Background: We aimed to determine the relationship of ischemia-modified albumin (IMA) with diabetic foot ulcers and its predictive value in the Wagner classification. Methods: Our cross-sectional study was conducted in 120 diabetic foot patients and 60 healthy individuals with similar body mass index and age. Patients with a diabetic foot were classified according to the Wagner classification. Biochemical parameters, C-reactive protein (CRP) and IMA levels were measured in all patients and healthy volunteers. Screening performance characteristics of CRP and IMA were calculated according to Wagner classes and the presence of osteomyelitis. Results: CRP and IMA levels in the patient group were significantly higher than the control group. The highest IMA levels were detected in Wagner grade 5. CRP had higher sensitivity and specificity than IMA in the discrimination of other grades, except for grade 4-5 separation. For Wagner grade 4-5 distinction, IMA had 84.6% sensitivity and 94.7% specificity. Conclusion: IMA may play a role in the pathogenesis of diabetic foot ulcers and had a higher predictive value in discrimination of the Wagner grade 4 and 5. In the management of diabetic foot patients, it may be recommended that IMA is evaluated by clinicians.

Objective: Malnutrition is associated with poor clinical outcomes in many diseases. The Controlling Nutritional Status (CONUT) is an objective index used for evaluating nutritional status of hospitalized patients. The aim of this study was to investigate the relationship between malnutrition assessed by CONUT score and the prognosis in patients undergoing carotid artery stenting (CAS). Methods: The study included 170 patients who underwent CAS due to symptomatic or asymptomatic severe carotid artery stenosis. Median follow-up period was 50 (interquartile range [IQR], 41-60) months. Patients were divided into two groups according to the CONUT score: (i) normal nutrition (<2) and (ii) malnutrition (≥2). Primary endpoint was accepted as MACE (major adverse cardiac events) including all-cause death and ischemic stroke. Results:The prevalence of MACE was significantly higher in the malnutrition group (p=0.001). Kaplan Meier analysis showed lower survival rates in the malnutrition group (log rank = 9.36, p=0.002; Figure 4). In multivariate logistic regression analysis, age and CONUT score were independent predictors of all-cause death and stroke after adjustment for confounding factors, respectively, (OR: 1.058, 95% CI: 1.013-1.105, p=0.011, OR: 1.318, 95% CI: 1.017-1.881, p=0.039). Conclusion: Higher CONUT scores were associated with adverse outcomes in patients with CAS. Malnutrition assessed by the CONUT score may provide valuable prognostic information in patients with CAS.

Objective: In this study, it was aimed to focus on the psychological aspect of unexplained infertility by comparing the mental symptoms of infertility due to known causes and fertile patients. Patients and Methods: 60 unexplained infertility patiens, 50 infertile patients with a known cause and 56 fertile patients were included in the study. Socio-demographic data form, Toronto Alexithymia Scale (TAS-20), Somatosensory Amplification Scale (SAS) and Anxiety Sensitivity Index (ASI-3) were applied to the patients. Results: No significant differences in the levels of alexithymia, somatosensory amplification, and anxiety sensitivity were detected across the groups (p>0.05). When the correlation of clinical scale scores with each other was analyzed in the whole group of infertile patients regardless of the cause, anxiety sensitivity was found increased as difficulty identifying feelings increased. Conclusion: In our study, it has been found out that; regardless of the knowledge of the etiology of infertility, the levels of alexithymia, somatosensory amplification, and anxiety sensitivity of infertile cases did not differ from those of fertile women. However, it has been shown that as the difficulty in identifying emotions increases in infertile cases, anxiety sensitivity, which may cause psychological infertility, also increases.

Background: The aim of this study was to investigate the effect on the occurrence of emergence delirium of propofol and ketofol with intranasal dexmedetomidine and midazolam applied as premedication to paediatric patients during magnetic resonance imaging (MRI). Methods: The study included children aged 2-10 years who received sedation for MRI, separated into four groups. Group MP received intranasal midazolam (0.2 mg/kg) for premedication and IV propofol (1 mg/kg) as the anaesthetic agent. Group MK received intranasal midazolam (0.2 mg/kg) for premedication and IV ketofol (1 mg/kg) as the anaesthetic agent. Group DP received intranasal dexmedetomidine (1 mcg/kg) for premedication and IV propofol (1 mg/kg) as the anaesthetic agent. Group DK received intranasal dexmedetomidine (1 mcg/kg) for premedication and IV ketofol (1 mg/kg) as the anaesthetic agent. The Paediatric Anaesthesia Emergence Delirium (PAED) scale was used to evaluate delirium. A PAED score ≥ 10 was accepted as delirium. Results: The need for additional anaesthetic was highest in Group DP at 94.3% and lowest in Group DK at 14.3%. The mean Aldrete and PAED scores were lower and the length of stay in the recovery room was shorter in Group DP than in the other groups. Delirium only developed in two patients in Group MP (5.7%) at 5 mins after anaesthesia. Conclusion: In our study, delirium was seen at a very low rate only in the Group MP and it is difficult to say the best combination in terms of delirium frequency with this result.

BACKGROUND: This study aims to determine nicotine dependence levels in pre and during pandemic and its correlations with COVID-19 phobia among healthy men during controlled social life: a sample of primary care population. METHODS: This cross-sectional study was conducted with 472 healthy men in Çorum, Black Sea Region, Turkey between February 2019 and October 2020. An online questionnaire was used to collect data including demographic profile, smoking behavior, intention to quit, Fagerström Nicotine Dependence test (FTND) pre and during COVID-19 pandemic and COVID-19 phobia scale. RESULTS: In this study, a percentage change of +6.2, +0.8, +1.9, -2.7, -5.1 was found in very low, low, medium, high and very high dependence categories respectively between pre-pandemic and during controlled social life in pandemic. A percentage change of +2.8 was seen in terms of intention to quit smoking. The mean score for COVID-19 phobia was 65.9 ± 15.8 and almost two-thirds of the participants (62%) had medium and high COVID-19 phobia. Men with high/very high dependence had significantly more COVID-19 phobia than the other two groups. There was a significant correlation between FTND scores and COVID-19 phobia. CONCLUSIONS: There were considerable changes in dependence levels and COVID-19 phobia was more common in high/very high dependence group. Controlled social life should be considered a golden opportunity for predicting levels of nicotine dependence and will bring benefit for lower smoking prevalence. COVID-19, Nicotine dependence, Phobia, men, Primary health care.

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Introduction: Global medical advances within healthcare have subsequently led to the widespread introduction of biological products such as grafts, haemostats, and sealants. Although these products have been used for many decades, this subject is frequently not discussed during the consent process and remains an area of contention. Methods: A nationwide confidential online survey was distributed to UK-based junior registrars (ST3-5), senior registrars (ST6-8), post-CCT fellows, specialist associates/staff grade doctors and consultants working in general/vascular surgery, neurosurgery, otolaryngology, oral & maxillofacial surgery and plastic surgery. Results: Data was collected from a total of 308 survey respondents. Biological derivatives were correctly identified in surgical products by only 25% of survey respondents, only 19% stated that they regularly consent for use of these products. Our results demonstrate that most participants in this study do not routinely consent (81%) to the intra-operative use of biological materials. An overwhelming 74% of participants agreed that further education on the intra-operative use of biological materials would be valuable. Discussion: This study highlights deficiencies in knowledge that results in potential ethical compromise of the consenting process for surgical procedures. A solution to this would be for clinicians to increase their awareness via educational platforms and to incorporate an additional statement on the consent form which addresses the potential intraoperative use of biological products and what their derivatives may be. Conclusion: Modernising the current consent process to reflect the development and use of surgical biological products will help to ensure improved patient satisfaction, fewer future legal implications as well as a better surgeon-patient relationship.

Background/aim: The aim of this study was to evaluate the effects of general anesthesia and ultrasonography-guided interscalene block on pain and oxidative stress evaluated by thiol–disulphide balance and C-reactive protein levels in patients undergoing shoulder arthroscopy. Materials and methods: A total of 42 patients aged 18–75 years who were scheduled to undergo shoulder arthroscopy were randomized into interscalene block group (Group-IB, n = 20) and general anesthesia group (Group-GA, n = 22). All patients received patient-controlled analgesia during the postoperative period. Additional analgesics were administered to patients with a visual analog scale score of > 4. Native -thiol, total -thiol, disulphide and C-reactive protein levels were measured. Patients’ visual analog scale scores, morphine and additional analgesic consumption were recorded. A shift in thiol–disulphide balance toward decreased thiol and increased disulphide levels was regarded as an indicator of oxidative stress. Results: Pain level, morphine and additional analgesic consumption were higher in Group-GA. Native-thiol and total-thiol levels were higher in Group-IB postoperatively and also disulphide levels were lower at postoperative 18 hours. C-reactive protein levels were similar in both the groups. Conclusion: Interscalene block induced less oxidative stress during the postoperative period, as evaluated by thiol–disulphide balance.

Aims: It is evident that COVID-19 pandemic have affected the medical practice and training of residents. In this study, we evaluated the Physical Examination (PE) habits of residents working in a university hospital and how their PE practices did change during the pandemic. Methods: This single-center, non-interventional, cross-sectional descriptive study was conducted in a university hospital using an online survey questionnaire from 5 to 20 October 2020. Results: 308 residents participated in the study of whom 172 of them (55.8%) were female and the median age was 27 (IQR:3). Among all, 263 participants (85.4%) declared that they have worked in the areas where suspected/confirmed COVID-19 patients were being served. A total of 262 (85%) residents stated that PE habits have changed generally during the pandemic. There was a significant difference between those residents who have worked in the COVID-19 areas (n=230,87.5%) and those who have not (n=32, 71.1%) (p=0.004). PE habits of Internal Medicine Residents were more changed than others (p<0.001). The main reason for the change in PE habits in general (77.9%) and during the examination of suspected/confirmed COVID-19 patients (89.7%) were ‘’self-protection”. Reliance on laboratory and radiologic investigations during practice and not having a thought that less PE will disrupt the diagnosis and course of COVID-19 were also independent risk factors for performing less PE in suspected/confirmed COVID-19 patients. Discussion: This study clearly demonstrated that the COVID-19 pandemic has had a serious impact on the PE habits of the residents while examing patients in general and with COVID-19.

Introduction The COVID-19 vaccination programme is under way. Anecdotal evidence is increasing that some people with Type 1 Diabetes Mellitus (T1DM) experience temporary instability of blood glucose (BG) levels post-vaccination which normally settles within 2-3 days. We report an analysis of BG profiles of 20 individuals before and after vaccination. Methods We examined the BG profile of 20 consecutive adults (18 years of age or more) with T1DM using the FreeStyle® Libre flash glucose monitor in the period immediately before and after COVID-19 vaccination. The primary outcome measure was percentage(%) BG readings in the designated target range 3.9-10mmmol/L as reported on the LibreView portal for 7 days prior to the vaccination (week -1) and the 7 days after the vaccination (week +1). Results There was a significant decrease in the %BG on target following the COVID-vaccination for the 7 days following vaccination (mean 45.2% ±se 4.2%) vs pre-COVID-19 vaccination (mean 52.6% ±se 4.5%). This was mirrored by an increase in the proportion of readings in other BG categories 10.1-13.9%/ ≥14%. There was no significant change in BG variability in the 7days post COVID-19 vaccination. This change in BG proportion on target in the week following vaccination was most pronounced for people taking Metformin/Dapagliflozin+basal bolus insulin (-23%) vs no oral hypoglycaemic agents (-4%), and median age <53 vs ≥53 years (greater reduction in %BG in target for older individuals (-18% vs -9%)). Conclusion In T1DM, we have shown that COVID-19 vaccination can cause temporary perturbation of BG, with this effect more pronounced in patients talking oral hypoglycaemic medication plus insulin, and in older individuals. This may have consequences for patients with T2DM who are currently not supported by flash glucose monitoring.

Background: Elevated red blood cell distribution width (RDW) levels were associated with mortality in patients with stable chronic obstructive lung diseases (COPD). There are limited data about RDW levels in COPD exacerbation. Aim/Objective: The association of the RDW levels with the severity of the acute exacerbation of COPD (AECOPD) were evaluated according to admission location, (outpatient-clinic, ward and intensive care unit (ICU). Methods: Cross sectional retrospective study designed in tertiary chest dieases hospital. COPD patients admitted to hospital outpatiens-clinic, ward and ICU due to AECOPD were included. Patients demographics, RDW, C-reactive protein (CRP), biochemistry values were recorded. RDW values were subdivided below 0.11% (low), above and equal 0.15% (high) and between 0.11-0.15% (normal). Neutrophile to lymphocyte ratio (NLR) and platelet to mean platelet volume (PLT-MPV) were also calculated. Recorded values were compared according to where AECOPD was treated. Results: 2771 COPD patients (33% female) and 1429 outpatients-clinic, 1156 ward and 186 ICU were enrolled in the study. The median RWD values in outpatients-clinic, ward and ICU were 0.16 (0.09-0.26), 0.07 (0.01-0.14) and 0.01 (0.00-0.07) respectively (p<0.001). In outpatient to ward and ICU, low RDW values were significantly increased (31%, 66%, 83% respectively) and high RDW values significantly decreased (54%, 24%, 10%) (p<0.001). According to attack severity, low RDW values were determined. Conclusion: Patients with AECOPD, lower RDW values should be considered carefully. Lower RDW can be used for decision of COPD exacerbation severity and follow up treatment response. What is already known about this topic; In current studies, elevated RDW levels were associated with mortality in patients with stable COPD. What does this article add; Currently , there are limited data about RDW levels in COPD exacerbation. In the present study, the association of the RDW levels according to the severity of AECOPD were evaluated due to admission location.

Objectives: Severe disease characterized by interstitial pneumonia may develop in some cases of coronavirus disease (COVID-19). Periostin has been associated with many respiratory diseases. In this study, we aimed to investigate whether periostin could be a useful new biomarker in the follow-up and severity assessment of the disease in patients with COVID-19 pneumonia. Methods: In the study, 32 patients followed up during May–July 2020 due to COVID-19 and 24 healthy controls were included. The patients were divided into two groups, namely, mild/moderate and severe, according to the severity of the disease. Serum periostin and transforming growth factor beta (TGF-β) levels were tested using an enzyme-linked immunosorbent assay (ELISA) method using commercially available ELISA kits. Results: It was observed that the periostin level was significantly higher in both mild/moderate cases and severe cases compared to the control group at first presentation. However, TGF-β levels at first presentation were similar between the groups. Conclusions: Our study is the first study to investigate periostin levels in patients with COVID-19, and we believe that periostin can be used as a new biomarker. Keywords: COVID-19, Periostin, TGF-β, Pneumonia, New Biomarker Coronaviruses are among the main pathogens that mainly target the human respiratory system. Severe disease characterized by interstitial pneumonia develops in 10-20% of patients. Periostin has recently been shown to be an indicator of disease progression in idiopathic pulmonary fibrosis and asthma. In this study, we aimed to investigate whether periostin could be a useful new biomarker in the follow-up and severity assessment of the disease in patients with COVID-19 pneumonia. This article demonstrated that periostin is a useful new biomarker for disease follow-up and severity in patients with COVID-19 pneumonia. It is also the first study on periostin levels in patients with COVID-19

Abstract The T.O.HO. scoring system was developed to predict stone-free status after flexible ureterenoscopy (fURS) lithotripsy applied for ureter and renal stones. This study aimed to perform the external validation of the T.O.HO. score in the Turkish population and propose a modification for this system. Material Methods Patients who underwent fURS for kidney and ureteral stones between January 2017 and January 2020 were retrospectively analyzed. The patient and stone characteristics and perioperative findings were noted. The T.O.HO. score was externally validated and compared with the STONE score. Stone-free parameters were evaluated with the multivariate analysis. Based on the results of this analysis, the T.O.HO. score was modified and internally validated. Results A total of 621 patients were included in the study. The stone-free rate was determined as 79.8% (496/621) after fURS. The regression analysis showed that stone area had better predictive power than stone diameter (p=0.025). Lower pole (reference), middle pole [odds ratio (OR)=0.492 p=0.016] and middle ureteral (OR=0.227, p=0.024) localizations, stone density (OR=1.001, p<0.001), and stone volume (OR = 1.008, p <0.001) were determined as independent predictive markers for stone-free status. Based on the effect size of the stone surface area in the nomogram, stone volume was divided into five categories, at 1-point intervals. The AUC values of the T.O.HO., STONE, and modified T.O.HO. score in predicting stone-free status were calculated as 0.758, 0.634, and 0.821, respectively. The modified T.O.HO. created by adding stone volume was statistically significantly superior to the original version (ROC curve comparison, p < 0.001). Conclusion The T.O.HO. score effectively predicted stone-free status after fURS. However, Modified T.O.HO. SS showed the best predictive performance compared with original T.O.HO. SS.

Aim: To investigate acute effects of add-on therapy with the sodium glucose co‐transporter 2 inhibitor tofogliflozin to dipeptidyl peptidase (DPP)-4 inhibitors on 24-hour glucose profile and glycemic variability evaluated by continuous glucose monitoring (CGM) in patients with type 2 diabetes. Patients and methods: We studied 17 patients with type 2 diabetes who were hospitalized for glycemic control. CGM was performed for 7 consecutive days in the last week of hospitalization. Tofogliflozin 20 mg/day was started on day 4 after initiating CGM and was administered to 10 patients receiving DPP-4 inhibitors and 7 patients not receiving DPP-4 inhibitors. We compared several CGM parameters between day 2 to 3 (ie, before treatment with tofogliflozin) and day 5 to 6 (ie, after starting treatment with tofogliflozin). Results: After starting treatment with tofogliflozin, mean 24-hour glucose and postprandial glucose after each meal were significantly decreased in both groups of patients. Time in range (ie, at a glucose level of 70-180 mg/dL) was significantly increased in both groups. The standard deviation of 24-hour glucose and mean amplitude of glycemic excursions, 2 indexes of glycemic variability, were significantly decreased in patients receiving DPP-4 inhibitors but were unchanged in those not receiving these drugs. Conclusions: Add-on therapy with tofogliflozin to DPP-4 inhibitors acutely reduces 24-hour glucose levels and improves glycemic variability in patients with type 2 diabetes.

Introduction: Early prediction of return of spontaneous circulation (ROSC) for cardiac arrest (CA) patients is a major challenge. This study’s goal was to investigate the value of the carboxyhemoglobin (COHb) and methemoglobin (MetHb) levels as a predictive marker for ROSC and prognostic marker for patients who achieve ROSC. Methods: A total of 241 adult patients (109 female, 132 male) diagnosed as non-traumatic CA were included in the study. The patients were divided into two groups based on whether they achieved ROSC. Complete blood count parameters, routine biochemistry measurements, coagulation parameters, and blood gas analysis, and cardiac markers values were compared between the groups. Results: COHb levels were significantly lower in the non-ROSC group (0.71 ± 0.57%) than in the ROSC group (0.95 ± 0.76%) and in the non-survival group (0.78 ± 0.53%) compared to the survivor group (1.45 ± 1.31%) (p =0.002, 0.022 respectively). There was no significant difference between the ROSC and non-ROSC groups and survivor group and non-survivor groups in terms of MetHb levels (p = 0.769 and 0.668, respectively). Conclusions: COHb levels in the blood gas analysis at the time of admission could be used as a predictive marker for ROSC and prognostic marker for the patients who achieved ROSC.

Objectives: To evaluate the bullying in individuals with cleft lip and/or palate (CLP) by Twitter analysis. Materials and Methods: Twitter’s advanced search function was used while the term ‘cleft lip and palate’ was kept constant, and the selected keywords were ‘bully’, ‘bullying’, ‘bullied’ and ‘teased’. A total of 150 tweets that met the criteria were selected. The data were qualitatively evaluated by thematic analysis and the themes were determined based on this analysis. Results: Most of the tweets were posted by a layperson (76%). Also, nearly half of the tweets were categorized in the theme ‘personal experience of being bullied’ (43%). The tweets were distributed according to their uploader status as CLP subjects (46%), irrelevant individuals (28%), and parents of CLP subjects’ (26%). Of the 150 tweets evaluated, 74 were identified as negative, while 25 were identified as neutral and 51 as positive. No significant differences were detected in retweet and like numbers between negative, neutral, and positive comments (P > .05). Conclusions: This is the first study in the literature regarding the bullying suffered by individuals with CLP using Twitter data. Twitter is a social media platform for bullying victims with CLP to share their experiences and seek for social support.

Aim: Although prostate adenocarcinoma is the most common cancer in men, survival is quite high and with the help of histopathological examination using the updated classification, patient management strategies are developing. We aimed to evaluate the correlation between the histopathological features and biochemical recurrence (BCR) in patients who underwent radical prostatectomy (RP) using the new classification. Methods: A total of 285 prostate adenocarcinoma cases that underwent RP between January 2009 and December 2017 and followed up for at least 3 months were included in the study. The cases were re-evaluated according to WHO-ISUP 2016 classification and the findings were recorded. Results: The mean age was 63,4 years. Gleason scores of the cases were as follows: 3+3 144 cases (50.5%), 3+4 81 cases (28.4%), 4+3 28 cases (9.8%), 4+4 7 cases (2.5%) , 3+5 6 cases (2.1%), 5+3 2 cases (0.7%), 4+5 17 cases (6%). There were 198 (69,5%) pT2, 54 (18,9%) pT3a and 33 (11,6%) pT3b cases. The mean follow-up time was 44,1 months and BCR was detected in 97 cases (34%). The relationship between the Group Grades and BCR was statistically significant. BCR rate increased as the tumor volume and the percentage of pattern 4 increased (p<0.001).There was a significant correlation between preoperative PSA value, extraprostatic extension, seminal vesicle invasion, surgical margin positivity, tumor volume, pattern 4 percentage, presence of cribriform glands and BCR and recurrence-free survival in both univariate and multivariate analysis and recurrence-free survival was also affected by these parameters. Among the morphological subtypes of Pattern 4, recurrence-free survival decreased as the incidence of cribriform glands increased (p <0.001). Conclusion: Histopathological evaluation is important in predicting BCR in prostate adenocarcinoma, the Group Grade system seems to be helpful in this regard. More studies are needed to prove the relatively worse prognostic effect of cribriform glands.

Background: Pediatric Emergency Care Applied Research Network (PECARN) is a useful Clinical Decision Support Tool (CDST) to identify traumatic brain injuries and reduce the use of head CT scans among pediatric patients. The present Meta-analysis aims to evaluate the diagnostic accuracy of the PECARN rule from 2009 to 2020 in children with a very low risk of blunt head trauma. Methods: A detailed search was conducted from the databases of Medline (via PubMed), Cinahl (via Ebsco), Scopus, Web of Sciences, from 2009 till the end of December 2020 using the keywords like decrease use of CT scan, blunt head trauma (BHT) combined with accuracy, Pediatric Emergency Care Applied Research Network (PECARN) OR Clinical Decision Support Tool (CDST). Studies showing the diagnostic accuracy of the PECARN rule in children younger than 18 years of age with minor BHT were included. Results: 13 studies were included in the present analysis. Pooled sensitivity of 0.08, (95% confidence interval of 0.074 - 0.087), pooled specificity of 0.20 ( 95% CI of 0.196 - 0.213) and diagnostic odds ratio of 0.004 (95% CI of 0.000-0.1666) was in <2 years of age. The overall sensitivity of 0.07, specificity of 0.66, and diagnostic odds ratio of 0.54 (95% CI of 0.10 -2.78) was seen in ≥2 years of age. Overall sensitivity of 0.13 (95% CI 0.12-0.14), specificity of 0.81 (95% CI 0.80-0.82) and diagnostic odds ratio of 0.79 (95% CI of 0.08 -7.71) was in 0-18 years of age. Conclusion: The present analysis indicates the PECARN decision tool as an accurate CDST in low-risk minor blunt head trauma cases in children below two years of age and can become a useful tool in reducing Head CT’s scan overuse in pediatric emergency departments.