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Does dissection method affect complications in endoscopic hernia surgery?

Aim: In this study, we aimed to explain how to achieve an accurate and comfortable dissection area in totally extraperitoneal (TEP) inguinal hernia repair to avoid unwanted complications and compare complications according to the dissection techniques in TEP repair.

Material and Methods: Sixty-three patients between June 2018 December 2019 included in the study were operated with the TEP technic in a tertiary university hospital. Patients were divided into two groups. In Group 1, blunt dissection was performed using a camera in 32 patients and in Group 2, precise dissection was performed on 31 patients using working instruments.  Demographic data (age, gender, body mass index (BMI)), American Society of Anesthesiologists (ASA) score, operative time, intraoperative, and postoperative incidents (vascular, nerve, or ductus deferens injury, peritoneal tear, conversion to open surgery) were compared between the two dissection methods.

Results: We observed significant differences in terms of intraoperative incidents, overall operative time, and postoperative seroma formation.

Discussion: Complications due to TEP hernia repair can be decreased and easily managed with the modification of the dissection method. For a better view and shortening the operation, time precise dissection with working instruments can be chosen as an alternative for balloon and camera dissection.


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Frequency and determinants of mild cognitive impairment among diabetic type II patients attending a secondary care hospital in Makkah, Saudi Arabia

Aim: Type II diabetes mellitus (TIIDM) is a common metabolic disorder, recent substantial amount of evidence showed that TIIDM is a risk factor for mild cognitive impairment (MCI). MCI can impede the management of patients, which can lead to increased risks of complications, functional disability and healthcare costs. The aim of this study is to measure the frequency and determinants of MCI among diabetic type II patients (TIIDM) attending the Diabetic Center at Al-Noor specialist hospital (NSH) in Makkah, Saudi Arabia.

Material and Methods: For this cross-sectional study, 179 TIIDM patients were recruited. A self-constructed validated questionnaire was used for data collection. The Arabic validated version of the Montreal Cognitive Assessment- Basic (MoCA-B) was used to diagnose MCI.

Results: Participants were equally distributed according to gender. Ages ranged from 31 to 80 years (58.6±9.6 years). The prevalence of MCI was 66.5% with 95% CI (0.6-0.7). MCI was found significantly higher in the elderly (p=0.046), in those who never practiced physical exercise (p<0.001), who had uncontrolled diabetes (p<0.001), cataract (p=0.001), diabetic retinopathy (p=0.003). Multivariate analysis showed that older patients were more likely to develop MCI (adjusted odds ratio “AOR”=1.3; 95% CI: 1.0-1.7), patients who never practiced physical exercise were more likely to develop MCI (AOR=5.4; 95% CI: 2.4-12.1), patients with cataract were at twice risk to develop MCI (AOR=2.3; 95%CI: 1.0-5.3), as well as patients with diabetic retinopathy (AOR=2.7; 95%CI: 1.4-5.3). Patients with uncontrolled diabetes had also an 11-fold higher risk of MCI (AOR=11.9; 95%CI: 5.1-27.7). Patients with hypertension were nine times more likely to develop MCI (AOR=9.3; 95%CI: 4.2-23.3). Patients with dyslipidemia had twice the risk (AOR=2.4; 95%CI: 1.2-4.8).  

Discussion: Mild cognitive impairment is prevalent among TIIDM patients attending the Diabetic Center at NSH, Makkah. Elderly patients, patients who had never practiced physical exercise, complicated by cataract and diabetic retinopathy, those with uncontrolled diabetes, and patients with co-morbid hypertension and dyslipidemia were at a higher risk for developing MCI.

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Anesthesia and neuromuscular block management in thymectomies performed in cases of thymoma and myasthenia gravis: A retrospective study

Aim: The aim of our study was to evaluate anesthesia management and the antagonism of neuromuscular blockade with sugammadex in thymectomies performed in patients with thymoma and myasthenia gravis (MG), especially in terms of the postoperative residual block, complications, and its effect on postoperative respiratory pattern.

Material and Methods: In order to evaluate the effectiveness of the anesthesia methods and neuromuscular block management procedures we use in thymectomy cases in our clinic, patient files, anesthesia record forms, early postoperative follow-up, and the discharge process were retrospectively reviewed. Patients who underwent thymectomy, used steroid neuromuscular blocking agents (NMBA) and preferred sugammadex for neuromuscular block antagonism were included in the study. 

Results: There was no difference between the time of anesthesia and surgery in patients, the total doses of rocuronium and sugammadex used, the time between the onset of spontaneous respiration and extubation, and the time when spontaneous respiration was started without any intervention. In the early postoperative period, complications such as reintubation due to respiratory failure, a decrease in peripheral O2 saturation below 90%, postoperative residual neuromuscular block were not observed.

Discussion: We recommend using propofol as an intravenous general anesthetic agent in thymectomy surgery applied to patients with MG, performing total intravenous anesthesia using propofol and opioid analgesics in anesthesia maintenance, and providing a good peroperative analgesia control. In addition, we think that sugammadex may be preferred for steroid NMBA antagonism in this patient group. 


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