Cardiovascular physiology and erectile dysfunction

Erectile dysfunction (ED) is defined as the inability to initiate or maintain an erection that is not satisfactory or sufficient for sexual activity. Erectile dysfunction affects the patient in many ways, especially the physical and psychosocial condition, and has extremely negative effects on the quality of life of the patient and his partner. There is increasing evidence that erectile dysfunction occurs in the early stages of coronary artery and peripheral vascular disease.This makes us think that ED is not only a condition that affects the quality of life but also a potential warning sign for cardiovascular diseases. Therefore, it is important to know the relationship between cardiovascular system physiology and erectile dysfunction. In this review, the relationship between cardiovascular system physiology and erectile dysfunction was evaluated in light of the literature

Evaluation of the Readability of Informed Consent Forms Used for Emergency Procedures

INTRODUCTION: The aim of the study was to evaluate the readability levels of informed consent forms used for patient consent before emergency procedures applied in emergency service in Necmettin Erbakan University Meram Medical Faculty Emergency Service Clinic through readability formula. METHOD: Fifteen informed patient consent forms used for emergency medical applications in Necmettin Erbakan University Meram Medical Faculty Emergency Medicine Department were evaluated. Information text available on the forms was transferred into Microsoft Word program. Average word number, syllable number and words with syllable number of four and above were calculated. Ateşman and Bezirci-Yılmaz formulas defined for determining the readability level of Turkish texts and Gunning fog, Flesch kincaid formulas measuring the general readability level were used for calculating the readability level of consent forms. RESULTS: Readability levels of all consent forms were detected at average difficulty level according to Ateşman formula, very difficult according to Flesch-Kincaid formula, difficult according to Gunning fog formula and at high school level according to Bezirci-Yılmaz. CONCLUSIONS: In this study, the readability level of emergency intervention consent forms used in the clinic was detected as hard and required high school or higher education level. The conclusion is that attention should be paid to this subject which is both medically and legally binding for the doctors and verbal and visual support should be provided for informing the patients in addition to consent forms

Is there a difference between the readabilities of informed consent forms used for procedures in the emergency services of state and university hospitals in Turkey?

Aim: The aim of the present study was to evaluate the readability levels of informed consent forms (ICFs) used for procedures in the emergency services of state and university hospitals by comparing through readability formulas. Materials and Methods: ICFs used in emergency medicine clinics in different university and state hospitals in Turkey were collected, and forms that were the same were included in the evaluation only once. A total of 32 ICFs, with 15 from university hospitals and 17 from state hospitals, were evaluated. Average word number, syllable number, and words with syllable number of four and above were calculated. Different formulas were used to determine readability levels. Results: Although the readability of ICFs used in university hospitals was found to be better than those in state hospitals, the readability levels of the ICFs for both groups were detected to have medium difficulty according to the Atesman formula, very difficult according to the Flesch-Kincaid formula, difficult according to the Gunning-Fog formula, and at high school level according to the Bezirci-Yilmaz formula. Conclusion: In conclusion, the readability rates of emergency procedure ICFs in both state hospitals and university hospitals were detected to be rather low according to the present study. The education level of our country and the local environment should be considered while preparing these ICFs

The impact of lung ultrasound on coronavirus disease 2019 pneumonia suspected patients admitted to emergency departments

Objective The aim of this study was to identify the sensitivity and specificity of lung ultrasound (LUS) and show its place in diagnosing patients with known coronavirus disease 2019 (COVID-19) pneumonia, according to chest computed tomography and the COVID-19 reporting and data system (CO-RADS). Methods Nineteen patients who admitted to a single university hospital emergency department between March 5, 2020, and April 27, 2020, describing dyspnea were included in the study and underwent LUS by a single emergency specialist. The patient population was divided into 2 groups, COVID-19 positive and negative, and the sensitivity and specificity of LUS according to chest computed tomography were calculated for COVID-19 pneumonia diagnosis. In the subgroup analysis, the patient group was divided into real-time reverse transcription-polymerase chain reaction positive (n = 7) and negative (n = 12), and sensitivity and specificity were calculated according to the CO-RADS. Results According to the CO-RADS, significant differences were detected between the LUS positive and negative groups in terms of COVID-19 pneumonia presence. Only 1 patient was evaluated as CO-RADS 2 in the LUS positive group, and 2 patients were evaluated as CO-RADS 4 in the LUS negative group (P = 0.04). The sensitivity of LUS according to the CO-RADS for COVID-19 pneumonia diagnosis was measured to be 77.78% (95% confidence interval [CI], 39.9%-97.1%), specificity was 90% (95% CI, 55.5%-99.75%), positive predictive value was 87.5% (95% CI, 51.35%-97.8%), and accuracy was 84.21% (95% CI, 60.4%-96.62%; P = 0.004). Conclusions In conclusion, LUS is easily used in the diagnosis of COVID-19 pneumonia because it has bedside application and is fast, easy to apply, reproducible, radiation free, safe for pregnant women, and cheap

Can hematological and biochemical parameters fasten the diagnosis of COVID-19 in emergency departments?

INTRODUCTION: The primary aim of the study was to compare the laboratory and radiological parameters of COVID-19 positive and negative patients confirmed by Real-Time Reverse Transcription Polymerase Chain Reaction (RT-PCR), and Chest Computed Tomography (CCT) of patients admitting with the suspicion of COVID-19. The secondary purpose of the study was to find objective parameters to speed up the clinician for further examination, treatment or referral decision in COVID-19 suspicion.   MATERIAL AND METHODS: A total of 61 COVID-19 suspected patients were evaluated in the study. Swab samples were taken for RT-PCR analysis. CCT was taken for 42 patients who described dyspnea. According to CCT and RT-PCR results, the patient population was divided into 2 groups as COVID-19 positive group (n = 32); and COVID-19 negative group (n = 29). Between two groups; demographic, clinical, laboratory and radiological parameters were compared.   RESULTS: Male gender (p = 0.03), PLR value (p = 0.021) and CO-RADS scores were higher in the COVID-19 positive group. Oxygen saturation (SaO2) (p = 0.027) and PCT, WBC, Neutrophil count, Lymphocyte count values were significantly low in COVID-19 positive group (p = 0.03, p = 0.001, p = 0.017, p = 0.021, respectively). PLR showed a positive correlation with fever, CRP, neutrophil count and NLR, which are indicators of inflammation.   CONCLUSIONS: SaO2, WBC, lymphocyte count, neutrophil count and low PCT levels, and PLR elevation showed a significant difference in COVID-19 patients in our retrospective cohort study examining the Turkish population. We believe that these results will allow clinicians to make quick decisions in patient management more simply

Deneysel sepsis modelinde oksidan-antioksidan sistem ve akciğer histopatolojisi üzerine okterotidin doza bağımlı etkileri

Acil Tıp alanında çalışan doktorların medikolegal endişeler, tükenmişlik, anksiyete durumları ve iş tatmini düzeylerinin yaş, cinsiyet, çalışma süresi, görev ünvanı ve çalışılan kuruma göre olası farklılıklarını ortaya koymak amacıyla yapılmıştır. Gereç ve Yöntemler Araştırma evrenini Türkiye' deki acil tıp kliniklerinde görev ünvanı pratisyen, asistan, uzman hekim ve öğretim üyesi olan doktorlar oluşturdu. Araştırma Eylül 2018- Ocak 2019 tarihleri arasında gerçekleştirildi. Verilerin toplanması için anketle bilgi toplama tekniği kullanıldı. Anketi tamamen dolduran toplam 141 Hekim çalışma popülasyonuna dâhil edildi. Anket kişisel bilgi formu, medikolegal endişeler anketi, Maslach Tükenmişlik Ölçeği, Durumluk- Süreklilik Anksiyete Ölçeği, Minnesota İş Doyum Ölçeği olmak üzere 5 ayrı bölümden oluşuyordu. Kişisel Bilgi Formu'nda hekimlerin; yaş, cinsiyet, çalışma süresi, görev ünvanı, çalışılan kurum konusunda bilgiler soruldu. Hekimler tarafından medikolegal endişeleri değerlendirmek için 29 sorudan oluşan "Medikolegal Endişeler Anketi" dolduruldu. Tükenmişlik düzeyini belirlemek için, Maslach tarafından geliştirilen Maslach Tükenmişlik Ölçeği (MTÖ), anksiyete düzeyini ölçmek için Durumluk-Süreklilik Anksiyete Ölçeği (STAI), iş tatminini ölçmek için Minnesota İş Doyum Ölçeği' nin kısa formu kullanıldı. Ayrıca çalışma populasyonu cinsiyet, çalışılan kurum, görev unvanı, yaş ve çalışılan hizmet süresi ortalamasına göre alt gruplara ayrıldı. Alt grup analizleri bu gruplar arasında yapıldı. Bu çalışma da değerlendirilen medikolegal endişeler anketi ile acil tıp hekimlerin malpraktis konusunda oldukça endişeli olduğu, komplikasyon- malpraktis ayrımının yapılamadığına inandıkları, onam formlarının ve yapılan tıbbi malpraktis sigortasının onları sorumluluktan kurtarmadığını, medikolegal endişeler ile çoğunlukla fazladan tetkik ve konsültasyon istediklerini, hastalara uygulamaları daha detaylı açıkladıkları, kayıtlar ve onam formlarının alınmasına daha çok özen gösterdikleri, dava riski ve mobbing uygulamasına maruz kaldıklarını, hekimlerin büyük oranda yurtdışına göç, mesleği bırakma veya değiştirme düşüncesinde olduklarını, yaptıkları uygulamalar ve tedaviler için güvende hissetmediklerini ortaya koymaktadır. Aynı zamanda bu cevaplara rağmen hastayla ilgili takip, tedavi planlaması, yatış ve sevk gibi konularda gerekli olan prosedürleri gerektiği gibi uyguladıklarını göstermektedir. Ayrıca STAI anksiyete ölçeğinin durumluk anksiyete ve sürekli anksiyete skorları düşük/ orta derece anksiyete varlığı, Minnesota İş Tatmini Ölçeği' ne göre dışsal iş tatminin düşük olduğu, Maslach "duygusal tükenmişlik" oranı yüksek derecede; Maslach "duyarsızlaşma" oranı orta derecede, Maslach "kişisel başarı hissinde azalma" duygusunun orta derecede olduğu saptandı. Bu skorların cinsiyet ve çalışılan kurum ile farklılık göstermediği belirlendi. Özellikle Maslach tükenmişlik parametrelerinin görev unvanı, yaş ve çalışılan görev yılı ile ilişkili olduğu, yaşı genç olan ve daha az tecrübeli olan asistan ve pratisyen hekimlerde, tükenmişliğin daha yüksek olduğu tespit edildi. Ayrıca duygusal tükenme, duyarsızlaşma, durumluk ve sürekli anksiyetenin artması ile genel, içsel ve dışsal iş tatmininin anlamlı düzeyde azaldığı tespit edildi. Sonuçlar Elde ettiğimiz sonuçlar nedeniyle gerekli hukuksal değişiklikler yapılarak ülkemiz acil tıp doktorlarının çalışma ve nöbet saatlerinin hekimleri yıpratmayacak şekilde düzenlenmesi, yeterli hekim sayısı ile hizmet verilmesi, yapılan işe karşılık uygun ücret verilmesi, hekimler üzerindeki mobbing uygulaması ve dava riskinin azaltılması, hastane öncesinde etkin triaj ile hasta yükünün azaltılabilmesi, acil bakım ve müdahale ihtiyacı olmayan hastaların acile yönlendirilmesinin engellenmesi ile medikolegal endişelerin azalabileceği, tükenmişlik ve anksiyetenin azalarak, iş doyumunun artacağı kanaatindeyiz. Ayrıca bu çalışmada elde edilen sonuçların bulgularının hem Türkiye' de hem de diğer ülkelerde daha önce yapılan çalışmalarla uyuşmasına rağmen, aynı zamanda oldukça farklı sonuçların olduğu gözlemlenmiştir. Bu nedenle, bu çalışmadan elde edilen bulgular, konuyla ilgili önceki çalışmalardan elde edilen çeşitli sonuçlar ışığında değerlendirilmelidir. Bu nedenle, burada incelenen ilişkileri daha iyi anlamak için ek çalışmalara ihtiyaç olduğu kanaatindeyiz.This research was made to present possible differences in medicolegal concerns, burnout, anxiety conditions and job satisfaction levels of doctors working in Emergency Medicine, considering age, gender, institution, title and duration of employment. Material and Methods Doctors working in emergency medicine departments in Turkey with general practitioner, assistant, specialist and assistant professor titles constituted the population of the study. The research was made between September 2018 and January 2019. Data was gathered through questionnaire. A total of 141 doctors who completed the questionnaire were included in the study. The questionnaire included five different sections as personal data form, medicolegal concerns questionnaire, Maslach Burnout Inventory, State-Trait Anxiety Inventory and Minnesota Job Satisfaction Scale. Age, gender, institution, title and duration of employment of the doctors were questioned through Personal Data Form. Doctors filled in "Medicolegal Concerns Questionnaire" including 29 questions to evaluate medicolegal concerns. Maslach Burnout Inventory (MBI) of Maslach to determine burnout level, State-Trait Anxiety Inventory (STAI) to measure anxiety level and short form of Minnesota Job Satisfaction Scale to measure job satisfaction were used. The study population was also divided into sub groups based on gender, institution, title and duration of employment and age. Sub group analyses were made among these groups. Results Medicolegal concerns questionnaire evaluated in this study showed that emergency medicine doctors are quite concerned about malpractice, believed there was no distinction in complication - malpractice, consent forms and medical malpractice insurance didn't take away their responsibilities, they generally demanded extra examinations and consultations due to medicolegal concerns, explained the applications to the patients in more detail, cared more about taking on interventions and consent forms, were exposed to mobbing, most of them thought about immigrating or leaving or changing their profession, didn't feel safe about the applications and treatments they make and applied the required procedures on patient follow-up, treatment planning, hospitalization and transfer as they should despite these answers they provided. It was also detected that STAI anxiety scale, state anxiety and trait anxiety scores showed presence of low/average degree of anxiety, external job satisfaction was low based on Minnesota Job Satisfaction Scale, Maslach "emotional exhaustion" ratio was high, Maslach "desensitization" ratio and Maslach "reduced sense of personal accomplishemnt" were average. No difference was detected in these scores based on gender and the institution of employment. It was detected that especially Maslach burnout parameters were related to age, title and duration of employment and burnout was higher in residents and general practitioners who are younger and have less experience. A significant decrease was also detected in general, inner and external job satisfaction with the increase in emotional exhaustion, desensitization and state and trait anxiety levels. Conclusions Due to the conclusions we acquired, through the required legal changes, we think that medicolegal concerns may decrease by arranging the working and shift hours of emergency medicine doctors in our country so that they wouldn't have burn out problem, providing service with adequate number of doctors, giving suitable salary for the work done, decreasing the risk of mobbing and legal action on doctors, decreasing the patient load through an active prehospital triage and preventing the emergency department referral of patients not requiring emergency care and intervention and we also think that job satisfaction would increase by decreasing burn-out and anxiety. It was also observed that, although the findings of this study are in line with previous studies made both in Turkey and other countries, there were also quite different results. So, the findings acquired from this study should be evaluated in the light of different results acquired from previous studies on the subject. Thus, we think that additional studies are required to better understand the connections examined here

New treatment modalities with vaccine therapy in renal cell carcinoma

The aim of implementing vaccine therapy is to activate immune response against malignant cells by overcoming the tolerance triggered by the tumor. These treatments are effective using the immune response against cancer. Not every type of cancer is suitable for vaccine therapies. For a vaccine therapy to be implemented, cancer should be immunogenic and contain tissue-specific proteins, should have a slow progression, and treatments should be feasible. For that reason, studies regarding urological cancers are mostly focused on the kidneys and the prostate. Vaccine therapies used in renal cell carcinoma (RCC) can be categorized under the following titles: autologous tumor cells, dendritic cells, genetically modified tumor cells, and protein/peptide. Although there are old studies on the implementation of vaccine therapies in RCC, researches have only been intensified recently. In addition to their effective potential for lengthening general survival, decreasing tumor burden and cancer development in long term, vaccine treatments are especially effective in metastatic RCC patients. We think that vaccine treatments would be applied more in near future since RCC are immunogenic. In this compilation, we will discuss vaccine therapies used in RCC, which urologists are not so familiar with, in the light of the up-to-date literature

Is There a Difference Between the Readabilities of Informed Consent Forms Used for Procedures in the Emergency Services of State and University Hospitals in Turkey?

WOS:000456457100010Aim: The aim of the present study was to evaluate the readability levels of informed consent forms (ICFs) used for procedures in the emergency services of state and university hospitals by comparing through readability formulas.Materials and Methods: ICFs used in emergency medicine clinics in different university and state hospitals in Turkey were collected, and forms that were the same were included in the evaluation only once. A total of 32 ICFs, with 15 from university hospitals and 17 from state hospitals, were evaluated. Average word number, syllable number, and words with syllable number of four and above were calculated. Different formulas were used to determine readability levels.Results: Although the readability of ICFs used in university hospitals was found to be better than those in state hospitals, the readability levels of the ICFs for both groups were detected to have medium difficulty according to the Atesman formula, very difficult according to the Flesch-Kincaid formula, difficult according to the Gunning-Fog formula, and at high school level according to the Bezirci-Yilmaz formula.Conclusion: In conclusion, the readability rates of emergency procedure ICFs in both state hospitals and university hospitals were detected to be rather low according to the present study. The education level of our country and the local environment should be considered while preparing these ICFs

What should be done to minimize pain without any sexual function deterioration in transrectal prostate biopsy?

WOS: 000418412900007PubMed: 29410888Introduction The aim of this study was to find an ideal method for the application of a transrectal ultrasound-guided prostate biopsy (TRUS-Bx) without deteriorating patient comfort. Material and methods TRUS-Bx was applied in a total of 93 patients. Taking the application method into consideration, these patients were divided into three groups, each consisting of 31 patients. Methods applied for pain control in the different groups were compared (groups 1, 2 and 3). Age, prostate specific antigen (PSA), prostate volume, cancer detection rate, re-biopsy consent ratio, complication rates, visual analog scale (VAS), and International Index of Erectile Function (IIEF-5) scores were compared among the groups. Results Age, PSA, prostate volume, cancer detection rate, and fever complication rate were not statistically different between the three groups. However, a statistically significant difference was detected among the groups for the VAS measured during and after TRUS-Bx, re-biopsy consent ratio, and hematuria (p < 0.001, p < 0.001, p < 0.001, and p = 0.027, respectively). There was no detected difference in pre-operation IIEF-5 scores, but the difference in IIEF-5 scores in the first month after the operation was significant (p = 0.116, p = 0.024, respectively). Conclusions Anal dilatation after the application of intrarectal topical anesthetic to provide anesthesia during TRUS-Bx and giving lidocaine hydrochloride with epinephrine for periprostatic nerve blockage (PNB) is a successful and effective method to maintain patient comfort, especially as it relates to pain control and sexual function. Anal dilatation seems to minimize any pain that may occur due to probe transition, and adding epinephrine as a vasopressor to the anesthetic agent chosen during the operation will be rather helpful for hemostasis control and pain that results from the needle

Etiological factors and management in priapism patients and attitude of emergency physicians

Objective: To present the underlying etiological factors in patients referring with priapism, sharing how they are managed according to etiology and priapism type together with our experiences, creating awareness so that urologists and emergency physicians may play a more active role together in priapism management. Materials and methods: Patients referring to emergency service with priapism were examined. Penile Doppler ultrasonography (PDU) and/or corporeal aspiration and blood gas analysis were made in order to determine priapism type after anamnesis and physical examination. The most appropriate treatment option was chosen and applied on the patients considering priapism type, underlying etiological factors and priapism time. Presence of a statistical difference between etiological factors causing priapism, priapism type and applied treatment methods was calculated using Chi square (χ2) test. Results: A total of 51 patients referring to emergency service with priapism attacks for 53 times were included in the evaluation. When compared to other etiological factors, number of priapism cases developing secondary to papaverine after PDU was found statistically significantly high (p &lt; 0.001). Ischemic priapism ratio was detected statistically higher compared to other groups (p &lt; 0.001). Aspiration and/or irrigation treatment were the most common method used for treatment at a statistically significant level (p &lt; 0.001). All patients (100%) were hospitalized in urology service without applying any treatment in emergency service and had treatment and intervention under the control of the urologist. Conclusions: Application of non-invasive treatments in suitable priapism patients would protect patients from invasive painful interventions. We believe that emergency physicians should be more effective in priapism phase management and at least noninvasive treatment phase