Change of cyclosporine absorption over the time after kidney transplantation

Although the immunosuppressant cyclosporine [CsA] is widely used after kidney transplantation over the long term, there is still no firm consensus on the best way to monitor of CsA blood levels. Cyclosporine [CsA] assay is critical for the management of renal transplant recipients due to inter- and intra-patient variation in CsA absorption and metabolism. Patients and In a retrospective cross sectional study, blood levels of CsA [through and 2 hours post dose] measured at least 5 times during 3 years post transplantation, in 7702 kidney transplant recipients from different transplant center of Tehran, IR Iran between 2008 and 2012. Cyclosporine absorption [CA] calculated C2/CO ratio. CA had a significant correlation with allograft function [P = 0.000, r =.0.285], this correlation was stronger than its relationship with CO and C2 blood levels [P = 0.000 and P = 0.000 as well as r = 0.033 and r = 0.090, respectively]. In univariate analysis during different times after transplantation, CO and C2 blood levels significantly decreased over three years follow up [P = 0.000], [P = 0.000]; While, CA reversely increases over the time [P = 0.000]. In linear regression model overall CA levels had correlation with lower age of recipient [P = 0.02], hypokalemia [P = 0.001], higher level of creatinine [P = 0.02] and triglyceride [P = 0.001]. The present study shows that CsA absorption changes trough the post-transplant time and appears to increases over time in long-term period after kidney transplantation

Thyroid function in epileptic children who receive carbamazepine, primidone, phenobarbital and valproic acid

In this study, we investigated the changes of the serum levels of thyroidhormones including Thyroxine [T4], Triiodothyronine [T3], T3 resin uptake andThyroid stimulating hormone [TSH] in epileptic children during treatment withanti-epileptic drugs [AEDs] including carbamazepine [CBZ], primidone [PRM],phenobarbital and valproic acid [VPA]. This study consisted of four case-series comparisons, was conducted on 115epileptic children [37 girls and 78 boys with an age range between 2 months and 15 years, mean: 62.06 A +/- 44.97 months]. These children were divided into4 groups who took either phenobarbital [n=29], PRM [n=28], CBZ [n=29], or VPA [n=29] for 3 months. Thyroid hormone levels [T3, T3 resin uptake, T4 and TSH] were measured at the beginning and three months after starting the study. At first, all patients were euthyroid and there were no clinical or laboratory findings suggestive of hypothyroidism. Regarding thyroid hormones before and after the administration of phenobarbital, carbamazepine, valproic acid and primidone, there were no significant changes in serum T3, T4, T3 resin uptake and TSH levels. Our findings showed that short term therapy with phenobarbital, carbamazepine, valproic acid and primidone had no effect on thyroid function tests

Investigation of deep sternal wound infection after coronary artery bypass graft and its risk factors

To investigate factors that predict sternal wound complications in patients after coronary artery bypass grafting [CABG] because prediction of deep sternal wound infection after surgery, might help us to do some interventions and reduce its consequences. The record of all these patients was reviewed retrospectively. DSWI was defined according to the guidelines of the Centers for Disease Control and Prevention. From Sep 2003 to Sep 2006 a total of 1014 patients who underwent coronary bypass graft surgery in a cross-sectional study was included in this study. Logistic regression analysis was conducted and the risk factors that significantly predicted sternal wound complications after coronary artery bypass graft surgery included older age, Diabetes mellitus, increasing BMI, and in class three or four of the New York Heart Association functional class. Most infections had a late and the majority of these were caused by staphylococcus epidermidis while other were pseudomonas aeroginosa, streptococcus pneumonia, staphylococcus aureus and one of them was Meticilline resistance. The clinically most fulminate infections were caused by e-coli and presented early after surgery. Advanced age, diabetes and obesity, NYHA high score were the important risk factors identified. As such we suggest more attention should be paid to these patient. Modifying the risk factor and making decision according to risk factor such as appropriate administration of prophylactic antibiotic in patient with poor physical status, good control diabetes are recommended