Background. The use of transcutaneous near-infrared spectroscopy (NIRS) for the monitoring of the perfusion of renal allografts in paediatric population has been proposed in the last years. This device might detect early decrease in allograft oxygenation allowing prompt detection of vascular complications. Methods. A systematic review of literature about the use of transcutaneous NIRS in monitoring allograft perfusion was performed according to the PRISMA guidelines. Results. The authors screened 1313 papers. The search yielded five pertinent articles. Three of them reported the experience of NIRS in kidney transplantation, for a total of 53 paediatric patients and 50 adults. In these studies, NIRS measurements was significantly related to serum creatinine, estimated glomerular filtration rate (eGFR), urinary neutrophil gelatinase-associated lipocalin (u-NGAL), serum lactate, resistive index assessed by doppler-ultrasonography and systolic blood pressure. In the paediatric studies no vascular complications were encountered. Conclusions. Preliminary studies have related NIRS monitoring to renal allograft perfusion and function. Further investigation is needed to establish the normal range of NIRS values for renal allografts and the factors influencing NIRS monitoring.
Our findings illustrate the widespread collateral impact of implementing measures to mitigate the impact of COVID-19 in people with, or being investigated for diabetes mellitus (DM). Ironically, failure to focus of the wider implications for people with DM and other groups with long-term conditions, may place them at increased risk of poor outcomes from SARS-CoV-2 infection itself, irrespective of the implications for their longer-term health prospects.
Aim Extracorporeal shockwave therapy (ESWT) is known as one of the most effective treatment methods in plantar fasciitis (PF). Low-dye taping, which is the most preferred method of banding treatments, provides an analgesic effect by correcting biomechanics. It was aimed to compare the efficacy of adjuvant low-dye kinesio-taping (KT), sham-taping, or extracorporeal shockwave therapy (ESWT) alone in plantar fasciitis (PF). Methods In this double-blind, sham-controlled study, forty-five patients with PF were randomized to 3-group (Group 1: ESWT plus low-dye KT, n=15; Group 2: ESWT plus Sham-taping, n=15; and Group 3: ESWT only, n=15) five-session ESWT were administrated. KT was performed and changed every 1-week for the ESWT sessions in Groups 1 and 2. The main outcome measures were the visual analog scale (VAS) change, the heel tenderness index (HTI), foot function index (FFI). The patients were evaluated at the beginning and end of the treatment and the 4-week follow-up. Results The demographic characteristics and baseline outcomes between groups were similar (p>0.05). VAS and HTI changes were observed in all three groups, there was no difference between groups. Repeated-measures ANOVA showed a significant interaction between the time and the groups in FFI-total (F3.919= 2.607; p=.043). At the 4-week follow-up, when Groups 1 and 2 were evaluated, the lower FFI-total, FFI-disability, and FFI-activity limitation were statistically significant in Group 1 (p=0.027; p=0.026; p=0.029, respectively). When Group 1 and 3 were compared, the decrease in FFI-pain and FFI-activity limitation were significant in Group 1 (p=0.042; p=0.035, respectively). Conclusions Low-dye KT, in addition to ESWT, is more effective than sham-taping and ESWT in pain relief and foot function improvement due to PF at a 4-week follow-up.
Introduction: The coexistence of diabetes mellitus (DM) and hypertension (HTN) worsen clinical outcomes and contribute to increased morbidity and mortality. Objective: This study aims to analyze the length of stay and healthcare costs by calculating the direct and indirect costs of diabetes with co-existing hypertension in North India. Methods: A prospective observational study was conducted at the medicine department of the three different hospitals. Results: The patients’ mean age was found to be (M=53.8, SD=11.5) years. Out of 1914 patients, 53.65% were found female. Our study revealed that the median cost of medical supplies and equipment was found to be 21.2 $. The median cost of dialysis was found at 47.5 $; the median cost of hospitalization was found to be 142.6 $. The treatment’s median direct cost was 188.5 $, followed by the overall median cost of 295.6 $. The maximum overall cost of treatment was observed at 603.9 $. It was observed that that maximum LOS was found to be 14 days for patients having BPS between 140 to 159 mmHg and BPD between 110- 119 mmHg, and minimum LOS was found to be 3.5 days. Conclusion: The present study highlighted that diabetes co-existing hypertension poses a high economic burden on patients. This study explored that highly significant result for BPS, BPD, FBS, and HbA1c, whereas the significant results were obtained when RBS is compared with LOS and treatment costs. Our study concluded that a mean difference of 9.24 $ in patients having FBS: 261-290 mg/dl and > 290 mg/dL. The LOS increases 6.57 days for patients with BPS between 140-159 mmHg compared to BPS between 180 -above 209 mmHg, which lower treatment costs by -21.31$. Keywords: Diabetes, Hypertension, length of stay, cost of treatment, direct medical cost, indirect medical cost
Objective: The main objective of this prospective and observational study is to investigate the effect of preoperative hospitalization period on early postoperative cognitive dysfunction (POCD) development in patients undergoing total hip replacement surgery under regional anesthesia. Materials and Methods: Between November 2013 to September 2014, 64 patients were enrolled the study. Test scores were obtained on the initial admission day (MMT1), 24 hours prior to surgery (MMT2) and 24 hours after the surgery (MMT3). Patients were divided into two groups according to MMT scores as “no cognitive dysfunction” (Group 1) and “cognitive dysfunction” (Group 2). Differences between groups were evaluated statistically. Statistical significance level was set as p<0.05 in a 95% confidential interval. Results: POCD incidence rate was calculated as 43.8% in all patients. Preoperative hospitalization duration was significantly higher in patients with POCD when compared to patients without POCD (p<0,001). The factors which affect POCD development were found to be advanced age (p<0,001), high ASA scores (p=0,004), presence of comorbid disease (p=0,025), duration of operation (p=0,018) and decreased postoperative hematocrit levels (p=0,014). Conclusion: In this study, we observed patients with early POCD had a relatively longer pre-operative hospitalization period when compared to patients without POCD. We consider that the prolonged preoperative hospitalization periods may contribute to increased POCD incidence rates in patients with risk factors.
Background: Mast cells play a critical role in tumor-associated immune pathways. We aimed to determine whether the urinary mast cell mediators predict the immune response in patients with non-muscle invasive bladder cancer (NMIBC) treated with Bacillus Calmette-Guérin (BCG) immunotherapy. Methods: Nineteen patients who have received immunotherapy due to NMIBC and 19 healthy participants were enrolled. Urine samples were collected to assay N-methylhistamine, histamine, and tryptase levels immediately before the first BCG instillation, immediately after the third and sixth instillations, and four weeks after the sixth instillation in patients with NMIBC and at a single visit in healthy participants. Cystoscopic examinations were performed on the patient with NMIBC at three-month intervals for two years. The changes in urinary markers due to BCC response, BCG instillation, and the presence of NMIBC were assessed. Results: The average age was 56.1 ± 10.5 years in patients with NMIBC. Fourteen patients had high-grade Ta tumors, and 5 had high-grade T1 tumors. While 12 patients responded, 6 presented with recurrence and 1 with progression. There was no correlation between the levels of mast cell mediators and BCG response. The N-methylhistamine and histamine levels were increased significantly with the onset of immunotherapy, and N-methylhistamine levels were significantly decreased when immunotherapy was terminated. Pre-BCG estimated marginal means of N-methylhistamine were significantly higher in patients with NMIBC than healthy participants. Conclusions: Our study is the first study to identify the changes in mast cell mediators with the onset of immunotherapy and with the presence of bladder cancer. However, these mediators were not found to predict the patients’ response to immunotherapy.
Objectives: To compare pain, quality of life(QoL), sexual function and lower urinary tract symptoms(LUTS) between rigid(RC) and flexible cystoscopy(FC). Methods: Forty-one patients who were planned control cystoscopies were enrolled the study. At the first cystoscopy, 20 patients(Group 1) and other 21 patients(Group 2) were performed by using flexible(15,5Fr) and rigid cystoscope(15,5Fr), respectively. At the second cystoscopies, the patients in group 1 and group 2 were performed by using rigid and flexible cystosacope, respectively. In all the patients, pain was measured with visual pain scale(VPS) shortly after cystoscopy. Also SF, QoL and LUTS were assessed by using IIEF, SF-36 and MLUTS forms, respectively. Results: While 22 of the patients preferred FC, the other 19 preferred RC(p>0,05). There were no statistically differences between VPS, IIEF, SF-36 and MLUTS scores of the two groups. In multivariate analysis regarding quality of life, although sexual function, pain and cystoscopy type did not affect QoL, voiding symptoms affected independently QoL. After the both cystoscopy type, IIEF, SF-36 and MLUTS scores did not change statistically. Conclusion: The results showed that the effects on pain, sexual function, QoL and LUTS of RC and FC were similar. In general, cystoscopy did not affect negatively on QoL, sexual function and LUTS of the patients.
Background: Hookah is a tobacco product of Middle Eastern origin; however, its popularity increases in Europe and the US. Despite its frequent use, hookah’s potentially detrimental effects are underestimated due to the scarcity of the relevant research. Since septoplasty is one of the most commonly performed procedures of otolaryngology practice, we aimed to investigate the impact of hookah consumption on recovery after septoplasty. Methods: Patients who underwent septoplasty in Sanliurfa Training and Research Hospital Department of Otolaryngology between January 2017 and December 2019 were divided into four groups based on their history of hookah and cigarette smoking. The patients’ prospectively collected data, including demographic features, healing time, and presence or absence of septal perforation during follow-up, were compared between these four groups. Results: The entire cohort included 270 patients. The mean patient age was 29.2±5.8 years. One hundred and thirty-two (48.9%) patients were non-smokers, 96 (35.5%) were cigarette smokers, 27 (10%) were hookah smokers, and 15 (5.6%) consumed both tobacco products regularly. Mean healing time was 10 days, and septal perforation was encountered in 10 patients (3.7%). A comparison of the groups revealed that cigarette smoking did not impact septal perforation rates (p=0.326) but prolonged the healing time. However, hookah smoking with or without cigarette smoking significantly influenced septal perforation rates and healing times. Conclusion: Patients should be questioned about hookah smoking in addition to cigarette smoking before the septoplasty procedure. Patients with a positive history of hookah smoking should be followed closely in terms of delayed healing and increased septal perforation rates.
Purpose:In the present study, the impact of penile nerve block(PNB) on postoperative pain and CRBD in transurethral resection of prostate(TURP) patients were evaluated. Methods:Participants of the present study were selected from patients who performed TURP under spinal anesthesia for benign prostatic hyperplasia(BPH) between January 2018-July 2020. This study was planned as a single center, randomized-controlled prospective study. The patients were divided into two groups; Group 1 was administered Control(n:40), and Group 2 ultrasonography(USG) guided PNB(n:40). The patients were included in the Groups respectively. Visual analogue scale(VAS) scores were questioned and recorded in order to evaluate the postoperative pain complaints of the patients after the operation. In addition, in order to evaluate the CRBD, VAS scores were questioned and recorded as 0-1th hour, 1st-2nd hours, 2nd – 4th hours, 4th-8th hours, 8th-12th hours, and 12th-24th hours. In addition, postoperative pain and analgesic need were recorded. Tramodol was given to patients with moderate to severe CRBD. The findings was compared between to the Groups. Results:There was no statistical difference between Group 1 and Group 2 between demographic and per-operative data. The CRBD and pain-related VAS scores was significantly higher in Group 1 between the 0-8th hours. There was no difference between VAS scores in the postoperative 8-24th hours. In total 24 hours, Group 2’s need for tramodol for CRBD and pain was significantly less than Group 1. On examining the factors affecting CRBD in the multivariate analysis, age, body mass index(BMI), prostate volume, operation time do not affect CRBD statistically, only PNB reduces CRBD (p: 0.029). While less drug-related complications were observed in Group 2, no serious complications related to PNB were observed. Conclusion:PNB is the effective method for the decrease pain and CRBD after urological surgery.It will also reduce the need for analgesics, and provide the painless patients in postoperative period.
ABSTRACT Aims of Study: To compare dynamic thiol/disulfide homeostasis between patients with with lung tuberculosis and healthy controls. Methods: Our study included 50 patients with active lung tuberculosis and 50 healthy controls. Serum thiol/disulfide was measured with a new automated spectrometric method developed by Erel and Neselioglu, and results were compared statistically. Results: We found that native and total thiol levels were significantly decreased in patients with lung tuberculosis, disulfide/native thiol and disulfide/total thiol levels were found to be higher in lung tuberculosis patients when compared with the control group. However, disulfide levels were higher in the control group than in the patient group. Conclusions: Based on the results of this study, it can be said that oxidative stress is closely associated with lung tuberculosis pathogenesis. There is a need for new studies that will show the possible effects of oxidative stress on lung tuberculosis pathogenesis.
Background: There is growing interest in physical medicine treatment options for renal colic. In this study, we aimed to determine whether or not heat-patch treatment with no drug was effective in relieving renal colic. Methods: For this purpose, patients who were diagnosed with renal colic in the emergency department were randomized to have either heat-patch or sham treatment. The Visual Analog Scale (VAS) scores of renal colic, body temperature (Btemp), and sub-patch skin temperature (Stemp) values were measured at 0,15,30,45, and 60 min. In addition, the salvage treatment needs of the groups were compared. Results: The average age of the study group was30.5 ± 8.3 years and that of the sham group was 31.0 ± 8.2 years (p = 0.75). According to the baseline VAS score of the patients, 15, 30, 45, and 60min VAS scores significantly decreased in the heat-patch group (p<0.001). The Btemp values did not differ significantly between the heat-patch and sham groups. In addition, no statistically significant difference was found between the two groups in terms of Stemp values at 0 and 15 min (p = 0.39and p = 0.10, respectively). However, there was a significant difference in the heat-patch group in terms of Stemp values at30, 45, and 60 min compared to the sham group (p<0.001). The salvage treatment rates for the heat-patch and sham groups were 11.5% and 31.4%, respectively (p = 0.01). Conclusion: As non-pharmaceutical treatment, the heat-patch has been shown to be a possible candidate for pain relief in patients with urolithiasis. Further research should concentrate on multicenter and large-scale randomized studies.
Purpose: to compare, in a real-world scenario, the effects of different levels of technology on attention, memory, electrophysiological response, and self-perceived benefit of new users of hearing-aids in a developing country such as Brazil. Method: A pragmatic parallel-group, single-blinded, and randomized pilot clinical trial was conducted. Patients were divided into 3 groups according to hearing aid technology: (A) advanced technology; (B) basic technology; and (C) placebo. Participants were ≥ 60 years old, had moderate sensorineural hearing loss, and had never been exposed to hearing aid before. Prior to data collection, patients were electronically randomized to receive unique identity numbers. Patient numbers were placed in opaque envelopes until the day of the first visit at which hearing aids were fitted with appropriate amplification settings. Attention, memory, and latency of auditory evoked potentials of patients were assessed while using the hearing aids at baseline and then after 12 weeks of use. The primary outcome was any improvement in scores on neuropsychological tests and/or shortening of latency in the auditory-evoked potentials. Results: A total of 22 individuals were assessed (A=8, B=6, and C=8). Participants had a mean age of 80.4 (±6.1) years, were predominantly female (63.63%), and were poorly educated (3.8±1.6 years). Comparison of groups AXC and of BXC revealed differences in NEUPSILIN scores (Brazilian instrument) for reverse counting (p=0.002, 95%CI 5.9;20.55) and recognition (p=0.013, 95%CI -6.1;-0.88). No difference between groups A and B were found. Responses on the International Outcome Inventory for Hearing Aids (IOI-HA) differed for the benefit (p<0.001), satisfaction (p=0.007), participation restriction (p=0.012) and quality of life (p=0.037). Conclusion: The level of technology of the devices had no impact on the general satisfaction of new users of hearing-aids and appeared to have no differential effect on memory or attention after 12 weeks of use of the sound amplification products.
Aims: To evaluate the diagnostic yield of investigations performed on patients with a history of urinary tract infections (UTI). Methods: A retrospective review was conducted on patients who underwent cystoscopy and imaging for a history of UTI between 2014-2019 in a single UK teaching hospital. Data was collected on demographics, cystoscopy and radiological findings requiring further management. The cohort was stratified by age, gender, and a confirmed history of recurrent UTI (rUTI). The subsequent algorithm was re-tested in a second cohort to validate its use. Results: 700 patients were included in the primary analysis, 427 female and 273 males. 331 meet the criteria of rUTI. The median age was 64y(18-97). Imaging abnormalities were equally frequent in males 6.3%(15/241) and females 8%(30/380) and the majority noted in patients aged ≥55y, 30/45(66.7%). Amongst those who did not meet the definition of rUTI, abnormal imaging was identified in 5-7% regardless of age group and gender. Cystoscopy abnormalities (n=24) were twice more likely in males, 5.5%(15/273) than females, 2%(9/427). 88%(21/24) were identified in patients ≥55y. There were no positive findings in women <55y. Applying baseline imaging but confining cystoscopy to those aged ≥55y and men with a confirmed history of rUTI would have saved 44% of procedures, missed no abnormalities with an overall diagnosis detection rate of 9.8%(69/700). This algorithm was validated in a separate cohort of 63 patients; applying it would have saved 46%(29/63) of cystoscopies with a positive diagnostic rate of 9.5% and no missed findings. Conclusion: To our knowledge this is one of the largest studies reporting the outcomes of investigations for UTI and rUTI. Our result suggests that imaging is a useful baseline assessment, but cystoscopy should be limited to specific subgroups. We propose and validate a simple decision algorithm to manage investigations for referrals for UTI in secondary care.
Background: Current guidelines for the management of asymptomatic hypertension (HTN) in the inpatient setting recommend the use of oral antihypertensives. However, in clinical practice, intravenous (IV) antihypertensives are commonly utilized with little supporting evidence. The objective of this study was to evaluate literature examining the safety/efficacy of IV hydralazine and labetalol in hospitalized patients with non-emergent, asymptomatic HTN. Methods: The PRISMA guidelines were utilized to structure the systematic review. A search strategy composed of drug-, inpatient-, and HTN-related terms was conducted utilizing PubMed, Embase, and Scopus databases through May 2020. Full-text, English-language articles describing IV labetalol and/or hydralazine use for non-emergent HTN in an inpatient setting that focused on clinical outcomes (i.e. vitals, adverse effects, healthcare utilization) were included. Identified studies were screened/extracted using DistillerSR by two reviewers at each stage, and studies were evaluated qualitatively for the presence of bias. Results: From 3362 records identified in the search, a final set of 10 articles were identified. Four studies focused on labetalol (40%), five studies on hydralazine and labetalol (50%), and one study on hydralazine (10%). The included studies presented a variety of outcomes, but several trends were identified, including reduction in average blood pressure in eight (80%) studies, a risk of adverse effects in six (60%), and increased length of stay in one (10%). Discussion: The studies identified in this review raise concerns regarding the safety of IV hydralazine and labetalol in non-emergent HTN. Despite relatively broad clinical experience with these drugs, experimental investigations regarding their utility are recommended.
Aim: To show if lower urinary tract symptoms (LUTS) could be symptoms of COVID-19 with validated questionnaires. Methods: The 96 COVID-19 patients who were hospitalized at a tertiary center were collected retrospectively. After the exclusion criteria, 46 patients were consisted as the study population. The male and female patients then fill formed the International Prostate Symptom Score and Urinary Symptom Profile respectively. All patients responded to these questions for the three period. Results: 27 female (58.6 %) and 19 male (41.4 %) COVID-19 patients answered the questions In the male patients, while there were no statistically significant differences in the total IPSS, the voiding IPSS score, and quality of life between the three periods (p=0.148; p=0.933, p=0.079, respectively), the storage IPSS scores had a significant difference between the three periods (p=0.05). In the female patients, low stream scores, were similar between the three periods (p=0.368). The scores of stress incontinence and an overactive bladder had a significant difference between the three periods (p=0.05 and p=0.05). Conclusion: LUTS, especially storage symptoms, might be one of the initial symptoms of COVID-19 and the clinicians should evaluate LUTS with other known symptoms of the virus when a patient is suspected of having COVID-19.
ABSTRACT Aim: To investigate the effect of COVID-19 on sexual dysfunction in women. Materials and Methods: The women diagnosed with COVID-19 and hospitalized at a tertiary hospital were included. They completed the Introductory Data Form, the Female Sexual Function Index-(FSFI), and the Short Form-36 Quality of Life Scale (SF-36). Results: 15 women between the ages of 19-49 who completed the treatment protocol, discharged at least 14 days before, and who had not been diagnosed as sexual dysfunction sexually active earlier were included to the study. It was detected that weekly sexual intercourse before and after COVID-19 significantly differed (p=0.047). The frequency of relationships decreased statistically after COVID-19. The mean value of the FSFI satisfaction score differs from COVID-19 before and after diagnosis (p=0.012). The mean satisfaction score before COVID-19 was 3.47, and after COVID-19 was 2.93. The score of the subgroups of FSFI did not differ from COVID-19 before and after diagnosis (p>0.050). The median value of SF-36 pain differs from COVID-19 before and after diagnosis (p=0.008). Conclusion: it was concluded that the frequency of sexual intercourse, sexual satisfaction in women decreased after COVID-19 disease, and the quality of life scores did not change in a statistically significant way.