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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.

Obesity is one of the main reversible causes of coronary artery disease. To investigate the relationship between body component measurements calculated with TANITA and SYNTAX score (SXscore), which indicates coronary complexity. 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). When the high SXscore group (50 patients) was compared with the low medium SXscore group (150 patients); for waist height ratio ( = 0.001), total fat weight ( = 0.001), total fat percentage ( = 0.006), total water percentage ( = 0.001), trunk fat percentage ( = 0.001), internal fat ( = 0.001) and metabolic age ( < 0.001), a statistical difference was found. In the correlation analysis, a correlation was detected between high SXscore and the waist height ratio ( = 0.042), trunk fat percentage ( = 0.047), internal fat ( < 0.001) and metabolic age ( = 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. 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.

Abstract Study Objectives This study aimed to evaluate and compare the effects of high and low-intensity expiratory muscle strength training (EMST) on disease severity, systemic inflammation, oxidative stress, respiratory muscle strength, exercise capacity, symptoms, daytime sleepiness, fatigue severity, and sleep quality in male patients with obstructive sleep apnea syndrome (OSAS). Methods Thirty-one male patients diagnosed with moderate OSAS were included in this double-blind, randomized, parallel study. Patients were randomized into two groups: High-EMST and Low-EMST groups. EMST was used at home 7 days/week, once a day, for 25 breaths, 12 weeks. Respiratory muscle strength was measured using a mouth pressure device. Disease severity (Apnea–Hypopnea Index [AHI]) and, respiratory sleep events by polysomnography, total oxidant level(TOS), total antioxidant level(TAS), oxidative stress index (OSI), C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10) levels by blood serum were evaluated. Results The percentage of AHI change in the high-EMST group(50.8%) was significantly higher than in the low-EMST group(6.3%; p = .002, d = 1.31). In general, as MEP increased by one unit, AHI decreased by 0.149 points (b = −0.149; CR = −3.065; p = .002), and as AHI increased by one unit, ODI increased by 0.746 points (b = 0.746; CR = 10.604; p < .001). TOS, OSI, TNF-α and IL-6 levels decreased at similar rates in both groups. Conclusions EMST significantly reduces systemic inflammation and oxidative stress while improving expiratory muscle strength in male patients with moderate OSAS. High-EMST is more effective in enhancing the severity of disease than low-EMST. EMST is a practical, effective, and promising treatment for pulmonary rehabilitation in patients with moderate OSAS. Clinical Trials Effect of EMST systemic inflammation and oxidative stress in patients with moderate OSAS, https://clinicaltrials.gov/study/NCT05242406, with the number NCT05242406. Graphical Abstract Graphical Abstract

Yoğun bakım ünitelerinde yatan ve ekstra-korporeal membran oksijenasyonu (ECMO) uygulanan koronavirüs hastalığı-2019 (COVİD-19) hastalarında uzun süreli yatak istirahati, enfeksiyon ve kritik hastalık nöropatisi/miyopatisi nedeniyle birçok kardiyak, pulmoner ve psikiyatrik komplikasyon ortaya çıkmaktadır. Fizyoterapi, ECMO dekanülasyonunu takiben subakut fazda fiziksel fonksiyonların eski haline getirilmesinde önemli bir rol oynamaktadır. Taburcu olduktan sonra, bu hastalar kombine rehabilitasyon ile daha hızlı iyileşmekte ve yaşam kaliteleri artmaktadır. Bu yazıda, ECMO tedavisi gören ve yoğun bakım ünitesinden taburcu olan COVİD-19’lu iki hastaya uygulanan kombine fizyoterapi programının etkileri tartışılmaktadır. Kombine rehabilitasyon programının taburcu olduktan sonra erken uygulanması olumlu sonuçlanmıştır. Many cardiac, pulmonary, and psychiatric complications occur due to long-term bed rest, infection, and critical illness neuropathy/myopathy in extra-corporeal membrane oxygenation (ECMO) applied coronavirus disease-2019 (COVID-19) inpatients in intensive care units. Physiotherapy plays an important role in restoring physical functions in the subacute phase following ECMO decannulation. After being discharged, and with combined rehabilitation, these patients experience a faster recovery and their quality of life increases. In this article, the effects of the combined physiotherapy program, which was applied to two patients with COVID-19 who received ECMO treatment and were discharged from the intensive care unit, is discussed. Early application of the combined rehabilitation program after discharge resulted in a positive outcome.

OBJECTIVEThe 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.METHODSIn 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.RESULTSThe 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).CONCLUSIONThe 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.

Objective: The purpose of this study was to compare the respiratory functions, exercise performance, and quality of sleep in patients with Obstructive Sleep Apnea syndrome (OSAS) and Chronic Obstructive Pulmonary disease (COPD) compared to healthy individuals. Materials and Methods: Seventeen patients with OSAS (12 M, 5 F), 24 patients with COPD (20 M, 4 F) and 20 healthy subjects (15 M, 5 F) participated in this cross-sectional study. Respiratory function and muscle strength tests were performed. Knee extensors, shoulder abductors, and hand grip strength were measured in patients with OSAS and COPD using a digital hand-held dynamometer. Exercise performance was evaluated using a 6-minute walk test (6MWT), and sleep quality was assessed by the Pittsburgh Sleep Quality index (PSQI). Results: The 6MWT distance, 6MWT% distance, actual and percentage values of shoulder abductors muscle strength of patients with COPD were significantly lower than those of the OSAS group (p<0.05). According to PSQI recordings, 58.8% of OSAS patients’ sleep quality, 58.3% COPD patients’ sleep quality, and 15.0% of healthy individuals’ sleep quality were poor (p=0.006). The PSQI-sleep disturbance, daytime dysfunction, habitual sleep efficiency subdimensions, and total scores of PSQI in OSAS and COPD group were higher than those of healthy individuals (p<0.05). Conclusion: This study showed that sleep quality is adversely affected in both OSAS and COPD patients and sleep disturbance and daytime dysfunction increases and habitual sleep efficiency decreases in OSAS and COPD patients compared to those of healthy individuals

Objective: Currently, there is a need for research that examines factors which affect physical activity (PA) participation in Obstructive Sleep Apnea syndrome (OSAS) patients. The purpose of this study was to investigate the relationship between the PA level and daytime sleepiness, fatigue perception, quality of life, and psychological status in patients with OSAS. Materials and Methods: This cross-sectional study involved 38 patients with OSAS between the ages of 30-60 years. The PA level was determined using the Turkish version of the International Physical Activity Questionnaire (IPAQ). Quality of life was evaluated by the Functional Outcomes of Sleep Questionnaire and Nottingham Health Profile (NHP). The Epworth Sleepiness Scale (ESS) was used for evaluation of the sleepiness status. The fatigue perception of the patients was evaluated by the Fatigue Impact Scale (FIS) and the Fatigue Severity Scale (FSS). Results: According to IPAQ classification, 44.7% of patients were inactive. A marked correlation was observed between IPAQ-total score with ESS score (r =-0.493, p=0.002), Hospital Anxiety and Depression Scale-Anxiety score (r=-0.338, p=0.041), NHP-social isolation score (r=-0.406, p=0.013), FIS-physical score (r=-0.404, p=0.013), and FISpsychosocial score (r=-0.411, p=0.012). Conclusion: This study showed that the total amount of PA in patients with OSAS is closely related to excessive daytime sleepiness, anxiety level, social isolation and effects of fatigue on physical and psychosocial functions.

Objective: The purpose of this study was to compare the respiratory functions, exercise performance, and quality of sleep in patients with Obstructive Sleep Apnea syndrome (OSAS) and Chronic Obstructive Pulmonary disease (COPD) compared to healthy individuals. Materials and Methods: Seventeen patients with OSAS (12 M, 5 F), 24 patients with COPD (20 M, 4 F) and 20 healthy subjects (15 M, 5 F) participated in this cross-sectional study. Respiratory function and muscle strength tests were performed. Knee extensors, shoulder abductors, and hand grip strength were measured in patients with OSAS and COPD using a digital hand-held dynamometer. Exercise performance was evaluated using a 6-minute walk test (6MWT), and sleep quality was assessed by the Pittsburgh Sleep Quality index (PSQI). Results: The 6MWT distance, 6MWT% distance, actual and percentage values of shoulder abductors muscle strength of patients with COPD were significantly lower than those of the OSAS group (p<0.05). According to PSQI recordings, 58.8% of OSAS patients' sleep quality, 58.3% COPD patients' sleep quality, and 15.0% of healthy individuals' sleep quality were poor (p=0.006). The PSQI-sleep disturbance, daytime dysfunction, habitual sleep efficiency subdimensions, and total scores of PSQI in OSAS and COPD group were higher than those of healthy individuals (p<0.05). Conclusion: This study showed that sleep quality is adversely affected in both OSAS and COPD patients and sleep disturbance and daytime dysfunction increases and habitual sleep efficiency decreases in OSAS and COPD patients compared to those of healthy individuals. Keywords: Obstructive sleep apnea, exercise test, muscle strength, respiratory muscles, Chronic Obstructive Pulmonary disease Amac: Bu calismanin amaci Obstruktif Uyku Apne sendromu (OUAS) ve Kronik Obstruktif Akciger hastaligi (KOAH) olan hastalarda solunum fonksiyonlari, egzersiz performansi ve uyku kalitesini saglikli bireylerle karsilastirmaktir. Gerec ve Yontem: Bu kesitsel calismaya 17 OUAS'li hasta (12 erkek, 5 kadin), 24 KOAH'li hasta (20 erkek, 4 kadin) ve 20 saglikli birey (15 erkek, 5 kadin) katildi. Solunum fonksiyonu ve kas kuvvet testleri yapildi. OUAS ve KOAH'li hastalarda diz ekstansorleri, omuz abduktorleri ve el kavrama kuvveti dijital el dinamometresi kullanilarak olculdu. Egzersiz performansi 6 dakika yurume testi (6DYT) kullanilarak, uyku kalitesi Pittsburgh Uyku Kalitesi indeksi (PUKI) ile degerlendirildi. Bulgular: KOAH'li hastalarin 6DYT mesafesi, 6DYT mesafesi (%), omuz abduktorleri kas kuvveti olculen ve yuzde degerleri OUAS grubuna gore anlamli olarak dusuktu (p<0,05). PUKI kayitlarina gore OUAS hastalarinin %58,8'inin, KOAH hastalarinin %58,3'unun ve saglikli bireylerin %15,0'inin uyku kalitesi zayifti (p=0,006). OUAS ve KOAH grubunda PUKI-uyku bozuklugu, gunduz fonksiyon bozuklugu, alisilmis uyku etkinligi alt boyutlari ve toplam PUKI skorlari saglikli bireylerden daha yuksekti (p<0,05). Sonuc: Bu calisma, hem OUAS hem de KOAH hastalarinda uyku kalitesinin olumsuz etkilendigini ve sa u likli bireylere gore OUAS ve KOAH hastalarinda uyku bozuklugu ve gnduz fonksiyon bozuklugunun arttigini ve alisilmis uyku etkinliginin azaldigini gostermistir. Anahtar Kelimeler: Obstruktif uyku apnesi, egzersiz testi, kas kuvveti, solunum kaslari, Kronik Obstruktif Akciger hastaligi

Obesity is strongly associated with impaired physical function and increased health risks. Functional performance tests such as the Timed Up and Go (TUG), Five Times Sit-to-Stand (5xSTS), and 4-Meter Walk Test (4MWT) are essential for evaluating mobility, strength, and gait speed. Although widely used in clinical practice, the reliability of remote tele-assessment of these tests in adults with obesity remains unclear. This study aimed to determine the inter- and intra-rater reliability of tele-assessment compared with face-to-face assessment for commonly used functional performance tests in adults with obesity. A repeated-measures observational study was conducted with 82 adults with obesity. Participants performed TUG, 5xSTS, and 4MWT tests both in a clinical setting and remotely at home using video-based tele-assessment. Inter-rater reliability was good for TUG (ICC = 0.826) and 5xSTS (ICC = 0.880), and moderate for 4MWT (ICC = 0.743). Intra-rater reliability across two tele-assessments was excellent for TUG (ICC = 0.910) and 5xSTS (ICC = 0.902), and good for 4MWT (ICC = 0.858). Tele-assessment provides a reliable alternative to face-to-face assessment of functional performance tests in adults with obesity. These findings support the integration of remote functional testing into digital health practice, expanding access to mobility and strength evaluations for populations with limited access to in-person care. Not applicable.

Coronary angiography (CAG) is invasive and expensive, while numbers of patients suspected of coronary artery disease (CAD) undergoing CAG results have no coronary lesions. To develop machine learning algorithms using symptoms and clinical variables to predict CAD. This study was conducted as a cross-sectional study of patients undergoing CAG. We randomly chose 2082 patients from 2602 patients suspected of CAD as the training set, and 520 patients as the test set. We utilized LASSO regression to do feature selection. The area under the receiver operating characteristic curve (AUC), confusion matrix of different thresholds, positive predictive value (PPV) and negative predictive value (NPV) were shown. Support vector machine algorithm performances in 10 folds were conducted in the training set for detecting severe CAD, while XGBoost algorithm performances were conducted in the test set for detecting severe CAD. The algorithm of logistic regression achieved an average AUC of 0.77 in the training set during 10-fold validation and an AUC of 0.75 in the test set. When probability predicted by the model was less than 0.1, 11 patients in the test set (520 patients) were screened out, and NPV reached 90.9%. When probability predicted by the model was less than 0.2, 110 patients in the test set were screened out, and reached 83.6%. Meanwhile, when threshold was set to 0.9, PPV reached 97.4%. When the threshold was set to 0.8, PPV reached 91.5%. Machine learning algorithm using data from hospital information systems could assist in severe CAD exclusion and confirmation, and thus help patients avoid unnecessary CAG.