Background: Hookah is a tobacco product of Middle Eastern origin; however, its popularity increases in Europe and the US. Despite its frequent use, hookah’s potentially detrimental effects are underestimated due to the scarcity of the relevant research. Since septoplasty is one of the most commonly performed procedures of otolaryngology practice, we aimed to investigate the impact of hookah consumption on recovery after septoplasty. Methods: Patients who underwent septoplasty in Sanliurfa Training and Research Hospital Department of Otolaryngology between January 2017 and December 2019 were divided into four groups based on their history of hookah and cigarette smoking. The patients’ prospectively collected data, including demographic features, healing time, and presence or absence of septal perforation during follow-up, were compared between these four groups. Results: The entire cohort included 270 patients. The mean patient age was 29.2±5.8 years. One hundred and thirty-two (48.9%) patients were non-smokers, 96 (35.5%) were cigarette smokers, 27 (10%) were hookah smokers, and 15 (5.6%) consumed both tobacco products regularly. Mean healing time was 10 days, and septal perforation was encountered in 10 patients (3.7%). A comparison of the groups revealed that cigarette smoking did not impact septal perforation rates (p=0.326) but prolonged the healing time. However, hookah smoking with or without cigarette smoking significantly influenced septal perforation rates and healing times. Conclusion: Patients should be questioned about hookah smoking in addition to cigarette smoking before the septoplasty procedure. Patients with a positive history of hookah smoking should be followed closely in terms of delayed healing and increased septal perforation rates.

Aims: To evaluate the diagnostic yield of investigations performed on patients with a history of urinary tract infections (UTI). Methods: A retrospective review was conducted on patients who underwent cystoscopy and imaging for a history of UTI between 2014-2019 in a single UK teaching hospital. Data was collected on demographics, cystoscopy and radiological findings requiring further management. The cohort was stratified by age, gender, and a confirmed history of recurrent UTI (rUTI). The subsequent algorithm was re-tested in a second cohort to validate its use. Results: 700 patients were included in the primary analysis, 427 female and 273 males. 331 meet the criteria of rUTI. The median age was 64y(18-97). Imaging abnormalities were equally frequent in males 6.3%(15/241) and females 8%(30/380) and the majority noted in patients aged ≥55y, 30/45(66.7%). Amongst those who did not meet the definition of rUTI, abnormal imaging was identified in 5-7% regardless of age group and gender. Cystoscopy abnormalities (n=24) were twice more likely in males, 5.5%(15/273) than females, 2%(9/427). 88%(21/24) were identified in patients ≥55y. There were no positive findings in women <55y. Applying baseline imaging but confining cystoscopy to those aged ≥55y and men with a confirmed history of rUTI would have saved 44% of procedures, missed no abnormalities with an overall diagnosis detection rate of 9.8%(69/700). This algorithm was validated in a separate cohort of 63 patients; applying it would have saved 46%(29/63) of cystoscopies with a positive diagnostic rate of 9.5% and no missed findings. Conclusion: To our knowledge this is one of the largest studies reporting the outcomes of investigations for UTI and rUTI. Our result suggests that imaging is a useful baseline assessment, but cystoscopy should be limited to specific subgroups. We propose and validate a simple decision algorithm to manage investigations for referrals for UTI in secondary care.

Our findings illustrate the widespread collateral impact of implementing measures to mitigate the impact of COVID-19 in people with, or being investigated for diabetes mellitus (DM). Ironically, failure to focus of the wider implications for people with DM and other groups with long-term conditions, may place them at increased risk of poor outcomes from SARS-CoV-2 infection itself, irrespective of the implications for their longer-term health prospects.

Objective: Increasing evidences suggest that oxidative stress is closely related to the pathogenesis of hepatitis C virus (HCV) infection. The purpose of this study was to examine the dynamic thiol/disulfide homeostasis (DTDH) and total oxidant/antioxidant status in patients with HCV infection. Methods: Levels of serum total thiol (TT), native thiol (NT), disulfide (DS), total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI; TOS/TAS ratio) as oxidative stress markers were determined in 162 individuals, including 74 patients with HCV infection and 88 non-HCV controls. Results: The NT, TT levels and NT/TT ratio were significantly lower and DS level, DS/NT and DS/TT ratios were significantly higher in HCV group compared to the control group. The TOS and OSI values were significantly higher and the TAS level was significantly lower in the HCV group than in the control group. No significant correlations were found between oxidative stress markers and albumin, alanine aminotransferase, aspartate aminotransferase and bilirubin levels in patients with HCV infection. A negative correlation was found only between OSI and albumin. Conclusion: These results indicate that patients with HCV infection are vulnerable to oxidative stress and have disturbed status of oxidant and antioxidant.

Background: Current guidelines for the management of asymptomatic hypertension (HTN) in the inpatient setting recommend the use of oral antihypertensives. However, in clinical practice, intravenous (IV) antihypertensives are commonly utilized with little supporting evidence. The objective of this study was to evaluate literature examining the safety/efficacy of IV hydralazine and labetalol in hospitalized patients with non-emergent, asymptomatic HTN. Methods: The PRISMA guidelines were utilized to structure the systematic review. A search strategy composed of drug-, inpatient-, and HTN-related terms was conducted utilizing PubMed, Embase, and Scopus databases through May 2020. Full-text, English-language articles describing IV labetalol and/or hydralazine use for non-emergent HTN in an inpatient setting that focused on clinical outcomes (i.e. vitals, adverse effects, healthcare utilization) were included. Identified studies were screened/extracted using DistillerSR by two reviewers at each stage, and studies were evaluated qualitatively for the presence of bias. Results: From 3362 records identified in the search, a final set of 10 articles were identified. Four studies focused on labetalol (40%), five studies on hydralazine and labetalol (50%), and one study on hydralazine (10%). The included studies presented a variety of outcomes, but several trends were identified, including reduction in average blood pressure in eight (80%) studies, a risk of adverse effects in six (60%), and increased length of stay in one (10%). Discussion: The studies identified in this review raise concerns regarding the safety of IV hydralazine and labetalol in non-emergent HTN. Despite relatively broad clinical experience with these drugs, experimental investigations regarding their utility are recommended.

Background: The prevalence of diabetes has been increasing, imposing massive costs on nations. Diet and physical activity are recommended for diabetes management. Evidence suggests theory-based interventions are more efficacious than non-theory approaches. This study aimed to test the effectiveness of an integrated theoretical model-based intervention to encourage compliance for low-fat food consumption, carbohydrate counting, and physical activity in adults with type 2 diabetes. Methods: A 4-week parallel randomized control trial was conducted in Iran. Data were collected using a self-report questionnaire at baseline and 8-weeks post-intervention. This survey assessed the Theory of Planned Behaviour (TPB) constructs of attitude, subjective norm (others’ approval), and perceived behavioural control (PBC). We also assessed risk perceptions (motivational) and planning (volitional) from the Health Action Process Approach (HAPA). Furthermore, weight, body mass index, triglyceride (TG), and LDL-cholesterol were measured. Results: For both low-fat food consumption and physical activity, only planning revealed a significant improvement over time for intervention rather than control participants (F=8.78, p≤0.001 for low-fat vs. F=11.26, p≤0.001 for physical activity). For carbohydrate counting, significant effects were found for behavior (F=4.37, p=0.03), intention (F=8.14, p≤0.001), PBC (F=7.52, p≤0.001), and planning (F=4.54, p=0.03), reflecting improvements over time in the intervention participants compared to controls. Further, the effects of the intervention on behavior were partially mediated via participants’ degree of planning (B=0.10, SE=0.06, CI=0.01 to 0.26). The serum TG level was significantly reduced from pre to post-intervention for intervention rather than for control participants (F=18.69, p≤0.001). Conclusions: This intervention was promising for carbohydrate counting but did not show improvements for low-fat diet nor physical activity. Given the improvement in psychological measures and self-reported behaviour for carbohydrate counting, coupled with the findings for TG, future research is needed to demonstrate longer-term improvements. Current theory-based educational strategies can be adopted for the management of carbohydrate intake in diabetes.

Purpose: COVID-19 pandemic has created a serious psychological impact worldwide since it has been declared. This study aims to investigate the level of psychological impacts of COVID-19 pandemic on Turkish population and to determine related factors. Methods: The study was carried out by using an online questionnaire using the virtual snowball sampling method. The sociodemographic data were collected on the following subjects: Participants’ experience on any signs of infection within the last month, the history of COVID-19 contact-treatment-quarantine, level of compliance with precautionary measures, the sources of information and level of knowledge about the pandemic process and their belief levels on the knowledge they acquire. Besides, questions that take place in the depression, anxiety, stress scale (DASS-21), and impact of events scale (IESR) were asked. Results: Of the 3549 participants, anxiety was found in 15.8%, depression in 22.6%, stress in 12.9%, and psychological trauma in 20.29%. Female gender, young age, higher education level, being single, high monthly income, presence of psychiatric illness, a high number of people living together, having any signs of infection, and contact history with COVID-19 infected person or contaminated object are identified as risk factors that may increase psychological impact. Compliance with the rules was found to reduce the risk of psychological response. Conclusions: During the pandemic, reducing the spread of the virus and knowing the risk factors in protecting the mental health of individuals will be guided in determining the measures to be followed and the policies to be followed.

Aim Extracorporeal shockwave therapy (ESWT) is known as one of the most effective treatment methods in plantar fasciitis (PF). Low-dye taping, which is the most preferred method of banding treatments, provides an analgesic effect by correcting biomechanics. It was aimed to compare the efficacy of adjuvant low-dye kinesio-taping (KT), sham-taping, or extracorporeal shockwave therapy (ESWT) alone in plantar fasciitis (PF). Methods In this double-blind, sham-controlled study, forty-five patients with PF were randomized to 3-group (Group 1: ESWT plus low-dye KT, n=15; Group 2: ESWT plus Sham-taping, n=15; and Group 3: ESWT only, n=15) five-session ESWT were administrated. KT was performed and changed every 1-week for the ESWT sessions in Groups 1 and 2. The main outcome measures were the visual analog scale (VAS) change, the heel tenderness index (HTI), foot function index (FFI). The patients were evaluated at the beginning and end of the treatment and the 4-week follow-up. Results The demographic characteristics and baseline outcomes between groups were similar (p>0.05). VAS and HTI changes were observed in all three groups, there was no difference between groups. Repeated-measures ANOVA showed a significant interaction between the time and the groups in FFI-total (F3.919= 2.607; p=.043). At the 4-week follow-up, when Groups 1 and 2 were evaluated, the lower FFI-total, FFI-disability, and FFI-activity limitation were statistically significant in Group 1 (p=0.027; p=0.026; p=0.029, respectively). When Group 1 and 3 were compared, the decrease in FFI-pain and FFI-activity limitation were significant in Group 1 (p=0.042; p=0.035, respectively). Conclusions Low-dye KT, in addition to ESWT, is more effective than sham-taping and ESWT in pain relief and foot function improvement due to PF at a 4-week follow-up.

ABSTRACT Aims of Study: To compare dynamic thiol/disulfide homeostasis between patients with with lung tuberculosis and healthy controls. Methods: Our study included 50 patients with active lung tuberculosis and 50 healthy controls. Serum thiol/disulfide was measured with a new automated spectrometric method developed by Erel and Neselioglu, and results were compared statistically. Results: We found that native and total thiol levels were significantly decreased in patients with lung tuberculosis, disulfide/native thiol and disulfide/total thiol levels were found to be higher in lung tuberculosis patients when compared with the control group. However, disulfide levels were higher in the control group than in the patient group. Conclusions: Based on the results of this study, it can be said that oxidative stress is closely associated with lung tuberculosis pathogenesis. There is a need for new studies that will show the possible effects of oxidative stress on lung tuberculosis pathogenesis.

Background: Open living donor hepatectomy (OLDH) is a highly painful procedure. Advanced strategies for enhancing perioperative analgesia and accelerating recovery are needed for patients undergoing OLDH. This study evaluated the effects of intravenous infusion of dexmedetomidine (DEX) during OLDH on postoperative analgesia and recovery. Methods: This prospective, randomized, double-blinded, and placebo-controlled study included 34 patients randomized to a control group (group C) and a DEX group (group D). Utilization of intravenous patient-controlled analgesia (IV-PCA) pump, pain intensity, and postoperative recovery variables were recorded. Moreover, intraoperative anesthetic consumption, hemodynamic parameters, and fluid status were also recorded. Results: During the first 24 hours after surgery, patients in group D had a lower pain intensity. The cumulative numbers of IV-PCA pump presses and fentanyl consumption within 24 and 48 hours postoperatively in group C were significantly higher than in group D. The time to first IV-PCA attempt was prolonged in group D. In addition, faster flatus passage was observed in group D. Intraoperatively, fewer anesthetic agents were required in group D. Less fluctuation in hemodynamics and reduced bleeding were also found in group D. Conclusions: The present study revealed that the addition of intravenous infusion of DEX during OLDH provided several benefits in relieving postoperative pain and promoting recovery. Therefore, we concluded that intraoperative DEX infusion may play an important role in enhancing recovery of patients undergoing OLDH.

Background: The pathogenesis of type 2 diabetes (T2D) is associated with chronic oxidative stress and inflammation. It is well known that the expression of some miRNAs such as miRNA-146a up- regulate in diabetic and hyperglycemic patients whereas, circulating miRNA-126 reduces. Therefore, the purpose of this study was to determinate the effects of Astaxanthin supplementation on the expression of miR-146a and miR-126, MDA and inflammation in patients with type 2 diabetes. Methods: This randomized double-blind placebo-controlled clinical trial was conducted on 44 type 2 diabetes patients who were randomly assigned to received 8mg of oral Astaxanthin/d (n=22) or placebo(n=22) for 8 weeks. Results: We observed that Astaxanthin supplementation could decrease plasma levels of MDA and IL-6 (P < 0.05) and declined the expression level of miR-146a over time (Fold change: -1/388) (P < 0.05). Conclusion: Astaxanthin supplementation might be beneficial for improving circulating MDA and IL-6 and down regulation of miR-146a. However, future investigations are suggested to confirm these results.

Objectives: To explore Knowledge and perceptions about COVID-19, among Syrian refugee mothers in Irbid governorate, the first outbreak of coronavirus in Jordan. Methods: This is an exploratory cross-section study was conducted among Syrian refugee mothers, who were currently pregnant or have a newborn child. The data collected through an online survey in April 2020 in North Jordan. Results: A total of 389 Syrian refugee mothers have participated in the study. The study showed that 66% of mothers often access information regarding COVID-19. The main used resources for information, were Facebook pages’ posters (87%), WhatsApp groups’ messages (69%), Television News (53%). While 21% indicated that they access a professional database or governmental websites. In general, Syrian refugee mothers appear well knowledgeable about COVID-19 the transition ways and prevention measures, and aspects that should be considered when diagnosing Coronavirus cases. However, they appeared to have a lack of knowledge about the aspects that should be considered for the transition of COVID-19 between the mother and the child and the concepts about the smoking risks associated with COVID-19. Conclusions: There is less focusing on media on aspects or still understudying of concepts about the smoking risks associated with COVID-19 and concepts around the transition of COVID-19 between the mother and the child. Providing health education regarding COVID-19 to mothers in Irbid would be helpful.

Introduction: Spirometry is of great value for understanding respiratory function and management of lung diseases. However, it presents special challenges when performed in children. Objective: To analyze factors that may influence the number of forced expiratory maneuvers required for successful spirometry in schoolchildren. Method: Healthy children aged between 6 and 12 years were tested. Forced spirometry maneuvers were conducted according to the American Thoracic Society. The children were grouped according to the number of attempts (maximum of eight). Factors that potentially influenced the number of maneuvers included: age; pulse oscillometry parameters; slow vital capacity; respiratory muscle strength; orofacial motor function, school performance, physical activity and quality of life. The Kolmogorov-Smirnov test was performed, followed by the Chi-Square, repeated measures ANOVA and Kruskal-Wallis tests. Next, multinomial logistic regression was applied. Significance level was set at 5%. Results: 149 children (80 girls) with mean age of 9.13 years (± 1.98) were studied. Age was related to the required number of spirometry maneuvers and children with poor school performance had a 2.84- fold greater chance of completing the exam in more than five attempts. Conclusion: Age and school performance influenced the number of forced expiratory maneuvers required for successful spirometry in schoolchildren.

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

Background. The use of transcutaneous near-infrared spectroscopy (NIRS) for the monitoring of the perfusion of renal allografts in paediatric population has been proposed in the last years. This device might detect early decrease in allograft oxygenation allowing prompt detection of vascular complications. Methods. A systematic review of literature about the use of transcutaneous NIRS in monitoring allograft perfusion was performed according to the PRISMA guidelines. Results. The authors screened 1313 papers. The search yielded five pertinent articles. Three of them reported the experience of NIRS in kidney transplantation, for a total of 53 paediatric patients and 50 adults. In these studies, NIRS measurements was significantly related to serum creatinine, estimated glomerular filtration rate (eGFR), urinary neutrophil gelatinase-associated lipocalin (u-NGAL), serum lactate, resistive index assessed by doppler-ultrasonography and systolic blood pressure. In the paediatric studies no vascular complications were encountered. Conclusions. Preliminary studies have related NIRS monitoring to renal allograft perfusion and function. Further investigation is needed to establish the normal range of NIRS values for renal allografts and the factors influencing NIRS monitoring.

Objective: The main objective of this prospective and observational study is to investigate the effect of preoperative hospitalization period on early postoperative cognitive dysfunction (POCD) development in patients undergoing total hip replacement surgery under regional anesthesia. Materials and Methods: Between November 2013 to September 2014, 64 patients were enrolled the study. Test scores were obtained on the initial admission day (MMT1), 24 hours prior to surgery (MMT2) and 24 hours after the surgery (MMT3). Patients were divided into two groups according to MMT scores as “no cognitive dysfunction” (Group 1) and “cognitive dysfunction” (Group 2). Differences between groups were evaluated statistically. Statistical significance level was set as p<0.05 in a 95% confidential interval. Results: POCD incidence rate was calculated as 43.8% in all patients. Preoperative hospitalization duration was significantly higher in patients with POCD when compared to patients without POCD (p<0,001). The factors which affect POCD development were found to be advanced age (p<0,001), high ASA scores (p=0,004), presence of comorbid disease (p=0,025), duration of operation (p=0,018) and decreased postoperative hematocrit levels (p=0,014). Conclusion: In this study, we observed patients with early POCD had a relatively longer pre-operative hospitalization period when compared to patients without POCD. We consider that the prolonged preoperative hospitalization periods may contribute to increased POCD incidence rates in patients with risk factors.

A document by Nilay Aksoy. Click on the document to view its contents.

Background Identification of published data on prevalent/incidence of atrial fibrillation/flutter (AF) often relies on inpatient/outpatient claims, without consideration to other types of healthcare services and pharmacy claims. Purpose To examine AF prevalence/incidence and associated individual comorbidity and multi-morbidity profiles for a large US adult cohort spanning across a wide age range for both males/females based on both medical/pharmacy claims. Methods We studied a population of 8,343,992 persons across many geographical areas in the U.S. continent from 1 January /2016 to 31 October 2019. The prevalence and incidence of AF were comparatively analyzed for different healthcare parameters. Results Based on integrated medical and pharmacy claims, AF prevalence was 12.7% in the elderly population (> 65 years) and 0.9% in the younger population (< 65 years). These prevalence rates are different from estimates provided by the US CDC for those aged > 65 years (9%) and age < 65 years (2%); thus, the prevalence is under-estimated in the elderly population and over-estimated in the younger population. The incidence ratios for elderly females relative to younger females was 15.07 (95%CI 14.47-15.70), a value that is about 50% higher than for elderly males (10.57 (95%CI 10.24-10.92)). Comorbidity risk profile for AF identified on the basis of medical and pharmacy criteria varied by age and sex. The proportion with multimorbidity (defined as ≥2 long term comorbidities) was 10-12%. Conclusion Continued reliance only on outpatient and inpatient claims greatly underestimates AF prevalence and incidence in the general population by over 100%. Multimorbidity is common amongst AF patients, affecting approximately 1 in 10 patients. AF patients with 4 or more co-morbidities captured 20 to 40% of the AF cohorts depending on age groups and prevalent or incident cases. Our proposed methodology can guide future analysis of quality/cost of care for progressive medical conditions at the population level.