Introduction:There is increasing evidence that dyspnea and impaired exercise capacity are partially associated with respiratory muscle dysfunction,particularly diaphragmatic dysfunction,in patients with IPF.We aimed to assess the functions of the diaphragm, which is the main respiratory muscle,using both US and sEMG in patients with IPF,and to establish the correlation of these data with pulmonary function parameters,exercise capacity and radiological extent of fibrosis. Methods:We measured diaphragmatic mobility,diaphragmatic thickness and TF by US and the strength of diaphragmatic contraction on sEMG in IPF patients and compared with healthy individuals.We further assessed the correlation of these measurements with each other and with FVC,DLCO,6MWT,spO2 changes,mMRC score and TFS in patients with IPF. Results:41 IPF patients and 21 healthy individuals were included in the study.There was no difference in diaphragmatic mobility on US during quiet breathing between the patient and control groups(2.35 cm vs. 2.56 cm;p=0.29).Diaphragmatic mobility during deep breathing was lower in the patient group compared to the control group(5.02 cm vs. 7.66 cm;p<0.0001).IPF patients had greater diaphragmatic thickness during quiet and deep breathing than the control group(0.24 cm vs. 0.22 cm, 0.33 cm vs. 0.31 cm,respectively;p=0.045;p=0.043).There was no difference in TF between the two groups(39.37% vs. 44.16%;p=0.49).The strength of diaphragmatic contraction measured on sEMG was higher in IPF patients compared to healthy individuals(0.61 mV vs. 0.51 mV;p=0.03).In IPF patients,US and sEMG measurements had no significant relationship with FVC,DLCO,6MWT,spO2 change levels,mMRC scores and TFS(p>0.05).When the relationship between US and sEMG findings in IPF patients was evaluated,a positive correlation was found between the diaphragmatic thickness during quiet breathing and the strength of contraction(r=0.32;p=0.04). Conclusion:The functions of the diaphragm do not appear to be affected in IPF patients with mild-to-moderate restriction.However,the functions of the diaphragm may deteriorate as a result of inadequate compensatory response to the load on respiratory muscles in the later stages of the disease.

Aims: Metabolic Syndrome has become the greatest health hazard in the modern world, along with infectious diseases. We aimed to evaluate the effects of metabolic syndrome on disease course, laboratory values and mortality in patients with COVID 19 pneumonia. Methods: COVID 19 pneumonia patients with and without metabolic syndrome were compared in terms of laboratory parameters, clinical results and mortality rates retrospectively. Results: A total of 194 patients hospitalized with COVID 19 pneumonia (with and without metabolic syndrome n = 93 and 101, respectively) were included in the study. Patients with metabolic syndrome had lower oxygen saturation at the time of admission (88.76 vs 93.66 p <0.0001), higher neutrophil (5.85 vs 4.81 p = 0.02) and CRP levels (88.36 vs 62.93 p = 0.009) and COVID 19 involvement was more common in lung tomography (12.3 vs 7.7 p <0.0001). Total length of stay (12.3 vs 6.5 days p <0.0001) and clinical length of stay (7.8 vs 5.9 days p = 0.003) were longer in patients with metabolic syndrome. Requirement of intensive care (45.2% vs 4.9% p <0.0001) and mortality rates (24.7% vs 0.9% p <0.0001) were higher in patients with metabolic syndrome. Presence of metabolic syndrome (OR 32.86, 95% CI 4.34 to 249 p<0.05) were significantly associated with increased mortality. Discussion and conclusion: Our results demonstrated that patients with metabolic syndrome that were hospitalized with COVID 19 pneumonia had significantly higher mortality and intensive care requirement. They have lower oxygen saturations, higher CRP levels and more widespread radiological involvement. Keywords: Covid 19 - Metabolic syndrome – Pneumonia - Mortality