Outcome of immediate use of the permanent peritoneal dialysis catheter in children with acute and chronic renal failure

Peritoneal dialysis remains the only available option for patients which need immediate dialysis and it could be a bridge between end-stage renal failure [ESRD] and transplantation. There is a paucity of published experience of children with immediate use of permanent Tenckhoff Catheter for peritoneal dialysis from developing countries. In this study we report our experience on immediate use of permanent peritoneal access and continued peritoneal dialysis for a prolonged time. Fifty six patients were studied including 30 males and 26 females within the age range of 1 month to 14 years with mean age of 6.5 years in Urmia, Northwest Iran. No operative morbidity was seen. During a total of 499.5 continuous ambulatory peritoneal dialysis months, 16 patients had 28 episodes of peritonitis, which means a overall result of one episode per 17.8 months. There were 3 patients [5.35%] with catheter site leakage, 12 [21.4%] catheter obstructions [which led to omentectomy], 4 [7.2%] exit site infections [2 patients in the early postoperative period and 2 patients in during follow up]. Death due to catheter related complications occurred in 1 per 56 patients and due to non-catheter related causes in 10 per 56 patients. Present results indicate that catheter-related complications were not higher than those previously reported and peritoneal dialysis could be initiated immediately after catheter implantation and could be a safe bridge between end-stage renal failure [ESRD] and transplantation

Co- transplantation of bone marrow stromal cells with schwann cells evokes mechanical allodynia in the contusion model of spinal cord injury in rats

Several studies have shown that, although transplantation of neural stem cells into the contusion model of spinal cord injury [SCI] promotes locomotor function and improves functional recovery, it induces a painful response, Allodynia. Different studies indicate that bone marrow stromal cells [BMSCs] and Schwann cells [SCs] can improve locomotor recovery when transplanted into the injured rat spinal cord. Since these cells are commonly used in cell therapy, we investigated whether co-transplantation of these cells leads to the development of Allodynia. In this experimental research, the contusion model of SCI was induced by laminectomy at the T8-T9 level of the spinal cord in adult female wistar rats [n=40] weighting [250-300g] using the New York University Device. BMSCs and SCs were cultured and prelabeled with 5-bromo-2-deoxyuridine [BrdU] and 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate [DiI] respectively. The rats were divided into five groups of 8 including: a control group [laminectomy only], three experimental groups [BMSC, SC and Co-transplant] and a sham group. The experimental groups received BMSCs, SCs, and BMSCs and SCs respectively by intraspinal injection 7 days after injury and the sham group received serum only. Locomotion was assessed using Basso, Beattie and Bresnahan [BBB] test and Allodynia by the withdrawal threshold test using Von Frey Filaments at 1, 7, 14, 21, 28, 35, 42, 49 and 56 days after SCI. The statistical comparisons between groups were carried out by using repeated measures analysis of variances [ANOVA]. Significant differences were observed in BBB scores in the Co- transplant group compared to the BMSC and SC groups [p< 0.05]. There were also significant differences in the withdrawal threshold means between animals in the sham group and the BMSC, SC and the Co-transplant groups [p<0.05].BBB scores and withdrawal threshold means showed that co-transplation improved functioning but greater Allodynia compared to the other experimental groups. The present study has shown that, although transplantation of BMSCs, SCs and a combination of these cells into the injured rat spinal cord can improve functional recovery, it leads to the development of mechanical Allodynia. This finding indicates that strategies to reduce Allodynia in cell transplantation studies are required

report of the injuries sustained in Iran air flight 277 that crashed near Urmia, Iran

Background: On January 9, 2011 Iran Air Flight 277 crashed during approach to Urmia, Iran. Out of 105 passengers, 27 survived. This brief report presents a perspective of the passengers' sustained injuries

Methods: We reviewed the recorded injuries of all passengers as provided by the Legal Medicine Organization authorities. The Injury Severity Score [ISS], an anatomical scoring system, was used to provide an overall code for those who survived with multiple anatomical injuries

Results: There were a total of 96 ISS body region injuries among those who survived. Facial injuries [83%] were the most frequent injuries noted among fatalities, which was statistically significant [P=0.000]. In those who survived, injuries to the head and neck [37%] and facial [33%] regions were relatively less frequent than other anatomical regions. The most serious injuries among survivors belonged to the extremity [85%] region, particularly lower limb fractures [62%]. Differences in extremity injuries between the survivors and fatalities were not statistically significant

Conclusion: The findings of this study were similar to other studies where the most frequent serious injuries were fractures of the extremities, particularly the lower limbs

[Comparing intravenous oxytocin Vs. rectal misoprostol for third-stage management after second-trimester medically induced abortion]

Induction of medical abortion during the second trimester of pregnancy is considered under certain medical conditions. Abortion in the second trimester of pregnancy could be accompanied by several side effects including hemorrhage and placenta retention. Several types of medications including oxytocin, ergots, and prostaglandins are used to control and optimize the third stage of labor and condition of delivery. The aim of this study was to compare the efficacy of intravenous oxytocin versus rectal misoprostol for the management of the third stage of labor during pregnancy termination. In this randomized clinical trial, 80 pregnant women between 14 to 24 weeks of gestational age were randomly assigned into two intervention groups. Twenty units of intravenous oxytocin was used as the standard regimen and it was compared with 400 microg of rectal misoprostol to manage the third stage of labor. In this study, the frequency of placenta retention was significantly [P=0.034] lower in the misoprostol group [n=3, 7.5%] compared with oxytocin group [n=10, 25%]. The average duration of placenta delivery was significantly lower in the misoprostol group [7.95 min Vs. 19.22 min, respectively; P=0.015]. Decreases in hemoglobin concentration was not significantly different between the two groups. Generally, management of the third stage of labor in second-trimester abortions could reach a better outcome, regarding lower risks of placenta retention and duration of delivery, if rectal misoprostol is administered instead of intravenous oxytocin

accuracy of intraoperative aspiration cytology in diagnosis of ovarian tumors

To determine the accuracy of cytology in intraoperative diagnosis of ovarian tumors and to compare it with frozen section [F.S] and permanent section. We compared the accuracy of intraoperative cytology [I.O.C] with F.S in 105 cases of ovarian tumors received in Urmia Imam Khomeini and Shahid Motahari hospitals during March 2007 to March 2008. Sensitivity of both techniques of F.S and I.O.C was 93.1%. Specificity of F.S and I.O.C were 98.7% and 94.7%, respectively. Positive predictive value of F.S was 96.4% and of I.O.C, 87.1%. Negative predictive value of both methods was 97.4%. Accuracy of F.S and I.O.C were 97.1% and 94.3% respectively. The area under receiver operating characteristic [ROC] curve was 0.959 for F.S and 0.939 for I.O.C. These results showed that intra operative cytology can be performed for intraoperative diagnosis of ovarian tumors as an alternative to Frozen Section [FS], however combination of these two techniques is more reliable

Assessment of self-care practice and its associated factors among diabetic patients in urban area of Urmia, northwest of Iran

Self care of diabetes is essential for control of disease and improvement of quality of patients' life. The aim of this study was to assess factors influencing self-care practice of patients in urban area of Urmia, Northwest of Iran. In this cross-sectional study, 400 diabetic patients were randomly selected from eight healthcare centers in Urmia City in 2010. Data collection tools was a questionnaire included data on demographic characteristics, diabetes statues, and self-care practice. Patients' self-care practice was classified to good, moderate, and poor levels. ANOVA and Chi-square tests were used to exam the association between self-care practice and clinical and behavioral factors. Spearman's rho correlation was used to examine the relation between self-care practice and control of glycemia. The patients' self-care practice was good in 15.1%, moderate in 58.7%, and poor in 26.2%. There was a significant association between education [P=0.030], duration of disease [P=0.04], and treatment intensity [P=0.001] and self-care practice of patients. Despite the important role of self-care practice in management of diabetes and preventing its serious complications, most patients who have medical record in health care centers had inappropriate self-care practice especially in SMBG, which has critical role in controlling diabetes

Differentiation of keratoacanthoma from squamous cell carcinoma by argyrophilic nucleolar organizer region [AgNOR] staining

The objective was to evaluate the differentiation of keratoacanthoma from squamous cell carcinoma by using argyrophilic nucleolar organizer region staining. Thirty one cases of keratoacanthoma and 31 cases of squamous cell carcinoma [S.C.C] were selected. The AgNOR staining carried out. Counting of AgNOR was done in 100 cells of each tumor. Two criterias including M.AgNOR [mean number of AgNORs] and P.AgNOR [percentage of nuclei with five or more than five AgNORs per nucleous] were used. Statistical analysis was done by Mann- Whitney test. Significant increase in M.AgNOR and P.AgNOR was found in S.C.C compared with keratoacanthoma [M.AgNOR =16.52 +/- 10.1 and P.AgNOR = 84.12 +/- 23.4 in S.C.C compared with M.AgNOR = 6.58 +/- 4.4 and P.AgNOR = 52.29 +/- 26.7 in keratoacanthoma, P=0.000]. Exceptionally overlapping was seen. This study indicated that the AgNOR counting is a valuable diagnostic criterion for differentiation of keratoacanthoma and S.C.C especially in cases with borderline histologic features

Normal values for random urinary calcium to creatinine ratio in Iranian children

Due to worldwide variations, reference values of urinary calcium to creatinine ratio in pediatric population are not yet well established. To determine normal values for urinary calcium to creatinine ratio and its relation to urinary sodium or potassium, a descriptive [correlation type] study was conducted in 7 to 12 years old healthy children in Urmia, Iran. Primary school children were divided into two sectors and 7 clusters [4 cluster school boys and 3 school girls]. The subjects were randomly selected. Random, non-fasting morning urine samples were obtained from 364 healthy children aged 7 to 12 years during fall 2005 and immediately sent to laboratory to determine urine calcium [Uca], creatinine [Cr], sodium [Na] and potassium [K]. For data analysis, mean and 95th percentile of UCa/Cr and UNa/K were used. Pearson test was used to determine any relationship between UCa/Cr and UNa/K values. For comparison of UCa/Cr and UNa/K values between males and females, Mann-Withny test was used. A total number of 364 children were enrolled in the study. There were 208 [57.1%] males and 156 [42.9%] females. The mean and 95th Percentile for UCa/Cr was 0.11 [0.10 and 0.24 respectively. The mean and 95th percentile for UNa/K were 2.30 [1.42 and 5.21 respectively. There was no significant difference in UCa/Cr and UNa/K between two sexes [P > 0.05]. We found a weak relationship between UCa/Cr and UNa/K [P < 0.01]. UCa/Cr value may differ according to geographic location. For screening purposes, reference values should be determined in each geographic location

Technetium Tc 99m dimercaptosuccinic acid renal scintigraphy in diagnosis of urinary tract infection in children with negative culture

The aim of this study was to evaluate the accuracy of Technetium Tc 99m dimercaptosuccinic acid [99mTc-DMSA] renal scintigraphy in the diagnosis of urinary tract infection [UTI] in children with suspected infection but with a negative urine culture. The records of all children with suspected or definite diagnosis of UTI presented during a 2-year period were reviewed in this study. Abnormal findings on renal scintigraphy, voiding cystourethrography [VCUG], and ultrasonography were evaluated and compared between the patients with the definite diagnosis of UTI and those with suspected UTI and negative urine cultures. Of 210 patients, 86 had a definite diagnosis of UTI [group 1] and 124 had suspected UTI without a positive culture [group 2]. Abnormal findings on DMSA scans were seen in 76 patients [88.4%] in group 1 and 84 [67.7%] in group 2. Vesicoureteral reflux was detected by VCUG in 50% and 32.3% of the patients in groups 1 and 2, respectively. In group 2, vesicoureteral reflux was seen in 40.5% of the patients with abnormal DMSA scan. Ultrasonography findings were abnormal in 51.3% and 39.8% of the patients with abnormal DMSA scan findings in groups 1 and 2, respectively. According to our findings, in children with a negative urine culture and abnormal urinalysis, 99mTc-DMSA renal scintigraphy is helpful in diagnosing UTI and vesicoureteral reflux; we recommend VCUG when DMSA scan supports UTI despite a negative urine culture and a normal ultrasongraphy

Measles IgG sero-prevalence and its attributable factors in 5-25 year old cases prior to mass vaccination campaign in Urmia-Iran

Measles is a vaccine preventable infectious disease. Despite the widespread availability of an effective measles vaccine, number of measles cases is noticeable in Iran. Because measles-specific antibody titer after vaccination is lower than after natural infection there is a concern that vaccinated persons may gradually lose protection from measles. To examine the persistence of vaccine induced antibody, participants with documented history of vaccination were assessed to determine the sero-prevalence and titer of measles antibody. This study was carried out in Urmia- Iran. Documented history of at least a single dose of live attenuated measles vaccine [at 9 or 15 month of age] was necessary to be included. Blood was collected from 840 subjects between 5-25 years old. The sera were tested for anti-measles IgG antibodies, by ELISA [IBL Germany]. Associations between predictive factors such as demographic data, vaccination status [once or twice] with IgG sero prevalence in routine vaccinated subjects were investigated by logistic regression analysis. The antibody titers in 54.76% of cases were in the range of protective level [IgG> 12IU]. The mean of antibody was significantly increasing after the 16[th] year of life The antibody titers were higher in participants who received one dose of measles vaccine in comparison with the persons who were immunized with two doses of measles vaccine. Antibody titers were slightly higher in men than in women. On multiple logistic regression analysis, of all variables examined, only vaccination status retained a significant association with anti measles sero-positivity rate [estimated odds ratio 0.395 n<0.05]. Elevation of antibody titer many years after vaccination is most likely due to boosting effect from repeated exposure to circulating wild virus resulting in unapparent or sub-clinical reinfection. This group of persons would be the most likely to support viral transmission in the absence of disease