Background: Caesarean delivery rate is increasing globally including in Nigeria. Caesarean delivery is a life-saving surgery for both mother and child. Objective: The aim of the study was to assess the caesarean deliv...Background: Caesarean delivery rate is increasing globally including in Nigeria. Caesarean delivery is a life-saving surgery for both mother and child. Objective: The aim of the study was to assess the caesarean delivery rate at the Kogi State Specialist Hospital, Lokoja, Nigeria over a one-year period. Methods: This was a prospective assessment of the demographic characteristics of patients, indications, types, rates and outcomes of Caesarean delivery in Kogi State Specialist Hospital, Lokoja, Nigeria from December 15, 2020 to December 14, 2021. Data collected were analyzed using SPSS version 20.0 statistical package (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp). The categorical data were displayed using tables and charts. Results: There was a total of 491 deliveries, out of which were 113 Caesarean deliveries and 378 spontaneous vaginal deliveries making the Caesarean delivery rate in Kogi State Specialist Hospital, Lokoja, Nigeria 23.0%. There were no instrumental deliveries during the study period. The commonest indication for Caesarean section was obstructed labour in 31% of cases. There was no maternal mortality. There were three early neonatal deaths due to severe birth asphyxia. Conclusion: The rate of Caesarean delivery in this study was 23.0% and obstructed labour was the leading indication in 31% of cases. The rate of Caesarean delivery in this study is high, albeit the overall outcome was good for both mother and child. Caesarean delivery, therefore, remains one of the means for reducing maternal and perinatal morbidity and mortality in Nigeria.展开更多
The COVID-19 outbreak in late 2019 was declared a pandemic by the World Health Organization(WHO)on March 12,2020.[1]As of the latest WHO data,COVID-19 has caused over 770 million cases and nearly 7 million deaths worl...The COVID-19 outbreak in late 2019 was declared a pandemic by the World Health Organization(WHO)on March 12,2020.[1]As of the latest WHO data,COVID-19 has caused over 770 million cases and nearly 7 million deaths worldwide.[2]Hospitalizations due to COVID-19 are correlated with advanced age.[3,4]According to re-ports,individuals over the age of 65 account for 80%of COVID-19-related deaths.[3,4]This is primar-ily due to the increased burden of comorbidity with age.展开更多
Objective: We studied the feasibility of using Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) linked with Brief Intervention (ALBI) in treating Substance Use Disorder in Nigeria. There is a clear ...Objective: We studied the feasibility of using Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) linked with Brief Intervention (ALBI) in treating Substance Use Disorder in Nigeria. There is a clear gap in meeting the needs for treatment and care for people with drug use disorders in Nigeria with many users reporting a self-perceived need for treatment and about 40% of them wanting to receive drug treatment but were unable to access such services. Methods: ASSIST questionnaire was used to gather baseline data, and ALBI along with Motivational Interviewing (MI) was used to intervene for 6 weeks following which ASSIST score was repeated and compared with baseline. Results: Majority of the participants were aged 21 - 30 years, mostly males with (61.3%) lacking steady jobs. Lifetime prevalence of any drug use was (88.2%). Three months prevalence was nicotine (72.0%), alcohol (66.7%), cannabis (47.3%), opioids (11.8%) among others. The ASSIST scores were mostly on the severe ranges. ASSIST result after six weeks showed marked reduction. The Mean Difference (MD) in the ASSIST scores after intervention was significant for tobacco, opioids, alcohol, and cannabis. The Cohen’s D effect size was large for tobacco (1.08), alcohol (0.92) and cannabis (0.73) but low for other substances. Conclusion: ALBI along with MI was helpful in combating the menace of substance use.展开更多
We aim to evaluate the incidence of incontinence following laser endoscopic enucleation of the prostate(EEP)comparing en-bloc(Group 1)versus 2-lobe/3-lobe techniques(Group 2).We performed a retrospective review of pat...We aim to evaluate the incidence of incontinence following laser endoscopic enucleation of the prostate(EEP)comparing en-bloc(Group 1)versus 2-lobe/3-lobe techniques(Group 2).We performed a retrospective review of patients undergoing EEP for benign prostaticenlargement in 12 centers between January 2020 and January 2022.Data were presented as median and interquartile range(IQR).Univariable and multivariable logistic regression analysis was performed to evaluate factors associated with stress urinary incontinence(SUI)and mixed urinary incontinence(MUI).There were 1711 patients in Group 1 and 3357 patients in Group 2.Patients in Group 2were significantly younger(68[62–73]years vs 69[63–74]years,P=0.002).Median(interquartile range)prostate volume(PV)wassimilar between the groups(70[52–92]ml in Group 1 vs 70[54–90]ml in Group 2,P=0.774).There was no difference in preoperativeInternational Prostate Symptom Score,quality of life,or maximum flow rate.Enucleation,morcellation,and total surgical time weresignificantly shorter in Group 1.Within 1 month,overall incontinence rate was 6.3%in Group 1 versus 5.3%in Group 2(P=0.12),and urge incontinence was significantly higher in Group 1(55.1%vs 37.3%in Group 2,P<0.001).After 3 months,the overall rate ofincontinence was 1.7%in Group 1 versus 2.3%in Group 2(P=0.06),and SUI was significantly higher in Group 2(55.6%vs 24.1%in Group 1,P=0.002).At multivariable analysis,PV and IPSS were factors significantly associated with higher odds of transient SUI/MUI.PV,surgical time,and no early apical release technique were factors associated with higher odds of persistent SUI/MUI.展开更多
This article offers additional clinical and biomechanical insights into using the peroneus longus tendon(PLT)autograft in posterior cruciate ligament recon-struction.While recent studies report favorable knee outcomes...This article offers additional clinical and biomechanical insights into using the peroneus longus tendon(PLT)autograft in posterior cruciate ligament recon-struction.While recent studies report favorable knee outcomes,concerns remain regarding donor site morbidity.The PLT plays a key role in foot biomechanics,and its harvesting may lead to subtle changes,as suggested by imaging and pe-dobarographic studies.Tendon regeneration may limit long-term morbidity,but further studies are needed.We recommend that future research include gait analysis,long-term follow-up,and insights from anterior cruciate ligament li-terature.展开更多
AIM:To evaluate changes in corneal light scattering and anterior segment parameters in newly diagnosed rheumatoid arthritis(RA)patients who achieved remission with systemic treatment,compared to healthy controls.METHO...AIM:To evaluate changes in corneal light scattering and anterior segment parameters in newly diagnosed rheumatoid arthritis(RA)patients who achieved remission with systemic treatment,compared to healthy controls.METHODS:A cross-sectional study was conducted at a tertiary care hospital,in ophthalmology,and rheumatology departments.A total of 42 RA patients(13 men and 29 women)and 56 healthy individuals(23 men 33 women)underwent comprehensive ophthalmologic evaluations,including Scheimpflug corneal densitometry and Pentacam HR measurements.Those who initiated systemic treatment for RA were monitored at first,third,and sixth-month follow-ups.Participants who achieved remission at each follow-up assessment were included.RESULTS:Significant differences in corneal densitometry were observed,with higher values in RA patients,particularly in the middle and posterior layers.Anterior segment parameters such as anterior chamber volume and angle were significantly reduced in RA patients compared to other groups(P<0.001).Following systemic treatment and achievement of remission,these parameters showed regression toward normal values.CONCLUSION:The study underscores the potential utility of corneal densitometry and anterior segment analysis as sensitive indicators of subclinical ocular involvement in RA,offering insights into disease progression and treatment efficacy.These findings highlight the importance of early detection and regular monitoring in preventing vision-threatening complications in RA patients.展开更多
BACKGROUND Sleep disturbances are a prominent feature of bipolar disorder(BD)and often persist even in remission,thereby contributing to poor clinical outcomes.Despite the widespread use of lithium and valproic acid a...BACKGROUND Sleep disturbances are a prominent feature of bipolar disorder(BD)and often persist even in remission,thereby contributing to poor clinical outcomes.Despite the widespread use of lithium and valproic acid as mood stabilizers,their effects on sleep quality have not been examined in adequate detail.AIM To evaluate and compare the effects of lithium and valproic acid on sleep quality in BD patients under remission.METHODS A total of 130 patients meeting the Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition criteria for BD in remission were included in this crosssectional study.The participants were receiving either lithium(n=78),or valproic acid(n=52),for a minimum of six months either alone or in combination with antipsychotics.Sleep quality was measured using the Pittsburgh Sleep Quality Index(PSQI).Comparative analyses between the lithium and valproic acid groups were conducted using independent t-tests,χ^(2)tests,and ANCOVA,adjusting for key variables such as age,sex,and body mass index.RESULTS Both groups demonstrated poor sleep quality,with the mean PSQI scores above the clinical threshold of 5.Patients in the lithium group exhibited significantly better habitual sleep efficiency(lithium:0.47±0.65,valproic acid:0.78±0.87,P=0.009)and fewer sleep disturbances(lithium:1.26±0.57,valproic acid:1.61±0.84,P=0.005).Other sleep parameters,including total sleep duration(P=0.082)and sleep latency(P=0.625),did not differ significantly.CONCLUSION Patients in the lithium group showed significantly better habitual sleep efficiency and fewer sleep disturbances compared to those receiving valproic acid,although other sleep parameters did not differ.These findings suggest a potential advantage of lithium in certain aspects of sleep quality in BD patients under remission.Future studies using objective sleep measures and longitudinal designs are warranted to confirm these findings.展开更多
BACKGROUND In the treatment of rectal cancer,a temporary loop ileostomy(TLI)is created after low anterior resection to protect bowel function in the postoperative period.Dehydration and kidney failure are significant ...BACKGROUND In the treatment of rectal cancer,a temporary loop ileostomy(TLI)is created after low anterior resection to protect bowel function in the postoperative period.Dehydration and kidney failure are significant potential complications in loop ileostomies.Compared to late closure(3-6 months),early closure(10-14 days)of the TLI may facilitate faster patient recovery and shorter hospital stays.AIM To compare early and late closure of TLIs and demonstrate that early stoma closure can be performed without increasing morbidity.METHODS This study included patients who underwent TLI for rectal cancer,with data collected prospectively between June 2016 and October 2024 and analyzed retrospectively.Patients whose stomas were closed in the late period(3-6 months)between June 2016 and October 2022(group A)were compared with those who underwent early closure(10-14 days)between October 2022 and 2024(group B),with the primary outcome being complication rate and the secondary outcome being quality of life.RESULTS A total of 270 TLIs were created(70.9%).Of these,120(44.4%)were closed in the late period(group A),and 150(55.6%)were closed in the early period(group B).There was no statistically significant difference between group A and group B in terms of demographic and clinicopathological characteristics(P>0.05).Perioperative(anesthesia management,operative time,blood loss,surgical technique)and postoperative findings(anastomotic leak,infection)were similar between the two groups and were not statistically significant(P>0.05).There were no statistically significant differences in complication rates as the primary outcome between the two groups.Quality of life as a secondary outcome was significantly higher in the early closure group(P<0.05).CONCLUSION No statistically significant difference was found between early and late loop ileostomy closure in terms of perioperative and postoperative morbidity.Early closure accelerated patients’psychological and social recovery.展开更多
Aim:The aim of this study was to investigate the factors affecting treatment success in children that got either pyeloplasty or J stent placement in ureteropelvic junction obstruction(UPJO).Patients and Methods:The st...Aim:The aim of this study was to investigate the factors affecting treatment success in children that got either pyeloplasty or J stent placement in ureteropelvic junction obstruction(UPJO).Patients and Methods:The study comprised 126 patients who either J stent placement or pyeloplasty performed by the same physician for UPJO from 2012 to 2022.The criteria for surgical intervention adhered to the European Association of Urology(EAU)recommendations.Symptomatic patients with verified obstruction,with a split renal function(SRF)over 40%,low-grade hydronephrosis(Society of Fetal Urology grade 2),and an obstructive segment measuring less than 1 cm,had Double-J stent placement.Furthermore,in infants exhibiting poor health or development retardation,a J stent was inserted as a temporary measure to alleviate obstruction and maintain renal function,notwithstanding the recommendation for pyeloplasty.Results:The treatment success rate was 43.9%in the J stent group and 88.4%in the pyeloplasty group,with a statistically significant difference(p<0.001).The kind of procedure(pyeloplasty vs.stent)was the sole independent prognostic factor predicting treatment success(HR:4.77,p<0.001)in the multiple logistic regression analysis.No statistically significant change was observed in preoperative and postoperative SRF(48%vs.48.5%,p=0.923)among patients with stent failure,confirming a transient preservation of functional advantage.Conclusion:The placement of a stent may have restricted success rates in specific patients with UPJO.Preserving renal function may be advantageous until definitive surgery,particularly in cases where there are hazards associated with anesthesia and invasive procedures.展开更多
Background:Obesity remains a major global health challenge,closely linked to individuals'health beliefs and lifestyle behaviors.Descriptive and relational research methods were used to ascertain the correlation be...Background:Obesity remains a major global health challenge,closely linked to individuals'health beliefs and lifestyle behaviors.Descriptive and relational research methods were used to ascertain the correlation between health beliefs and healthy lifestyle behaviors in obese individuals based on the Health Belief Model.Methods:The population of the research are obese individuals who are treated in the internal medicine clinic in a state hospital in Diyarbakır and applied to a dietitian.Based on power analysis,the study’s sample consisted of 192 obese people.The health belief model scale in obese individuals(HBMSO),the Healthy Lifestyle Behaviors Scale-II(HLBS-II),and the Personal Information Form were used to gather the data.The data was evaluated using the following methods:mean,standard deviation,linear regression analysis,Mann-Whitney U test,Kruskal-Wallis test,Shapiro Wilk and Kolmogorov Smirnov tests,post-hoc Dunn-Benferronni tests,Pearson and Spearman correlation,and others.Results:It was determined that 26.0%of obese individuals were in the 46–55 age range,63.5%were female,64.6%were married,60.4%had a BMI in the range of 30–34.9 kg/m^(2),and 42.7%partially exercised.All sub-dimensions and HBMSO sub-dimensions had statistically significant correlation with the HLBS-II total score.The linear regression analysis results used to identify the predictors of the HLBS-II total score showed that the increase in the level of education and the HBMSO“Importance of Health”sub-dimension score increased the HLBS-II total score,while not exercising and an increase in the HBMSO“Obstacle Perception”sub-dimension score decreased the HLBS-II total score.Conclusion:Individuals’health attitudes have a major impact on leading a healthy lifestyle,which is consistent with the research results.展开更多
Dear Editor,We recently reviewed two important studies that investigate the use of botulinum-A toxin(BoNT-A)injections into the bulbospongiosus muscle as a treatment for lifelong premature ejaculation(PE).While both s...Dear Editor,We recently reviewed two important studies that investigate the use of botulinum-A toxin(BoNT-A)injections into the bulbospongiosus muscle as a treatment for lifelong premature ejaculation(PE).While both studies share the goal of evaluating the efficacy and safety of BoNT-A in this context,they reached very different conclusions.The study by Shaher et al.demonstrated significant improvements in ejaculatory latency,indicating that BoNT-A injections may be a helpful treatment for PE.展开更多
BACKGROUND Although previous findings indicated that pathological assessment of tumor budding(TB),desmoplastic reaction(DR),and tumor-infiltrating lymphocytes(TILs)may play a role in determining tumor behavior in many...BACKGROUND Although previous findings indicated that pathological assessment of tumor budding(TB),desmoplastic reaction(DR),and tumor-infiltrating lymphocytes(TILs)may play a role in determining tumor behavior in many malignancies,the relationship between TB,DR,and TILs in patients with pancreatic ductal adenocarcinoma(PDAC)is still unknown.AIM To evaluate relationships of TB,DR,and TILs with histopathological parameters and determine their prognostic value in patients with PDAC.METHODS The study cohort comprised 100 patients diagnosed with PDAC.Peritumoral budding(PTB)and intratumoral budding(ITB)were assessed according to the International Tumor Budding Consensus Conference guidelines.DR was classified based on stromal maturation.TILs were evaluated semiquantitatively with a 5%cutoff.Additionally,cases were categorized into two groups according to lymphocyte density:No/Low lymphocytes and medium/high lymphocytes.RESULTS A significant correlation was observed between ITB and PTB(r=0.890).Higher PTB was associated with fewer TILs and immature stroma(P<0.001).PTB and TILs were significantly related to tumor dimension,lymphovascular invasion,lymph node metastasis(LNM),and stage(P<0.005).ITB was also associated with the presence of lymph node involvement.The results of the univariate analysis revealed a significant correlation between poor survival rates and the presence of lymphovascular invasion,LNM,PTB,ITB,and TILs according to scoring(P<0.001).The multivariate analysis revealed LNM,PTB,ITB,and TILs according to scoring as independent prognostic factors.CONCLUSION TB assessment stratified patients with PDAC.PTB-ITB correlation showed diagnostic relevance of ITB in biopsy specimens.The prognostic significance of DR and interplay with TIL subsets warrant further investigation.展开更多
BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an invasive endoscopic procedure used mainly to treat hepato-pancreato-biliary(HPB)diseases.The need for ERCP has increased with the rising number of H...BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an invasive endoscopic procedure used mainly to treat hepato-pancreato-biliary(HPB)diseases.The need for ERCP has increased with the rising number of HPB diseases over the past decade.Thus,due to increased demand,ERCP is performed at more centers.Currently,it is performed by general surgeons,gastroenterology and invasive radiology specialists in the United States and Europe as recommended by the British Society of Gastroenterology(BSG).AIM To present the results of ERCP procedures from fourteen surgical centers in Türkiye.METHODS Fourteen surgical centers performing ERCP were included in the present study.The age,gender,ERCP indication,success status,post-ERCP complications,ERCP reports and the files of 66993 patients who underwent ERCP were collected from the participating centers.The results are discussed according to the targets declared by the BSG,which are volume load per annum,proportion of successful cannulation(>85%),bile duct clearance rate(>75%),stenting rate for strictures(>80%)and complications(<6%).RESULTS A total of 66993 ERCP procedures were performed in the centers included in the study up to August 2024.29250(43.6%)of the procedures were performed urgently,especially for suppurative cholangitis,biliary tract injuries,etc.The remaining 37743(56.4%)cases were performed electively.50.2%of the patients were female and 49.8%were male.The average ages were 56.5 years for women and 55.9 years for men.General anesthesia was used in 84.1%of the patients while sedation was used in 15.9%.The indications were bile duct stone(78.7%),pancreatic tumor(3.9%),papillary tumor(3.3%),cholangiocarcinoma(2.6%),Oddi sphincter dysfunction(2.4%),bile leakage after cholecystectomy(2%),bile leakage after hydatid cyst surgery(1.9%),biliary stricture(1.7%),and other diseases(3.1%).Hyperamylasemia and post-ERCP pancreatitis were the most common complications as observed in 8.1%of the patients.They were usually self-limited and responded to supportive measures.The frequency of the other complications was also consistent with the literature.CONCLUSION There is a huge shortage of ERCP endoscopists worldwide due to insufficient ERCP training and centers especially in developing and underdeveloped countries.As patients requiring ERCP usually present to surgical practitioners,the incorporation of surgeons into this training program is an effective and reliable solution.The BSG recommends the incorporation of surgeons and radiologists in addition to gastroenterology specialists.This study is the first to present the results of ERCP procedures from fourteen surgical centers throughout Türkiye.The results suggest that the surgical centers included were able to achieve the targets set by the BSG.This study demonstrated that the surgical ERCP units in the present work have reached satisfactory results and provided a reliable and successful ERCP service.There are currently no issues regarding the validity and appropriateness of the surgeons performing ERCP.Therefore,ERCP training should be encouraged in surgeons and more surgical ERCP centers should be provided.展开更多
AIM:To assess and compare the conjunctival bacterial flora in patients with congenital ptosis(CP)to that of healthy individuals.METHODS:The study included 38 patients with CP and 42 healthy control subjects.Conjunctiv...AIM:To assess and compare the conjunctival bacterial flora in patients with congenital ptosis(CP)to that of healthy individuals.METHODS:The study included 38 patients with CP and 42 healthy control subjects.Conjunctival cultures were collected using a cotton-tipped swab applied to the inferior conjunctival fornix.The samples were inoculated into blood agar,eosin methylene blue agar,chocolate agar for bacteria,and Sabouraud dextrose agar medium for fungi.RESULTS:The culture positivity rate was 68.4%in CP and 47.6%in the control group(P<0.001).Additionally,there was a significant difference in culture positivity between the eyes of patients with unilateral ptosis(P=0.039).In the CP group,the most common found microorganism was Staphylococcus epidermidis at 23.67%,followed by Haemophilus species at 21.04%,and Corynebacterium species at 15.78%.In the control group,Staphylococcus epidermidis and Corynebacterium species were both the most commonly isolated microorganisms,each accounting for 19.04%.More than one species of bacteria was grown in the cultures of 36.84%and 23.80%of the CP and control subjects,respectively.Gram-negative bacteria were more common in CP than in control subjects(P=0.031).CONCLUSION:Culture positivity is significantly higher in the ptotic eyes of CP.Potentially pathogenic microorganisms are more frequently isolated from the CP group compared with the healthy control group.展开更多
Background: The lumbar artery perforator(LAP) flap is an important autologous option in breast reconstruction.As the lumbar perforator flap is relatively new in this field,several questions remain regarding preoperati...Background: The lumbar artery perforator(LAP) flap is an important autologous option in breast reconstruction.As the lumbar perforator flap is relatively new in this field,several questions remain regarding preoperative preparation,especially concerning computed tomography(CT) and magnetic resonance imaging of the donor site.The objective of this study was to aid the surgical approach to the LAP flap in female patients by precisely determining the characteristics of the lumbar perforators.Methods: We retrospectively reviewed the computed tomographic angiography images of 20 patients who underwent evaluation of the perforator positions from the four lumbar arteries.Four characteristics were studied:length,diameter,path of the lumbar pedicle,and thickness of the tissues available for transfer.Results: We analyzed 20 CT images,identifying 149 perforating vessels of the lumbar artery.The most suitable perforator for flap harvesting was the L4 perforator,which exhibited a larger diameter,a greater number of perforasomes,and a higher percentage of the cutaneous-septal tract.Conclusion: The LAP flap is a viable option for breast reconstruction and as a free flap in women.The L4 perforator artery is the most suitable for harvesting,owing to its superior perfusion capacity,diameter,and course;however,an interposition graft may be required to lengthen the vascular pedicle.展开更多
BACKGROUND Metastatic colorectal cancer(mCRC)is a global health challenge with a poor prognosis.Prognostic markers are critical for survival prediction.METHODS This multicenter,retrospective study measured baseline ca...BACKGROUND Metastatic colorectal cancer(mCRC)is a global health challenge with a poor prognosis.Prognostic markers are critical for survival prediction.METHODS This multicenter,retrospective study measured baseline carcinoembryonic antigen and carbohydrate antigen 19-9 levels to calculate a TMI as the geometric mean of values normalized to their upper limits of normal.Receiver operating characteristic curve analysis assessed TMI’s prognostic accuracy,and patients were stratified into high-TMI(≥1.39)and low-TMI(<1.39)groups.The primary endpoint was overall survival(OS),with progression-free survival and treatment response as secondary endpoints.RESULTS The study included 305 mCRC patients with a median follow-up of 22.9 months.The median OS for high-TMI patients was 29.5 months,significantly lower than the 45.6 months observed in the low-TMI group(P=0.02).The 2-year OS rates for the high-and low-TMI groups were 59.4%and 72.9%,respectively.Median progression-free survival was also shorter for the high-TMI group(14.0 vs 16.0 months,P=0.84).High TMI is an independent prognostic factor for worse OS.CONCLUSION TMI is a simple,cost-effective prognostic tool for mCRC,with high TMI associated with poorer survival outcomes.展开更多
The historical dogma that bladder calculi comprise the main indication for prostatic surgery has recently been questioned.In this study,we aimed to predict which patients should undergo simultaneous prostate and bladd...The historical dogma that bladder calculi comprise the main indication for prostatic surgery has recently been questioned.In this study,we aimed to predict which patients should undergo simultaneous prostate and bladder calculi surgery or only bladder calculi removal by evaluating preoperative risk factors.One hundred and seventeen men with bladder stones and concomitant benign prostate enlargement(BPE)who had not received medical treatment before were included in the study.In the first step,only the bladder calculi of patients were removed and medical treatment was given for BPE.The patients who benefited from medical treatment during the follow-up were defined as Group 1 and the patients who required prostate surgery for any indication comprised Group 2.Risk factors for prostate surgery requirements were determined by comparing preoperative characteristics between the two groups with a cox regression model.In the follow-up of 117 patients with bladder stones removed and medical treatment initiated,49(41.9%)patients had prostate surgery indications.The indication for 33(67.3%)of 49 patients was medical treatment failure.The presence of intravesical prostatic protrusion(IPP;hazard ratio:2.071,95%confidence interval[Cl]:1.05-4.05,P=0.034),and high postvoiding residual urine volume(hazard ratio:1.013,95%Cl:1.007-1.019,P<0.001)were found to be preoperative risk factors for needing future prostate surgery.In patients who have not received medical treatment for BPE before,bladder calculi developing secondary to BPE do not always constitute an indication for prostate surgery.展开更多
Objective:To investigate the antibiotic resistance genes inserted into class I and class 2integrons in Acinetobacler baumannii[A.baumannii)isolates obtained from nine different cities in Turkey.Methods:A collection of...Objective:To investigate the antibiotic resistance genes inserted into class I and class 2integrons in Acinetobacler baumannii[A.baumannii)isolates obtained from nine different cities in Turkey.Methods:A collection of 281 A.baumannii clinical isolates were collected from nine diferenl state hospitals in Turkey and were confirmed as A.baumannU by conventional biochemical,API testing and bla_(-OXA-51)specific PCR.The isolates were examined by PCR for existence of class I and2 integron gene cassettes.Results:They were characterized by antimicrobial susceptibility testing and the highest resistance rates were determined for piperacillin(90.03%),ciprofloxacin(87.54%),cefepime and trimethoprim/sulfamethoxazole(81.13%).The lowest resistance rates was for cefotaxime(3.55%).class 1 integrons were detected in 6.4%(18/281)of A.baumannii strains and no class 2 integron was detected.The gene casselles of class 1 inlegrons AacCI-AAC(3)l-aadAI,AacCI-aadA1,AAC(3)-I,AAC(3)-I-AAC(3)-I-aadA1,TEM-1.AAC(3)-I-aadA1-AAC(3)-I-AAC(3)-I,AAC(3)-I-AAC(3)-I-AAC(3)-I-aadA1,AAC(3)-I-aadA1,AAC(3)-I-AAC(3)-I,AAC(3)-I-aadA1-AAC(3)-I-aadA1,AAC(3)-I-AAC(3)-I-aadA1-AAC(3)-I-aadA1 were detected in eighteen strains.The aac genes family were most frequently found integrated into the class 1 inlegrons and it was followed by aadA genes and TEM-1 genes.Conclusions:This is an extensive study on the distribulion of class 1 integron among A.baumannii in Turkey.In addition to these,two new alleles were observed.Their percentage rates of similarity to other cassettes are 95%aadA1(TK A18)and 89%,aadA 1(ANKA3).展开更多
Objective This study aimed to investigate the level of knowledge among urologists of usage of fluoroscopy during percutaneous nephrolithotomy.MethodsWe conducted an anonymous internet-based survey addressed to the EAU...Objective This study aimed to investigate the level of knowledge among urologists of usage of fluoroscopy during percutaneous nephrolithotomy.MethodsWe conducted an anonymous internet-based survey addressed to the EAU Section of Uro-Technology and the International Alliance of Urolithiasis members with particular interest in the stone treatment at all levels of expertise.The final version of the questionnaire included 31 questions,evaluated the level of knowledge on X-ray utilization and exposure,and identified correlations between geographic areas,levels of seniority,surgical volumes,and awareness on radiation protection.ResultsIn total,586 respondents were included.Knowledge of fluoroscopy settings appeared low,particularly among trainees(up to 87.5%were uninformed,p=0.008).Precautions to reduce exposure appeared poorly followed as up to 25.4%of respondents used regularly continuous fluoroscopy,and up to 20.5%used regularly high-frequency setting and this trend was more obvious among senior specialists(6.2%of trainees used high-frequency settings vs.21.3%of consultants,p<0.05).Additionally,only 24.9%of respondents would provide X-ray protection to patients too.ConclusionAlthough high and routinary utilization of X-rays,the level of awareness and adhesion to“as low as reasonably achievable”principles among endourologists seems suboptimal in 65.0%of all respondents.Highest volume surgeons,inevitably at higher risk,do not seem to adopt more precautions.More efforts should be addressed to improve these results,reducing the risk related to excessive radiation exposure for both surgical staff and patients in order to minimize health related issues.展开更多
Objective:An investigation of an outbreak of measles in a district in Nigeria was initiated following confirmation of the outbreak.The objectives of the study were to assess the size and determine the cause of the out...Objective:An investigation of an outbreak of measles in a district in Nigeria was initiated following confirmation of the outbreak.The objectives of the study were to assess the size and determine the cause of the outbreak. Methods:Visits were made to health facilities and affected communities.Cases were line-listed using specified forms and descriptive epidemiology carried out on collected data.Results:A total of 18 cases and 0 deaths were identified over a period of six weeks.Two of the cases(11%) were 【 9 months of age.The proportion of zero-dose children was 39%.Conclusion:Low herd immunity was suggested as the cause of the outbreak.展开更多
文摘Background: Caesarean delivery rate is increasing globally including in Nigeria. Caesarean delivery is a life-saving surgery for both mother and child. Objective: The aim of the study was to assess the caesarean delivery rate at the Kogi State Specialist Hospital, Lokoja, Nigeria over a one-year period. Methods: This was a prospective assessment of the demographic characteristics of patients, indications, types, rates and outcomes of Caesarean delivery in Kogi State Specialist Hospital, Lokoja, Nigeria from December 15, 2020 to December 14, 2021. Data collected were analyzed using SPSS version 20.0 statistical package (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp). The categorical data were displayed using tables and charts. Results: There was a total of 491 deliveries, out of which were 113 Caesarean deliveries and 378 spontaneous vaginal deliveries making the Caesarean delivery rate in Kogi State Specialist Hospital, Lokoja, Nigeria 23.0%. There were no instrumental deliveries during the study period. The commonest indication for Caesarean section was obstructed labour in 31% of cases. There was no maternal mortality. There were three early neonatal deaths due to severe birth asphyxia. Conclusion: The rate of Caesarean delivery in this study was 23.0% and obstructed labour was the leading indication in 31% of cases. The rate of Caesarean delivery in this study is high, albeit the overall outcome was good for both mother and child. Caesarean delivery, therefore, remains one of the means for reducing maternal and perinatal morbidity and mortality in Nigeria.
文摘The COVID-19 outbreak in late 2019 was declared a pandemic by the World Health Organization(WHO)on March 12,2020.[1]As of the latest WHO data,COVID-19 has caused over 770 million cases and nearly 7 million deaths worldwide.[2]Hospitalizations due to COVID-19 are correlated with advanced age.[3,4]According to re-ports,individuals over the age of 65 account for 80%of COVID-19-related deaths.[3,4]This is primar-ily due to the increased burden of comorbidity with age.
文摘Objective: We studied the feasibility of using Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) linked with Brief Intervention (ALBI) in treating Substance Use Disorder in Nigeria. There is a clear gap in meeting the needs for treatment and care for people with drug use disorders in Nigeria with many users reporting a self-perceived need for treatment and about 40% of them wanting to receive drug treatment but were unable to access such services. Methods: ASSIST questionnaire was used to gather baseline data, and ALBI along with Motivational Interviewing (MI) was used to intervene for 6 weeks following which ASSIST score was repeated and compared with baseline. Results: Majority of the participants were aged 21 - 30 years, mostly males with (61.3%) lacking steady jobs. Lifetime prevalence of any drug use was (88.2%). Three months prevalence was nicotine (72.0%), alcohol (66.7%), cannabis (47.3%), opioids (11.8%) among others. The ASSIST scores were mostly on the severe ranges. ASSIST result after six weeks showed marked reduction. The Mean Difference (MD) in the ASSIST scores after intervention was significant for tobacco, opioids, alcohol, and cannabis. The Cohen’s D effect size was large for tobacco (1.08), alcohol (0.92) and cannabis (0.73) but low for other substances. Conclusion: ALBI along with MI was helpful in combating the menace of substance use.
文摘We aim to evaluate the incidence of incontinence following laser endoscopic enucleation of the prostate(EEP)comparing en-bloc(Group 1)versus 2-lobe/3-lobe techniques(Group 2).We performed a retrospective review of patients undergoing EEP for benign prostaticenlargement in 12 centers between January 2020 and January 2022.Data were presented as median and interquartile range(IQR).Univariable and multivariable logistic regression analysis was performed to evaluate factors associated with stress urinary incontinence(SUI)and mixed urinary incontinence(MUI).There were 1711 patients in Group 1 and 3357 patients in Group 2.Patients in Group 2were significantly younger(68[62–73]years vs 69[63–74]years,P=0.002).Median(interquartile range)prostate volume(PV)wassimilar between the groups(70[52–92]ml in Group 1 vs 70[54–90]ml in Group 2,P=0.774).There was no difference in preoperativeInternational Prostate Symptom Score,quality of life,or maximum flow rate.Enucleation,morcellation,and total surgical time weresignificantly shorter in Group 1.Within 1 month,overall incontinence rate was 6.3%in Group 1 versus 5.3%in Group 2(P=0.12),and urge incontinence was significantly higher in Group 1(55.1%vs 37.3%in Group 2,P<0.001).After 3 months,the overall rate ofincontinence was 1.7%in Group 1 versus 2.3%in Group 2(P=0.06),and SUI was significantly higher in Group 2(55.6%vs 24.1%in Group 1,P=0.002).At multivariable analysis,PV and IPSS were factors significantly associated with higher odds of transient SUI/MUI.PV,surgical time,and no early apical release technique were factors associated with higher odds of persistent SUI/MUI.
文摘This article offers additional clinical and biomechanical insights into using the peroneus longus tendon(PLT)autograft in posterior cruciate ligament recon-struction.While recent studies report favorable knee outcomes,concerns remain regarding donor site morbidity.The PLT plays a key role in foot biomechanics,and its harvesting may lead to subtle changes,as suggested by imaging and pe-dobarographic studies.Tendon regeneration may limit long-term morbidity,but further studies are needed.We recommend that future research include gait analysis,long-term follow-up,and insights from anterior cruciate ligament li-terature.
文摘AIM:To evaluate changes in corneal light scattering and anterior segment parameters in newly diagnosed rheumatoid arthritis(RA)patients who achieved remission with systemic treatment,compared to healthy controls.METHODS:A cross-sectional study was conducted at a tertiary care hospital,in ophthalmology,and rheumatology departments.A total of 42 RA patients(13 men and 29 women)and 56 healthy individuals(23 men 33 women)underwent comprehensive ophthalmologic evaluations,including Scheimpflug corneal densitometry and Pentacam HR measurements.Those who initiated systemic treatment for RA were monitored at first,third,and sixth-month follow-ups.Participants who achieved remission at each follow-up assessment were included.RESULTS:Significant differences in corneal densitometry were observed,with higher values in RA patients,particularly in the middle and posterior layers.Anterior segment parameters such as anterior chamber volume and angle were significantly reduced in RA patients compared to other groups(P<0.001).Following systemic treatment and achievement of remission,these parameters showed regression toward normal values.CONCLUSION:The study underscores the potential utility of corneal densitometry and anterior segment analysis as sensitive indicators of subclinical ocular involvement in RA,offering insights into disease progression and treatment efficacy.These findings highlight the importance of early detection and regular monitoring in preventing vision-threatening complications in RA patients.
文摘BACKGROUND Sleep disturbances are a prominent feature of bipolar disorder(BD)and often persist even in remission,thereby contributing to poor clinical outcomes.Despite the widespread use of lithium and valproic acid as mood stabilizers,their effects on sleep quality have not been examined in adequate detail.AIM To evaluate and compare the effects of lithium and valproic acid on sleep quality in BD patients under remission.METHODS A total of 130 patients meeting the Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition criteria for BD in remission were included in this crosssectional study.The participants were receiving either lithium(n=78),or valproic acid(n=52),for a minimum of six months either alone or in combination with antipsychotics.Sleep quality was measured using the Pittsburgh Sleep Quality Index(PSQI).Comparative analyses between the lithium and valproic acid groups were conducted using independent t-tests,χ^(2)tests,and ANCOVA,adjusting for key variables such as age,sex,and body mass index.RESULTS Both groups demonstrated poor sleep quality,with the mean PSQI scores above the clinical threshold of 5.Patients in the lithium group exhibited significantly better habitual sleep efficiency(lithium:0.47±0.65,valproic acid:0.78±0.87,P=0.009)and fewer sleep disturbances(lithium:1.26±0.57,valproic acid:1.61±0.84,P=0.005).Other sleep parameters,including total sleep duration(P=0.082)and sleep latency(P=0.625),did not differ significantly.CONCLUSION Patients in the lithium group showed significantly better habitual sleep efficiency and fewer sleep disturbances compared to those receiving valproic acid,although other sleep parameters did not differ.These findings suggest a potential advantage of lithium in certain aspects of sleep quality in BD patients under remission.Future studies using objective sleep measures and longitudinal designs are warranted to confirm these findings.
文摘BACKGROUND In the treatment of rectal cancer,a temporary loop ileostomy(TLI)is created after low anterior resection to protect bowel function in the postoperative period.Dehydration and kidney failure are significant potential complications in loop ileostomies.Compared to late closure(3-6 months),early closure(10-14 days)of the TLI may facilitate faster patient recovery and shorter hospital stays.AIM To compare early and late closure of TLIs and demonstrate that early stoma closure can be performed without increasing morbidity.METHODS This study included patients who underwent TLI for rectal cancer,with data collected prospectively between June 2016 and October 2024 and analyzed retrospectively.Patients whose stomas were closed in the late period(3-6 months)between June 2016 and October 2022(group A)were compared with those who underwent early closure(10-14 days)between October 2022 and 2024(group B),with the primary outcome being complication rate and the secondary outcome being quality of life.RESULTS A total of 270 TLIs were created(70.9%).Of these,120(44.4%)were closed in the late period(group A),and 150(55.6%)were closed in the early period(group B).There was no statistically significant difference between group A and group B in terms of demographic and clinicopathological characteristics(P>0.05).Perioperative(anesthesia management,operative time,blood loss,surgical technique)and postoperative findings(anastomotic leak,infection)were similar between the two groups and were not statistically significant(P>0.05).There were no statistically significant differences in complication rates as the primary outcome between the two groups.Quality of life as a secondary outcome was significantly higher in the early closure group(P<0.05).CONCLUSION No statistically significant difference was found between early and late loop ileostomy closure in terms of perioperative and postoperative morbidity.Early closure accelerated patients’psychological and social recovery.
文摘Aim:The aim of this study was to investigate the factors affecting treatment success in children that got either pyeloplasty or J stent placement in ureteropelvic junction obstruction(UPJO).Patients and Methods:The study comprised 126 patients who either J stent placement or pyeloplasty performed by the same physician for UPJO from 2012 to 2022.The criteria for surgical intervention adhered to the European Association of Urology(EAU)recommendations.Symptomatic patients with verified obstruction,with a split renal function(SRF)over 40%,low-grade hydronephrosis(Society of Fetal Urology grade 2),and an obstructive segment measuring less than 1 cm,had Double-J stent placement.Furthermore,in infants exhibiting poor health or development retardation,a J stent was inserted as a temporary measure to alleviate obstruction and maintain renal function,notwithstanding the recommendation for pyeloplasty.Results:The treatment success rate was 43.9%in the J stent group and 88.4%in the pyeloplasty group,with a statistically significant difference(p<0.001).The kind of procedure(pyeloplasty vs.stent)was the sole independent prognostic factor predicting treatment success(HR:4.77,p<0.001)in the multiple logistic regression analysis.No statistically significant change was observed in preoperative and postoperative SRF(48%vs.48.5%,p=0.923)among patients with stent failure,confirming a transient preservation of functional advantage.Conclusion:The placement of a stent may have restricted success rates in specific patients with UPJO.Preserving renal function may be advantageous until definitive surgery,particularly in cases where there are hazards associated with anesthesia and invasive procedures.
文摘Background:Obesity remains a major global health challenge,closely linked to individuals'health beliefs and lifestyle behaviors.Descriptive and relational research methods were used to ascertain the correlation between health beliefs and healthy lifestyle behaviors in obese individuals based on the Health Belief Model.Methods:The population of the research are obese individuals who are treated in the internal medicine clinic in a state hospital in Diyarbakır and applied to a dietitian.Based on power analysis,the study’s sample consisted of 192 obese people.The health belief model scale in obese individuals(HBMSO),the Healthy Lifestyle Behaviors Scale-II(HLBS-II),and the Personal Information Form were used to gather the data.The data was evaluated using the following methods:mean,standard deviation,linear regression analysis,Mann-Whitney U test,Kruskal-Wallis test,Shapiro Wilk and Kolmogorov Smirnov tests,post-hoc Dunn-Benferronni tests,Pearson and Spearman correlation,and others.Results:It was determined that 26.0%of obese individuals were in the 46–55 age range,63.5%were female,64.6%were married,60.4%had a BMI in the range of 30–34.9 kg/m^(2),and 42.7%partially exercised.All sub-dimensions and HBMSO sub-dimensions had statistically significant correlation with the HLBS-II total score.The linear regression analysis results used to identify the predictors of the HLBS-II total score showed that the increase in the level of education and the HBMSO“Importance of Health”sub-dimension score increased the HLBS-II total score,while not exercising and an increase in the HBMSO“Obstacle Perception”sub-dimension score decreased the HLBS-II total score.Conclusion:Individuals’health attitudes have a major impact on leading a healthy lifestyle,which is consistent with the research results.
文摘Dear Editor,We recently reviewed two important studies that investigate the use of botulinum-A toxin(BoNT-A)injections into the bulbospongiosus muscle as a treatment for lifelong premature ejaculation(PE).While both studies share the goal of evaluating the efficacy and safety of BoNT-A in this context,they reached very different conclusions.The study by Shaher et al.demonstrated significant improvements in ejaculatory latency,indicating that BoNT-A injections may be a helpful treatment for PE.
文摘BACKGROUND Although previous findings indicated that pathological assessment of tumor budding(TB),desmoplastic reaction(DR),and tumor-infiltrating lymphocytes(TILs)may play a role in determining tumor behavior in many malignancies,the relationship between TB,DR,and TILs in patients with pancreatic ductal adenocarcinoma(PDAC)is still unknown.AIM To evaluate relationships of TB,DR,and TILs with histopathological parameters and determine their prognostic value in patients with PDAC.METHODS The study cohort comprised 100 patients diagnosed with PDAC.Peritumoral budding(PTB)and intratumoral budding(ITB)were assessed according to the International Tumor Budding Consensus Conference guidelines.DR was classified based on stromal maturation.TILs were evaluated semiquantitatively with a 5%cutoff.Additionally,cases were categorized into two groups according to lymphocyte density:No/Low lymphocytes and medium/high lymphocytes.RESULTS A significant correlation was observed between ITB and PTB(r=0.890).Higher PTB was associated with fewer TILs and immature stroma(P<0.001).PTB and TILs were significantly related to tumor dimension,lymphovascular invasion,lymph node metastasis(LNM),and stage(P<0.005).ITB was also associated with the presence of lymph node involvement.The results of the univariate analysis revealed a significant correlation between poor survival rates and the presence of lymphovascular invasion,LNM,PTB,ITB,and TILs according to scoring(P<0.001).The multivariate analysis revealed LNM,PTB,ITB,and TILs according to scoring as independent prognostic factors.CONCLUSION TB assessment stratified patients with PDAC.PTB-ITB correlation showed diagnostic relevance of ITB in biopsy specimens.The prognostic significance of DR and interplay with TIL subsets warrant further investigation.
文摘BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an invasive endoscopic procedure used mainly to treat hepato-pancreato-biliary(HPB)diseases.The need for ERCP has increased with the rising number of HPB diseases over the past decade.Thus,due to increased demand,ERCP is performed at more centers.Currently,it is performed by general surgeons,gastroenterology and invasive radiology specialists in the United States and Europe as recommended by the British Society of Gastroenterology(BSG).AIM To present the results of ERCP procedures from fourteen surgical centers in Türkiye.METHODS Fourteen surgical centers performing ERCP were included in the present study.The age,gender,ERCP indication,success status,post-ERCP complications,ERCP reports and the files of 66993 patients who underwent ERCP were collected from the participating centers.The results are discussed according to the targets declared by the BSG,which are volume load per annum,proportion of successful cannulation(>85%),bile duct clearance rate(>75%),stenting rate for strictures(>80%)and complications(<6%).RESULTS A total of 66993 ERCP procedures were performed in the centers included in the study up to August 2024.29250(43.6%)of the procedures were performed urgently,especially for suppurative cholangitis,biliary tract injuries,etc.The remaining 37743(56.4%)cases were performed electively.50.2%of the patients were female and 49.8%were male.The average ages were 56.5 years for women and 55.9 years for men.General anesthesia was used in 84.1%of the patients while sedation was used in 15.9%.The indications were bile duct stone(78.7%),pancreatic tumor(3.9%),papillary tumor(3.3%),cholangiocarcinoma(2.6%),Oddi sphincter dysfunction(2.4%),bile leakage after cholecystectomy(2%),bile leakage after hydatid cyst surgery(1.9%),biliary stricture(1.7%),and other diseases(3.1%).Hyperamylasemia and post-ERCP pancreatitis were the most common complications as observed in 8.1%of the patients.They were usually self-limited and responded to supportive measures.The frequency of the other complications was also consistent with the literature.CONCLUSION There is a huge shortage of ERCP endoscopists worldwide due to insufficient ERCP training and centers especially in developing and underdeveloped countries.As patients requiring ERCP usually present to surgical practitioners,the incorporation of surgeons into this training program is an effective and reliable solution.The BSG recommends the incorporation of surgeons and radiologists in addition to gastroenterology specialists.This study is the first to present the results of ERCP procedures from fourteen surgical centers throughout Türkiye.The results suggest that the surgical centers included were able to achieve the targets set by the BSG.This study demonstrated that the surgical ERCP units in the present work have reached satisfactory results and provided a reliable and successful ERCP service.There are currently no issues regarding the validity and appropriateness of the surgeons performing ERCP.Therefore,ERCP training should be encouraged in surgeons and more surgical ERCP centers should be provided.
文摘AIM:To assess and compare the conjunctival bacterial flora in patients with congenital ptosis(CP)to that of healthy individuals.METHODS:The study included 38 patients with CP and 42 healthy control subjects.Conjunctival cultures were collected using a cotton-tipped swab applied to the inferior conjunctival fornix.The samples were inoculated into blood agar,eosin methylene blue agar,chocolate agar for bacteria,and Sabouraud dextrose agar medium for fungi.RESULTS:The culture positivity rate was 68.4%in CP and 47.6%in the control group(P<0.001).Additionally,there was a significant difference in culture positivity between the eyes of patients with unilateral ptosis(P=0.039).In the CP group,the most common found microorganism was Staphylococcus epidermidis at 23.67%,followed by Haemophilus species at 21.04%,and Corynebacterium species at 15.78%.In the control group,Staphylococcus epidermidis and Corynebacterium species were both the most commonly isolated microorganisms,each accounting for 19.04%.More than one species of bacteria was grown in the cultures of 36.84%and 23.80%of the CP and control subjects,respectively.Gram-negative bacteria were more common in CP than in control subjects(P=0.031).CONCLUSION:Culture positivity is significantly higher in the ptotic eyes of CP.Potentially pathogenic microorganisms are more frequently isolated from the CP group compared with the healthy control group.
文摘Background: The lumbar artery perforator(LAP) flap is an important autologous option in breast reconstruction.As the lumbar perforator flap is relatively new in this field,several questions remain regarding preoperative preparation,especially concerning computed tomography(CT) and magnetic resonance imaging of the donor site.The objective of this study was to aid the surgical approach to the LAP flap in female patients by precisely determining the characteristics of the lumbar perforators.Methods: We retrospectively reviewed the computed tomographic angiography images of 20 patients who underwent evaluation of the perforator positions from the four lumbar arteries.Four characteristics were studied:length,diameter,path of the lumbar pedicle,and thickness of the tissues available for transfer.Results: We analyzed 20 CT images,identifying 149 perforating vessels of the lumbar artery.The most suitable perforator for flap harvesting was the L4 perforator,which exhibited a larger diameter,a greater number of perforasomes,and a higher percentage of the cutaneous-septal tract.Conclusion: The LAP flap is a viable option for breast reconstruction and as a free flap in women.The L4 perforator artery is the most suitable for harvesting,owing to its superior perfusion capacity,diameter,and course;however,an interposition graft may be required to lengthen the vascular pedicle.
文摘BACKGROUND Metastatic colorectal cancer(mCRC)is a global health challenge with a poor prognosis.Prognostic markers are critical for survival prediction.METHODS This multicenter,retrospective study measured baseline carcinoembryonic antigen and carbohydrate antigen 19-9 levels to calculate a TMI as the geometric mean of values normalized to their upper limits of normal.Receiver operating characteristic curve analysis assessed TMI’s prognostic accuracy,and patients were stratified into high-TMI(≥1.39)and low-TMI(<1.39)groups.The primary endpoint was overall survival(OS),with progression-free survival and treatment response as secondary endpoints.RESULTS The study included 305 mCRC patients with a median follow-up of 22.9 months.The median OS for high-TMI patients was 29.5 months,significantly lower than the 45.6 months observed in the low-TMI group(P=0.02).The 2-year OS rates for the high-and low-TMI groups were 59.4%and 72.9%,respectively.Median progression-free survival was also shorter for the high-TMI group(14.0 vs 16.0 months,P=0.84).High TMI is an independent prognostic factor for worse OS.CONCLUSION TMI is a simple,cost-effective prognostic tool for mCRC,with high TMI associated with poorer survival outcomes.
文摘The historical dogma that bladder calculi comprise the main indication for prostatic surgery has recently been questioned.In this study,we aimed to predict which patients should undergo simultaneous prostate and bladder calculi surgery or only bladder calculi removal by evaluating preoperative risk factors.One hundred and seventeen men with bladder stones and concomitant benign prostate enlargement(BPE)who had not received medical treatment before were included in the study.In the first step,only the bladder calculi of patients were removed and medical treatment was given for BPE.The patients who benefited from medical treatment during the follow-up were defined as Group 1 and the patients who required prostate surgery for any indication comprised Group 2.Risk factors for prostate surgery requirements were determined by comparing preoperative characteristics between the two groups with a cox regression model.In the follow-up of 117 patients with bladder stones removed and medical treatment initiated,49(41.9%)patients had prostate surgery indications.The indication for 33(67.3%)of 49 patients was medical treatment failure.The presence of intravesical prostatic protrusion(IPP;hazard ratio:2.071,95%confidence interval[Cl]:1.05-4.05,P=0.034),and high postvoiding residual urine volume(hazard ratio:1.013,95%Cl:1.007-1.019,P<0.001)were found to be preoperative risk factors for needing future prostate surgery.In patients who have not received medical treatment for BPE before,bladder calculi developing secondary to BPE do not always constitute an indication for prostate surgery.
基金Supported by Recep Tayyip Erdogan University(Grant No.BAP2012.102.03.4.and BAP-2013.102.03.4)
文摘Objective:To investigate the antibiotic resistance genes inserted into class I and class 2integrons in Acinetobacler baumannii[A.baumannii)isolates obtained from nine different cities in Turkey.Methods:A collection of 281 A.baumannii clinical isolates were collected from nine diferenl state hospitals in Turkey and were confirmed as A.baumannU by conventional biochemical,API testing and bla_(-OXA-51)specific PCR.The isolates were examined by PCR for existence of class I and2 integron gene cassettes.Results:They were characterized by antimicrobial susceptibility testing and the highest resistance rates were determined for piperacillin(90.03%),ciprofloxacin(87.54%),cefepime and trimethoprim/sulfamethoxazole(81.13%).The lowest resistance rates was for cefotaxime(3.55%).class 1 integrons were detected in 6.4%(18/281)of A.baumannii strains and no class 2 integron was detected.The gene casselles of class 1 inlegrons AacCI-AAC(3)l-aadAI,AacCI-aadA1,AAC(3)-I,AAC(3)-I-AAC(3)-I-aadA1,TEM-1.AAC(3)-I-aadA1-AAC(3)-I-AAC(3)-I,AAC(3)-I-AAC(3)-I-AAC(3)-I-aadA1,AAC(3)-I-aadA1,AAC(3)-I-AAC(3)-I,AAC(3)-I-aadA1-AAC(3)-I-aadA1,AAC(3)-I-AAC(3)-I-aadA1-AAC(3)-I-aadA1 were detected in eighteen strains.The aac genes family were most frequently found integrated into the class 1 inlegrons and it was followed by aadA genes and TEM-1 genes.Conclusions:This is an extensive study on the distribulion of class 1 integron among A.baumannii in Turkey.In addition to these,two new alleles were observed.Their percentage rates of similarity to other cassettes are 95%aadA1(TK A18)and 89%,aadA 1(ANKA3).
文摘Objective This study aimed to investigate the level of knowledge among urologists of usage of fluoroscopy during percutaneous nephrolithotomy.MethodsWe conducted an anonymous internet-based survey addressed to the EAU Section of Uro-Technology and the International Alliance of Urolithiasis members with particular interest in the stone treatment at all levels of expertise.The final version of the questionnaire included 31 questions,evaluated the level of knowledge on X-ray utilization and exposure,and identified correlations between geographic areas,levels of seniority,surgical volumes,and awareness on radiation protection.ResultsIn total,586 respondents were included.Knowledge of fluoroscopy settings appeared low,particularly among trainees(up to 87.5%were uninformed,p=0.008).Precautions to reduce exposure appeared poorly followed as up to 25.4%of respondents used regularly continuous fluoroscopy,and up to 20.5%used regularly high-frequency setting and this trend was more obvious among senior specialists(6.2%of trainees used high-frequency settings vs.21.3%of consultants,p<0.05).Additionally,only 24.9%of respondents would provide X-ray protection to patients too.ConclusionAlthough high and routinary utilization of X-rays,the level of awareness and adhesion to“as low as reasonably achievable”principles among endourologists seems suboptimal in 65.0%of all respondents.Highest volume surgeons,inevitably at higher risk,do not seem to adopt more precautions.More efforts should be addressed to improve these results,reducing the risk related to excessive radiation exposure for both surgical staff and patients in order to minimize health related issues.
文摘Objective:An investigation of an outbreak of measles in a district in Nigeria was initiated following confirmation of the outbreak.The objectives of the study were to assess the size and determine the cause of the outbreak. Methods:Visits were made to health facilities and affected communities.Cases were line-listed using specified forms and descriptive epidemiology carried out on collected data.Results:A total of 18 cases and 0 deaths were identified over a period of six weeks.Two of the cases(11%) were 【 9 months of age.The proportion of zero-dose children was 39%.Conclusion:Low herd immunity was suggested as the cause of the outbreak.
