Which of us were more affected by the pandemic? The psychiatric impacts of the COVID-19 pandemic on healthcare professionals in the province where the first quarantine units were established in Turkey

Introduction Psychiatric problems, such as stress and anxiety disorders, are encountered amongst healthcare professionals fighting epidemics. Considering that COVID-19 suddenly became a pandemic and healthcare professionals have not had access to sufficient information, it is a fact that healthcare professionals have been affected on a large scale. Heavy workloads, insufficient equipment and anxiety over families increase this impact. We aimed to investigate the extent to which healthcare professionals have been psychologically affected by COVID-19 and related factors. Methodology Data obtained through questionnaires completed by 348 healthcare professionals working during the COVID-19 pandemic and 350 participants who are in the control group were investigated. The Impact of Event Scale-revised (IES-R) for post-traumatic stress disorder (PTSD) and the Severity Index (ISI) for insomnia were used. Differences regarding gender, occupation, age group, marital status and sub-groups were statistically analysed. Results Of the 348 healthcare professionals, 176 (50.6%) were women and 172 (49.4%) men, while 190 (54.6%) were doctors and 158 (45.4%) nurses. The incidence of PTSD was statistically significantly higher in the healthcare professionals group than in the control group (P < .001). The incidence of PTSD was statistically significantly higher amongst nurses (P = .001), women (P = .002) and those who were married (P = .007). Both PTSD and insomnia were found to be statistically significantly higher amongst those working in the "area of final diagnosis" (P = .016 and P = .002, respectively). Conclusions The determination of the groups most affected amongst professionals working in epidemics is important for the planning of in-service training and psychological support studies. If the fight against pandemics includes health teams with strong psychological grounding, it leads to qualified medical care for patients

The effect of COVID-19 epidemic on the sexual function of healthcare professionals

Studies have shown that healthcare professionals struggling with epidemics develop symptoms of post-traumatic stress disorder. The aim of this study is to show how often and severely erectile dysfunction, one of the components of post-traumatic stress disorder, is seen among healthcare professionals during COVID-19 outbreak. The Impact of Event Scale-Revised (IES-R) and the Index of Erectile Function-5 (IIEF-5) were applied to 159 male healthcare professionals working in COVID-19 units and a control group of 200 people. Healthcare professional group was divided into subgroups according to occupation (physician, nurse), age-group (18-25, 26-30, >30), marital status and unit of work (Suspected Patient Area, Diagnosed Patient Area). Both stress disorder and erectile dysfunction were seen at higher rates in healthcare professionals group (p < .001). The median IIEF-5 scores of nurses, married subjects and those working in the Diagnosed Patient Area, were found to be higher (p < .001, p = .014, p = .011 respectively). During the COVID-19 outbreak, healthcare professionals are exposed to psychological trauma and their sexual function may be negatively affected. The measures to be taken are important to estimate which groups are more affected

Erkek üretrası içinde kulak temizleme çubuğu : alışılmadık üretral yabancı cisme ait vaka raporu

Urethral foreign bodies are rare urological emergencies and early management is vital. Mostly, the patient with a psychiatric disorder inserts the foreign body himself for erotic satisfaction. In this paper, we reported a case of a 22-year-old male patient who inserted a cotton swab into his urethra.Üretral yabancı cisimler, az rastlanan fakat erken müdahalenin hayati olduğu ürolojik acillerdendir. Çoğunlukla, psikiyatrik bir sorunu olan hasta erotik tatmin amacıyla yabancı cismi kendi yerleştirmektedir. Biz bu yazıda , kendi üretrasına kulak temizleme çubuğu yerleştiren 22 yaşındaki erkek hastaya ait bir vakayı raporladık

The effectiveness of radiation-free RIRS (Retrograde intrarenal surgery) in children and factors affecting success

Pediatrik hasta populasyonunda, üriner taşlar için mevcut tedavi seçenekleri arasında ESWL, perkütan nefrolitotomi ve üreteroskopik işlemler yer almaktadır. Literatürde intrarenal taşların üreteroskopik tedavisine ilişkin veriler sınırlıdır. İntrarenal taşların endoskopik tedavi modalitelerinden en önemlisi olan RIRS (Retrograd Intrarenal Surgery), rutin olarak bazı aşamalarında floroskopi kullanılan bir yöntemdir. Çalışmamızda kliniğimizde rutin olarak floroskopi kullanılmadan (radiation- free) uyguladığımız RIRS ile ilgili deneyimlerimizi inceledik. Bu çalışmada incelediğimiz yaş grupları arasında sonuçların farklılık gösterip göstermediğini , kendi sonuçlarımız ile az sayıdaki diğer çalışmaların sonuçları ile arasındaki farkı ve floroskopinin bu yöntemdeki gerekliliğini, operasyon ve taş kırma sürelerini incelediğimiz faktörlerin nasıl etkilediğini , cerrahi başarıyı etkileyen faktörlerin neler olduğunu ve nasıl etkilediklerini değerlendirmeyi amaçladık. Ağustos 2013 ile Ocak 2017 tarihleri arasında kliniğimizde intrarenal taşları için RIRS uyguladığımız 52 pediatrik hastayı (<18yaş) retrospektif olarak inceledik. Yaş ortalaması 7,6 (1-17) olan tüm hasta grubu, okul öncesi yaş grubu (0-5yaş), okul çağı yaş grubu (6-10yaş) ve adolesan yaş grubu olmak üzere üç ayrı gruba ayrıldı. Tüm hasta grubunun yaş ,cinsiyet , taşın bulunduğu taraf ve lokalizasyon, taşın kimyasal yapısı, boyutu, preoperatif uygulanan görüntüleme yöntemi, operasyon ve taş kırma süreleri, preoperatif J stent takımı ve intraoperatif UAS (ureteral access sheat) uygulanması, cerrahi başarı durumu verileri değerlendirildi. Üç grubun bu verilerle ilgili aralarında fark olup olmadığı incelendi. Operasyon ve taş kırma süreleri ve bunları etkileyen faktörler değerlendirildi. Cerrahi başarı 3mm ve üstünde rezidü kalmaması olarak belirlendi. Hastaların taşsızlık oranları işlemden 1 ay sonra çekilen üriner sistem ultrasonu veya spiral opaksız taş tomografisi ile değerlendirildi. Ortalama yaş 7,6 olan toplam 52 hastaya (26 erkek/ 26 kadın) RIRS uygulandı. Ortalama taş boyutu 10,2mm (4-27) idi. Ortalama operasyon süresi 37,3 dk (25-70) iken ortalama taş kırma süresi 25,3 dk (10-45) idi. Cerrahi başarı oranı %73,1 olarak hesaplandı. Hastaların %32,3 üne preoperatif J stent takılırken, %42,3&#8223;üne intraoperatif UAS (ureteral access sheat) uygulandı. Hastaların hiçbirinde herhangi bir komplikasyon tespit edilmedi. Yaş, taş boyutu, taraf, lokalizasyon, preoperatif J stent takılması ve UAS uygulanması faktörlerinin cerrahi başarıya olan etkileri incelenmiş; sadece taş boyutu ile cerrahi başarı arasında anlamlı ilişki bulunmuştur. Operasyon ve taş kırma süresini etkileyen faktörler incelenmiş. Korelasyon analizi ile peoperatif J stent takılmasının, UAS uygulamasının operasyon süresini kısalttığı, taş boyutunun büyüdükçe operasyon süresinin uzadığı görülmüştür. Yine UAS uygulananlarda taş kırma süresinin kısaldığı, taş boyutu artıkça bu sürenin uzadığı görülmüştür. Fleksibıl üreterorenoskopi pediatrik hasta populasyonunda intrarenal taşların tedavisinde güvenli ve etkili bir yöntemdir. Bu yöntemde tecrübenin artmasıyla floroskopi kullanmadan da benzer sonuçlar elde edilebilir. Fleksibıl üreterorenoskopi yüksek taşsızlık oranları ve düşük komplikasyon oranları ile orta boy taşlar için kurumumuzda ilk basamak tedavi olarak yerini almıştır.In the pediatric patient population, available treatment options for urinary stones include ESWL, percutaneous nephrolithotomy and ureteroscopic procedures. Literature on ureteroscopic treatment of intrarenal stones is limited. RIRS (Retrograde Intrarenal Surgery), which is the most important endoscopic treatment modality of intrarenal stones, is a method that routinely uses fluoroscopy in some stages. In our study, we evaluated our experience with RIRS, which we routinely use without fluoroscopy (radiation-free) in our clinic. The aim of this study is to evaluate whether the results differ between age groups we examined, the difference between our own results and the results of a few other studies, the necessity of fluoroscopy in this modality, how the factors we examined affect the duration of operation and lithotripsy, the factors affecting surgical success, and their mode of influence. We retrospectively reviewed 52 pediatric patients (<18 years old) who underwent RIRS for intrarenal stones between August 2013 and January 2017 in our clinic. The entire patient group was divided into three groups: pre-school age group (0-5 year old), school age group (6-10 years old) and adolescent age group and the mean age was 7.6 (1-17). For all patient groups, age, sex, side and localization of the stone, stone chemical structure and size, preoperative imaging method, operation and stone breaking time, preoperative J stent insertion and intraoperative UAS (ureteral access sheat) application, and data on the surgical success were evaluated. The presence of any differences between the three groups regarding these data was analyzed. The duration of operation and lithotripsy and the factors affecting those were evaluated. Surgical success was determined as the absence of residues sized 3mm or higher. The stone-free rates of the patients were evaluated by urinary system ultrasonography or spiral opacity- free stone tomography 1 month after the procedure. A total of 52 patients (26 male / 26 female) with a mean age of 7.6 underwent RIRS. The average stone size was 10.2mm (4-27). The mean duration of operation was 37.3 min (25-70) while the mean duration of lithotripsy was 25.3 min (10-45). Surgical success rate was calculated as 73.1%. Preoperative J stent was applied in 32.3% of patients and intraoperative UAS (ureteral access sheath) was applied to 42.3% of patients. No complications were detected in any of the patients. The effects of age, stone size, side and localization of the stone, preoperative J stent insertion and UAS application factors on surgical success were examined; the only statistically significant correlation was between the stone size and surgical success. Factors affecting duration of operation and lithotripsy were investigated. Correlation analysis showed that insertion of a pre-operated J stent and UAS application shortened the operation time and that the operation time was prolonged as the stone size increased. Again, UAS application shortens the duration of the lithotripsy, and this duration was prolonged as the stone size increased. Flexible ureterorenoscopy is a safe and effective method for the treatment of intrarenal stones in a pediatric patient population. As experience increases in this method, similar results can be obtained without using fluoroscopy. Flexible ureterorenoscopy has taken its place as the first-line treatment for medium stones in our institution, due to its high stone-free and low complication rates

Is it safe and effective to begin percutaneous nephrolithotomy in a 2nd stage state hospital? : First 60 case

GİRİŞ ve AMAÇ: Bu çalışmada uzmanlık eğitimi sonrası PNL’ye ilk kez 2. basamak devlet hastanesinde başlayan bir cerrahın bu cerrahide yetkinliğe ulaşıldığı düşünülen ilk 60 vakasının sonuçlarını retrospektif olarak değerlendirerek PNL’ye 2. basamak hastanelerinde güvenli ve etkin bir şekilde başlanabileceğini değerlendirmek amaçlandı. YÖNTEM ve GEREÇLER: Çalışmaya perkütan nefrolitotomi yapılan 60 renal ünite (58 hasta) dahil edildi. Tüm hastalara prone pozisyonda standart (30Fr) perkütan nefrolitotomi 25 Fr rijit nefroskop ve pnömotik litotriptör ile uygulandı. Yaş, cinsiyet, opere edilen taraf gibi hastaya ilişkin veriler ile birlikte taş yükü, taş sayısı, taşın lokalizasyonu, renal akses lokalizasyonu ve sayısı, operasyon süresi, postop komplikasyonlar, kan transfüzyonu gereksinimi, başarı oranı, hastanede kalış süresi ve ek tedavi gereksinimleri gibi veriler retrospektif olarak toplandı. BULGULAR: Hastaların 43 (%74) ‘ü erkek, 15 (%26)’i kadın olup yaş ortalaması 47,8 ± 10,5 (22-67) idi. Taşların 20 (%33,3)’si basit taşlarken 40 (%66,7)’ı kompleks taşlardı. Ortalama taş yükü 8,4 cm2 ve ortalama Hounsfield Ünite (HU) 1121 ± 267 idi. Ortalama ameliyat süresi 125 ± 34 dakika idi. Hastalar ortalama 4,4 ± 2 (2-12) gün hastanede yattı. %26,7 renal ünitede komplikasyon görülürken Clavien grade 4 ve 5 komplikasyon görülmedi. Ek girişimlerle birlikte %90 başarı (taşsızlık + klinik önemsiz rezidüel fragmanlar) elde edildi. TARTIŞMA ve SONUÇ: PNL’ye 2. basamak devlet hastanelerinde güvenli ve etkin bir şekilde literatürle uyumlu komplikasyon ve başarı oranları ile başlanabileceği düşünülmekte olup konu ile ilgili prospektif randomize kontrollü çalışmalara ihtiyaç vardırINTRODUCTION: The aim of this study was to evaluate the results of the first 60 patients of a surgeon who started performing PNL for the first time in a state hospital after the residency and to evaluate that PNL can be started safely and effectively in 2nd stage hospitals. METHODS: Sixty renal units (58 patients) undergoing percutaneous nephrolithotomy were included in the study. All patients underwent standard (30Fr) percutaneous nephrolithotomy with 25 Fr rigid nephroscope and pneumatic lithotriptor in the prone position. The data was evaluated retrospectively in terms of patients age, gender, operated side and stone burden, stone number, stone localization, location and number of renal accesses, duration of operation, complications, blood transfusion requirement, success rate, hospital stay and additional treatment requirements. RESULTS: 43 (74%) of patients were male and 15 (26%) were female and the mean age was 47.8 ± 10.5 (22-67). Of the stones, 20 (33.3%) were simple stones and 40 (66.7%) were complex stones. The mean stone burden was 8.4 cm2 and the mean Hounsfield unit (HU) was 1121 ± 267. The mean operative time was 125 ± 34 minutes. The patients were hospitalized for an average of 4.4 ± 2 (2-12) days. Complications were observed in 26.7% renal unit and no Clavien grade 4 and 5 complications. 90% success (stone free + clinically insignificant residual fragments) was obtained with additional interventions. DISCUSSION and CONCLUSION: It is thought that PNL can be started with complication and success rates compatible with the literature safely and effectively in 2nd level state hospitals and prospective randomized controlled studies are needed

The use of flexible ureteroscopy is required to improve stone-free rates in ureteroscopy for proximal ureteral stones

Introduction: The main target in the treatment of proximal ureteral stones (PUS) is to provide a high stone-free rate (SFR) with low morbidity. In this study, we aimed to evaluate the need for flexible ureteroscopy (URS) by retrospectively examining one surgeon’s two-year experience of URS for PUS in a center where the flexible ureteroscope and holmium laser lithotriptor are available.Patients and methods: The medical records of all patients who underwent URS due to PUS by a single surgeon from November 2016 to November 2018 were evaluated retrospectively. Success was accepted as patient with no stones or clinically insignificant residual fragments (&lt;4 mm) observed at postoperative 4th and 8th weeks by radiological investigation.Results: URS was performed for PUS in 49 renal units of 48 patients. The mean age was 41.5 ± 12. The operation was completed with pure semirigid URS without the use of flexible URS in 13 (26.5%) RUs. Even in stones with a distance of &gt;5 cm to UPJ, two of nine stones required the use of flexible URS. 34 of 40 stones with a distance of &lt;5 cm to UPJ required the use of flexible URS. 24 of 26 stones with a distance of &lt;3 cm to UPJ required the use of flexible URS. Overall success rates were 100% (38/38) for pure PUS and 93.9% (46/49) for PUS with ipsilateral renal stones.Conclusion: URS is a safe and successful treatment in PUSs. As we have shown in our data, if we want to achieve high SFR with low comorbidity, we should always have flexible URS in the operating room and should use it if necessary.</p

Anterior Urethral Valve and Anterior Urethral Diverticulum with an Intradiverticular Stone: A Case Report and a Literature Review

Anterior urethral valve (AUV) is a rare but well-defined congenital anomaly. AUV can be isolated or occur in association with anterior urethral diverticulum (AUD). Here, we present the first pediatric case report of AUV and AUD which is complicated with an intradiverticular stone. We also review the literature involving AUV with AUD cases

Parameatal Urethral Cyst: A Case Report

WOS: 000561681300015A parameatal urethral cyst is a rare benign congenital anomaly. Approximately 50 patients with parameatal urethral cysts have been reported in the literature. These cysts are usually asymptomatic. They are recognized and diagnosed in the neonatal and early childhood periods. They are usually less than 1 cm in diameter and occur on the ventral or lateral edge of the meatus. These cysts are treated by complete excision. in this report, we present a nine-month-old boy with an asymptomatic parameatal urethral cyst who underwent surgical excision and simultaneous circumcision

Prognostic role of preoperative albumin to globulin ratio in predicting survival of clear cell renal cell carcinoma.

To investigate the prognostic role of preoperative albumin/globulin ratio (AGR) in predicting disease-free survival (DFS) and overall survival (OS) in localized and locally advanced clear cell renal cell carcinoma (RCC) patients

Prognostic role of preoperative albumin to globulin ratio in predicting survival of clear cell renal cell carcinoma

ABSTRACT Purpose: To investigate the prognostic role of preoperative albumin/globulin ratio (AGR) in predicting disease-free survival (DFS) and overall survival (OS) in localized and locally advanced clear cell renal cell carcinoma (RCC) patients. Patients and Methods: 162 patients who met the criteria specified were included in the study. The DFS and OS ratios were determined using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were performed to determine the prognostic factors affecting DFS and OS. Results: Median follow-up period was 27.5 (6-89) months. There was a statistically significant relationship between low AGR and high pathological tumor (pT) stage, presence of collecting system invasion, presence of tumor necrosis, and a high platelet count (p = 0.012, p = 0.01, p = 0.001, and p = 0.004, respectively). According to the Kaplan-Meier survival analysis, both OS and DFS were found to be significantly lower in the low AGR group (p = 0.006 and p = 0.012). In the multivariate Cox regression analysis, collecting system invasion and tumor necrosis were found to be independent prognostic factors in predicting OS and pT stage was found to be an independent prognostic factor in predicting DFS (HR: 4.08, p = 0.043; HR: 8.64, p = 0.003 and HR: 7.78, p = 0.041, respectively). Conclusion: In our study, low AGR was found to be associated with increased mortality and disease recurrence in localized and locally advanced RCC