Aim: To investigate the mean thrombocyte volume (MPV) in asymptomatic children infected with COVID-19. Methods: The study included 55 children infected with COVID-19 and 60 healthy children for the comparison of leukocyte and thrombocyte count, MPV, and serum C-reactive protein (CRP) levels. Demographic data and clinical findings of all the cases were recorded, including age, gender, weight, temperature, cough, shortness of breath and contact history. Results: The MPV values were determined to be statistically significantly high (p<0.001) and the lymphocyte values were significantly low (p:0.002) in the asymptomatic children infected with COVID-19 compared to the healthy control children. No difference was determined between the groups in respect of CRP level, leukocyte and thrombocyte counts (p>0.05). The optimal cutoff point for MPV was determined as 8.74 fl (Area under the curve-AUC:0.932) with 81.82% sensitivity and 95% specificity for the determination of children infected with COVID-19. A cutoff value of <2.12/mm3 for lymphocytes (AUC:0.670) was determined with 49.09% sensitivity and 86.67% specificity for the prediction of COVID-19. Based on the ROC analysis, the sensitivity and specificity of MPV was determined to be higher than that of lymphocyte levels. Conclusion: The results of this study that MPV levels are significantly high in asymptomatic children infected with COVID-19 demonstrate that this is an important predictive value and has better predictive capacity than lymphocyte values. The evaluation of MPV and lymphocyte levels together could increase diagnostic success in asymptomatic COVID-19 cases.

Fever clinics are designed to provide prompt assessment, management, laboratory examination and decision-making for the potential infected cases, which serves as the crucial first-line of defense to control nosocomial infection. Guided by the primary principle of ‘early assessment, early detection, and early isolation’, fever clinics played a significant role in triaging suspected cases and minimize the risk of nosocomial infection during the Coronavirus Disease 2019 (COVID-19) combat in China. However, fever clinics failed to function normally as expected, with an astonishing number of healthcare workers infected. In this comment, we systematically evaluated the current limitations of fever clinics and recommended several countermeasures, aiming to enhance and maximize the capability and capacity of fever clinics for acute infectious diseases.

Background Many people are used to administering their drugs with food, beverages, or herbs, which may contain chemicals that interfere with the prescribed drugs that could potentially lead to changes in their efficacy or safety and alteration in their pharmacokinetic properties. Objective To assess the extent of perception and use of food, beverages and herbs alongside with conventional drugs and their potential interactions among Jordanian society. Methods This descriptive cross-sectional survey was conducted in Jordan (20 April - 5 May 2020). The survey was developed using Google forms, validated and distributed via social media platforms. Data was analyzed using Statistical Package for Social Sciences-24. Main outcome measure Use and perception of food, beverages, herbs and their drug interactions among Jordanians. Results Of all participants (n = 789), 77.8% were females, 46.2% were 50-year-old, 69.7% were married, 70.8% were medically insured, and 51.1% had a bachelor’s degrees. Seventy percent of the study participants reported use of medicinal plants. About 66% of participants agreed that medicinal plants or herbs could treat diseases and 58.6% thought that medications could interact with drugs. In general, the participants’ knowledge about food/beverage/herb-drug interactions was considered poor. However, linear regression analysis illustrated that the level of knowledge was significantly affected (p-value <0.05) by gender, marital status, social status, the educational level, and employment sector. Conclusion Jordanians have a positive perception towards herbs and their ability to treat diseases. However, their knowledge about food/beverage-drug interactions was poor. This call needs to enhance the community awareness on food/beverage/herb-drug interactions.

Background: To compare long-term oncological and renal functional outcomes of laparoscopic and robotic partial nephrectomy for small renal masses. Methods: A total of 103 patients who underwent laparoscopic (n= 31) and robotic (n= 72) partial nephrectomy between April 2015 and November 2018 were included in the study. Perioperative parameters, long-term oncological and functional outcomes were compared between the laparoscopic and robotic groups. Results: No significant differences were found in terms of age, tumor size, RENAL and PADUA scores, preoperative estimated glomerular filtration rate (eGFR), and presence of chronic hypertension and diabetes (p=0.479, p=0.199, p=0.120 and p=0.073, p=0.561 and p=0.082 and p=0.518, respectively). Only estimated blood loss was significantly higher in the laparoscopic group in operative parameters (158.23±72.24 mL vs 121.11±72.17 mL; P=0.019), but transfusion rates were similar between the groups (p=0.33). In the laparoscopic group, two patients (6.5%) required conversion to open, while no conversion was needed in the robotic group (p=0.89). There were no differences in terms of positive surgical margin and complication rates (p=0.636 and p=0.829, respectively). No significant differences were observed in eGFR changes and postoperative new-onset chronic kidney disease at one year after the operation (p=0.768, p=0.614, respectively). The overall mean follow- up period was 36.07±13.56 months (p=0.007). During the follow-up period, no cancer-related death observed in both group and non-cancer specific survival was 93.5% and 94.4% in laparoscopic and robotic groups, respectively (p=0.859). Conclusions: In this study, perioperative and long-term oncological and functional outcomes seems to be comparable between laparoscopic and robotic partial nephrectomies.

Background: This study aimed to evaluate the risk factors and the association of acute kidney injury (AKI) with outcomes, and resource utilization in patients hospitalized due to salicylate intoxication in the United States. Methods: Hospitalized patients with a primary diagnosis of salicylate intoxication from 2003 to 2014 were identified in the National Inpatient Sample (NIS) database. End-stage kidney disease patients were excluded. The occurrence of AKI was identified using hospital diagnosis code. Clinical characteristics, in-hospital treatment, outcomes and resource utilization were compared between patients with and without AKI. Results: A total of 13,787 eligible hospital admissions were included in the analysis. AKI occurred in 1,279 (9.3%) admissions. Older age, male sex, more recent year of hospitalization, anemia, hypertension, congestive heart failure, chronic kidney disease, volume depletion, sepsis, and ventricular arrhythmia/cardiac arrest were significantly associated with increased risk of AKI, whereas Hispanic race was associated with decreased risk. AKI was significantly associated with increased risk of organ failure, and in-hospital mortality. In addition, the need for ventilation support, blood component transfusion, renal replacement therapy, length of hospital stay, and hospitalization cost were higher in AKI patients. Conclusion: Approximately one tenth of salicylate intoxication patients developed AKI during hospitalization. AKI was associated with higher morbidity, mortality, and resource utilizations.

Aims: To evaluate the diagnostic significance of the novel index combining preoperative hemoglobin, albumin levels, lymphocyte and platelet counts (HALP) in prostate cancer (PCa) patients. Methods: Between January 1, 2015 to December 31, 2018 at the Hitit University Erol Olçok Education and Research Hospital 225 patients who had undergone transrectal ultrasound guided prostate biopsy or prostate surgery were analyzed retrospectively. A total of patients; 155 had benign prostate hyperplasia (group 1) and 70 had PCa (group 2). The preoperative serum levels of hemoglobin, albumin, lymphocyte counts, and platelet counts were recorded. The HALP scores and the sub parameters of this index for each of the two groups were compared. Results: The total Prostate Specific Antigen (PSA), albumin and lymphocyte differences between the groups were statistically significant (p=0.0002, p=0.0001, p= 0.005). The median value of HALP scores in Group 1 and 2 were 49.43 and 51.2 respectively, and this was not statistically significant between groups (p=0.737). The HALP score had the least Area Under Curve (AUC) value compared to the others (0.514). the AUC of Albumin was larger than PSA for diagnostic efficacy in PCa patients (0.696-0.656). However, albumin levels were statistically significant compared to platelet count and the HALP score (p=0.0033, p=0.0068), except PSA and lymphocyte (p=0.4580, p=0.1717). Conclusion:Further prospective clinical studies that include more patients from multiple centers are needed to show the diagnostic role of the HALP score and its compounds on the patients with PCa.

Background: Rapid advancement of stem cell (SC) therapies provides both opportunities and risks for patients and physicians alike. Physicians have a role in counseling patients about unproven SC therapies, requiring a basic level of knowledge and access to information about SCs. Objective: This study sought to assess SC-related knowledge of and attitudes among physicians in Jordan to elucidate areas of deficiency that can be addressed. Methods: A cross-sectional survey, comprising questions on demographics and SC knowledge and attitudes, was designed as a scoring system to evaluate physicians’ knowledge and attitudes. Participants were recruited from 10 major hospitals in Jordan over 3 months between February and April 2019. The internal consistency of the scoring scales was calculated using Cronbach’s alpha reliability coefficient. Gender differences were evaluated with an independent t-test. Results: 382 physicians in Jordan completed the survey (59.9% response rate). They demonstrated a low/moderate level of overall SC knowledge (51.3%), but most lacked confidence in their ability to answer patients’ questions about SC therapies (64.7%). However, the total attitude score was moderate/high positive (66.8%) and most were interested in learning more about SCs (80.8%). Male physicians reported significantly more knowledge than females (p<0.0001). Conclusions: This study reveals Jordanian physicians’ hesitancy to counsel patients about SC therapies, largely due to gaps in knowledge. However, overall attitudes toward SC research and therapies are positive. The results of this study demonstrate a need to cover SC-related information in medical curricula in Jordan, as well as to support initiatives to regulate SC tourism in Jordan.

Introduction: To evaluate the long-term (5 years) effects of perioperative briefing and debriefing on team climate. We explored the barriers and facilitators of the performance of perioperative briefing and debriefing to explain its effects on team climate and to make recommendations for further improvement of surgical safety tools. Methods: A mixed-method evaluation study was carried out among surgical staff at a tertiary care university hospital with 593-bed capacity in the Netherlands. Thirteen surgical teams were included. Team climate inventory and a standardised evaluation questionnaire were used to measure team climate (primary outcome) and experiences with perioperative briefing and debriefing (secondary outcome), respectively. Thirteen surgical team members participated in a semi-structured interview to explore barriers and facilitators of the performance of perioperative briefing and debriefing. Results: The dimension ‘participative safety’ increased significantly 5 years after the implementation of perioperative briefing and debriefing (p = 0.02 (95% confidence interval 1.18–9.25)). Perioperative briefing and debriefing was considered a useful method for improving and sustaining participative safety and cooperation within surgical teams. The positive aspects of briefing were that shared agreements made at the start of the day and that briefing enabled participants to work as a team. Participants were less satisfied regarding debriefing, mostly due to the lack of a sense of urgency and a lack of a safe culture for feedback. Briefing and debriefing had less influence on efficiency. Conclusions: Although perioperative briefing and debriefing improves participative safety, the intervention will become more effective for maintaining team climate when teams are complete, irrelevant questions are substituted by customised ones and when there is a safer culture for feedback.

Aim: our aim was to explore the association between life habits and the controlled attenuation parameter (CAP) and liver stiffness measurements (LSM) as the surrogate markers of liver steatosis and fibrosis in a large cohort of nonalcoholic fatty liver disease (NAFLD) patients. Methods: In this prospective, cross-sectional study we had analyzed 1998 patients with diagnosed NAFLD. Sleeping duration was categorized in three groups: short (S) (<6h), moderate (M) (6-8h) and long (L) (>8h) sleep duration. Coffee drinking was categorized into no (0), moderate (1–2) and frequent (≥3) consumption (in cups/day). Smoking was categorized as yes vs. no. Results: Frequent coffee consumers had the lowest prevalence of obesity, hypertension, dyslipidemia, and diabetes. Furthermore, coffee non-consumers had highest values of hepatic enzymes, CAP and LSM. Moderate sleep duration was associated with lower values of CAP and LSM. Coffee consumption was associated with lower CAP in all the multivariate models (CAP unadjusted and model 1,2 and 3), with largest effect in most frequent coffee consumers (≥3, model 3). Also, most frequent coffee consumers were associated with lower LSM in unadjusted model, model 1 and 2, while this was not the case for model 3 and those who consumed 1-2 cups of coffee per day. Reduced sleeping was confirmed as risk factor for elevated CAP in most of the models (unadjusted and model 1 and 2). Also, negative association of LSM was also confirmed in unadjusted model and model 2. Patients which slept 6-8 hours per day were mostly associated with lower CAP and LSM. Smoking did not affect CAP or LSM values. Conclusion: Coffee consumption has beneficial effect on CAP and LSM and this effect is dose dependent since and independent of a variety of relevant confounders. We have shown that moderate sleep duration has also beneficial effect on CAP and LSM.

Abstract Background: Current literature on COVID-19 pandemic has identified diabetes as a common comorbidity in patients affected. However, the evidence that diabetes increases the risk of infection, effect of diabetes on outcomes and characteristics of patients at risk is not clear. Objectives: To explore the prevalence of diabetes in COVID-19 pandemic, effect of diabetes on clinical outcomes and to characterise the patients with diabetes affected by COVID-19. Methods: A literature review of articles published in English language and reported outcomes on prevalence and effect of diabetes on outcomes and patients characteristics. Results: The prevalence of diabetes in COVID-19 patients appears similar to that in the general population. The evidence of diabetes increasing the risk of severe infection and adverse outcomes is substantial. The progression of the disease into acute respiratory distress syndrome, the requirement for intensive care admission or mechanical ventilation and mortality all have been increased by the presence of diabetes. Patients with diabetes at risk of COVID-19 appear to be obese, of older age, have uncontrolled glycaemia and have coexisting comorbidities especially cardiovascular disease and hypertension. Tight glycaemic control on admission to hospital using insulin infusion has shown some beneficial effects however, the role of hypoglycaemic medications in the management of these patients is not yet clear. Conclusion: High risk group should be identified and prioritised in future vaccination programmes. Future research is required to optimise management of patients with diabetes and develop new ways to manage them via technological developments such as telecare.

Aims: We aim to find out the factors affecting the use of anticoagulants and the intensity of their choices, and to establish a basis for improving neurologists’ effective implementation of the guidelines. Methods: A cross-sectional study is conducted in Hubei province in central China. Each neurologist completes a standard-structured anonymous questionnaire through face-to-face interviews. The problems include the attitude and options about anticoagulant therapy. Results: A total of 611 neurologists from 38 hospitals respond to this survey. For the best treatment of atrial fibrillation, more than 80% of physicians choose anticoagulant therapy. For patients with atrial fibrillation and cerebral infarction, physicians think Warfarin is the preferred drug as high as 93.8%. Among the anticoagulant drugs ever used by clinicians, the use rate of Warfarin is 93.8%, but the use rate of direct oral anticoagulants is extremely low. The use of direct oral anticoagulants is related to the educational level and the geographical location of the hospital. Bleeding risk is the first reason influencing clinicians’ choice of Warfarin, accounts for 88.9%. 97.7% of the clinicians recommend patients with Warfarin regularly monitoring the INR, but the frequency of monitoring is inconsistent. Clinicians have a high willingness to learn about AF, but the proportion of hospitals carry out appropriate training is low. Conclusions: There are still some gaps with the guidelines on the choice of anticoagulant drugs. Neurologists have positive attitude towards anticoagulant therapy and a strong willingness to learn, but the corresponding training is lacking. Continuous professional training is necessary.

Objective: There are many clinical conditions that need to be followed and treated during pandemic like lung cancer. Carrying out health care for these patients who are immune-suppresive require extra care. Method: Among 108 lung cancer patients who has been hospitalized during pandemic, 18 of them with respiratory symptoms were evaluated. Results: Median age was 64±9.4 with male predominance (male n=16, female n=2). Thirteen of them was non-small cell lung cancer (NSCLC) and 5 of them was small cell lung cancer (SCLC). Nine (50%) patients were receiving chemotherapy. The most common symptom was shortness of breath (n=14, 77.8%), followed by fever (n=10, 55.6%). Findings confirmed on computed thorax tomography (CTT) were as follows: Consolidation (n=8, 44.4%), ground glass opacities (n=8, 44.4%) and thoracic tumour/mediastinal-hilar lymphadenopathy (n=3, 16.7%). Hypoxia was seen in 11 patients (61.1.%). Twelve patients had elevation of LDH (median=302±197) and lymphopenia (median=1055±648). There were 5 (27.7%) highly suspected cases for COVID-19. Any of their nasopharyngeal swap was positive. Two of these 5 patients received COVID-19 specific treatment even they have negative PCR results for 3 times. They responded well both clinical and radiological. For one case with SCLC receiving immunotherapy metil-prednisolone was initiated for radiation pneumonitis after excluding COVID-19. Conclusion: In line with the health policies of the countries and the adequacy of the health system, the necessity of a multidisciplinary approach in the management and treatment of complications in patients with lung cancer becomes even more important in this pandemic.

Aims: Our study aimed to investigate the relationships between elevated carotid-intima media thickness (CIMT) and serum uric acid (SUA) levels in hypertensive patients attending primary care clinics. Methods: We conducted a cross-sectional study on 140 hypertensive patients attending out-patient follow-up in two primary care clinics in Sungai Buloh, Malaysia, using a convenient sampling method. Serum uric acid levels were measured and divided into 4-quartile. Two radiologist specialists performed B mode ultrasonography to assess the right and left CIMT in all participants. Results: Participants’ mean SUA level was 355.75 ± 0.13. Their mean age was 53.44 (± 9.90), with a blood pressure control of 137.09 ± 13.22 / 81.89 ± 8.95. Elevated CIMT taken at ≥75th percentile was 0.666 for the left and 0.633 for the right common carotid arteries. Using multiple logistic regression, compared with the first quartile of the SUA level, the odd of elevated CIMT in quartile four in the common carotid artery was (OR=2.00; 95% CI= 0.64-6.27, p=0.576) for the right and (OR=0.62; 95% CI= 0.20-2.00, p=0.594) for the left. Waist circumference (p = 0.001), body mass index (p=0.013), triglycerides (p<0.001) and high-density lipoprotein cholesterol (p=0.001) were significantly associated with the SUA quartiles. Conclusion: Although there was an increasing trend in the odd of elevated right CIMT across the SUA quartiles, this association, however, was not significant. Preventive effort to tackle the clustering effect of metabolic markers within this study population is needed to reduce the future risk of developing cardiovascular disease.

Objectives: There is no standardized and up-to-date education model for urology residents in our country. We aimed to describe our National E learning education model for urology residents. Methodology: The ERTP working group; consisting of urologists was established by Society of Urological Surgery to create E-learning model and curriculum at April 2018. Learning objectives were set up in order to determine and standardize the contents of the presentations. In accordance with the Bloom Taxonomy, 834 learning objectives were created for a total of 90 lectures (18 lectures for each PGY year). Totally 90 videos were shoot by specialized instructors and webcasts were prepared. Webcasts were posted at uropedia.com.tr, which is the web library of Society of Urological Surgery. Satisfaction of residents and instructors was evaluated with feedbacks. An assessment of knowledge was measured with multiple-choice exam. Results: A total of 43 centers and 250 urology residents were included in ERTP during the academic year 2018/2019. There were 93/38/43/34/25 urology residents at 1st/2nd/3rd/4th and 5th year of residency, respectively. Majority of the residents (99.1%) completed the ERTP. The overall satisfaction rate of residents and instructors were 4,29 and 4,67(min:1 so bad, max:5 so good). An assessment exam was performed to urology residents at the end of the ERTP and the mean score was calculated as 57.99 points (min:20, max:82). Conclusion: Due to the Covid-19 pandemic, most of the educational programs had to move online platforms. We used this reliable and easily accessible e-learning platform for standardization of training in urology on national basis. We aim to share this model with international residency training programs.

Introduction: Access to public healthcare is limited in Brazilian underserved areas, and long waiting lists remain for echocardiography (echo). We aimed to develop a tool to optimize indications and shorten waiting lists for standard echo in primary care. Methods: Patients in waiting list for standard echo were enrolled. For derivation, patients underwent a clinical questionnaire, simplified 7-view echo screening by non-physicians with handheld devices (GE-VSCAN), and standard echo (Vivid-Q) by experts. Two models were adjusted, one including clinical variables and other adding screen-detected major heart disease (HD). For validation, patients were risk-classified according to the clinical score. High-risk patients and a sample of low-risk underwent standard echo. Intermediate-risk patients first had screening echo, with a complete study if HD was suspected. Discrimination and calibration of the 2 models were assessed to predict HD in standard echo. Results: In derivation (N=603), clinical variables associated with HD were female gender, body mass index, Chagas disease, prior cardiac surgery, coronary disease, valve disease, hypertension, and heart failure, and this model was well calibrated with C-statistic=0.781. Performance was improved with the addition of echo screening, with C-statistic=0.871 after cross-validation. For validation (N=1,526), 227 (14.9%) patients were classified as low-risk, 1082 (70.9%) as intermediate-risk, and 217 (14.2%) as high-risk by the clinical model. The final model with 2 categories had high sensitivity (99%) and negative predictive value (97%) for HD in standard echo. Model performance was good with C-statistic=0.720. Conclusion: The addition of screening echo to clinical variables significantly improves the performance of a score to predict major HD.

INTRODUCTION: The anemia leads to a worse prognosis in patients with heart failure(HF). There are few data on the impact of anemia on mortality in patients with acute heart failiure(AHF), and the studies available are mainly retrospective and include hospitalized patients. OBJECTIVE. Evaluate the role of anemia in 30-days and one-year mortality in patients with AHF attended in hospital emergency departments(HEDs). METHODS. Multicenter, observational study of prospective cohorts of patients with AHF. Study variables: anemia(hemoglobin<12g/dL in women and <13g/dL in men), 30-days-mortality and at one year, risk factors, comorbidity, functional impairment, basal functional grade for dyspnea, chronic and acute treatment, clinical and analytical data of the episode and patient destination. Statistical analysis: bivariate analysis and survival analyses using Cox regression. RESULTS. A total of 13,454 patients were included, 7662(56.9%) of whom had anemia. Those with anemia were older, had more comorbidity, a worse functional status and New York Heart Association class, greater renal function impairment and more hyponatremia. The mortality was higher in patients with anemia at 30-days and one-year: 7.5% vs. 10.7%(p<0.001) and 21.2% vs. 31.4%(p<0.001), respectively. The crude and adjusted hazard ratios of anemia for 30-days-mortality were: 1.46(confidence interval[CI]95% 1.30-1.64);p<0.001 and 1.20(CI95% 1.05-1.38);p=0.009, respectively, and 1.57(CI95% 1.47-1.68) and 1.30(CI95% 1.20-1.40) for one-year-mortality. The weight of anemia on mortality was different in each follow-up period. CONCLUSIONS. Anemia is an independent predictor of 30-days-mortality and one year in patients with AHF attended in HEDs. It is important to study the etiology of AHF since adequate treatment would reduce mortality.

A Gynecologist's perspective on the limitations of telemedicine in the setting of early pregnancy diagnosis during the COVID-19 Pandemic.

Aims: To investigate current practices and problems of neurological prognostication in comatose cardiac arrest (CA) patients. Methods: An anonymous questionnaire was distributed to 1600 emergency physicians in 75 hospitals which were selected randomly from China between January and July 2018. Results: 92.1% respondents fulfilled the survey. The details of the neurological prognosis were not well understood. The predictive value of brain stem reflex, motor response and myoclonus was confirmed by 63.5%, 44.6% and 31.7% respondents respectively. Only 30.7% knew that GWR value <1.1 indicated poor prognosis and only 8.1% know the most commonly used SSEP N20. Epileptiform, burst suppression, and isoelectric was considered to predict poor outcome by 35.0%, 27.4% and 45.7% respondents. 46.7% knew NSE, and only 24.7% knew S-100β. Only a few respondents knew that neurological prognostication should be performed later than 72h from CA either in TTM or non-TTM patients. In practice, the most commonly used method was clinical examination (85.4%). 67.9% had used brain CT for prognosis, and 18.4% for MRI. NSE (39.6%) was a little more widely used than S-100β (18.0%). However, SSEP (4.4%) and EEG (11.4%) were occasionally performed. The survey may have been subject to bias ascertainment as only university affiliated hospitals and university teaching hospitals were selected, making it likely that the degree of neuroprognostication awareness and practice reflected in our survey is an optimistic perspective. Conclusions: Neurological prognostication in CA survivors had not been well understood and performed by emergency physicians in China. They were more likely to use clinical examination rather than objective tools, especially SSEP and EEG, which also illustrated that multimodal approach was not well performed in practice.