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

Uyku Apnesi Sınıflandırma Performansını Geliştirmek İçin Çok Kipli ve Öznitelik Seçimine Dayalı Bir Yaklaşım

Obstructive sleep apnea (OSA) is a sleep disorder with long-term adverse effects such as cardiovascular diseases. However, clinical methods, such as polisomnograms, have high monitoring costs due to long waiting times and hence efficient computer-based methods are needed for diagnosing OSA. In this study, we propose a method based on feature selection of fused oxygen saturation and electrocardiogram signals for OSA classification. Specifically, we use Relieff feature selection algorithm to obtain robust features from both biological signals and design three classifiers, namely Naive Bayes (NB), k-nearest neighbors (kNN), and Support Vector Machine (DVM) to test these features. Our experimental results on the real clinical samples from the PhysioNet dataset show that the proposed multimodal and Relieff feature selection based method improves the average classification accuracy by 4.67% on all test scenarios

The learning curve of laparoscopic inguinal hernia repair: A comparison of three inexperienced surgeons

Introduction: Studies with inexperienced surgeons in terms of the learning curve for laparoscopic totally extraperitoneal (TEP) inguinal hernia repair are limited. Aim: To compare three inexperienced surgeons in terms of the learning curve without supervision. Material and methods: Patients' data, which were from consecutive laparoscopic TEP hernioplasties between December 2017 and February 2020, were analysed retrospectively. The primary outcome was to compare the learning curve of three surgeons (Surgeon A, B, and C) in terms of complications, conversion, and duration of surgery. Secondary outcomes were recurrence rates. Results: A total of 299 patients were included in the study. Conversion and intraoperative complication rates decreased after the first 60 cases (from 10% to 2.5%, p = 0.013 and from 9% to 2.5%, p = 0.027, respectively). The mean operative time reached a plateau of less than 40 min after 51-81 cases (Surgeon A 51, B 71, and C 81 cases). Ageing was a risk factor for intraoperative complications and recurrence (p < 0.001, p = 0.008, respectively), and higher body mass index (BMI) was a risk factor for conversion (p = 0.004). Age = 60 years compared to age < 60 years increased intraoperative complications five-fold and recurrence six-fold (p = 0.001). On the other hand, BMI = 30 kg/m(2) increased the possibility of conversion to open surgery nine-fold (p < 0.001). In addition, a positive correlation was found between the operative time and the BMI and VAS score (p = 0.004, p = 0.015, respectively). Conclusions: In order to reach the plateau in the operative time during the TEP learning curve period, more than 50 cases should be experienced, whereas more than 60 cases are needed for conversion, intraoperative complications, and recurrence

Biochemical evaluation of ischemia-reperfusion injury in the rat bladder after acute urinary retention

Introduction: The aim of this study was to see the effects of ischemia-reperfusion injury on reactive oxygen species (ROS) in acute urinary retention and to determine whether these effects would be normalized by different antioxidant agents. Materials and Methods: We used 37 male Wistar Albino rats in our research. We formed five groups totally, as a combination of 1 sham, 1 retention and 3 treatment groups including 5, 8, 8 male rats in each group respectively. In the treatment groups allopurinol and/or verapamil were used. After clamping the rat penile urethra, diuresis was forced and overdistension was maintained. After 30 minutes under overdistension the rat's bladder was emptied with 3F catheter. After reperfusion of their bladders and waiting for 30 minutes in this condition, the rats were sacrificed. Bladder tissue samples were taken and malondialdehyde (MDA) & myeloperoxidase (MPO) measurements were made. Results: In the retention group both MDA and MPO levels were increased significantly when compared with the sham group. In the treatment groups, decreases in MDA and MPO levels were found statistically important when compared with the retention group. We didn't find any significant difference between treatment and sham group, and within the treatment groups. Conclusion: The MDA and MPO increase in the retention group show that the decompression following acute urinary retention, leads ischemia reperfusion injury in the bladder and leukocytes have a role in this injury. We found that both allopurinol and verapamil were effective in decreasing the injury and the combination of these agents, compared with the mono-treatment, didn't make any additional benefit

Acute colonic pseudoobstruction: A rare clinical entity

Background/aims: In this study, a review of the clinical presentation, management and outcome of 15 patients with acute colonic pseudoobstruction at the Colorectal Surgery Unit of Ege University Medical School Hospital was undertaken between 1985 and 1998. Methods: Eight women and seven men with mean age of 59.8 years were included. Results: Plain abdominal x-rays uniformly showed colonic distension, especially in the caecum, in all patients. While eleven patients underwent surgery, four patients were treated conservatively. Colonoscopic decompression was not attempted in any of the 15 patients. Mortality was seen in one patient (6.6%) and the morbidity rate was 46.6% (n=7). Conclusions: The present study questions the need for early endoscopic, surgical or non-interventional therapy in patients with acute pseudoobstruction of the colon.Amaç: 1985 ve1998 yılları arasında, Ege Üniversitesi Tıp Fakültesi Kolorektal Cerrahi Ünitesinde akut kolonik pseudoobstrüksiyon tanısı alan 15 olgunun klinik bulguları, tedavileri ve sonuçlarını inceledik. Yöntem: Olgular yaş ortalaması 59.8 olan sekiz kadın ve yedi erkekten oluşmaktaydı. Bulgular: Tüm olguların direkt karın filmlerinde özellikle çekumda belirgin distansiyon mevcuttu. Yedi olguya cerrahi uygulanırken , dört olgu konservatif olarak tedavi edildi. Olguların hiçbirinde kolonoskopik girişimde bulunulmadı. Bir olguda(%6.6) mortalite gözlenirken, morbidite oranı %46.6 (n=7) olarak belirlendi. Sonuç: Bu çalışma kolonik pseudoobstrüksiyonlu olgularda erken endoskopik girişim, cerrahi ya da girişimsel olmayan tedavi modalitelerinin hangisinin gerekli olduğunu irdelemektedir

Risks of Laparoscopic Harvest of Free Intestinal Flaps for Esophageal Reconstruction

Background: Performing ablative surgery using an laparoscope is a common practice. However, its use in the harvest of a segment of intestine for reconstruction has 2 major challenges: risk of damage to the vascular pedicle of the flap as well as to the vessels of other parts of the intestine that remain in the peritoneal cavity and risk of damage to the intestinal flap while pulling it out through a small opening in the abdominal wall. The aim of this study was to report advantages and disadvantages of harvesting free intestinal flaps using the laparoscopic method, explaining the challenges faced and lessons learned from this experience. Patients and Methods: Free intestinal flaps were harvested by laparoscopy in 12 patients aged 28 to 63 years. There were 9 free jejunal flaps for the reconstruction of the cervical esophagus and 3 ileocolic flaps for the reconstruction of both the cervical esophagus and voice reconstruction. Results: In 1 patient, laparoscopy was converted to laparotomy due to previous colectomy, which resulted in compromised circulation to the rest of the colon. One jejunal flap had leakage at its pharyngeal end; therefore, a pectoralis major myocutaneous flap was used for closure. In addition, 1 ileocolic flap had partial loss of its anterior wall, and a free anterolateral flap was used as a patch for closure. Furthermore, it was very difficult to harvest 1 free jejunal flap due to the thick and fat mesentery. Conclusion: Prolonged operative times, unexpected leakage at the anastomosis sites, partial loss of flaps, possible risk of vascular pedicle damage or venous compromise, demanding pedicle dissection in obese patients, and requirement of conversion to laparotomy are the major drawbacks of harvesting free intestinal flaps by laparoscopy