Elevated Cardiovascular Disease Risk in Patients with Restless Legs Syndrome.

Objective: There are studies in the literature that link restless legs syndrome with increasing cardiovascular disease risk. The reason for this was that increased sympathomimetic activation in restless legs syndrome causes tachycardia, hypertension, and autonomic instability. We intended to assess the cardiovascular disease risk in patients with restless legs syndrome using electrocardiogram parameters. Methods: The present investigation compared the demographic characteristics, electrocardiogram variables, and lab results of 40 patients diagnosed with restless legs syndrome with 43 healthy controls. Results: Restless legs syndrome patients had a higher frontal QRS-T angle than healthy control patients. Restless legs syndrome patients had lower hemoglobin, neutrophil, lymphocyte, basophil, albumin, and high-density lipoprotein cholesterol levels. There was a significant increase in eosinophil, platelet, C-reactive protein, total cholesterol, low-density lipoprotein cholesterol, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, and C-reactive protein-to-albumin ratio values in patients with restless legs syndrome. The frontal QRS-T angle is highly correlated with the neutrophil-to-lymphocyte ratio (P = .001). Similarly, monocyte-to-lymphocyte ratio and C-reactive protein-to-albumin ratio values were significantly correlated with frontal QRS-T (P = .011 and P = .24). Conclusion: The fact that frontal QRS-T angle and neutrophil-to-lymphocyte ratio were correlated in the restless legs syndrome group in our study suggests that the inflammatory process may have increased the risk of cardiovascular disease in restless legs syndrome patients. Our findings show that the frontal QRS-T angle is high in restless legs syndrome patients. We conclude that C-reactive protein-to-albumin ratio, neutrophil-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio are higher in the restless legs syndrome patient group and are related to cardiovascular disease risk.

Investigation of Neurological Symptoms Caused by COVID-19 in Intensive Care Unit.

We examined the neurological symptoms of patients treated in intensive care for COVID-19 in this study. We obtained the study data retrospectively from data records of 1,699 patients treated in the COVID-19 clinics of a training and research hospital. The study is a descriptive and cross-sectional study. Sociodemographic and Disease Information Form were used for data collection. Statistical Packed for the Social Sciences 25.0 IBM was used in Data analysis. It was observed that 37% of the COVID-19 patients were between the ages of 66-80 years and 55.6% of the COVID-19 patients were male. The most common neurological symptoms in the disease process and their rates were as follows: insomnia 74.6%, taste loss 74%, smell loss 75.6%, muscle pain 83.2%, headache 45.1%, dizziness 32.2%, weakness 20.2%, and agitation 34.7%. Assessment of neurological symptoms of patients followed up for COVID-19 is of great importance. We suggest that neurological problems should be tried to be cured with appropriate treatment protocols and therapy support before they progress further and the neurological prognosis progresses.

The effect of proliferative hypertrophic scars on determining treatment options for preventing recurrence of vesicourethral anastomotic stenosis after radical prostatectomy: a single-center cross-sectional study

ABSTRACT BACKGROUND: Vesicourethral anastomotic stenosis (VUAS) following retropubic radical prostatectomy (RRP) significantly worsens quality of life. OBJECTIVES: To investigate the relationship between proliferative hypertrophic scar formation and VUAS, and predict more appropriate surgical intervention for preventing recurrent VUAS. DESIGN AND SETTING: Retrospective cross-sectional single-center study on data covering January 2009 to December 2019. METHODS: Among 573 male patients who underwent RRP due to prostate cancer, 80 with VUAS were included. They were divided into two groups according to VUAS treatment method: dilatation using Amplatz renal dilators (39 patients); or endoscopic bladder neck incision/resection (41 patients). The Vancouver scar scale (VSS) was used to evaluate the characteristics of scars that occurred for any reason before development of VUAS. RESULTS: Over a median follow-up of 72 months (range 12-105) after RRP, 17 patients (21.3%) had recurrence of VUAS. Although the treatment success rates were similar (79.5% versus 78.0%; P = 0.875), receiver operating characteristic (ROC) curve analysis indicated that dilatation using Amplatz dilators rather than endoscopic bladder neck incision/resection in patients with VSS scores 4, 5 and 6 may significantly reduce VUAS recurrence. A strong positive relationship was observed between VSS and total number of VUAS occurrences (r: 0.689; P < 0.001). VSS score (odds ratio, OR: 5.380; P < 0.001) and time until occurrence of VUAS (OR: 1.628; P = 0.008) were the most significant predictors for VUAS recurrence. CONCLUSIONS: VSS score can be used as a prediction tool for choosing more appropriate surgical intervention, for preventing recurrent VUAS.

Evaluation of comorbidity indices in determining the most suitable candidates for uro-oncological surgeries in elderly men.

INTRODUCTION: We aimed to evaluate the superiority of different comorbidity indices in determining the most suitable elderly male candidates for uro-oncological operations. While making this assessment, we also aimed to determine the risk factors that may affect surgery-related major complications and overall survival. MATERIAL AND METHODS: Data of 543 male patients, 60 years or older, who underwent uro-oncological surgery (radical cystectomy, radical prostatectomy, radical or partial nephrectomy, transurethral resection of bladder tumor) between September 2009 and January 2019 were retrospectively evaluated. Demographic, clinical and pathological characteristics of the patients, preoperative comorbidity indices, postoperative complications, length of hospitalization, re-admission rates within 90 days and postoperative follow-up outcomes were recorded. Patients in similar tumor stages were divided into different subgroups. All subgroups were divided into two main categories: middle age (60-69 years-old) and elderly age (≥70-years-old). RESULTS: No significant difference was found for all types of surgery in terms of postoperative outcomes in both age groups (p >0.05). Age-adjusted Charlson Comorbidity Index (ACCI), Preoperative Score to Predict Postoperative Mortality (POSPOM), Rockwood Frailty Index (RFI) and tumor characteristics were found to be more significant predictors for postoperative major complications and overall mortality than Eastern Cooperative Oncology Group (ECOG), American Society of Anesthesiologists (ASA) and New York Heart Association (NYHA) functional classification. CONCLUSIONS: Our findings show that patient age alone is not a risk factor for increased postoperative complications and overall mortality. Although many different comorbidity indices have been used in urological practice, ACCI, POSPOM and RFI are more valuable predictors. Uro-oncological surgeries may be performed safely in elderly males after a good clinical decision based on these indices.

The effect of proliferative hypertrophic scars on determining treatment options for preventing recurrence of vesicourethral anastomotic stenosis after radical prostatectomy: a single-center cross-sectional study.

BACKGROUND: Vesicourethral anastomotic stenosis (VUAS) following retropubic radical prostatectomy (RRP) significantly worsens quality of life. OBJECTIVES: To investigate the relationship between proliferative hypertrophic scar formation and VUAS, and predict more appropriate surgical intervention for preventing recurrent VUAS. DESIGN AND SETTING: Retrospective cross-sectional single-center study on data covering January 2009 to December 2019. METHODS: Among 573 male patients who underwent RRP due to prostate cancer, 80 with VUAS were included. They were divided into two groups according to VUAS treatment method: dilatation using Amplatz renal dilators (39 patients); or endoscopic bladder neck incision/resection (41 patients). The Vancouver scar scale (VSS) was used to evaluate the characteristics of scars that occurred for any reason before development of VUAS. RESULTS: Over a median follow-up of 72 months (range 12-105) after RRP, 17 patients (21.3%) had recurrence of VUAS. Although the treatment success rates were similar (79.5% versus 78.0%; P = 0.875), receiver operating characteristic (ROC) curve analysis indicated that dilatation using Amplatz dilators rather than endoscopic bladder neck incision/resection in patients with VSS scores 4, 5 and 6 may significantly reduce VUAS recurrence. A strong positive relationship was observed between VSS and total number of VUAS occurrences (r: 0.689; P < 0.001). VSS score (odds ratio, OR: 5.380; P < 0.001) and time until occurrence of VUAS (OR: 1.628; P = 0.008) were the most significant predictors for VUAS recurrence. CONCLUSIONS: VSS score can be used as a prediction tool for choosing more appropriate surgical intervention, for preventing recurrent VUAS.

The Effect of Cardiovascular Morbidity on Clinical Responsiveness to Anticholinergics in Postmenopausal Women With Urge Urinary Incontinence.

OBJECTIVE: To evaluate whether there is an association between severity of cardiovascular morbidity and urge urinary incontinence (UUI), and to assess the clinical responses of postmenopausal female patients in different cardiovascular risk groups to anticholinergics. METHODS: A total of 220 postmenopausal female patients aged 43-70 years old with overactive bladder with UUI between December 2019 and July 2020 were included. They were divided into 3 groups according to the Framingham risk score that calculates the 10-year risk of cardiovascular disease development: low-risk (n: 90, 40.9%), intermediate-risk (n: 47, 21.3%), and high-risk (n: 83, 37.8%).Their demographic and clinical data were recorded. The intensity of UUI and its effect on quality of life (QoL) were evaluated at admission, 8th week and 16th week of anticholinergic therapy. RESULTS: At admission attendance, BMI, smoking rate, presence of hypertension and diabetes mellitus, total cholesterol level and severity of UUI were higher in the high-risk group, whereas HDL level was lower and the effect of UUI on QoL was worse (P< .001). At the 16-week follow-up the improvement of UUI severity and QoL was significantly more pronounced in the low-risk and intermediate-risk groups (P< .001).The highest daily-dryness rates were observed in the low-risk group (65.6%), while the highest rates for refractory overactive bladder (OAB) were seen in the high-risk group (19.3%). CONCLUSION: Our findings show that more severe UUI and more impaired QoL is observed in high-risk patients for cardiovascular morbidity. Individualized treatment may be important in the high-risk group since they may benefit less from anticholinergics and refractory OAB can be more common.

Early maladaptive schemas in patients with bipolar and unipolar disorder.

OBJECTIVE: The aim of our study is to determine the difference between the bipolar disorder, unipolar disorder and control groups in terms of maladaptive schemes and childhood trauma. METHODS: Two groups of patients under monitoring with a diagnosis of bipolar or unipolar disorder and one group of healthy controls were enrolled in this study. Each group consisted of 60 subjects. The Young Mania Rating Scale and Beck Depression Inventory were used to confirm that patients were in remission. The Childhood Trauma Questionnaire and Young Schema Questionnaire-Short Form 3 were used to identify childhood traumas and early maladaptive schemas. RESULTS: In bipolar disorder, a positive, low power correlation was observed between the vulnerability to threats schema and emotional, physical and sexual abuse. In the unipolar disorder group, there was a positive, low power correlation between the emotional inhibition, failure, approval seeking, dependence, abandonment and defectiveness schemas and social isolation, and a positive, moderate correlation between social isolation and emotional abuse. CONCLUSIONS: Individuals with bipolar disorder suffered greater childhood trauma compared to subjects with unipolar disorder and healthy individuals. Greater maladaptive schema activation were present in individuals with bipolar disorder compared to those with unipolar disorder and healthy individuals.

Social Cognition in Schizophrenia Patients and Their First-Degree Relatives.

INTRODUCTION: Social cognition is a person's ability to configure the designs of relationships between themselves and others and to use these designs to guide social behaviors in a flexible manner. The models that are the most studied and describe social cognition are the theory of mind (ToM) and emotion recognition. This study was aimed to detect ToM and emotion recognition disorders in schizophrenia patients and their first-degree relatives. METHODS: Thirty schizophrenia patients in remission, the first-degree relatives of schizophrenia patients (n=30), and 30 healthy volunteers who were paired with the patients in terms of age and duration of education were included in the study. The Positive and Negative Symptom Scale (PANSS), Dokuz-Eylül Theory of Mind Scale (DEToMS), Reading the Mind in the Eyes test, Facial Emotion Identification Test (FEIT), and Facial Emotion Discrimination Test (FEDT) were performed by the patients participating in this study. RESULTS: ToM and emotion recognition were found to be defective in the schizophrenia patients and their relatives. The performances of ToM and emotion recognition were ranked as the schizophrenia group, family group, and control group, from the worst to the best. The schizophrenia group showed poor performance in all sub-components except irony. In the family group, the empathy subcomponent showed similar performance with the control group, whereas the subcomponents of the second-order false belief, metaphor, and faux pas tests showed similar performance with the patient group. There were differences among the three groups in the first-order false belief subscale as well as the total DEToMS. The patient and family groups showed the poorest performances, whereas the control group showed the best performance. CONCLUSION: The detection of ToM and emotion recognition disorders in the remission period, regardless of the attack period and asymptomatic first-degree relatives, may support the view that the period of schizophrenia is an independent continuous variable.

The relationship between histopathology and age factor in patients who were operated for renal masses.

OBJECTIVE: Renal neoplasms have a predilection to occur in older patients and they are often malignant. They may have different structural characteristics according to age groups. In our study, we have investigated age-related demographic characteristics of the patients who were operated because of suspected malignant renal masses. MATERIALS AND METHODS: Between 2010 and 2014, 129 patients were treated surgically for suspected malignant renal masses at our institution. These cases had undergone open radical, open partial, and laparoscopic radical nephrectomies. Patients were divided into two groups based on their ages and evaluated accordingly as Group 1 (≤50 years) and Group 2 (>50 years). Groups were compared based on their clinical and pathological features. RESULTS: Group 1 and Group 2 consisted of 29 (22.4%) and 91 (77.6%) patients, respectively. The mean age of younger patients was 43.1 years (23-49 years), with a male to female ratio of 19/10, while the average tumor size was 57.6 mm (20-120 mm). Twenty-four patients (83%) had a malignant pathology and five patients (17%) had a benign pathology. Clear cell carcinoma was diagnosed in 67% of the patients in both groups. There was no significant difference with respect to age and tumor size of male and female patients in the younger age group, while younger female adults tended to have a more benign pathology than their male counterparts (40% and 5%, respectively, p<0.05). CONCLUSION: There was no significant difference with respect to gender, tumor size, laterality, and surgical and pathologic features between younger and older patients. An organ- sparing approach should be strongly considered when treatment for renal tumors in young females is performed because of a potentially higher incidence of a benign pathology of renal masses.

Novel approach for pain control in patients undergoing prostate biopsy: iliohypogastric nerve block with or without topical application of prilocaine-lidocaine: a randomized controlled trial.

PURPOSE: To investigate the efficacy of a novel anesthetic technique called iliohypogastric nerve block (INB) for pain control in patients undergoing prostate biopsy. MATERIALS AND METHODS: A total of 59 consecutive patients who underwent transrectal ultrasound guided prostates biopsies were included in the study. Patients were randomized into four groups: (1) control, no method of anesthesia was administered, (2) intrarectal prilocaine-lidocaine cream application, (3) INB and (4) INB + intrarectal prilocaine-lidocaine cream application (combined group). Patients were asked to use a scale of 0-10 in a Visual Analogue Scale (VAS) questionnaire about pain during probe insertion (VAS 1) and prostate biopsy (VAS 2). RESULTS: The mean VAS 1 and VAS 2 scores were 0.7 and 4.9 for controls, 0.5 and 1.8 for INB, 0.5 and 2.6 for the intrarectal cream group, and 0.4 and 1.8 for the combined group. The mean VAS 1 scores were not different between groups. However, the mean VAS 2 scores were significantly lower in INB, prilocaine-lidocaine cream and combined groups compared to the control group (P < .001). In addition, the INB group had significantly lower VAS 2 scores compared to the cream application group (P = .03). On the other hand, there was no difference between the INB and combined groups (P = .8). CONCLUSION: Any form of anesthesia was superior to none. However, INB alone seemed to be superior to prilocaine-lidocaine cream application in patients undergoing prostate biopsy. Addition of prilocaine-lidocaine cream application to INB may not provide better analgesia. 

Synchronous bladder and prostate cancers in the specimens of radical cystoprostatectomy: a multicenter retrospective analysis.

The purpose of this study was to evaluate the features of prostate cancer that have been incidentally detected in radical cystoprostatectomy specimens of bladder cancer patients. The researchers of the current study retrospectively evaluated the data from 119 men who underwent radical cystoprostatectomy at four referral institutions in Ankara, Turkey. Of the 21 prostate cancer patients, 17 (81%) were aged ≥ 60 years; 10 (47.6%) had clinically significant diseases; three had a Gleason score of 6, three had a Gleason score of 7, three had a Gleason score of 8, one had a positive surgical margin along with extracapsular invasion of the tumor and a high Gleason score, and three patients had a tumor volume of ≥ 0.5 cm(3), of which two also had a high Gleason score. Patients were followed-up for a mean of 29 ± 10.2 months; the overall survival was 96.6% (n = 115) during that period. Preoperative digital rectal examination and prostate-specific antigen values did not differ between the benign and prostate cancer groups. There was no survival advantage in the insignificant prostate cancer and benign prostate groups. No additional benefit for predicting prostate cancer was found with digital rectal examination and prostate-specific antigen tests, although some clinicians advised such. In patients aged < 60 years, organ-sparing cystectomy seems reasonable. In prostate-sparing surgery, candidates who are aged >60 years, the preoperative work-up may routinely include prostate biopsy, especially the apex. Preoperative findings of multifocality of bladder cancers and the presence of carcinoma in situ have the risk of prostatic involvement.

[Possible subtypes of panic disorder]. / Panik Bozuklugunda Olasi Alt Tipler.

OBJECTIVE: The present study, is aimed to investigate the distributiondispersion of panic attack symptoms, the possible subtypes of panic disorder, and the clinical features related to these subtypes in patients with panic disorder. MATERIAL AND METHODS: The study included 105 patients that presented to the Ondokuz Mayis University Faculty of Medicine Psychiatric Outpatient Clinic and met the DSM-IV-TR diagnostic criteria for panic disorder. The Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I), Panic Attack Symptom Checklist (PASC), Structured Clinical Interview for DSM-III-R (SCID-II), Beck Anxiety Inventory (BAI), Anxiety Sensitivity Index (ASI), Panic Disorder Severity Scale (PDSS), and Panic and Agoraphobia Scale (PAS) were administered to all the patients. This study examined the correlation between clinical scales and the factors based on factor analysis using PASC. RESULTS: The 3 most frequently observed symptoms during panic attacks were palpitation, sensations of shortness of breath, and sensation of choking, and the 3 most severe were palpitation, chest pain, and sensation of shortness of breath. The 3 most frequently observed non-DSM-IV-TR symptoms were feeling of discomfort, dry mouth, and blurred vision. As a result of our analysis, 3 factors were defined: respiratory-circulatory, cognitive, and autonomic. Panic attack severity, panic attack frequency, and grade of agoraphobia were strong predictors of the respiratory-circulatory subtype; anticipatory anxiety was a strong predictor of the cognitive subtype. Grade of being anxious for health was stronger predictor for respiratory-circulatory subtype, predictor for the "autonomic" subtype, and a reverse predictor for the cognitive subtype. CONCLUSION: It should be considered that the panic attack symptoms in DSM-IV-TR are insufficient to determine the panic disorder subtypes that are based on symptom profiles. The determination of subtypes could contribute in prognosis of disorder and studies about treatment methods.

Panic disorder with nocturnal panic attacks: symptoms and comorbidities.

The aim of this study was to determine the relationship between nocturnal panic attacks and comorbidities, clinical variables and panic attack symptoms. One hundred and six consecutive patients with DSM-IV panic disorder were enrolled in the study. The patients were divided into two groups depending on the presence of nocturnal panic attacks. Comorbidities were diagnosed with the help of SCID-I and SCID-II. The groups were compared using the Beck Depression Inventory, State-Trait Anxiety Inventory and Symptom Checklist. Nocturnal panic attacks were not related to comorbidities or age at the onset of the disease. The scores from the Beck Depression Inventory, general scores from the Symptom Checklist, somatization, obsession-compulsion, interpersonal sensitivity and anger-hostility sub-scale scores were higher in the nocturnal panic attack group. Patients with nocturnal panic attacks experience more frequent respiratory symptoms, suggesting that nocturnal panic attacks may be related to respiratory symptoms. Our findings demonstrate that patients with nocturnal panic attacks have more respiratory symptoms of panic, depressive and other psychiatric symptoms than the no nocturnal panic group.