Listening to music during arteriovenous fistula surgery alleviates anxiety: A randomized single-blind clinical trial

BACKGROUND Both end-stage renal disease and being wait-listed for a kidney transplant are anxiety-causing situations.Wait-listed patients usually require arteriovenous fistula surgery for dialysis access.This procedure is performed under local anesthesia.We investigated the effects of music on the anxiety,perceived pain and satisfaction levels of patients who underwent fistula surgery.AIM To investigate the effect of music therapy on anxiety levels and perceived pain of patients undergoing fistula surgery.METHODS Patients who were on a waiting list for kidney transplants and scheduled for fistula surgery were randomized to control and music groups.The music group patients listened to music throughout the fistula surgery.The State-Trait Anxiety Inventory was performed to assess anxiety,additionally visual analog scale was used to evaluate perceived pain,willingness to repeat the procedure and patient satisfaction.Demographic features,comorbidities,surgical history,basic surgical data(location of fistula creation,duration of surgery,incision length)and intraoperative hemodynamic parameters were recorded by an investigator blinded to the study group.An additional trait anxiety assessment was performed following the surgery.RESULTS There was a total of 55 patients included in the study.However,14 patients did not fulfill the criteria due to requirement of sedation during surgery or uncompleted questionnaires.The remaining 41 patients were included in the analysis.There were 26 males and 15 females.The control and music groups consisted of 20 and 21 patients,respectively.With regard to basic surgical and demographic data,there was no difference between the groups.Overall patient satisfaction was significantly higher and intra-operative heart rate and blood pressure were significantly lower in the music group(P<0.05).Postoperative state anxiety levels were significantly lower in the music group.CONCLUSION Music therapy can be a complimentary treatment for patients undergoing fistula surgery.It can reduce anxiety and perceived pain,improve intraoperative hemodynamic parameters and enhance treatment satisfaction,thus may contribute to better compliance of the patients.

The Performance of Abnormal Digital Rectal Examination for the Detection of Prostate Cancer at Stratified Prostate Specific Antigen Levels

Objective: Our aim was to determine the performance of abnormal digital rectal examination (DRE) in prostate cancer detection at different PSA levels. Methods: A total of 1612 patients having abnormal DRE and/or elevated PSA whom underwent TRUS guided prostate biopsies were included in the study. Any palpable induration or nodularity was accepted as abnormal DRE findings. Pathologic features of biopsy specimens were compared within groups according to DRE findings and serum PSA level groups of 2.5 - 4, 4 - 10 and >10 ng/ml. Results: Abnormal DRE was detected in 339 patients;of whom 48.7% were determined to have cancer. Cancer detection rates of patients having abnormal DRE were found to be 20%, 31.5% and 68% at PSA ranges 2.5-4, 4-10 and > 10 ng/ml, respectively. Significantly higher grade cancers were detected by abnormal DRE at each PSA group. The positive and negative predictive values of abnormal DRE according to groups of PSA 2.5 - 4, 4 - 10 and > 10 ng/ml were 20% and 84.1%, 31.5% and 80.6%, 68% and 66.6%, respectively. Conclusion: At each PSA group DRE resulted in detecting significantly more cancers with Gleason score > 7. Although predictive value of abnormal DRE diminishes with concomitantly decreasing PSA levels, significance of DRE in the diagnosis of prostate cancer cannot be ignored.

COVID-19 infection in a kidney transplant recipient—special emphasis on pharmacokinetic interactions:A case report

BACKGROUND Solid organ transplant recipients are considered to be at high-risk of developing coronavirus disease 2019(COVID-19)-related complications.The optimal treatment for this patient group is unknown.Consequently,the treatment of COVID-19 in kidney transplant recipients should be determined individually,considering patient age and comorbidities,as well as graft function,time of transplant,and immunosuppressive treatment.Immunosuppressive treatments may give rise to severe COVID-19.On the contrary,they may also lead to a milder and atypical presentation by diminishing the immune system overdrive.CASE SUMMARY A 50-year old female kidney transplant recipient presented to the transplant clinic with a progressive dry cough and fever that started three days ago.Although the COVID-19 test was found to be negative,chest computed tomography images showed consolidation typical of the disease;thus,following hospital admission,anti-bacterial and COVID-19 treatments were initiated.However,despite clinical improvement of the lung consolidation,her creatinine levels continued to increase.Ultrasound of the graft showed no pathology.The tacrolimus blood level was determined and the elevation in creatinine was found to be related to an interaction between tacrolimus and azithromycin.CONCLUSION During the COVID-19 pandemic,various single or combination drugs have been utilized to find an effective treatment regimen.This has increased the possibility of drug interactions.A limited number of studies published in the literature have highlighted some of these pharmacokinetic interactions.Treatments used for COVID-19 therapy;azithromycin,atazanavir,lopinavir/ritonavir,remdesivir,favipiravir,chloroquine,hydroxychloroquine,nitazoxanide,ribavirin,and tocilizumab,interact with immunosuppressive treatments,most importantly with calcineurin inhibitors.Thus,their levels should be frequently monitored to prevent toxicity.

Correlation of Surgical Times with Laparoscopic Live Donor Kidney Transplant Outcomes

Most studies revealed that ischemic time has substantial role in occurrence of delayed graft function (DGF) after deceased donor kidney transplantation. However, less is known about the potential impact of surgical times on early outcomes following live donor kidney transplantation. A retrospective cohort of 189 consecutive laparoscopic live donor kidney transplant (LDKT) recipients from January 2006 to August 2012 was analyzed to reveal the impact of pneumoperitoneum time (PT) and anastomosis time (AT) on donor and recipient length of hospital stay and early graft function (EGF). DGF was observed in 13 (6.8%) patients while slow graft function (SGF) was seen in 27 (14%) of the recipients. The median AT was 28 minutes (interquartile range 23, 35 minutes). AT was associated with DGF (Odds Ratio [OR] 1.044, per minute, 95% CI 1.007, 1.082, p = 0.018). Median recipient length of hospital stay was 8 (interquartile range 7, 11) days. Every 13.5 minutes of longer AT was associated with 1 extra day in hospital. The median PT was 180 minutes (interquartile range 144, 234 minutes). PT was associated with both DGF (OR 1.013 per minute, 95% CI 1.005, 1.021, p = 0.001) and SGF (OR 1.009 per minute, 95% CI 1.002, 1.016, p = 0.016). Every extra hour of PT was associated with 0.42 more days in hospital for the donor. Surgical times may be underestimated variables in dictating use of hospital resources. The effect of surgical times on long term hard outcomes entails further study.

Current practice of live donor nephrectomy in Turkey

BACKGROUND Over the last few years,the deceased donor organ donation rate was declined or remained stable,whereas the live donor organ donation rate has increased to compensate for the demand.Minimally invasive techniques for live donor nephrectomy(LDN)have also improved the live donor kidney donation rates.This increase has led to an interest in the surgical procedures used for LDN.AIM To evaluate the LDN techniques performed in Turkey,the structure of surgical teams,and the training received.Additionally,the number of kidney transplantations at different centers,the surgeon experience level,differences in surgical approach during donor surgeries,and outcomes were assessed.METHODS A questionnaire was sent to the Turkish Ministry of Health-accredited transplant centers.It inquired of the number of LDN surgeries,surgical techniques,complications,optimization protocols,the experience of surgeons,and the training.Descriptive statistics were outlined as follows:Discrete numeric variables were expressed as medians(minimum-maximum),while categorical variables were shown as numbers and percentages.As a result of the goodness-of-fit tests,if the significance of the differences between the groups in discrete numerical variables for which the parametric test statistical assumptions were not met,data were analyzed with the Mann Whitney U test and theχ^(2)test.RESULTS The questionnaire was sent to 72 transplant centers,all of which replied.Five centers that reported not performing LDN procedures were excluded.Responses from the remaining 67 centers were analyzed.In 2019,the median number of kidney transplants performed was 45,and the median number of kidney transplants from living donors was 28(1-238).Eleven(16.5%)centers performed 5-10,while 34(50.7%)centers performed more than 100 live donor kidney transplants in 2019.While 19(28.4%)centers performed the LDN procedures using the open technique,48(71.6%)centers implemented minimally invasive techniques.Among the centers preferring minimally invasive techniques for LDN,eight(16.6%)used more than one surgical technique.The most and the least common surgical techniques were transperitoneal laparoscopic(43 centers,89.6%)and single port laparoscopic LDN(1 center,2.1%)techniques,respectively.A positive association was found between the performance of minimally invasive techniques and the case volume of a transplant center,both in the total number and live donor kidney transplants(15 vs 55,P=0.001 and 9 vs 42,P≤0001 respectively).The most frequently reported complication was postoperative atelectasis(n=33,49.2%).There was no difference between the techniques concerning complications except for the chyle leak.CONCLUSION Turkish transplant centers performed LDN surgeries successfully through various techniques.Centers implementing minimally invasive techniques had a relatively higher number of live donor kidney transplants in 2019.

Vitamin D deficiency may predispose patients to increased risk of kidney transplant rejection

BACKGROUND Vitamin D deficiency occurs in more than 80%of kidney transplant recipients.Its immunomodulatory effects can predispose transplant recipients to rejection and chronic allograft nephropathy(CAN).This study determined the association between serum 25(OH)vitamin D,biopsy-proven allograft rejection,and CAN rates.AIM To determine the relationship between serum 25(OH)vitamin D level and biopsy-proven allograft rejection and CAN rate in renal transplant recipients.METHODS Adult renal transplant recipients followed at the clinic between January 2013 and 2018 were included.Recipients requiring graft biopsy due to declined function,hematuria,and proteinuria were reviewed.The two groups were compared regarding collected data,including the biopsy results,immunologic parameters,vitamin D,parathyroid hormone(PTH),phosphorus,albumin levels,and graft function tests.RESULTS Fifty-two recipients who underwent graft biopsy met the inclusion criteria.In all,14 recipients had a vitamin D level>15 ng/mL(group 1)vs≤15 ng/mL(group 2)in 38.In total,27 patients had biopsy-proven rejection,and 19 had CAN.There was only 1 recipient with biopsyproven rejection in group 1,whereas there were 24 patients with rejection in group 2.The rejection rate was significantly higher in group 2 than in group 1(P<0.001).Four patients were diagnosed with CAN in group 1 vs fifteen in group 2.There was no significant difference in the CAN rate between the two groups.PTH was higher at the time of graft biopsy(P=0.009,P=0.022)in group 1 with a mean of 268 pg/mL.Donor-specific antibodies were detected in 14(56.0%)of the recipients with rejection.Vitamin D level was 9.7±3.4 ng/mL in the rejection group vs 14.7±7.2 in the non-rejection group;this difference was statistically significant(P=0.003).The albumin levels were significantly lower in patients with rejection than in those without rejection(P=0.001).In univariate regression analysis of risk factors affecting rejection,sex,serum vitamin D,phosphorus and albumin were found to have an impact(P=0.027,P=0.007,P=0.023,P=0.008).In multivariate regression analysis,the same factors did not affect rejection.CONCLUSION The serum 25(OH)vitamin D level in kidney transplant recipients remained low.Although low serum vitamin D level emerged as a risk factor for rejection in univariate analysis,this finding was not confirmed by multivariate analysis.Prospective studies are required to determine the effect of serum vitamin D levels on allograft rejection.

Challenges of pancreas transplantation in developing countries,exploring the Turkey example

Pancreas transplantation significantly improves the quality of life for people with type 1 diabetes,primarily by eliminating the need for insulin and frequent blood glucose measurements.Despite the growing numbers of solid organ transplantations worldwide,number of pancreas transplantations in the developing countries`remain significantly low.This difference of pancreas transplantation practices was striking among the participating countries at the 1st International Transplant Network Meeting which was held in Turkey on 2018.In this meeting more than 40 countries were represented.Most of these counties were developing countries located in Africa,Middle East or Asia.The aim of this article is to identify the challenges and limiting factors for pancreas transplantations in these developing countries,by exploring the Turkish example.The challenges faced by the developing countries are broadly classified in four categories;wait-listing,donor pool,team work and follow up.Under these categorical titles,issues are further discussed in detail,giving examples from Turkish practice of pancreas transplantation.Additionally,several solutions to these challenges have been proposed-some of which have already been undertaken by the Turkish Ministry of Health.With the insight and methods presented in this article,pancreas transplantation should be made possible for the potential recipients in the developing countries.