Outcomes of coblation tonsillectomy versus bipolar electrocautery tonsillectomy in pediatric population

Background: Bipolar electrocautery tonsillectomy has been the preferred technique for many otolaryngologists, yet coblation tonsillectomy is gaining popularity in the current practice. This study aims at comparing both techniques in terms of pain, bleeding, and healing. Result(s): A total of 120 patients were randomly divided into two equal groups. Overall mean pain score associated with coblation tonsillectomy was statistically less than that caused by bipolar electrocautery throughout the follow-up period (p < 0.001). The difference in pain duration was statistically longer for the bipolar group. The incidence of postoperative hemorrhage-both reactionary and secondary-was statistically higher in the bipolar group. Coblation tonsillectomy showed statistically shorter duration of healing (p < 0.001). Conclusion(s): Coblation tonsillectomy is associated with less pain severity and shorter pain duration, fewer bleeding incidents, and more prompt healing.Copyright © 2022, The Author(s).

Diagnosis of Nasal Breathing Using a Rhinomanometer in Patients with Osa Prescribed Conservative Treatment with Intraoral Devices

In recent years, diagnostics in the field of medicine has developed at an extremely rapid pace, thanks to the use and improvement of new medical devices and devices. The problem of timely and adequate diagnosis and treatment of the syndrome of obstructive sleep apnea (OSA) and snoring is particularly relevant world-wide. The disease has been proven to worsen the patients' quality of life, and may even threaten it. Obstructive sleep apnea and snoring syndrome (OSAS) is a widespread disease of social importance in which there is a reduction or cessation of airf low through the nose/mouth during sleep due to upper airway collapse. Obstructive sleep apnea affects the cardiovascular, endocrine, neurocognitive and other systems of the body. There are symptoms of loud snoring, choking, hypoxemia, and micro-awakenings, leading to sleep frag-mentation, daytime fatigue, and sleepiness. The latter greatly worsens the quality of life of patients. There are real risks to the life and health of the patient and others, given the possibility of falling asleep at the wheel in drivers with sleep apnea and participation in traffic accidents. To diagnose the syndrome, a poly-somnographic study is performed, which is still the gold standard. For a better diagnosis, it is recommend-ed to combine it with rhinomanometry. Treatment of OSA includes control of risk factors and removal of obstructive factors that make breathing difficult. Severe OSA syndrome is treated with continuous positive pressure ventilation (CPAP) during sleep, possibly in combination with intraoral devices. Rhinomanome-try can also be used to monitor the effectiveness of CPAP therapy in severe forms of the syndrome by deter-mining tissue resistance. The impact on patients with a milder form of OSA treated with intraoral devices is also monitored. The method can also be used in patients with allergic rhinitis, sinusitis of rhinogenic and other origin, and patients with orthodontic deformities. The correct choice of intraoral appliances for conservative treatment of OSA and timely diagnosis are key to successful treatment.Copyright © 2022, Bulgarian-American Center. All rights reserved.

Avascular necrosis in pediatric mandibular distraction - Report of a rare complication with a review on the pathogenic mechanism and management strategies

Avascular osseo-necrosis is one of the rare complications that has never been reported in pediatric mandibular distraction. However extensive periosteal stripping, developing tooth buds and aberrations related to the inferior alveolar canal in malformed syndromic mandible may lead to compromised vascularity to the osteotomised segments leading to avascular necrosis after monofocal mandibular distraction. The aim of the current case report is to describe this rare complication after pediatric MMDO and discuss in detail the possible etio-pathologic mechanisms and provide an insight for the management strategies.Copyright © 2021 The Authors

Sleep disturbances in post-Covid patients as a function of sex

Introduction: Within the post-Covid syndrome, sleep disturbances are one of the most persistent symptoms, in which women are more 50% vulnerable than men to insomnia. Objective(s): To compare the prevalence of sleep disorders in post-Covid patients according to sex. Method(s): A cross-sectional observational study was carried out. The participants were 264 post-Covid patients evaluated 3 months after hospital discharge, divided into men (n=156, G1) and women (n=108, G2). A general sleep habits survey and the Berlin SAOS questionnaire were used for sleep assessment. Statistical analyses were performed using SPSS v25. Result(s): Mean age was G1: 54.16 +/-11.751 and G2: 54.23 +/- 13.319. There were differences (p<0.05) between both sexes in the following disorders (G1 vs G2): snoring (73.1% vs 58.3%), primary snoring (45.6% vs 28.6%), unrefreshing sleep more than 3 times a week (28.2% vs 43.5%), tiredness or fatigue during the day at least 3 times a week (30.1% vs 51.9%), sudden movements in extremities: (37.2% vs 22.2%), onset insomnia: (34.0% vs 53.7%), intermediate insomnia (36.5% vs 58.3%), final insomnia: (39.7% vs 55.6%). No differences (p>0.05) were found in pauses in breathing, teeth grinding, feeling of paralysis and feeling of choking, with a prevalence greater than 20% in all cases. Conclusion(s): In our study, the affectation of most sleep disorders are more frequent in the female sex, with the predominance of different types of insomnia (onset, intermediate and final);which could be related to affective disorders. In men, the most prevalent disorders were snoring and sudden movements, mostly linked to respiratory disorders.

Diagnostic utility of the modified Berlin Questionnaire vs Berlin Questionnaire for the diagnosis of obstructive sleep apnoea in adults with a history of COVID-19 infection

Background: We have recently developed a modified Berlin Questionnaire (mBQ) based on three subcategories, ignoring obesity and hypertension, and showed that COVID-19 patients with high-risk obstructive sleep apnoea (OSA) had worse prognosis compared to those with low-risk OSA. Aims and Objective: We aimed to validate the mBQ and compare the results with the BQ in the same cohort. Method(s): Out of 320 subjects from the initial study, 70 completed the BQ and underwent an overnight polysomnography (PSG). The mBQ included 3 subcategories;snoring intensity/frequency, witnessed apneas, and morning/daytime tiredness. The patients were classified as high-risk OSA when they were positive on at least 2 subcategories. The apnoea-hypopnoea-index threshold on the PSG was set as 15 events/h. Result(s): In all, 27 patients (39%) were categorized as having OSA based on the PSG;the true positive rate was 85.2% for the mBQ, and 70.4% for the BQ. For the 43 cases without OSA on the PSG, the true negative rate was 90.7% for the mBQ, and 67.4% for the BQ. The mBQ had a sensitivity of 85.2%, a specificity of 90.7%, and the area under the curve was 0.87 (95% CI 0.78 - 0.97). Corresponding values were 60.6%, 78.4%, and 0.72 (95% CI 0.60 - 0.84) for the BQ, respectively. Conclusion(s): The mBQ had a better sensitivity and specificity compared to the BQ for OSA diagnosis in adults with a history of COVID-19 infection. The mBQ can be used in clinical management of cases with high-risk OSA in hospitals with long waiting lists for PSG, and to eliminate unnecessary PSG investigations for adults with low-risk OSA. Clinical trial registration: NCT04363333.

Unusual case of Obesity and Hypoventilation in Childhood

Objectives Childhood obesity can be monogenic or polygenic in etiology and is associated with significant morbidities. Rapid-onset obesity with hypoventilation, hypothalamic dysfunction, and autonomic dysregulation, and neural crest tumor (ROHHHAD[NET]) syndrome, is a rare autonomic and respiratory pediatric disorder presenting with rapid weight gain in early childhood, hypothalamic-pituitary dysfunction, central hypoventilation, and an association with neural crest tumors. Methods A 6-year-old Asian girl with abnormal weight gain since the age of 3 years, presented to the pediatrician's office due to pulse oximeter readings in the 60s at home. Parents were monitoring saturations at home as a way of screening for COVID-19 infection. The pediatrician confirmed hypoxemia and transferred the patient to the Children's Medical Center emergency department on oxygen via EMS. She had occasional snoring and nighttime cough, but no history of respiratory distress, or signs of infection. There was no hyperphagia, neonatal hypoglycemia, or developmental or behavioral concerns. On examination her body weight was 30 kg (+1.56 SD) and height was 113 cm (-1.46 SD) with a body mass index (BMI) of 23.4 kg/m2 (+2.33 SD). No acanthosis nigricans, cushingoid features, or respiratory distress were noted on examination. In the intensive care unit, she was diagnosed with central hypoventilation requiring mechanical ventilation. Her laboratory work-up revealed central hypothyroidism (low Free T4 of 0.64 ng/dl, TSH 1.553 microIU/L). Other anterior pituitary hormones were normal (adrenocorticotropic hormone, 16.3 pg/mL;cortisol, 10.7 mug/dL;prolactin, 9.95 ng/ml;Insulin-like growth factor-1, 83 ng/mL;and IGF binding protein 3, 3.02 mg/L). Genetic investigations revealed no known mutations in the PHOX2B gene, making a diagnosis of central hypoventilation syndrome unlikely. Results Rapid onset weight gain around 3 years of age, central hypoventilation, and anterior pituitary hormone deficiency in our patient with negative PHOX2B is consistent with a clinical diagnosis of ROHHHAD[NET]. Our patient was started on levothyroxine;received tracheostomy for mechanical ventilation;and gastrostomy for pharyngeal dysphagia. She is doing well, goes to school, and is tolerating trials off the ventilator during the day. Conclusions ROHHAD is an important differential to consider for any child with rapid and early obesity and hypoventilation as early diagnosis is critical in improving the clinical management and the prognosis.

Novel Conservative Management For Recurrent Temporomandibular Joint Dislocation

Introduction/Aims: We present the difficulties of managing a medically compromised patient with recurrent Temporomandibular Joint Dislocation who presented to us during the COVID-19 pandemic. We describe the novel use of an anti-snore head strap, in conjunction with a soft cervical collar which was successful in preventing further TMJ dislocations. To our knowledge, this has not been previously reported in the literature. It is important that clinicians must explore all options in patients with limited scope for surgical management when treating recurrent TMJ dislocations. Material(s) and Method(s): An anti-snore device was acquired online and in conjuction with a soft cervical collar was used to maintain the TMJ in it's position and prevent further recurrent dislocations. Results/Statistics: This simple, cost-effective and comfortable device reduced the number of hospital admissions for the patient, thereby additionally reducing her risk of contracting COVID-19. Prior to this intervention, the patient had presented for admission 10 times, resulting in a total stay of 65 days - the cost for this was 66,121.09. The anti-snore head device cost 11.99. Conclusions/Clinical Relevance: We present a novel technique in managing TMJ dislocation in a patient with severe morbidity who is limited with surgical treatment options. Therefore, we suggest the use of an anti-snore chin strap in conjunction with a soft cervical collar as a conservative management in medically compromised recurrent TMJ dislocations. Copyright © 2022

Snoring may transmit infectious aerosols from the upper to the lower respiratory tract.

Migration to the lungs of an initial upper airway infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or other respiratory pathogens can lead to pneumonia, associated with progression from mild to severe symptoms. Chemical pneumonitis or bacterial pneumonia may be caused by the 'macroaspiration' of large volumes of oropharyngeal or gastroesophageal secretions into the lower respiratory tract. 'Microaspiration', i.e., a similar mechanism but involving much smaller amounts of oropharyngeal secretions, is considered the pathogenetic mechanism for most pneumonias, including that associated with COVID-19. Here, we hypothesize an alternative mechanism: Rather than by microaspiration, these fluids enter the lungs as microdroplets that are generated by snoring and then carried by the inspired airstream. Laboratory measurements indicate that snoring generates (a) comparable numbers and sizes of oral fluid droplets as loud speaking and (b) total fluid quantities that are similar to those reported for microaspiration. Snoring propensity is strongly correlated to known risk factors for severe COVID-19, including male gender, age, obesity, diabetes, obstructive sleep apnea, and pregnancy. Therefore, more research is urgently needed to determine if various methods that decrease snoring can prevent progression to pneumonia after initial infection of the upper airways.

Cloud Nine: A Population Study of Sleep During the COVID-19 Pandemic

Introduction: In this study, we aimed to evaluate how the COVID-19 pandemic has affect sleep patterns. To do this, we used the Functional Outcomes of Sleep Questionnaire (FOSQ10) tool among the general US population. Method(s): A Qualtrics survey containing the FOSQ10 questions and additional demographics was created for Amazon MTurk, a crowdsourcing platform. Respondents aged 18 years and older completed the survey anonymously in October 2021. Two-way analysis of variance and 2-tailed t tests were used for analyses. Result(s): A total of 2474 responses were included. The 3 most prevalent sleep disorders were snoring (48% of respondents), insomnia (11% of respondents), and sleep apnea/mild/ moderate/severe (6% of respondents). The 3 most common services and/or procedures that people indicated interest in were sleep study (32% of respondents), nasal appliance (28% of respondents), or oral appliance (22% of respondents). The 3 most common social media platforms used before bed were Facebook (48% of respondents), Instagram (47% of respondents), and YouTube (39% of respondents). Individuals who had COVID-19 had a lower average FOSQ10 score than those who did not (27.0+/-6.4 [SD] vs 29.2+/-7.2), P<.0001. Individuals who snore had a lower average FOSQ10 score than those who do not (27.6+/-6.6 vs 29.4+/-7.4), P<.0001. Individuals who had a romantic partner or family member complain about their sleeping pattern (restlessness, snoring, etc) had a lower average FOSQ10 score than those who do not (27.1+/-6.5 vs 30.0+/-7.3), P<.0001. Individuals who have seen an otolaryngologist about snoring or any other sleep-related problems had a lower average FOSQ10 score than those who have not (26.7+/-6.0 vs 29.4+/-7.4), P<.0001. Conclusion(s): A higher score on the FOSQ10 was found to be associated with better sleep outcomes. It is an appropriate tool for assessing functional outcomes of sleep in the US population and can be used by otolaryngologists to better understand and treat patients with impaired sleep.

A PATIENT WITH COVID-19 PNEUMONIA, PULMONARY EMBOLISM, AND OSA

SESSION TITLE: Global Case Reports in Critical Care SESSION TYPE: Global Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Thrombotic complications in patients diagnosed with COVID-19 pneumonia are emerging as an important and significant morbidity and mortality burden, with overwhelming inflammation, hypoxia, immobilization, and diffuse intravascular coagulation among possible causes of a procoagulant state (1). Obstructive sleep apnea (OSA), with intermittent arterial oxygen desaturation, may in its turn contribute to a procoagulant state, causing hemodynamic alterations as polycythemia and sluggish blood flow (2). Here we report on a case of sudden and massive non-lethal pulmonary thromboembolism (PTE) in a patient with COVID-19 severe pneumonia, for whom OSA was suspected and documented as a possible concurrent mechanism of thromboembolic complication during follow-up. CASE PRESENTATION: A 55-year-old male non-smoker obese (BMI 33 Kg/m2) was admitted to our hospital after 9 days of fever. In the Emergency Room, a chest HRCT scan showed bilateral diffuse ground glass opacities. He was treated with subcutaneous Tocilizumab (324 mg) single shot, Remdesivir (200 mg/day for first day and 100/daily for further 4 days), methyl-prednisolone 40 mg/daily, Enoxaparin 6000 UI/twice daily, azithromycin 500 mg/daily, high flow nasal cannula oxygen (50 L/min, TC 34°C, FiO2 35%) for moderate acute respiratory failure due to COVID-19 pneumonia (pO2: 58 mmHg, PCO2 34 mmHg pH 7.50, P/F 275). After 10 days, patient's clinical conditions worsened, needing non-invasive respiratory support;D-dimer increased abruptly, rising to 10 ng/mL, with findings consistent with PTE at a computed tomographic angiography (CTA, Fig 1). The patient was successfully treated with 10 mg/daily subcutaneous fondaparinux for 12 days, while assisted in the Intensive Care Unit, being discharged home in room air shortly later with oral anticoagulants. At the 3-month follow-up visit, OSA was suspected due to reported excessive daytime sleepiness and weakness, snoring, disturbed night sleep, morning headache in the last 4 years. The patient underwent a home sleep apnea test (HSAT) overnight. Test results revealed an AHI of 50 events/h, with several prolonged episodes of obstructive sleep apnea (307 apnea and hypopnea (A+H) events, 70 obstructive apnea and 233 hypopnea events, with a mean duration of 10% and an average arterial saturation of 93% (Fig. 2). He was adapted to CPAP therapy, with benefit and good correction of polygraphic indexes. DISCUSSION: The pathogenetic mechanisms of COVID 19 and OSA could have played a synergistic effect on endothelial damage, thus increasing the risk of thromboembolism. CONCLUSIONS: The presence of underdiagnosed comorbidities may well worsen the clinical course and complication of COVID-19;an earlier diagnosis of OSA is a prerequisite for timely treatment and, potentially, improved long-term clinical outcomes. Reference #1: Suh YJ, et al. Pulmonary embolism and deep vein thrombosis in COVID 19: a systematic review and meta-analysis. Radiology 2021;298 (2): E70-E80. Reference #2: Alfonso-Fernandez A., Garcia Surquia A., de la Pena M. OSA is a risk factor for recurrent VTE Chest. 2016;150 (6): 1291-1301. DISCLOSURES: no disclosure on file for Antonietta Esposito;no disclosure on file for Antonella Frattari;no disclosure on file for Giustino Parruti;no disclosure on file for Giorgia Patrizio;no disclosure on file for Pierpaolo Prosperi;no disclosure on file for Giorgia Rapacchiale;No relevant relationships by ANTONELLA SPACONE no disclosure on file for Giacomo Zuccarini;

COVID-19 in a 16-Year-Old Adolescent With Mucopolysaccharidosis Type II: Case Report and Review of Literature

Coronavirus disease 2019 (COVID-19) in patients with underlying diseases, is associated with high infection and mortality rates, which may result in acute respiratory distress syndrome and death. Mucopolysaccharidosis (MPS) type II is a progressive metabolic disorder that stems from cellular accumulation of the glycosaminoglycans, heparan, and dermatan sulfate. Upper and lower airway obstruction and restrictive pulmonary diseases are common complaints of patients with MPS, and respiratory infections of bacterial or viral origin could result in fatal outcomes. We report a case of COVID-19 in a 16-year-old adolescent with MPS type II, who had been treated with idursulfase since 5 years of age. Prior to infection, the patient’s clinical history included developmental delays, abdominal distension, snoring, and facial dysmorphism. His primary complaints at the time of admission included rhinorrhea, cough, and sputum without fever or increased oxygen demand. His heart rate, respiratory rate, and oxygen saturation were within the normal biological reference intervals, and chest radiography revealed no signs of pneumonia. Consequently, supportive therapy and quarantine were recommended. The patient experienced an uneventful course of COVID-19 despite underlying MPS type II, which may be the result of an unfavorable host cell environment and changes in expression patterns of proteins involved in interactions with viral proteins. Moreover, elevated serum heparan sulfate in patients with MPS may compete with cell surface heparan sulfate, which is essential for successful interaction between the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein and the host cell surface, thereby protecting against intracellular penetration by SARS-CoV-2.

Experience with over 10,000 sleep telemedicine visits for diagnosis and treatment of OSAS

Introduction: Since March 2020 BlueSleep has completed over 10,000 telemedicine consultations for diagnosis and treatment of sleep apnea exclusively by real-time telemedicine consultations using HIPAA-compliant video conferencing. Materials and Methods: This is a retrospective chart review of all virtual consultations performed between March 13, 2020 and December 31, 2021 at the BlueSleep center. This period coincided with the lockdown in New York City because of the COVID19 Pandemic. 10,171 telemedicine consultations were performed both for new and existing patients. No patients under the age of 18 were evaluated. The median patient age was 40 years old;2,412 males, 1,098 females. Diagnosis of sleep apnea was performed with disposable single-night or multi-night Home Sleep Tests (HST) with WatchaptOne (Itamar Medical) or Nightowl (Ectosense). Patients were given instructions for HSTs via asynchronous videos. HST data was transmitted to a portal for scoring and interpretation. Follow-up visit was by telemedicine, and treatment options including oral appliance therapy and CPAP were discussed. Surgical options were not available during the lockdown. If oral appliance therapy was chosen by the patient, a virtual visit with a dental professional was scheduled before sending a home impression kit. Home impressions were guided in real time with a dental professional. Dental impressions were submitted to the dental labs for fabrication of Mandibular Advancement Devices (MAD), and sent to the patient for a virtual home delivery by the dental professionals. A follow-up virtual visit was scheduled after the 4-week titration period, and depending on subjective results of decreased snoring and decreased daytime sleepiness, the patient was then instructed to repeat a HST for efficacy evaluation. If the patient chose CPAP, CPAP was shipped to the home, and a follow-up visit was scheduled for a virtual set-up visit, followed by compliance visits. All patients were scheduled for continuous telemedicine follow-up visits. Results: 10,171 visits were completed including first and follow-up visits. A total of 289 single-night and 2,275 multi-night HSTs were performed. 2,348 patients were diagnosed with OSA. 36% with mild OSA, 41% of patients with moderate OSA, and 23% with severe OSA. 1,163 had no OSA. 53% of patients were treated with OAT, 20% with CPAP. 271 patients were treated for primary snoring. 256 patients were treated for insomnia. 31 patients were diagnosed with Narcolepsy, and 636 patients were diagnosed with "other". Conclusions: A fully virtual model for diagnosis and treatment for obstructive sleep apnea and other sleep disorders is feasible and desirable. Telemedicine allows greater convenience (less time lost from work), and availability (greater geographic availability), and is a lower cost option. Acknowledgements: We wish to thank the entire BlueSleep staff that has helped make our service to patients available during the Covid 19 Pandemic.

Prevalence of sleep disorders symptoms in health professionals attending patients with suspicion or confirmation of COVID-19

Introduction: In November 2019, in China, an outbreak of a disease caused by the new coronavirus (SARS-CoV-2) has begun. The spread of Coronavirus Disease 2019 (COVID-19) to hundreds of countries, causing respiratory illness and death, especially in risk groups, led the World Health Organization to declare a pandemic in March 2020. For patient's management, an extensive network of multidisciplinary care is necessary, exposing them to a greater contamination risk. Objective: This study aims to describe the prevalence of sleep disorders on health professionals who care for patients with suspicion/ confirmation of COVID-19. Methods: This is a crosssectional study, carried out using an online form sent to health professionals, with higher education, of both genders, aged 18 years or more, from any city in Brazil. Data collection took place from August to December 2020 (epidemiological weeks 32 to 53). The participants were asked about the frequency of several sleep disorders, sociodemographic, health and lifestyle characteristics. Subsequently, descriptive statistics were performed. The study protocol was approved by the National Research Ethics Committee (CONEP) under opinion 4.073.427. Results: The sample consisted of 184 health professionals with an average age of 37 (±9,3) years, predominantly female (69,9%), physicians (48,4%), living in Rio Grande do Sul (77,7%), graduated in the last 10 years (53,3%), working in the morning (83,1%), afternoon (82,6%) and night (32,1%), who have non-transferable chronic diseases (25,5%), consume alcoholic beverages (54,9%) and practice physical activities (57,6%). Regarding sleep disorders, participants presented tiredness on waking up (88,6%), waking up at night (82,1%), excessive daytime sleepiness (73,4%), nightmares (69,6%), difficulty in starting sleep (69%), waking up too early and not being able to go back to sleep (63,6%), grinding or clenching teeth during sleep (59,2%), snoring (58,7%), sleep apnea (13%) and sleepwalking (8,7%). 74,5% of participants had 5 or more symptoms simultaneously. Conclusion: The results demonstrate a high number of symptoms of sleep disorders in the sample, especially tiredness on waking up and night awaking, as well as a high number of health professionals with 5 or more associated symptoms. The data are of concern, as they affect the performance of these professionals, which may expose them and the patients to greater risks.

Polysomnography performed in home during the pandemic as a diagnostic alternative for patients in research of respiratory sleep disorders

Introduction: Obstructive sleep apnea and hypopnea syndrome (OSAHS) is characterized by pauses in breathing during sleep, due to multiple collapses and/or narrowing of the upper airway, causing a drop in blood oxygen saturation and sleep fragmentation. Obesity, male gender, craniofacial abnormalities, tonsil hypertrophy, nasal obstruction, endocrine abnormalities, and family history are predictive factors for OSAHS. Objective: The aim of the study was to investigate OSAHS through home polysomnography during the COVID-19 pandemic. Methods: Data were collected between March 16, 2020, and June 25, 2021 in the city of Surubim-PE, totaling 191 subjects. The Apnea link Air portable polysomnographic device was used. With the following channels: respiratory effort, pulse, oxygen saturation, nasal flow and snoring. Data were analyzed using IBM SPSS 28.0 software. Results: The apnea and hypopnea index (AHI) was considered: Normal in 33 women (17.0%;2.1+1.3) and 41 men (21.2%;2.5+1.2);Mild on 18 women (9.3%;9.4+3.3) and 39 men (20.2%;8.8+3.1);Moderate in 5 women (2.5%;19.5+4.5) and 27 men (13.9%;21.4+4.7);and Severe in 8 women (4.1%;52.5+14.4) and 22 men (11.3%;51.5+17.4). The oxygen desaturation index (IDO) was, 32 women (16.5%;2.1 + 1.7) and 40 men (20.7%;2.6 + 1.1) were classified as normal;Mild in 18 women (9.3%;9.6 + 2.9) and 30 men (15.5%;8.8 + 2.8);Moderate in 6 women (3.1%;20.9 + 5.2) and 27 men (13.9%;21.4 + 4.4);and Severe in 7 women (3.6%;53.2 + 11.5) and 22 men (11.4%;50.2 + 17.3). A positive correlation was observed both between BMI and the apnea-hypopnea index (AHI) (r=0.527;p=<0.01), as well as the BMI and oxygen desaturation index (ODI) (r=0.516;p=<0.01). There is an effect of gender (p<0.008) and age (p<0.001) on the AHI, but there is no interaction between the variables gender and age (p=0.936) A similar result was observed for the ODI, in which there is an effect of gender (p<0.009) and age (p<0.001), but not in the interaction between the two variables (p=0.948) BMI had an effect on the AHI (p<0.001) and ODI (p<0.001) but not in the interaction between BMI and gender (p=0.250 and p=0.223 respectively). Conclusion: High BMI implies higher values of AHI and ODI in the study population. Although there is an effect of gender and age on the AHI and ODI, an interaction between these two variables is not maintained when analyzed.

CONTINUES REMOTE CARDIAC MONITORING IN CRITICALLY ILL COVID-19 PATIENTS (C3 STUDY)

Objective: 1. To evaluate the use of remote cardiac monitoring of critically ill COVID-19 patients. 2. To correlate DOZEE early warning score(DEWS) with severity and outcome Design and method: Ballistocardiography (BCG)Ballistocardiography is a noninvasive method based on the measurement of the body motion generated by the ejection of the blood at each cardiac cycle. It also contains motion arising from breathing, snoring and body movements. Dozee Early Warning System (DEWS): DEWS is an overall score for risk assessment of the physiological status of a person. It is a cumulative score of risk levels of physiological parameters like HR,RR and SPo2, which acts as an early predictor for possible physiological decline. Assessment of severity of of Acute-illness Detection of clinical deterioration Initiation of a timely and competent clinical response Total 39 subjects were observed where 24 of the subjects were Male and 15 Female and the average duration of stay at the hospital was 5 days. There were 20 patients who had comorbid conditions like HYPOTHYROID, NHL,ASTHMA etc. 19 patients did not present with any co morbidities. The outcome of 10 patients was death and 29 patients were discharged after recovery, as reported by the healthcare professionals at the ward. The vitals of the subjects were continuously monitored by Dozee, a contactless remote patient monitoring system enabled with Dozee Early Warning System (DEWS) which reflects the overall patient condition based on the Respiration, Heart Rate and Spo2 of the patients. Results: The data from the continuous monitoring of the respiration rate, heart rate and oxygen saturation of the 39 patients were analysed for their duration of stay at the hospital. The DEWS score of the patients were also analysed Conclusions: It was concluded that continuous vitals monitoring of the patients and the resulting Dews scores were an indicator of the improving or deteriorating condition of the patients. The discharged patients showed a decrease in the DEWS score, especially Breathing DEWS before they recovered. However, the expired patients showed steady increase or a stagnant high Breathing dews until time of death.

HALO-TRACTION INDUCED OBSTRUCTIVE SLEEP APNEA

Introduction: Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. It is a multi-factorial disease with a variety of identified causes including age, male gender, obesity, craniofacial and upper airway abnormalities. We would like to describe a patient who had severe OSA following application of Halo traction, which significantly improved following the removal of the device. Report of Cases: 14-year-old male with medical history of spina bifida, chiari malformation s/p decompression, shunted hydrocephalus and severe scoliosis, was admitted to the hospital for anterior spinal discectomy L2-S1 and Halo application with traction for scoliosis. He previously had nocturnal polysomnogram (NPSG) in 2017 that demonstrated very mild mixed apnea with an apnea hypopnea index (AHI) of 5.5. Because central apneas were very brief and clustered in REM, family elected to repeat a study rather than treat. In 2019, he had a follow up study with complaints of snoring and thirst, and this demonstrated an AHI of 21 with 29 brief central apneas and 72 hypopneas, 1 obstructive apnea. He had a T&A and turbinate ablation and due to the global pandemic did not undergo repeat sleep study. During admission for his anterior spinal discectomy and Halo, he demonstrated persistent night time hypoxia. A split night sleep study showed evidence of severe OSA with pretreatment AHI of 94.4, oxygen nadir 86%. Continuous positive airway pressure (CPAP) was initiated at 5 cm of water and titrated to 11 cm of water. On CPAP of +11 severe obstructive events continued with an AHI of 40.6, oxygen nadir 92%. A bilevel positive airway pressure (BIPAP) titration study the subsequent night started at pressures of 12/6 and titrated to 21/9 with respiratory rate of 12 yet demonstrated AHI of 51, oxygen nadir 89%. Study transitioned to average volume assisted pressure support (AVAPS) with IPAP max of 26, IPAP minimum of 12 EPAP of 9, tidal volume of 175ml, rate of 12 with inadequate control of his obstructive events with an AHI of 24.8, minimum oxygen saturations of 91. While hospitalized, he remained on AVAPS with normal capillary blood gases. Halo traction was removed 2 weeks following his surgery with plan was to send him home on AVAPS and repeat NPSG in 6 weeks. However, as a result of COVID pandemic/Philips recall, CPAP was the only device available for home use, so CPAP therapy at +8 cm was trialed overnight, demonstrating oxygen nadir of 92% and a normal capillary blood gas in the morning. Patient was then discharged home on CPAP of +8 cm of water. He returned back to sleep center for a BIPAP titration study to re-establish BIPAP/AVAPS settings, as his inpatient sleep study had shown severe OSA. During the sleep study, he was started on BIPAP 12/6 and he remained on it throughout the night with 0 central and 0 obstructive events. As he did well, he was advised to continue CPAP +8 with plans to repeat the sleep study off CPAP. In clinic follow up, he reported mild skin breakdown and occasionally waking unrefreshed. Conclusion: As our patient did significantly better following the removal of Halo traction device, it is likely that Halo traction device caused fixed over flexion of the cervical spine that resulted in decrease in his airway diameter, which further worsened during his sleep, and caused severe OSA.

Gaisbock in 2021

Case Report The purpose of the study is to explore the possible diagnosis of Gaisbock in a patient with long-standing erythrocytosis and hypertension. Methods Used Case Study Summary of Results A 40-year-old Caucasian man with obesity was admitted with recurrent leg swelling and increasing oxygen requirements two weeks after hospitalization with COVID-19 pneumonia. Upon review of the patient's history, he was found to have untreated hypertension over several medical encounters and an erythrocytosis spanning ten years. Recent medical history included a diagnosis of deep vein thrombosis (DVT) in the same leg two and a half months prior and was treated with Xarelto. The patient reported a history of low testosterone for 12 years. However, he had not used any testosterone supplementation for the last nine months. He reported daytime fatigue, frequent bouts of nighttime awakenings, and frequent snoring. The patient never had a sleep study or used a CPAP. The patient used half a can of chewing tobacco daily for thirteen years, and he smoked one pack per day for ten years but quit 12 years ago. He worked strenuous jobs in the construction industry most of his life. On this admission, the patient's lab work was notable for hemoglobin of 18.7 gm/dL (13.7-17.5) and a normal erythropoietin level of 5.7 MIU/mL (2.6-18.5) without thrombocytosis or leukocytosis and a positive factor V Leiden mutation. His blood pressure was 132/91 mmHg. On review of previous records, the patient was found to have consistently elevated hemoglobin The patient had a stocky, ruddy appearance without hepatosplenomegaly. Conclusion Erythrocytosis can be categorized as primary, secondary, or relative. Patients with relative erythrocytosis have a decreased plasma volume with a relative increase in hemoglobin. Additionally, elevated hemoglobin levels have been associated with hypertension. Gaisbock's syndrome, first described in 1905, is characterized by hypertension and erythrocytosis without splenomegaly, leukocytosis, or thrombocytosis. It is associated with mild obesity, elevated blood pressure, and increased blood viscosity, which may explain why these patients often develop cardiovascular complications. Patients with relative erythrocytosis are at a higher risk for thromboembolic complications. In this case, Gaisbock's syndrome was suspected because the patient had had a stocky, plethoric appearance with persistently elevated hemoglobin and blood pressure with a normal erythropoietin level. Gaisbock's syndrome establishes a relationship between benign erythrocytosis, hypertension, and an increased risk for cardiovascular events. (Table Presented).

The etiology of preeclampsia.

Preeclampsia is one of the "great obstetrical syndromes" in which multiple and sometimes overlapping pathologic processes activate a common pathway consisting of endothelial cell activation, intravascular inflammation, and syncytiotrophoblast stress. This article reviews the potential etiologies of preeclampsia. The role of uteroplacental ischemia is well-established on the basis of a solid body of clinical and experimental evidence. A causal role for microorganisms has gained recognition through the realization that periodontal disease and maternal gut dysbiosis are linked to atherosclerosis, thus possibly to a subset of patients with preeclampsia. The recent reports indicating that SARS-CoV-2 infection might be causally linked to preeclampsia are reviewed along with the potential mechanisms involved. Particular etiologic factors, such as the breakdown of maternal-fetal immune tolerance (thought to account for the excess of preeclampsia in primipaternity and egg donation), may operate, in part, through uteroplacental ischemia, whereas other factors such as placental aging may operate largely through syncytiotrophoblast stress. This article also examines the association between gestational diabetes mellitus and maternal obesity with preeclampsia. The role of autoimmunity, fetal diseases, and endocrine disorders is discussed. A greater understanding of the etiologic factors of preeclampsia is essential to improve treatment and prevention.

Daytime Hypersomnolence in COVID-19: A Case Report and Literature Review

Coronavirus infectious disease 2019 (COVID-19) is confirmed to develop neurocognitive complications. In the present paper, we describe two patients with laboratory-confirmed COVID-19 and excessive daytime sleepiness. In the present study, we reported two laboratory-confirmed cases of COVID-19 with excessive daytime sleepiness. Patients had drowsiness and mild confusion on presentation. In both cases, CNS infections, including meningitis and encephalitis, were ruled out. Both patients' symptoms remarkably improved following the therapeutic course indicating the direct effect of SARS-CoV2 in sleep modulating centers on the brain. COVID-19 should be considered in patients with excessive daytime sleepiness and drowsiness in the current outbreak. [ FROM AUTHOR] Copyright of Acta Medica Iranica is the property of Tehran University of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

IoT snoring sound detector prototype as a model of future participatory healthcare.

BACKGROUND: Traditional healthcare is centred around providing in-hospital services using hospital owned medical instruments. The COVID-19 pandemic has shown that this approach lacks flexibility to insure follow-up and treatment of common medical problems. In an alternative setting adapted to this problem, participatory healthcare can be considered centred around data provided by patients owning and operating medical data collection equipment in their homes. OBJECTIVE: In order to trigger such a shift reliable and price attractive devices need to become available. Snoring, as a human sound production during sleep, can reflect sleeping behaviour and indicate sleep problems as an element of the overall health condition of a person. METHODS: The use of off-the-shelf hardware from Internet of Things platforms and standard audio components allows the development of such devices. A prototype of a snoring sound detector with this purpose is developed. RESULTS: The device, controlled by the patient and with specific snoring recording and analysing functions is demonstrated as a model for future participatory healthcare. CONCLUSIONS: Design of monitoring devices following this model could allow market introduction of new equipment for participatory healthcare, bringing a care complementary to traditional healthcare to the reach of patients, and could result in benefits from enhanced patient participation.