Evening type negatively affects semen quality by deteriorating sperm morphology: Results from an infertility clinic.

OBJECTIVE: The effect of sleep-related variables on the reproductive system has garnered attention in recent years. One of the mediators that reportedly plays an important role in the relationship between sleep disorders and the reproductive system is a disruption of the circadian rhythm. The aim of curent study is to investigate the effect of chronotype on morning semen quality. STUDY DESIGN: Three-hundred and fourteen patients who applied to the infertility clinic were included in the study. The patients filled a socio-demographic data form. The "Pittsburg Sleep Quality Index (PSQI) was used to evaluate the sleep quality while the chronotypes of the patients were evaluated with the "Morningness -Eveningness-Questionnaire (MEQ)". Semen analyses and biochemical analysis for testosterone serum plasma level of all patients were performed. RESULTS: Twenty-one patients were assigned as evening, 187 patients were assigned as intermediate, and 106 were assigned as morning chronotype. No statistically significant difference was identified in the comparison of the mean MEQ scores between patients with low and normal sperm concentrations(p = 0.884). A correlation analysis indicated the presence of a significant positive correlation between normal morphology and MEQ scores (r = 0.13, p < 0.05) and a negative corelation between the hours spent in bed and sperm concentration (r = -0.13, p < 0.05). A general linear model created with independent variables suggested that the presence of varicocele and MEQ scores had a significant effect on normal morphology. CONCLUSION: The results of present study support that evening type could negatively affect sperm morphology; additionally, the time spent in bed also negatively affected sperm concentration.

Are there factors in the disease of peroneal necrotizing fasciitis which should be used when choosing the anesthetic technique?: Descriptive analysis of a cohort from two centers.

BACKGROUND: This study aims to examine the factors affecting the selection of anaesthesia method in Fournier's gangrene. METHODS: A retrospective evaluation was made of 113 patients operated on because of Fournier's gangrene between January-May 2019. The operations were performed under spinal anaesthesia in 78 cases (Group S) and under general anaesthesia in 35 cases (Group G). The patients were evaluated regarding age, gender, the anaesthesia method used (spinal, general) anaesthetic agent applied, presence of sepsis, and biochemical, hematological and inflammatory parameters. RESULTS: When the patients were evaluated regarding the Fournier Gangrene Severity Index (FGSI), patients in Group S had lower scores (p=0.001). Examination of the tomography images revealed that in 13 (37.1%) patients, air values were seen in the right or left gluteal area, or both, extending to the subcutaneous tissue. In the evaluation of the factors affecting the selection of general anaesthesia, a positive correlation was determined between an increase in FGSI (r=0.482, p=0.001) and the presence of sepsis (r=0.485, p=0.001) and gluteal region involvement (r=0.628, p<0.001). CONCLUSION: The selection of anaesthesia method in Fournier gangrene patients is a complex process affected by factors, such as the patients' general condition, sepsis, and whether or not there is bleeding diathesis. The risk -benefit balance in the selection of anaesthesia method should be evaluated individually for patients.

Evaluation of the effect of shift working and sleep quality on semen parameters in men attending infertility clinic.

We aimed to evaluate the effect of shift work on semen parameters together with the effect of sleep quality in men attending infertility clinic. The participants were divided into two groups as follows: 104 shift worker men (Group 1) and 116 nonshift worker men (Group 2). Groups were compared in terms of semen parameters, Depression Anxiety Stress Scale-21 (DASS-21), and Pittsburg Sleep Quality Index (PSQI) scores. A higher rate of oligozoospermia and poor sleep quality and a lower mean normal morphology percentage was observed in shift workers than nonshift workers (p = .006, .039 and .036 respectively). In addition, a positive correlation was seen between sleep duration and sperm concentration, while a negative correlation was found between sleep latency and total sperm count. Shift working together with high PSQI score was also a significant association with oligozoospermia when controlling for the other variables of age, total testosterone, DASS-21 stress score, smoking and varicocele (OR = 2.11, 95% CI 1.03-4.34 and OR = 1.18, 95% CI 1.01-1.39 respectively). In this study, infertile shift workers had a lower percentage of normal morphology and higher rates of oligozoospermia and poor sleep quality. Considering that shift workers have lower sleep quality, it seems that shift working negatively affects the circadian rhythm.

Pre-treatment Delta Neutrophil Index as a Predictive Factor in Renal Cell Carcinoma.

OBJECTIVE: To determine the diagnostic value of the pre-treatment delta neutrophil index (DNI) before treatment in patients with renal cell carcinoma (RCC) and to compare this marker with other routine inflammation markers, such as neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR). STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Urology, Kahramanmaras Sutcu Imam University, Turkey, from February 2017 to January 2020. METHODOLOGY: Data of patients who underwent radical nephrectomy for RCC, were evaluated. For comparison, healthy individuals were included in the study as a control group. Demographic data, such as age, gender, routine laboratory tests, DNI, NLR, and PLR levels of the groups were recorded and compared. RESULTS: There were 73 patients in the RCC group and 71 healthy individuals in the control group. DNI, NLR and PLR levels were significantly higher in the RCC group (p <0.001, each). DNI and NLR were significantly higher in patients with advanced stage (T3-T4) and high grade (G3-G4). In univariate logistic regression analysis hemoglobin (p=0.023), neutrophil (p<0.001), lymphocyte (p=0.009), platelet (p<0.001), DNI (p<0.001), NLR (p<0.001) and PLR (p<0.001) were identified as predictors for RCC. In multivariate logistic regression analysis, DNI and NLR (p<0.001, each) were found to be the predictors of RCC. Cut-off values were 0.45% for DNI, 1.80 for NLR, and 130.09 for PLR. CONCLUSION: DNI is a new inflammatory marker, which is included in complete blood count parameters; and does not require any additional calculation, unlike NLR and PLR. It can be used in the prediction of RCC. Key Words: Renal cell carcinoma, Delta neutrophil index, Neutrophil-lymphocyte ratio, Platelet-lymphocyte ratio.

At What Age Threshold does the Decline in Semen Parameters Begin?

OBJECTIVE:  To analyse changes in semen parameters according to different age groups in men presenting to an infertility clinic, and determine the age threshold for decline in semen quality. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Andrology Laboratory, Department of Urology, Kahramanmaras Sütçü Imam University, Turkey, from January 2018 to December 2019. METHODOLOGY: Semen analysis records of infertile men, who were referred to Andrology Laboratory, were retrospectively evaluated. The age groups were categorised as 20-29, 30-34, 35-39, 40-44, and 45-55 years. Each group was completed to 100 semen samples retrospectively and sequentially without any preferences. The differences of semen parameters between age groups were analysed with the one-way ANOVA test. Linear relationship was checked by ANOVA. RESULTS: The mean age of 500 patients was 37.18 ± 8.11 years. While no linear relationship was observed in semen volume, concentration, and total sperm count with age (p=0.133, p=0.290 and p=0.261, respectively). A linear decline was observed in progressive motility, vitality, and morphology parameters with advancing age (all, p<0.001). In linear contrast analysis according to the 20-29 age group; significant decline in progressive sperm motility, morphology, and vitality started and continued in the 35-39 age group (all, p<0.001). CONCLUSION: With advancing age, a significant linear decrease in sperm motility, morphology and vitality was observed in infertile men. This significant decline in sperm motility, morphology and vitality continues at age 35 and over. Therefore, infertile men who plan to postpone paternity should consider the age factor. Key Words: Aging, infertility, Paternal age, Semen analysis, Sperm.

The Delta Neutrophil Index is an Early Predictive Marker of Acute Pyelonephritis in Patients with Ureteral Stone.

OBJECTIVE: To determine the predictive value of the delta neutrophil index (DNI) for acute pyelonephritis (APN), which increases in conditions of infection and inflammation. STUDY DESIGN: Observational, comparative cross-sectional study. PLACE AND DURATION OF STUDY: Department of Urology, Kahramanmaras Sütçü Imam University, Turkey, from December 2014 to November 2019. METHODOLOGY: The data of 205 patients, diagnosed with ureteral stone and urinary tract infection (UTI), were evaluated. For comparison, patients were categorised into two groups: those with lower UTI (LUTI) and those with APN. Together with demographic data of patients and ureteral stone, DNI, C-reactive protein (CRP), white blood cell (WBC) and other biochemical parameters were analysed. RESULTS: There were 165 patients (80.5%) in the LUTI group and 40 patients (19.5%) in the APN group. In univariate analysis, age (p=0.023), creatinine (p=0.001), PT/INR (p=0.007), WBC (p <0.001), CRP (p=0.002) and DNI (p <0.001) were identified as predictors of APN. In multivariate analysis, CRP (p=0.019) and DNI (p=0.009) were significantly associated with the predictors of APN. Cut-off values were 11.75 mm3 for WBC, 22.2 mg/dL for CRP, and 1.3% for DNI. DNI value was positively correlated with WBC and CRP (r=0.369 vs. 0.740 and p <0.001, each). CONCLUSION: As an infection marker that can be monitored with a complete blood count and does not require additional costs, DNI can be used as an early predictor of APN. Patients with a DNI value of >1.3% should be considered for early intervention. Key Words: Ureteral stone, Acute pyelonephritis, Delta neutrophil index, C-reactive protein, White blood cell.

Infective complications in patients after transrectal ultrasound-guided prostate biopsy and the role of ciprofloxacin resistant Escherichia coli colonization in rectal flora.

OBJECTIVE: In the present study, we aimed to invastigate the ciprofloxacin resistance in rectal flora of the patients undergoing prostate biopsy in our department. Additionally, the possible effects of the presence of ciprofloxacin resistant bacteria in faecal flora on the risk of infective complications after the procedure as well as the effect of antibiotic prophylaxis on such infectious complications have been evaluated. MATERIAL AND METHODS: A total of 142 patients undergoing transrectal ultrasound-guided prostate biopsy were included into the study program. Rectal swab samples were taken from all patients prior to biopsy. The presence of complications have been evaluated after a week following the biopsy procedure. Patients with fever were also evaluated. The possible correlation between the presence of ciprofloxacin-resistant bacteria in faecal flora and the risk of urinary tract infection development and the other complications were evaluated. RESULTS: E. coli bacteria were present in all cultures of rectal swab samples obtained from 142 patients prior to prostate biopsy. Of all these patients, while ciprofloxacin-resistant E. coli (CR E. coli) grew in 76 (53.5%) patients; ciprofloxacin susceptible E. coli (CS E. coli) was obtained in 66 (46.5%) patients. In 16 patients (11.3%), infectious complications were observed. While the infective complications were present in the 14.5% of patients with CR E. coli; they were present in the 7.6% of patients with CS E. coli (p=0.295). High fever was observed in nine patients (6.3%). Of these nine patients, although six had CR E. coli growth as detected during culture sensitivity tests; three had CS E. coli growth in their rectal swab culture tests. Sepsis was observed in three (2.1%) of these patients with high fever. Ciprofloxacin-resistant E. coli grew in all of the rectal swab cultures obtained from these patients with sepsis. CONCLUSION: In the light of our findings we may say that, it will be appropriate to reconsider the ciprofloxacin prophylaxis and prefer to use other prophylactic agents for a certain period of time in populations with higher rates of resistance to this medical agent. Furthermore, it will be appropriate again to obtain rectal swab specimens for culture tests before biopsy procedure in order to perform targeted prophylaxis according to the culture antibiogram test results. This approach will enable us to evaluate the cost-effectiveness of the procedure in detail.

Ureteral wall thickness at the impacted ureteral stone site: a critical predictor for success rates after SWL.

The aim of the study was to determine the possible predictive value of certain patient- and stone-related factors on the stone-free rates and auxiliary procedures after extracorporeal shock wave lithotripsy in patients with impacted proximal ureteral calculi. A total of 111 patients (86 male, 25 females M/F: 3.44/1) with impacted proximal ureteral stones treated with shock wave lithotripsy were evaluated. Cases were retrieved from a departmental shock wave lithotripsy database. Variables analyzed included BMI of the case, diameter of proximal ureter and renal pelvis, stone size and Hounsfield unit, ureteral wall thickness at the impacted stone site. Stone-free status on follow-up imaging at 3 months was considered a successful outcome. All patients had a single impacted proximal ureteral stone. While the mean age of the cases was 46 ± 13 years (range 26-79 years), mean stone size was 8.95 mm (5.3-15.1 mm). Following shock wave lithotripsy although 87 patients (78.4%) were completely stone-free at 3-month follow-up visit, 24 (21.6%) cases had residual fragments requiring further repeat procedures. Prediction of the final outcome of SWL in patients with impacted proximal ureteral stones is a challenging issue and our data did clearly indicate a highly significant relationship between ureteral wall thickness and the success rates of shock wave lithotripsy particularly in cases requiring additional procedures. Of all the evaluated stone- and patient-related factors, only ureteral wall thickness at the impacted stone site independently predicted shock wave lithotripsy success.