Preoperative anxiety and health literacy in patients applying to the anesthesia outpatient clinic

Background

Evaluation of preoperative anxiety and health literacy is important for healthcare professionals to understand the needs and expectations of patients and provide them with the necessary support. The study aimed to evaluate the preoperative anxiety levels of patients who applied to the anesthesia outpatient clinic and its relationship with health literacy.

Methods

A cross-sectional study was conducted on patients who applied to the anesthesia outpatient clinic of Eskişehir Osmangazi University Medical Faculty Hospital in March 2022. The questionnaire form, which was prepared by making use of the literature, was filled in by face-to-face interview method after obtaining the participants’ verbal consent. The 6 item Amsterdam Preoperative Anxiety and Information Scale (APAIS) in which the scores that can be taken range from 6 to 30 and higher score means higher anxiety was used to assess the level of anxiety, and the 16 item European Health Literacy Scale Short Form was used to assess health literacy. Descriptive statistics, Chi-Square test and Logistic Regression analysis were used to analyze the data.

Results

In the study group, 197 (50.3%) were female. Their ages ranged from 18 to 86, with a mean of 45.7 ± 17.2 years. The median (min-max) APAIS score was 15 (6-30). There was a moderate negative correlation between the scores obtained from the APAIS and the European Health Literacy Scale Short Form (r= -0.50, p < 0.01). According to the logistic regression analysis, preoperative anxiety was found to be 1.53 (%95 CI; 1.01-2.30) times higher in women, 3.49 (%95 CI; 1.23-9.94) times higher in those with low family income, and 1.61 (%95 CI; 1.07-2.42) times higher in those with type A personality.

Conclusions

More than half of the patients had preoperative anxiety. The level of preoperative anxiety decreased as the health literacy level increased.

Key messages

The Level of Cyber-Ostracism and Self-Esteem in Medical Faculty Students

Background

Social media, which has become an indispensable part of our lives in recent years, is important for young people to socialize in online groups and to develop their self-esteem (SE). One of the dangers of increased use of social media is cyber ostracism (CO), defined as not being able to join a group and being ignored on social media. In the study, it was aimed to evaluate the level of CO and SE in medical faculty students.

Methods

This is a cross-sectional study conducted on students of Eskişehir Osmangazi University Faculty of Medicine in 2021 spring semester. The questionnaire prepared based on the literature was filled out online by the participants. The study group consisted of 1092 (70% response rate) students who agreed to participate in the survey. The CO Scale was used to assess the level of CO, and the Rosenberg SE Scale was used for the assessment of SE. Mann Whitney-U test, Kruskal Wallis test, Spearman correlation analysis and Multiple Linear Regression analysis were used to analyze the data.

Results

In the study group; 593 (54.3%) were female. Their ages ranged from 17-27, with a mean of 21.6 ± 2.0 years. The scores obtained from the CO scale ranged from 14 to 70, with an average of 24.8 ± 9.9 points. A moderate positive correlation was found between the scores the students got from the CO Scale and the SE Scale (r: 0.49, p: 0.001). Multiple Linear Regression analysis showed that; living in an extended family, not sparing time for hobbies during the day, having a type-A personality, poor face-to-face communication with peers, negative evaluation of parental attitudes, age at first use of smartphone below years 12 or less, use of smartphones for 5 hours or more a day, and Creating membership in social media by hiding their identity was a predictor for CO (F: 30.338, R2: 0.212, p < 0.001).

Conclusions

It can be said that CO is at a moderate level in medical faculty students. An inverse relationship between CO and SE was found in the study.

Key messages

İt’s recommended to plan more comprehensive studies on CO which is a new concept for digital health. Public health policies to reduce the level of CO may contribute to higher SE in future physicians.

Assessment of knowledge of metabolic syndrome and health literacy level among adults in Western Turkey

Background

Metabolic syndrome (MetS) has become an issue in the public health discipline.

Aims

The primary aim of this study is to assess the potential determinants for both knowledge level of metabolic syndrome and health literacy (HL) level among the adult population. The second purpose of this study is to show whether there is a relationship between the MetS knowledge level and the HL level in western Turkey.

Methods

This cross-sectional study was conducted between October 10, 2017 and November 15, 2017 in western Turkey. The participants of the study were adult population who applied to seven "family health centers". The MetS knowledge level was measured with the Metabolic Syndrome Knowledge Level Scale (MetS-KS). HL level was measured with the HLS-EU-Q16. A General Linear Model was constructed to evaluate the relationship between MetS-KS scores and HLS-EU-Q16 scores. For statistical significance, P < 0.05 was accepted.

Results

Younger age, having higher education level, being single, having a high family income, not having a chronic disease, doing regular physical activity, viewing television less than 3 hours a day, previous measurement of waist circumference, previous attempts to lose weight, not being abdominally obese, not being at risk for hypertension and not having optimal body mass index (BMI) were associated with high HL levels (P < 0.05 for each one). According to the general linear model, the level of HL was not related to the level of MetS knowledge level (P > 0.05).

Conclusions

Younger age, having a high educational level, high socioeconomic level and positive health behaviors were related with both MetS knowledge level and HL level. However, there was no direct relationship between MetS knowledge level and HL level.

Perception of Social Gender Roles in Medical Faculty Students

Background

“Gender equality’’ is the fifth of the Sustainable Development Goals put forward in order to ensure the development in all areas. Medical faculty students, who will be a doctor, should practice with a gender equality perspective and shape their views and attitudes with equality in mind which will have an important part in the adoption of equality by society. The aim of the study was to evaluate the perception of social gender roles in medical students.

Methods

This cross - sectional study was performed with all students in Eskisehir Osmangazi University Faculty of Medicine. The questionnaire includes sociodemographic characteristics and Gender of Perception Scale(PCS) to measure perception of social gender roles. The scores that can be taken from the scale are ranged from 25 to 125, and high scores indicate that perception of gender is positive and equality. Mann Whitney U, Kruskal Wallis were used in univariate analysis; multivariate linear regression was used in multivariate analysis.

Results

The study group consisted of 1023 (84.3%) students in the study group, 52.8% were females and their ages ranged from 17 to 30 and the mean was 21.36 ± 2.06. The PCS scores ranged from 32 to 125 and the mean was 108.07±16.58. Multivariate linear regression analyzes were performed to determine the factors associated with the PCS. According to the results of last model sex, living with grandparents until the age of 18, region of the majority of life and parental attitudes were found to be related to perception of social gender roles (F = 29.602, R2=0.170, p &lt; 0.001).

Conclusions

The perception of gender of medical students was found to be positive. Sex and the characteristics of the social environment were related to perception of gender. In order to raise awareness on gender equality, it might be useful to ensure integration in the medical education curriculum.

Key messages

Factors that can be changed, such as the social characteristics of the living environment, were found to be related to perception of social gender roles. Ensuring gender equality, one of the Sustainable Development Goals, is important for medical students who will be a role model for society.

Evaluation of Social Media Use Disorder in Medical Faculty Students

Background

Recently, social media usage disorder has become a behavioral addiction with the internet which has entered our daily life rapidly. One of the important factors considered to be associated with social media use disorder is thought to be loneliness. The aim of the study was to evaluate the social media use disorder in medical school students.

Methods

This study is a cross-sectional study conducted on the students who were studying in Eskisehir Osmangazi University Faculty of Medicine between January 2 and February 28, 2019. The study group consisted of 422 internet user students. The level of social media usage was assessed by Social Media Disorder Scale (SMD-scale). The level of loneliness was evaluated with the short-form of the UCLA Loneliness Scale (ULS-8). Mann Whitney U, Kruskal Wallis, Spearman correlation analysis were used.

Results

Of the participants 226 (53.6%) was male. The age of the study group ranged from 17 to 29 years and the mean (SD) was 19.78 (1.33) years. The scores obtained from SMD-scale ranged from 0 to 63, with a mean of 12.18±10.35 (median = 9.0). All students had at least one social media account. In the study, no difference was found between the scores obtained from gender, age group, father’s education status, family income status and family type. While the scores of the students whose mothers have a university education level are lower; those who spent more than 2 hours a day on social media had a higher score. There was a weak positive correlation between the scores obtained from SMD-scale and ULS-8 (p &lt; 0.001, r = 0.215). There was a weak negative correlation between the scores obtained from the SMD-scale and the academic grade point average (p = 0.012, r = -0.123).

Conclusions

It is concluded that the correct use of social media can be increased by informing about this issue. Increasing platforms such as student clubs in which individuals could socialize in real life may be useful in reducing this disorder.

Key messages

Public health studies could help prevent social media use disorder transform into more serious health problem in future. Further studies are needed to determine the effects of social media use disorders on mental and physical health.

Predictive ability of Guy's stone score in pediatric patients undergoing percutaneous nephrolithotomy

BACKGROUND

Several authors have evaluated, in a number of external validation and predominantly adult studies, Guy's stone score (GSS) as a predictive tool for the assessment of stone clearance after percutaneous nephrolithotomy (PCNL). However, there are limited and conflicting data investigating whether GSS could be a potential independent factor associated with residual stone rates and complications of PCNL for children.

OBJECTIVE

The aim of the current study was to evaluate the ability of GSS, as an independent factor, to predict residual stone rates and complications in pediatric patients undergoing PCNL.

STUDY DESIGN

The records of the pediatric patients who had undergone PCNL for stone disease at the current department were retrospectively reviewed. Variables included patient, stone, and treatment parameters. The GSS was used for assessment of stone complexity. Univariate and multivariate analyses were performed to evaluate factors associated with residual stone rates and complications of pediatric PCNL.

RESULTS

The study group consisted of 114 children (63 boys and 51 girls) with a median (interquartile range) age of 6 (3-11) years and who had undergone 122 PCNLs (eight bilateral). Multivariate logistic regression analysis (Summary Table) demonstrated that the independent risk factors for increased residual stone rate following pediatric PCNL monotherapy were GSS (OR 3.14, 95% CI 1.31-7.49, P = 0.01) and number of calyces involved (OR 4.02, 95% CI 1.11-14.53, P = 0.033). Multivariate logistic regression analysis demonstrated that the independent risk factors for complications following pediatric PCNL were surgical experience (OR 2.72, 95% CI 1.09-6.82, P = 0.032), and operation time (OR 1.01, 95% CI 1.00-1.03, P = 0.040).

DISCUSSION

A prediction model is needed to pre-operatively counsel patients and evaluate outcomes for measuring treatment success of PCNL. The GSS provides a simple, reliable and reproducible tool for describing the complexity of PCNL while predicting postoperative stone-free status, despite its limitations. However, little research has been conducted on the applicability of GSS in pediatric patients undergoing PCNL. In addition, conflicting results have been reported about its association with complications of pediatric PCNL.

CONCLUSIONS

The current study found that although GSS had a significant predictive ability for residual stone rates after pediatric PCNL revealed by multivariate logistic regression, the results did not conclude that complexity of GSS was directly proportional to complications of pediatric PCNL. The factors, including calyceal involvement and surgeon experience, may need to be incorporated in GSS to further improve its ability to predict outcomes of pediatric PCNL.

IRB APPROVED PROTOCOL NUMBER

1422.

Evaluation of frequency of nausea and vomiting as well as depression level in pregnant women

OBJECTIVE

To determine the frequency of nausea and vomiting in pregnant (NVP) women, review associated factors, and evaluate the depression level.

MATERIALS AND METHODS

The study is a cross-sectional research conducted in pregnant women who applied to Sakarya Training and Research Hospital and Sakarya Maternity and Children Hospital between January 13, 2013 and March 23, 2013. The study group consisted of 606 pregnant women who were below 20 weeks gestation and agreed to take part in the study. The questionnaire form prepared in line with the study objective was completed by the pregnant women under supervision. The women who had a complaint of nausea and vomiting at least once a day during their pregnancy were deemed as "having a history of nausea and vomiting". Rhodes index was used to evaluate the severity of nausea and vomiting. Depression level was evaluated with the Beck Depression Inventory. Chi-square test and Spearman's Correlation Analysis were used to analyze the data. Statistical significance value was accepted as p < 0.05.

RESULTS

The age of pregnant women in the study group ranged from 17 to 39 years (mean age: 25.55 ± 4.95). The frequency of having nausea and vomiting in the pregnant women was determined to be 35.1% (n = 213). The frequency of having nausea and vomiting was determined to be higher in those with a nuclear family, working women, those with a poor family income, those who used any contraception method before the pregnancy, and those who had a history of nausea and vomiting in their previous pregnancy(ies) (p < 0.05 for each). The pregnant women with a history of nausea and vomiting reported that their complaints increased the most with the smell of food as well as perfume/cigarette/body odor. In the women with a history of nausea and vomiting, frequency of depression was significantly higher (p < 0.05). A positive relationship was found between the severity of nausea and vomiting and depression level (p < 0.05).

CONCLUSIONS

Nausea and vomiting were determined to be a major health problem in pregnancy. Depression frequency was higher in those with a history of nausea and history. The severity of nausea and vomiting increased with higher depression levels. More detailed studies are required to determine the causes of NVP as well as the risk factors.

Effects of infectious complications on patients' survival in peritoneal dialysis

AIM

To investigate the impacts of infectious complications on mortality and morbidity; and to identify the other potential factors effective in mortality in peritoneal dialysis (PD) patients.

PATIENTS AND METHODS

We included patients who initiated therapy between 2001-2011. Patients were divided into two groups regarding to presence or absence of infectious complications. Socio-demographic data and clinical courses were compared and the reasons for PD withdrawal were obtained. Survival analysis of all patients was performed and the effects of infectious complications on mortality were investigated.

RESULTS

301 patients were included in this retrospective study. 214 patients (mean follow-up time 28.7±16.5 months) had infection history, 87 patients (mean follow-up time 48.9±29.6 months) had no infection history. There were no statistically significant difference in comparison of the groups in terms age, gender, education levels, hemodialysis history. In patients with infection history, 465 peritonitis and 213 catheter exit site infection attacks were diagnosed. The most frequently agent was methicillin-sensitive Staphylococcus aureus and Methicillin-resistant Staphylococcus aureus in both conditions, while 25% of catheter exit site infection and 25% of peritonitis attacks were culture negative. During follow-up period, 60 patients transferred to hemodialysis, 58 patients died, 18 patients had renal transplantation in patients with infection history. In other group, 27 patients died, 23 patients had renal transplantation and 11 patients transferred to hemodialysis. Mean survival times were 56.3±2.8 months in patients with infection history and 86.8±6.1 months in other group. Mortality rate was found higher in patients with infection history (long-rank: 0.030). PD preference (OR: 5.213, p < 0.001), pretreatment low serum albumin (OR: 0.378, p = 0.001), low hemoglobin levels (OR: 0.810, p = 0.029) were found as predictors of survival in patients with infection history.

CONCLUSIONS

Infectious complications have negative effects on patient survival. Nature of PD preference, initial hypoalbuminemia and anemia were found to increase the mortality rate. The major causes of deaths were peritonitis and/or sepsis in patients with infectious complications, while the major cause of death was cardiac reasons in patients without infectious complications.

Fungal peritonitis in peritoneal dialysis: a 10 year retrospective analysis in a single center

INTRODUCTION

Fungal peritonitis (FP) is a rare but serious complication in patients undergoing peritoneal dialysis (PD), and is associated with higher morbidity, mortality. We aimed to analyze the predisposing factors, etiological agents, outcome and treatment of FP in patients with PD.

METHODOLOGY

We evaluated retrospectively all PD patients PD center between 2001 and 2011. Sixteen patients with FP were included into the study.

RESULTS

The clinical records of 16 patients with FP among 355 patients were reviewed for the clinical and laboratory data. Among 506 episodes of PD-related peritonitis in 10 years, we identified 16 episodes of FP. Median PD duration was 36.7±22.2 months. In 87.5% of patients had one or more previous episode of bacterial peritonitis that were treated with multiple broad-spectrum antibiotics. FP was primary infection in five patients, whereas eleven patients experienced FP during the course of treatment of bacterial peritonitis. Six patients died due to the fungal infection whereas others were transferred to haemodialysis.

CONCLUSIONS

Treatment of bacterial peritonitis with broad spectrum antibiotics was an important risk factor predisposing to the development of FP. The catheter removal and initiation of antifungal therapy as soon as possible are obligatory in episode of FP because it is responsible from high mortality rate.

Effects of rosiglitazone treatment on insulin resistance and TNF-alpha levels in patients with chronic kidney disease: a prospective study

AIM

The aim of the study was to investigate the effects of rosiglitazone treatment on insulin resistance (IR) and tumor necrosis factor-alpha (TNF-alpha) levels in non-diabetic chronic kidney disease (CKD) patients with IR.

PATIENTS AND METHODS

Thirty non-diabetic CKD patients with IR were enrolled in the study. Patients were grouped into two: group 1 (n = 15) received rosiglitazone 4 mg tablet for 3 months and patients who did not receive rosiglitazone treatment constituted the group 2 (n = 15). Baseline and after rosiglitazone treatment, homeostatis model assessment-insulin resistance (HOMA-IR) and TNF-alpha levels were measured.

RESULTS

There were no statistical differences in gender, age, HOMA-IR and TNF-alpha levels among group 1 and group 2 (p > 0.05 for all). Compared to baseline in group 1, significant differences were found in HOMA-IR and TNF-alpha levels after 3 months (p = 0.023; p = 0.001, respectively).

CONCLUSIONS

Our study indicates that, rosiglitazone treatment improves the IR and decreases TNF-alpha levels in non-diabetic patients CKD with IR.

Risk factors for progression of renal disease in patient with diabetic nephropathy

AIM

The aim of this study was to investigate the annual rate of glomerular filtration rate (GFR) decline and associated risk factors with this decline in diabetic nephropathy patients.

PATIENTS AND METHODS

A total of 122 type 2 diabetes mellitus (DM) patients (66F, mean follow up time 39 +/- 19 months, mean age 56 +/- 10 years, mean duration of diabetes diagnosis 12.1 +/- 9.5 years) between 2003 and 2010 were evaluated retrospectively. Socio-demographic characteristics and blood pressure data, laboratory parameters, HbAlc, daily urine protein excretion both of the first and last visits of all patients were recorded. Patients were separated into three groups according to rate of GFR decline. Group 1 (n:35), group 2 (n:42) and group 3 (n:45) consisted of patients < 1 ml/dk/1.73 m2, 1-5 ml/dk/1.73 m2 and > 5 ml/dk/1.73 m2 annual rate of GFR decline respectively. Demographics, laboratory data and their treatments were compared in all three groups and were investigated factors that may influence the rate of GFR decline.

RESULTS

The annual rate of GFR decline was 1.4 +/- 2.3 ml/sec, -2.9 +/- 1.0 ml/sec and -11.9 +/- 9.1 ml/sec in group 1, 2 and 3 respectively. Daily urine protein excretion was 0.9 +/- 1.3, 1.2 +/- 1.5 and 5.2 +/- 5.5 g in groups respectively, was found significantly higher in group 3 (p < 0.001). Serum albumin level was significantly lower in group 3 (p < 0.001). We found positive correlation between annual rate of GFR decline and last visit systolic blood pressure (SBP), daily proteinuria and parathormone levels (r: 0.339, 0.447 and 0.289 p < 0.001, < 0.001 and 0.02 respectively) and negative correlation between GFR decline and deltaSBP (delta systolic blood pressure), pretreatment albumin, calcium and hemoglobin levels (r: -0.409, -0.526, -0.233 and -0.467, p < 0.001, < 0.001, < 0.001 and 0.016 respectively).

CONCLUSIONS

Proteinuria, hypoalbuminemia, anemia, and a change in SBP were found most effective in annual rate of GFR decline in patients with diabetic nephropathy. The early detection of these factors may slow the progression of nephropathy.

Nephrotic syndrome after oral bisphosphonate (alendronate) administration in a patient with osteoporosis

Alendronate is a widely used bisphosphonate in the treatment of osteoporosis. Although it has been proven to be a very useful drug, it has some side effects as well. In this paper, we describe a case of nephrotic syndrome due to alendronate administration. A 36-year-old man was admitted to the nephrology outpatient clinic with widespread edema 4 months after initiation of alendronate. He had a 13-kg weight gain within a 2-week period. He had no clinical or laboratory problems apart from osteoporosis, which was the indication for initiation of the drug. Physical examination at admission was unremarkable, but for nephrotic edema. Laboratory studies revealed nephrotic range proteinuria (13.5 g/day), normal renal function, hypoalbuminemia (1.7 g/dl), and also hypercholesterolemia (400 mg/dl). A kidney biopsy was performed. Light microscopic evaluation revealed a slight increase in mesangial cells and matrix; however, no abnormalities in the tubules or interstitium were noted. Alendronate was withdrawn and diuretic therapy was initiated. Patient's weight gradually decreased from 84 to 67 kg within a 1-week period. No other drugs for the treatment of nephrotic syndrome were administered. During the clinical course, serum creatinine remained stable, and proteinuria gradually decreased and disappeared 40 days after stopping alendronate. It was noted that alendronate administration can give rise to nephrotic syndrome, while discontinuation of this drug may improve the pathology without any specific treatment.

Correlation between the resistive index values of renal and orbital arteries

BACKGROUND

Resistive index (RI) is an indirect measurement of blood flow resistance that can be used to evaluate vascular damage.

AIMS

The purpose of this study is to evaluate the association between RI values of orbital and intrarenal arteries by means of Doppler ultrasonography (US).

METHODS

We evaluated 103 diabetic patients. As a control group, 30 subjects were examined. The patients were divided into two groups. Group 1 consisted of patients with urinary albumin excretion (UAE) <300 mg/day and estimated glomerular filtration rate (eGFR) levels >90 ml/min (n = 50); Group 2 had a UAE >300 mg/day and/or eGFR levels between 89 and 60 ml/min (n = 53). The association between RI values obtained with Doppler US of the ophthalmic artery, central retinal artery, posterior ciliary artery and intrarenal arteries were calculated.

RESULTS

Both orbital and intrarenal arterial RI values in Group 1 and Group 2 were higher than the control group (p = 0.001); furthermore, values were higher in Group 2 than in Group 1 (p = 0.0004/0.029/0.036, p = 0.016, respectively). A positive correlation was found between orbital and intrarenal arterial RI values in Group 2 (r = 0.475, 0.285, 0.363, p < 0.01, respectively).

CONCLUSION

Both orbital and renal arterial RI values were shown to be higher than the control group. Further, a trend towards higher RI values was observed with renal disease. RI may be useful as one of the markers for early diagnosis and follow-up of diabetic nephropathy and retinopathy.

Effect of cholecalciferol on parathyroid hormone and vitamin D levels in chronic kidney disease

AIM

We aimed to determine the effect of a monthly oral vitamin D on the serum 25-hydroxyvitamin D levels and iPTH levels in patients with CKD.

METHODS

This was a prospective controlled trial of 48 patients with CKD stage 3-4. Patients were divided into two groups Group1 the cholecalciferol treatment group, Group 2, the control group. One patient in Group 1, and 3 patients in Group2 were excluded after the baseline 25(OH)D levels were determined to be greater than 30ng/ml. Two patients in Group1, and one patient in Group 2 were excluded after the baseline iPTH was determined to be less than 70 pg/ml and greater than 300 pg/ml. Five patients in both groups were lost to follow-up. Thus, a total of 16 patients in Group 1 and 15 patients in Group2 completed the three month study. Group1 patients received 300,000 IU month oral cholecalciferol.

RESULTS

The mean serum 25(OH)D concentration of the group1 was significantly higher at baseline (P=0.039). At the end of the three months; serum 25 (OH) D level increased significantly in Group1 (P=0.001). iPTH level of Group1 was significantly lower at baseline (P=0.034). The values of the group1 before and end of third month was compared, serum Ca (P=0.011), P (P=0.013) level showed significant increase, but no significant increase in the Group 2 (P>0.05). The groups had not a clinically significant change in serum Ca and P level (P>0.05).

CONCLUSION

Oral cholecalciferol supplementation can be used safely and effective in reducing iPTH levels and correcting vitamin D insufficiency/deficiency in patients with CKD.

Effect of Olmesartan on serum cystatin C levels in the patients with essential hypertension

AIM

We aimed to investigate whether Olmesartan had an effect on cystatin C levels in hypertensive patients, and evaluate its correlation with blood pressure (BP).

MATERIALS AND METHODS

Seventy-two patients essential hypertension patients with a known for, at most, the last 3 years were enrolled to the study. Patients were divided in three groups (group 1; receives 20 mg/day olmesartan; group 2, receives 40 mg/day olmesartan; group 3, receives Olmesartan plus hydrochlorothiazide), according to their BP measurements. Blood samples (serum urea, creatinine, sodium, potassium and cystatin C) were collected initially and at the end of the study from all patients and the correlation of these parameters with BP and drug use was investigated.

RESULTS

There were no significantly difference between the groups in terms of age, gender, serum urea, creatinine, cystatin C and diastolic BP levels (p > 0.05); while, systolic BP was significantly higher in group 3 at baseline (p = 0.001). After 3 months of olmesartan treatment, the mean serum cystatin C (p: 0.001, 0.023 and 0.018 respectively), systolic (p: 0.001, 0.001 and 0.001 respectively) and diastolic BP levels (p: 0.001, 0.001 and 0.001 respectively) decreased in all groups. However, there was no significant difference in serum creatinine levels (p > 0.05). There were not found correlation between the changes of systolic and diastolic BP and cystatin C levels.

CONCLUSIONS

Cystatin C is a more sensitive marker to detect of early kidney dysfunction compared to serum creatinine level. Olmesartan treatment led to a decrease of cystatin C level. Therefore, olmesartan can be used to prevent the renal damage in patients with hypertensive and it is independent of drop in blood pressure.

Fetuin-A, inflammation, and coronary artery calcification in hemodialysis patients

Hemodialysis patients have extremely increased cardiovascular mortality. Vascular calcification, inflammation, and low serum fetuin-A levels are implicated for increased mortality. In this study, relationship between coronary artery calcification, inflammation, and serum fetuin-A levels were investigated. Seventy-eight hemodialysis patients (38 male, 40 female, mean age: 52±14.5 years) were included. All patients were on dialysis for more than 6 months. Coronary artery calcium scores (CACS) are determined by electron-beam computed tomography. Serum CRP, IL-1β, IL-6, TNF-α, and serum fetuin-A levels were measured. Mean CACS value was 488.5±94.5. Serum fetuin-A levels were negatively correlated with CACS (r:–0.30, P=0.009). Patients are divided into two groups according to total CACS value; group 1 (CACS<10), group 2 (CACS≥10). There was a statistically significance difference in fetuin-A levels between CACS group 1 and group 2 (P=0.001). In this study, serum fetuin-A levels were associated with total CACS. This Fetuin-A may play a role in increased mortality in this group of patients via facilitating CAC.

The role of percutaneous nephrolithotomy in the management of medium-sized (1-2 cm) lower-pole renal calculi

OBJECTIVES

The objective of this study was to determine the efficacy (defined by stone-free rates) and safety of percutaneous nephrolithotomy (PNL) in the treatment of medium sized (1-2 cm) symptomatic lower pole renal calculi, and establishment of the short-term morbidity.

METHODS

We performed a retrospective analysis of 60 evaluable patients who had undergone PNL for 1 to 2 cm diameter lower-pole (LP) stones between November 2006 to March 2009 and compared these results with other treatment modalities in published literature.

RESULTS

In all cases, stones were located in the lower calix. Thirty-six procedures were performed on the left side, and 24 were performed on the right side. The mean time to access the collecting system was 20.4 minutes (range 8-70 min) and mean operative time was 62.2 minutes (range 13-155 min). Abdominal radiography performed on postoperative day 1 demonstrated a stone free status in 56 (93.3%) patients. However, 4 patients (6.7%) required ancillary procedures (secondary PNL in 1, retrograde intrarenal surgery in 1, and SWL in 2). After this secondary procedures a complete stone-free status was achieved in 98.3% of patients. The morbidity of patients undergoing PNL at our hospital was minimal, with a mean hospital stay of 3.7 days.

CONCLUSIONS

We demonstrated that, PNL is a safe and effective method for medium sized (1 to 2 cm) lower pole renal calculi and percutaneous removal should be considered the primary approach for lower pole stones greater than 10 mm.

A Fournier's gangrene after transurethral resection of the prostate

Fournier's gangrene is a rapidly progressive and potentially lethal disease that affects the perineum and mal genitalia. Predisposing factors included age, diabetes, alcoholism, malnutrition, and low socio-economic status. Herein, we present a 70-year-old patient who developed Fournier's gangrene following transurethral resection of the prostate. He had no predispositional factors to develop Fournier's gangrene.

Percutaneous nephrolithotomy in hypertensive patients with different sizes of instruments

OBJECTIVES

The risk of major complications, especially hemorrhage, is significantly elevated during surgery in hypertensive patients. To determine whether percutaneous nephrolithotomy (PCNL) can be safely performed in the hypertensive patients using different sized instruments.

METHODS

We reviewed the records of 602 patients undergoing PCNL at our institution and identified 53 who were on antihypertensive therapy at the time of surgery. Patients were categorized into three groups according to size of devices used in surgery : those 24 F percutaneous tract with 22 F nephroscope (Group 1, n = 12 [22.7%]; 26 F percutaneous tract with 24 F nephroscope (Group 2, n = 19 [35.8%]) and 30 F percutaneous tract with 26 F nephroscope (Group 3, n = 22 [41.5%]). We compared the groups with regard to baseline characteristics, intraoperative parameters, stone-free and complication rates, and the length of hospitalization.

RESULTS

There were no differences between the three groups in age, gender, weight and stone laterality. Fluoroscopy time, access to the collecting system and mean operative time for per cm2 stone did not differ between the groups. Hemoglobin decrease, postoperative hospital stay and blood transfusion rate was higher in group 3. Stones were completely cleared in 83.3%, 84.2% and 81.3% of patients, which increased to 91.6%, 89.5%, and 90.1% with adjunctive therapy in the group 1,2 and 3, respectively.

CONCLUSIONS

PCNL with smaller devices is a safe and effective method in hypertensive patients. It has significantly a shorter hospital stay and less bleeding rates compared to classical PCNL.

Membranoproliferative glomerulonephritis and a rare bleeding disorder: Factor X deficiency

Factor X (FX) deficiency is a rare hereditary coagulation disorder. This is the first case report on the association of FX deficiency and membranoproliferative glomerulonephritis (MPGN) type I. The patient, a 17-year-old male, presented with edema, hypertension, and microscopic hematuria, followed by a mild upper respiratory tract infection. Laboratory tests revealed: serum creatinine 1.6 mg/dl, serum albumin 2.80 g/dl, C3 16 mg/dl and proteinuria (1,800 mg/day). The renal biopsy showed MPGN type I. The coagulation profile prior to percutaneous renal biopsy revealed prolonged prothrombin time and activated partial thromboplastin time values. The patient was given fresh frozen plasma and vitamin K before the biopsy. Further evaluation showed the functional activity of FX was 7% of the norm. This case emphasizes the need for routine coagulation screening before percutaneous renal biopsy.

Urinary N-Acetyl B Glucosaminidase as an Earlier Marker of Diabetic Nephropathy and Influence of Low-Dose Perindopril/Indapamide Combination

INTRODUCTION

Tubulointerstitial injury is both a key feature of diabetic nephropathy and an important predictor of renal dysfunction. N-Acetyl B glucosaminidase (NAG) is derived from proximal tubular cells and is widely used to evaluate tubular renal function.

OBJECTIVE

The objective of this study is whether NAG can be used as an early marker of diabetic nephropathy by comparing the urinary NAG levels between healthy controls and diabetic patients and determining changes in urinary NAG excretion after treatment with low-dose combination perindopril (2 mg)/ indapamide (0.625 mg)/o.d.

MATERIALS AND METHODS

A total of 50 patients (29 female) with type II diabetes mellitus applying to our diabetes outpatient clinics for the first time were included in our study (Group 1). Diabetic patients were classified into three subgroups on the basis of their duration of diabetes: Group 1A (n = 15) < or = 3 years, Group 1B (n = 19) 3 to 5 years, and Group 1c (n = 16) > 5 years. The inclusion criteria were no prior use of antihypertensive agents; blood pressure < 130/85 mmHg; urinary albumin excretion < 30 mg/day; and absence of renal failure, diabetietes, and hypertensive retinopathy. A total of 30 healthy individuals (16 female) (Group 2) were assessed as the control group. Systolic and diastolic blood pressures, HbA1c, body mass index, 24-h microalbuminuria (MAU), and NAG measurements in urine samples were performed by using colorimetric assay method in an analyzer (Roche Cobas Mira). The assay defined as fragmentation of 3-cresolsulfonphthaleinyl-N-acetyl-beta-D-glucosaminide molecule by NAG to 3-cresolsulphonphthalein and N-acetylglucosamine molecules and serum creatinine were measured in all groups. Type II diabetic patients were administered perindopril (2 mg)/indapamide (0.625 mg) combination once daily for 4 months, and urinary NAG levels were measured at the end of treatment.

RESULTS

Statistically significant differences were observed between the groups 1 and 2 with respect to the levels of NAG and HbA1c (p < 0.05). In the treatment group, NAG levels decreased significantly (p < 0.05), whereas blood pressure and HbA1c levels did not change significantly (p > 0.05). In diabetic patients, pretreatment NAG were lowest in Group 1A and highest in Group 1c, although the difference between the treatment subgroups was not statistically significant (p > 0.05).

CONCLUSION

Urinary NAG excretion is elevated in type II diabetic patients as compared with the healthy individuals. Perindopril/indapamide administration is effective in reducing urinary NAG excretion in these patients, and this effect seems to be independent from blood pressure and glycemia control. Presence of tubular proteinuria may be an early indicator of diabetic renal disease in patients without microalbuminuria. Perindopril (2 mg)/ indapamide (0.625 mg)/o.d. treatment may have beneficial effect on the tubulointerstitial damage in diabetic kidney disease.

Occult intrasacral meningocele: case report and review of the literature

Occult intrasacral meningocele, characterised by the presence of a cyst within the sacral spinal canal, is an unusual congenital lesion. A 26-year-old female presented with a history of low back pain and sensory disturbance in the lower extremities, and urinary incontinence. CT scan of the sacral region showed an asymmetrical widening of the sacral canal and the existence of a thinned bone contour. Magnetic resonance (MR) imaging revealed an intrasacral mass as a low signal intensity area on the T1-weighted image and a high signal intensity area on the T2-weighted image, suggesting a cyst containing cerebrospinal fluid (CSF). The patient underwent sacral laminectomy and posterior exploration showed the presence of sacral erosion and an intrasacral cyst containing CSF devoid of neural contents. Partial surgical excision of the cyst was carried out, but the patient's postoperative course was complicated by a CSF leak due to a small connection that was obliterated in a second operation. Control MR imaging confirmed the removal of the cystic lesion. The clinical, neuroradiological and surgical features of this rare condition are discussed and the importance of a differential diagnosis is stressed.

Combined transurethral resection of prostate and inguinal mesh hernioplasty

We aimed to evaluate the difference among early post-operative morbidities of transurethral resection of prostate (TURP), inguinal herniorrhaphy and their combination in this study. Between 1998 and 2004, 44 patients undergoing combined inguinal herniorrhaphy and TURP (Group I) were compared with 50 consecutive cases of TURP alone (Group II) and 50 consecutive cases of inguinal herniorrhaphy alone (Group III). There were no differences in the mean age and mean prostatic volume between Group I and II. The mean operation time and length of hospital stay were 126.1 +/- 20.9 min, 3.0 +/- 0.7 days for Group I, 61.4 +/- 15.6 min and 2.9 +/- 0.69 days for Group II and 55.0 +/- 15.6 min and 1.2 +/- 0.4 days for Group III, respectively. The mean operation time of Group I was found as longer than Group II and III. There were no significant differences among all groups regarding post-operative complications. No mesh infection was detected. Combined TURP and inguinal herniorrhaphy is a practical, safe and effective procedure.