The Research of Sleep Disorders and Their Effects on Quality of Life in Patients with Chronic Renal Failure and Renal Transplant

Objective End stage renal insufficiency (ESRI) is defined as the irreversible loss of renal functions. In its treatment is used hemodialisis, peritoneal dialisis or renal transplantation. Sleep disorders cause excesive daytime sleepiness, mental problems, dysfunction in general health and functions; and therefore affect the quality of life in patients with ESRI. In this study is evaluated the relationship between sleep quality and the qulity of life in patients with hemodialisis, peritoneal dialisis and renal transplantation. Materials and Methods A total of 117 patients being treated in Uludağ University Faculty of Medicine Dialisis Unit between years 2011-2012 were enrolled. Pittsburg Sleep Quality Index (PSQI) were used to determine sleep quality of patients, and Epworth Sleepiness Scale (EUS) and Rolls Royce Quality of Life Scale were used. Results In PSQI, poor sleep quality was observed in 81.5% of patients with hemodialisis, which was 80.8% in patients with renal transplantation and 82% in patients with peritoneal dialisis. In Rolls-Royce Quality of life scale, general health, physical symptoms and activities were higher in patients with renal transplantation, and sleep disorders were higher in patients with hemodialisis. Conclusion Chronic renal insufficiency is a very common condition. Sleep disorders in these patients may affect self-care and show a negative influence on the quality of life. Fort his reason, sleep disorders should be questioned and treated in these chronically ill patients with ESRI

Case reports of hyperthyroidism after kidney transplantation: a review of literature

Different disturbances of thyroid hormones in the absence of concurrent thyroid disease have been reported in patients on maintenance hemodialysis. After a successful kidney transplant, thyroid hormone metabolism normalizes. Although increased frequency of goiter and thyroid adenomas have been observed, hyperthyroidism is very rare. Herein, we report two kidney transplant recipients under immunosuppressive therapy that presents with hyperthyroidism. [Med-Science 2017; 6(2.000): 361-4

The Effect of Trandolapril on Insulin Resistance is Determined by the Degree of Baseline Resistance Level

Insulin resistance (IR) is the core problem in type 2 diabetes mellitus that may lead to cardiovascular morbidity and mortality. Hypertension commonly accompanies type 2 diabetes. Antihypertensive agents improving IR may reduce the risk of cardiovascular diseases. This study was conducted to assess the effect of trandolapril on IR, glucose and lipid metabolisms in hypertensive subjects with different degrees of IR and investigate the importance of IR level in angiotensin converting enzyme inhibitor response. The subjects were nondiabetic and type 2 diabetic hypertensive patients treated with trandolapril for 12 weeks. Blood pressures (BP) and metabolic parameters were measured in all patients at baseline and after 12 weeks of trandolapril treatment and compared. Trandolapril reduced BP similarly in nondiabetic and diabetic patients. Homeostasis model assessment insulin resistance (HOMA-IR), serum glucose and hemoglobin A1C (A1C) in diabetic patients were higher than nondiabetics. HOMA-IR (from 9.0  1.0 to 6.6  0.7, p4.67 responded better. In conclusion, trandolapril improved insulin sensitivity better in type 2 diabetic hypertensive patients with higher degree of IR compared with the ones with low grade IR, being independent of its hemodynamic action. [Med-Science 2014; 3(2.000): 1140-54

Medicine Science 2014;3(2):1140-54 Trandolapril and insulin resistance Original Investigation The Effect of Trandolapril on Insulin Resistance is Determined by the Degree of Baseline Resistance Level Trandolapril and insulin resistance Original Investigat

Abstract Insulin resistance (IR) i

Losartan and QT Dispersion in Hypertensive Patients on Maintenance Hemodialysis

QT and corrected QT (QTc) intervals and their increased dispersions (QTd, QTcd) have been linked to the occurrence of arrhythmias in hemodialysis (HD) patients. This study was performed to determine the effects of the angiotensin II receptor blocker losartan on these parameters in HD patients. Our cohort comprised 24 dialysis patients and 14 healthy controls. 15 dialysis patients were treated for 16 weeks with losartan (HD losartan group) but not 9 patients (HD control group). Blood pressures (BP) and electrocardiogram-derived data (Sokolow-Lyon and Cornell voltages, QT, QTd, QTc and QTcd) were measured in all patients. At the beginning of the study, there were no differences in patient characteristics among the 3 groups. Baseline maximum QTc, QTd, QTcd and Socolow-Lyon and Cornell voltages and BPs of the healthy group were lower than those of HD groups. While these parameters were similar in the dialysis groups, only BPs in losartan group were higher. After 16 weeks, BPs, Socolow-Lyon and Cornell voltages values in losartan group significantly decreased but not in the HD control group. Whereas maximum QT and QTc, QTd, QTcd, heart rate and QRS interval did not change in the HD groups. Electrocardiographic LVH of 2 patients improved in the losartan group. Losartan reduced BP and electrocardiographic LVH was improved in HD patients without affecting QTd and QTcd during the 16-week study period. [Med-Science 2014; 3(4.000): 1627-38

The effect of calcineurin inhibitors on anthropometric measurements in kidney transplant recipients

Background This study was designed to investigate the effect of calcineurin inhibitors (CNIs), cyclosporine (CsA), and tacrolimus (Tac) on anthropometrics in kidney transplant recipients. Methods 111 of 128 adult kidney transplant recipients who received post-transplant CNIs were included in this retrospective study. Anthropometrics were recorded in the pre-transplant and post-transplant 4-year follow-up periods (1(st), 3(rd), 6(th), 12(th), 24(th), 36(th) and 48(th) months). Results Compared to pre-transplant values, significant increases in body weight and body mass index (between 3(rd) and 48(th) months), waist and hip circumferences (between 1(st) and 48(th) months), waist-to-hip ratio (between 1(st) and 3(rd) or 6(th) months) and neck circumference (between 1(st) and 12(th) or 24(th) months) were observed in both CsA and Tac groups. A significant increase was noted in post-transplant body fat percentage values for the 3(rd) to 24(th) months in the CsA group, whereas for the 24(th) to 48(th) months in both CsA and Tac groups. Hip circumferences percentage changes from the pre-transplant period to the 1(st), 12(th) and 24(th) months were significantly higher in CsA than in the Tac group. At each time point, there was no significant difference in percentage changes for other anthropometric parameters between the CsA and Tac groups. De novo diabetes mellitus developed in 8.3% of the CsA group and 19.1% of the Tac group. Conclusions After a successful kidney transplant, anthropometric measurements increase in most recipients. Although the effect of calcineurin inhibitor type on weight gain is unclear, a regression analysis showed that CNI type was not a risk factor for the development of obesity in the 48(th) month. However, it is helpful to be cautious about its dyslipidemic effect in patients using CsA and the potential hazards of using Tac in patients with a diabetic predisposition

A Rare Cause of Primary Hyperparathyroidism Presented with Giant Adenoma, Multiple Brown Tumors And End Stage Renal Failure

Single gland adenoma is the most common cause of primary hyperparathyroidism (PHPT). Although PHPT is generally an asymptomatic disease detected by an incidental finding of hypercalcemia, overt skeletal disease, renal failure and huge adenoma that cause local pressure can be seen seldomly in neglected cases. We report a case of a parathyroid adenoma weighing 116 g (normal weight 25 - 40 mgs)causing multiple brown tumors, renal failure and refractory anemia. [Med-Science 2014; 3(2.000): 1262-8

Factors affecting the attitudes and opinions of ICU physicians regarding end-of-life decisions for their patients and themselves: A survey study from Turkey.

INTRODUCTION:Turkey is constitutionally secular with a Muslim majority. There is no legal basis for limiting life-support at the end-of-life (EOL) in Turkey. We aimed to investigate the opinions and attitudes of intensive care unit (ICU) physicians regarding EOL decisions, for both their patients and themselves, and to evaluate if the physicians' demographic and professional variables predicted the attitudes of physicians toward EOL decisions. METHODS:An online survey was distributed to national critical care societies' members. Physicians' opinions were sought concerning legalization of EOL decisions for terminally ill patients or by patient-request regardless of prognosis. Participants physicians' views on who should make EOL decisions and when they should occur were determined. Participants were also asked if they would prefer cardiopulmonary resuscitation (CPR) and/or intubation/mechanical ventilation (MV) personally if they had terminal cancer. RESULTS:A total of 613 physicians responded. Religious beliefs had no effect on the physicians' acceptance of do-not-resuscitate (DNR) / do-not-intubate (DNI) orders for terminally ill patients, but atheism, was found to be an independent predictor of approval of DNR/DNI in cases of patient request (p50%) terminally ill patient ratio (p<0.05). CONCLUSION:Most ICU physicians did not want legalization of DNR and DNI orders, based solely on patient request. Even if EOL decision-making were legal in Turkey, this attitude may conflict with patient autonomy. The proportion of terminally ill patients in the ICU appears to affect physicians' attitudes to EOL decisions, both for their patients and by personal preference, an association which has not been previously reported