Ischemic scores increased as HbA1c levels increased in patients with acute myocardial infarction. CONCLUSIONS: The results demonstrated that admission plasma glucose and HbA1c levels are prognostic factors associated with mortality after acute myocardial infarction.