COVID-19 pandemic continues to spread across the world in late September 2020. To date, total cases of COVID-19 exceed 33 million including 996.342 deaths according to the WHO data. Although hydroxychloroquine, oseltamivir, remdesivir, favipiravir have been reported as an anti-SARS-CoV-2 effect, it is still unclear the fully effective protective drug and treatment. Herein, we report a woman under Tenofovir diphosphate who live and close contact with his COVID-19 positive husband. Although she had close contact with his husband without measure in the home she did not show any symptoms and signs of COVID-19 and her PCR test along with antibody test negative. Given the high reproduction number of SARS-CoV-2 and long-term close contact of the case, it can be speculated that Tenofovir could interfere with the transmission of COVID-19.
Conspiracy theories, omnipresent in traditional and modern societies , span demographic strata and political differences  and have fascinated people for ages . While many conspiracy theories are harmless and may even be entertaining, the ones related to medical and public health topics can be particularly dangerous for the individual and collective well-being . This second category includes misinformation and conspiracy theories related to COVID-19, which is likely one the most significant pandemics of our lifetime. Compounding the challenges that it opened for the economy, social and political sciences, and biomedical, translational, and clinical research, COVID-19 also propelled discussions about conspiracy theories and media health literacy to the forefront of public health in ways that were nearly impossible to predict.Situations of crisis, fear, and uncertainty increase the likelihood of conspiratorial thinking . A key difference between COVID-19 and the 1918 flu pandemic, which is sometimes used as a reference, is that a highly interconnected world, to a great extent on social media, is setting the stage for distributing information and misinformation about COVID-19 . In the short time since the beginning of the pandemic, the number of COVID-19-related conspiracy theories increased and propagated on social media. According to some metrics, online sensationalist and conspiratorial sites and articles generate more user engagement than more reputable sources such as the World Health Organization and the US Centers for Disease Control and Prevention  or mainstream news media such as the BBC and New York Times .An important way in which misinformation related to COVID-19 differs from misinformation that impacts other health-related topics is its multi-layered nature, in the sense that it concomitantly targets multiple facets of the pandemic. These include misinformation and conspiracies casting doubt on the very existence of the virus, minimizing the value of long-proven preventive strategies, and questioning the safety, efficacy, and potential ulterior motives of a vaccine that is not even available yet, and not sure it will ever be. In the wake of COVID-19, an ocean of misinformation  that spans all these domains has accumulated faster than for many other health-related topics. As a result, mutually incompatible and contradictory conspiracy theories were sometimes being endorsed and circulated together . Misinformation and disinformation during the pandemic contributed to the demonization of health care workers . As patients avoided hospitals or had difficulties making appointments in the wake of the pandemic, they experienced delays in accessing healthcare for various medical conditions [11-14]. An increased mortality from acute heart disease was reported in several countries . In this context, ambiguous messages about the pandemic endanger the delivery of healthcare in virtually all clinical areas and can place patients at a heightened risk of complications.Some conspiratorial claims include assertions that COVID-19 is a hoax, arguments that the virus was created artificially [16, 17] and spread on purpose  as a bioweapon , or allegations that governments are using the emergency situation to pursue their anti-democratic goals . As early as in January 2020, social media stories contained claims that 5G technologies either caused or accelerated the spread of the pandemic [21, 22]. Other conspiracies argued that people in power are taking advantage of the pandemic as a plan to inject microchip quantum-dot spy software and monitor people . Videos or articles perpetuating these theories were viewed by millions of people on social media platforms. Another conspiracy theory, circulating in several languages, claimed that the swab test reaches the back of the nasopharynx and damages the blood brain barrier, and urged people to refuse testing [23, 24]. Yet another conspiracy theory, spread thousands of times on social media, claimed that testing itself infects people with the coronavirus and urged them to refuse testing .The use of face masks has become a passionately debated topic [25, 26], even though many studies support their benefit against SARS-CoV, SARS-CoV-2, MERS-CoV, [27, 28], flu, and seasonal coronaviruses . Some people wearing masks have faced alienation or discrimination . Claims on social media that the virus crosses the masks, and therefore the mask is useless, have been circulating together with claims that the virus persists on the surface of the mask and wearing a mask would, therefore, infect people, or that the mask could “activate the virus” . Other social media claims include warnings that masks may cause fungal or bacterial pneumonia  or oxygen deprivation and carbon dioxide poisoning , an especially worrisome complication for children and pregnant women, despite evidence that no differences exist in heart rate and oxygen saturation between pregnant and non-pregnant women wearing N95 respirators for a short period of time .Most recently, warnings on social media advised people of the dangers of having their temperature checked upon entering closed spaces, based on the false claim that infrared light damages their pineal gland, when in reality infrared thermometers detect radiation emitted by the body [35, 36]. Other pseudoscientific claims advanced unproven therapies, including homeopathic arsenic-based products or colloidal silver solutions , advocated for prophylactic vitamin megadoses , promoted vitamin C and garlic as miracle remedies , and recommended ginger, hot pepper, and lemon to limit the impact of the pandemic .A vaccine is highly anticipated but not yet available, and it is uncertain which of the several vaccines that are currently pursued will succeed, if any. As of late July 2020, ~200 vaccine candidates were under active development and 15 were in human clinical trials . Prior to the widespread use of social media and crowdsourcing to obtain medical information and advice, the spread of infectious disease outbreaks was usually limited to confined geographic locations; now, the availability of misinformation widens the footprint of its harm. Vaccine-related misinformation on social media is rampant. In late April 2020, a false story that circulated claimed that one of the first volunteers in the UK during a COVID-19 vaccine trial died from complications . Another conspiracy theory claimed that the vaccine will be used to establish a global surveillance network . Additionally, various social media posts are already providing advice on how to avoid the vaccine. A WebMD poll in late July 2020 found that if a COVID-19 vaccine was available, fewer than one-third of the respondents would take it in the first 90 days, and fewer than one-half of the people would take it in the first year .Each of these conspiracy theories may be destructive in itself. While it is challenging to demonstrate the direct influence of any given conspiracy theory on an individual’s behavior, there are some suggestive trends. In the wake of the misinformation linking 5G technologies to the pandemic, attacks were perpetrated against telecommunication masts on several continents, and engineers were subjected to verbal and physical abuse . Between April 2-6, 2020, it was estimated that at least 20 phone masts were damaged in the UK. This included a hospital in Birmingham, UK, whose phone mast was set on fire . There are previous examples to illustrate the heavy price of denial and misinformation in the wake of an infectious disease crisis. During the HIV/AIDS pandemic, claims that the virus does not exist or that it does not cause AIDS were incredibly harmful . When the South African government, in its widely criticized denialist approach , withheld lifesaving drugs and promoted non-tested alternative solutions instead , the public health damage was incalculable and estimated to have claimed >330,000 lives [47-49].Anti-vaccination rhetoric and conspiracies are not new. They existed since Edward Jenner’s time, when some rumors claimed that vaccination will make people grow horns [50, 51]. The themes have been strikingly similar across time, and include distrust of the medical establishment or governments mandating vaccination; revulsion at the idea of introducing unknown substances into the body; accusations that the ingredients are harmful; or suspicion that the real motives behind vaccines are to make people sick or to control the population. Like many conspiracy theories, some worries over history have been rooted in a kernel of truth. Such examples include the Tuskegee Syphilis Study, where the government and the medical establishment have abused their power at the cost of people’s health [52-54]; the rare cases when contaminated vaccines caused harm [55-57]; or instances when vaccination was used as a cover for intelligence operations . During the Zika virus epidemic, some of the conspiracy theories claimed that the disease was caused by vaccines, and an Australian anti-vaccination Facebook group emphasized that the vaccine used to prevent diphtheria, tetanus, and pertussis in pregnant women was introduced in Brazil only months before the Zika outbreak [59-61]. This makes it understandable, to a certain extent, why some people continue to view vaccines with suspicion.A paradox in the vaccination debate seems to be the fact that even though vaccines have well-known and widely-reported adverse effects [62-64], most conspiratorial discussions focus on false claims about adverse effects that were never linked to vaccines, while the actual adverse effects, that scientists and regulators are attempting to address and avoid, are rarely discussed, if ever. What makes the COVID-19 vaccine refusal so different is that the debates are directed against a vaccine that was not even manufactured yet. Amidst these multiple layers of misinformation and conspiratorial discourse, the potential for damage is unpredictable, poignant, and difficult to manage, and the challenges associated with bringing the pandemic under control adopt a new, amplified, and more acute perspective.On the bright side, overall, social media harbors a larger volume of accurate information than misinformation . The sobering news is that misinformation seems to be more popular , become more prevalent over time , and spread faster, farther, and deeper [67, 68]—though whether this is true of health emergencies is less clear . Several studies found that COVID-19 conspiracy beliefs negatively correlate with COVID-19 health-protective behaviors [70, 71], and individuals who support COVID-19 conspiracy theories are less likely to accept the advice of public health experts .Even though social media made it easier to disseminate misinformation, it is not clear to what extent it causes more people to believe in them. Surveys of public opinion around conspiratorial beliefs, particularly during an ongoing global event such as the current pandemic, should be interpreted with caution. The responses to such surveys depend on the questions asked. As noted, conspiracy theories often make a multitude of specific, sometimes mutually contradictory claims; COVID-19 conspiracy theories are no exception. As a result, it is difficult for a single survey to cover all variants of any given conspiracy theory. While research suggests that endorsement of one conspiracy theory predicts the endorsement of others, general conspiratorial ideation has been found to be relatively weakly predictive of general conspiracy claims about COVID-19, and even more weakly predictive of a plethora of specific claims . Even more basic aspects of survey design such as the wording of available response options can have a substantial influence on responses . The extent to which such surveys over- or underestimate true engagement with conspiracy theories is therefore unknown. It must also be noted that misinformation constitutes only a small fraction of people’s news consumption, and that news consumption itself is only a small fraction of people’s overall information diet . The nuances of public opinion around conspiracy claims should receive increased attention in the years to come, as they have the potential to directly impact public health.Even though initial surveys indicate that many people would hesitate to adopt a coronavirus vaccine, it is important not to over-extrapolate, as responses to hypothetical questions may reflect many unstated assumptions and variables. However, the link merits increased focus over the coming months and years. We also need to recognize that hesitancy does not necessarily suggest that someone is a conspiracy theorist, or that they won’t actually seek vaccination should it become a reality with demonstrated safety and efficacy. A lot remains to be understood about people’s attitudes towards vaccines, and we should support this topic to further develop in the years to come.As we are exploring the best way forward during the COVID-19 pandemic, an ongoing challenge and a critical task will be to understand how to limit the rapid spread of misinformation, for which the term “infodemic” was coined to reflect its amplitude and extent [75-77]. Prompt, effective, and targeted interventions that seek to delegitimize misinformation emerge as an important strategy to reduce its impact. It was suggested that social media users should take advantage of the mechanisms available to report misinformation on the respective platforms . More extensive efforts need to be dedicated to advance and promote media and social media literacy, and to interrogate the impact of misinformation, disinformation, and conspiratorial thinking on the different facets of this pandemic and of other public health emergencies. For sure, the road ahead will be long and tortuous.
Aims: This study aims to analyze the novel Coronavirus disease (COVID-19) related testicular pain in hospitalized patients due to COVID-19 and to review as an etiological factor for epididymitis, orchitis or both. Methods: A total of 91 patients were included in the study. A questionnaire was formed for the questioning of testicular pain or epididymo-orchitis in patients with COVID-19. Demophrahics and past medical history was also recorded. Patients’ neutrophil and lymphocyte counts, neutrophil-lymphocyte ratios (NLR), C-reactive protein (CRP) levels and D-dimer values were recorded. Patients with COVID-19 were divided into two groups according to absence or presence of testicular pain or epididymo-orchitis as group 1 and group 2. All results were compared for both groups. Results: The median age of patients was similar in both groups. Testicular pain was occured in 10.98% of the patients. Clinical presentation of epididymo-orchitis was diagnosed in only one patient. No statistically significant difference was reported in terms of patients’ age, levels of CRP and D-Dimer or NLR and results of questionnaire form queries between the two groups (p>0.05). Conclusion: Testicular pain was observed more frequently in hospitalized COVID-19 cases. While no inflammation marker which is related to predict of testicular pain or epididymo-orchitis was found in patients with COVID-19.
COVID-19 and late-onset hypertension with hyporeninaemic hypoaldosteronismAmit K J Manda, MB, FRCP(Ed), FRCP, FACP1Jason Kho MBBCh, BAO1Sofia Metaxa, MD, PhD 1Constantinos G Missouris, MD, FRCP, FACP1,21Wexham Park Hospital, Frimley Health NHS Foundation Trust, UK2University of Cyprus Medical School, Nicosia, Cyprus
Objectives: A significant proportion of COVID-19 patients may have cardiac involvement including arrhythmias. Although arrhythmia characterization and possible predictors were previously reported, there are conflicting data regarding the exact prevalence of arrhythmias. Clinically applicable algorithms to classify COVID patients’ arrhythmic risk are still lacking, and are the aim of our study. Methods: We describe a single center cohort of hospitalized patients with a positive nasopharyngeal swab for COVID-19 during the initial Israeli outbreak between 1/2/2020 –30/5/2020. The study’s outcome was any documented arrhythmia during hospitalization, based on daily physical examination, routine ECG’s, periodic 24-hour Holter, and continuous monitoring. Multivariate analysis was used to find predictors for new arrhythmias and create classification trees for discriminating patients with high and low arrhythmic risk. Results: Out of 390 COVID-19 patients included, 28 (7.2%) had documented arrhythmias during hospitalization, including: 23 atrial tachyarrhythmias, combined atrial fibrillation (AF) and ventricular fibrillation, ventricular tachycardia storm, and 3 bradyarrhythmias. Only 7/28 patients had previous arrhythmias. Our study showed significant correlation between disease severity and arrhythmia prevalence (p<0.001) with a low arrhythmic prevalence among mild disease patients (2%). Multivariate analysis revealed background heart failure (CHF) and disease severity are independently associated with overall arrhythmia while age, CHF, disease severity, and arrhythmic symptoms are associated with tachyarrhythmias. A novel decision tree using age, disease severity, CHF, and troponin levels was created to stratify patients into high and low risk for developing arrhythmia. Conclusions: Dominant arrhythmia among COVID-19 patients is AF. Arrhythmia prevalence is dependent on age, disease severity, CHF, and troponin levels. A novel simple Classification tree, based on these parameters, can discriminate between high and low arrhythmic risk patients.
Objective: To present a nation-wide analysis of the workload of urology departments in Turkey week-by-week during Covid-19 pandemic. Methodology: The centers participating in the study were divided into three groups as tertiary referral centers, state hospitals and private practice hospitals. The number of outpatients, inpatients, daily interventions and urological surgeries were recorded prospectively between 9-March-2020 and 31-May-2020. All these variables were recorded for the same time interval of 2019 as well. The weekly change of the workload of urology during pandemic period was evaluated; also the workload of urology and the distributions of certain urological surgeries were compared between the pandemic period and the same time interval of the year 2019. Results: A total of 51 centers participated in the study. The number of outpatients, inpatients, urological surgeries and daily interventions were found to be dramatically decreased by the third week of pandemics in state hospitals and tertiary referral centers; however the daily urological practice were similar in private practice hospitals throughout the pandemic period. When the workload of urology in pandemic period and the same time interval of the year 2019 were compared; a huge decrease was observed in all variables during pandemic period. However, temporary measures like ureteral stenting, nephrostomy placement and percutaneous cystostomy have been found to increase during Covid-19 pandemic compared to normal life. Conclusions: Covid-19 pandemic significantly effected the routine daily urological practice likewise other subspecialties and priority was given to emergent and non-deferrable surgeries by urologists in concordance with published clinical guidelines.
Aim There are few types of drugs that can be used in the active phase of Peyronie’s disease. Methylprednisolone is a corticosteroid with a strong anti-inflammatory effect. In this study, we aimed to evaluate the effect of intralesional low dose methylprednisolone treatment on patients in the active phase of Peyronie’s disease. Patients and Methods Forty-eight patients suffering from Peyronie’s disease active phase symptoms were included in the study. Methylprednisolone was administered intralesionally for 8 weeks, once per week, at a dose of 40 mg. The injection was applied into the plaques, which causes maximum curvature. Patients were evaluated before and after treatment for plaque size, angle of curvature, and erectile dysfunction according to the International Index of Erectile Function-5 and Peyronie’s Disease Questionnaire. Results The mean age of the patients was 61.1 (43-78) years. Mean duration of the symptoms was 3.4 (0-9) months. The average plaque size before treatment was 13.6 mm (7.1-16.8) and after treatment, this value decreased to 10.8 mm (4.3-14.6) (p:0.025). The average scores of Peyronie’s Disease Questionnaire elements; symptom severity, penile pain and bother/discomfort were 12.3, 19.1 and 6.2, respectively before the treatment. These scores were decreased to 8.9, 9.6 and 4.4, respectively after treatment. All subgroups of Peyronie’s Disease Questionnaire scores were significantly improved after treatment (p:0.001, p<0.001, p:0.045, respectively). No adverse events were observed during or after treatment. Conclusion In order to recover the symptoms and signs, new and easily accessible drugs are required for use in the acute period of Peyronie’s disease. In this context, treatment with intralesional low dose methylprednisolone in acute phase Peyronie’s Disease is a promising and safe treatment option.
Aims of the study Patient comprehension is a critical part of meeting standards of informed consent in study designs. The aim of the study was to determine if extant literature exists to require clinicians to disclose the specific risk that COVID-19 vaccines could worsen disease upon exposure to challenge or circulating virus. Methods used to conduct the study Published literature was reviewed to identify extant preclinical and clinical evidence that COVID-19 vaccines could worsen disease upon exposure to challenge or circulating virus. Results of the study Based on the history of coronavirus vaccine development, COVID-19 vaccines designed to elicit neutralizing antibodies may sensitize vaccine recipients to more severe disease than if they were not vaccinated. Vaccines for SARS, MERS and RSV have never been approved, and the data generated in the development and testing of these vaccines suggest a serious mechanistic concern: that vaccines designed empirically using the traditional approach (consisting of the unmodified or minimally modified coronavirus viral spike to elicit neutralizing antibodies), be they composed of protein, viral vector, DNA or RNA and irrespective of delivery method, may worsen COVID-19 disease via antibody-dependent enhancement (ADE) of either infection or disease. Conclusions drawn from the study and clinical implications The specific and significant COVID-19 risk of ADE should have been and should be clearly and emphatically disclosed to research subjects currently in vaccine trials, as well as those being recruited for the trials and future patients after vaccine approval, in order to meet the medical ethics standard of patient comprehension.
Introduction The rapid spread of the pandemic caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)(COVID-19) virus resulted in governments around the world instigating a range of measures, including mandating the wearing of face coverings on public transport/in retail outlets. Methods We developed a sequential assessment of risk reduction provided by face coverings using a step-by-step approach. The United Kingdom Office of National Statistics(ONS) Population Survey data was utilised to determine the baseline total number of community-derived infections. These were linked to reported hospital admissions/hospital deaths to create case admission risk ratio/admission-related fatality rate. Results Overall, we show that only 7.3% of all community-based infection risk associates with public transport/retail outlets. The reported weekly community infection rate was 29,400 new cases at the start (24th July). The rate of growth in hospital admissions and deaths for England was around -15%/week, suggesting the infection rate, R, in the most vulnerable populations was just above 0.8. In this situation, average infections over the evaluated 13week follow-up period was 9,517/week. With face covering of 40% effectiveness, this reduced average infections by 844/week, hospital admissions by 8/week and deaths by 0.6/week; a fall of 9% over the period total. If, however, the R-value rises to 1.0, then average community infections would stay at 29,400/week and face coverings could reduce average weekly infections by 3,930, hospital admissions by 36 and deaths by 2.9/week; a 13% reduction. These reductions should be seen in the context of 102,000/week all-cause hospital emergency admissions in England and 8,900 reported deaths in the week ending 7thAugust 2020. Conclusion We have illustrated that the policy on mandation of face coverings in retail outlets/on public transport may have limited value in reducing hospital admissions/deaths. Impact appears small compared to all other sources of risk, thereby raising questions regarding effectiveness of the policy.
Aim: We evaluated the COVID-19 threat in patients receiving intravesical BCG therapy which has immunotherapeutic effects and is of vital importance in most of the individuals with high-risk non-muscle-invasive bladder cancer (NMIBC) and investigated the need for postponement of this therapy. Methods: A total of 71 patients, who were diagnosed with high-risk NMIBC and on intravesical BCG treatment regularly (induction or maintenance), were enrolled in the study. The patients were classified into two groups depending on whether they were diagnosed with COVID-19 during the pandemic period or not. Results: Of 71 patients, 26 underwent a COVID-19 polymerase chain reaction test with clinical suspicion during the pandemic period. Of these 26 patients, 4 were diagnosed with COVID-19. Age of the patients, working status (working/retired), compliance with containment measures against the pandemic, number of BCG courses, adverse effects after BCG therapy, and systemic immune-inflammation index, which is an inflammation-related parameter, were not different between groups (p>0.05). Neutrophil/lymphocyte ratio was significantly higher in the COVID-19 positive group (p<0.05). COVID-19 positivity was higher in age groups 50-64 (6.6%) and 65-80 (5.8%) years than that in similar age groups of the normal population. Conclusion: Every effort should be made to administer intravesical BCG treatment in high-risk NMIBC patients even during the pandemic period. However, increased risk of COVID-19 transmission should be kept in mind and protective measures against COVID-19 for healthcare providers and patients before the procedure should be taken optimally. The procedure should be postponed in patients with lymphopenia in recent complete blood count.
Aim: The purpose of this study is to determine the level of attention between shifts and to make recommendations about the regulation of shifts. Methods:The researchers applied the Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Pittsburgh Sleep Quality Index (PSQI) and Stroop color word interaction test (SCWI) in 72 intensive care workers working in different shifts. Result: The study included a total of 72 participants, including 30 (43.3%) females and 42 (58.3%) males. There were statistically significant differences between the groups in the sub-items of the HAM-D and SCWI test (Table 3). There was a significant elongation in the night shift employees at all times within the SCWI sub-items. A significant height in the number of errors and corrections in the cards applied in the continuation of the test was also determined in the night shift group. Conclusion: This study revealed a significant decrease in the level of attention in the night-shift compared to the day-shift. This increase in attention deficit may also be a preventable cause of increased mortality in the night-shift What is already known about this topic? • Mortality rates in intensive care units are higher than in other clinics. What this paper adds? • Our study reported significantly poor results of the SCWI test in the night-shift compared to the day-shift. The implications of this paper: • This study revealed a significant decrease in the level of attention in the night-shift compared to the day-shift. We believe that it will be beneficial to shorten the shift times, to keep the number of patients per staff at international standards, to set active rest periods and to plan personnel and hours to reduce the lack of attention observed in the night shift. KEYWORDS Attention, healthcare worker, night-shift, intensive care
Objective: We aimed to evaluate the effect of body mass index (BMI) on oncological and surgical outcomes in patients who underwent radical cystectomy (RC) for bladder cancer (BC). Materials and Methods We retrospectively assessed data from patients who underwent RC with pelvic lymphadenectomy and urinary diversion for BC recorded in the bladder cancer database of the Urooncology Association, Turkey between 2007 and 2019. Patients were stratified into three groups according to the BMI cut-off values recommended by the WHO; Group 1 (normal weight, <25 kg/m2), Group 2 (overweight, 25.0–29.9 kg/m2) and Group 3 (obese, ≥30 kg/m2) Results In all, 494 patients were included, of them 429 (86.8%) were male and 65 (13.2%) were female. The median follow-up was 24 months (12-132 months). At the time of surgery, the number of patients in groups 1, 2 and 3 were 202 (40.9%), 215 (43.5%) and 77 (15.6%), respectively. The mean operation time and time to postoperative oral feeding were longer and major complications were statistically higher in Group 3 compared to Groups 1 and 2 (p=0.019, p<0.001 and p=0.025 respectively). Although the mean overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS) and metastasis-free survival (MFS) was shorter in cases with BMI ≥30 kg/m2 compared with other BMI groups, differences were not statistically significant (p=0.532, p=0.309, p=0.751 and p=0.213 respectively). Conclusion Our study showed that, although major complications are more common in obese patients, the increase in BMI does not reveal a significant negative effect on OS, CSS, RFS, and MFS.
Objective: To identify pathophysiological mechanisms of nocturia and the correlation of these mechanisms with nocturia severity. Methodology: After approval by the local ethics committee, all patients with nocturia (≥1 nocturnal void/night) were included and filled the overactive bladder questionnaire (OABq), nocturia quality of life (N-QoL), ICIQ-MLUTS (male), ICIQ-FLUTS (female) and 3-day frequency-volume chart. Patients were divided into three groups according the severity of nocturia: group 1 consisted of patients with mild (1-2 voids/night), group 2 with moderate (3-4 voids/night) and group 3 with severe nocturia (>4 voids/night). Comparative analysis were performed between groups, p<0.05 was deemed as statistically significant. Results: 68.1%, 64.1% and 8.7% of the patients had nocturnal polyuria, reduced bladder capacity and global polyuria; respectively. 42.7% of the patients had mixed nocturia. 6.1% of the patients did not comply with the afore-mentioned subtypes and defined as isolated nocturia. Regarding the severity of nocturia; 155 (41%) patients had mild, 167 (45%) patients had moderate and 57 (15%) patients had severe nocturia. Increased nocturia severity was related with decreased quality of life; higher age, urinary tract symptom scores, nocturnal urine volume, evening fluid consumption and beta-blocker medication rates. Increased nocturia severity was also associated with higher nocturnal polyuria, global polyuria and reduced bladder capacity rates. Conclusions: Nocturia mechanisms may vary between mild and moderate to severe nocturia groups according to the present study. Nocturia grading with identification of subtypes may help for better standardization of the diagnostic and treatment approaches as well as for the design of future clinical trials.
Aim: The cognate receptor expression of AGE (RAGE; receptor for AGE) on malignant tissues in diabetic patients has been suggested as a co-factor in determining the clinical course and prognosis. We aimed to search this relationship between RAGE expression and clinicopathological features of prostate neoplasia. Methods: A total of 197 patients; 64 (diabetic n=24; non-diabetic n=40) with benign prostate hyperplasia, and 133 (diabetic n=71; non-diabetic n=62) with localized (LPCa)/metastatic prostate cancer (MetPCa) were included the study. The expression of RAGE was studied by immunohistochemically on prostate specimens. The RAGE score was assessed in the specimens according to the extent of immunoreactivity and staining intensity. Results: The RAGE scores of BPH patients (diabetic and non-diabetic) were found as negative. Patients with both LPCa and MetPCa showed significantly higher scores, respectively (LPCa and MetPCa vs. BPH; p<0.01). RAGE scores of diabetic patients with LPCa and MetPCa were found to be 4.71±3.14 and 4.97±3.69, respectively. RAGE scores of the non-diabetic patients who had LPCa and MetPCa were 1.52±1.87 and 1.69±1.58, respectively. When compared both groups with LPCa, RAGE scores of the diabetic patients were significantly higher than that of the non-diabetics (p=0.01). Similar results were revealed as for the patients with MetPCa (4.97±3.69 vs. 1.69±1.58 (diabetic vs. non-diabetic), respectively (p<0.01). Conclusion: We found a high rate of RAGE expression in malign prostate neoplasias to the BPH. Furthermore, as expected, higher scores were demonstrated in those with diabetes than non-diabetics. Disease progression and survival parameters were worse in the patients with high RAGE levels. RAGE may be useful in the diagnosis of prostate cancer and in determining its prognosis.
Background: Radiofrequency ablation in patients with atrial fibrillation (AF) is effective but hampered by pulmonary veins reconnection due to insufficient lesions. High power shorter duration ablation (HPSD) seen to increase efficacy and safety. This analysis aimed to evaluate the clinical benefits of HPSD in patients with AF. Methods: The Medline, PubMed, Embase, and the Cochrane Library databases were searched for studies comparing HPSD and Low power longer duration (LPLD) ablation. Results: A total of seven trials with 2023 patients were included in the analysis. Pooled analyses demonstrated that HPSD showed a benefit of first-pass pulmonary vein isolation (PVI) [risk ratio (RR): 1.27; 95% confidence interval (CI): 1.18–1.37, P < 0.001]. HPSD could reduce recurrence of atrial arrhythmias (RR: 0.70; 95% CI: 0.50–0.98, P = 0.04). Additionally, HPSD was more beneficial in terms of procedural time [Weighted Mean Difference, (WMD): −44.62; 95% CI, −63.00 to −26.23, P < 0.001], ablation time (WMD: −21.25; 95% CI: −25.36 to −17.13, P < 0.001), and fluoroscopy time (WMD: −4.13; 95% CI: −7.52 to −0.74, P < 0.001). Moreover, major complications and esophageal thermal injury (ETI) were similar between two groups (RR: 0.75; 95% CI: 0.44–1.30, P = 0.31) and (RR: 0.64; 95% CI: 0.17–2.39, P = 0.51). Conclusion: HPSD was safe and efficient for treating AF with clear advantages of procedural features, it also showed benefits of higher first-pass PVI and reducing recurrence of atrial arrhythmias compared with the LPLA. Moreover, major complications and ETI were similar between two groups.
Aim: Ultrasound-guided plane blocks are increasingly used in the multi-modal analgesic concept for reducing opioid consumption. The present study was conducted to compare the analgesic effect of intravenous nonsteroidal anti-inflammatory drugs (NSAIDs) and erector spinae plane (ESP) block in renal colic patients. Methods: In this prospective randomized study, 40 patients with renal colic pain were randomly assigned to into two groups; Group NSAID (n=20) received an intravenous infusion of 50 mg of dexketoprofen trometamol, Group ESP (n=20) received ultrasound-guided erector spinae plane block with 30 ml 0.25% bupivacaine at the T8 level. The pain severity of patients was assessed using the visual analog scale (VAS) at baseline, 5., 15., 30., 45. and 60. minutes after intervention. Opioid consumption, patient satisfaction and side effects were recorded. Results: In the ESP group, the VAS scores were significantly lower than the NSAID group at 5., 15., 30., 45. and 60. minutes after the procedure (P<0.001). Opioid consumption was significantly higher in the NSAID group compared with the ESP group (10/20 vs. 0/20, respectively; p<0.001). Patient satisfaction was significantly higher in the ESP group (p<0.001). Conclusions: ESP block can be an alternative, efficient, and safe method for the relief of acute renal colic pain.
Background Many people are used to administering their drugs with food, beverages, or herbs, which may contain chemicals that interfere with the prescribed drugs that could potentially lead to changes in their efficacy or safety and alteration in their pharmacokinetic properties. Objective To assess the extent of perception and use of food, beverages and herbs alongside with conventional drugs and their potential interactions among Jordanian society. Methods This descriptive cross-sectional survey was conducted in Jordan (20 April - 5 May 2020). The survey was developed using Google forms, validated and distributed via social media platforms. Data was analyzed using Statistical Package for Social Sciences-24. Main outcome measure Use and perception of food, beverages, herbs and their drug interactions among Jordanians. Results Of all participants (n = 789), 77.8% were females, 46.2% were 50-year-old, 69.7% were married, 70.8% were medically insured, and 51.1% had a bachelor’s degrees. Seventy percent of the study participants reported use of medicinal plants. About 66% of participants agreed that medicinal plants or herbs could treat diseases and 58.6% thought that medications could interact with drugs. In general, the participants’ knowledge about food/beverage/herb-drug interactions was considered poor. However, linear regression analysis illustrated that the level of knowledge was significantly affected (p-value <0.05) by gender, marital status, social status, the educational level, and employment sector. Conclusion Jordanians have a positive perception towards herbs and their ability to treat diseases. However, their knowledge about food/beverage-drug interactions was poor. This call needs to enhance the community awareness on food/beverage/herb-drug interactions.
Background: To compare long-term oncological and renal functional outcomes of laparoscopic and robotic partial nephrectomy for small renal masses. Methods: A total of 103 patients who underwent laparoscopic (n= 31) and robotic (n= 72) partial nephrectomy between April 2015 and November 2018 were included in the study. Perioperative parameters, long-term oncological and functional outcomes were compared between the laparoscopic and robotic groups. Results: No significant differences were found in terms of age, tumor size, RENAL and PADUA scores, preoperative estimated glomerular filtration rate (eGFR), and presence of chronic hypertension and diabetes (p=0.479, p=0.199, p=0.120 and p=0.073, p=0.561 and p=0.082 and p=0.518, respectively). Only estimated blood loss was significantly higher in the laparoscopic group in operative parameters (158.23±72.24 mL vs 121.11±72.17 mL; P=0.019), but transfusion rates were similar between the groups (p=0.33). In the laparoscopic group, two patients (6.5%) required conversion to open, while no conversion was needed in the robotic group (p=0.89). There were no differences in terms of positive surgical margin and complication rates (p=0.636 and p=0.829, respectively). No significant differences were observed in eGFR changes and postoperative new-onset chronic kidney disease at one year after the operation (p=0.768, p=0.614, respectively). The overall mean follow- up period was 36.07±13.56 months (p=0.007). During the follow-up period, no cancer-related death observed in both group and non-cancer specific survival was 93.5% and 94.4% in laparoscopic and robotic groups, respectively (p=0.859). Conclusions: In this study, perioperative and long-term oncological and functional outcomes seems to be comparable between laparoscopic and robotic partial nephrectomies.