Background: Helicobacter pylori (H. pylori) is the most common cause of gastric cancer. Growing evidence suggests that the regular arrangement of collecting venules (RAC) can be used as an endoscopic marker to diagnose H. pylori infection. However, data on the diagnostic accuracy of RAC for H. pylori infection are conflicting. We performed a systematic review and meta-analysis of relevant studies to determine the diagnostic accuracy and clinical utility of RAC for the diagnosis of H. pylori infection. Methods: We systematically searched PubMed, Embase, Web of Science, and the Cochrane Library between inception and Oct 29, 2020, for studies that assessed the diagnostic accuracy of RAC for H. pylori infection. Results: The literature search yielded 2921 nonduplicated screened titles, of which 58 underwent full-text review. Fifteen studies, representing a total of 6621 patients, met the inclusion criteria. The area under the summary receiver operating characteristic curve was 0.98 (95% CI 0.96 to 0.99). The pooled estimates for RAC were 0.98 (95% CI 0.95 to 0.99) for sensitivity and 0.75 (95% CI 0.54 to 0.88) for specificity. The pooled positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 3.8 (95% CI 1.9 to 7.7) and 0.03 (95% CI 0.02 to 0.07), respectively. Conclusions: RAC can be used as an endoscopic marker for exclusion of H. pylori infection. However, it cannot be recommended as a single indicator for the confirmation of H. pylori infection. The conclusion of this study should be treated with caution because significant heterogeneity exists between the evaluated studies.
Objectives: In this study, we aimed to evaluate the haemodynamic changes of laparoscopic adrenalectomy (LA) in geriatric patients with pheochromocytoma (PHEO). To the best of our knowledge, it is the first study evaluating the haemodynamic outcomes of pure LA in this patient population. Methods: Between 2000-2020, data of 350 patients who underwent single-side transperitoneal LA were reviewed retrospectively. Patients with a histopathological diagnosis of PHEO were enrolled and classified into two groups according to their ages at the date of surgery. Older than 65 years were accepted as elderly according to the World Health Organisation recommendations. Results: Overall 54 patients underwent single side LA for PHEO. Fifteen patients were enrolled in the elderly group and 39 in the young group. There were no significant differences regarding the operation site (0.564) and tumour size (0.878). There were no statistically significant differences in terms of perioperative outcomes, such as mean anaesthesia and operation times, blood loss and haemodynamic changes. Regarding postoperative outcomes; there were no statistically significant differences in mean hospitalization and intensive care unit times. In 1 patient in each grade-1 (prolonged ileus, managed with medical treatment) and grade 2 complication (transfusion during surgery) observed in the elderly and young groups, respectively (p=0.498). Conclusion: Laparoscopic adrenalectomy in elderly patients with PHEO is as safe and effective as in younger patients. One of the most important conditions for achieving good perioperative and postoperative outcomes in the elderly patient population with this challenging surgery is the multidisciplinary approach.
Introduction: Due to the high mortality of coronavirus disease 2019 (COVID-19), there are difficulties in the managing emergency department. We investigated whether the d-dimer/albumin ratio (DAR) and fibrinogen/albumin ratio (FAR) predicts mortality in the COVID-19 patients.Methods: A total of 717 COVID-19 patients who were brought to the emergency department from March to October 2020 were included in the study. Levels of d-dimer, fibrinogen, and albumin, as well as DAR, FAR, age, gender, and in-hospital mortality status of the patients were recorded. The patients were grouped by in-hospital mortality. Statistical comparison was conducted between the groups.Results: Of the patients included in the study, 371(51.7%) were male, and their median age was 64 years (50–74). There was in-hospital mortality in 126 (17.6%) patients. The area-under-the-curve (AUC) and odds ratio values obtained by DAR to predict in-hospital mortality were higher than the values obtained by the all other parameters (AUC of DAR, albumin, d-dimer, FAR, and fibrinogen: 0.773, 0.766, 0.757, 0.703, and 0.637, respectively; odds ratio of DAR>56.36, albumin<4.015, d-dimer>292.5, FAR>112.33, and fibrinogen>423: 7.898, 6.216, 6.058, 4.437, and 2.794, respectively). In addition; patients with concurrent DAR>56.36 and FAR>112.33 had an odds ratio of 21.879 with respect to patients with concurrent DAR<56.36 and FAR<112.33.Conclusion: DAR may be used as a new marker to predict mortality in COVID-19 patients. In addition the concurrent high DARs and FARs were found to be more valuable in predicting in-hospital mortality than either separately.Keywords: Covid-19, D-dimer, Fibrinogen, Serum Albumin, in-Hospital Mortality
Background: Tailgut cysts (TGCs) are benign congenital abnormalities that usually present with non-specific symptoms, comprising a diagnostic dilemma for the physicians. The aim of this study was to systematically review the literature concerning clinical manifestations, diagnostic modalities and histologic findings of TGCs and highlight current knowledge on therapeutic management of this rare entity. Methods: PubMed and Embase databases were systematically searched by two independent investigators (last search February 18, 2021) for studies concerning TGCs published in the last two decades. Results: Totally, 144 articles, including 135 case reports and 9 case series, met our inclusion criteria. 184 patients were included (3:1/female: male) with an age of 42.3 ± 18.7 (mean, SD) years, while 5 cases concerned newborn infants. Pain was the prevailed clinical manifestation (41.8%) whereas 16.8% were asymptomatic. MRI and CT were utilized for diagnosis in 58.7% and 54.7% of cases, respectively. The majority of cysts were multilocular, while ciliated columnar epithelium and smooth muscles of the cyst wall were the prevailed histological findings. Malignant degeneration of TGCs was reported on 32.1% of cases while carcinoid tumors were the most frequent malignancies. Surgical resection was performed at 155 cases, while laparoscopic and robotic approach at 18 and 2 cases respectively. A posterior approach was implemented in 80.9%, anterior technique in 9% and combined technique in 6.7% of cases. Postoperative complications and recurrence of the cystic lesion were reported in 17.4% and 7.6% of cases, respectively. Conclusions: TGCs constitute a dilemma for the physicians. Surgical resection comprises the ultimate treatment in order to avoid complications or malignant transformation of the cyst. Further well-designed studies are needed to assess follow-up strategies and the optimal therapeutic options for TGCs.
Aims: Lysosomal β-glucocerebrosidase (GBA) deficiency causes Gaucher disease (GD), a recessive disorder caused by bi-allelic mutations in GBA. The prevalence of GD is associated with ethnicity, but largely unknown and potentially underestimated in many countries. GD may manifest with organomegaly, bone involvement and neurological symptoms as well as abnormal laboratory biomarkers. This study attempted to screen for GD in patients using abnormal platelet, alkaline phosphatase (ALP) and ferritin results from laboratory databases. Methods: Electronic laboratory databases were interrogated using a 2-4 year time interval to identify from clinical biochemistry records patients with a phenotype of reduced platelets (<150x109/L) and either elevated ALP (>130iu/L) or ferritin (>150 (female) or >250µg/L(male)). The mean value over the screening window was used to reduce variability in results. A dried blood spot sample was collected for the determination of GBA activity in patients meeting these criteria. If low GBA activity was found then the concentration of the GD-specific biomarker glucosyl-sphingosine (lyso-GB1) was assayed, and the GBA gene sequenced. Results: Samples were obtained from 1058 patients; 232 patients had low GBA activity triggering further analysis. No new cases of GD with homozygosity for pathogenic variants were identified but 12 patients (1%) were identified to be carriers of a pathogenic variant in GBA. Conclusions: Pathology databases hold routine information that can be used to screen for patients with inherited errors of metabolism. However, biochemical screening using mean platelets, ALP and ferritin has a low yield for unidentified cases of Gaucher Disease.
Vaccination against the COVID-19 virus began in December 2020 in the UK and is now running at 5% population/week. High Levels of social restrictions were implemented for the third time in January 2021 to control the second wave and resulting increases in hospitalisations and deaths. Easing those restrictions must balance multiple challenging priorities, weighing the risk of more deaths and hospitalisations against damage done to mental health, incomes and standards of living, education outcomes and provision of non-Covid-19 healthcare. Weekly and monthly officially published values in 2020/21 were used to estimate the impact of seasonality and social restrictions on the spread of COVID-19 by age group, on the economy and healthcare services. These factors were combined with the estimated impact of vaccinations and immunity from past infections into a model that retrospectively reflected the actual numbers of reported deaths closely both in 2020 and early 2021. It was applied prospectively to the next 6 months to evaluate the impact of different speeds of easing social restrictions. The results show vaccinations are significantly reducing the number of hospitalisations and deaths. The central estimate is that relative to a rapid easing, the avoided loss of 57,000 life years from a strategy of relatively slow easing over the next 4 months comes at a cost in terms of GDP reduction of around £0.4 million/life-year loss avoided. This is over 10 times higher than the usual limit the NHS uses for spending against Quality Adjusted Life Years (QALYs) saved. Alternative assumptions for key factors affecting give significantly different trade-offs between costs and benefits of different speeds of easing. Disruption of non-Covid-19 Healthcare provision also increases in times of higher levels of social restrictions. In most cases, the results favour a somewhat faster easing of restrictions in England than current policy implies.
Introduction: In dermoscopic studies on dermatofibromas, some publications divide the appearance of lesions into standardized patterns, and some publications classify the clinical appearance of the lesions by comparing them with existing dermatological lesions. Objectives: This study aims to re-evaluate the dermoscopic findings and patterns of dermatofibromas from a different perspective. Methods: In this study, 142 lesions of 72 patients were evaluated dermoscopically and their patterns were schematized. Results: In our study, a total of 15 patterns consisting of main and sub-patterns were created. The most common patterns we detected were pattern 1 (1a: 13.4%, 1b: 8.5%), pattern 8 (8a: 10.6%, 8b: 4.2%), pattern 2 (2a: 9.2%, 2b: 4.2%), respectively. Conclusions: Patterns of DFs were reclassified while preserving basic patterns. We think that the new sub-patterns and schematization with this study can contribute to better understanding of DFs.
Psoriasis is one of the most common chronic cutaneous skin disorders, having genetic and immunological components. It is currently unknown what exactly triggers it, or how far reaching are the etiological factors, although great strides have been made in uncovering the pathophysiological cascade. Presently, there is a wide diversity of treatment methods for psoriasis, yet not all are applicable for each patient. Selection of both drug and dosage depends on both the knowledge and experience of the treating dermatologist, but also on the specific characteristics of each patient. Therefore, the treating physicians should be made aware of the management possibilities, their advantages, as well as their side effects. Current therapies are divided into topical, systemic, and biological agents. In the following manuscript, we present an updated version of these therapies, alongside their indications, posology and most common side effects, a guide that may be useful for every practitioner in this field.
Aims: To assess the effect of oral anticoagulant (OAC) administration on incidence of dementia in patients with atrial fibrillation (AF) with Systematic review and meta-analysis in according with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols. Methods: We systematically searched the electronic databases including Pubmed, Embase, Cochrane library, and ClinicalTrails.gov for relevant articles. The primary outcome was the incidence of dementia. The adjusted risk ratio (RR), odds ratio, or hazard ratio were extracted and pooled by the random-effects models. Subgroup analysis was performed according to the setting observational window. Risk of bias was assessed using the Newcastle-Ottawa Scale, while publication bias was assessed by the Begg’s and Egger’s tests. Results: Nine studies included in this review (2 prospective and 7 retrospective observational studies, including 613,920 patients). The results presented the significant association between OAC therapy and the reduced risk of dementia compared with no treatment (RR [95%CI] =0.72 [0.60, 0.86], I2=97.2%; P =0.000). In the subgroup analysis, the pooled RR became statistically non-significant (including four studies, RR [95%CI] =0.75 [0.51, 1.10], I2=98.8%; P =0.000). There is no significant risk of bias and publication bias. Conclusions: This study indicated the protective effect of OAC therapy for dementia in patients with AF. However, the results are limited because of high heterogeneity, inconsistent direction of effect in subgroup analysis. Further prospective well-designed study is needed with longer follow-up duration in younger patients.
An unusual localization of genital ulcer in Behçet’s disease: external urethral meatusRunning head: Unusual genital ulcer in Behçet’s diseaseÇağrı Turan1, İbrahim Karabulut 21Department of Dermatology and Venereology, the Republic of Turkey, Health Sciences University Erzurum Regional Training and Research Hospital, Turkey2Department of Urology, the Republic of Turkey, Health Sciences University Erzurum Regional Training and Research Hospital, TurkeyCorresponding Author : Çağrı TURAN; Department of Dermatology and Venereology, the Republic of Turkey, Health Sciences University Erzurum Regional Training and Research Hospital, Turkey; Üniversite Mahallesi, Çat Yolu Cd., Yakutiye/Erzurum, Post Code: 25070e-mail: firstname.lastname@example.org, telephone number: +905445252504Word count: 471Table count: 0Supplementary table: 0Figure count: 1Funding sources : We declare no financial support or relationships that may pose a conflict of interest.Conflict of interest: There is no conflict of interest.The paper has not been published or submitted for publication elsewhere.All authors have contributed significantly, and all authors agree with the content of the manuscript.Informed consent form was obtained from the patient.Key words: Behçet’s disease, genital ulcer, Urethra, VasculitisDear editor,Behçet’s disease (BD) is a chronic, recurrent, multisystemic vasculitis which can affect all vascular system. The most common symptom is genital ulcer accompanying oral aphthae, and its diagnosis is currently made according to the International Criteria for Behçet’s Disease (ICBD). Providing two points for oral aphthae, genital ulcers, and ocular involvement and one point for the other skin lesions (erythema nodosum, papulopustular/acneiform lesions in post-adolescent), vascular involvement, and neurological findings are evaluated if the patient scores reach four or more; the patient is considered to be BD1, 2. In men, genital aphthous ulcers occur in 60 to 65% of cases and are most common in the scrotum, shaft and glans penis, and rarely in the groin and perineum, extremely rare in the urethral orifice2, 3We presented a patient with a complaint of painful micturition, ultimately diagnosed with BD. A 34-year-old male patient was consulted from the urology following the evaluation of his painful voiding complaint 10 days accompanying wound in the periurethral orifice. On genital examination, an oval, and sharp circumscribed aphthous ulcer with a serous floor, approximately 4 mm in diameter, was seen on the external urethral orifice (Figure 1a). The patient who had no known disease has refused to use any medication, similar complaints, suspicious sexual contact, except for oral aphthae recurring 8-10 times a year (Figure 1b). After noticing a few pustular lesions with peripheral partial erythema on his back, we focused on BD and inflammatory bowel diseases in the examination (Figure 1c). We learned that the patient had no family history and other related symptoms. Bowel habits were normal. Hepatitis, HIV, syphilis serologies were negative. CRP and sedimentation were 3.2 mg/dl (0-5 mg/dl) and 27 mm/hour (0-20 mm/hour); respectively. Other hematological and biochemical parameters were within normal limits. Complement levels, antinuclear antibody, anti-dsDNA, p-ANCA, c-ANCA and rheumatoid factor were normal. Pathergy test was positive. The patient was diagnosed with BD with a score of 6 according to the current ICBD, and no pathology was found in the eye and cardiology consultations. His complaints improved within 1 week without leaving any scar, after treatment with topical betamethasone valerate applied to the urethral orifice and oral colchicine 1.5 mg/day. No clinical progression has been observed for 2 years in the follow-up.A urethral ulcer is an unusual finding in BD. Aktaş recently reported a 27-year-old male patient with clinical features quite similar to our case, but with negative pathergy4. Interestingly, Cobilinschi et al. reported that a 34-year-old female patient with BD who was admitted with progressive dysuria, pain in the right lumbar region, and hydronephrosis was determined a necrotic ulcer in the ureter whose histopathology was compatible with vasculitis5.We present this case to draw attention to the aphthous ulcer in the urethra as an unusual genital involvement for BD, and the importance of physical examination.
Background:Microwave ablation has a great potential to treat primary hyperparathyroidism; but its predictors and the therapeutic efficiency are not clear enough and so the more investigations are required. Aim:The purpose of this study was to explore safety and predictors of the MWA efficacy in patients with primary hyperparathyroidism (PHPT) induced by parathyroid adenoma. Methods: Patients with PHPT treated with MWA were included in this study. Depending on the treatment efficacy, patients divided into two groups as response and no response group. Possible predictors as age, gender, Parathyroid adenoma volume, baseline levels of calcium (Ca), phosphorous (P), alkaline phosphate (ALP), vitamin D and location of parathyroid adenoma and the instrumental parameters which are microwave ablation time and power were compared between two groups. The resulting possible predictors the MWA efficacy exhibiting statistically significant difference was investigated by using logistic regression. Results: Thirty-two patients participated into predictor analysis for MWA efficacy. Comparison of the values of response and no response groups in terms possible predictors revealed only the baseline Ca level as the potential predictor of the efficacy of MWA (P <0.05). Further logistic regression results showed the baseline Ca level as insignificant to construct a mathematical model to predict the efficacy of MWA (P = 0.071). Furthermore, a significant difference in time differences was observed after 1 day of the MWA treatments in the levels of Ca, P, and PHT except than ALP, those of which was 30 days later (P <0.001). Later on, the difference stayed steady until the end of follow up. Conclusions:MWA is an effective and safe therapy for in patients with PHPT caused by parathyroid adenoma. Baseline Ca level has been found as potential but detailed investigations revealed none of the explored factors as predictive for the assessed patients. Keywords:Primary hyperparathyroidism, microwave ablation, predictor, efficacy
Background: Antibiotics’ rational prescribing is a major goal of the World Health Organization’s (WHO) global action-plan to tackle antimicrobial resistance. Evaluation of antibiotic prescribing patterns is necessary to guide simple, globally applicable stewardship interventions. The impact of antimicrobial resistance is devastating, especially in low-income countries. We aimed to introduce ambulatory data on patterns of pediatric antibiotic prescribing in Jordan, which could be used to guide local stewardship interventions. Methods: A cross-sectional retrospective study was conducted by selecting a random sample of pediatric patients, who attended ambulatory settings in 2018. Records of outpatients (age 18 years) receiving at least one antibiotic were included. The WHO’s model of drug utilization was applied, and all prescribing indicators were included. Multiple linear regression was performed to examine factors influencing the ratio of prescribed antibiotics to overall medications per encounter. Results: A total of 20,494 prescriptions, containing 45,241 prescribed drugs, were obtained. Average number of prescribed drugs per prescription was (2.21 0.98). 77.5% of overall ambulatory prescriptions accounted for antimicrobials. Only 0.6% of total prescriptions were for injectables. All antimicrobials (100%) were prescribed by generic-names and from essential drug list. Antibiotics were most commonly prescribed for respiratory tract infections. Age, gender, season, and facility type were significant predictors of prescribed antibiotics to overall medications ratio. Conclusions: This is the first study of antibiotic prescribing patterns among outpatient pediatrics that covers wide regions in Jordan. Results indicate high rates of antibiotics use among outpatient pediatrics. Such findings necessitate more focused efforts and regulations that support rational utilization of drugs.
Research of Occult Hepatitis B Infection in HIV-infected Patients, Schindler Study ABSTRACT Objective: Occult hepatitis B infection seems to be more prevalent among subjects at high risk for HBV infection and with concomitant liver disease. The aim of this study was to assess the prevalence of OHBI in group of HIV-1+/HBsAg- Turkish patients. Methods: Ten centers in Turkey have been included in the study. Gender, age, occupation, place of residence, treatment status, clinic, immunodeficiency panel, eliza tests, hemogram, biochemistry and coagulation laboratory results of the patients were evaluated retrospectively. Results: The number of HIV-infected patients followed in these centers is 3172. The mean age of the patients was 37.2 ± 13.1, and they were 235 males (84.5%) and 43 (15.5%) females. 278 (99.6%) of the patients are patients who received antiretroviral treatment. included in the s Of the 279 patients included in the study, it was determined that HBsAg was negative in all of them, 169 were positive for Anti HBs and 125 were positive for Anti HBc IgG. HIV RNA (203/278) was detected in 203 of the patients. 4 (1.4%) of the patients were diagnosed with OHB. In our study, no significant difference was found in hemoglobin and bilirubin levels and complete blood count in patients with HIV-OHB co-infection. However, albumin values were found to be <3.5 in three OHD patients (p = 0.043). Conclusion: Reasearch the presence of OHB infection in HIV-infected patients is important in determining treatment options and predicting the survival of patient. Hypoalbuminemia could be showing hepatic failure and we can suggest the importance of treatment that diseases.
Introduction The dissection of perirenal fat is of critical importance to kidney surgery and ease of dissection is more important when using minimally invasive approaches. This study aimed to determine the clinical, radiological, and pathological significance of adherent perirenal fat(APF). Materials and Methods This prospective study included 22 patients scheduled for partial nephrectomy and 40 patients for donor nephrectomy. Intra-operative fat dissection time was recorded and the complexity of perirenal fat dissection was surgeon-classified as easy, moderate, and difficult. Perirenal fat and subcutaneous fat thickness was measured. Measurement of perirenal fat depth, and the Hounsfield unit(HU) for both perirenal and subcutaneous fields was performed using CT images. All specimens were submitted for histopatological analysis. Researchers in each arm were blinded to other researchers’ data. Results Mean age of the patients was 51.3±12.7years. Mean perirenal fat dissection time was 15.0±13.5min. Patient demographics, BMI, nor occupational status differed between the 3 complexity of perirenal fat dissection groups. Radiological findings showed that there was a significant correlation between perirenal fat depth and complexity of perirenal fat dissection(p<0.05), but not with HU measurements or subcutaneous fat thickness. Surgeon classification of the complexity of perirenal fat dissection was in accordance with the duration of dissection(p<0.05). Perinephric fat contained more fibrous tissue in the patients with histologically proven APF than in those without(p<0.05). Conclusions APF is a challenge during kidney surgery. Difficult dissection prolongs the duration of surgery, which can lead to complications. Perirenal fat thickness measured via pre-operative CT might be used to predict APF.
Background: Despite major advances in basic and advanced life supports, patients who survived from out of hospital cardiac arrest (OHCA) has still poor prognosis. Several inflammatory parameters have been used to determine early and long-term prognosis in patients with OHCA. C-reactive protein-to-albumin ratio (CAR) is also a novel marker of systemic inflammation. To our knowledge, there is no study evaluating the clinical importance of CAR in OHCA patients. Aims: To evaluate the effect of CAR on mortality in patients with OHCA. Methods: A total of 102 patients with OHCA were included in this study. The study population were divided into two groups as survivor (n = 43) and non-survivor (n = 59) during follow-up. Complete blood cell counts, biochemical and blood gas analysis were recorded for all patients. Neutrophil to lymphocyte ratio (NLR) was calculated as the ratio of neutrophil to lymphocyte. CAR was calculated as the ratio of CRP to the albumin. Results: NLR (P=0.012), CAR (P<0.001) and serum lactate level (P =0.002) were significantly higher whereas lymphocyte (P=0.008) and serum albumin (P<0.001) were significantly lower in non-survivor group compared to survivor group. Multivariate logistic regression analysis showed that NLR (odds ratio [OR]: 1.044, 95% confidence interval [CI]: 1.044-1.437, P=0.013), CAR (OR: 1.971, 95% CI: 1.327-2.930, P=0.001), and lactate level (OR: 1.268, 95% CI: 1.095-1.469, P=0.002) were independent predictors of mortality. Conclusions: We have demonstrated for the first time that CAR was an independent predictor of in-hospital mortality in OHCA patients.
Purpose: To investigate the quality of life (QoL) in patients with end-stage renal disease who underwent open or robot-assisted renal transplantation (ORT and RART). Materials and Methods: Patients who underwent ORT and RART at Bakirkoy Sadi Konuk Training and Research Hospital between June 2016 and December 2018 constituted the target population of this study. The patient group was divided into two groups as per the surgical technique (i.e., open vs. robot-assisted). Demographic data, preoperative and postoperative data of all patients were collected prospectively. The QoL of the patients was assessed preoperatively and on the postoperative 30th day. Results: 67 patients who underwent ORT and 60 patients who underwent RART were included. The mean patient age and BMI were calculated as 40,9 ± 11,6 years and 24,4 ± 2,9 kg/m2, respectively. While mean total ischemia time was shorter in the ‘open’ group, incision length, duration of surgical drainage and hospital stay were shorter in the ‘robot-assisted’ group. The physical component scores of the QoL questionnaire revealed that postoperative impairment of quality of life was more significant in the ORT than the RART. Conclusion: Patients who underwent RART have a higher QoL than the patients who were treated with ORT as per their self-reported QoL scores in the early postoperative period. Keywords: End-stage renal disease; Open renal transplantation; Robot-assisted renal transplantation; Quality of life
Objectives: In this study, we aimed to compare the outcomes and complication rates of percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) in geriatric patients according to Charlson comorbidity index (CCI). Materials and Methods: Between April 2011 and January 2020, patients who underwent PCNL and RIRS for renal stone between 10 and 30 mm in geriatric patients were retrospectively evaluated. All patients’ Pre-surgery comorbidities were recorded and the CCI was calculated. The two groups’ perioperative values, stone free rates and complication rates were compared. Postoperative complications were noted according to the Clavien scoring system. Results: There were 89 and 72 patients in the PCNL and RIRS group, respectively. The median age was 67 years in both of groups (p=0.192). The stone size were 22.2 ± 3.5 and 19.9 ± 7.1 in the PCNL and RIRS group, respec¬tively ( p = 0.082). CCI scores were similar in both groups (p=0.098). Stone free and complication rates were significantly higher in PCNL group (p = 0.021, p = 0.034). Also we found that overall complication and major complication rates were statistically significant difference with especially Charlson comorbidity index score ≥2 in PCNL group (p = 0,016, p = 0,029). According to correlation analysis of intraoperative and postoperative results with Charlson comorbidity index, there was positive correlation between total complication with PCNL and RIRS group, respectively (p < 0,001, p = 0.024). In addition, there was positive correlation between lenght of hospital stay with PCNL and RIRS group, respectively (p = 0,007, p < 0,001). Also there was positive correlation between blood transfusion requirement with PCNL group (p=0,009). Conclusion: Despite there was higher stone clearence in PCNL, the complication rates were higher compared to RIRS. So RIRS might be a safe alternative treatment method to PCNL in older patients with a high CCI score.
Objectives: During the pandemic, anxiety, stress, and depression may occur increasingly in the whole society. To evaluate the possible cause, incidence and levels of anxiety and depression in the relatives of the patients in the ICU in accordance with the patients’ SARS-CoV-2 PCR result. Materials and Method: The study was prospectively conducted on relatives of patients admitted to tertiary ICU during COVID-19 pandemic. Sociodemographic characteristics of the patients and their relatives were recorded. “The Turkish version of the Hospital Anxiety and Depression Scale” questionnaire was applied twice to the relatives of 120 patients to determine the symptoms of anxiety and depression in accordance with the PCR results of the patients (PCR positive n=60, PCR negative n=60). Results: The ratios above cut-off values for anxiety and depression among relatives of the patients were 45,8% and 67,5% for the first test and 46,7% and 62,5% for the second test respectively. The anxiety and depression in the relatives of PCR positive patients was more frequent than the PCR negative (p< 0,001 for HADS-A and p=0,034 for HADS-D). The prevalence of anxiety and depression was significantly higher in female participants (p=0,046 for HADS-A and p=0,009 for HADS-A). There was no significant correlation between HADS and age of the patient or education of the participants. The fact that the patients were hospitalized in the ICU during the pandemic was an independent risk factor for anxiety (AUC = 0.746) while restriction of patient visiting in the ICU was found to be an independent risk factor for depression (AUC= 0.703). Conclusion: While patient with positive PCR and participant with female gender is responsible for both anxiety and depression, hospitalization in the ICU due to COVID-19 is an independent risk factor for anxiety and restriction of patient visiting in the ICU is an independent risk factor for depression.