Inter-observer agreement on varicoceles diagnosis among patients referred to Shiraz Namazi Hospital

Background: Varicocele is the collection of dilated veins of pampiniform plexus which is the most common cause of infertility occurred in 35-40 percent of infertile men. Despite all the diagnostic tools exist for varicocele diagnosis; still, a physical examination is the first step

Objective: This study was done to determine the inter-observer agreement on varicoceles diagnosis

Materials and Methods: In this cross-sectional study, two expert examiners evaluated 93 men with infertility, scrotal pain, and enlarged scrotum for the presence of varicocele. The urologists examined patients independently in two separate rooms. The inter-observer agreement on varicocele grading analyzed by the Spearman Rho correlation coefficient

Results: The grading of varicocele were similar in 34 [36.5 percent] and 59 [63.4 percent] cases in the left and right side, respectively with correlation coefficient of 0.65 [0.51-0.75] and 0.25 [0.04-0.43], respectively. It implies that inter-observer agreement was substantial for left varicocele assessment and moderate for right varicocele assessment

Conclusion: Physical exam is the essential diagnostic tool for varicocele. As long as the observers educated with the same standard method the disagreements reduced to the negligible extent

Risk factors for contrast-related acute kidney injury according to risk, injury, failure, loss, and end-stage criteria in patients with coronary interventions

Although a series of risk factors for contrast-induced nephropathy are known, data on significance of some of the risk factors such as age, sex, hypercholesterolemia, hyperuricemia, and dose of contrast medium are inconsistent. Our aim was to identify risk factors for contrast-related acute kidney injury [AKI]. In this prospective study, 290 consecutive patients with a serum creatinine level lower than 3 mg/dL undergoing percutaneous angiography were analyzed. Contrast-related AKI was evaluated using the risk, injury, failure, loss, and end-stage [RIFLE] criteria, and its correlation with clinical and laboratory data of the patients was analyzed. Contrast-related AKI was found in 15.5% of the patients, with a maximum RIFLE category [risk in 13.8%, injury in 1.4%, and failure in 0.3%]. Serum creatinine level, contrast volume, safe contrast volume factor, diabetes mellitus, and dehydration were significantly associated with contrast-related AKI. Age, sex, and serum uric acid level did not differ significantly between those with and without contrast-related AKI. Multiple logistic regression analysis disclosed diabetes mellitus to be the strongest predictor for being at risk of contrast-related AKI [odds ratio, 5.1; 95% confidence interval, 1.9 to 11.0; P=.001], followed by hypercholesterolemia [odds ratio, 4.6; 95% confidence interval, 1.1 to 8.3; P=.03], and an estimated glomerular filtration rate lower than 90 mL/min/1.73 m[2] [odds ratio, 3.0; 95% confidence interval, 1.8 to 5.7; P=.003]. Our results indicate that diabetes mellitus, hypercholesterolemia, and underlying chronic kidney disease are the major factors of contrast-related AKI

Dialysis adequacy and kidney disease outcomes quality initiative goals achievement in an Iranian hemodialysis population

We conducted this study to measure hemodialysis adequacy and determine to what extent some Kidney Disease Outcomes Quality Initiative [KDOQI] goals are achieved in our patients. In a cross-sectional study in Pars province, Iran, we assessed 632 patients on hemodialysis in 15 dialysis centers. The Kt/V was calculated, and data on serum levels of albumin, cholesterol, and triglyceride, hemoglobin level, blood pressure, body weight, and body mass index were collected. The values were compared with the KDOQI recommended target values. The mean age of the patients was 54.36 +/- 16.34 years. The mean Kt/V was 0.97 +/- 0.42, which was significantly higher in those who received 3 dialysis sessions per week than those on 2 dialysis sessions per week [P = .03]. Only 32.1% of all patients achieved the Kt/V goal. Seventy-four percent of the patients had a serum albumin equal or greater than 4 g/dL. Hemoglobin levels were between 4.6 g/dL and 16.8 g/dL, and half of the patients had attainment of the hemoglobin target. Cholesterol target was reached in 40% of patients. Only 43 patients [6.8%] attained all targets recommended by the KDOQI guidelines. The target values, except for serum albumin, were not reached in our patients. We conclude that it is necessary to provide essential equipment of dialysis centers such as dialysis machine and trained staffs, and also to raise awareness of KDOQI goals among patients and physicians