INTRODUCTION: The prognostic assessment tools such as pulmonary embolism severity ýndex (PESI) and simplified PESI (sPESI) are used to predict the mortality in patients with acute pulmonary embolism. The aim of this study is to assess PESI and sPESI accuracy for the prediction of the prognostic outcomes in coronavirus disease (COVID).
METHODS: This retrospective single-center was done as a cohort study. Data on hospital admission obtained from medical records were used to calculate PESI and sPESI. All the consecutive patients were assigned to low risk and high-risk groups using of PESI and sPESI. The primary outcome was hospital mortality. Accuracy of the models was assessed to predict mortality by calculating specificity, predictive values, and sensitivity of the patients at low to high risk. The area under receiver operating characteristic (ROC) was calculated to compare the discriminative power of the models.
RESULTS: The PESI and sPESI had similar sensitivities (82.1% vs. 84.6%), negative predictive values (96.7% vs. 97%) for predicting mortality. The area under the ROC curve for predicting mortality was 0.82 (p<0.001) for PESI and 0.72 (p<0.001) for sPESI. PESI and sPESI had a similar discriminatory to predict hospital mortality.
DISCUSSION AND CONCLUSION: Hospital mortality could be predicted, and risk stratification can be facilitated in COVID-19 patients based on PESI and sPESI Scores.

INTRODUCTION: Insomnia is one of the most frequent sleep disorders. Unhelpful cognitive processes and interpersonal factors play a role in insomnia. The aim of the present study is to investigate the perceived stress levels, attachment, and coping styles of individuals diagnosed with chronic insomnia and the relationship between these parameters.
METHODS: The study group consisted of 40 patients diagnosed with insomnia according to International Classification of Sleep Disorders and 40 healthy controls. The sociodemographic data form, insomnia severity index (ISI), Pittsburgh sleep quality index (PSQI), perceived stress questionnaire (PSQ), coping with stress scale, and inventory of close relationship experiences 2 were applied.
RESULTS: The mean ISI score of the patients was 19.5±5.5, and the mean total PSQI score was 14.3±3.7. The mean PSQ score in the patient group was 31.0±8.9 and was significantly higher than controls (p<0.001). When the coping styles were examined, the helpless style was higher in the patient group (p=0.002), while the self-confident and optimistic style were significantly higher in the control group (p=0.036, p=0.001). Looking at the attachment styles, the anxious attachment was significantly higher in chronic insomnia patients than in the control group (p=0.022). Significant correlations were found between ISI score and anxious attachment, PSQ score, self-confident, helpless, and optimistic styles (r=0.266, p=0.017; r=0.607, p=0.001; r=–0.254, p=0.023; r=0.278, p=0.012; and r=–0.380, p=0.001).
DISCUSSION AND CONCLUSION: Cognitive processes and interpersonal factors are important factors that predispose, trigger, and maintain chronic insomnia. Understanding the relationship between insomnia, stress, coping, and attachment styles will both provide an understanding of the disease process and will guide the treatment.

INTRODUCTION: Iron depletion and dopamine dysfunction are the best-recognized mechanisms in the pathophysiology of restless leg syndrome (RLS). A novel perspective has risen that inflammation plays a part; however, the evidences remain limited. We investigated the potential roles of systemic inflammatory markers in the disease.
METHODS: This cross-sectional study contains 70 patients and 50 healthy controls. We recorded the demographic data from patients’ filed archives. RLS was diagnosed by the International Classification of Sleep Disorders Diagnostic Criteria, The severity of disease was evaluated by the International RLS Study Group Rating Scale and patients were divided into four subgroups as “mild (1–10),” “moderate (11–20),” “severe (21–30)” and “very severe (31–40)” We obtained the blood samples from the medial cubital vein regarding an 8-h of fasting. Red cell distribution width (RDW), platelet-to-lymphocyte (PLR), neutrophil-to-lymphocyte (NLR), and C-reactive-protein-to-albumin (CAR) ratios were estimated and compared with controls.
RESULTS: We detected no difference in gender and age among the groups. The mean NLR was 3.42±2.2 in patients and 1.44±0.64 in controls (p=0.001), PLR was 200.54±180.67 in patients and 63.39±13.76 in controls (p=0.001), and RDW was 50.06±4.27 in patients and 45.43±4.28 in controls (p=0.001). All of them were are statistically higher in patients. RDW was predictive at 37.4 with a 85.7% sensitivity and 40.0% specificity. NLR was at 2.33 with a 58.57% sensitivity and 96%, PLR was predictive at 95.34 with a 65.71% sensitivity and 98% specificity.
DISCUSSION AND CONCLUSION: PLR, NLR, and RDW are statistically higher in patients, which supports the hypothesis that there is a relationship between peripheral inflammation and RLS. Moreover, PLR, NLR, and RDW may be used as biomarkers to predict the disease. Additional investigations are needed to understand the nature of the disease.

INTRODUCTION: We aimed to demonstrate probable neuronal benefits derived from glycemic control in diabetic patients without diabetic retinopathy (DRP) by using multifocal electroretinography (mfERG).
METHODS: Forty patients with HbA1c level >8% were included in this study. Baseline mfERG measurement (first kernel order) of patients were done. The study group consisted of patients existed 1 unit decrease in HbA1c relative to baseline and the control group consisted of patients with an insufficient decrease (n=16). The control mfERG measurements of the study group were done after HbA1c decrease is obtained (mean 13.6 months) and in the first year follow-up in the control group.
RESULTS: Baseline HbA1c level was 8.7±0.6 in the study group and 8.4±0.5 in the control group and the levels were 7.5±0.5 and 8.35±0.4 respectively after glycemic control. Decrease of HbA1c levels in the study group was significant. Comparing baseline and follow up measurements the difference between P1 and N1 wave amplitude and implicit time values weren’t statistically significant in the study group in which glycemic control was good relative to baseline.
DISCUSSION AND CONCLUSION: We have determined no significant changes in mfERG parameters after approximately 1 year follow up in both good and insufficient glycemic control groups. The reasons for this could be the progression of retinopathy in diabetic patients despite glycemic control or inadequacy of first kernel orders in revealing functions of inner retina layers.

INTRODUCTION: Rectal prolapse is still a disease that causes social problems with an unknown etiology. In our study, we aimed to compare the results of the presacral mesh application and perineal surgical procedures performed in our clinic and to determine the effectiveness of the methods.
METHODS: Between 2014 and 2020, perineal surgery was performed only in patients with rectal prolapse with high comorbidity, and presacral mesh without resection was applied to those with low comorbidity. In the preoperative and postoperative follow-up, the symptoms of the patients were standardized and compared according to Rome II and Boutsis Ellis criteria.
RESULTS: The results of 20 patients who underwent abdominal (n=15) and perineal procedures (n=5) due to rectal prolapse were retrospectively evaluated. There was a statistically significant difference between the two groups between age (p=0.041), American Society of Anesthesiology score (p=0.000), and type of anesthesia applied (p=0.016). In the abdominal group, the complaint of constipation was found to be statistically significantly different in the preoperative and postoperative evaluations (p=0.000). There was no significant difference in the perineal group (p=0.151). Incontinence complaints were significantly decreased postoperatively in the abdominal group (p= 0.000), while there was no significant difference in the number of patients whose symptoms continued in the perineal group despite the decrease in the stages of symptoms (p=0.07).
DISCUSSION AND CONCLUSION: Presacral mesh application alone is an effective minimally invasive method that can be applied with a low risk of complications in patients with rectal prolapse.

INTRODUCTION: Penoscrotal web is the extension of skin from scrotum skin to ventral skin of the penis that causes malformation of the penis and may lead to problems during sexual intercourse in adulthood. V-Y plasty, double Z plasty, V plasty, and double V plasty techniques have been described for penoscrotal web repair. In our study, we aimed to share the outcomes of patients who underwent penoscrotal web repair with the double V plasty technique.
METHODS: The data of 30 patients who were observed to have penoscrotal web during the pre-circumcision examination in our clinic and underwent web repair along with circumcision were retrospectively analyzed. After all patients underwent web repair using the double V technique, circumcision was performed with the sleeve technique. The cosmetic outcomes of the patients who were checked in the post-operative 1st month were evaluated.
RESULTS: Thirty patients underwent penoscrotal web repair with double V plasty together with circumcision with the sleeve technique in our clinic between 2017 and 2019. The average age of the patients was 3.70±3.68. The patients who were operated under general anesthesia were discharged on the same day without any problem. The cosmetic outcomes of the patients who were called for control 1 month after the operation were evaluated. It was observed that the webs of all patients disappeared. It was determined that the circumcision incision and wounds in the penoscrotal region were healed smoothly.
DISCUSSION AND CONCLUSION: In the literature, many different techniques have been described on penoscrotal web repair. We also successfully apply the double V plasty technique in our clinic. We consider that our results related to penoscrotal web repair, on which there are few studies in the literature, will contribute to the literature by revealing them.

INTRODUCTION: Vitiligo is an acquired skin disease characterized by depigmentation and characterized by loss of epidermal melanocytes in the skin. The low levels of Vitamin D have been observed in vitiligo patients and with other autoimmune diseases. This study aimed to investigate whether 25(OH) Vitamin D levels are associated with clinical types and features of vitiligo.
METHODS: A total of 60 patients with vitiligo and 60 healthy volunteers were included in our study. The patients were divided into four groups; patients newly diagnosed with vitiligo in the winter season (W-VP), participants who visited the clinic in the winter season and were found to be healthy (W-HP), patients newly diagnosed with vitiligo in the summer season (S-VP), and participants who visited the clinic in the summer season and were found to be healthy (S-HP). Participants’ age, sex, incidence of other autoimmune diseases among participants and their families, clinical type of vitiligo (localized (focal, segmental, or mucosal), common (acrofacial, vulgaris, or mixed), or universal), and 25(OH) Vitamin D levels were evaluated.
RESULTS: Twenty-five (41.7%) of the patients and 33 (55%) of the control group were women. The mean age of vitiligo group was 42.2±13.29 years and the mean age of control group was 30.5±12.6 years. The groups were similar in terms of age and sex (p>0.05). About 45% of the patients were localized, 53.32% were widespread, and 1.6% were universal type vitiligo. Another autoimmune disease was accompanying in 55%. No significant difference was found between the W-VP and S-VP groups in terms of vitiligo types (p>0.05). The incidences of other autoimmune diseases among the families of patients with vitiligo did not differ between both the sexes (p>0.05). There was no statistically significant difference between the clinical types of vitiligo and incidence of autoimmune diseases (p>0.05). The 25(OH) Vitamin D levels of participants in the W-VP and S-VP groups were statistically lower than those of participants in the W-HP and S-HP groups (p<0.05). Comparison of the 25(OH) Vitamin D levels of the W-VH with S-VP groups and the W-HP with S-HP groups did not show any statistically significant difference (p>0.05). There was no statistically significant difference between patients with autoimmune disease in the W-VH and S-VP groups in terms of clinical type of vitiligo and 25(OH) Vitamin D levels (p>0.05).
DISCUSSION AND CONCLUSION: Plasma 25 (OH) Vitamin D level is lower in vitiligo patients compared to the normal population. Vitamin D supplementation can be effective in the treatment and control of vitiligo.

INTRODUCTION: The objective of the study was to investigate whether low back pain (LBP) with or without lumbar disc herniation (LDH) would affect paraspinal muscle volumes in adolescents.
METHODS: A total of 205 adolescent patients were distributed into two groups – LBP with LDH (Group A) and LBP without LDH (Group B). Multifidus (MF), erector spinae (ES), and psoas major (PM) volumes at the L4–5 and L5-S1 intervertebral disc levels were measured.
RESULTS: No statistically significant difference in bilateral MF, ES, and PM volumes was observed between the groups at the L4–5 and L5-S1 levels. The right side ES volumes at the L4–5 were lower than the left volumes in Group A (p=0.000/p<0.05). At the L5-S1, the right MF and ES volumes were lower than those on the left (MF p=0.008/p<0.05; ES p=0.000/p<0.05). In Group B, the right MF and ES volumes were lower than those on the left (MF p=0.001/p<0.05 and ES p=0.000/p<0.05) at the L4–5 level. At the L5-S1, the right MF, ES, and PM volumes were lower than those on the left (MF p=0.001/p<0.05; ES p=0.000/p<0.05; and PM p=0.024/p<0.05).
DISCUSSION AND CONCLUSION: Paraspinal muscle volume loss can be seen as a result of LBP in adolescents like in adults. Since LDH more commonly occurs as the central type in the pediatric age, perhaps it may not contribute to volume changes of paraspinal muscle.

INTRODUCTION: A low-cost alternative that can be used to measure shoulder range of motion (ROM) is the goniometer applications available on the iPhone®(Apple, Cupertino, CA, USA) and various smartphones. The validity and reliability of active internal rotation ROM measurement of shoulder with smartphone in patients with shoulder pain were investigated.
METHODS: Eighteen patients with shoulder pain who applied to the physical medicine and rehabilitation, shoulder subspecialty outpatient clinic, and 18 volunteers who had not experienced shoulder pain before enrolled in the study. Shoulder internal rotation ROM measurements were conducted with both standard goniometer and iHandy application separately without seeing each other for each participant by one physiatrist and one physiotherapist.
RESULTS: It is observed that the intraclass correlation coefficient values of Observer B, except from goniometric measurements, are >0.99 and consistency is very strong among practitioners. For both goniometer measurement and app measurement, the compatibility between the observers was found to be above 0.92.
DISCUSSION AND CONCLUSION: This study shows that it is a reliable and valid method to measure shoulder internal rotation movement with the iPhone application.

Angiomyxoma is a soft-tissue lesion found particularly in women who are of childbearing age. It is mostly encountered in perineal, pelvic, and gluteal area. Due to its recurring nature, surgical intervention is necessary. In our case, a 39-year-old female patient who was operated with the perianal hemangioma pre-diagnosis and whose patholog-ic evaluation was reported as angiomyxoma was presented.

Kidneys with large stones associated with chronic renal failure are not rare in areas where stone disease is endemic, such as our country. The high rate of these patients having additional vascular diseases and increased bleeding tendencies can present various difficulties in diagnosis and treatment. Frequent and safe percutaneous nephrolithotomy in contemporary urology may become debatable because of bleeding or nephron loss concerns. We think that laparoscopic pyelolithotomy can be performed safely in such cases.

The restriction of freedom for the purposes of protection deals with the concept of involuntary/compulsory hospitalization and treatment in practice and has been discussed for many years in social, psychological and ethical aspects. The main criticism of involuntary hospitalization and treatment, the scope of which is explained in article 432 of the Turkish Civil Code, is the insufficient decision and supervision mechanisms. In this article, we aimed to discuss the victimization that involuntary hospitalization and treatment practices can occur in the light of the literature based on a case. We suggest that a more medical, ethical and humanitarian regulation is urgently needed.