Everolimus Treatment and Selective Artery Embolization Application in a Case of Tuberous Sclerosis-Related Bilateral Renal Angiomyolipoma

Angiomyolipomas are the most common benign mesenchymal tumors of the kidney. Although they are often seen sporadically, they can also be observed as a part of the tuberous sclerosis complex (TSC). They occur at an earlier age in cases associated with tuberous sclerosis (TS), bilateral mass and epithelioid formation. There are various treatment approaches such as active surveillance, nephron-sparing surgery, nephrectomy, angioembolization, and use of mammalian target of rapamycin (mTor) inhibitors. Our case was a patient with bilateral multiple renal angiomyolipomas associated with TS. We applied mTOR inhibitor and angioembolization therapy to this patient. In our article, we tried to evaluate our success rate in our treatment and the treatment regimens to be applied in these patients

Diagnostic Role of Intravesical Prostatic Protrusion and Visual Prostate Symptom Score in Lower Urinary Tract Symptoms in Male

INTRODUCTION: In this study, it was aimed to evaluate non-invasive, effective and low-cost diagnostic methods of bladder filling and voiding abnormalities in male patients. METHODS: Visual Prostate Symptom Score (VPSS) and the International Prostate Symptom Score (IPSS) were completed by the patients. Patients' intravesical prostatic protrusion (IPP), prostate volume, and post voiding residual urine (PVR) were measured by suprapubic ultrasound. Bladder Outlet Obstruction Number (BOON) was used to calculate urethral resistance. Patients with a BOON value above -20 were considered obstructive. RESULTS: This study included 219 male patients aged 50 years and over.The number of patients with a BOON value over -20 were 34 (obstructed) and below -20 were 61 (non-obstructed). There was a significant difference between these two groups in terms of PSA, prostate volume, IPP, Qmax, PVR, IPSS, and VPSS. It was observed that IPSS and VPSS were correlated (r=0.786, p=0.001). Obstructive (r=0.779, p=0.000) and irritative symptoms (r=0.813, p=0.000) of IPSS and VPSS were also observed to be correlated. DISCUSSION AND CONCLUSION: VPSS was found to be equivalent to IPSS in the diagnosis of lower urinary tract symptoms (p=0.001). IPP is an important, practical, and non-invasive method that correlates with IPSS, VPSS, and BOON

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Delastria, A NEW GENUS OF HYPOGEOUS FUNGI RECORD FOR THE TURKISH MYCOBIOTA

In the present study, fungal samples collected from Enez and Süloğlu districts of Edirne Province, in Türkiye with the help of truffle-detecting dogs were analyzed. The macroscopic features and environmental details of the collection sites were documented in their natural habitats. The samples were investigated with light- and scanning electron microscopy (SEM) and were also used in ITS rDNA-based molecular phylogenetic analysis, which revealed that they belong to Delastria rosea Tul. & C. Tul. The identification was further supported by morphological data. This is the first record of D. rosea in Türkiye at the genus and species level. A brief description of the newly reported species is provided. Macro- and microphotographs of the spores taken by both ligth and electron microscop (SEM). With this study, the number of genera and species of Turkish truffles and truffle-like fungi has increased to 36 and 105, respectively

Effects of psoriasis and metabolic syndrome on male sexual functions

Background and Objective: Psoriasis is a chronic inflammatory systemic skin disease triggered by psychological, genetic and environmental factors. The effect of psoriasis on sexual health has not been fully elucidated. Coexistence of psychiatric disorders also affects negatively the life quality of psoriasis patients. This study investigates the relationship between the severity of the current illness, psychosocial health problems and coexisting metabolic syndrome on sexual health in male patients with psoriasis. Materials and methods: 52 male patients diagnosed with psoriasis and 50 healthy men included for the study. Patient groups Psoriasis Area Severity Index (PASI) and The Dermatology Life Quality Index (DLQI) were tested, subsequently International Index of Erectile Function (IIEF), Hamilton Rating Scale for Depression (HAM-D) tests and Metabolic syndrome (MetS) were reported for both groups. Eventually, the patient groups treaments were recorded. Results: IIEF, HAM-D scores and MetS were significantly different between the two groups (P = 0.017, P = 0.005, P = 0.009). IIEF score had a significant negative correlation with age, HAM-D and PASI scores (r = –0.405, –0.217 and –0.394, P = 0.028, 0.043 and 0.014). It is seen that the frequency and severity of ED increased with methotrexate treatment. Conclusion: It is showed that psoriasis has negative effects on male sexual health in this study. Our opinion of the reason is the natural course of the disease, its coexistence with diseases such as metabolic syndrome and depression, and the agents used in its treatment

Management of Priapism: Results of a Nationwide Survey and Comparison with International Guidelines

Objective: The aim of this study is to evaluate current urologic practice regarding the management of priapism in Turkey and compare with international guidelines. Methods: Urologists and urology residents were invited to an online survey consisting of 30 multiple-choice questions on priapism-related clinical practices that were considered most important and relevant to practices by using Google Forms. Results: Total number of responses was 340. Respondents reported that they recorded a detailed patient’s medical history and physical examination findings (n = 340, 100%) and laboratory testing, which includes corporal blood gas analysis (n = 323, 95%). Participants announced that they performed Doppler ultrasound for 1/4 cases (n = 106, 31%), but 22% of the participants (n = 75) replied that they performed in >75% of cases. Participants (n = 311, 91%) responded that the first-line treatment of ischemic priapism is decompression of the corpus cavernosum. Moreover, most respondents (n = 320, 94%) stated that sympathomimetic injection drugs should be applied as the second step. About three-quarters of respondents (n = 247, 73%) indicated adrenaline as their drug of choice. Phosphodiesterase type 5 inhibitors seems to be the most preferred drug for stuttering priapism (n = 141, 41%). Participants (n = 284, 84%) replied that corpora-glanular shunts should be preferred as the first. A large number of participants (n = 239, 70%) declared that magnetic resonance imaging can be performed in cases with delayed (>24 hours) priapism to diagnose corporal necrosis. Most of the participants (84%) responded that penile prosthesis should be preferred to shunts in cases with delayed (>48 hours) priapism. Conclusion: It would be appropriate to improve the training offered by professional associations and to give more training time to the management of priapism during residency

TÜRKIYE’DE YOĞUN BAKIM ÜNITELERINDE VENTILATÖR ILIŞKILI PNÖMONIYI ÖNLEMEK IÇIN ALINAN GÜNCEL ÖNLEMLER: TÜRK TORAKS DERNEĞI SOLUNUM YETMEZLIĞI VE YOĞUN BAKIM ÇALIŞMA GRUBU NOKTA PREVALANS ÇALIŞMASI

Objectives: The inadequate quality and nature of sleep is a commonly reported problem among hospitalized patients. The purpose of this study is to examine the effects of progressive muscle relaxation training program on sleep quality, sleep state, pain and life quality of patients who underwent pulmonary resection