Viruses are considered as one of the primary drivers for human evolution. Humans in return have also offered them an ideal habitat for their growth and evaluation. However, both, humans and viruses are diverse, astute, competitive, and avaricious in nature, which engage them in a never-ending battle. Today, the world goes to win the battle against COVID-19 for sure. However, this never ending merciless battle between viruses and humans looks like an arms race for their survival in which neither a virus wins nor a human but each battle provides them an opportunity to bounce back for the next.

Introduction: Patients with chronic obstructive pulmonary disease (COPD) have impaired balance and hence fall more frequently. Easy application of balance evaluation tests can prevent the loss of time in the outpatient clinic for patients with COPD. Therefore, we compared the effectiveness of the Berg Balance Scale (BBS) test, a relatively more recommended but time-consuming test, with easy-to-perform tests such as the Single Leg Stance (SLS), Five Repetition Sit to Stand (5STS), Four Step Square (FSS), and Timed Up and Go (TUG) tests. Methods: A total of 71 patients with COPD and 70 control subjects with matching demographic characteristics were included in the study. All patients undertook pulmonary function tests and their scores of 6-min walk-test (6MWT), modified Medical Research Council (mMRC) dyspnea scale, COPD assessment questionnaire (CAT), and body mass index (B) were recorded. In addition, the severity of airway obstruction (O), the dyspnea severity (D), and exercise capacity (E) (BODE) index scores were measured. All patients with COPD were classified into 4 groups, A to D, based on the GOLD 2017 criteria. All subjects undertook the BBS, SLS, 5STS, Four Step Square Test, and TUG tests. Results: Balance tests revealed increased balance impairment in patients with COPD in comparison with the control subjects (P < 0.05). The BBS, SLS, Four Step Square Test (FSST), and TUG examinations suggested that balance impairment was frequent in Groups C and D patients with COPD (P < 0.05). TUG and FSST had the highest correlation with BBS (r = −0.812 and −0.842 and P <0.001 and <0.001, respectively). The results of TUG and FSST were the closest to those of BBS test. Conclusions: TUG and FSST tests can be applied for the assessment of bodily balance status among patients with COPD in outpatient clinics.

Aim Clinical application of insulin infusion therapy is usually accomplished with regular human insulin. It is known that the regular insulin adsorbed to the hydrophobic surfaces and different approaches were implemented into the clinical practices. It was aimed to evaluate the rate of adsorption of insulin to PP bags and PVC infusion sets and stability of insulin during the infusion. Methods 100 IU insulin was added to PP bags containing 100 ml of 0.9% NaCl solution(n = 6). The infusion was started at a rate of 2 ml/h using infusion sets in the PVC structure. Insulin quantification was performed in the samples taken both from the bag and from the end tip of the infusion set during infusion. The stability of insulin solutions stored at room (+24°C) and refrigerator (+4°C) temperatures were compared. Samples were analyzed using reverse-phase high-performance liquid chromatography. Results No statistically significant difference was found between the concentrations of the samples taken from the bags stored at room and refrigerator temperatures at the 4th, 12th, and 24th hours (p>0.05). It was seen that the adsorption rate of insulin to PVC set was 57% and PP bags is at most 5% at the 24th hour. Conclusion When PP bags are used for insulin infusion, it is predicted that 24-hour change can be made instead of frequent change. In addition, losses caused by the high rate of insulin adsorption to PVC infusion sets should be considered and PP infusion sets would be the better option to use if available.

Purpose Only 25% of oesophageal adenocarcinoma (OAC) patients have a pathological response to neo-adjuvant therapy (NAT) before oesophagectomy. Early response assessment using PET imaging may help guide management of these patients. We performed a systematic review and meta-analysis to synthesise the evidence detailing response rate and diagnostic accuracy of early PET-CT assessment. Methods We systematically searched several databases including MEDLINE and Embase. Studies with mixed cohorts of histology, tumour location, and a repeat PET-CT assessment after more than one cycle of NAT were excluded. Reference standard was pathological response, defined by Becker or Mandard classifications. Primary outcome was metabolic response rate after one cycle of NAT defined by a reduction in maximum standardised uptake value (SUVmax) of 35%. Secondary outcome was diagnostic accuracy of treatment response prediction, defined as the sensitivity and specificity of early PET-CT using this threshold. Quality of evidence was also assessed. Random-effects meta-analysis pooled response rates and diagnostic accuracy. This study was registered with PROSPERO (CRD42019147034). Results Overall, 1341 articles were screened, and six studies were eligible for analysis. These studies reported data for 518 patients (aged 27-78 years; 452 [87.3%] were male) between 2005-2020. Pooled sensitivity of early metabolic response to predict pathological response was 77.2% (95%CI 53.2%-100%). Significant heterogeneity existed between studies (I2=80.6% (95%CI 38.9%-93.8%), p=0.006). Pooled specificity was 75.0% (95%CI 68.2%-82.5%), however no significant heterogeneity between studies existed (I2=0.0% (95%CI 0.0%-67.4%), p=0.73). Conclusion High-quality evidence is lacking, and few studies met the inclusion criteria of this systematic review. The sensitivity of PET using a SUVmax reduction threshold of 35% was suboptimal and varied widely. However, specificity was consistent across studies with a pooled value of 75.0%, suggesting early PET assessment is a better predictor of treatment resistance than of pathological response. Further research is required to define optimal PET-guided treatment decisions in OAC.

A Gynecologist's perspective on the limitations of telemedicine in the setting of early pregnancy diagnosis during the COVID-19 Pandemic.

Aim: Aspects of parenting is an under-investigated topic among children with voiding complaints. We aimed to investigate the association between voiding complaints among children and two specific parenting related behaviors: 1) parental availability during the child’s leisure time and 2) frequency of witnessing interparental conflict. Material and Method: Children aged between 6 and 11 years with their parents were the participants. Two survey forms and informed consent form were sent to potential participants via children’s teacher. Voiding dysfunction complaints were evaluated with the Dysfunctional Voiding and Incontinence Symptom Scale (DVISS). Results: Data analyses were performed with 1101 eligible participants. Mean duration of parental availability during the child’s leisure time was below 2 hours per day. Nearly one out of every four children witnessed interparental conflict at least once a month. Age, educational level of the mother, parental availability for the child’s leisure time, and frequency of witnessing parental conflicts were found to be significantly associated with DVISS ratings. Adjusting age, socioeconomic level, and educational level of the parents and later adjusting parental availability during the child’s leisure time did not change the association of frequency of witnessing interparental conflict with DVISS rates. Increase in the age, educational level of the mother, and parental availability during the child’s leisure time were correlated with better scores on DVISS while increase in the frequency of witnessing interparental conflict strongly correlated with worse scores. Conclusion: Exposing children to interparental conflicts and shorter togetherness with their leisure time is associated with voiding complaints.

More than 1.2 million people died from chronic kidney damage (CKD) globally, in 2017. Anemia is a common complication of CKD. Roxadustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor that stimulates erythropoiesis and regulates iron metabolism. Roxadustat is often used to treat anemia caused by renal diseases. Its adverse effects include high blood pressure, myocardial infarction, heart failure, high potassium, and dizziness; however, there are no reports about rhabdomyolysis associated with roxadustat. One of our patients developed rhabdomyolysis after he was administered roxadustat to treat anemia caused by chronic renal failure. Physicians should be alert about the occurrence of rhabdomyolysis when roxadustat is used.

Objectives: To investigate lung volume and density in patients with SSc and changes in these parameters due to PF, using a software-aided image quantification method, and compare this with a matched healthy control group. Methods: Thoracic high-resolution computed tomography (HRCT) images of patients and controls were analyzed using Myrian XP Lung 3D software. Right, and left lung densities and volumes were calculated separately by a blinded operator. Results were analyzed between subgroups to investigate associations with the clinical features. Results: A total of 135 patients with SSc and 38 healthy controls (HC) were included. Characteristics of the SSc patients were 94 (69.6%) without PF, 85.4% female, mean age 49.8 (15.4) years; 41 (30.4%) with PF, 88.3% female, mean age 50.2 (11.5) years and HC group were 89.5% Female, mean age 52.2 (5.8) years. The right and left lung densities were significantly higher, and right and left lung volumes were significantly lower in the SSc patients with signs of fibrosis than those without and HC (p<0.001 and p<0.001; p=0.006 and p=0.002, respectively). After excluding patients with PF, right and left lung densities and volumes differed significantly between diffuse cutaneous SSc, limited cutaneous SSc, and HC (p=0.002 and p<0.001; p=0.045 and p=0.044, respectively). Patients who developed PF during follow-up had significantly lower baseline right and left lung densities than those who did not (p=0.018; p=0.014, respectively). Forced vital capacity and carbon monoxide diffusing capacity showed weak correlation with lung densities and volumes in patients without PF and moderate to high correlation in PF patients. Conclusion: Lung density and volume in SSc patients changed significantly in those with PF and those without. Quantitative information extracted by soft-ware aided methods may contribute more to the detection, screening, and risk prediction in SSc related PF.

Abstract Background The benefits of hospital clinical pharmacy services are well established, though staff numbers required for its delivery have not been well described, leading to variation in pharmacy staffing between hospitals. The need to identify a consistent, objective method of determining staffing levels was recognised at a UK University Hospital and a Clinical Pharmacy Workforce Calculator (CPWC) was developed. Objective To report on the validation of the CPWC across acute hospital settings in Great Britain. Method Using the World Health Organisation’s Workload Indicators of Staffing Need (WISN) methodology, a two-round Delphi consensus study with an Expert Panel of UK hospital pharmacy managers was undertaken to develop the Activity Standard for pharmaceutical care and to identify the time unavailable for clinical work inherent in employing staff. Consenting Panel members then tested the CPWC by calculating the staff resource required for three staffing scenarios to determine whether it could be reliably used by different operators. Results Thirty-six participants consented to participate, and data was returned from 22 participants (61%) of whom 20 (56%) supplied analysable data. Consensus was achieved on the tasks required for pharmaceutical care delivery, the mean time each takes, the frequency of completion and the unavailable time in the employment of each grade of staff identified. The CPWC uses this data in an algorithm to calculate staffing requirements. Eleven participants (55%) tested the CPWC and analysis of their responses showed that 31 of 33 (94%) calculations were accurately completed using the CPWC. Conclusion This study has defined the WISN Activity Standard for pharmaceutical care delivery to hospital inpatients and validated the CPWC for acute medical and surgical hospital settings. The CPWC offers hospital pharmacy managers a useful tool to negotiate adequate staffing to deliver pharmaceutical care and its development methodology could be applied widely in pharmacy practice internationally.

COVID-19 disease, caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), first appeared in Wuhan, China, and spread throughout the world in a short period of time (1). On 30 January 2020, WHO declared the outbreak a Public Health Emergency of International Concern (PHEIC) and than on 11 March 2020, WHO declared the Coronavirus as a pandemic. The pandemic was called as COVID-19.

Background : Critically ill patients with coronavirus disease 2019（COVID-19）was surging and far outnumbered existing beds. Aims :  To describe how to rapidly convert general wards to intensive care units for critically ill patients with COVID-19. Materials & Methods :  Comprehensive assessment and analysis of available resources and standard requirements. Results : The ICUs were successfully assembled in four days. The conversion included environment reconstruction, configuration and management of equipment, information system construction and human resource allocation. A total of 172 critically ill patients had been admitted to the contemporary ICUs and none medical staff was infected. Discussion :  The epidemic situation of COVID-19 poses a great challenge to various management departments of the hospital, especially for critically ill patients with high mortality rate. To save more critically ill patients, the conversion of a general ward to a quarantine ICU ward must be completed in a short time, and the optimal allocation of resources must be appropriate to ensure that the medical team works effectively and is of high quality. In face of the overloaded medical system, the ideal non-negative pressure ward is hard to achieve. However, we have demonstrated with evidence that our conversions are effective in both providing care to the critical patients and protecting the safety of our staff. Conclusion:  The conversion is successful and the running experience would be a reference for hospitals in other areas nationally or globally.

Purpose: to compare, in a real-world scenario, the effects of different levels of technology on attention, memory, electrophysiological response, and self-perceived benefit of new users of hearing-aids in a developing country such as Brazil. Method: A pragmatic parallel-group, single-blinded, and randomized pilot clinical trial was conducted. Patients were divided into 3 groups according to hearing aid technology: (A) advanced technology; (B) basic technology; and (C) placebo. Participants were ≥ 60 years old, had moderate sensorineural hearing loss, and had never been exposed to hearing aid before. Prior to data collection, patients were electronically randomized to receive unique identity numbers. Patient numbers were placed in opaque envelopes until the day of the first visit at which hearing aids were fitted with appropriate amplification settings. Attention, memory, and latency of auditory evoked potentials of patients were assessed while using the hearing aids at baseline and then after 12 weeks of use. The primary outcome was any improvement in scores on neuropsychological tests and/or shortening of latency in the auditory-evoked potentials. Results: A total of 22 individuals were assessed (A=8, B=6, and C=8). Participants had a mean age of 80.4 (±6.1) years, were predominantly female (63.63%), and were poorly educated (3.8±1.6 years). Comparison of groups AXC and of BXC revealed differences in NEUPSILIN scores (Brazilian instrument) for reverse counting (p=0.002, 95%CI 5.9;20.55) and recognition (p=0.013, 95%CI -6.1;-0.88). No difference between groups A and B were found. Responses on the International Outcome Inventory for Hearing Aids (IOI-HA) differed for the benefit (p<0.001), satisfaction (p=0.007), participation restriction (p=0.012) and quality of life (p=0.037). Conclusion: The level of technology of the devices had no impact on the general satisfaction of new users of hearing-aids and appeared to have no differential effect on memory or attention after 12 weeks of use of the sound amplification products.

Aim: To describe the pattern of paediatric soft tissue sarcomas with emphasis on the grade and stage at the first surgical or medical oncologic intervention. Methods: We retrospectively reviewed all cases of histologically confirmed paediatric Soft Tissue Sarcomas in the Department of Pathology, University College Hospital (UCH), Ibadan, Nigeria in children age 0-14 years. The study period was January 1991 to December 2016. Information obtained included age, gender, morphology and site of the tumours. The tumour grade and pathologic/clinical staging of all cases that had surgical biopsy or surgical resection were also obtained and verified from the clinical records. Tumour grading was carried out using the Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) Sarcoma group grading system and staging was done using TNM. Results: One hundred and twelve cases were seen with an almost equal male-to-female ratio and age range from 5 months to 14 years (median 8.5 years). The peak age group was 5-9 years. Rhabdomyosarcoma was by far the most common histological type (73.2%). Other types were undifferentiated sarcomas (6.3%), fibrosarcoma (5.4%), Kaposi sarcoma (4.5%), and 2.7% each for synovial sarcoma, dermatofibrosarcoma protuberans. The common primary sites were the head and neck (including the orbit) 51(45.5%), and the abdominopelvic 27(24.1%) regions. Other sites included the lower limb 13(11.6%), trunk 12(10.7%), upper limb 6(5.4%). Majority (67.9%) had histologic grade 3 at presentation based on the FNCLCC grading system. About 48.2% had Stage T2b while 9.8% were stage T2a based on American Joint Committee on Cancer Staging (AJCC) system. Conclusion: Rhabdomyosarcoma, undifferentiated sarcomas and Kaposi sarcoma are the commonest paediatric malignant soft tissue tumours in our practice. Majority of our patients present with late stage tumour and with high histologic grade thereby conferring poor prognosis at presentation/first surgical or medical oncologic intervention.

The COVID-19 pandemic has substantial implications on almost every aspect of life. Its ongoing influence on health care, as well as other financial, social, psychological, educational and emotional aspects are yet to be fully recognized. Although the COVID-19 outbreak emerged in China at the end of December 2019, the first patient arrived in Israel on February 21st. This nearly two month gap enabled the Israeli health system to implement preparations at a both national and institutional level. Every hospital established an isolated internal medicine ward, which was assigned to treat only COVID-19 patients. Since there was no previous experience or recommended published guidelines, on a national level the Ministry of Health instructed each hospital to convert at least one standard internal medicine ward into a specialized isolated COVID 19 unit, usually within a few days. Although several series of protocols to treat critical COVID-19 patients in ICUs have been proposed, similar recommendations for treatment in internal medicine wards are scarce (1,2). Hence, we would like to summarize our experience in the organizational aspects of managing COVID-19 patients in an isolated internal medicine ward of a tertiary medical center.Minimal exposure . The major concept of working in the isolation ward is minimal exposure to the pathogen. The medical and nursing staff are essential resources and it is crucial to minimize their risk of SARS-COV-2 infection. The staff are also instructed to minimize social contacts outside of working hours to avoid infection risk outside of the hospital. The ward’s staff is divided into two separate ”capsules”, each capsule with consistent personnel (nursing and medical staff) that work at separate shifts without physical interaction between the shifts. In this manner, if one member is accidently infected, only one capsule is isolated instead of the entire staff.Minimal exposure concept is facilitate in the following methods:Medical staff enter the ward the least as possible – usually once for morning rounds and later only for new admissions or for deteriorating patients.Every entrance to the ward is carried out only with the minimal staff needed (e.g. two physicians and two nurses). Communication with the remaining team situated outside of the isolation unit is continuous.Every entrance is planned ahead and equipment (e.g. PCR swabs, fluids) are prepared a priori.We conduct minimal procedures and only on an as-need bases.We use point-of-care ultrasound for lung and heart physical examination instead of stethoscope use(3)Situation room. We facilitate a situation room (SR) manned 24/7 by a physician or nurse. Patients’ vital signs and medical follow-up are transmitted from the isolated ward to the SR. The are multiple communication channels for facilitating transmission of medical data to and from the SR. In addition, the SR is connected to other units inside and outside of the hospital who used as needed.Telemedicine. Telemedicine devices allow the staff to monitor patients with little SARS COV 2 exposure(4). The ward is interconnected with cameras which broadcast to the SR, allowing continued monitoring of the patients. In a addition, mobile sensors are attached to the patients, which wirelessly transmit vital signs, via wifi, to the SR. A remote control mobile robot with a screen, microphone and camera, can be remotely moved around the isolated ward, allowing constant communication with the patients.Patients examination. Due to the use of personal protective equipment (PPE) the routine physical examination of COVID 19 patients is limited. Instead, we recommend focusing on appreciating the general condition of the patients, his/her speech flow, mobility level and in mild to moderate cases on POCUS of the lungs.Inter-disciplinary approach. The significance of inter-disciplinary cooperation cannot be more emphasized. During rounds physicians assist nursing staff in their routine tasks: e.g. measuring vital signs, feeding patients and replacing bed ridden patient’s diaper. We also are aided by social workers with routine talks with patients and family members for daily updates and for psychological support (5). In addition, a physiotherapist is involved to perform respiratory and ambulatory physiotherapy as needed.Research. We initiated several small-scale studies in our ward. Data of the admitted COVID 19 patients are collected to evaluate possible association with demographical and clinical characteristics. We also evaluate several compounds with minimal adverse evets, which were recently reported to have possible positive effect on disease progression, such as hydroxychloroquine, Zinc, vitamin C and N-acetyl-cysteine(6,7).In conclusion, treating COVID-19 patients create unique clinical and institutional challenges. These challenges can be managed with minimal exposure to the medical staff, but without losing the therapeutic Continuum. Notwithstanding, the basic concept of internal medicine remain the same: maximal treatment with minimal risk for the patients (Primum non nocere), but also to the treating team. More studies are needed to investigate the functioning of the isolated COVID-19 wards in larger scales, and the preparedness of health systems to this pandemic at national levels.All authors declare no conflict of interest(1) Xie J, Tong Z, Guan X, Du B, Qiu H, Slutsky AS. Critical care crisis and some recommendations during the COVID-19 epidemic in China. Intensive Care Med 2020:1-4.(2) Wang H, Wang S, Yu K. COVID-19 infection epidemic: the medical management strategies in Heilongjiang Province, China. Crit Care 2020 Mar 18;24(1):107-020-2832-8.(3) Peng QY, Wang XT, Zhang LN, Chinese Critical Care Ultrasound Study Group (CCUSG). Findings of lung ultrasonography of novel corona virus pneumonia during the 2019-2020 epidemic. Intensive Care Med 2020 Mar 12.(4) Wendelboe AM, Amanda Miller J, Drevets D, Salinas L, Miller E, Jackson D, et al. Tabletop exercise to prepare institutions of higher education for an outbreak of COVID-19. Journal of Emergency Management 2020;18(2):1-20.(5) Lima CKT, de Medeiros Carvalho, Poliana Moreira, Lima, Igor de Araújo Silva, de Oliveira Nunes, José Victor Alexandre, Saraiva JS, de Souza RI, et al. The Emotional Impact Of Coronavirus 2019-Ncov (New Coronavirus Disease). Psychiatry Res 2020:112915.(6) Matthay MA, Aldrich JM, Gotts JE. Treatment for severe acute respiratory distress syndrome from COVID-19. Lancet Respir Med 2020 Mar 20.(7) Razzaque M. COVID-19 Pandemic: Can Maintaining Optimal Zinc Balance Enhance Host Resistance? 2020.

Abstract Purpose: To compare the functional outcomes of patients who underwent partial (PN) or radical nephrectomy (RN) for clinical T1 (cT1) renal tumors using the Kidney Cancer Database of the Urooncology Association, Turkey. Methods: We retrospectively reviewed 1004 patients who underwent PN and RN for cT1 renal tumors at multiple academic tertiary centers between 2000 and 2018. Patients with preoperative end-stage chronic kidney disease and/or metastatic disease were excluded. Results: There were 452 patients in the PN group and 552 patients in the RN group. The eGFR was significantly reduced in both groups on postoperative day one (PN=13.7 vs. RN=19.1 ml/min/1.73 m2: p<0.001). In the PN group, eGFR showed a tendency to recover according to a quadratic pattern and reached preoperative levels in the first and third years (95.6±28.8 ml/min/1.73 m2 and 96.9±28.9 ml/min/1.73 m2, respectively), with no significant difference between the eGFRs in the 1st and 3rd years (p=0.710). To define groups at risk, different cut-off values for the GFR were considered. Among patients with a baseline GFR<90, the RN cohort had significantly lower eGFRs in the first and third years than the PN cohort (p=0.02). Logistic regression showed that comorbidities, coronary artery disease, diabetes and hypertension had no adverse impacts on the changes in the eGFR (p=0.60, p=0.13, and p=0.13, respectively). Conclusion: For the treatment of stage T1 kidney tumors, the first choice should be open or laparoscopic partial nephrectomy due to the superior long-term preservation of renal function and overall survival, regardless of age and comorbidities.

Background: Mast cells play a critical role in tumor-associated immune pathways. We aimed to determine whether the urinary mast cell mediators predict the immune response in patients with non-muscle invasive bladder cancer (NMIBC) treated with Bacillus Calmette-Guérin (BCG) immunotherapy. Methods: Nineteen patients who have received immunotherapy due to NMIBC and 19 healthy participants were enrolled. Urine samples were collected to assay N-methylhistamine, histamine, and tryptase levels immediately before the first BCG instillation, immediately after the third and sixth instillations, and four weeks after the sixth instillation in patients with NMIBC and at a single visit in healthy participants. Cystoscopic examinations were performed on the patient with NMIBC at three-month intervals for two years. The changes in urinary markers due to BCC response, BCG instillation, and the presence of NMIBC were assessed. Results: The average age was 56.1 ± 10.5 years in patients with NMIBC. Fourteen patients had high-grade Ta tumors, and 5 had high-grade T1 tumors. While 12 patients responded, 6 presented with recurrence and 1 with progression. There was no correlation between the levels of mast cell mediators and BCG response. The N-methylhistamine and histamine levels were increased significantly with the onset of immunotherapy, and N-methylhistamine levels were significantly decreased when immunotherapy was terminated. Pre-BCG estimated marginal means of N-methylhistamine were significantly higher in patients with NMIBC than healthy participants. Conclusions: Our study is the first study to identify the changes in mast cell mediators with the onset of immunotherapy and with the presence of bladder cancer. However, these mediators were not found to predict the patients’ response to immunotherapy.

Purpose:In the present study, the impact of penile nerve block(PNB) on postoperative pain and CRBD in transurethral resection of prostate(TURP) patients were evaluated. Methods:Participants of the present study were selected from patients who performed TURP under spinal anesthesia for benign prostatic hyperplasia(BPH) between January 2018-July 2020. This study was planned as a single center, randomized-controlled prospective study. The patients were divided into two groups; Group 1 was administered Control(n:40), and Group 2 ultrasonography(USG) guided PNB(n:40). The patients were included in the Groups respectively. Visual analogue scale(VAS) scores were questioned and recorded in order to evaluate the postoperative pain complaints of the patients after the operation. In addition, in order to evaluate the CRBD, VAS scores were questioned and recorded as 0-1th hour, 1st-2nd hours, 2nd – 4th hours, 4th-8th hours, 8th-12th hours, and 12th-24th hours. In addition, postoperative pain and analgesic need were recorded. Tramodol was given to patients with moderate to severe CRBD. The findings was compared between to the Groups. Results:There was no statistical difference between Group 1 and Group 2 between demographic and per-operative data. The CRBD and pain-related VAS scores was significantly higher in Group 1 between the 0-8th hours. There was no difference between VAS scores in the postoperative 8-24th hours. In total 24 hours, Group 2’s need for tramodol for CRBD and pain was significantly less than Group 1. On examining the factors affecting CRBD in the multivariate analysis, age, body mass index(BMI), prostate volume, operation time do not affect CRBD statistically, only PNB reduces CRBD (p: 0.029). While less drug-related complications were observed in Group 2, no serious complications related to PNB were observed. Conclusion:PNB is the effective method for the decrease pain and CRBD after urological surgery.It will also reduce the need for analgesics, and provide the painless patients in postoperative period.

Background: There is growing interest in physical medicine treatment options for renal colic. In this study, we aimed to determine whether or not heat-patch treatment with no drug was effective in relieving renal colic. Methods: For this purpose, patients who were diagnosed with renal colic in the emergency department were randomized to have either heat-patch or sham treatment. The Visual Analog Scale (VAS) scores of renal colic, body temperature (Btemp), and sub-patch skin temperature (Stemp) values were measured at 0,15,30,45, and 60 min. In addition, the salvage treatment needs of the groups were compared. Results: The average age of the study group was30.5 ± 8.3 years and that of the sham group was 31.0 ± 8.2 years (p = 0.75). According to the baseline VAS score of the patients, 15, 30, 45, and 60min VAS scores significantly decreased in the heat-patch group (p<0.001). The Btemp values did not differ significantly between the heat-patch and sham groups. In addition, no statistically significant difference was found between the two groups in terms of Stemp values at 0 and 15 min (p = 0.39and p = 0.10, respectively). However, there was a significant difference in the heat-patch group in terms of Stemp values at30, 45, and 60 min compared to the sham group (p<0.001). The salvage treatment rates for the heat-patch and sham groups were 11.5% and 31.4%, respectively (p = 0.01). Conclusion: As non-pharmaceutical treatment, the heat-patch has been shown to be a possible candidate for pain relief in patients with urolithiasis. Further research should concentrate on multicenter and large-scale randomized studies.