Introduction: Human Immunodeficiency virus is a chronic infection that attacks the immune system of the human body, particularly CD4 T lymphocytes. Combined antiretroviral therapies are highly effective in virological suppression of human immunodeficiency virus infection. It has been shown that some retroviral therapies have a higher nephrotoxicity potential. As a result of renal injury, serum creatinine increases, and the estimated glomerular filtration rate is reduced. The aim of our study was to assess changes in kidney function during a 24-month period in HIV-positive patients who were begun on combined antiretroviral therapy. Material-method: A total of 127 HIV positive patients were enrolled. The patients were divided into five groups; patients who received no therapy were designated as Group 1; those that received Dolutegravir/Abacavir/Lamivudine combination as Group 2; those that received Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Fumarate combination as Group 3; those that received Emtricitabine/Tenofovir Disoproxil Fumarate/Dolutegravir combination as Group 4; and those that received Emtricitabine/Tenofovir Disoproxil Fumarate/Raltegravir combination as Group 5. We compared the effects of these drugs on estimated glomerular filtration rate during a 24-month follow-up period. Results: At the 24th month of therapy, a significant difference was observed between the eGFR levels of the study groups (p:<0.001). eGFR level was significantly higher in Group 4 compared to Groups 1, 2, and 3 (p:0.009, p:<0.001, p:<0.001, respectively) while it was significantly lower in Group 5 than groups 1, 2, and 3 (p:0.005, p:<0.001, p:<0.001, respectively). No significant eGFR difference was found between Group 4 and Group 5 (p>0.05). Serum creatinine level was significantly higher in Groups 4 and 5 compared to the other groups (p<0.001). Conclusion: The use of TDF-containing regimens causes renal dysfunction. Therefore, we recommend close monitoring of renal function, especially in patients treated with TDF.

Objective: We aimed to investigate the effects of hypotensive anesthesia on oxidative stress with serum thiol/disulfide balance in patients undergoing elective septoplasty procedures under general anesthesia. Methods: Seventy-two patients between the ages of 18-60, with a physical condition I –II, according to the American Society of Anesthesiologists, were included in this prospective observational study. Septoplasty was chosen for standard surgical stress. According to the maintenance of anesthesia, patients were divided into the groups as Hypotensive Anesthesia (n = 40) and Normotensive Anesthesia (n = 32). Serum thiol/disulfide levels were measured by the method developed by Erel & Neşelioğlu. Results: The native thiol and total thiol values of both groups measured at the 60th minute intraoperatively were significantly lower than the preoperative values (both p < 0.01). Intraoperatively, at the 60th minute, there was no significant difference in terms of post-native thiol and post-total thiol levels between hypotensive and normotensive anesthesia groups (p = 0.68, and p = 0.81, respectively). Age > 40 years and female gender were found to have a significant effect on dynamic oxidative stress (p = 0.002, and p = 0.001, respectively). Conclusion: This pilot study has found that hypotensive anesthesia had no adverse effect on dynamic thiol/disulfide balance in elective surgeries.

Object: Our aim is to evaluate the elevation of pancreatic enzymes in COVID-19 patients and their relationship with severity of COVID-19. Method: In this study, 1378 patients with COVID-19 infection were included. Relation of elevated amylase and lipase levels and co-morbid conditions with the severity of COVID-19 were checked. The effect of hemodynamic parameters and organ failures on pancreatic enzymes and their relations with prognosis were statistically analyzed. Results: There were 678 (%49,2) female patients and 700 (50,8%) male patients. Of all patients, 687 (49,9%) had mild, 691 (50,1%) severe COVID-19 infections. Elevated amylase levels were detected in 23% of patients (n:316). 19% (261) of them had a slight (1-3 times) increase in amylase levels, while 4% (55) had a more than 3 times increase in amylase than normal. Only 6% of patients with elevated amylase leves had the acute pancreatitis according to Atlanta criteria. According to univariate and multivariate analyses, elevated amylase levels was found statistically related with severity of COVID-19 (OR:4,37-p <0,001). And also diabetes mellitus (DM) (OR:1,82-p:0,001), kidney failure (OR:5,18- p< 0,001), liver damage (OR:6,63 p < 0,001), hypotension (OR:6,86-p< 0,001), sepsis (OR:6,20-p:0.008) were found to related to death of COVID-19. Conclusions: Elevated pancreatic enzyme levels in COVID-19 infections is to related to severity of COVID-19 infection and hemodynamic instability. Similar to other organs, the pancreas can be affected by severe COVID-19 infection.

Aims: The guidelines propose optical dilatation before retrograde intrarenal surgery (RIRS), but there are no evidence-based studies concerning the impact of optical dilatation with semirigid ureteroscopy (sURS) in the literature. The aim of this study was to evaluate the effect of optical dilatation through sURS prior to the procedure on the success and complications of RIRS. Methods: In a multicentre retrospective study, 422 patients were included in the study. The patients were divided into two groups according to whether sURS was to be performed. Patients’ demographics, stone parameters and operative outcomes were compared. Surgical success was defined as no or up to 3-mm residual stone fragments without the need for additional procedures. The independent predictors for surgical success were determined with a multivariable logistic regression model. Results: Of the 422 patients, 133 (31.5%) were in the sURS group and 289 (68.5%) were in the non-sURS group. Operation time in the sURS group was significantly long (p<0.0001). A ureteral access sheath (UAS) could not be placed in four (3.0%) patients in the sURS group, nor in 25 (8.7%) patients in the non-sURS group (p=0.03). Compared with the non-sURS group, the intraoperative complication rate was low in the sURS group (14 (4.8%) vs 1 (0.8%), p=0.04). The surgical success rate was higher in the sURS group (p=0.002). Nevertheless, sURS had no independent effect on surgical success. We have found two independent predictors for surgical success rate: stone number (p<0.0001, OR:2.28) and failed UAS placement (p=0.035, OR:3.49) Conclusion: Optical dilatation with sURS before RIRS increases surgical success by raising the rate of UAS placement and reducing the rate of intraoperative complications. We suggest that this method can be routinely applied in the group of patients who have not been passively dilated with a JJ stent

Background Some drugs used in the treatment of coronavirus disease 2019 (COVID-19) are likely to increase the risk of QT interval prolongation and related arrhythmias or death. Due to the low sensitivity of the reverse transcriptase-polymerase chain reaction (RT-PCR) test, chest computed tomography (CT) imaging is being used for COVID-19 diagnostic correlation and to evaluate whether there is pneumonic involvement in the lung. Objective In this study, we aimed to compare whether there was a difference in terms of QT interval prolongation and effect on heart rate in COVID-19 patients based on their chest CT findings and drug treatment regimes. Methods This was a single-center retrospective cohort study of non-intensive care unit (ICU) patients hospitalized . A total of 344 patients with a mean age of 46.34 ± 17.68 years were included in the study (56.1% men). Patients were divided into four groups according to their chest CT results as having typical, atypical, indeterminate, or no finding of pneumonic involvement. Mean QTc intervals and heart rates calculated from electrocardiograms at admission and after treatment were compared. Results There were no significant differences between groups with regards to age, gender, and body mass index (BMI). There were also no significant differences between the groups in terms of mean QTc interval values upon admission (p:0.127) or after treatment (p:0.205). Heart rate values were similar among the groups as well, with no significant differences in mean heart rate on admission (p:0.648) and post-treatment (p:0.229) ECGs. Conclusion This study has demonstrated finding of COVID-19 infection based on chest CT does not affect QT interval prolongation and bradycardia in non-ICU COVID-19 patients. There is a need for additional larger studies investigating the effect of chest CT findings on QT interval prolongation and bradycardia in COVID-19 patients.

Aims: The role of urodynamic studies in the diagnosis and prognosis of interstitial cystitis/bladder pain syndrome (IC/BPS) remains controversial. We evaluated the correlation of baseline voiding dysfunctions with long-term treatment outcome in a large cohort of patients with IC/BPS. Methods: We studied 211 patients with nonulcerative IC/BPS. All patients underwent video urodynamic examination at baseline to identify their voiding conditions and they received subsequent treatments. The primary endpoint was the global response assessment (GRA) at the current interview. Secondary endpoints included O’Leary-Sant score (OSS), Visual Analog Scale (VAS) for pain, and the rate of IC symptom flare-up. Results: Mean patient age was 56.8 ± 12.8 years and mean IC symptom duration was 16.0 ± 9.9 years. At baseline, 83 (39.3%) patients had a voiding problem and 62.7% had one to three comorbidities. The duration, comorbidity, treatments, changes in OSS and VAS, maximum bladder capacity (MBC), glomerulations, GRA, and flare-up rate were not significantly different among the different voiding subtypes. When we divided the patients by their voiding conditions of normal (n = 32) and hypersensitive bladder with (n = 76) and without (n = 103) voiding dysfunctions, only MBC (P = 0.002) and glomerulation (P = 0.021) demonstrated a significant difference. When we analyzed subgroups by GRA, patients with a GRA ≥ 2 had a significantly shorter disease duration. There also were significant associations between GRA and the changes in OSS and VAS (P < 0.001). Conclusions: Voiding dysfunctions in patients with non-Hunner IC/BPS do not affect long-term treatment outcome.

Introduction Inter-professional education (IPE) is becoming an integral part of many professional programmes throughout the UK, ensuring health professionals are competent to work as part of an inter-professional team upon entry into their profession. IPE has become a fundamental component of curriculum content in health and social care degrees. Aims Research aim - to evaluate a simulated IPE intervention. Methods A one day IPE intervention, ‘Evening On-Call’ was run involving nursing and medical students and pre-registration pharmacists (student pharmacists in year 5 of training) in an on-call setting. This IPE incorporated manikin and actor patients in a simulated ward. During the intervention, the 3 groups of students are assessed under observation on their clinical, prioritisation and communication skills. Participants perceptions of this intervention were evaluated by completion of a questionnaire to capture their perceptions regarding the experience, the pre-IPL briefing and post-IPL feedback and perceived relevance of this training. Free text sections collected additional comments and a follow-up questionnaire was sent six months later. Results Initial questionnaire feedback was predominantly positive for each professional group. The majority perceived the simulated IPL had given them a greater understanding of other professionals’ roles, had enhanced their professional confidence and would help them prioritise workload once qualified. The 6 months follow up questionnaire supported the initial questionnaire findings. Some responses highlighted participants believed the simulated IPL had helped them work more effectively with other healthcare professionals, communicate more effectively and better prioritise their workload. There may be some evidence of sustained self-reported effectiveness in teaching certain professional and clinical skills to participants using this type of simulated intervention.

Background: An emerging body of evidence has highlighted the protective role of spirulina in human health. Thus, we conducted a randomized controlled trial to discern the effects of spirulina supplementation on anthropometric indices, blood pressure, sleep quality, mood, fatigue status, and quality of life among ulcerative colitis patients. Methods: Eighty participants with ulcerative colitis were randomly allocated to receive, either, 1 g/day (two 500 mg capsules) spirulina (n=40) or placebo (n=40), in a clinical trial for eight weeks. Dietary intake, physical activity, sleep quality, mental health, fatigue status, and quality, were assessed for each participant at baseline and trial cessation. Anthropometric indices and blood pressure were also assessed. Results: Seventy-three participants completed the intervention. Our results revealed that spirulina supplementation significantly reduced sleep disturbances (p=0.03), while no significant changes occurred in the sleep quality score or other sleep parameters, vs. the placebo group (p> 0.05). Furthermore, a significant reduction in stress score (p=0.04) and increase in quality of life (p=0.03) was detected, but not anxiety, depression, or fatigue scores (p> 0.05). Additionally, anthropometric indices and blood pressure did not significantly change (p> 0.05). Conclusion: An improved quality of life was observed among ulcerative colitis patients following spirulina supplementation, which could be attributed to improved sleep disturbance and stress status. Further clinical studies, with longer duration interventions and suitably powered sample sizes, are necessary to p elucidate the veracity of our findings.

Abstract Introduction The COVID-19 pandemic has resulted in a significant burden on healthcare systems causing disruption to medical and surgical training of doctors globally. Aims and objectives This is the first international survey assessing the perceived impact of the COVID-19 pandemic on training of doctors of all grades and specialties. Methods An online global survey was disseminated using Survey Monkey® between 4th August 2020 and 17th November 2020. A global network of collaborators facilitated participant recruitment. Data was collated anonymously with informed consent and analysed using univariate and adjusted multivariable analysis. Results 743 doctors of median age 27 (IQR: 25-30) were included with the majority (56.8%, n=422) being male. Two-thirds of doctors were in a training post (66.5%, n=494), 52.9% (n=393) in a surgical specialty and 53.0% (n= 394) in low- and middle-income countries. 69.2% (n=514) reported an overall perceived negative impact of the COVID-19 pandemic on their training. A significant decline was noted among non-virtual teaching methods such as face-to-face lectures, tutorials, ward-based teaching, theatre sessions, conferences, simulation sessions and morbidity and mortality meetings (p≤0.05). Doctors from low or middle-income countries were associated with perceived inadequate supervision while performing invasive procedures under general, local or regional anaesthetic. (p≤0.05) Conclusion In addition to the detrimental impact of the COVID-19 pandemic on healthcare infrastructure, there has been an indirect consequence of disrupted training within medical and surgical subspecialties. A focus on reconfiguration of training programs through a variety of additional resources will become imperative to reduce the long-term sequalae of COVID-19 on doctors’ training.

Background - Since SARS-CoV-2 spread, evidences regarding sex differences in progression and prognosis of COVID-19 have emerged. Besides this, studies on patients’ clinical characteristics have described electrolyte imbalances as one of the recurrent features of COVID-19. Methods - We performed a case-control study on all patients admitted to the emergency department (ED) from 1st March to 31st May 2020 who had undergone a blood gas analysis and a nasopharyngeal swab test for SARS-CoV-2 by rtPCR. We defined positive patients as cases and negatives as controls. The study was approved by the local ethics committee Area 3 Milan. Data were automatically extracted from the hospital laboratory SQL-based repository in anonymized form. We considered as outcomes potassium (K+), sodium (Na+), chlorine (Cl-) and calcium (Ca++) as continuous and as categorical variables, in their relation with age, sex and SARS-CoV-2 infection status. Results - We observed a higher prevalence of hypokalemia among patients positive for SARS-CoV-2 (13.7% vs 6% of negative subjects). Positive patients had a higher probability to be admitted to the ED with hypokalemia (OR 2.75, 95% CI 1.8-4.1 p<0.0001) and women were twice as likely to be affected than men (OR 2.43, 95% CI 1.67-3.54 p<0.001). Odds ratios for positive patients to manifest with an alteration in serum Na+ was (OR 1.6, 95% CI 1.17-2.35 p<0.001) and serum chlorine (OR 1.6, 95% CI 1.03-2.69 p<0.001). Notably, OR for positive patients to be hypocalcemic was 7.2 (95% IC 4.8-10.6 p<0.0001) with a low probability for women to be hypocalcemic (OR 0.63, 95% IC 0.4-0.8 p=0.005). Conclusions - SARS-CoV-2 infection is associated with a higher prevalence of hypokalemia, hypocalcemia, hypochloremia and sodium alterations. Hypokalemia is more frequent among women and hypocalcemia among men.

The novel coronavirus disease-2019 (COVID-19) illness and deaths, caused by the severe acute respiratory syndrome coronavirus-2, continue to increase. Multiple reports highlight the thromboembolic complications, such as pulmonary embolism (PE), in COVID-19. Imaging plays an essential role in the diagnosis and management of COVID-19 patients with PE. There continues to be a rapid evolution of knowledge related to COVID-19 associated PE. This review summarizes the current understanding of prevalence, pathophysiology, role of diagnostic imaging modalities, and management, including catheter-directed therapy for COVID-19 associated PE. It also describes infection control considerations for the radiology department while providing care for patients with COVID-19 associated PE.

Background: Cardiac arrests (CA) are a leading global cause of mortality. The American Heart Association (AHA) promotes several important strategies associated with improved cardiac arrest outcomes, including decreasing pulse check time and maintaining a chest compression fraction (CCF) > 0.80. Video review is a potential tool to improve skills and analyze deficiencies in various situations, however its use in improving medical resuscitation remains poorly studied in the emergency department (ED). We implemented a quality improvement initiative, which utilized video review of cardiac arrest resuscitations in an effort to improve compliance with such AHA quality metrics. Methods: A cardiopulmonary resuscitation Video Review Team (CoVeRT) of emergency medicine residents were assembled to analyze CA resuscitations in our urban academic ED. Videos were reviewed by two residents, one of whom was a senior resident (PGY-3 or -4), and analyzed for numerous quality improvement metrics, including pulse check time, CCF, time to intravenous access, and time to patient attached to monitor. Results: We collected data on 94 cardiac arrest resuscitations between July 2017 and June 2020. Average pulse check time was 13.09 (SD ±5.97) seconds, and 38% of pulse checks were less than 10 seconds. After the implementation of the video review process, there was a significant decrease in average pulse check time (p=0.01) and a significant increase in CCF (p=0.01) throughout the study period. Conclusions: Our study suggests that the video review and feedback process was significantly associated with improvements in AHA quality metrics for resuscitation in CA among patients presented to the ED.

Background and objectives Breast cancer is one of the most common malignant tumors in women. Herein, we compared the analgesic efficacy of ultrasound-guided rhomboid intercostal nerve block , erector spinae plane block and serratus plane block after modified radical mastectomy of unilateral breast cancer. Methods: A total of 90 patients who underwent modified radical mastectomy for unilateral breast cancer were selected. patients were randomly allocated into three groups receiving ultrasound-guided serratus plane block, erector spinae plane block, and the rhomboid intercostal block group. All groups received 20 mL 0.5% ropivacaine. Within 24 hours after operation, the patient received intravenous injection of tramadol 1-2 mg/kg to relieve pain in the surgical ward. Results: The dosage of tramadol 24-hours postoperatively in the rhomboid intercostal block and erector spinae plane block groups was significantly lower than that in serratus plane block group (P < 0.001). There was no statistical difference in tramadol consumption between the erector spinae plane block and rhomboid intercostal block groups within 24 hours (P = 0.676). The numerical rating scale scores in the erector spinae plane block and rhomboid intercostal block groups at 0.5, 1, 3, 6, 12, 18, and 24 hours postoperatively once patients were active were significantly lower than in the serratus plane block group (P < 0.05 for all comparisons); however, The numerical rating scale scores between rhomboid intercostal block and erector spinae plane block groups did not differ significatively within 24 hours after surgery when patients were active. Conclusions: Ultrasound-guided rhomboid intercostal block and erector spinae plane block can reduce the dosage of tramadol and NRS score compared with serratus plane block after modified radical mastectomy.

The Short Synacthen Test is the way that we most often determine whether people's adrenal glands are working. We here have shown that an extra blood sample taken at 60 minutes post Synacthen vs a 30 minute sample alone, may make the test more effective at excluding those people who do not need to go on hydrocortisone supplementation or need further evaluation.

Abstract Objective: To demonstrate evidence from available clinical studies to clarify the scientific points that have been achieved in relation to thyroid disorders and ejaculatory dysfunction. Data sources: Clinical trial articles published in English on Medline. Eligibility criteria: Clinical studies that investigated the association of thyroid disorders with the ejaculatory function of subjects and the trials evaluating the effect of thyroid dysfunction treatment on the ejaculatory function of the subjects were eligible. Synthesis methods: We searched Medline with “ejaculation” and different combinations of “thyroid,” “serum TSH,” “serum T3,” “serum T4” keywords in PubMed. Results: Standardized mean serum thyroid-stimulating hormone (TSH) levels in premature ejaculation (PE) sufferers differed from non-PE control subjects (p=.05). Hyperthyroidism was associated with increased odds among PE subjects (OR=2.0, p=.03). Delayed ejaculation was seen with increased odds in hypothyroid patients compared with hyperthyroidism patients (OR=57, p=.0001). Serum TSH and mean intra-vaginal ejaculation latency time (IELT) of the subjects showed a correlation both before and after treatment for thyroid disorder. Treatment of thyroid disorders improved the mean IELT measures of the subjects. The overall estimate of the effect of hyperthyroidism treatment on mean IELT was .64 (p=.0001) in the random-effects model. Limitations: The low quality and quantity of evidence from available studies limited the interpretation of our study findings. Conclusions: The causal relationship between ejaculatory dysfunction and thyroid disorders remains to be clarified. Sufferers of delayed ejaculation acquired PE subjects, and PE sufferers who have accompanying erectile dysfunction and/or anxiety may benefit from thyroid disorder investigation.

During the COVID-19 pandemic, many specialists doctors found themselves in a situation that they had not faced for a long time: treating patients out of their subarea of expertise. The possibilities of teaching and learning through the modalities of webinars brought to these days the urgent necessity for teamwork and interdisciplinary approach, taking advantage of different areas of expertise to the same patient. With the amount of papers published and the speed at which data are accessed, and analyzed it is impossible to be aware of new findings in all medical areas. The lesson that the COVID-19 pandemic brought to us was the urgent need for the interdisciplinary approach to treating better our patients, and not only each disease they present with. We must review our traditional approach to medical students, residents, colleagues, and patients in which we became stuck to distance and time obstacles. We must use the technology on our behalf to offer the best treatment and follow-up for patients. We live now in the Medicine 4.0 era. As Darwin a long time ago proved: we must evolve!

Aim: To undertake a prospective study of the efficacy of two models (LACE and BOOST) in predicting unplanned hospital readmission. Methods: Data were collected from a single centre prospectively over a continuous 30-day period on all patients over 75 years old admitted to the acute medical unit. The primary outcome was the area under the curve for both models. Results: Area under the curve were calculated for both tools with BOOST score 0.667 (95% CI: 0.559-0.775, p=0.005) and C-statistic for LACE index 0.685 (95% CI: 0.579-0.792, p=0.002). Conclusion: In this prospective study, both the BOOST and LACE scores were found to be significant predictive models of hospital readmission. Recent hospitalisation was found to be the most significant contributing factor. Key Words: Elderly, prediction, readmission

Introduction: Most patients with COVID-19 have mild or moderate manifestations, however, there is a wide spectrum of clinical presentations and even more severe repercussions that require high diagnostic suspicion. Vital sign acquisition and monitoring are crucial for detecting and responding to patients with COVID-19. Objective: Thus, we conducted this study to demonstrate the impact of using a tool called Smart Check on the triage time of patients with suspected COVID-19 and to identify the main initial clinical manifestations in these cases. Methodology: We assessed triage times before and after the use of Smart Check in 11,466 patients. In this group, we identified 211 patients for the identification of COVID-19 clinical manifestations in a case-control analysis. Results: Smart Check was able to decrease the triage time by 33 seconds on average, with 75% of the exams being performed within 5 minutes, whereas with the usual protocol these steps were performed within 6 minutes. A range of clinical presentations made up the COVID-19 initial manifestations. Those with the highest frequency were dry cough (46.8%), fever (41.3%), dyspnea (35.8%), and headache (32.1%). Loss of appetite, fever, and ageusia were the manifestations that had a statistically significant association with the SARS-CoV-2 presence. Conclusions: Smart Check, a simple clinical evaluation tool, along with the targeted use of rapid PCR testing, can optimize triage time for patients with and without COVID-19. In triage centers, a number of initial signs and symptoms should be cause for SARS-CoV-2 infection suspicion, in particular the association of respiratory, neurological, and gastrointestinal manifestations. Keywords: new coronavirus, COVID-19, triage, clinical manifestations