The impact of the Covid-19 pandemic on the short and mid-term urological emergencies and the emergency department

Dynamic changes are observed in the delivery of health care services due to the COVID-19 Pandemic. Its effect in the short term is a dramatic decrease in service, however, its effect in the medium and long term is unknown. In this study, we aimed to investigate the effects of the COVID-19 pandemic on emergency department and emergency urological surgery in the short and medium term during the 8-month period, and the reasons for possible changes. Emergency department operations, urology operations and emergency surgical procedures between April and November were compared as the 2020 pandemic period and the 2019 non-pandemic period. The relevant information was obtained from the hospital management information system. Descriptive analysis and statistical methods comparing the two periods were used. In the early stages of the pandemic, significant decreases were observed in both urology procedures and emergency department operations. In the medium period, while emergency department operations and urology consultations returned to the non-pandemic periods, there was no such a change in in emergency urological surgeries. In the medium-term effects of the pandemic, emergency department operations returned to the non-pandemic periods due to reasons such as patients' abuse of emergency departments in line with their requests for rapid diagnosis and treatment. In accordance with the changing nature of the pandemic, it is necessary to make different scheduling for emergency department operations and emergency surgeries.

Effects of Covid-19 pandemic in Turkey: Physical activity, smartphone usage, musculoskeletal system

This study aims to evaluate relationship between physical activity level, smartphone usage, back and neck health during Covid-19 pandemic. Participants between ages of 18-65 were included in study. Smartphone usage was evaluated with Smartphone Addiction Scale-Short Version, physical activity levels with short form of International Physical Activity Questionnaire. Oswestry Disability Index and Neck Bournemouth Questionnaire was used to evaluate back and neck problems. A total of 251 people (179 women, 72 men, age: 28.11±9.49 years, min-max: 18-62 years) participated in study. 134 participants (53.38%) had low physical activity levels; 35 individuals (13.94%) had sufficient physical activity levels while 82 participants (32.66%) were not physically active. A weak positive correlation was found between neck pain and total score of smartphone addiction scale, daily smartphone usage time, daily smartphone check frequency, and first check time after waking up (r=0.199, r=0.149, r=0.132, respectively). A weak negative correlation was found between neck pain and first check time after waking up (r=-0.145). As a result of study, it was observed that physical activity levels were insufficient in majority of individuals who participated in survey. The relationships we expected between physical activity level, smartphone usage characteristics, low back and neck health could not be demonstrated, only weak relationships were found between some features of smartphone use and neck health. We believe that finding solutions to increase physical activity levels of individuals during pandemic period will have both protective effects on health and will prevent problems by affecting musculoskeletal system positively.

A rare case: Covid-19 infection diagnosed by transthoracic fine needle aspiration biopsy

Covid 19 is an acute respiratory disease caused by a novel type of Coronavirus (SARS-CoV-2) that was first detected in Wuhan, Hubei Province of China. Its most common symptoms are fever, cough, and weakness; and in the early stages, there may not be findings on chest computed tomography. In pulmonary involvement, peripheral ground-glass areas, a cobblestone appearance, consolidated areas, and interlobular septal thickening, which are usually prominent in the lower lobes may be seen in thorax computed tomography. Consolidation, solid nodules, halo sign, inverted halo sign, vascular enlargement, subpleural line, air bronchograms, and bronchiectasis are other less common findings. In our case, we aimed to present our 69 years old female patient with bilateral nodular densities on thoracic CT and transthoracic fine-needle aspiration biopsy result was reported as lesions compatible with interstitial fibrosis due to Covid-19 inflammation.

How have the obstetricians and gynecologists struggled in the clinics during the COVID-19 pandemic?

As all branches of the medicine, the obstetrical and gynecological clinical approach has been greatly affected by the pandemic. In our study, we aimed to reveal the effect of the pandemic on current obstetrics and gynecologic clinical approach and urgency/semi-urgency evaluations of physicians related with both obstetrical and gynecological cases. The obstetricians in Turkey from different hospitals and clinics have completed our online questionnaire-based survey using ‘docs.google.com’. The survey questionnaire was created in three sections: Demographic, occupational analysis and thoughts about outbreak, clinical approach scale and clinical urgency scale. SPSS 22 program was used to analyze the validity and reliability of the scales. The outbreak has affected the clinical approach according to our study. The effect degree was 3.79, 3.15, 3.72 respectively at clinical effect, clinical functioning and struggle and prevention. The specialists regardless of the year in the occupation were more affected than research assistants in terms of clinical effect (p=0.017) and also postponed obstetrical (p=0.000) and gynecological (p=0.000) conditions more frequently. As the effect of the pandemic on clinical functioning increases, the delay of gynecological cases increases. With the postponement of obstetrics cases, the probability of delaying gynecological cases increases. In the current study, it was concluded that the pandemic has affected the clinical approach in obstetrics and gynecology clinics. We think that the study will help in determining our approach to obstetrical and gynecological cases in the future. Scenarios should be made patient-centered without neglecting the burden and possible damages on healthcare professionals.

Epidemiology, virology, clinical features, diagnosis, and treatment of SARS-CoV-2 infection

Since December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged and spread quickly worldwide. The disease is generally mild in adult people but in any with comorbidities may proceed to acute respiratory distress syndrome (ARDS), pneumonia, and multi-organ dysfunction. By performing molecular tests on respiratory secretions can diagnose the virus. Elevated C-reactive protein (CRP) and normal/low white cell counts are common laboratory diagnoses of COVID-19 while the tomographic chest scan is usually irregular for many infected people. Some patients progress to respiratory failure, pneumonia, and finally death by the end of the first week of illness because of the sharp rise in inflammatory cytokines such as IL7, IL2, GCSF, IL10, MIP1A, MCP1, IP10, and TNFα. Various approaches to the COVID- 19 are being performed by scientists. Use of chemical medical drugs that are effective for other viral infections. Among them, remdesivir was approved by FDA on 1th May 2020 because of its impact to treat patients. Also, several studies have revealed that many Chinese herbal remedies have a remarkable impact on the healing process when simultaneously were used along with pharmacological drugs. In the meantime, many efforts have been made to produce an effective vaccine, and so far, the Ad5-vectored COVID-19 vaccine has been successful and has entered phase 2 in the human trial. The current review focus on epidemiology, virology, clinical features, diagnosis, and available treatment of coronavirus that might assist researchers and clinicians in establishing action options for timely against this infection.

Affecting factors on the publication rate of surgical theses from different departments in Turkey

The aim of the study is to investigate and compare the factors affecting publication rates of otorhinolaryngology (ORL) theses and plastic and reconstructive surgery (PRS) theses. In order to examine ORL and PRS specialization theses published between 2013 and 2017, the author scanned the Council of Higher Education Thesis Center’s browsing system that contains a list of all published theses for the terms “ear, nose, and throat” and “plastic and reconstructive surgery”. All accessible theses (in total, 689), including 454 ORL and 235 PRS theses were included in the study. Most ORL and PRS theses authors were male (72.5% and 84.3%, respectively). Most of the ORL theses were conducted in state universities (76.9%), whereas most of the PRS theses were conducted in public universities (87.2%). More than half (50.9%) of the ORL advisors were professor doctors, compared to 46.3% of the PRS advisors. Most of the ORL studies were clinical studies (81.7%), while 74.9% of the PRS studies were experimental animal studies. In total, 24.5% of the ORL theses were published, and 29.7% of them were accepted in SCI- indexed journals. In comparison, a total of 19.6% of the PRS theses were published. The publication rates of experimental PRS and ORL studies were significantly higher than clinical studies. In order to increase the quality of medical theses and to publish them in scientific journals, the frequency of thesis production should be increased and that the factors affecting publication rates should be carefully examined, monitored, and improved.

Analyzing the biochemical, clinical, and hormonal characteristics of patients with polycystic ovary syndrome

To analyze the biochemical, clinical, and hormonal characteristics of patients with four phenotypes of Polycystic ovary syndrome (PCOS). A total of 225 patients admitted to Medistate Kavacık Hospital Gynecology and Obstetrics outpatient clinic and Giresun University Faculty of Medicine Gynecology and Obstetrics clinic between January 2019 and January 2020 diagnosed as PCOS and healthy controls were included in the study. The revised Rotterdam criteria were applied to diagnose PCOS. The patients with PCOS were divided into Type I classic, Type II classic, Ovulatory and Normoandrogenic PCOS. Biochemical, clinical, and hormonal values were compared. The mean age of the participants is 28 (±5.7) and the mean body mass index (BMI) is 26.15 (±5.36). The mean Ferriman Gallwey Score (FGS) is 7.4(±5.4), which is normal. There is a statistically significant difference between the four PCOS groups and control group in terms of age (p-value=0.000), BMI (p- value=0.000), Luteinizing hormone / Follicle stimulating hormone (LH/FSH) (p-value=0.000), and fasting blood sugar (p-value=0.01). There is a statistically significant difference among the four phenotypes in terms of BMI (p-value =0.002), LH/FSH (p-value =0.000), LH (p-value =0.000), free T4 (p-value =0.01), fasting insulin (p-value =0.001), total testosterone (p-value =0.000), FGS (p-value =0.000), etc. Age, BMI, LH/FSH, FSH, LH, fasting blood sugar, and hirsutism are good predictors of PCOS.

Investigation of in vitro activity of colistin and tygecyclin against Stenotrophomonas maltophilia isolates

Stenotrophomonas maltophilia has emerged as an important opportunistic pathogen, causing infections whose management is often problematic due to its inherent resistance to many antibiotics. In this study, we aimed to investigate the antimicrobial susceptibility of colistin and tygecyclin as an alternative treatment options for S. maltophilia infections. A total of 122 S. maltophilia isolates were tested. Minimum inhibitory concentration (MIC) values of colistin and tygecycline were determined by broth microdilution method. Susceptibility of TMP/SMX and levofloxacin (LVX) were determined by disc diffusion method and MIC value of ceftazidime (CAZ) was determined by using E-test. Out of 122 S. maltophilia isolates, 5 (4%) of them were resistant to TMP-SXM. MIC range was 0.125- >512 μg/ml and MIC50 64 μg/ml, MIC90 512 μg/ml for colistin. MIC range for tygecyclin was detected as 0.5- >8, MIC50 2 μg/ml and MIC90 8 μg/ml. Tygecyclin resistance was detected as 66.4% according to the EUCAST guideline and 13.1% according to the USA-FDA breakpoints. And colistin resistance was determined as 86.9% according to both guidelines.

Descending necrotizing mediastinitis due to an odontogenic infection: A case report

Descending necrotizing mediastinitis a clinical entity formed by the spreading of cervical infection from the dental and oropharyngeal structures through the deep cavities between the deep fascia on the neck to the mediastinum, pleural and pericardial spaces with necrosis of soft tissue and has a high mortality. Herein we present the case of a 73-year-old admitted to emergency department with septic clinic. The patient was diagnosed with descending necrotizing mediastinitis due to odontogenic infection. Although sternal irrigation, sternal debridement and mediastinal drainage were performed patient was died postoperative third day.

The importance of aminoguanidine and methylprednisolone administration in lung contusion after chest trauma

This study aims to evaluate the effect of the antioxidant and anti-inflammatory properties of aminoguanidine and metylprednisolone (MP) on lung tissue in a pulmonary contusion model of rats and evaluate whether their combined use improves treatment efficacy. This study included 35 female Sprague Dawley rats weighing 250-300 grams. The rats were divided into five groups as following: Sham; Pulmonary Contusion (PC); PC+MP, PC group treated with i.p methylprednisolone; PC+AG, PC group treated with i.p Aminoguanidine; and PC+AG+MP, PC group treated with Aminoguanidine and methylprednisolone. Each group had seven animals. Blood and lung tissues were studied biochemically and histopathologically. When compared groups according to serum levels of biomarkers, serum YKL-40, nitrate-nitrite, catalase, and TBARS levels were significant different. Serum YKL-40 levels were decreased after treatments in three groups. The serum YKL-40 levels in PC+AG group were lower than the other treatment groups, especially compared to PC + MP (p=0.028). Serum nitrate-nitrite levels were decreased in all treatment groups (PC+MP, PC+AG and PC+MP+AG). The lowest levels were measured in PC+MP+AG; but there was no statistically significant difference compared to PC group (p>0.05). Serum catalase levels were increased in all treatment groups. The higher levels were measured in PC+MP+AG than the other single treatment groups; however, PC+MP+AG and PC+MP were statistically significant different compared to PC group (p=0.001 and p=0.002 respectively). Serum TBARS levels were decreased in all treatment groups compared to Sham group (p<0.001) and PC group (p<0.001). The lowest levels were measured in PC+MP+AG compared to PC group (p<0.001). Histopathologic and immunohistochemical staining scores were decreased at all the treatment groups, especially PC+MP+AG. We suggest the use of combined treatment of methylprednisolone and aminoguanidine for the treatment of pulmonary contusion.