Physicians' irrational attitudes on the antibiotic prescribing for the treatment of COVID-19 in Turkey: A multicenter survey.

BACKGROUND: The inappropriate and excessive use of antibiotics during the coronavirus pandemic has become an important issue. OBJECTIVE: Our primary aim is to ascertain the attitudes of physicians toward the antibiotics prescribing for the treatment of COVID-19 in Turkey. Our secondary aim was to identify factors affecting to physicians' decisions regarding antibiotic therapy for the treatment of COVID-19 and risk factors associated with antibiotic overprescribing. METHODS: It was a multicenter cross-sectional survey. Physicians from 63 different cities were invited to survey through social media (Facebook, Instagram, WhatsApp). Data were collected from respondents through an online questionnaires during November-December 2021. RESULTS: The survey was completed by 571 participants from 63 cities. Pulmonologists comprised the majority (35.20%), followed by internal medical specialists (27.85%) and general practitioners (23.29%). The rates of participants who started empirical antibiotics in the outpatient, ward, and ICU (intensive care unit) were 70.2%, 85.5%, and 74.6%, respectively. When the practice of prescribing antibiotics by physicians for the treatment of COVID-19 in outpatients was compared according to the healthcare setting (primary, secondary, tertiary care hospitals) no significant difference was found. Sputum purulence (68.2%) was recognized as the most important factor for the decision of antibiotic therapy, followed by procalcitonin levels (64.9%) and abnormal radiological findings (50.3%). The most prescribed antibiotics were respiratory quinolones. (48%, 65.9%, 62.7% outpatient, ward, ICU respectively) CONCLUSIONS: In this study, we found that physicians frequently had irrational attitudes toward antibiotic prescription to COVID-19 patients, including those with minor diseases. Our findings underline that the necessity of particular, workable interventions to guarantee the prudent use of antibiotics in COVID-19.

Management of circumscribed choroidal hemangioma at a tertiary care center.

PURPOSE: To review long-term outcomes of circumscribed choroidal hemangioma (CCH). METHODS: Hospital charts of all CCH cases diagnosed from 2008 to 2019 were retrospectively reviewed. RESULTS: All 172 patients were managed with either observation, transpupillary thermotherapy, argon laser photocoagulation, photodynamic therapy, plaque brachytherapy or stereotactic radiosurgery. The most common 3 modes of management were clinical observation (30.2%), transpupillary thermotherapy (52.9%) and argon laser photocoagulation (8.7%). Median follow-up time was 10 months (range: 3, 160). Anatomical outcomes were stable in 87.1% of observation group and improved in 60.5% of thermotherapy group. Quantified optical coherence tomography angiography findings showed statistical differences in vascular and perfusion densities in fellow eyes of hemangioma patients. CONCLUSION: Circumscribed choroidal hemangioma can be treated in various ways. Transpupillary thermotherapy is an anatomically effective treatment in selected cases. The diagnosis of CCH may have vascular implications in fellow eyes of the patients.

Adaptation of the scale of effects of social media on eating behavior in Hungarian university students.

Background: People live in a technological world, where social media is used very commonly. Social media has effects on eating behaviors, as in other aspects. For this reason, it is important to measure social media effect. Objective: This study aimed to adapt the Scale of Effects of Social Media on Eating Behaviour (SESMEB) that examines the effect of social media on eating behavior in Hungarian university students. Material and methods: The SESMEB was translated into the target language by taking various stages. The online questionnaire including general information, social media use, and the eighteen-item SESMEB was used to collect data. The scale was administered to the study group consisting of 213 Hungarian university students, and data from 203 of them were analyzed. Confirmatory factor analyses were performed to test construct validity, and the Cronbach alpha coefficient was calculated for the reliability of the scale in Hungarian. Results: Total correlation value was higher than 0.50 for all items of the scale. The fit indices were at an acceptable level or had a perfect fit. The t-values were significant at the level of 0.1 and ranged between 2.927 and 5.706. The Spearman-Brown coefficient was calculated at 0.894. The reliability coefficient of the scale was calculated to be 0.866. SESMEB scores were different according to spending time daily, sharing content, and using filters or Photoshop on social media (p < 0.05). Conclusions: Higher than 0.80 Cronbach's alpha coefficient and other results show that Hungarian SESMEB is a valid and reliable tool. Therefore, Hungarian SESMEB will be useful for further studies to determine the impact of social media on eating behaviors.

Impact of Isthmocele on Assisted Reproductive Treatment Outcomes: An Age-matched Retrospective Study.

STUDY OBJECTIVE: To evaluate whether the presence of an ultrasonographic visible isthmocele has an impact on the chance of pregnancy in women undergoing embryo transfer. DESIGN: Age-matched retrospective study. SETTING: Private-assisted reproductive center. PATIENTS: The study included a total of 150 patients with a history of cesarean delivery with 75 isthmocele cases and 75 controls. All patients underwent embryo transfer from January 2017 through June 2018. The diagnosis of isthmocele was based on transvaginal ultrasound assessment. Isthmocele was defined as an anechoic indentation on the previous cesarean scar at the midsagittal plane, with a depth of >1 mm. INTERVENTIONS: Embryo transfer. MEASUREMENTS AND MAIN RESULTS: The groups were similar in patient and treatment characteristics. The live birth rate was 44% in the isthmocele group and 46.7% in the control group (odds ratio [OR] 0.89; 95% confidence interval [CI], 0.47-1.71; p = .743). The clinical pregnancy rates were 49.3% and 50.7%, respectively (OR, 0.94; 95% CI, 0.50-1.79; p = .870). The miscarriage rate was greater in the isthmocele group (8%) than in the control group (4%); however, it did not reach statistical significance (OR, 2.09; 95% CI, 0.50-8.67; p = .302). The multiple pregnancy rate was similar between the groups (8% vs 5.3%, respectively; OR, 1.54; 95% CI, 0.41-5.70; p = .513). The groups were also similar in ectopic pregnancy rates (p = .560). These outcomes remained similar when adjusted for potential confounders on the regression analysis. CONCLUSION: Isthmocele does not seem to have a significant impact on the chance of pregnancy in assisted reproductive treatment settings. However, the embryo transfer procedure may be more difficult in the presence of an isthmocele.

Development of the scale of effects of social media on eating behaviour: a study of validity and reliability.

OBJECTIVES: The aim of the current study is to develop a valid and reliable instrument with psychometric qualities to measure effect of social media usage on eating behaviour in university students. DESIGN: A thirty-eight-item draft scale developed by the researchers. After content validity, twenty-two items are remained and was used to collect the data. In the analysis of the data, confirmatory factor analyses were performed to test construct validity. For the reliability of the scale, Cronbach alpha coefficient was calculated for the whole of the scale. SETTING: The participants attended from various departments of different universities in Ankara. PARTICIPANTS: The scale was administered to the study group consisting of 247 university students. RESULTS: Four items that had total correlation value less than 0·40 were removed from scale. The reliability coefficient of the whole eighteen-item scale was found to be 0·928. CONCLUSIONS: It has been shown that the scale developed as a result of the validity and reliability analyses performed for the scale is a valid and reliable measurement tool and can be used in studies.

A Rare Cause of Dysphagia: Giant Lipoma in Parapharyngeal Space.

BACKGROUND: Parapharyngeal area is one of the most complex areas of head and neck anatomy. Tumors of the parapharyngeal region are very rare among head and neck tumors. Lipomas also constitute a tiny proportion of parapharyngeal tumors so parapharyngeal area lipomas are very rare in the literature. Due to anatomical location, these tumors treatment is challenging. CLINICAL REPORT: A 20-year-old male patient admitted to our department with complaints of swallowing difficulty and a mass on the right side of the neck. Magnetic resonance imaging was performed, and it was reported as a 6 × 4.5 cm lipoma. He underwent excision of parapharyngeal area lipoma by a transoral approach. CONCLUSION: Parapharyngeal lipomas are very rare, and difficult to diagnose before they turn out symptomatic. The primary treatment approach in tumors of the parapharyngeal area is surgery and the surgical approach should be chosen according to the anatomical location of the lesion.

Assessment of total sialic acid levels in patients with hyperemesis gravidarum: a preliminary study.

To determine the levels of serum total sialic acid (TSA) in patients with hyperemesis gravidarum (HG) and their gestational age-matched controls. Thirty pregnant women with HG, and 30 healthy pregnant women at up to 14 weeks of gestation were enrolled in this preliminary study. Total sialic acid levels in maternal serum were measured using the quantitative sandwich ELISA method. We observed statistically significant difference in TSA levels between HG and the control groups (p = .003). The identification of the role of SA in the prediction, diagnosis and follow-up of HG warrants more comprehensive studies in the future. Impact Statement What is already known on this subject? The derivatives of neuraminic acid are collectively referred to as sialic acid (SA). Changes in SA levels are known to trigger various conditions and disorders, including inflammatory, cardiovascular, neurological and endocrine diseases. Although a sensitive test capable of identifying hyperemesis gravidarum (HG) would be useful for diagnosis purposes, such a test is currently not available. Studies focussing on identifying new potential indicators and biomarkers for HG - as well as identifying their relevance in establishing diagnosis and assessing disease severity - would not only assist in elucidating the underlying causes of this condition but would also contribute to the development of new diagnostic tests for HG. What the results of this study add? Total sialic acid levels are significantly higher in sera of the patients with HG. The present study is the first in the literature to assess total sialic acid levels in patients with HG and healthy pregnant women before 14 weeks of gestation. What the implications are of these findings for clinical practice and/or further research? Total sialic acid levels could give an idea to clinicians in the etiopathogenesis of HG. The identification of the role of sialic acid in the prediction, diagnosis and follow-up of HG warrants more comprehensive studies in the future.

Assessment of oxidative stress markers in recurrent pregnancy loss: a prospective study.

OBJECTIVE: To determine the levels of oxidative stress markers in recurrent pregnancy loss using a novel automated method. MATERIALS AND METHODS: 30 pregnant women in their first trimester with a history of recurrent pregnancy loss (RPL) and 30 healthy pregnant women were enrolled in this prospective controlled study. Total antioxidant capacity (TAC), total oxidant level (TOL) and oxidative stress index (OSI) in maternal serum were measured using the more recently designated Erel method. RESULTS: We observed statistically significant increased TOL and OSI levels in patient group (p = 0.032, p = 0.007, respectively). We also demonstrated statistically significant decreased TAC in pregnant women who had a history of RPL (p = 0.013). CONCLUSION: Our results support the concept that oxidative stress plays a central role in the etiopathogenesis of RPL. Further studies to evaluate the predictive role of TAC, TOL, OSI levels using Erel method are needed.

The characteristics of e-scooter accidents reported by police in Türkiye.

OBJECTIVES: Shared e-scooter service has been offered by various operators in Türkiye since 2019. The use of private and shared e-scooters is increasing, especially in large cities. This raises social concerns about the dangers e-scooters pose regarding traffic safety and injuries requiring medical attention. This study aims to investigate the accidents related to e-scooters in Türkiye to determine the contributing factors and accident characteristics. METHODS: In this study, accident reports (collision reports) for 780 e-scooter collisions that occurred in 2021 in Türkiye were examined, and 771 accidents were included. Accident data were obtained from the Traffic Department of the Ministry of Interior, General Directorate of Security. Descriptive statistics of the factors affecting e-scooter accidents are presented to determine the relationship and differences; chi-square tests, independent samples t-tests, one-way analysis of variance, and binary logistic regression methods were used. RESULTS: Male e-scooter riders are involved in crashes and injured approximately 4 times more often than female riders. The average age for men injured in e-scooter accidents is 30.4, and the mean age for women is 27.2. For both males and females, most injuries occurred in the 15 to 20 age group. Riders under the age of 18 constitute a significant proportion of the accidents (32.5%). Most e-scooter accidents occur on Mondays and during the month of August. Most accidents occurred between 12:00 p.m. and 1:59 p.m. (15.7%) and between 4:00 p.m. and 5:59 p.m. (15.7%), mainly during the daytime. About half of the accidents occurred at intersections. In 10.5% of accidents, the accident occurred at a pedestrian crossing. Approximately one-fifth of the accidents involved falls, and the most common type of collision was a side collision (44.2%). The binary logistic regression model showed that multivehicle accidents occur more often at intersections and during busy traffic hours. Single-vehicle accidents are more common on concrete roads and stone block roads. CONCLUSIONS: Deaths and injuries caused by road traffic accidents are a public health problem in Türkiye and constitute a significant health burden. If necessary precautions are not taken, this burden is likely to increase. We hope that the findings from this study will help reduce e-scooter accidents in Türkiye.

The Effect of Nitroglycerin Treatment Initiation Time on Survival in Partial Flap Necrosis: An Experimental Study.

Background: Nitroglycerin is suggested to improve flap survival based on promising results; however, there are no data on the effectiveness of treatment initiation time. This study aimed to compare the effect of various nitroglycerin treatment initiation times on partial flap survival. Materials and Methods: The study included 50 Sprague-Dawley rats. Modified McFarlane flaps were elevated on the dorsum of each rat. Group A received placebo treatment. Groups B, C, D, and E received topical nitroglycerin 2% starting 1 day before surgery, on the day of surgery, postoperative d 2, and postoperative d 4, respectively. After 7 days, the flap survival rates were calculated. Afterward, the severity and extent of inflammation and ischemia, and the severity of edema were evaluated histologically. Results: The flap survival rate was highest in group B, followed by groups C, D, E, and A. The difference between groups B and C was not significant, whereas the difference between group B and groups A, D, and E was. In addition, the difference between groups A, D, and E was not significant. Histological analysis showed that inflammation was less severe in groups B and C than in groups A, D, and E. Ischemia was the most severe in groups A and D and was the least severe in group C. Conclusion: Topical nitroglycerin treatment increases flap survival when initiated before or on the day of surgery, but has no benefit when initiated on postsurgery d 2 or 4. Preoperative initiation of nitroglycerin treatment positively affects flap survival.

Contexte: L'utilisation de la nitroglycérine a été proposée pour améliorer la survie d'un lambeau à partir de résultats prometteurs. Il n'y a cependant aucune donnée sur l'efficacité du délai d'instauration du traitement. Cette étude a visé à comparer l'effet de différents moments d'instauration du traitement avec la nitroglycérine sur la survie d'un lambeau partiel. Matériels et méthodes: L'étude a inclus 50 rats Sprague-Dawley. Des lambeaux modifiés de McFarlane ont été surélevés sur le dos de chaque rat. Le groupe A a reçu un placebo, tandis que les groupes B, C, D et E ont reçu de la nitroglycérine topique à 2% en commençant, respectivement, la veille de la chirurgie, le jour de la chirurgie, 2 jours et 4 jours postopératoires. Les taux de survie du volet ont été calculés après 7 jours. Ensuite, la sévérité et l'étendue de l'inflammation et de l'ischémie ainsi que la sévérité de l'œdème ont été évaluées histologiquement. Résultats: Le taux de survie des volets a été le plus élevé dans le groupe B, suivi des groupes C, D, E et A. La différence entre les groupes B et C n'était pas significative, tandis que la différence entre le groupe B et les groupes A, D et E l'était. En outre, la différence entre les groupes A, et E n'était pas significative. L'analyse histologique a montré que l'inflammation était moins sévère dans les groupes B et C que dans les groupes A, D et E. L'ischémie a été la plus importante dans les groupes A et D et la moins importante dans le groupe C. Conclusion: Le traitement topique avec la nitroglycérine augmente la survie d'un lambeau quand il est commencé le jour de la chirurgie ou avant, mais il n'apporte pas d'avantage s'il est instauré au 2e ou au 4e jour postopératoire. L'instauration d'un traitement par la nitroglycérine en préopératoire a un effet positif sur la survie des lambeaux.

The role of lung ultrasound and ultrasound elastography in diagnosis of interstitial lung diseases.

Introduction: Ultrasound elastography (US-E) is a novel, tissue stiffness-sensitive imaging method. We aimed to investigate whether lung ultrasound (US) and US-E can play a role in diagnosing interstitial lung diseases (ILDs) in which lung elasticity is affected due to fibrosis. Materials and Methods: A prospective cohort study. Patients with ILD were defined as ''ILD group'' and with other pulmonary diseases as ''control group". All subjects were examined and compared by lung US in B and elastography modes. Besides, the relationship between ultrasonography and high-resolution computerized tomography (HRCT) and chest X-ray findings was evaluated. Result: A total of 109 patients, 55 in ILD and 54 in the control group, with a mean age of 62 ± 14 years, were included. A positive correlation was found between the Warrick score (calculated from HRCT to determine the severity of ILD) and the number of B-lines (discrete vertical reverberation artifacts, indicating interstitial lung syndrome) in lung US (p= 0.001, r= 0.550) in the ILD group. In US-E, blue color (meaning more rigid tissue) dominated in the ILD group, and green color (indicating medium tissue stiffness) dominated in the control group (p= 0.001). Lung US diagnosed the ILD with 69% accuracy, 80% sensitivity, and 60% specificity compared to HRCT. Combined with chest X-ray, diagnostic accuracy was 74%, sensitivity 60%, and specificity 89%. Conclusions: Although lung US and US-E are not superior to gold standard HRCT in diagnosing ILDs, they can still be accepted as promising, novel, noninvasive tools, especially when combined with chest X-rays. Their role still needs to be clarified with further studies.

Relative Cortical Atrophy Index as a Strong Predictor of Recurrence After Surgery for Chronic Subdural Hematoma.

BACKGROUND AND OBJECTIVES: Chronic subdural hematoma (CSDH) presents significant management challenges in neurosurgical practice, with recurrence being a notable postoperative consideration. This study aimed to evaluate the Relative Cortical Atrophy (RCA) Index as a predictor of recurrence after CSDH surgery. METHODS: A retrospective analysis was conducted on 98 patients who underwent surgical evacuation for unilateral CSDH. The RCA Index was calculated using pre- and postoperative cranial imaging, correlating it with patient demographics, hematoma characteristics, and recurrence. Inter-rater reliability among measurements by 4 independent physicians was assessed using the intraclass correlation coefficient (ICC). Correlation and regression analyses were performed to identify the correlation of the RCA Index with other factors and their potential predicting power of CSDH recurrence, respectively. RESULTS: The study population had a mean age of 74.1 (11.9) years, with a 23.5% (23 patients) recurrence rate of CSDH. The ICC analysis showed excellent inter-rater reliability for RCA Index measurements (ICC: 0.998, 95% CI: 0.997-0.998, P < .001). A higher preoperative RCA Index was significantly associated with recurrence (0.215 [0.031] in the recurrent group vs 0.125 [0.034] in the nonrecurrent group, P < .001). The preoperative RCA Index highly correlated with the postoperative RCA Index (Pearson's correlation: 0.918, P < .001), and there was only a small (average: 0.005) but significant increase in the RCA Index of the unaffected hemisphere after surgery (P = .01).The preoperative RCA Index positively correlated with age, preoperative SDH thickness and volume, and recurrence. A RCA Index cutoff value of 0.165 predicted CSDH recurrence with high sensitivity (95.6%) and specificity (93.3%) (area under the curve = 0.97, 95% CI: 0.93-1). CONCLUSION: The RCA Index is a simple yet robust predictor of CSDH recurrence. Incorporating this measure into the preoperative assessment may enhance surgical planning and postoperative management, potentially reducing recurrence rates.

Perceptibility and acceptability thresholds for color differences of light and dark maxillofacial skin replications.

The aim of this study was to assess the perceptibility and acceptability thresholds of maxillofacial silicones for light and dark skin colors and to evaluate the effect of gender and professional experience on these thresholds. Two different sets of specimens (as light and dark) each, consisting of 14 (25 × 25 × 6-mm3) silicone skin replications, were produced. Four specimens of each set were produced from the same silicon mixture of the relevant set and polymerized simultaneously to provide standardized fabrication conditions. These 4 light/dark specimens were assigned as "baseline color specimens (BCs)" in each set, while the other 10 specimens were produced with a color difference level that increased gradually from BC. These stepped levels were obtained by controlled increasing of the pigment concentration in the relevant baseline silicon mixture. Color difference levels of specimens were calculated by using the CIELAB and CIEDE2000 formulas. Observers comprised of 3 different professional experiences as first-year dental students, interns, and dentists (n = 30/group, gender-balanced) were included. Combinations consisting of 5 specimens with 4 BCs and 1 different color were shown to the observers to assess whether the color difference was perceptible or acceptable. Perceptibility and acceptability percentages were regressed with color difference levels to estimate the best fit curve and confidence intervals were calculated (α = 0.05). The highest estimation of the coefficient of determination (R2) was found in the cubic curve for all parameters. A significant difference was found between the light and dark colors. The perceptibility thresholds (ΔE*ab/ΔE00) were 0.8/0.59 and 2.63/1.75 for light and dark colors, respectively. The acceptability thresholds (ΔE*ab/ΔE00) were 3.35/2.25, 10.07/7.04 for light and dark colors, respectively. No significant differences were found between gender and among experience groups concerning visual thresholds. Regardless of gender and experience, observers could perceive color differences more easily in light skin colors.

Measurement of Uncertainty in Prediction of No-Reflow Phenomenon after Primary Percutaneous Coronary Intervention Using Systemic Immune Inflammation Index: The Gray Zone Approach.

Systemic immune-inflammation index (SII), which is a good predictive marker for coronary artery disease, can be calculated by using platelet, neutrophil, and lymphocyte counts. The no-reflow occurrence can also be predicted using the SII. The aim of this study is to reveal the uncertainty of SII for diagnosing ST-elevation myocardial infarction (STEMI) patients who were admitted for primary percutaneous coronary intervention (PCI) for the no-reflow phenomenon. A total of 510 consecutive acute (STEMI) patients with primary PCI were reviewed and included retrospectively. For diagnostic tests which are not a gold standard, there is always an overlap between the results of patients with and without a certain disease. In the literature, for quantitative diagnostic tests where the diagnosis is not certain, two approaches have been proposed, named "grey zone" and "uncertain interval". The uncertain area of the SII, which is given the general term "gray zone" in this article, was constructed and its results were compared with the "grey zone" and "uncertain interval" approaches. The lower and upper limits of the gray zone were found to be 611.504-1790.827 and 1186.576-1565.088 for the grey zone and uncertain interval approaches, respectively. A higher number of patients inside the gray zone and higher performance outside the gray zone were found for the grey zone approach. One should be aware of the differences between the two approaches when making a decision. The patients who were in this gray zone should be observed carefully for detection of the no-reflow phenomenon.

Cut-off values of internal rotation in the glenohumeral joint for functional tasks in children with brachial plexus birth injury.

The aim of this study was to determine the cut-off values of the range of internal rotation motion in the isolated glenohumeral joint that is required for functional tasks in children with an upper root injury of the brachial plexus. Internal rotation motion was measured using a universal goniometer in 97 participants. The Mallet Hand to Spine and Mallet Hand to Belly tasks were assessed as functional tasks that require internal rotation of the shoulder. For the Hand to Spine task, 41° passive and 30° active internal rotation were necessary to reach the S1 level. For the Hand to Belly task, 42° passive and 29° active internal rotation were required to place the palm on the belly without wrist flexion. Of our participants, 97% could touch the belly with or without wrist flexion, but 28% could not reach S1 in the Hand to Spine task. The results of this study show the necessary amount of internal rotation of the shoulder that should be considered in treatment strategies.Level of evidence: III.

Role of interventional radiology in the management of iatrogenic urinary tract injury: the factors affecting the outcome.

PURPOSE: To evaluate the efficacy of interventional radiological (IR) procedures in iatrogenic urinary tract injury and investigate the factors affecting the outcome. METHODS: Fifty-eight patients (21 male) with a mean age of 50.3 ± 15.8 years referred for iatrogenic urinary tract injury were enrolled in this study. Technical success was defined as (i) successful placement of a nephrostomy catheter within the renal pelvis and/or (ii) successful antegrade ureteral stent placement (double J stent) between the renal pelvis and bladder lumen. Complete resolution was defined as maintained ureteral patency without an external drain and ureteral stent. The factors that may affect complete resolution [ureteral avulsion, ureterovaginal fistula (UVF), history of malignancy/radiotherapy, and time to IR management] were also investigated. The receiver operating characteristic analysis was performed to estimate the cut-off time point for the IR management timing affecting complete resolution. RESULTS: The technical success rate for nephrostomy and ureteral stent placement was 100% (n = 58/58) and 78% (n = 28/36), respectively. In 14 patients, non-dilated pelvicalyceal systems were evident. In 18 patients, no further intervention after percutaneous nephrostomy was performed due to (i) poor performance status (n = 6) and (ii) reconstruction surgery upon clinicians' and/or patients' request (n = 12). Reconstruction surgery was required in 11 of the remaining 40 patients due to failure of percutaneous treatment (n = 11/40, 27.5%). In six of the patients, ureteral stents could not be removed due to the development of benign ureteral strictures (n = 6/40, 15%). Our complete resolution rate was 57.5% (n = 23/40). Age, gender, type of surgery (endoscopic or open), side and location of the injury did not statistically affect the complete resolution rate. The presence of ureteral avulsion, history of malignancy and radiotherapy individually or in combination significantly affected the complete resolution rate negatively. The presence of UVF also had a negative effect on the complete resolution rate; however, it did not reach statistical significance. Delayed intervention was also a significant factor related to lower complete resolution. The optimal cut-off point of the time interval for favorable clinical outcome was found to be 0-19th day following the surgery. CONCLUSION: IR procedures are safe and effective in the management of iatrogenic urinary tract injuries. Antegrade ureteral stenting should be performed as soon as possible to establish ureteral integrity without the development of stricture.

Intraoperative frozen section is essential for assessment of myometrial invasion but not for histologic grade confirmation in endometrial cancer: a ten-year experience.

PURPOSE: To evaluate the accuracy of endometrial biopsy (EB), transvaginal ultrasonography (TVS) and intraoperative frozen section (FS) for assessment of myometrial invasion and histologic grade to predict more conservative surgery in endometrial carcinoma. METHODS: Demographic and clinical data of 220 patients with endometrial carcinoma were retrospectively reviewed. Preoperatively, the subjects were evaluated by EB and TVS. Intraoperatively, FS was also performed to evaluate histological grading and myometrial invasion. All patients underwent surgical-pathological staging after removal of the uterus, adnexa and pelvic lymph nodes. Sensitivity and specificity values were calculated for EB, TVS and FS with regard to detection of histological grading and neoplastic invasion of the myometrium according to the final histopathologic examination. RESULTS: Bilateral pelvic and common iliac lymphadenectomy was performed in 80 patients without performing intraoperative biopsy because of preoperative high risk. Evaluation of the tumor grade by preoperative EB showed a sensitivity, specificity and accuracy of 73, 97 and 91%, respectively. Evaluation of the tumor grade by intraoperative biopsy showed a sensitivity, specificity and accuracy of 73, 96 and 90%, respectively. Evaluation of the depth of myometrial invasion with TVS showed a sensitivity, specificity and accuracy of 52, 91 and 79%, respectively. Evaluation of the depth of myometrial invasion with intraoperative biopsy showed a sensitivity, specificity and accuracy of 86, 94 and 92%, respectively. CONCLUSIONS: Evaluation of the histologic grade by EB and of the depth of myometrial invasion by intraoperative biopsy is a good option for deciding the necessity of lymphadenectomy.

Burden of deaths from road traffic injuries in children aged 0-14 years in Turkey.

Background: Childhood road traffic injuries (RTIs) are a major public health problem worldwide. Reliable and valid information on childhood RTIs is essential to reduce the number of deaths. Aims: To determine the burden of deaths from RTIs in children aged 0-14 years from 2006 to 2019 in Turkey. Methods: This descriptive study examined the change in road traffic fatalities in children according to age, gender, road user type, and place. The necessary data for this study were obtained from the Turkish Statistical Institute. We used Microsoft Excel to analyse data from 4614 children who died from RTIs in 2006-2019 in Turkey. Results: The fatality rate from RTIs per 100 000 children aged 0-14 years increased from 1.41 in 2006 to 2.13 in 2019. The fatality rate for boys aged 0-9 and 10-14 years was higher than that for girls of the same age. The fatality rate for girls aged 0-9 years was higher than that for girls aged 10-14 years. The fatality rate for boys aged 10-14 years was higher than that for boys aged 0-9 years. Among the children who died from RTIs, 6.65% were drivers, 41.31% pedestrians and 52.04% passengers. Children lost their lives mostly as pedestrians on urban roads and as passengers on rural roads. Conclusion: The death of children due to RTIs is a significant health burden in Turkey.

The effect of COVID-19 on nasal mucociliary clearance.

BACKGROUND: The impacts of coronavirus disease-2019 (COVID-19) on nasal mucociliary clearance (MCC) have shown conflicting results. OBJECTIVES: The aim of this study was to determine whether COVID-19 infections affect nasal mucociliary activity using the saccharin test to measure nasal MCC time. MATERIAL AND METHODS: This prospective comparative investigation included 25 patients with COVID-19 infection and 25 healthy controls. The nasal MCC time was assessed using the saccharin test. Saccharin test was applied to COVID-19 patients between the 10th and 20th days of COVID-19 test positivity. Patients admitted to the otolaryngology outpatient clinic with non-nasal symptoms and no history of COVID-19 infection served as the control subjects. RESULTS: Age, gender distribution, smoking, and alcohol usage, and the existence of other systemic disorders had no statistically significant differences between the groups (p = 0.25, p = 0.77, p = 1.00, p = 0.28, p = 0.54, respectively). The COVID-19 group had a mean nasal MCC time of 12.00 ± 2.51 min, compared to 9.77 ± 2.51 min in the control group. The nasal MCC time in the COVID-19 group was statistically significantly longer (p = 0.043). CONCLUSIONS AND SIGNIFICANCE: The COVID-19 infection negatively affects mucociliary activity and causes prolongation of MCC. As the nasal defense mechanism weakens in the early period after COVID-19 infection, susceptibility to respiratory infections may occur.

Safety and Efficacy of the Amplatzer Septal Occluder: A Systematic Review and Meta-Analysis.

OBJECTIVES: To assess the safety and efficacy of the Amplatzer Septal Occluder in the closure of secundum type atrial septal defects. BACKGROUND: The Amplatzer Septal Occluder (ASO; Abbott, St. Paul, MN) is an FDA-approved device for percutaneous closure of secundum type atrial septal defects (ASD). Previous small cohort trials have shown a favorable safety and technical efficacy profile. METHODS: We conducted a systemic review and meta-analysis of all prospective case series and controlled trials that evaluated the ASO's safety and implant efficacy. The primary endpoint was the technical success rate of implantations. Secondary outcomes included proportions of arrhythmias and embolism specific-adverse events. RESULTS: We included a total of 12 studies with 2972 patients. The ratio of device implantation was 2:1 by sex [female: male]. Pooled technical success rate of implantation was 98% (95% CI: 0.968-0.990, P < 0.01). The cumulative adverse event rate was 5.1% (95% CI: 0.035-0.068, P < 0.01), which included arrhythmia and embolism specific adverse event rates of 1.8% (95% CI: 0.007-0.032, P < 0.01) and 0.7% (95% CI: 0.002-0.013, P < 0.01), respectively. Sensitivity analysis did not significantly affect pooled outcomes for success rate and adverse events; both forest plot and Begg's and Egger's regression tests supported symmetricity. CONCLUSION: A high likelihood of technical success can be expected when implanting the ASO in secundum type ASDs. Adverse event rates are expected for one in twenty patients, and thus, our results support the safe use of ASO in secundum type ASDs closure. CONDENSED ABSTRACT: The AMPLATZER Septal Occluder is an FDA-approved device for percutaneous closure of secundum type atrial septal defects (ASD). We conducted a systemic review and meta-analysis of all prospective case series and controlled trials that evaluated the ASO's safety and implant efficacy. We included a total of 12 studies with 2972 patients. Pooled technical success rate of implantation was 98% (P < 0.01). The cumulative adverse event rate was 5.1% (P < 0.01), 1.8% (P < 0.01) rate of arrhythmias, and 0.7% (P < 0.01) rate of embolisms. A high likelihood of technical success can be expected with a low rate of adverse events.