Additional burden of intensive care to rehospitalizations following kidney transplantation. A study of rate, causes, and risk factors

Little information exists on the burden of intensive care unit [ICU] to the posttransplant rehospitalizations of kidney allograft recipients. We do not clearly know the extent of the need for ICU during rehospitalizations and causes of readmissions. In this study, we aimed to assess ICU admissions of kidney transplant recipients, to determine the risk factors of ICU admissions in rehospitalized patients, and to evaluate the additional burden of ICU admission. A total of 581 posttransplant rehospitalizations of kidney transplant recipients were assessed for ICU admission. Clinical characteristics of the patients and the length of hospital stay, transplantation-admission interval, hospitalization costs, and mortality rate were reviewed. Twenty-five rehospitalized kidney transplant recipients [4.3%] had been admitted to ICU with kidney dysfunction [36.0%], cerebrovascular accident [24.0%], sepsis [16.0%], brain tumor [8.0%], brain abscess [4.0%], diabetic ketoacidosis [4.0%], trauma [4.0%], and hemodynamic shock [4.0%]. The risk factors of referral to ICU were higher age [P = .001] and hospitalization for cerebrovascular accident [P = .001] and malignancy [P = .004]. Additional burdens were 1.8, 3.3, and 11.4 times as high as the rehospitalization burden for the length of hospital stay, hospitalization costs, and mortality rate, respectively. Age and some special causes of hospitalizations are risk factors of ICU admission of kidney transplant recipients, and this occurs in about 5% of rehospitalizations. Admission to ICU adds considerably to the burden of rehospitalizations, warranting measures to prevent conditions that lead to the need for intensive care in these patients

Rodent control operations against zoonotic cutaneous leishmaniasis in rural Iran

Zoonotic cutaneous leishmaniasis [ZCL] is a serious and increasing public health problem in many rural areas of Iran. Previous studies showed that rodent control operations are effective in destroying rodents and reducing the incidence of ZCL on a small scale and in special circumstances. The objective of this study was to determine suitable timing for rodent control operations in reducing the incidence of ZCL in an endemic area in Badrood, Iran. We conducted rodent control operations by baiting rodent holes using zinc phosphide once a month in May, June, July and September in 1997 within a 500-meter circle of houses in the intervention area. From 1999 to 2002, the numbers of active rodent holes were counted in May and October in the intervention and control areas. When the numbers of rodent holes increased to 30% or more of the number before the first baiting in May 1997, holes in the intervention area were baited again with zinc phosphide in the intervention area; no baiting was done in the control village. Case findings were done by house-to-house visits once every season during 2000 to 2002. Changes in the number of rodent holes over time in the intervention and control villages were statistically significant [P<0.000001]. There were also significant differences in the incidence of ZCL between the intervention and control villages [P<0.005] during 2000 to 2002. The incidence of ZCL was unchanged in the years 2000 and 2001, but increased in one village in 2002 after an increase in the number of rodent holes. We suggest that rodent control operations using zinc phosphide be done within a 500-meter circle of houses once every two years before the beginning of the active season of sandflies, which begins in late April