Comparison of coronary artery lesion complexity and body component parameters measured by TANITA.

Introduction: Obesity is one of the main reversible causes of coronary artery disease. Aim: To investigate the relationship between body component measurements calculated with TANITA and SYNTAX score (SXscore), which indicates coronary complexity. Material and methods: 200 acute subendocardial myocardial infarction patients were included in our study. Body component measurements were made with the TANITA BC-601 device. After coronary angiography, patients were divided into two groups: high SXscore (≥ 22) and low-medium SXscore (< 22). Results: When the high SXscore group (50 patients) was compared with the low medium SXscore group (150 patients); for waist height ratio (p = 0.001), total fat weight (p = 0.001), total fat percentage (p = 0.006), total water percentage (p = 0.001), trunk fat percentage (p = 0.001), internal fat (p = 0.001) and metabolic age (p < 0.001), a statistical difference was found. In the correlation analysis, a correlation was detected between high SXscore and the waist height ratio (p = 0.042), trunk fat percentage (p = 0.047), internal fat (p < 0.001) and metabolic age (p = 0.009). ROC curve analysis for prediction of high SXscore detection; the cut-off value for internal fat and metabolic age was found to be 13.5-60.5 with 60-64% sensitivity and 61.3-62.7% specificity. Conclusions: We demonstrated the relationship between parameters such as internal fat, trunk fat percentage and metabolic age calculated by TANITA and SXscore, which is the coronary complexity score. We recommend that patients with high values detected during TANITA measurements be followed more carefully in terms of primary preventive medicine.

Are Sleep Quality, Physical Activity Levels, and Fear of Movement of Obstructive Sleep Apnea Syndrome Patients Different From Healthy People During the Coronavirus Disease 2019 Pandemic?

OBJECTIVE: The sleep quality and physical activity levels of patients with obstructive sleep apnea syndrome during the lockdown period have not yet been investigated. The aim of this study was to evaluate the sleep quality, physical activity level, and fear of movement in patients with obstructive sleep apnea syndrome and healthy individuals during the coronavirus disease 2019 pandemic. MATERIAL AND METHODS: Patients with obstructive sleep apnea syndrome (n = 33) and healthy individuals (n = 30) were included in the study. Physical activity levels, sleep quality, and fear of movement were evaluated. RESULTS: The total physical activity amount of patients with obstructive sleep apnea syndrome and healthy individuals was lower than the acceptable levels. The obstructive sleep apnea syndrome group had significantly lower leisure-time physical activity (P = .006) and higher sitting time (P = .008) than the healthy individuals. Patients with obstructive sleep apnea syndrome had significantly more sleep disturbances, daytime dysfunction, and daytime sleepiness than healthy people (P < .001). Fear of movement was negatively correlated with the amount of vigorous (r = -0.395, P = .023) and leisure activities (r = -0.557, P = .001) in the obstructive sleep apnea syndrome group. CONCLUSION: During the coronavirus disease 2019 pandemic, patients with obstructive sleep apnea syndrome and healthy individuals had lower physical activity levels. Physical activity counseling is an important strategy for increasing the physical activity of patients with obstructive sleep apnea syndrome and healthy individuals during and after the coronavirus disease 2019 pandemic.

High- and low-intensity expiratory muscle strength training in patients with severe obstructive sleep apnea syndrome using non-invasive mechanical ventilation: A double-blinded, randomized controlled trial.

BACKGROUND: The effects of expiratory muscle strength training (EMST) with different intensity on stages of sleep were not examined in patients with obstructive sleep apnea syndrome (OSAS). OBJECTIVES: The aim of this study was to compare the effects of high- and low-intensity EMST (H-EMST and L-EMST) on disease severity, sleep stages, disease-related symptoms, daytime sleepiness, fatigue severity, and sleep quality in adult patients with severe OSAS using non-invasive mechanical ventilation (NIMV). METHODS: Thirty-one clinically stable patients with severe OSAS were included in this prospective, randomized controlled, double-blinded study. These were randomly divided into two groups. The H-EMST group underwent training at 60% of maximum expiratory pressure (MEP) and the L-EMST group at 30% of MEP, seven days a week for eight weeks. Apnea hypopnea index (AHI), sleep stages, and respiratory sleep parameters were recorded using polysomnographic sleep analysis. RESULTS: AHI decreased by 34.57% and 20.20% in the H-EMST and L-EMST groups, respectively. A statistically significant improvement in disease severity classifications distributions was observed in the H-EMST group after training (p = 0.016). A greater number of symptoms improved in the H-EMST. The effects of training on respiratory muscle strength, daytime sleepiness, fatigue perception, and sleep quality levels were comparable between the two groups (p>0.05). CONCLUSIONS: H-EMST training is more effective in reducing disease severity and disease-related symptoms than L-EMST. Further studies are warranted for evaluating the long-term effects of EMST with larger sample sizes in OSAS.

Mitral Valve Surgery in Patients With an Implanted Amplatzer Septal Occluder: A Review of 2 Cases.

Surgical approaches for mitral valve exploration vary, with the preferred approach being via the interatrial groove. Data on whether the interatrial groove approach can be used for mitral valve surgery in patients with a previously implanted Amplatzer septal occluder (ASO) (St Jude Medical, an Abbott company) are extremely limited. The authors performed mitral valve surgery using the transatrial septal approach on 2 patients following explantation of an ASO, which significantly impedes the interatrial groove approach. Concomitant surgical procedures with mitral valve replacement, removal of the ASO, and closure of an atrial septal defect with a patch significantly prolonged the cross-clamp and cardiopulmonary bypass durations, which is the reason for intraoperative low cardiac output syndrome. An intra-aortic balloon pump and venoarterial extra-corporeal membrane oxygenation were used in these 2 patients because of low cardiac output syndrome. When planning mitral valve surgery in patients with a previously implanted ASO, the device precludes the interatrial groove approach and can produce an unpredictable clinical scenario.

Reliability and Validity of the Turkish Version of the Performance Measure for Activities of Daily Living-8 for Patients with Mild Symptomatic Heart Failure.

OBJECTIVE: The Performance Measure for Activities of Daily Living-8 (PMADL-8) for patients with congestive heart failure is an International Classification of Functioning, Disability, and Health-based Activities of Daily Living (ICF) questionnaire to evaluate disease-specific functional limitations in chronic heart failure (CHF). The purpose of this study was to investigate the reliability and validity of the Turkish version of the PMADL-8 in CHF patients. METHODS: In this study, 50 patients with CHF were included. Test-retest reliability of the PMADL-8 was assessed by intraclass correlation coefficient and Cronbach's alpha was calculated for internal consistency. Correlation coefficients between the PMADL-8 and New York Heart Association (NYHA) functional class, Chronic Heart Failure Questionnaire (CHQ), Nottingham Health Profile (NHP) were analyzed for construct validity. RESULTS: The Cronbach's alpha value of the PMADL-8 test and retest scores were recorded as 0.996, indicating that the scale is highly reliable. Test-retest reliability results of the PMADL-8 (mean intraclass correlation coefficient = 0.996) were excellent. The PMADL-8 score was moderately correlated with the NHP total score (r = 0.629, P < .001) and NHP physical abilities score (r = 0.517, P < .001). The PMADL-8 score was weakly correlated with the NYHA functional class (r = 0.385, P < .006), CHQ dyspnea (r = -0.475, P < .001), CHQ fatigue (r = -0.340, P = .016), and total score (r = -0.367, P = .009). CONCLUSION: The Turkish version of PMADL-8 is a reliable and valid assessment tool that could be used to determine activity limitations in CHF. The PMADL-8 is also useful for health professionals during the ICF evaluation of CHF patients.

The effectiveness of oropharyngeal exercises compared to inspiratory muscle training in obstructive sleep apnea: A randomized controlled trial.

BACKGROUND: Inspiratory muscle training (IMT) and oropharyngeal exercises (OE) have different advantages and disadvantages and a comparison of these modalities has been recommended. The aim of this study was to compare the effects of IMT and OE on important outcomes for patients with OSAS. METHODS: This was a randomized controlled clinical trial. Forty-one clinically stable OSAS patients not receiving CPAP therapy were randomly divided into three groups. Patients in the IMT group (n = 15) trained with a threshold loading device 7 days/week for 12 weeks. Patients in the OE group (n = 14) practiced exercises 5 days/week for 12 weeks. Twelve patients served as control group. Apnea-hypopnea index (AHI), respiratory muscle strength, snoring severity and frequency (Berlin Questionnaire), daytime sleepiness (Epworth Sleepiness Scale; ESS), sleep quality (Pittsburg Sleep Quality Index; PSQI), impact of sleepiness on daily life (Functional Outcomes of Sleep Questionnaire; FOSQ), and fatigue severity (Fatigue Severity Scale; FSS) were evaluated before and after the interventions. RESULTS: AHI and sleep efficiency did not change significantly in any of the groups. Significant decreases in snoring severity and frequency, FSS and PSQI total scores were found in the IMT and OE groups after the treatments (p < 0.05). There was a significant reduction in neck and waist circumference and significant improvement in respiratory muscle strength (MIP and MEP) in IMT group compared to control group (p < 0.05). The%MEPpred value and FOSQ total score significantly increased and ESS score reduced after the treatment in OE group compared to control group (p < 0.05). CONCLUSIONS: Our results indicate that both OE and IMT rehabilitation interventions are applicable in rehabilitation programs for OSAS patients who do not accept CPAP therapy. Our findings could lead to increase these methods' use among rehabilitation professionals and decrease in cost of CPAP treatment in OSAS.

What Is the Best Pulmonary Physiotherapy Method in ICU?

Objective. Effects of high frequency chest wall oscillation technique were investigated on intubated ICU patients. Background. Thirty intubated patients were included in the study. The control group (n = 15) received routine pulmonary rehabilitation technique. In addition to the pulmonary rehabilitation technique, the study group (n = 15) was given high frequency chest wall oscillation (HFCWO). APACHE II, dry sputum weight, lung collapse index, and blood gas values were measured at 24th, 48th, and 72nd hours and endotracheal aspirate culture was studied at initial and 72nd hour. The days of ventilation and days in ICU were evaluated. Results. There is no significant difference between APACHE II scores of groups. The dry sputum weights increased in the study group at 72nd hour (p = 0.001). The lung collapse index decreased in study group at 48th (p = 0.003) and 72nd hours (p < 0.001). The PO2 levels increased in the study group at 72nd hour (p = 0.015). The culture positivity at 72nd hour was decreased to 20%. The days of ventilation and staying in ICU did not differ between the groups. Conclusions. Although HFCWO is very expensive equipment, combined technique may prevent the development of lung atelectasis or hospital-acquired pneumonia more than routine pulmonary rehabilitation. It does not change intubated period and length of stay in ICU. However, more further controlled clinical studies are needed to use it in ICU.