Restless-legs syndrome and insomnia in hemodialysis patients

Aim/background: Restless legs syndrome (RLS) is a common neurological movement disorder which is commonly seen in hemodialysis (HD) patients. Insomnia, depression, and anxiety disorders frequently show concurrence. In this study, we aimed to investigate RLS and insomnia prevalence and related factors in HD patients. Subjects and methods: Patients who were under HD treatment and healthy controls with similar mean age, sex ratio, and hypertension and diabetes mellitus frequency were included in this study. Depression, insomnia, and daytime sleepiness assessments were performed by using Beck Depression Inventory, Insomnia Severity Index, and Epworth Sleepiness Scale. The diagnosis of RLS was made using the International RLS Study Group consensus criteria. Results: About 156 HD patients and 35 controls were enrolled. The mean age was 50.6 in the HD group and 49.7 in the control group. Female sex was 43.9% in the HD group and 57.1% in the control group. RLS was significantly more frequent in HD patients compared with controls. The rate of sub-threshold insomnia and insomnia with moderate severity was higher in HD patients. While insomnia severity score and diabetes mellitus were significantly associated with the presence of RLS, depression, RLS, older age, and being under HD treatment were independently associated with insomnia severity. Conclusions: HD patients commonly have RLS and insomnia. Insomnia and diabetes mellitus seem to be major factors underlying RLS in HD patients. Furthermore, depression and RLS seem to be closely related to insomnia in these patients. Treatment of depression, insomnia, and RLS may be beneficial to improve quality of life in HD patients

Placenta, Secret Witness of Infant Morbidities: The Relationship Between Placental Histology and Outcome of the Premature Infant

Objective: The microscopic and macroscopic features of the placenta can contribute to the clinical understanding of premature delivery. The aim of our study was to figure out the relationship between the histopathological findings of the placentas of premature deliveries and its effects on neonatal morbidity and mortality. Material and Method: The placentas of 284 singleton preterm infants with <35 weeks of gestation were examined. three groups created as the normal, chorioamnionitis and vasculopathy according to histopathological findings in placentas subjects. Results: The mean gestational age of the infants in the study group was 30.5 ± 3.2 weeks, and the mean birth weight was 1588 ± 581 g. The pathology was normal in ninety-six (33.8%), vasculopathy in 153 (53.9%) and chorioamnionitis in 35 (12.3%). The gestation age of the infants was lower in the chorioamnionitis group. Moreover, retinopathy of prematurity, early onset neonatal sepsis, and duration of respiratory support were found to be higher in the chorioamnionitis group. In the vasculopathy group, preeclampsia and small for gestational age were found to be significantly higher. Conclusion: Histopathological findings of the placentas from preterm deliveries provided important data in determining the etiology of preterm delivery and outcomes of infants. Infants delivered by mothers with chorioamnionitis were particularly found to be more preterm, and these preterm infants would have a longer hospital stay, higher respiratory support requirement, and more serious morbidities

Comparison of the effects of cyclooxygenase 2 spesific inhibitors on proteinuria and renal functions with the classical nonsteroidal anti-inflammatory drugs in patients with renal amyloidosis secondary to rheumotological diseases

Bu çalışma U. Ü. T. F. İç hastalıkları ABD Nefroloji-Romatoloji bilim dalında; nefrotik, nefritik ve mikroalbuminürik düzeyde proteinürisi olan Romatolojik hastalıklara ikincil renal amiloidozlu 11 olgu üzerinde yapıldı. Olgularda; Selekoksib 200 mg/gün tek doz ile Indometazin 100 mg/gün iki doz kullanıldı. Çalışmada ilaçların proteinüri ve diğer böbrek fonksiyonları üzerine olan etkileri araştırıldı. Bu amaçla her ilaç 4 hafta süre ile uygulandı. İki ilaç arasında 3 hafta ara verildi. Hastalarda serum üre, kreatinin, sodyum, potasyum, kreatinin klirensi, hemogram, idrar sodyumu ve proteinüri düzeyleri araştırıldı. Sonuç olarak, Romatolojik hastalıklara sekonder gelişen AA tipi renal amiloidozlu olgularda Cox-2 inhibitörü Selekoksib ile klasik NSAII olan Indometazin arasında antiproteinürik etki açısından istatistiksel olarak anlamlı fark saptanmamıştır. Hastaların serum üre, serum kreatinin, kreatinin klirensi, idrar sodyumu yönleriyle yapılan istatistiksel değerlendirmede, her iki ilaç grubunda tedavi öncesi-sonrası ve tedaviler arası yüzde değişimlerde istatistiksel olarak anlamlı farklılık saptanmamıştır. İndometazinin Selekoksib'e göre serum sodyumu arttırıcı etkisinin daha fazla olduğu görülmüştür. Selekoksib'in ise serum potasyumu arttırdığı saptanmıştır. Indometazin kullanan hastaların birinde melena tespit edilmiştir. Indometazin Selekoksib'e göre serum sodyumu arttırıcı etkisinin daha fazla olduğu görülmüştür. Selekoksib'in ise serum potasyumu arttırdığı saptanmıştır. İndometazin kullanan hastaların birinde melena tespit edilmiştir. Indometazin grubunda, hemoglobinin yüzde değişiminde olan azalma, Selekoksib grubunun yüzde değişimi ile karşılaştırıldığında istatistiksel olarak anlamlı olduğu görülmüştür. Indometazin alan iki hastada şiddetli baş ağrısı ve ödem gelişmiş olup hastalardan biri tedavisini tamamlayamamıştır.This study was conducted in Uludag University School of Medicine Department of Rheumathology and Nephrology, into the study 11 cases with nephrotic, nephritic and microalbuminuric range of proteinuria were enrolled. To the cases Celecoxib which is a new generation NSAID was given 200 mg qid and indomethazine 100 mg bid. In the study the effects of the drugs mentioned above on renal function and proteinuria was investigated. For this purpose both drugs were given for four weeks with a washout period of three weeks in the middle. The levels of urea, creatinine, sodium, potassium, hemoglobine, proteinuria, urinary sodium; and creatinine clearences were determined in the cases at the beginning and end of each study period. As a result, in AA type amyloidosis secondary to rheumatologic diseases, it is shown that Cox-2 inhibitors which belong to the new As a result, in AA type amyloidosis secondary to rheumatologicdiseases, it is shown that Cox-2 inhibitors which belong to the newgeneration NSAID lead to a reduction in proteinuria that doesn't reach tostatistically significant levels. It was shown that lndomethazine had a moreprofound effect in sodium increase than Celocoxib. Celecoxib was detectedto increase potassium. With lndometazine use we found a significantreduction in serum hemoglobin levels compared to Celocoxib. We did not findany significant difference in creatinine clearances levels of urinary sodiumand serum urea and creatinine of the cases. In two cases on lndomethazinesevere headache and edema occured and these cases were unable to go onwith the therapy

Upper extremity problems and functioning in patients with end stage renal failure receiving haemodialysis

WOS: 000437429200002Objective: This study aims to evaluate upper extremity problems, upper extremity and hand functions in haemodialysis patients with chronic renal failure and to investigate differences between diabetic and non-diabetic patients. Materials and Methods: Demographic characteristics, upper extremity symptoms, The Quick Disabilities of the Arm, Shoulder and Hand Survey-Turkish scores (Q-DASH-T), Duruoz Hand Index scores, upper extremity locomotor system and neurologic system examinations of 150 haemodialysis patients were evaluated. Results: The most frequently detected problems in upper extremities were shoulder periarthritis (18%) and rotator cuff problems (12%) in all haemodialysis patients. Clinical shoulder periarthritis was detected in 25.4% of diabetic patients and 13.2% of non-diabetic patients whereas there was no statistically significant difference between the groups. Clinical rotator cuff problems were detected in 13.5% of diabetic patients and 10.9% of non-diabetic patients since there was no statistically significant difference between the groups. Carpal tunnel syndrome was detected significantly higher in diabetics compared to non-diabetics (23.7% and 2.2%, respectively). Shoulder circumference, elbow extension, first finger abduction and opposition muscle function weaknesses were significantly more frequent in the diabetic group. In all haemodialysis patients, impaired Q-DASH-T score and Duruoz Hand Index were detected as 30.7% and 16.7% respectively. There were no significant differences in terms of upper extremity and hand functions between diabetic haemodialysis patients compared to non-diabetics. Conclusion: The most common upper extremity problems were shoulder periarthritis and rotator cuff problems in all haemodialysis patients regardless from the presence of diabetes. Carpal tunnel syndrome was found to be more prevalent in diabetic haemodialysis patients compared to non-diabetics. Regardless from the presence of diabetes, impaired upper extremity and hand functions were detected in 30.7% and 16.7% of all haemodialysis patients, respectively

An overlooked complication of bariatric surgery: Gluteal compartment syndrome

Gluteal compartment syndrome (GCS) is an uncommon non-traumatic rhabdomyolysis induced by staying in the same position for a long time during a surgical operation or under the effect of drugs. In bariatric surgery, overweight patients are more prone to this syndrome. If a patient has complaints such as hip or leg pain, sciatic nerve palsy and red-brown colored urine in the post-op period, GCS should be taken into consideration. For patients having a long operation time due to technical problems, the creatinine kinase level should be controlled and the gluteal region should be examined carefully. The treatment options of GCS include early aggressive fluid replacement, alkalinization of urine with sodium bicarbonate, surgical decompression and debridement. Here we present a case of a 40-year-old obese patient who underwent bariatric surgery resulting in GCS, renal failure, and death

Aquired cytomegalovirus ınfection of extremely low birth weight ınfant

Anne sütü, özellikle prematürelerde kazanılmış sitomegalovirüs (CMV) enfeksiyonu için majör kaynaktır ve anne sütünden kazanılan CMV enfeksiyonu seropozitif anne bebeklerinde görülmektedir. Türkiye’de annelerin çoğunluğunun seropozitif olmasına karşın prematüre bebeklerde yaşamı tehdit eden akkiz CMV enfeksiyonu yalnızca vaka sunumları şeklinde çok az olguda bildirilmektedir. Preterm semptomatik anne sütü kaynaklı CMV enfeksiyonunun tedavisi klinik bulguların ağırlığına göre yapılmalıdır. Postnatal 111. gününde menenjit-sepsis tanısı alan, anne sütünden kazanılan CMV enfeksiyonu tanımlanan ancak yaşamı tehdit eden çoklu organ yetmezliği gelişmemesi nedeniyle antiviral tedavi verilmeyen prematüre bir bebek literatür bilgileri eşliğinde sunulmuştur. Preterm bebeklerde etken saptanmayan sepsis kliniği, açıklanamayan trombositopeni, karaciğer enzim yüksekliği ve direkt bilirübinemi varlığında kazanılmış CMV enfeksiyonu akla getirilmelidir.Breast milk is a major source for acquired cytomegalovirus infection especially in premature infants and acquired CMV infection occurs in infants whose mothers were seropositive for CMV. Although most of mothers of premature infants are seropositive in Turkey, acquired life-threatening breast milk acquired CMV infection was reported occasionally. Treatment of preterm with symptomatic breast milk acquired CMV infection should be done according to the severity of clinical signs. In this report, a preterm case with a diagnosis of breast milkacquired CMV meningitis and sepsis without multiorgan failure on the 111th day of life, who did not require antiviral therapy was presented and discussed in the context of the acquired CMV literature. In preterm babies, when there is sepsis with no apparent causes, unexplained thrombocytopenia, elevated liver transaminases and direct hyperbilirubinemia acquired CMV infection should be suspected

Diagnostic accuracy of UriSed automated urine microscopic sediment analyzer and dipstick parameters in predicting urine culture test results

Introduction: Urinary tract infection (UTI) is one of the most common types of infection. Currently, diagnosis is primarily based on microbiologic culture, which is time- and labor-consuming. The aim of this study was to assess the diagnostic accuracy of urinalysis results from UriSed (77 Electronica, Budapest, Hungary), an automated microscopic image-based sediment analyzer, in predicting positi-ve urine cultures. Materials and methods: We examined a total of 384 urine specimens from hospitalized patients and outpatients attending our hospital on the same day for urinalysis, dipstick tests and semi-quantitative urine culture. The urinalysis results were compared with those of conventional semi-quantitative urine culture. Results: Of 384 urinary specimens, 68 were positive for bacteriuria by culture, and were thus consi-dered true positives. Comparison of these results with those obtained from the UriSed analyzer indi-cated that the analyzer had a specificity of 91.1%, a sensitivity of 47.0%, a positive predictive value (PPV) of 53.3% (95% confidence interval (CI) = 40.8-65.3), and a negative predictive value (NPV) of 88.8% (95% Cl = 85.0-91.8%). The accuracy was 83.3% when the urine leukocyte parameter was used, 76.8% when bacteriuria analysis of urinary sediment was used, and 85.1% when the bacteriuria and leukocyturia parameters were combined. The presence of nitrite was the best indicator of culture positivity (99.3% specificity) but had a negative likelihood ratio of 0.7, indicating that it was not a relia-ble clinical test. Conclusions: Although the specificity of the UriSed analyzer was within acceptable limits, the sensitivity value was low. Thus, UriSed urinalysis results do not accurately predict the outcome of culture

Evaluation of serum spondin 2 levels in the different etiologies of glomerular diseases

Bu çalışma, 28-31 Mayıs 2015'de Londra[Birleşik Krallık]'da düzenlenen 52. Congress of the European Renal Association-European Dialysis and Transplant Assocation'da bildiri olarak sunulmuştur

Portal Vein Thrombosis of a Newborn with Corrected Total Anomalous Pulmonary Venous Return

Total anomalous pulmonary venous return (TAPVR) is a rare and frequently isolated defect identified in 1% to 3% of all congenital heart diseases. To the best of our knowledge, portal vein thrombosis (PVT) associated with TAPVR has not been reported in the literature. We report a successfully managed PVT in a newborn with infracardiac-type TAPVR and review the literature. Anticoagulation therapies were used during the neonatal period to prevent thrombus progression. PVT should be kept in mind in TAPVR patients who have open heart repair with total correction. The treatment in each neonate should be individualized with consideration of the risk/benefit ratio