Comparison of the effect of heparin, reteplase, and taurolock in the prevention of thrombosis in hemodialysis catheters.

Background and Aim: One of the complications of using catheters is the occurrence of thrombosis, which can be dangerous for patients. The main objective of this study is to compare the effect of heparin, reteplase, and taurolock in the prevention of thrombosis in hemodialysis catheters. Methods: The present study is a clinical trial, in which the effect of three drugs, heparin, reteplase, and taurolock, in the prevention of thrombosis in hemodialysis catheters, has been investigated. The research units were studied in two intervention and control groups. The stratified random allocation method was used to assign patients to five groups (control, Heparin 50, Heparin 1000, reteplase, and taurolock), with strata based on the patient's age (20-70 years), gender, and duration of dialysis. Within each stratum, patients were also assigned to groups using the randomized block permutation method and a random number table tool. To prevent bias, this study is triple-blinded. This means that the patient, the thrombosis assessor, and the statistical analyst are unaware of the type of intervention received by the patient. Results: Gender (p < 0.999), age distribution (p = 0.774), and duration of dialysis (p = 0.875) showed no statistically significant relationship with thrombosis. However, significant differences were observed among the five groups regarding thrombosis incidence. The relative risk of thrombosis in the Heparin 50, Heparin 1000, reteplase, and taurolock groups compared to the control group was 92.5%, 92.2%, 98.2%, and 89% lower, respectively. Conclusion: Our study underscores the efficacy of heparin, reteplase, and taurolock in preventing thrombosis in hemodialysis catheters. While all three drugs demonstrated efficacy, the Heparin 50 group exhibited the highest relative risk reduction. These findings suggest that heparin, particularly at a low dose, should be considered a standard prophylactic treatment in hemodialysis patients.

Molecular epidemiology and associated risk factors of oral cavity parasites in hemodialysis patients in western Iran.

Renal disorders are able to make patients more susceptible to infections, including those caused oral cavity infections. Today, it has been proven that during end stage renal failure, hemodialysis results in acquired immune response defects through failings of humoral and cell-mediated immune. This survey was intended to assess the molecular epidemiology and associated risk factors of Entamoeba gingivalis and Trichomonas tenax as the main oral cavity protozoa in hemodialysis patients in Lorestan Province, western Iran. The investigation was performed on 73 hemodialysis patients referring to hemodialysis centers of Lorestan Province, Iran during May 2021 to February 2022. The frequency of oral cavity protozoa was investigated using microscopic and conventional polymerase chain reaction (PCR). A provided questionnaire with a number of demographical information and related risk factors was completed for each patient. The results showed that E. gingivalis and T. tenax parasites were found in 18 (24.6%) and 20 (27.4%) of the hemodialysis participants by microscopic and PCR test, respectively. Among samples, 13 (17.8%) of the hemodialysis participants were infected with E. gingivalis; whereas 7 (9.6%) of the participants were positive for T. tenax. No significant association was reported between gender, age, education, flossing, use of mouthwash, and prevalence of oral protozoa in hemodialysis participants. However, a significant correlation was observed among between living in rural regions (OR = 13.16; 95% CI = 2.64-56.81; p = 0.002), brushing teeth (OR = 8.51; 95% CI = 1.71-42.3; p = 0.009) and prevalence of oral protozoa in hemodialysis participants. The findings of these epidemiological study clearly showed the high frequency of oral cavity parasites in hemodialysis patients in Lorestan Province, Western Iran. Awareness of the main risk factors for oral cavity parasites particularly teeth brushing is necessary in refining public and oral health policies in hemodialysis patients. Consequently, dental practitioners, nephrologist, and urologist must be alert of these risk factors to carefully identify and achieve oral health concerns in hemodialysis patients to prevent the oral diseases and infections.

Carotid Intima-media Thickness in Hemodialysis Patients and Related Biochemical and Clinical Factors.

INTRODUCTION: Cardiovascular complications are the most frequent cause of death in chronic kidney disease that happens due to both general and uremic risk factors. Recently, the medical literature has declared the carotid artery intima-media thickness to be an indicator for predicting cardiovascular diseases. METHODS: This paper is an attempt to introduce an analytical cross-sectional study of 128 hemodialysis patients. The researchers collected the data by reviewing medical records, interviewing the patients, chemical analysis of the patient's serum and carotid artery Doppler ultrasound, and providing the relevant questionnaire. We performed descriptive statistics, bivariate correlation, and general linear model (GLM) analysis. And, the significance level of hypothesis tests was .05. RESULTS: Seventy-three patients (57%) were male, and 55 (43%) were female. The mean and standard deviation of the age was 58.66 ± 15.54 years. Nearly 42% of patients affected by diabetes, 95.3% were hypertensive and 28.1% had a history of cardiovascular disease. In the bivariate analysis, age, serum albumin, serum magnesium, hypertension, and history of cardiovascular disease showed a statistically significant relationship with carotid intima-media thickness (CIMT). In GLM, we observed a statistically significant relationship between CIMT, age and magnesium. CONCLUSION: Increased CIMT is observed in a considerable percentage of hemodialysis patients. Age and serum magnesium concentration demonstrate a statistically significant association with CIMT. We recommend more precise long-term longitudinal follow-up studies to investigate the relationship between biochemical risk factors and CIMT. Therefore, multivariate analysis is necessary to assess the simultaneous effects of independent variables and manage influences of confounding factors. We also recommend developing a practical guideline for periodic determination of CIMT in hemodialysis patients to implement convenient preventive or therapeutic measures.  DOI: 10.52547/ijkd.7303.

Angiotensin-converting enzyme gene insertion/deletion polymorphism and hypertension disease.

Background: The renin-angiotensin system (RAS), which is important for controlling haemostasis in the body, can increase the development of essential hypertension (HTN). Various surveys have shown that ACE I/D polymorphism that influences ACE activity, a key component of RAS, has been known to be associated with the risk of HTN. The goal of this study was to investigate the correlation between ACE (I/D) polymorphism and HTN.Methods: Blood samples were obtained from 102 patients and 104 healthy individuals. The two groups were matched by age and sex. Informed consent was prepared for the study. The demographic data were collected using a questionnaire. White blood cells (WBCs) and then DNA were extracted from whole blood. After this, the PCR test was performed using specific primers. PCR products were examined using 1% agarose gel. Individuals with genotype II having a band of 490 bp, ID two band of 490 bp and 190 bp, and individuals with DD genotype, have a band in region 190 bp.Results: The average age of the patients was 52.7 ± 7.5 years. A significant difference was seen in the distribution of DD, II and I/D genotypes of ACE polymorphism between the essential hypertensive patients (44.1, 10.8, and 45.1%) and their ethnically matched healthy control (61.5, 3.8, and 24.6%, respectively). Our study showed an increased risk of disease in people with II genotype in comparison to ID and DD genotypes (0.46 (0.1-1.75) and 0.26 (0.05-0.94), respectively).Conclusions: The present study demonstrated that ACEI/D polymorphism is characterised with greater risk of essential HTN in the Lorestan province. II genotype increased the relative risk of essential HTN in the population. In the future, more investigations with more samples size are recommended for the better study of genetic factors in hypertensive patients.

Coronavirus case presentation in a patient with loss of consciousness due to dyspnea.

INTRODUCTION AND IMPORTANCE: Severity of corona virus disease 2019 (COVID19) is presented with respiratory distress. CASE PRESENTATION: We present a case of a 29-year-old male who was not presented with typical symptoms of COVID19 at the time of referral but loss of consciousness. CLINICAL DISCUSSION: The importance of testing patients without typical symptoms for coronavirus infection and multi-system manifestation of the virus is presented in this case. CONCLUSION: Severe drop in oxygen saturation in asymptomatic patients can lead to encephalopathy.

Missed bladder rupture following vaginal delivery: Possible role of assessing ascitic fluid creatinine levels?

Bladder injury is the most common urological trauma following the gynecological procedure. Normal vaginal delivery candidates with unresponsive and prolonged ascites and bladder-emptying complaints should be examined for bladder rupture. We also suggest measurement of ascitic fluid creatinine levels in these patients.

The Application of Urinary NGAL Measurement for Early Detection of AKI in Hospitalized Patients with Poisoning.

INTRODUCTION: Early diagnosis of acute kidney injury is critical for decision-making. Neutrophil gelatinase-associated lipocalin (NGAL) is a biomarker introduced for early detection of acute kidney injury (AKI). We evaluated urinary NGAL level in hospitalized patients due to poisoning as a predictor of AKI. METHODS: We studied patients with poisoning due to various causes. Urinary NGAL and urine creatinine levels were measured. Serum creatinine levels were measured for all patients at baseline and after 24 and 48 hours. Then, a ROC curve developed for urinary NGAL, and cutoff point and accuracy of urinary NGAL test were determined. RESULTS: Ninety hospitalized patients with acute poisoning were consecutively recruited into the study over an eight-months period. With the gold standard test (i.e., serum creatinine measurement), 21 patients were diagnosed with acute kidney injury (AKI) and 69 with non-AKI, whereas according to ROC curve, at a cutoff point of 110 ng/ml, urinary NGAL with an 81% sensitivity and 91.3% specificity distinguished 23 patients with AKI and 67 with non- AKI. The false positive and false negative values of urinary NGAL test were 8.7% and 19%, respectively. The positive predictive value and negative predictive value of urinary NGAL were estimated to be 73.9% and 94%, respectively. CONCLUSION: Urinary NGAL test, with an AUC of ROC curve of approximately 90% and a sensitivity of 81%, can be used for early detection of AKI. It has a high specificity (91.3%), indicating that the percentage of false positive cases (8.7%) will be small.

Study of Urine Composition of Patients With Recurrent Nephrolithiasis in Lorestan, Iran.

INTRODUCTION: Nephrolithiasis is one of the most common urinary tract diseases. After the first episode of urinary calculus, the risk of recurrence is nearly 40% to 50% at 5 years. Nephrolithiasis is a systemic disease that is associated with some metabolic disorders. This study aimed to provide a picture of the frequency of metabolic abnormalities in patients with nephrolithiasis from west part of Iran. MATERIALS AND METHODS: Patients with recurrent urinary tract calculi referred to the Nephrology-Urology Clinics in Khorramabad city were recruited. After collection of demographic data of all the patients, 24-hour urine and blood samples were taken to measure biochemical factors. RESULTS: Of the 232 participants, 125 were males and 107 were females. Hyperoxaluria was seen in 93 (40.1%) of the participants, hypercalciuria in 55 (23.7%), hypocitraturia in 58 (25%), and hyperuricosuria in 33 (14.9%). Hyperoxaluria in the males was significantly more frequent than in the female patients. There were no significant differences between the two groups in other urinary metabolic disorders. CONCLUSIONS: Patients with nephrolithiasis from Lorestan province may have metabolic characteristics varying from those of regions; ethnicity may be a possible reason. Variation of dietary regimens, such as the amount of meat or vegetable in the diet that can change oxalate, calcium, or citrate of urine, might have influenced the results. Time of sampling is another factor. Population-specific studies are helpful to health care providers for preventive planning for nephrolithiasis.

Ghrelin is a suppressor of testicular damage following experimentally induced cryptorchidism in the rat.

BACKGROUND: Cryptorchidism is associated with increased level of reactive oxygen species and lipid peroxidation. This study was undertaken to examine the possible ghrelin ability in attenuation of testicular damage in response to elevated temperature. METHODS: Thirty male rats were subdivided into sham-operated, cryptorchidism-saline and cryptorchidism-ghrelin group. Bilateral cryptorchidism was induced in groups 2 and 3, surgically. The animals in group 3 were given ghrelin for 7 days and all testes were taken for biochemical and photomicrograph analysis. RESULTS: Glutathione peroxidase activity and glutathione content significantly promoted on day 7 in the cryptorchid rats treated by ghrelin. Catalase activity was higher in the ghrelin-exposed animals than the cryptorchidism-saline group on both experimental days. Although superoxide dismutase activity was elevated by ghrelin treatment on both days, it did not differ significantly. By contrast, significant reduction was observed in thiobarbituric acid reactive substances concentrations following ghrelin administration on day 7. Moreover, ghrelin could improve histopathological scores of the testes, and diminished formation of giant cells and tubular vacuolization. CONCLUSIONS: These findings indicate for the first time the novel evidence of ghrelin antioxidant properties in attenuation of rat testicular injury following experimentally induced cryptorchidism.