Comparison of clinical features of cystic fibrosis patients eligible but not on CFTR modulators to ineligible for CFTR modulators.

INTRODUCTION: Cystic fibrosis transmembrane conductance regulator (CFTR) modulator drugs target the underlying defect and improve CFTR function. They are a part of standard care in many countries, but not all patients are eligible for these drugs due to age and genotype. Here, we aimed to determine the characteristics of non-eligible patients for CFTR modulators in the CF registry of Turkey (CFRT) to highlight their clinical needs. METHODS: This retrospective cohort study included CF patient data from the CFRT in 2021. The decision of eligibility for the CFTR modulator was determined according to the 'Vertex treatment-Finder' on the Vertex® website. Demographic and clinical characteristics of patients were compared between eligible (group 1) and ineligible (group 2) groups for CFTR modulators. RESULTS: Among the study population (N = 1527), 873 (57.2%) were in group 1 and 654 (42.8%) were in group 2. There was no statistical difference between groups regarding sex, meconium ileus history, diagnoses via newborn screening, FEV1 z-score, CF-associated complications, organ transplant history, and death. Patients in group 2 had a higher incidence of pancreatic insufficiency (87.7% vs. 83.2%, p = .010), lower median height z-scores (-0.87 vs. -0.55, p < .001), lower median body mass index z-scores (-0.65 vs. -0.50, p < .001), longer days receiving antibiotics due to pulmonary exacerbation (0 [interquartile range, IQR: 0-2] vs. 0 [IQR: 0-7], p = 0.001), and more non-invasive ventilation support (2.6% vs. 0.9%, p = 0.008) than patients in group 1. CONCLUSION: The ineligible group had worse clinical outcomes than the eligible group. This highlights their need for life-changing drugs to improve clinical outcomes.

Comparison of refugee patients with cystic fibrosis and their counterpart children from Turkey during the war.

Since the outbreak of the Syrian civil war in 2011, the population of Arab refugees in Turkey has rapidly increased. While cystic fibrosis (CF) is believed to be rare among Arabs, recent studies suggest it is underdiagnosed. This study aims to present the demographic, clinical, and genetic characteristics of CF patients among Arab refugees in Turkey. Additionally, a comparison is made between the findings in the National CF Registry 2021 in Turkey (NCFRT) and the refugee CF patient group. The study included refugee patients between the ages of 0 and 18 years who were diagnosed with CF and received ongoing care at pediatric pulmonology centers from March 2011 to March 2021. The study examined demographic information, age at diagnosis, age of diagnosis of patients through CF newborn screening (NBS), presenting symptoms, CF transmembrane conductance regulator (CFTR) mutation test results, sputum culture results, weight, height, and body mass index (BMI) z score. Their results were compared with the NCFRT results. The study included 14 pediatric pulmonology centers and 87 patients, consisting of 46 (52.9%) boys and 41 (47.1%) girls. All of the patients were Arab refugees, with 80 (92%) being Syrian. All the patients were diagnosed in Turkey. The median age at diagnosis of patients was 22.33 (interquartile range, 1-258) months. The median age of diagnosis of patients through NBS was 4.2 (interquartile range, 1-12) months. The median age of older patients, who were unable to be included in the NBS program, was 32.3 (interquartile range, 3-258) months. Parental consanguinity was observed in 52 (59.7%) patients. The mutation that was most frequently found was F508del, which accounted for 22.2% of the cases. It was present in 20 patients, constituting 32 out of the total 144 alleles. There was a large number of genetic variations. CFTR genotyping could not be conducted for 12 patients. These patients had high sweat tests, and their genetic mutations could not be determined due to a lack of data. Compared to NCFRT, refugee patients were diagnosed later, and long-term follow-up of refugee CF patients had significantly worse nutritional status and pseudomonas colonization.  Conclusion: Although refugee CF patients have equal access to NBS programs and CF medications as well as Turkish patients, the median age at diagnosis of patients, the median age of diagnosis of patients through NBS, their nutritional status, and Pseudomonas colonization were significantly worse than Turkish patients, which may be related to the difficulties of living in another country and poor living conditions. The high genetic heterogeneity and rare mutations detected in the refugee patient group compared to Turkish patients. Well-programmed NBS programs, thorough genetic studies, and the enhancement of living conditions for refugee patients in the countries they relocate to can have several advantages such as early detection and improved prognosis. What is Known: • Children who have chronic diseases are the group that is most affected by wars. • The outcome gets better with early diagnosis and treatment in patients with Cystic Fibrosis (CF). What is New: • Through the implementation of a newborn screening program, which has never been done in Syria previously, refugee patients, the majority of whom are Syrians were diagnosed with cystic fibrosis within a duration of 4 months. • Despite equal access to the newborn screening program and CF medications for both Turkish patients and refugee patients, the challenges of living in a foreign country have an impact on refugees.

Childhood interstitial lung disease in Turkey: first data from the national registry.

The childhood interstitial lung diseases (chILD) Turkey registry (chILD-TR) was established in November 2021 to increase awareness of disease, and in collaboration with the centers to improve the diagnostic and treatment standards. Here, the first results of the chILD registry system were presented. In this prospective cohort study, data were collected using a data-entry software system. The demographic characteristics, clinical, laboratory, radiologic findings, diagnoses, and treatment characteristics of the patients were evaluated. Clinical characteristics were compared between two main chILD groups ((A) diffuse parenchymal lung diseases (DPLD) disorders manifesting primarily in infancy [group1] and (B) DPLD disorders occurring at all ages [group 2]). There were 416 patients registered from 19 centers. Forty-six patients were excluded due to missing information. The median age of diagnosis of the patients was 6.05 (1.3-11.6) years. Across the study population (n = 370), 81 (21.8%) were in group 1, and 289 (78.1%) were in group 2. The median weight z-score was significantly lower in group 1 (- 2.0 [- 3.36 to - 0.81]) than in group 2 (- 0.80 [- 1.7 to 0.20]) (p < 0.001). When we compared the groups according to chest CT findings, ground-glass opacities were significantly more common in group 1, and nodular opacities, bronchiectasis, mosaic perfusion, and mediastinal lymphadenopathy were significantly more common in group 2. Out of the overall study population, 67.8% were undergoing some form of treatment. The use of oral steroids was significantly higher in group 2 than in group 1 (40.6% vs. 23.3%, respectively; p = 0.040).   Conclusion: This study showed that national registry allowed to obtain information about the frequency, types, and treatment methods of chILD in Turkey and helped to see the difficulties in the diagnosis and management of these patients. What is Known: • Childhood interstitial lung diseases comprise many diverse entities which are challenging to diagnose and manage. What is New: • This study showed that national registry allowed to obtain information about the frequency, types and treatment methods of chILD in Turkey and helped to see the difficulties in the diagnosis and management of these patients. Also, our findings reveal that nutrition should be considered in all patients with chILD, especially in A-DPLD disorders manifesting primarily in infancy.

Long-term outcomes of standardized training for caregivers of children with tracheostomies: The IStanbul PAediatric Tracheostomy (ISPAT) project.

BACKGROUND AND OBJECTIVES: Children with tracheostomies are at increased risk of tracheostomy-related complications and require extra care. Standardized training programs for caregivers can improve tracheostomy care and reduce complications. In this study, we compared caregiver knowledge and skill scores after a standardized theoretical and practical training program on tracheostomy care (IStanbul PAediatric Tracheostomy (ISPAT) project) immediately and 1 year post-training and evaluated how this training affected the children's clinical outcomes. MATERIALS AND METHODS: We included 32 caregivers (31 children) who had received standardized training a year ago and administered the same theoretical and practical tests 1 year after training completion. We recorded tracheostomy-related complications and the number and reasons for admission to the healthcare centers. All data just before the training and 1 year after training completion were compared. RESULTS: After 1 year of training completion, the median number of correct answers on the theoretical test increased to 16.5 from 12 at pretest (p < 0.001). Compared with pretest, at 1-year post-training practical skills assessment scores, including cannula exchange and aspiration, were significantly higher (both p < 0.001) and mucus plug, bleeding, and stoma infection reduced significantly (p = 0.002, 0.022, and 0.004, respectively). Hands-on-training scores were better than pretest but declined slightly at 1 year compared to testing immediately after training. Emergency admission decreased from 64.5% to 32.3% (p = 0.013). Hospitalization decreased from 61.3% to 35.5% (p = 0.039). CONCLUSION: Our findings indicate that caregiver training can lead to a persistent increase in knowledge and skill for as long as 1 year, as well as improvements in several measurable outcomes, although a slight decrease in scores warrants annual repetitions of the training program.

Effect of Mesoappendix Volume on Preoperative Pain of Acute Appendicitis.

OBJECTIVE: To investigate the relationship between preoperative pain scores and the mesoappendix volume and the presence of complications in patients with acute appendicitis. STUDY DESIGN: Cross-sectional observational study. Place and Duration of the Study: Department of General Surgery at Kutahya Health Sciences University, Kutahya, Turkey, from January to December 2021. METHODOLOGY: Pain degrees in patients with acute appendicitis were measured by Numerical Rating Scale (NRS) and Wong-Baker Scale (WBS). Mesoappendix volume was calculated using the formula: mesoappendix length x width x height. Appendicitis type (as complicated or uncomplicated) was grouped. RESULTS: There was a positive and statistically significant correlation (17%) between the NRS and mesoappendix volume (p=0.065). In addition, there was a positive and statistically significant correlation (17%) between the WBS and mesoappendix volume (p=0.057). Additionally, there was a statistically significant relationship between the NRS, WBS, and complicated appendicitis (p=0.022, p=0.022, respectively). CONCLUSION: The mesoappendix volume might contribute to preoperative pain process in acute appendicitis patients. Specifically, there is a statistically significant correlation between complicated appendicitis and preoperative pain scores. KEY WORDS: Appendicitis, Pain, Mesentery, Complicated appendicitis.

A Survey of Symbiotic Radio: Methodologies, Applications, and Future Directions.

The sixth generation (6G) wireless technology aims to achieve global connectivity with environmentally sustainable networks to improve the overall quality of life. The driving force behind these networks is the rapid evolution of the Internet of Things (IoT), which has led to a proliferation of wireless applications across various domains through the massive deployment of IoT devices. The major challenge is to support these devices with limited radio spectrum and energy-efficient communication. Symbiotic radio (SRad) technology is a promising solution that enables cooperative resource-sharing among radio systems through symbiotic relationships. By fostering mutualistic and competitive resource sharing, SRad technology enables the achievement of both common and individual objectives among the different systems. It is a cutting-edge approach that allows for the creation of new paradigms and efficient resource sharing and management. In this article, we present a detailed survey of SRad with the goal of offering valuable insights for future research and applications. To achieve this, we delve into the fundamental concepts of SRad technology, including radio symbiosis and its symbiotic relationships for coexistence and resource sharing among radio systems. We then review the state-of-the-art methodologies in-depth and introduce potential applications. Finally, we identify and discuss the open challenges and future research directions in this field.

Drought stress resistance indicators of chickpea varieties grown under deficit irrigation conditions.

The aim of this study was to determine the drought stress resistance of three chickpea cultivars (Inci, Hasanbey and Seçkin) grown under water deficit conditions and to discuss the use of yield, crop water stress index and chlorophyll index values as drought stress tolerance indicators in breeding studies. Three drought stress levels, (full irrigation = no stress - I100, deficit irrigation = moderate stress - I50, and no irrigation = severe stress - I0) were used as irrigation treatments. The highest seed yield (1,984 kg ha-1) in severe stress conditions was recorded for the Inci cultivar with a low crop water stress index (CWSI) (0.50) and high chlorophyll index (33.60 SPAD). The lowest seed yield (1,783.66 kg ha-1) in I0treatment was noted for the Seçkin cultivar which had a high CWSI (0.58) and low chlorophyll index (32.88 SPAD). The highest seed yield (2,566.33 kg ha-1) in full irrigation was recorded for the Inci cultivar which had a low CWSI (0.19) and high chlorophyll index (44.39 SPAD), while the lowest seed yield (2,328.00 kg ha-1) in I100 treatment was recorded for the Seçkin cultivar which had a high CWSI (0.26) and low chlorophyll index (42.12 SPAD). The seed yield of the Hasanbey cultivar in both severe stress (1,893 kg ha-1) and full irrigation (2,424.00 kg ha-1) conditions was between Inci and Seçkin varieties. The chlorophyll index and yield had a significant positive (r = 0.877) correlation, while a significant negative (r = -0.90) relationship was determined between CWSI and yield. Seed yield of the Inci cultivar in I0and I100treatments and water use efficiency revealed that the Inci cultivar is resistant to drought stress. Therefore, the Inci cultivar can be used in drought stress tolerance studies. In addition, the CWSI and chlorophyll index values can be employed as resistance indicators in chickpea breeding studies to determine the drought resistant chickpea cultivars.

Predictive factors for the development of Gartland type IV supracondylar humerus fractures: a prospective clinical study.

OBJECTIVE: This study aimed to identify the preoperative predictive factors for the development of Gartland type IV supracondylar humerus fracture based on the patient characteristic, fracture mechanism, and preoperative radiographic fracture characteristics. METHODS: This prospective study included the data of 120 patients with Gartland type III and IV supracondylar humerus fractures treated in a single center from 2020 to 2021. Patients' age, gender, height/weight percentile values, injury mechanisms, the proximity of fracture fragment to the skin (i.e., dimple sign), and time from trauma to surgical treatment were recorded. In the preoperative radiographs, the degree of extension or flexion deformity between fracture fragments in the sagittal plane, varus/valgus angulation between fracture fragments in the coronal plane, the amount of translation (medial or lateral) in the coronal plane, and the amount of osseous apposition between fracture fragments in the coronal plane were evaluated. With the authors' consensus, the patients were divided into 2 groups based on the presence of multidirectional instability during the intraoperative reduction: group 1 (Gartland type III; 99 patients) and group 2 (Gartland type IV; 21 patients). Fixation of the fractures was then completed. RESULTS: Significant differences were observed between groups in the valgus/varus angle and amount of osseous apposition (P < .001). Although no significant difference was found in terms of translation amount between the groups (P=.088), there was a significant correlation with medial translation in type IV fractures (P < .001). The correlation between the results and the groups was checked with Spearman's test. Medial translation (r=0.352), varus or valgus angulation (r=0.616), and osseous apposition (r=0.433) exhibited a positive correlation. The probability of type IV fracture was modeled for the preoperative parameters using binary logistic regression. The regression analysis showed that the diagnosis of type IV supracondylar fractures could be predicted, if varus or valgus angulation was more than 25.5° (81% sensitivity, 85% specificity, odds ratio=1.725; 95% CI=1.170-2.541, P=.001, r=0.616) and if the amount of osseous apposition was more than 9.5 mm (85% sensitivity, 81% specificity, odds ratio=1.471; 95% CI=0.714-3.029, P=.001, r=0.433) in the preoperative radiographs. There was also a significant correlation between medial translation (varus angulation) (P < .001, r=0.352), age (P=.019, r=0.255), and patients with more than 90 height/weight percentile values (P < .001, r=0.508) with the possibility to have Gartland type IV fractures. CONCLUSION: This study has found some preoperative factors that may be relevant for type IV Gartland fractures. Height/weight values greater than the 90 percentile, varus or valgus angulation greater than 25.5°, bone apposition values greater than 9.5mm, medial translation values greater than 11mm, and older than eight years patients type IV fractures were more common in such patients. If surgeons can more accurately diagnose a Gartland type IV fracture preoperatively, the surgeon can more accurately inform the patient and plan better treatment. LEVEL OF EVIDENCE: Level II, Diagnostic Study.

The effects of nusinersen treatment on respiratory status of children with spinal muscular atrophy.

BACKGROUND: Respiratory involvement is the main factor predicting the prognosis of spinal muscular atrophy (SMA). Significant responses in motor functions have been demonstrated with nusinersen, but pulmonary outcomes are still varied. We aimed to explore the effects of nusinersen on the respiratory functions of patients with SMA. METHODS: Patients with SMA who were receiving regular nusinersen treatment in our tertiary care hospital were enrolled in this study. We evaluated the patients in terms of the necessity to ventilatory or nutritional support, presence of motor involvement and other comorbidities related with prognosis at three consecutive assessments. RESULTS: The study group consisted of 43 patients (18 type 1, 12 type 2, and 13 type 3) with SMA with a mean age of 27.8 months at diagnosis and 60.8 months at the beginning of nusinersen treatment. The respiratory function improvements were noted in six patients at third assessment. Early initiation of nusinersen was significantly correlated with reduced hospital admissions (P = 0.026). Nutritional support and weight gain were remarkable in the ventilatory-supported group. Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders scores were significantly higher in the non-tracheostomized group in patients with SMA type 1 (P < 0.005). CONCLUSIONS: We posit that nusinersen may change the natural prognosis of SMA and improve care of children with SMA. Following up children with SMA for longer periods under nusinersen may be beneficial for understanding the effects of treatment. Results of our study need to be supported by future long-term studies to reach a consensus on nusinersen, considering the overall genetic and environmental status as well as the cost-effectiveness of the treatment.

Comparisons of Clinical Features and Outcomes of COVID-19 between Patients with Pediatric Onset Inflammatory Rheumatic Diseases and Healthy Children.

(1) Background: We aimed to describe the clinical features and outcomes of coronavirus disease-2019 (COVID-19) in children and late adolescents with inflammatory rheumatic diseases (IRD) and to measure their severity risks by comparing them with healthy children. (2) Methods: Among children and late adolescents found to be severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) positive via polymerase chain reaction (PCR) test, IRD patients with an at least six-months follow-up duration, and healthy children were included in the study. Data were obtained retrospectively. (3) Results: A total of 658 (339 (51.5%) females) (healthy children: 506, IRD patients: 152) subjects were included in the study. While 570 of 658 (86.6%) experienced COVID-19-related symptoms, only 21 (3.19%) required hospitalization with a median duration of 5 (1-30) days. Fever, dry cough, and fatigue were the most common symptoms. None of evaluated subjects died, and all recovered without any significant sequelae. The presence of any IRD was found to increase the risk of both hospitalization (OR: 5.205; 95% CI: 2.003-13.524) and symptomatic infection (OR: 2.579; 95% CI: 1.068-6.228). Furthermore, increasing age was significantly associated with symptomatic infection (OR: 1.051; 95% CI: 1.009-1.095). (4) Conclusions: Our study emphasizes that pediatric rheumatologists should monitor their patients closely for relatively poor COVID-19 outcomes.

The ISPAT project: Implementation of a standardized training program for caregivers of children with tracheostomy.

BACKGROUND: Tracheostomy-related morbidity and mortality mainly occur due to decannulation, misplacement, or obstruction of the tube. A standardized training can improve the skills and confidence of the caregivers in tracheostomy care (TC). OBJECTIVE: Our primary aim was to evaluate the efficiency of standardized training program on the knowledge and skills (changing-suctioning the tracheostomy tube) of the participants regarding TC. MATERIALS AND METHODS: Sixty-five caregivers of children with tracheostomy were included. First, participants were evaluated with written test about TC and participated in the practical tests. Then, they were asked to participate in a standardized training session, including theoretical and practical parts. Baseline and postintervention assessments were compared through written and practical tests conducted on the same day. RESULTS: A significant improvement was observed in the written test score after the training. The median number of correct answers of the written test including 23 questions increased 26%, from 12 to 18 (p < .001). The median number of correct steps in tracheostomy tube change (from 9 to 16 correct steps out of 16 steps, 44% increase) and suctioning the tracheostomy tube (from 9 to 17 correct steps out of 18 steps, 44% increase) also improved significantly after the training (p < .001, for both). CONCLUSION: Theoretical courses and practical hands-on-training (HOT) courses are highly effective in improving the practices in TC. A standardized training program including HOT should be implemented before discharge from the hospital. Still there is a need to assess the impact of the program on tracheostomy-related complications, morbidity, and mortality in the long term.

A Comprehensive Experimental Emulation for OTFS Waveform RF-Impairments.

The orthogonal time-frequency space (OTFS) waveform exceeds the challenges that face orthogonal frequency division multiplexing (OFDM) in a high-mobility environment with high time-frequency dispersive channels. Since radio frequency (RF) impairments have a direct impact on waveform behavior, this paper investigates the experimental implementation of RF-impairments that affect OTFS waveform performance and compares them to the OFDM waveform as a benchmark. Firstly, the doubly-dispersive channel effect is analyzed, and then an experimental framework is established for investigating the impact of RF-impairments, including non-linearity, carrier frequency offset (CFO), I/Q imbalances, DC-offset, and phase noise are considered. The experiments were conducted in a real indoor wireless environment using software-defined radio (SDR) at carrier frequencies of 2.4 GHz and 5 GHz based on the Keysight EXG X-Series devices. The comparison of the performances of OFDM and OTFS in the presence of RF-impairments reveals that OTFS significantly outperforms OFDM.

Analysis and classification of radiological results and epidemiology of patients with COVID-19 pneumonia.

ABSTRACT: The coronavirus disease-2019 (COVID-19) pneumonia which is caused by the severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) virus is the current urgent issue world over. According to the Health Ministry of Turkey, the first COVID-19 patient was diagnosed on March 11, 2020. Since then, approximately 5.5 million patients have been confirmed to be positive SARS CoV-2 virus. In this retrospective study, we aimed at analyzing the epidemiological and radiological findings of COVID-19 cases at the Hospital of Grand National Assembly of Turkey from April 1, 2020 to December 31, 2020.A total of 130 patients (84 male, 25-87 years) were diagnosed as positive with High Resolution Computed Tomography (HRCT) scans and 71 of them confirmed with positive Real Time Polymerase Chain Reaction using the patients' nasopharyngeal and throat samples.HRCT scans were classified into 4 stages. Stage I (39.2%) patients' group; the HRCT results were found to be mosaic perfusion, whereas Stage II (39.2%) were found to be Ground Glass Opacity. Also, consolidation was detected in Stage III (20%). Finally, Stage IV, considered the most severe lung findings, and named as a crazy paving pattern was determined in 2 patients (1.53%). Furthermore, 20% of patients were found to be positive using IgG antibody against to SARS CoV-2 virus.Our findings showed that HRCT could be most prominent technique compared to real time polymerase chain reaction for the diagnosis of COVID-19 pneumonia. The novel classification of HRCT findings will be helpful to early diagnosis of the disease, time saving and eventually cost-effective.

Periprosthetic infection risks and predictive value of C-reactive protein / albumin ratio for total joint arthroplasty.

BACKGROUND AND AIM: There are no gold standard markers to estimate the risk of developing periprosthetic infections. Our aim is to compare the risks of periprosthetic infection in patients with THA and THA and to investigate the predictive significance of the CRP / albumin ratio. METHODS: This is a retrospective study containing data from 241 osteoarthritis patients and 19 patients with periprosthetic infections who underwent TKA and THA in our hospital from January 2014 to January 2019.12 risk factors(CRP/ albumin, albumin, CRP, age, gender, BMI, DM, ASA, nasal culture, urine culture, hospital stay, operation time) were analyzed. RESULTS: In the binary logistic regression model and multivariate regression analysis, the rate of CRP / albumin was 17.161 times higher than the patients with ≤0.16 cut-off value. (CRP / albumin ratio (odds ratio (OR) = 17.16, 95% CI: 1.55-189.03, P: 0.02). High BMI increased the risk of periprosthetic infection 1.3 times. Nasal bacterial colonization (OR = 0.99, 95% CI: 0.868-1.38, P: 0.7) and bacterium in urine (OR = 0.502, 95% CI: 0.07-3.598, P: 0.703) did not pose a significant risk for periprosthetic infection. CONCLUSION: According to our findings, the CRP / albumin ratio has a more prognostic capacity than other risks in determining the risk of periprosthetic infection for total joint arthroplasty. CRP / albumin ratio is a cheap and easy to apply marker. Routine urine and nasal bacteria screening is not required before total joint arthroplasty.

The effect of nebulized antibiotics in children with tracheostomy.

INTRODUCTION: Children with tracheostomy have an increased risk of bacterial colonization and infection of the lower respiratory tracts. This study aimed to investigate the effects of nebulized antibiotics on the bacterial load, the need for oral antibiotics, the number of hospitalizations, and the length of stay in the intensive care unit in tracheotomised children with persistent colonization. METHODS: Children with tracheostomy and persistent bacterial colonization who were started on nebulized antibiotic therapy after a lower respiratory tract infection were included in the study. Nebulized gentamicin or colistin were used according to the results of the tracheal aspirate cultures. Demographic and clinic characteristics were recorded from one year prior until one year after initiation of nebulized antibiotic treatment. RESULTS: Nebulized antibiotic treatment was initiated in 22 patients. Nebulized gentamicin was administered to 14 patients (63.6%) and colistin to 8 patients (36.4%). The median duration of treatment was 3 months (range 2-5 months). Following nebulized antibiotic treatment, median number of hospitalizations decreased from 2 (range 1.0-3.5) to 1 (range 0.0-1.5) (p = 0.04). The median length of stay in the intensive care unit reduced significantly from 89.5 days (range 43.0-82.5) to 25 days (range 7.75-62.75) after starting nebulized antibiotics (p = 0.028). Following nebulized antibiotic treatment median bacterial colony count also decreased (from 105 CFU/ml (range 105-106) to 6 × 104 CFU/ml (range 104-105); p = 0.003). There were no significant side effects during nebulized antibiotic therapy. CONCLUSIONS: The use of nebulized antibiotics reduced the number of hospitalizations, length of stay in the intensive care unit, and bacterial load in tracheotomised children with persistent airway colonization without significant side effects. The use of nebulized antibiotics showed a statistically significant decrease in the measures studied. Use of nebulized antibiotics may help to decrease the health care burden of these children, families and health care system. Further studies are needed to determine the indications and optimal duration of long-term nebulized antibiotic treatment in children with tracheostomy.

Comparison of Clinical and Laboratory Features and Treatment Options of 237 Symptomatic and Asymptomatic Children Infected with SARS-CoV-2 in the Early Phase of the COVID-19 Pandemic in Turkey.

Little is known about the therapeutic use of hydroxychloroquine in pediatric patients with coronavirus disease 2019 (COVID-19). Here, we retrospectively retrieved data of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) PCR-positive pediatric patients from 20 hospitals in 8 Turkish cities. We obtained epidemiological, clinical, and laboratory features of the patients, as well as the drugs used for treating COVID-19. A total of 237 nasopharyngeal swab SARS-CoV-2 PCR-positive children were included in the study from March 26, 2020 to June 20, 2020. The mean age of asymptomatic children (118 ± 62 months) was higher than that of symptomatic children (89 ± 69 months). Symptomatic children had significantly lower mean lymphocyte counts and higher mean CRP, D-dimer, procalcitonin, and LDH levels than asymptomatic children in the univariate analysis. Among 156 children, 78 (50%), 15, 44, and 21 were treated with a hydroxychloroquine-containing regimen, hydroxychloroquine + azithromycin + oseltamivir, hydroxychloroquine + azithromycin, and hydroxychloroquine alone, respectively. Among 156 patients who received medical treatment, 90 (58%) underwent pre- and/or post-treatment electrocardiogram (ECG). However, none of them had ECG abnormalities or required hydroxychloroquine discontinuation due to adverse drug reactions.

Efficient Spectrum Occupancy Prediction Exploiting Multidimensional Correlations through Composite 2D-LSTM Models.

In cognitive radio systems, identifying spectrum opportunities is fundamental to efficiently use the spectrum. Spectrum occupancy prediction is a convenient way of revealing opportunities based on previous occupancies. Studies have demonstrated that usage of the spectrum has a high correlation over multidimensions, which includes time, frequency, and space. Accordingly, recent literature uses tensor-based methods to exploit the multidimensional spectrum correlation. However, these methods share two main drawbacks. First, they are computationally complex. Second, they need to re-train the overall model when no information is received from any base station for any reason. Different than the existing works, this paper proposes a method for dividing the multidimensional correlation exploitation problem into a set of smaller sub-problems. This division is achieved through composite two-dimensional (2D)-long short-term memory (LSTM) models. Extensive experimental results reveal a high detection performance with more robustness and less complexity attained by the proposed method. The real-world measurements provided by one of the leading mobile network operators in Turkey validate these results.

Mid-term outcomes of surgical treatment in fractures in patients with osteopetrosis.

AIMS: Osteopetrosis (OP) is a rare hereditary disease that causes reduced bone resorption and increased bone density as a result of osteoclastic function defect. Our aim is to review the difficulties, mid-term follow-up results, and literature encountered during the treatment of OP. METHODS: This is a retrospective and observational study containing data from nine patients with a mean age of 14.1 years (9 to 25; three female, six male) with OP who were treated in our hospital between April 2008 and October 2018 with 20 surgical procedures due to 17 different fractures. Patient data included age, sex, operating time, length of stay, genetic type of the disease, previous surgery, fractures, complications, and comorbidity. RESULTS: The mean follow-up period was 92.5 months (25 to 140). Bony union was observed in all of our patients. Osteomyelitis developed in two patients with femoral shaft fractures, and two patients had peri-implant stress fractures. CONCLUSION: Treatment of fractures in OP patients is difficult, healing is protracted, and the risk of postoperative infection is high. In children and young adults with OP who have open medullary canal and the epiphyses are not closed, fractures can be treated with surgical techniques such as intramedullary titanium elastic nail (TENS) technique or fixation with Kirschner (K)-wire. Cite this article: Bone Joint J 2020;102-B(8):1082-1087.

An evaluation of treating non-union of femoral neck fractures with valgus angulation osteotomy using sliding hip screws.

This study presents the outcomes of patients treated with non-union of femoral neck fractures healed with valgus osteotomy, fixed with a Dynamic Hip Screw (DHS). The study retrospectively evaluated 16 patients who, between 2007 and 2014, developed pseudarthrosis following treatment for a femoral neck fracture and who were treated with DHS-osteosynthesis, after a valgus subtrochanteric osteotomy. Postoperative clinical evaluation of the patients was done? using the Harris Hip Scoring (HHS) system. Union of both the fracture and the osteotomy site was achieved in 17.2 weeks (range: 14-24 weeks) in all patients. The average Pauwels angle decreased from 72o (range 62-80) preoperatively to 26o (range 20-50) postoperatively. All fractures were Pauwels type III preoperatively and 4 type II and 12 type I postoperatively. The average HHS increased from 26 (range 18-34) preoperatively to 85 (range 68-94) postoperatively. Of the patients who were followed up for a mean duration of 3.1 years (range: 1-5 years), four had 1-cm shortening. No patient developed postoperative AVN of the femoral head. For patients with non-union after femoral neck fracture, DHS-osteosynthesis after valgus osteotomy is a method with a shorter learning curve, which can be successfully performed.

OFDM with Index Modulation for Asynchronous mMTC Networks.

One of the critical missions for next-generation wireless communication systems is to fulfill the high demand for massive Machine-Type Communications (mMTC). In mMTC systems, a sporadic transmission is performed between machine users and base station (BS). Lack of coordination between the users and BS in time destroys orthogonality between the subcarriers, and causes inter-carrier interference (ICI). Therefore, providing services to asynchronous massive machine users is a major challenge for Orthogonal Frequency Division Multiplexing (OFDM). In this study, OFDM with index modulation (OFDM-IM) is proposed as an eligible solution to alleviate ICI caused by asynchronous transmission in uncoordinated mMTC networks. In OFDM-IM, data transmission is performed not only by modulated subcarriers but also by the indices of active subcarriers. Unlike classical OFDM, fractional subcarrier activation leads to less ICI in OFDM-IM technology. A novel subcarrier mapping scheme (SMS) named as Inner Subcarrier Activation is proposed to further alleviate adjacent user interference in asynchronous OFDM-IM-based systems. ISA reduces inter-user interference since it gives more activation priority to inner subcarriers compared with the existing SMS-s. The superiority of the proposed SMS is shown through both theoretical analysis and computer-based simulations in comparison to existing mapping schemes for asynchronous systems.