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The purpose of simulation is to refine the process of surgical training through valid, reliable, and feasible platforms. Immersive technology describes a spectrum of simulation platforms which balance the physical world on one end and the virtual world on the other. The value of immersive technology in urological simulation has been evidenced by a prolific literature base. This has demonstrated its pedagogic value and cost-efficiency with increasing investments in science and technology in order to advance the models and modalities available to deliver simulation. Urology is a unique specialty, at the forefront of innovative surgical techniques, with a trend towards progressively minimally invasive surgery, featuring a range of laparoscopic, robotic and endoscopic procedures, each associated with a unique learning curve. As a result, it is important to cater the simulation model to the type of urological procedure practiced and the needs of the learner. This chapter also discusses how the implementation of these technologies both in surgical training and in the operating theatre has been accelerated by several historic pressures on surgical training, such as the introduction of the European Working Time Directive and more recently, the COVID-19 pandemic, which exposed deficiencies in existing systems and reiterated the value of virtual platforms. These technologies are beneficial in the formative years of surgical training, aiding the development of technical and non-technical skills as well as in the real-life operative setting, clinical application, enhancing patient treatment and aiding doctor-patient collaboration. Finally, research and innovation consider the potential of immersive technologies to advance surgical practice and techniques by providing an intermediary between laboratory based research and the real world, bypassing some of the ethical concerns associated with conducting research in the context of surgery. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
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Aim: COVID-19 has the potential to affect many systems and organs, resulting in serious clinical symptoms that necessitate admission to the intensive care unit. The purpose of this study was to examine the relationship between CAR, other laboratory findings, comorbidities, and mortality in patients infected with the original SARSCoV-2 or other variants.Materials and Methods: The data of 368 patients admitted to the intensive care unit with COVID-19 pneumonia between March 2020 and July 2021 were analyzed. These patients were divided into two groups. The first group included [(OC) Original SARSCoV-2 ] COVID-19 infected patients in the first period of the pandemic. The second group [(OV) Other Variants] included patients with COVID-19 infection due to other variants.Results: The mean age (Mean +/- SD) in the OC group was 69.79 +/- 11.77 years. The mean age of the patients in OC was higher than in the OV group (p=0.001). The most common comorbid disease in both groups was Hypertension (54.1%, 48.8%), followed by diabetes mellitus (DM) (30.2%, 31.6%). The mean age of the survivors in the OC and OV groups was lower (64.53 +/- 13.04, 57.85 +/- 16.78, p=0.001, p=0.001, respectively). It was observed that albumin and lymphocyte counts were lower in the deceased, while LDH, CRP, Neutrophil, procalcitonin, NLR and CAR were higher (p<0.05). Discussion: In critically ill COVID-19 patients, high CAR and NLR are good predictors of mortality. In the period when the variants were dominant, the mean age of the patients and the length of stay in the intensive care unit were lower.
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The COVID-19 outbreak has affected healthcare systems around the world, and has led to changes in the clinical and treatment approaches to all diseases. To reveal the reflection and negative effects of the psychological trauma associated with the COVID-19 pandemic among those with acute appendicitis. A retrospective analysis is made of the data of patients admitted to the emergency departments in our city (Trabzon, Turkey) and taken into operation. Comparative analysis of two patient groups diagnosed with acute appendicitis in our region was included in our study: In the COVID-19 pandemic period (Group 2);and on the same dates a year ago (Group 1). Groups 1 and 2 comprised 231 and 144 patients, respectively (p<0.001). There was no statistically significant difference in the type of anesthesia between the groups (p=0.280). There was no statistically significant difference between the groups in terms of median duration of surgery (p=0.239). There was a statistically significant difference in the pathological diagnoses of Groups 1 and 2 (p<0.001). Considering the pathological diagnoses, a significant difference was established in the duration of hospital stay of the cases, which was longer in patients diagnosed with perforated appendicitis (p<0.001). It is apparent that during the COVID-19 outbreak, hospitals are associated with increased transmission risk, causing people to delay their referral to the emergency department, and leading to an increase in irreversible complications and mortality rates. Copyright © 2022 Ondokuz Mayis Universitesi. All rights reserved.
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BACKGROUND AND AIM: Obstructive sleep apnea (OSA), having an increased inflammatory state due to an imbalance between sympathetic and parasympathetic activity, intermittent hypoxia, and increased cytokines, may aggravate the immune response for COVID-19 infection. Our aim was to evaluate the effect of OSA upon inflammatory response and length of stay in patients with favorable outcomes. METHODS: Patients admitted to an outpatient clinic after being hospitalized for treatment of COVID-19 were included consecutively in this cross-sectional multicenter observational study. STOP-Bang Questionnaire and a cut-off value of 3 points were used to identify patients with a high risk of OSA. RESULTS: Study population consisted of 201 patients with a median STOP-Bang score of 2.0 (1.0-4.0) points. According to the cut-off value of 3 points, 94 (46.8%) patients were classified as high-risk OSA patients. High-risk OSA patients were older, had many comorbidities such as hypertension, coronary artery disease, and diabetes mellitus, had higher serum D-dimer, ferritin, C-reactive protein, and procalcitonin measurements, and had a longer hospital stay. Possible risk factors associated with length of stay were age, lymphocyte count, and total STOP-Bang score. Multivariable analysis revealed that a 1 point increase in STOP-Bang score results in a 0.43 day longer hospital stay. CONCLUSIONS: Prevalence of OSA within COVID-19 patients with favorable outcomes is similar to the general population. However, the length of stay is related to the presence of high-risk OSA. Our study, therefore, suggests that OSA is related to delayed improvement of COVID-19 infection.
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Introduction: As of June 27, 2022, the COVID-19 pandemic has caused over 540 million infections and 6.3 million deaths. We aimed to investigate the effect of the vaccine on the clinical course of elderly patients hospitalized in the intensive care unit and to determine the prognosis of the patients according to their vaccination status. Material(s) and Method(s): The study included 157 patients over the age of 65. Patients were divided into two groups. The first group consisted of patients who were vaccinated with two doses of CoronaVac, and the second group consisted of patients who were not vaccinated. Demographic data of the patients, prehospital clinical frailty scales, Charlson Comorbidity Indexes, APACHE II scores, laboratory values, and patient prognoses were recorded. Result(s): Of the 157 patients, 93 (59.2%) were female, and the median age was 76 years (65-99). 96 (61.1%) patients were vaccinated and 61 (38.9%) patients were unvaccinated. Patients were grouped as survivors (n=26) and deceased. We found that APACHE II, prehospital clinical frailty scales, and Charlson Comorbidity Indexes scores were higher in patients who died. There was a significant difference between blood lymphocyte and ferritin levels and survival. The 28-day survival rate was higher and intensive care unit overall survival time were longer in the vaccinated group. Conclusion(s): We observed that the vaccinated patients had higher survival times and lower mortality rates than those who were not vaccinated. We think that it is important to vaccinate elderly patients and that additional doses may be needed. Copyright © 2022, Geriatrics Society. All rights reserved.
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Background and Aim: We aimed to evaluate cardiac manifestations of the multisystem inflammatory syndrome in children(MIS-C) and the changes in cardiac function during one year of follow-up. Method(s): All children diagnosed as MIS-C with cardiac involve-ment were enrolled in this prospective study. The diagnosis and severity of the disease of MIS-C was made according to the Centers for Disease Control and World Health Organization guidelines. Clinical findings, laboratory parameters including car-diac markers, electrocardiographic and echocardiographic findings at the time of diagnosis and during follow-up were evaluated. Cardiac magnetic resonance imaging (MRI) was performed on all children with echocardiographic abnormality. Result(s): Between April 1st 2020 and December 1st 2021,71 chil-dren were diagnosed with MIS-C and 44 of these patients had car-diac involvement (25 male and 19 female). 24 patients were followed up in the intensive care unit and all of these patients had myocardial involvement. All the patients had elevated NT-proBNP levels (median:5893pg/ml) whereas troponin-T levels were above upper limit in 13 patients. A significant positive cor-relation was found between troponin-T and NT-proBNP (plt;0.01). The NT-proBNP levels were also positively correlated with the severity of MIS-C (plt;0.05). On admission 22 patients had tachycardia and atrioventricular conduction disturbances and supraventricular tachycardia developed in 5 of these patients during follow-up. Bradycardia was observed in 18(40%) patients during hospitalization (4 of these occurred after tachycardia). Although 26 patients had an echocardiographic abnormality, only twelve patients had systolic dysfunction (9 with mild and 3 with moderate) and two patients had diastolic dysfunction. NT-proBNP and troponin-T were negatively correlated with ejection fraction ve fractional shortening (respectively, p = 0.003, p = 0.013). Cardiac MRI was normal in all patients except 3 patients who had myocardial late gadolinium enhancement of left ven-tricle. Pericardial effusion was observed in 14 patients. The echo-cardiographic abnormalities disappeared in 42 patients during follow-up, one patient died on the second day of hospitalization and and 1 patient has ongoing LV systolic dysfunction. Conclusion(s): Bradycardia and myocardial involvement is common during MIS-C. Although myocardial dysfunction can be observed during acute disease, commonly the disease does not cause perma-nent damage during one year of follow-up.
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Objective: Sleep disturbances are reported as common in children during the COVID-19 outbreak. This study was designed to investigate relationship between sleep problems of children and depression/anxiety symptoms in both children and their parents. Methods: A total of 372 parents completed a web-based survey on sociodemographic and clinical data. The psychiatric status was assessed using Depression Anxiety and Stress Scale-21 (DASS-21), Health Anxiety Inventory (HAI), Revised Child Anxiety and Depression Scale–Parent Version (RCADS-P), and Sleep Disturbance Scale for Children. Results: It was found that significant sleep disturbances were higher in school-aged children (P =.015). HAI and RCADS-P scores were higher in children with sleep disturbances in all developmental periods. DASS-21 subscale scores were higher in preschoolers and school-aged children with significant sleep disturbances. Conclusion: Depression and anxiety symptoms in children and parents are associated with sleep problems in children. In addition, school-aged children can be thought to be more at risk for depression/anxiety symptoms and sleep problems. Psychiatric evaluation of children and their parents is recommended when sleep problems occur in children during the COVID-19 outbreak.
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The frequency of sudden loss of smell is quite high among the COVID-19 symptoms described. On the other hand, striking modifications can result due to viral infection in terms of neuronal renewal and function. Viral infections promote an increase in the turnover of the epithelium cells. A 55-year-old male patient who suffered from anosmia after a nasal trauma he received while doing kung-fu 34 years ago and whose sense of smell changed during COVID-19 is presented.
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The Covid-19 related restrictions have severe effects on individuals' ability to perform physical activities. As a result of the isolation measures, people stayed at home and could not sustain an active lifestyle. However, maintaining physical activity is even more critical during the pandemic considering its positive impact on mental well-being and its impact on general health (Dwyer et al. 2020;Matias et al. 2020;Teferi 2020). Given the importance of adherence to physical activity during the pandemic, understanding factors that influence exercise behavior is valuable. The objective of the study is to test a model of leisure-time exercise behavior that integrates participatory and regulatory motives in the context of Covid-19 pandemic conditions. It is suggested that physical participation motives, which relate to physical goals individuals try to achieve with exercise, influence regulatory motives, which relate to exercise behavior's underlying reasons (Ingledew and Markland 2008). The effects of isolation, positive and negative affect, amount of stress, and ability to handle stress on exercise participation motives and exercise behavior are also examined. An online survey is employed to gather data from 283 university students. The data is analyzed using structural equation modeling. The study results demonstrate that physical and psychological exercise participation motives are significantly associated with exercise behavior. Concerning the behavioral regulation constructs, it is revealed that intrinsic and introjected regulation predict exercise behavior. Additionally, while isolation and negative affect have a negative impact, coping with stress positively impacts exercise behavior. Moreover, it is shown that the indirect effects of participatory motives on exercise behavior are mediated by amotivation and intrinsic regulation. Finally, significant mediating effects of exercise participation motives are shown linking positive and negative affect, ability to cope with stress, and exercise behavior. The findings of the study provide practical implications for exercise promotion and intervention programs. For instance, since isolation and negative affect reduce exercise behavior, designing in-home physical activity routines, providing counseling for people, and teaching them stress reduction techniques such as meditation and breathing are recommended. Furthermore, it is suggested that emphasizing the fun aspect of exercise and avoidance of guilt may improve the persuasiveness of exercise promotion campaigns. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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In this study, it is aimed that the experiences of post-traumatic growth in individuals treated for coronavirus (COVID-19) are examined. In this research, in-depth individual interviews were carried out with those over the age of 18 years old who had been diagnosed and completed treatment for COVID 19 and agreed to participate to the research. The research was conducted with 16 individuals (22-45 years) who met the research criteria. A phenomenological qualitative research method was used for this study. The data was gathered over the internet-based teleconferencing programs (Zoom, Google Meeting, Skype, etc.) in order to prevent the spread of COVID-19. The thematic analysis method was used in the data analysis. In consequence of the qualitative data analysis, two categories were obtained as " Effects of COVID-19" and "Post Traumatic Growth." In the category of the effects of COVID-19, three themes and five subordinate themes were established, and in the category of post-traumatic growth, two themes and eight subordinate themes were established. As a result of the research, it was established that the perspectives of individuals who experienced this sickness on life and their self-perception were positively developed, their relationships were strengthened, and the support resources surrounding them positively affected them during the period. The research presents significant experiences with regard to planning and implementing interventions aimed at the factors that promote psychological growth in COVID-19 patients. © 2022, Cyprus Mental Health Institute. All rights reserved.
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Novel coronavirus or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes severe respiratory infectious disease, known as coronavirus disease-19 (COVID-19). Over the past few months, a considerable rise in the incidence rate and prevalence of COVID-19 infection have been witnessed. Considering the high disease burden and rapid spread of the COVID-19 and no effective treatment is currently existing, stem cells, engineered nanobiomaterials, natural killer cells based therapy, RNA metabolites and extracellular vesicles are promising alternatives to tackle devastating epidemic. This review spotlights the applications and potential of above-mentioned methods in the treatment of COVID-19.
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The COVID-19 pandemic continues infecting people causing deaths globally. Although various medicines have been tried to combat with COVID-19, there is no medicine or treatment that has been validated yet. People have been using natural products for centuries against bacterial and viral illnesses. This study aimed to test the effects of the biomolecule oleuropein, whey collected from industrial waste and soaproot extracts obtained from Gypsophila arrostii Guss. var. nebulosa Boiss. & Heldr. and Saponaria officinalis L. on the expression of the human ACE2 gene as SARS-CoV-2 receptor on the A549 adenocarcinoma cell-line by Real-Time Quantitative Polymerase Chain Reaction (qPCR). According to the cytotoxicity tests, G. arrostii var. nebulosa and S. officinalis extract treatments showed a dose dependent cytotoxic effect on the cells. The EC50 values of G. arrostii var. nebulosa and S. officinalis were found to be 54.3 mu g/ml and 17.3 mu g/ml, respectively. Oleuropein showed moderate cytotoxic effects with the EC50 value over 250 mu g/ml. Whey (fermented and non-fermented) did not show any cytotoxic effect at the applied doses. The qPCR results showed that the ACE2 mRNA level decreased by 89.8% and 35.2% due to the fermented and non-fermented whey extracts, respectively. Similarly, G. arrostii var. nebulosa and S. officinalis downregulated ACE2 by 79.8% and 90.1%, respectively. In contrast, oleropein upregulated ACE2 (102.8%). Our results showed that the natural supporting products produced from soaproot extracts and fermented whey can be used against COVID-19 by both cancer patients and people in potential risk groups.
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Purpose: The aim of this study is to examine the levels of intolerance of uncertainty, rumination and resilience among healthcare workers during the COVID-19 pandemic. Materials and Methods: This descriptive and cross-sectional study was conducted with 310 healthcare workers. Data were collected using an Introductory Information Form, the Intolerance of Uncertainty Scale, the Ruminative Thought Style Questionnaire and the Brief Resilience Scale. Results: In this study, it was found that ruminative thinking style was lower in healthcare workers aged 37 years and over and with more experience, and higher in shift workers. As a result of multiple linear regression analysis, it was determined that intolerance to uncertainty and psychological resilience have a significant effect on ruminative thinking style. Intolerance of uncertainty and resilience explained 38.5% of the total variance in rumination, and both variables were identified as significant predictors of rumination. Conclusion: The levels of intolerance of uncertainty and rumination among healthcare workers can be reduced by closely monitoring the working conditions and mental states of the workers and developing programs to protect the workers from potential negative psychological effects and to improve their resilience.
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Objective: We aimed to investigate the content of Covid-19 news in the media before and after the declaration of the first Covid-19 case in Turkey, as well as the compatibility of their medical massages with World Health Organisation (WHO) data. Methods: In this descriptive cross-sectional study, Covid-19 news in Turkey's most visited webpages of five newspapers and five internet news sites was examined retrospectively for two months categorized as the periods of one month before and one month after the first Covid-19 case declaration in Turkey. The news was evaluated according to their content, sources, content and headline compatibility, evidence and accuracy levels in terms of WHO reports, its potential to evoke social negative emotions such as anxiety, fear, panic, and to produce negative bias against China. Statistical analysis was performed by using the SPSS 21 program and the results were expressed as numbers and percentages. Results: It was determined that in total of 7915 news, the most content was about the protection and prevention methods. In the news before and after the first case declaration in Turkey, the content-headline incompatibility rates were 50,8% and 1,1%;incompatibility rates of the medical information in the news with WHO reports were 7,1% and 2,9%;the rates of referencing were 74,3% and 66,9%, the rates of the news having the potential to produce anxiety and fear in the reader were 56,9% and 19,6% and to produce prejudice and negative attitudes towards China were 19,7% and 4,6%, respectively. Conclusions: It seems that the declaration of the first Covid-19 case changed the news making pattern of the media to a more responsible behaviour for the public. We suggest that it is a rational approach to use the power of the media correctly in enhancing public awareness towards Covid-19 pandemic.
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Objective: MIS-C is a rare hyperinflammatory syndrome requiring intensive care due to severe cardiovascular effects associated with COVID 19. It has been reported that 68% of the patients need intensive care, while about 4% need extracorporeal membrane oxygenation (ECMO). The mortality rate of cases developing ECMO need has been reported as 22.5%. Methods: We reported a patient who developed a need for ECMO with a diagnosis of severe MIS-C and who was successfully weaned from ECMO. Results: Herein we present a 14.5-year-old female patient who was diagnosed with MIS-C because of fever, diarrhea, and COVID 19 antibody positivity. Inotrope treatments were started immediately after the development of fluid-resistant hypotension. Plasma exchange, IVIG, pulse steroid and anakinra treatments for immunomodulation were started. Vasoactive inotrope score of the patients was 42 and ejection fraction was 20% in echocardiography. Despite inotropic support and immunomodulatory treatment hypotension and hyperlactatemia were persisted and patient was put on V-A ECMO on the 3rd day of hospital admission. Second session of plasma exchange was applied to the patient after initiation of ECMO support. Functions of right and left ventricle were improved and inflammatory parameters were decreased under ECMO support. Patient was weaned from ECMO and decannulated on the 6th day of ECMO support. No ECMO complications occurred. Patient was extubated on the 10th day of admission and the patient was supported with noninvasive mechanical ventilation for 3 days. Physiotherapy was initiated because of critical illness myopathy. The patient was discharged with full recovery on the 25th day of hospitalization. Conclusions: ECMO should always be kept in mind as a support method that can bridge recovery in severe MISC patients.
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Introduction: Neurological symptoms in SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infected patients and the course of COVID-19 in patients with neurological findings are determined. Material and methods: Inpatient cases aged =18 years, followed-up in clinical services for COVID-19 diagnosis are studied. Patients were visited on 04.20.2020 and examined for central nervous system (CNS), peripheral nervous system (PNS) manifestations and muscular injury, from onset of symptoms to hospitalization. Risk factors associated with the severity of COVID-19 and the comparison of variables in terms of existence of neurological findings including CNS and PNS findings were performed. Results: Overall, 133 (54%) of the 242 patients of the study were male, mean age was 56.82±16.35 (18-91) years. Of these, 128 (52%) cases were defined as severe COVID-19. Outstanding symptoms at the onset were cough (62.8%), fever (46.7%), dyspnea (45.9%), and tiredness (31%). Further, 82 (33.9%) cases showed neurological findings at the first admission. Of those with neurological symptoms, 25.6% had CNS, 16.1% had PNS, 1.7% had muscular symptoms. In patients with CNS manifestations, the most common symptoms were headache (20.6%) and dizziness (7.4%). Impaired taste was the most common manifestation of PNS (11.2%). Neurological symptoms showed no significant difference between severe and non-severe COVID-19 groups except impaired taste (significantly higher in non-severe group). During follow-up, 17 (7%) patients needed intensive care unit. Nine (3.6%) patients died. Conclusion: Frequency and variety of neurological findings in COVID-19 cases is too high to underestimate. Early diagnosis of these findings may prevent spread of COVID-19.
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Study Objectives: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a hemorrhage control technique involving the intra-vascular occlusion of the thoracic aorta using a balloon catheter and may help to increase coronary and cerebral perfusion during out-of-hospital cardiac arrest (OHCA) by blocking blood flow to the lower body. Primary Objective: The primary objective of this study is to assess the feasibility of an emergency medicine (EM)-initiated multi-disciplinary protocol for REBOA in non-traumatic OHCA. Secondary Objectives: Secondary objectives are procedural outcomes (eg, attempts required for common femoral access), hemodynamic outcomes before and after aortic occlusion (end-tidal carbon dioxide, diastolic blood pressure), and rates of return of spontaneous circulation (ROSC) and survival to hospital discharge with a favorable neurologic outcome. Methods: This single-arm early feasibility study of REBOA initiated in the emergency department (ED) for OHCA uses an investigational device approval with a community exception from informed consent. Subjects under 80 years of age with witnessed OHCA and down time under 45 minutes are eligible. On arrival to the ED, an emergency physician obtains common femoral access using a 7Fr introducer sheath while the REBOA catheter is prepared and subsequently advanced by an interventional radiologist (IR). Results: Two patients were enrolled between January and February 2020, with a temporary pause in enrollment due to the COVID pandemic from March - August 2020. To our knowledge, this is the first trial of ED-initiated REBOA involving emergency physicians for non-traumatic OHCA (two similar recent reports exist in the anesthesia and critical care literature). Our initial patient was a 77-year-old man who presented in refractory ventricular fibrillation. The emergency physician placed the common femoral sheath on the first attempt using ultrasound guidance under chest compressions and the REBOA catheter was then advanced by the interventional radiologist. After inflation of the aortic balloon, investigators noted immediate improvements in mean arterial pressure (MAP) (37 to 50 mmHg) and end-tidal carbon dioxide (ETCO2) (35 to 50 mmHg), with transient non-sustained ROSC. The second patient, a 63-year-old man, underwent successful REBOA placement with similar improvements in MAP (22 to 50 mmHg) and ETCO2 (33 to 43 mmHg). Unfortunately, both patients were in refractory ventricular fibrillation and despite multiple defibrillation attempts and antiarrhythmics they did not survive to hospital admission. Conclusion: REBOA has been hypothesized to improve outcomes in OHCA by blocking blood flow to the lower body and redirecting it towards the heart and brain, improving the perfusion of these vital organs. In both cases, REBOA was temporally associated with improved hemodynamics during chest compressions with transient ROSC in one case. Performance of REBOA by a multi-disciplinary team for OHCA in the ED was feasible in these initial two cases. Future research will examine the feasibility of REBOA catheter advancement by the emergency physician and further quantify the hemodynamic effects associated with aortic occlusion. [Formula presented]