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 < 0.001). Ischemic priapism ratio was detected statistically higher compared to other groups (p < 0.001). Aspiration and/or irrigation treatment were the most common method used for treatment at a statistically significant level (p < 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.

Impact of VieScope® on first-attempt success during simulated COVID-19 patients intubation: A randomized cross-over simulation trial.

BACKGROUND: The purpose of our study was to determine the efficacy of intubation with VieScope® and Macintosh laryngoscope in different scenarios of simulated COVID-19 patients by paramedics wearing personal protective equipment (PPE) for aerosol gener-ating procedures (AGPs). METHODS: Study was designed as a prospective, observational, randomized, crossover simulation trial. 37 paramedics took part in the study. They performed endotracheal intubation (ETI) of a person suspected of COVID-19. Intubation was performed using VieS-cope® and Macintosh laryngoscopes in two research scenarios: Scenario A - normal airway and Scenario B - difficult airway. Both the order of participants and the methods of intubation were random. RESULTS: In Scenario A, time to intubation using VieScope® and Macintosh laryngoscope amounted to 35.3 (IQR; 32-40) seconds and 35.8 (IQR: 30-40)s, respectively. Nearly all participants performed ETI successfully both with VieScope® and Macintosh laryngo-scope (100% vs. 94.6%). In scenario B, intubation with the VieScope®, compared to the Macintosh laryngoscope, was associated with a shorter intubation time (p<0.001), a higher success rate of the first intubation attempt (p<0.001), a better visualization degree glottis (p=0.012) and ease of intubation (p<0.001). CONCLUSION: Our analysis suggests that the use of a VieScope® compared to Macintosh laryngoscope in difficult airway intuba-tion performed by paramedics wearing PPE-AGP is associated with shorter intubation times, greater intubation efficiency as well as better visualization of the glottis. Additional clinical trials are necessary to confirm the obtained results.

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.

Histopathologic Evaluation of the Effects of Intraurethral Platelet Rich Plasma in Urethral Trauma Experimentally Induced in Rat Model.

OBJECTIVE: To determine the efficacy of platelet rich plasma applied early initialization after urethral trauma for preventing inflammation and spongiofibrosis. MATERIALS AND METHODS: Twenty-three rats were randomized and divided into 3 groups, with 10 rats in 2 groups. Only sham group had 3 rats. The urethras of all rats were traumatized with a pediatric urethrotome knife at 6- and 12-o'clock. For 15 days, group I was given platelet rich plasma (PRP) once a day without urethral injury (sham group), group II (n = 10) was not given any medical treatment only urethral injury group (UI-PRP), group III (n = 10) was given PRP once a day intraurethrally as instillation using a 22 ga catheter sheath with urethral injury (UI+PRP). On day 15, the penises of the rats were degloved to perform penectomy. RESULTS: A significant difference was detected in all parameters when the sham, UI-PRP, UI+PRP groups were compared (respectively, P = .001, / <.001, / .008 / .007) and a significant difference was observed among mucosal inflammation, fibrosis, and edema parameters when UI-PRP and UI+PRP groups were compared. (Respectively; P <.001, / <.001 / .006). CONCLUSION: In this study, it was shown that intraurethral PRP applied after urethral trauma significantly decreased mucosal inflammation, spongiofibrosis, and edema. Depending on the results we acquired in this study, we think that PRP may be a promising option in urethral stricture treatment.

Is there a Difference in Platelet-Rich Plasma Application Method and Frequency to Protect Against Urethral Stricture?

PURPOSE: To determine the efficacy of instillation frequency and submucosal injection of platelet-rich plasma (PRP) after urethral trauma to prevent urethral inflammation and spongiofibrosis. MATERIALS AND METHODS: Sixty-five rats were used in the study; 50 rats were randomized into 5 groups with 10 rats in each group and 15 rats were allocated for PRP preparation. The urethras of all rats were traumatized with a pediatric urethrotome knife at 6 and 12 o'clock positions, except in the sham group. Group 1 was the sham group and had only urethral catheterization daily for 15 days, Group 2 was given 0.9% saline (physiologic saline [(UI+PS]) once a day after urethral injury (UI+ PS), Group 3 was injected with PRP submucosally after urethral injury, Group 4 was given PRP once a day as intraurethral instillation using a 22 Ga catheter sheath with urethral injury, and Group 5 was given PRP twice a day as intraurethral instillation using a 22 Ga catheter sheath with urethral injury. Each administration of PRP was administered as 300 million platelets/150 microliters. On day 15, the penises of the rats were degloved to perform penectomy. Histopathologic evaluation was made for spongiofibrosis, inflammation, and congestion in vascular structures. RESULTS: When the sham group, UI+PS, UI+PRPx1, UI+PRPx2 and UI+PRPs groups are compared in total, there were significant differences identified for parameters other than edema. When the UI+PS, UI+PRPx1, UI+PRPx2 and UI+PRPs groups are compared, the UI+PS group was observed to have significantly more inflammation (mucosal inf. 2.42 ± 0.53) and spongiofibrosis (2.42 ± 0.53). All the PRP groups were identified to have significantly less mucosal inflammation (UI+PRPs 1 ± 0, UI + PRPx1; 1.4 ± 0.51, PRPx2; 1.33 ± 0.5) and spongiofibrosis (UI+PRPs; 1.57 ± 0.53, PRPx1; 1.2 ± 0.42, PRPx2; 1.55 ± 0.52). The group with the lowest spongiofibrosis was the PRPx1 group. CONCLUSION: This study showed that PRP significantly reduced mucosal inflammation and spongiofibrosis, independent of the administration route, when applied to the urethra after urethral trauma.

Evaluating Stable Chronic Obstructive Pulmonary Disease by Ultrasound.

BACKGROUND AND AIM: The purpose of the study was to evaluate the relationship between COPD severity and the diaphragmatic function measured by point-of-care US in patients with stable COPD. METHOD: A total of 61 patients with COPD and 40 healthy subjects who had been admitted to Ufuk University Hospital between December 2018 and May 2019 were enrolled. Point-of-care US was performed, and lung silhouette and anterior, right, and left hemidiaphragm method in M-mode were used to evaluate the diaphragm. RESULTS: The point-of-care US measurements, lung silhouette method right (Lung Sil R), lung silhouette method left (Lung Sil L), right hemidiaphragm US method in B-mode (Ant B-Mode R), and right hemidiaphragm US method in M-mode (Ant M-Mode R), were significantly different among groups (P < 0.001 for each). FEV1 was strongly correlated with Lung Sil R, Lung Sil L, Ant B-Mode R, and Ant M-Mode R (r = 0.963, P < 0.001; r = 0.956, P < 0.001; r = 0.953, P < 0.001; and r = 0.917, and P < 0.001, respectively). Negative correlations were detected between the number of exacerbations per year and Lung Sil R and the number of exacerbations per year and Ant M-Mode R (r = -0.599, P < 0.001 and r = -0.587, and P < 0.001, respectively). CONCLUSION: In this study, FEV1 and annual number of exacerbations turned out to be strongly correlated US findings. The use of US in COPD patients could help to support clinical decision, but further clinical studies are necessary to confirm those findings.

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

INTRODUCTION: 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.