The impact of the preoperative red blood cell distribution width on weight loss prediction after sleeve gastrectomy.

AIM: We aimed to evaluate whether RDW has a predictive impact on weight loss after obesity surgery. MATERIAL AND METHODS: This was a single-institution retrospective study. Multiple linear regression analysis was used to determine the variables affecting the %EBMIL and %EWL values. Surgery of patients with %EMBIL > 50% and %EWL > 25% was considered successful. RESULTS: Hundred and ten patients were included in the study. The %EBMIL and %EWL values of patients with RDW>14.5% were lower. In the evaluation of successful surgeries, the probability of failure for those with RDW>14.5% is 10.93 times higher for %EBMIL and 21.55 times for %EWL. DISCUSSION: After the linear regression analysis, it was observed that the %EBMIL and %EWL were higher in the patients whose RDW values were 14.5 and below in the preoperative period. In these patients, it is an indication that more weight loss has occurred. Similar to our study, Wise et al. showed that weight loss was greater with a decrease in the RDW value 10. CONCLUSION: Preoperative RDW value can be used as a predictor of weight loss and surgical success. It can provide an idea about whether the patient will lose enough weight and the success of the surgery. KEY WORDS: Prediction, RDW, Sleeve Gastrectomy.

Role of Systemic Inflammatory Markers in Pediatric Kidney Transplantation.

BACKGROUND: Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), systemic immune-inflammation index (SII = N × P/L), and neutrophil percentage-albumin ratio (NPAR) have become accepted markers of inflammation in recent years. These indices are used as indicators of disease activity, mortality, and morbidity in many diseases. This study evaluated the relationship between inflammatory indices and graft function in pediatric kidney transplant recipients. METHODS: Medical records of pediatric patients who underwent kidney transplantation at Ege University between 1995 and 2020 were reviewed retrospectively. Demographic, clinical, and laboratory data were recorded during the third month, first year, and fifth year of transplantation and at the last visit. RESULTS: The median age of the 119 patients (60 boys/59 girls) at the time of transplantation was 154 months, and the median follow-up period was 101 months. According to Spearman correlation analysis, patients' final creatinine levels were positively correlated with NLR (r = 0.319), PLR (r = 0.219), SII (r = 0.214), and NPAR (r = 0.347) of the last visit; final estimate glomerular filtration rate levels were negatively correlated with NLR (P = .010, r = -0.250) and NPAR (P = .004, r = -0.277). The median NPAR of the patients with chronic allograft dysfunction at the last visit was found to be statistically significantly higher than without (P = .032). CONCLUSION: NLR, PLR, SII, and NPAR values are correlated with creatinine levels after 5 years of kidney transplantation. The NPAR and final creatinine levels had the highest correlation coefficient among these inflammatory markers. These results suggest that inflammatory markers, especially NPAR, may be a candidate to be an indicator of ongoing inflammation in the graft.

Tension-free inguinal hernia repair with transversus abdominis plane (TAP) block in elderly high-risk patients.

BACKGROUND: Inguinal hernia repair is still being studied today because it is one of the most commonly performed surgical procedures in the world and is used in people of all ages. Although many centers use spinal anesthetic to treat inguinal hernias, complications such as hypotension from peripheral vasodilation, delayed mobilization from paralysis, urine retention and post-spinal headache might occur. Regional blocks are a significant component of multimodal anaesthesia that promotes postoperative recovery. Transversus abdominis plane (TAP) block is a regional anesthetic block technique that is effective on the parietal peritoneum, skin, and anterior abdominal wall. METHODS: This study aimed to show that TAP block administration may be done safely without the use of an extra anesthetic treatment, especially in older patients who may experience complications from general or spinal anesthesia. Without either general, spinal or epidural anesthetic, we conducted a tension-free - Lichtenstein - inguinal hernia repair operation with only TAP block application. This retrospective case-control study received ethics committee approval (decision number 21-5T/108). Between September and December 2019, patients who underwent elective Lichtenstein hernia repair in our clinic were evaluated retrospectively. RESULTS: We think that inguinal hernia repair can be safely performed with only TAP block and that TAP block application has fewer anaesthesia-related complications such as postspinal headache and urinary retention compared with spinal anaesthesia, and that it can be used as an alternative to spinal anaesthesia in patients who cannot tolerate general anaesthesia. CONCLUSION: Even hernia surgery can be very challenging in patients with advanced age and comorbidities. We wanted to show the feasibility of the TAP block method as an alternative to anaesthesia in such patients.

Effects of Individual and Co-exposure of Copper Oxide Nanoparticles and Copper Sulphate on Nile Tilapia Oreochromis niloticus: Nanoparticles Enhance Pesticide Biochemical Toxicity.

Copper, like iron and zinc, is one of the most essential trace elements for organisms. Different forms of copper have distinctive and specific uses. For example, copper oxide nanoparticles (CuO-NP) are widely used in the world as a nanomaterial. Copper sulphate (CuSO4) is worldwide used as a fungicide in agriculture and as an algaecide in aquaculture. Nowadays, the increasing use of these chemicals raises concerns regarding their potential effects on the health of aquatic organisms and ecological risks. Therefore, in the present research, toxic effects of CuSO4 and CuO-NP, alone and in combination, were evaluated using biochemical markers (plasma biochemical and gill and liver oxidative stress) in freshwater fish, Oreochromis niloticus. The fish were exposed to 0.05 mg/L CuSO4, CuO-NP, and CuSO4+CuO-NP for 4 and 21 days.  Especially at 21 days, CuSO4 and CuO-NP, alone and combined, generally increased plasma alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, cortisol, glucose, creatinine, blood urea nitrogen, and tissue malondialdehyde while they decreased plasma total protein, and tissue superoxide dismutase, catalase, glutathione-S-transferase, glutathione reductase, and glutathione. Consequently, our results illustrate that CuSO4 and CuO-NP have similar toxic effects in fish, however, co-exposure of CuO-NP and CuSO4 is more toxic than effects of these chemicals alone.

Nonoperative Management of Leaks After Laparoscopic Sleeve Gastrectomy With Endoscopic Stents in a Tertiary Referral Center.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is a frequently performed operation. Leaks are formidable complications; however, the optimal management of these leaks is controversial. METHODS: We retrospectively reviewed the medical records of 15 patients referred to our tertiary center between 2012 and 2016 with leaks after LSG. RESULTS: In 12 patients with whom ongoing leaks were identified, stents were inserted with the intent of definitive therapy. In addition to attempts at source control, percutaneous drainage was carried out for intraabdominal collection in 9 patients and pleural effusion in 4 patients. The length of stay in the intensive care unit was significantly shorter in patients referred earlier or in those without any intervention. CONCLUSION: LSG leaks can be treated nonoperatively in well-organized centers under meticulously designed protocols, depending on the clinical condition of the patient.

An Investigation on Freshwater Fish Oreochromis niloticus (Linnaeus, 1758): Assessing Hemotoxic Effects of Different Copper Compounds Used as Nanomaterial or Pesticide.

Considering the constant exposure of fish to copper oxide nanoparticles (CuO-NPs) and copper sulphate (CuSO4) in natural aquatic environments as a result of increased usage of these chemicals in industry, medicine and aquaculture/agriculture over the past few decenniums, the current investigation aimed to reveal their comparative hemotoxic effects on freshwater fish Oreochromis niloticus by measuring hematological and blood oxidative stress biomarkers and Cu levels. Fish were exposed to 0.05 mg/L CuO-NPs and CuSO4 for 4 and 21 days. Both copper forms decreased erythrocyte, hematocrit, and hemoglobin values, and superoxide dismutase and catalase activities while they elevated glucose-6-phosphate dehydrogenase activity, and glutathione, malondialdehyde and Cu levels. Leukocyte levels and glutathione peroxidase activity did not show any significant change. In a conclusion, the current research demonstrates that CuO-NPs and CuSO4 for O. niloticus have similar hemotoxic effects, however, CuO-NPs are slightly more toxic than CuSO4 regarding hematological changes and oxidative stress observed.

Incidence and risk factors for incisional hernia after abdominal aortic aneurysm and aortic occlusive disease surgery.

BACKGROUND: This study aims to investigate incisional hernia incidence and risk factors after abdominal aortic aneurysm and aortic occlusive disease surgery via a midline laparotomy. METHODS: A total of 110 patients (66 males, 44 females; mean age: 69.3±8.8 years; range, 36 to 88 years) who underwent open elective surgery for aortoiliac occlusive diseases or abdominal aortic aneurysm between January 2005 and December 2016 were retrospectively analyzed. Both patient groups were compared in terms of surgical procedures, sex, age, American Society o f A nesthesiologists s core ( 1-3), b ody m ass i ndex (<25 vs. ≥25 kg/m2), smoking (non-smoker <1 pack/day, smoking ≥1 pack/day), and time to incisional hernia development. RESULTS: Incisional hernia occurred in 14.3% of the patients operated for aortoiliac occlusive disease and in 17.6% of the patients operated for abdominal aortic aneurysm (p=0.643). Incisional hernia was seen in three (5.7%) of 53 patients with a body mass index of <25 kg/m2 and was in 15 (26.3%) of 57 patients with a body mass index of ≥25 kg/m2 (p=0.03). CONCLUSION: High body mass index is a risk factor for incisional hernia in patients undergoing aortic reconstructive surgery.

Comparative Acute Toxicity Assessment of Organophosphate and Avermectin Insecticides on a Freshwater Fish Oreochromis niloticus.

Oreochromis niloticus was exposed to 10.0 ppb of organophosphate insecticide chlorpyrifos (CPF) and avermectin insecticides abamectin (ABM) and emamectin benzoate (EB) for 48 and 96 h. RBC and Hb decreased in CPF- and ABM-exposed fish after 96-h. Plasma ALT, AST, cortisol, and glucose increased in 96-h CPF-, ABM- and EB-exposed fish, while plasma ions declined in 96-h CPF-exposed ones. Insecticides caused alterations in liver oxidative stress parameters. In fish exposed to CPF, CAT increased after 48-h whereas it decreased after 96-h. Also, CAT declined in 48- and 96-h ABM-exposed fish, whereas it elevated in 48-h EB-exposed ones. Insecticides caused decreases in SOD at 48- and 96-h and in GR after 96-h. GSH elevated in CPF-exposed fish after 48-h, while it decreased in all the tested insecticide exposures after 96-h. Malondialdehyde of fish exposed to insecticides for 96-h increased. Consequently, toxic effects of insecticides on O. niloticus were generally as CPF > ABM > EB.

Prognostic factors in acute mesenteric ischemia and evaluation with multiple logistic regression analysis effecting morbidity and mortality.

<b>Background:</b> Acute mesenteric ischaemia (AMI) is a catastrophic abdominal emergency characterized by sudden critical interruption to the intestinal blood flow which commonly leads to bowel infarction and death. AMI still has a poor prognosis with an in-hospital mortality rate of 50-69 %. This high mortality rate is related to the delay in diagnosis which is often diffucult and overlooked. Early intervention is crucial and the potential for intestinal viability. <br><b>Methods:</b> The charts of 140 patients who were hospitalazed with AMI between May 1997 and August 2013 in Ege University Faculty of Medicine, department of general surgery were retrospectively reviewed. Demographical and clinical features of patients determining the best predictors which effect on morbidity and mortality were evaluated by Multiple Logistic Regression analysis by Enter method after adjustment for all possible confounding factors. <br><b>Results:</b> After Multiple LR analysis by Enter method after adjustment for all possible confounding factors affecting morbidity; shock, exploration and stay in hospital were statistically significant. Age, cardiac comorbidities, ASA scores, the time delay between onset of acute abdominal pain to surgery, the presence of acidosis and shock, the involved organs (small bowel and both), type of surgery and medical treatment and small bowel length under 100 cm were statistically significant on mortality. <br><b>Conclusion:</b> Risk factors related to mortality and morbidity have been poorly analyzed due to lack of prospective studies and smaller number of patients. Early diagnosis generally depends on clinical awareness and suspicion. Age and time of delay between onset of acute abdominal pain to surgery longer than 24 hours are the most important parameters that predict the mortality for patients presenting with shock and acidosis.

Omega-3 fatty acids inhibit oxidative stress in a rat model of liver regeneration.

PURPOSE: Lipid peroxidation and consequent reactive oxygen species in the setting of oxidative stress have crucial roles in liver regeneration, which may adversely affect the regeneration itself and lead to liver failure. The aim of the current study is to investigate whether omega-3 fatty acid supplementation inhibits oxidative stress in an experimental model of liver regeneration. METHODS: Forty rats were allocated to four groups. Rats in group A received a sham operation. Rats in group B were subjected to right portal vein ligation (RPVL) and saline infusion. Rats in groups C and D were subjected to RPVL and total parenteral nutrition (TPN) with an all-in-one admixture containing a soybean oil based lipid emulsion. Rats in group D were additionally supplemented with omega-3 fatty acid infusion. Oxidative stresses in the blood and liver were measured by glutathione, superoxide dismutase, catalase, glutathione peroxidase, malondialdehyde, and nitric oxide. RESULTS: Omega-3 supplementation to the TPN solution significantly corrected alterations in the blood and tissue concentrations of oxidants and anti-oxidants during regeneration (P < 0.05). CONCLUSION: Omega-3 fatty acid supplementation to the TPN solution revealed promising results in removal of oxidative stress that emerges during liver regeneration.

Prognostic factors in peptic ulcer perforations: a retrospective 14-year study.

Regarding the complications of peptic ulcer, a perforation remains the most important fatal complication. The aim of our retrospective study was to determine relations between postoperative morbidity and comorbid disease or perioperative risk factors in perforated peptic ulcer. In total, 239 patients who underwent emergency surgery for perforated peptic ulcer in Ege University General Surgery Department, between June 1999 and May 2013 were included in this study. The clinical data concerning the patient characteristics, operative methods, and complications were collected retrospectively. One hundred seventy-five of the 239 patients were male (73.2%) and 64 were female (26.8%). Mean American Society of Anesthesiologists (ASA) score was 1 in the patients without morbidity, but mean ASA score was 3 in the morbidity and mortality groups. Primary suture and omentoplasty was the selected procedure in 228 of the patients. Eleven patients underwent resection. In total, 105 patients (43.9%) had comorbidities. Thirty-seven patients (67.3%) in the morbidity group had comorbid diseases. Thirteen (92.9%) patients in the mortality group had comorbid diseases. Perforation as a complication of peptic ulcer disease still remains among the frequent indications of urgent abdominal surgery. Among the analyzed parameters, age, ASA score, and having comorbid disease were found to have an effect on both mortality and morbidity. The controversial subject in the present study is regarding the duration of symptoms. The duration of symptoms had no effect on mortality nor morbidity in our study.

Long-term outcome of kidney transplantation from elderly living and expanded criteria deceased donors.

The imbalance between organ demand and supply causes the increasing use of suboptimal donors. The aim of this study is to investigate the survival and allograft function of kidney transplantation from standard (SLD) and elderly living (ELD), standard criteria (SCDD) and expanded criteria deceased (ECDD) donors. All patients transplanted from 1997 to 2005 were investigated according to the donor characteristics. Data were collected retrospectively during the 83.4±43.1 months of follow-up period. ELD was defined as donor age≥60 years. ECDD was defined as UNOS criteria. A total of 458 patients were divided into four groups: SLD (n:191), ELD (n:67), SCDD (n:154), and ECDD (n:46). Seven-year death-censored graft survival in SLD, ELD, SCDD, and ECDD were 81.6%, 64.8%, 84.7%, and 68.3%, respectively (p=0.003). The death-censored graft survival in ELD group was lower than in SLD (p=0.007) and SCDD (p=0.007) groups, while in ECDD group it was lower than in SCDD group (p=0.026). Patient survival was similar. In ECDD group, 83% of total deaths occurred within the first 3 years, mainly due to infections (66.6%) (p<0.05). Estimated glomerular filtration rate (eGFR) was lower in ELD (compared with SLD and SCDD); and ECDD (compared with SCDD) at last visit. In multivariate analysis, ELD, experience of an acute rejection episode and presence of delayed graft function were the independent predictors for death censored graft loss. Transplantation of a suboptimal kidney provides inferior graft survival and function. A higher number of deaths due to infection in the early post-transplant period in the ECDD group are noteworthy.

Use of oxidative stress biomarkers in Cyprinus carpio L. for the evaluation of water pollution in Ataturk Dam Lake (Adiyaman, Turkey).

Adiyaman city, which is located in the north of the Ataturk Dam Lake, has no wastewater purification facilities which results in municipal, agricultural, and industrial wastewater discharges directly entering the reservoir. To assess the pollution in the dam lake, we used several oxidative stress biomarkers in blood tissue of Cyprinus carpio. Fish samples were taken from Sitilce, polluted area by untreated wastewaters, and Samsat, relatively clean area, in the reservoir in August 2012. The activity of catalase and level of malondialdehyde increased while activity of superoxide dismutase and glutathione level decreased in fish from Sitilce site when compared to Samsat site. The findings of the present investigation suggest that the presence of certain prooxidative compounds that can lead to oxidative stress in the fish at the Sitilce site and oxidative stress biomarkers may be important in order to evaluate the effects of untreated wastewaters on living organisms in the dam lake.

A horseshoe kidney from a live donor as a renal transplant: case report.

OBJECTIVES: This case report presents our experience regarding a horseshoe kidney from live donor to be used as a renal transplant. MATERIALS AND METHODS: The recipient was a 48-year-old man with chronic renal failure owing to hypertension who had been on hemodialysis for 2 years. The donor was his 43-year-old sister who had an uncomplicated horseshoe kidney with negative results on a urinalysis. An aortogram showed that the arterial supply to the kidney consisted of 2 superior arteries (1 on each side) and 1 inferior accessory artery that was divided to feed the lower fused parenchyma of the kidney. RESULTS: Surgery was performed via a retroperitoneal lumbotomy incision; the left half of the kidney was mobilized. The left kidney was procured by clamping the inferior accessory renal artery, transecting the parenchyma within the demarcation boundary. The transplant kidney was placed in the recipient's contralateral iliac fossa. The graft vein was anastomosed to the recipient's external iliac vein, the artery to the external iliac artery, and the ureter to the bladder. After perfusing the graft, no urine leakage was detected from the transacted surfaces, and the graft began producing urine. There were no complications after surgery. The patient was discharged on the 10th day after surgery with a creatinine level of 0.07 µmol/L. Maintenance immunosuppressive treatment included tacrolimus, mycophenolate mofetil, and prednisolone. CONCLUSIONS: We believe using a horseshoe kidney as a renal allograft after a detailed preoperative evaluation may help expand the donor pool.

Assessment of pollution in Ataturk Dam Lake (Adiyaman, Turkey) using several biochemical parameters in common carp, Cyprinus carpio L.

Ataturk Dam Lake, the largest impounded lake in Turkey, has been contaminated by domestic, industrial and agricultural effluents coming from Adiyaman city. In this study, we investigated the possible effects of pollutants on several biochemical parameters in the cyprinid fish, Cyprinus carpio, by comparing the parameters in fish collected from a polluted area (Sitilce) to a relatively clean area (Samsat) in August 2011. The activities of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and lactate dehydrogenase and levels of cortisol, glucose, and K increased while total protein, cholesterol, Ca, Na and Cl levels decreased in fish from the Sitilce site when compared to the Samsat site. The observed alterations in these biochemical parameters indicate that the Ataturk Dam Lake is affected by untreated wastewater discharges.

Protective effect of selenium against mercury-induced toxicity on hematological and biochemical parameters of Oreochromis niloticus.

In this study, to identify mercury (Hg) toxicity and whether selenium (Se) has any role in alleviation of this toxicity, it was investigated the changes in hematological and serum biochemical parameters of Oreochromis niloticus. Fish were exposed to 0.01 and 0.1 mg/L Hg and 0.01 mg/L Hg + 0.1 mg/L Se and 0.1 mg/L Hg + 1.0 mg/L Se for 7 and 14 days. The exposure of O. niloticus to Hg alone resulted in decreases in red blood cell, white blood cell, hemoglobin, hematocrit values, and cholinesterase activity while it increased in alanine aminotransferase and aspartate aminotransferase activities and cortisol and glucose levels. Se, in combination with Hg, partially or totally caused an alleviation for the toxic effect of Hg on the above mentioned hematological and biochemical parameters. The results of our study showed that Se has a protective effect against toxicity induced by Hg.