Comparison of Serum Neutrophil Gelatinase-associated Lipocalin (NGAL) with Serum Creatinine in Prediction of Kidney Recovery after Renal Transplantation.

BACKGROUND: Because of some insult to kidney during transplantation, assessment of kidney function after the procedure is essential. It would be ideal to find a marker better than creatinine to early predict the acute kidney injury. OBJECTIVE: To compare with creatinine the predictive value of serum neutrophil gelatinase-associated lipocalin (NGAL) in detecting kidney recovery after renal transplantation. METHODS: We studied 33 patients who received kidney transplantation (deceased [n=20] and live [n=13]) during a 6-month period in 2010. Serum NGAL and creatinine, hemoglobin, and blood glucose were measured at 0, 12, 24, 48, and 72 hours after transplantation. The need for dialysis and kidney function in one week were studied. RESULTS: There were 16 men and 17 women with the mean±SD age of 36.3±12.2 (range: 14-58) years. Of the studied patients, 6 had delayed graft function (DGF; hemodialysis within the first week of transplant); 9 had slow graft function (SGF; serum creatinine reduction from transplantation to day 7 <70%), and 23 had immediate graft function (IGF; reduction in serum creatinine ≥70%). At any time, serum NGAL, and creatinine levels were significantly higher among patients with DGF (p=0.024) and SGF (p=0.026) compared with those with IGF. However, in those who got IGF vs non-IGF, serum creatinine levels were not significantly different (p=0.59) but serum NGAL levels differed significantly(p=0.020). Receiver-operating characteristic (ROC) curve and area under curves (AUCs) of serum NGAL and serum creatinine levels on the first post-transplantation day had similar significance in predicting the patient's need to dialysis in the first week. However, using AUC of serum creatinine was not helpful in predicting non-IGF, compared to serum NGAL. The AUCs of the serum NGAL were 0.70 (95% CI: 0.52-0.89) and 0.76 (95% CI: 0.59-0.93) after 12 and 24 hours, respectively (p<0.05). The highest AUC (0.82) was attributed to serum NGAL of 24 hour (p=0.002). CONCLUSION: Serum NGAL level especially 24 hours post-transplantation, seems to be an early accurate predictor of both the need to dialysis and slow graft function within the first week of kidney transplantation.

Association of myocardial infarction with stressful life events and psychiatric symptoms: a population-based survey.

Psychosocial factors such as depression, hostility, social isolation are associated with increased risk of coronary heart disease. We aimed to determine the association of psychiatric symptoms and psychosocial factors with myocardial infarction (Ml). We performed a secondary analysis of data from a population-based survey of Iranians aged 18-15 years using standardized psychosocial instruments. Of the 2158 participants, 51 had suffered an Ml. In univariate analysis: number of stressful life events, stressfulness, somatization, depression, anxiety, phobic anxiety and psychoticism were significantly associated with Ml(P < 0.05). In multivariate logistic regression, interpersonal sensitivity (P= 0.047), phobic anxiety (P = 0.016) number of stressful life events (P= 0.054), stressfulness (P= 0.057) and age (P = 0.001) remained at significanty associated with Ml.

Association of myocardial infarction with stressful life events and psychiatric symptoms: a population based survey

Psychosocial factors such as depression, hostility, social isolation are associated with increased risk of coronary heart disease. We aimed to determine the association of psychiatric symptoms and psychosocial factors with myocardial infarction [Ml]. We performed a secondary analysis of data from a population-based survey of Iranians aged 18-65 years using standardized psychosocial instruments. Of the 2158 participants, 51 had suffered an Ml. In univariate analysis; number of stressful life events, stressfulness, somatization, depression, anxiety, phobic anxiety and psychoticism were significantly associated with Ml [P< 0.05]. In multivariate logistic regression, interpersonal sensitivity [P = 0.047], phobic anxiety [P = 0.016], number of stressful life events [P =0.054], stressfulness [P= 0.057] and age [P= 0.001] remained at significantly associated with MI

Prevalence of coronary artery disease risk factors in Iran: a population based survey.

BACKGROUND: Coronary artery disease (CAD) is a leading cause of mortality, morbidity, and disability with high health care cost in Iran. It accounts for nearly 50 percent of all deaths per year. Yet little is known about CAD and CAD risk factors in the Iranian population. We aimed to assess the prevalence of different CAD risk factors in an Iranian population. METHODS: A descriptive cross sectional survey was conducted involving 3000 healthy adults at 18 years of age or above who were recruited with cluster random sampling. Demographic data and risk factors were determined by taking history, physical examination and laboratory tests. RESULTS: The average age was 36.23 +/- 15.26. There was 1381 female (46%) and 1619 male (54%) out of which 6.3% were diabetic, 21.6% were smoker, and 15% had positive familial heart disease history. 61% had total cholesterol level > 200 mg/dL, 32% triglyceride > 200 mg/dl, 47.5% LDL-c > 130 mg/dl, 5.4% HDL-c < 35 mg/dl, 13.7% systolic blood pressure > 140 mmHg, 9.1% diastolic blood pressure > 90 mmHg and 87% of them were physically inactive. CONCLUSION: Clinical and Para-clinical data indicated that Iranian adult population are of a high level of CAD risk factors, which may require urgent decision making to address national control measures regarding CAD.

Local control of long bone giant cell tumour using curettage, burring and bone grafting without adjuvant therapy.

Giant cell tumour (GCT) is a benign, but aggressive, primary tumour of the bone. The recurrence rate after surgical treatment has been reported to be as high as 50%. Many surgical techniques have been employed in the treatment of this tumour. More aggressive interventions, such as en bloc resection and bulk allograft or prosthetic reconstruction, are generally understood to be associated with lower rates of local recurrence. However, because of lessened morbidity, intralesional techniques have come to be favoured for this condition. In addition to curettage, various adjuvant procedures and packing materials have been advocated in order to control and reconstruct long bone defects secondary to this neoplasm. We report our experience with 40 long bone GCT patients treated with curettage, burring, bone grafting and no adjuvants between 1997 and 2002. There was a local recurrence rate of 32.5%, with most recurrences noted within the first 30 months after surgery. Minor complications were found in 18% of patients. The risk of local recurrence in this study is acceptable (within the range that has been historically reported for curettage and bone grafting). In cases where more resources are available, the addition of adjuvant therapies, as noted in the recent literature, may be beneficial. The results of this study should be considered when designing multicenteric studies in the future.

Relationship between erythrocyte lithium concentration and renal concentrating capacity.

BACKGROUND: Studies investigating possible correlations between plasma lithium concentration, lithium treatment duration, and frequency of lithium administration, and lithium nephrotoxicity have yielded conflicting results. OBJECTIVES: Our main objective was to investigate whether there was any relationship between erythrocyte lithium concentration (ELC) and renal side effects. Another objective of our study was to identify a parameter, which could be estimated inexpensively, for assessing possible renal side-effects of lithium. METHOD: Seventy Iranian inpatients with bipolar disorder entered this case-control study. Medications taken concurrently by the patients were recorded. A direct method of measuring ELC was used in this study. The cases were patients on lithium who had urine specific gravity (SG) of 1.006 or less after 8-10 h water deprivation at night and the controls consisted of patients on lithium with urine SG of 1.011 or more after this period. Blood urea nitrogen, serum creatinine, sodium and potassium and urine SG, sodium, and potassium were measured in all patients during this time. Renal indices were compared by using independent sample t-test at a significance level of a P-value of 0.05 or less. Non-parametric Spearman's rank correlation test was used to investigate the relationship between clinical variables and the indices of renal function. RESULTS: Results revealed that in case group mean serum sodium concentrations were significantly higher (P = 0.008) and mean urine sodium and potassium were significantly lower than those of controls (P = 0.004 and 0.007 respectively). We found no statistically difference in lithium ratios between the two groups. However, ELCs were significantly higher in the cases (P = 0.026). There were no significant correlation between concomitant use of neuroleptics, benzodiazepines or carbamazepine and ELC or lithium renal side-effects. CONCLUSION: This study showed that ELC may reflect lithium renal side-effects better than plasma lithium level.

Evaluation of the effect of acetazolamide on cystoid macular oedema in patients with Behcet's disease.

AIM: To study the effect of acetazolamide on cystoid macular oedema (CMO) in patients with Behcet's disease. PATIENTS AND METHODS: A total of 67 eyes of 35 Behcet's patients with chronic, but well-controlled uveitis, and CMO were randomised into a double-masked, crossover trial comparing the effect of acetazolamide vs placebo. The patients received an initial 4-week course of either 250 mg acetazolamide twice daily (b.i.d.) or placebo, followed by a 4-week washout period. They then received a 4-week course of the reverse study medication. An improvement in visual acuity and fundus fluorescein angiographic findings was assessed. RESULTS: In total, 29 patients (55 eyes) completed the trial and were available for analysis. Of the 29, 16 men and 13 were women. The age range was 13-50 years (mean 33.6 years). Patients on acetazolamide showed a slightly better improvement of angiographic signs (at least by one grade improvement) over that of placebo (12 vs five eyes). They also had less deterioration of angiographic signs over that of placebo (three vs seven eyes). However, these findings were not statistically significant (P=0.99). Acetazolamide had no statistically significant effect (P=0.53) on the improvement of visual acuity of patients over that of placebo (13 vs eight eyes), nor on the deterioration of visual acuity (three vs 11 eyes). CONCLUSION: Despite seemingly favourable results, the 4-week course of acetazolamide (250 mg b.i.d.) has no statistically significant effect on the improvement of the visual acuity and the fluorescein angiographic findings in Behcet's patients with CMO.