Association Between Delayed Graft Function (DGF) Biomarkers and Long-term Outcomes After Living Donor Kidney Transplantation.

BACKGROUND AND OBJECTIVES: The association between preoperative Urine Neutrophil Gelatinase-associated Lipocalin (uNGAL) and interleukin-18 (uIL-18) with poor 1-year allograft function has been shown in deceased-donor kidney transplant recipients previously, and also these markers could predict 3-month allograft function. However, it is unknown whether there is an association between these postoperative biomarkers with important recipient outcomes beyond this time in livedonor transplants. METHODS: NGAL and IL-18 four and 24 hours were measured in live-donor kidney transplant recipients after transplantation. The relationships between changes in these markers with clinical outcomes as well as kidney function were examined at 1 month and 2 years. Moreover, the association between delayed graft function with clinical outcome and Serum Creatinine (SrCr) was evaluated during this period. RESULTS: The Mean age for kidney recipients was 23.9 years. Significant interaction was observed between uNGAL 24 hr (pvalue=0.01) and uIL-18 four and 24 hr after transplantation (pvalue=0.04, 0.03; respectively) with patients' outcome after 1 month and changes in uNGAL with outcomes after 2 years (pvalue= 0.04). CONCLUSION: Changes in urine NGAL postoperative are associated with worst outcomes, 2 years after kidney transplantation, suggesting its potential role in identifying patients that are at high risk for diminished allograft function, outcome and survival.

Assessment of Depression Prevalence and Its Relation With Interleukin 18 One Year After Renal Transplantation.

Renal transplantation is the treatment of choice for many patients with end-stage renal disease. Because there is little information about depression after kidney transplantation, we investigated frequency and determinant factors of depression and also its association with interleukin (IL)-18. Kidney transplant recipients were investigated between January 2011 and February 2013. Depression was assessed using the Beck Depression Inventory (BDI, BDI-II). We investigated the relationship between 1-year posttransplantation depression and all-cause mortality, acute kidney injury, and serum creatinine 1, 3, and 12 months after transplantation. Furthermore, the association of depression with IL-18 biomarker was recorded 1 year after transplantation. A total of 74 patients (age: 37.06 ± 16.2 years; 59.5% male) were enrolled in this study 1 year after transplantation. Nineteen (25.6%), 2 (2.7%), and 1 (1.3%) of them experienced mild, moderate, and severe depression, respectively. IL-18 biomarker (independent variable) was significantly associated with depression 1 year after transplantation. Our data suggested that IL-18 level increased significantly in renal transplant patients with depression.

Pharmacists' Knowledge and Attitudes Towards Upper Respiratory Infections (URI) in Iran: A Cross Sectional Study.

OBJECTIVES: To identify the knowledge and attitudes of community pharmacists towards upper respiratory infections. SETTING: The pharmacists, who participated in an annual clinical pharmacy congress in Tehran, were enrolled in this study. INTERVENTION: We conducted a cross-sectional descriptive study to assess the knowledge and attitudes of 72 community pharmacists towards upper respiratory infections (URI) using a questionnaire. MAIN OUTCOME MEASURES: We investigated the knowledge and attitudes of pharmacists towards rational antibiotics use in URI in Iran. Also we tried to detect causes of irrational antibiotic use. RESULTS: The response rate of our study was 72%. Of all respondents, 98.61% answered the knowledge question" inappropriate use of antibiotics could lead to drug resistance and would increase drug allergy" correctly. More than half (55.56%) of the community pharmacists believed that pharmacists can be affected by patients' expectations for antibiotics prescription. A majority of pharmacists gave a correct response to questions about beneficial use of corticosteroid in URI (90.28%) and symptoms persistent after 10-14 days even with antibiotic therapy (86.11%). More than half of all pharmacists had misconceptions on antibiotic use for URI in children under 2 years old. More than half of all pharmacists believed that most cases of URI are viral infections. Also, 90.28% of all pharmacists believed that guidelines for antibiotics prescribing may be beneficial in appropriate antibiotic use. CONCLUSION: According to a high response rate for the question about efficiency of antibiotics prescription guidelines, reliable information on the appropriate use of antibiotics should be more widely available for pharmacists.