Purpose: Considering the anti-inflammatory effect of atorvastatin and the role of medical comorbidities such as hypertension and coronary artery disease on prognosis of the COVID-19 patients, we aimed to assess the effect of atorvastatin add-on therapy on mortality due to COVID-19. Methods: We conducted a retrospective cohort study, including patients who were hospitalized with confirmed diagnosis of severe COVID-19. Baseline characteristics and related clinical data of patients were recorded. Clinical outcomes consist of in hospital mortality, need for invasive mechanical ventilation and hospital length of stay. COX regression analysis models were used to assess the association of independent factors to outcomes. Results: Atorvastatin was administered for 421 out of 991 patients. The mean age was 61.640±17.003 years. Older age, higher prevalence of hypertension and coronary artery disease reported in patients who received atorvastatin. These patients had shorter hospital length of stay (P=0.001). Based on COX proportional hazard model, in hospital use of atorvastatin was associated to decrease in mortality (HR=0.679, P=0.005) and lower need for invasive mechanical ventilation (HR=0.602, P=0.014). Conclusions: Atorvastatin add-on therapy in patient with severe COVID-19 was associated with lower in hospital mortality and reduced the risk of need for invasive mechanical ventilation which support to continue the prescription of the medication.

Aim of the study: Subconjunctival hemorrage (SCH) is a frequent bleeding manifestation and a common cause of visits to the primary care. Trauma in young patients and vascular damage such as hypertension in the elderly are the most common causes of SCH and the prevalence of hematological diseases is less than 1%. We aimed to evaluate the prevalence of congenital or acquired bleeding disorders in patients with once or recurrent SCH. Methods used to conduct the study: It is a retrospective study and included fifty-two patients with SCH whose etiologic factor was not detected. Hemostatic tests were studied in 52 patients (25 male and 27 females). All patients included were evaluated for congenital or acquired bleeding disorder and SCH with once and those with 2 or more were compared for the laboratory results. Results of the study: Type I von Willebrand disease (vWD) was diagnosed in one patient with recurrent SCH and one patient with single SCH (3.8%). The prevalence of patients with type 1 vWD in the study was not statistically significant when compared with the frequency of vWD in the normal population. Fibrinogen level was found to be statistically higher in patients who had SCH once than those who had recurrent SCH. But fibrinogen level was in normal range in all patients. Conclusions drawn from the study and clinical implications: There was no increase in the incidence of congenital or acquired bleeding disorder in SCH compared to normal population. For this reason it was thought that there was no need for evaluation for bleeding disorders in spontaneous SCH.

Aim Sacroiliac joint dysfunction is an especially common cause of pain during pregnancy. Treatment options during pregnancy are very limited in order to reduce pain and increase the quality of life. We aimed to determine the efficacy of kinesiotaping (KT) in the treatment of sacroiliac joint pain in pregnant women. Methods A total of 50 pregnant women with sacroiliac joint pain were included in the study. Patients were randomized into two groups as KT and sham KT groups. Women in the KT group underwent a total of five weeks of KT once per week; the sham KT group also underwent five weeks of KT applications, but without tension in the kinesiotape. Patients were assessed before and five weeks after the treatment with a visual analogue scale (VAS) for pain and the Roland-Morris Disability Questionnaire (RMDQ) and Pelvic Girdle Questionnaire (PGQ) for disability and quality of life. Results The KT and sham KT groups were similar in terms of age, parity, gravidas, gestational week, and body mass index. At the beginning of the study, there were no statistically significant differences between the two groups in their VAS, RMDQ, or PGQ scores. Five weeks later, the KT group showed significant improvement in all parameters, but no significant differences were observed for the sham KT group in terms of VAS, RMDQ, or PGQ. Conclusions KT treatment improved the pain levels, functioning, and quality of life among pregnant women with sacroiliac joint pain. Keywords Sacroiliac joint pain; Pregnancy; Kinesiotaping

Purpose: We designed a multicenter, retrospective study to investigate the current trends in initial management of reflux with respect to EAU guidelines in Urology clinics of our country. Materials and Methods: The study group consisted of 1988 renal units (RU) of 1345 patients treated surgically due to VUR between years 2003-2017 in 9 different institutions. Patients were divided into 2 groups according to time of initial treatment and also grouped according to risk factors by “EAU guidelines on VUR”. Results: 1426 RUs were treated initially conservatively and 562 RUs were initially treated with surgery. In initially surgically treated group, success rates of surgery decreased significantly in low and moderate risk groups after 2013 (p=0.046, p=0.0001, respectively), while success rates were not significantly different in high risk group (p=0.46). While 26.6% of patients in low risk group were initially surgically treated before 2013, this rate has increased to 34.6% after 2013, but the difference was not statistically significant (p=0.096). However, performing surgery as the initial treatment approach increased significantly in both moderate and high risk groups (p=0.000 and p=0.0001, respectively) after 2013. Overall success rates of endoscopic and UNC operations were 65% and 92.9% before 2013, 60% and 78.5% after 2013, respectively. Thus the overall success rate for surgery was 72.6%. There was significant difference between success rates of UNC operations before and after 2013(p=0.000), while the difference was not significant in the STING group (p=0.076). Conclusion: Current trends in management of reflux in our country do not yet follow the EAU guidelines on VUR in low and moderate risk groups.

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.

Objective: There are many clinical conditions that need to be followed and treated during pandemic like lung cancer. Carrying out health care for these patients who are immune-suppresive require extra care. Method: Among 108 lung cancer patients who has been hospitalized during pandemic, 18 of them with respiratory symptoms were evaluated. Results: Median age was 64±9.4 with male predominance (male n=16, female n=2). Thirteen of them was non-small cell lung cancer (NSCLC) and 5 of them was small cell lung cancer (SCLC). Nine (50%) patients were receiving chemotherapy. The most common symptom was shortness of breath (n=14, 77.8%), followed by fever (n=10, 55.6%). Findings confirmed on computed thorax tomography (CTT) were as follows: Consolidation (n=8, 44.4%), ground glass opacities (n=8, 44.4%) and thoracic tumour/mediastinal-hilar lymphadenopathy (n=3, 16.7%). Hypoxia was seen in 11 patients (61.1.%). Twelve patients had elevation of LDH (median=302±197) and lymphopenia (median=1055±648). There were 5 (27.7%) highly suspected cases for COVID-19. Any of their nasopharyngeal swap was positive. Two of these 5 patients received COVID-19 specific treatment even they have negative PCR results for 3 times. They responded well both clinical and radiological. For one case with SCLC receiving immunotherapy metil-prednisolone was initiated for radiation pneumonitis after excluding COVID-19. Conclusion: In line with the health policies of the countries and the adequacy of the health system, the necessity of a multidisciplinary approach in the management and treatment of complications in patients with lung cancer becomes even more important in this pandemic.

TYPE OF THE ARTICLE: LETTERTITLE: BIOLOGICAL THERAPIES IN CHILDREN WITH RHEUMATIC DISEASES DURING THE COVID-19 PANDEMIC: A SINGLE CENTER EXPERIENCERUNNING TITLE: BIOLOGICAL THERAPIES DURING THE COVID-19 PANDEMIC

Aim: We compared the efficacy and safety of insulin degludec/insulin aspart co-formulation (IDegAsp) twice-daily to a free combination of basal insulin degludec and GLP-1 receptor agonist liraglutide (IDeg+Lira) once-daily for patients with inadequately controlled type 2 diabetes on insulin therapy and oral antidiabetic drugs. Subjects and Methods: Eligible patients were randomly allocated at a 1:1 ratio to receive either the once-daily dual-injection of IDeg+Lira (n=24) or twice-daily single-injection of IDegAsp (n=28). The primary endpoints were: HbA1c changes over 52 weeks of treatment and the percentage of participants achieving HbA1c<7.0% at week 52. Results: After 52 weeks, HbA1c decreased by 0.3% in the IDegAsp group and by 0.7% in the IDeg+Lira group. The HbA1c reduction was greater in the IDeg+Lira group than in the IDegAsp group. 19% of patients on IDegAsp versus 40% on IDeg+Lira achieved HbA1c<7.0%. Pre-breakfast and pre-dinner blood glucose at 52 weeks were significantly lower in the IDeg+Lira group than in the IDegAsp group. The reduction in body mass index (BMI) was greater in the IDeg+Lira group than in the IDegAsp group throughout the study period. The confirmed hypoglycemia rates were 1.32 and 0.69 per patient/year of exposure to IDegAsp and IDeg+Lira, respectively. Conclusions: In patients with inadequately controlled type 2 diabetes on insulin therapy and oral antidiabetic drugs, treatment with the once-daily dual-injection of IDeg+Lira compared to the twice-daily single-injection of IDegAsp showed no significant difference in glycemic control, but with a slightly larger reduction in HbA1c at 52 weeks, and statistically superior weight loss.

Since coronavirus disease 2019 (COVID-19) was reported globally pandemic, dentistry is known as one of the most critical disciplines. Teledentistry as a sub branch of telemedicine which can be a useful modality is defined by using any telecommunication technology facility, including digital photo and video to deliver oral care to isolated patients in distant places by low cost(1). Although teledentistry has been introduced as a valid tool to prevent unnecessary referrals, policy makers have not shown much interest on it yet (2,3).Diagnosis, treatment, and monitoring could be performed, meanwhile research and continuing education or public education could be done via teledentistry. In COVID-19 pandemic, teledentistry can prevent human and non-human resources burden. Oral chronic diseases like vesiculobullous and painful conditions are so dreadful and exhausting needing more care. Pediatric patients and those who are suffering from cancer are no more exceptions to this point. Tablets, smart phones, and all types of electronic gadgets can facilitate virtual communication which is helpful in telehealth.Traditional visual examination is a gold standard, in order to reach a better diagnosis and treatment plan. In teledentistry, intra oral or other high quality cameras can provide essential documents. There are so many investigations to compare visual and virtual examination, which showed only some problems in diagnosing interproximal carious lesions which is solved by digital radiography (3).Teledentistry examinations are valid, feasible, and comparable to visual examination for oral screening. Data storage is another crucial part in teledentistry due to privacy policies (2,3).Pediatric dentistry, oral medicine, orthodontics, and periodontics are the most common disciplines that have studied the efficacy of teledentistry rather than effectiveness. In developing countries, where emergency care is more important than preventive care, conservatism of decision makers, lack of resources and ICT infrastructure are the most common problems in providing teledentistry (4).Meanwhile there is a hidden advantage for teledentistry and telemedicine that it can avoid feelings of isolation and stress for patients; so, it can be more useful during COVID-19 quarantine (5).Teledentistry performs in two ways; asynchronous by transmission intraoral or extraoral images that are not used in real time; also, known as the store and forward method, synchronous by use of real-time interactive technologies, such as video or photoconferencing, and mobile health care services via smartphone apps and text messages.All the process should be recorded in patients file for further information. Accurate triage is another prominent advantage of teledentistry, which is so important during COVID-19.For people in need of care like geriatrics or patients with special needs telemedicine can eliminate some barriers (6).Besides to teledentirstry’s advantages, especially in a situation like a pandemic infection even with very primary facilities teledentistry can be performed and be useful for triage. By introducing dentistry as a very dangerous discipline, teledentistry can play a very specific role to solve the majority of patients’ problems as a helpful facility in this crisis and may be it can also persuade policy makers to perform teledentistry in a vast program.

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

Background: Many different internal factors have been proven to influence urine production such as age, weight, and quality of sleep. External factors such as consumption of caffeine and fluid consumption have been shown to have an impact on urine production. Aim: To investigate the impact of movement, physical activity, and position on urine production. Methods: This prospective observational study was executed at Ghent University Hospital, Belgium. Study participation was open for anyone visiting the hospital. Participants collected 1 basic and 2 extended 24-hour urine collections and filled in questionnaires concerning their general health and physical activity. Urinary levels of osmolality, sodium, and creatinine were determined. Data on movement, physical activity and position was described. Results: An increase in body movement leads to a significant increase in diuresis during daytime, night-time, and 24 hours (p=0,002, p= <0,001, and p=<0,001, respectively). An increase in body movement leads to a significant decrease in osmolality during night-time and 24 hours (p=0,009, and p=0,004, respectively). However, no significant influence of movement on osmolality was found during daytime (p=0,12). An increase in body movement leads to a significant decrease in creatinine during daytime, night-time, and 24 hours (p=0,001, <0,001, and p=<0,001, respectively). An increase in body movement leads to a significant increase in sodium during daytime (p=0,046) but this was statistically significant during night-time and 24 hours (p=0,32, and p=0,84 respectively). Conclusion: Our study demonstrates a statistically significant association of movement, physical activity, and position with urine production. It would therefore be interesting to explore this association further with the use of new technology to have more accurate data. Here lays a potential role for conservative measurements and lifestyle adaptations in the management of patients with bothersome LUTS and more precisely nocturia.

Aims: to test the hypothesis that a semi-supervised home physical exercise program improves the functional mobility and quality of life (QOL) of elderly in the community. Methods: This trial was conducted with elderly people (88% female), aged 60 years or older, sedentary and without cognitive decline. Elderly were randomly assigned to an intervention group - IG (home physical exercise and sleep hygiene) and a control group - CG (sleep hygiene). Were applied the International Questionnaire on Physical Activity; mental state mini-exam and the Timed Up and Go test (TUG) before and after the 12-week intervention period. Results: The IG showed an improvement in functional mobility, with a mean reduction in TUG execution time (p <0.01) and improvement in the QOL, (p <0.01) in WHOQOL-OLD. Conclusion: Semi-supervised physical home exercise is effective in improving the functional mobility and the QOL of sedentary elderly in the community. Trial Registration: Registro Brasileiro de Ensaios Clínicos (REBEC) Identifier: RBR-3cqzfy Keywords: Elderly; exercise; functional mobility; quality of life; community; physical activity; home exercise.

Background: Over the past few years, the benefits of co-administration of omega-3 and antioxidants have been reported in the management of non-alcoholic fatty liver disease (NAFLD) complications.This study evaluated the effects of Camelina sativa oil (CSO) supplementation as one of the richest dietary sources of omega-3 fatty acids on glucose homeostasis,inflammation, metabolic endotoxemia, and oxidative stress in NAFLD patients. Methods: In all, 43 subjects with NAFLD were allocated to either an intervention (20g/d CSO) or placebo (20g/d sunflower oil) group receiving a calorie-restricted diet for 12 weeks. Fasting serum levels of glycemic indices, hs-CRP, endotoxin, antioxidant enzymes activity, total antioxidant capacity (TAC), malondialdehyde (MDA), 8-iso-prostaglandin F2α (8-iso-PGF2α), and uric acid were measured at baseline and post-intervention. Results: CSO intake led to a significant decrease in insulin concentration (-17.49%), homeostasis model assessment of insulin resistance (HOMA-IR) (-20%), high-sensitive C-reactive protein (hs-CRP), (-12.94%), lipopolysaccharide endotoxin (-32.55%), malondialdehyde (MDA) (-18.75%), 8-iso-prostaglandin F2α (8-iso-PGF2α) (-19.55%) and a significant increase in the levels of total antioxidant capacity (TAC) (31.82%) and superoxide dismutase activity (10.22%) in the CSO group compared with the placebo group. Also, there was no significant difference between the two groups in fasting plasma glucose, quantitative insulin sensitivity check index (QUICKI), catalase, glutathione peroxidase activity, and uric acid level. In addition, within-group analyses showed a significant reduction of insulin, QUICKI, hs-CRP, and endotoxin levels in the intervention group. Conclusion: These findings indicate that CSO may improve glycemic, inflammation, metabolic endotoxima, oxidative stress status, and mental health in patients with NAFLD.

Objectives: In this paper we outline how inflammation related to oral disease such as periodontitis, bacteraemia and pulpal lesions have been linked to cardiovascular disease and undertake a systematic review of the literature focused on acute dental infection and cardiac arrhythmia. We also describe an illustrative case where an acute oral infection was associated with occurrence of new onset atrial fibrillation (AF). Methods: An electronic search was undertaken using MEDLINE and SCOPUS from 01 Jan 1970 until 30 June 2020. We also undertook manual searches using forward and backward citation chasing. Inclusion criteria were any primary research studies investigating symptomatic apical infections or dental abscess with outcomes of arrythmia. Results Over the last fifty years, only two low quality studies have been investigated this area. Our illustrative case involved a 58-year-old who was diagnosed with an acute dental infection from an upper canine tooth. The patient later developed tachycardia and new-onset AF. Conclusions: Based on the biological plausibility of a link between acute dental infection and arrythmia, together with the case report presented, it is evident that further study in this area is needed. If there are possible cardiovascular consequences for patients suffering acute dental infections, this has future implications for healthcare staff as they can integrate professional advice related to oral health and cardiovascular disease. Screening programmes situated in dental settings can also facilitate early intervention and prevention producing benefits not just for patients, but in savings to the health system.

During the COVID-19 pandemic, many specialists doctors found themselves in a situation that they had not faced for a long time: treating patients out of their subarea of expertise. The possibilities of teaching and learning through the modalities of webinars brought to these days the urgent necessity for teamwork and interdisciplinary approach, taking advantage of different areas of expertise to the same patient. With the amount of papers published and the speed at which data are accessed, and analyzed it is impossible to be aware of new findings in all medical areas. The lesson that the COVID-19 pandemic brought to us was the urgent need for the interdisciplinary approach to treating better our patients, and not only each disease they present with. We must review our traditional approach to medical students, residents, colleagues, and patients in which we became stuck to distance and time obstacles. We must use the technology on our behalf to offer the best treatment and follow-up for patients. We live now in the Medicine 4.0 era. As Darwin a long time ago proved: we must evolve!

Objective The aim of this study is to evaluate the attitude, knowledge and anxiety status of individuals about COVID-19 at the first period of the outbreak. Methods This was an observational study carried out in Turkey. An online semi-structured questionnaire was developed by using google forms and the link of the questionnaire was sent through emails, WhatsApp and other social media to the contacts of the investigators between 20th March 2020 and 25th March 2020. The questionare contained 21 questions and Beck anxiety scale. Results 1070 people were included in the study. Approximately one fifth of the participants had no idea about treatment and immunization against COVID19. According to the categorization of Beck Anxiety Inventory scores 8.6% showed severe anxiety symptoms. Anxiety levels of women, healthcare workers and those with psychiatric illness were higher (p <0.05). It was observed that women, healthcare professionals, those with chronic diseases, and those with moderate to severe anxiety used the medical facemask more frequently (p <0.05). 73% of the participants thought that they fully implemented the proposed measures; 25.2% of the them stated that population did not take any measures for the COVID-19. Conclusion: According to the results of the study individuals usually had better awareness and positive attitudes towards COVID 19 pandemic, but there were also things that needed improvement. The community anxiety rates in the early stages of the epidemic with low case rates also reveal that measures should be taken in this regard.

Objectives. Fifteen potentially low value practices in adult orthopaedic trauma care were previously identified in a scoping review. The aim of this study was to synthesize the evidence on these practices. Methods. We searched four databases for systematic reviews, randomized controlled trials (RCTs), cohort studies and case series that assessed the effectiveness of selected practices. Methodological quality was evaluated using the Measurement Tool to Assess Systematic Reviews version 2 (AMSTAR-2) for systematic reviews and the Critical Appraisal Checklist for Case Series. We evaluated risk of bias with the Cochrane revised tool for RCTs and the risk of bias in non-randomized studies of interventions tool for observational studies. We summarized findings with measures of frequency and association for primary outcomes. Results. Of the 30,670 records screened, 70 studies were retained. We identified high-level evidence of lack of effectiveness or harm for routine initial imaging of ankle injury, orthosis for A0-A3 thoracolumbar burst fracture in patients < 60 years of age, cast or splint immobilization for suspected scaphoid fracture negative on MRI or confirmed fifth metacarpal neck fracture, and routine follow-up imaging for distal radius and ankles fractures. However, evidence was mostly based on studies of low methodological quality or high risk of bias. Conclusion. In this review, we identified clinical practices in orthopedic injury care which are not supported by current evidence and whose use may be questioned. In future research we should measure their frequency, assess practice variations and evaluate root causes to identify practices that could be targeted for de-implementation.

ABSTRACT Purpose In our study, we aimed to evaluate the sleep disorders, sleep quality of the patients who applied to family health centers, to determine the situations that might be related with insomnia and to determine the insomnia rates of the general population in primary care. Methods This study is a descriptive research and conducted in Ankara Güdül, Antalya Değirmenözü, Bursa Sırameşeler, Gaziantep Family Health Center policlinics. The study population consisted of all patients over 18 years of age who were admitted to the family health centers for any reason. A 10-question questionnaire, Berlin questionnaire, Pittsburgh sleep quality index and insomnia severity scales were collected by the researchers from October to December 2017 using face-to-face interview method. Results 299 people participated in study and 54.5% of them were women. According to the results of Pittsburgh Sleep Quality Scale, it was found that 27.1% of the participants’ sleep quality was good and 72.9% of them were poor; according to the Berlin sleep questionnaire, 27.4% had high OSAS risk and 72.2% had a low OSAS risk. According to total Insomnia Severity Index, 27.1% had insomnia lower threshold, 15.4% had moderate insomnia, 3.7% severe insomnia was detected. Conclusions In this context, it will be very effective in terms of the quality of life of patients in order to determine the conditions that disrupt sleep hygiene and to perform the necessary interventions which can be intervened in the primary health care institutions and the other patients to be delivered to the related upper levels.