The Effects of Tranexamic Acid on Bleeding Control During and after Percutaneous Nephrolithotomy (PCNL): A Randomized Clinical Trial.

PURPOSE: Tranexamic acid is a fibrinolysis suppressor that is used for a variety of bleeding control procedures such as hematuria, surgery bleeding, and trauma caused bleeding. The advantages of using the tranexamic acid are bleeding control and less need for blood transfusion. MATERIALS AND METHODS: This double blind clinical trial was conducted on 108 patients in Imam Khomeni Hospital, Urmia, Iran 2013-14. The control and intervention groups consisted of 54 randomly selected participants each. The intervention group received 1gr of intravenous tranexamic acid with initiation of surgery and 500mg orally each 8hrs afterwards up to three days. The control group received placebo capsules containing starch of the same form. RESULTS: The mean term of hospitalization in the intervention group was significantly shorter than that of the control group (P<0.001). The difference between the two groups in terms of preoperative hemoglobin was not significant. However, the decrease in postoperative hemoglobin, intraoperative hemoglobin count in washing liquid, and hemoglobin count in the intervention group were significantly different from those of the control group (P<0.001). CONCLUSION: The findings showed that tranexamic acid decreased bleeding during PCNL and the need for blood transfusion. It also decreased the hospitalization term.

Comparison of the effectiveness of a 12 step substance use recovery program on quality of life.

Substance-related disorders can adversely impact quality of life. This study assessed a 12 step program on health-related quality of life for Iranian individuals seeking to recover from substance use. The study used a quasi-experimental, two group, three stage, pre- and post-test design and collected data at baseline, and at 1 and 3 months' post-intervention. The treatment group comprised 35 participants in a 12 step program with a non-equivalent comparison group of individuals admitted to addiction treatment centers. Physical and mental health quality-of-life domains were assessed using the Short Form 36 Health Survey Questionnaire. The treatment group improved in all aspects of health-related quality of life. The treatment group improved compared to the comparison group for two of eight quality of life dimensions - physical functioning and role limitations due to emotional problems - at 1 month post-intervention. There were additional improvements at 3 months' follow up in six of eight quality-of-life subscales compared to the comparison group. The benefits to quality of life related to mental health recovery extended beyond the treatment program, indicating that the program principles were effectively implemented in daily life.

Pediatric percutaneous nephrolithotomy using adult sized instruments: our experience.

PURPOSE: To evaluate the safety and efficacy of pediatric percutaneous nephrolithotomy (PCNL) using adult sized instruments in the management of pediatric urolithiasis. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 38 children younger than 15 years who had undergone 45 PCNLs with adult sized instruments in our center between August 2007 and February 2010. RESULTS: There were 26 boys and 12 girls, with a mean age of 8.4 ± 4.24 years (range, 12 months to 13 years). Twelve patients had complete staghorn stone. Mean stone burden was 2.93 ± 0.89 cm. The tract was dilated between 26 and 30F. Standard PCNL was performed in 8 patients and tubeless PCNL in the next 37 subjects. Simultaneous transurethral lithotripsy was done in 9 patients. Stone clearance rate was 67%. Mean pre and postoperative hemoglobin levels were 12.67 ± 1.7 and 11.39 ± 1.6 g/dL, respectively. Mean hospitalization was 3.5 ± 1.1 days. Eight subjects had postoperative fever beyond day 1. Blood transfusion was required in only one patient. In one patient (3 years old) with a staghorn stone, hyponatremia and seizure occurred, which were treated conservatively without any adverse sequela. There was a significant difference in hospital stay between tubeless and standard PCNL groups (P < .02). CONCLUSION: We concluded that PCNL using adult sized instruments was relatively safe in children, with a clearance rate of 67%. We suggest prospective randomized studies to compare mini-perc and adult sized instruments use in pediatric PCNL.

Association of interleukin-10, interferon-gamma, transforming growth factor-beta, and tumor necrosis factor-alpha gene polymorphisms with long-term kidney allograft survival.

INTRODUCTION: Single nucleotide polymorphisms within promoter or other regulatory sequences of cytokine genes mainly influence the level of production and secretion of proteins. A large amount of evidence has shown that cytokine gene variations alter graft survival length after kidney transplantation. We studied the association of gene polymorphisms in the interlekin-10 gene (IL10; -1082 G/A), interferon-gamma gene (IFNG; +874 T/A), transforming growth factor-beta gene (TGFB; +869 T/C), and tumor necrosis factor-alpha gene (TNFA; -308 A/G) with kidney allograft survival. MATERIALS AND METHODS: The IL10 (-1082 G/A), IFNG (+874 T/A), TGFB (+869 T/C), and TNFA (-308 A/G) genotypes were determined in 32 kidney allograft recipients with graft rejection during the 1st posttransplant year and 52 without rejection in 5 posttransplant years, using allele-specific oligonucleotides-polymerase chain reaction method. RESULTS: The IFNG +874 A/T genotype showed a significantly higher frequency among kidney recipients of the rejection group than the control group (odds ratio, 2.64, 95% confidence interval, 1.03 to 6.74; P = .04). Comparisons between the rejection and control groups in IL10 (-1082 G/A), IFNG (+874 T/A), TGFB (+869 T/C), and TNFA (-308 A/G) single nucleotide polymorphisms showed no significant difference. CONCLUSIONS: Based on the finding of this study, it seems polymorphisms in the genes that regulate IL-10, IFN-gamma, TGF-beta, and TNF-alpha cytokines do not play a major role in kidney allograft survival, and other potential factors in this regard should be considered.

Determinants of tobacco use among youths in Isfahan, Iran.

OBJECTIVE: To determine potential factors that may result in motivating the youths to adopt smoking behaviour. METHOD: This cross-sectional study was conducted on 210 smoking and 217 non-smoking youths, aged 12-20 years. RESULTS: The average age of starting cigarette and water pipe smoking was 14.5 +/- 2.4 and 11.2 +/- 1.5 years, respectively. The first experience with water pipe occurred mostly in the traditional teahouses for girls (54.8%), and in family parties (48.2%) for boys. In both genders, the first place of cigarette smoking was at friends' parties (56.8% for boys, and 52.1% for girls) and then followed by traditional teahouses (43.2% for boys, and 47.9% for girls). The most common reasons youths have picked up cigarette smoking were mainly to attract attention from friends, family inattention and poverty. Meanwhile, nearly all water pipe smokers reported using it for fun. The strongest predictors of smoking among boys were respectively father's occupation, having a smoking mother, and the number of smoking peers, whereas among girls, these factors were respectively having a smoking mother, frequenting traditional teahouses, and the number of smoking peers. Lower education of fathers and divorce among parents increased the probability of smoking in both genders, especially girls. School/work failure, as well as troubled relationship with parents and siblings were the other significant predictors of smoking in both genders, notably in girls. CONCLUSION: Public health control measures should be adopted not only to curtail cigarette use, but also to address water-pipe use. Preventive measures should be regarded as a high priority for socio-economically disadvantaged families.

Blood pressure and its influencing factors in a national representative sample of Iranian children and adolescents: the CASPIAN Study.

BACKGROUND: This study was performed to determine the blood pressure (BP) percentile curves by height, as well as to assess the prevalence of high BP and its influencing factors among children in the first national survey in this field in Iran. DESIGN: A multicentre national cross-sectional survey. METHODS: This study was performed in 23 provinces among a representative sample of 21,111 students aged 6-18 years. RESULTS: Age and sex-specific percentile curves of systolic and diastolic BP were obtained by height. A comparison of the values obtained corresponding to the 90th percentiles with the Second Task Force cut-offs showed that the BP values and trends were relatively similar in both studies. The overall prevalence of systolic, diastolic as well as systolic or diastolic hypertension according to the Second Task Force study 95th percentile cut-off points were 4.2, 5.4 and 7.7%, respectively, without a significant sex difference. A history of low birthweight, overweight, taller height, the consumption of solid hydrogenated fat, as well as the frequency of fast food consumption increased the risk of both systolic and diastolic hypertension. Male sex, large waist, and low education of the mother were the risks for systolic hypertension, whereas the risk of diastolic hypertension rose with living in an urban area, attending public school, low physical activity level, having a housewife mother, and a positive family history of obesity, especially in the parents. CONCLUSION: Considering the effect of modifiable environmental factors on the childrens' BP, encouraging breast feeding and a healthy lifestyle may have an important effect on public health.

Smoking behavior and its influencing factors in a national-representative sample of Iranian adolescents: CASPIAN study.

OBJECTIVES: To determine the national prevalence of smoking among Iranian youths and its environmental influencing factors. METHODS: This study was performed in 2003-2004 among 11,966 school students, ages 11-18 years, selected by multi-stage random cluster sampling from 20 provinces in Iran. The participants filled out self-administered anonymous questionnaires. RESULTS: The prevalence of self-reported cigarette smoking was 14.3%, with a higher prevalence in boys than in girls (18.5% vs. 10.1%, respectively, P < 0.001), and in high school than in middle school students (17.4% vs. 10.6%, respectively, P < 0.001). Overall, 42.2% of smokers were daily smoker, and the rest were occasional smoker. The mean age of the first attempt to smoke was 13.2 +/- 2.5 years with no significant gender difference but was significantly lower in daily than in occasional smokers. The place of the first attempt to smoke was mostly in friend parties (41.6%) and traditional teahouses (23.2%) for boys and the family parties (37.1%) and the traditional teahouses (27.4%) for girls. The higher school level and having a tobacco user at home significantly increased the likelihood of smoking in adolescents, with the highest odds ratio (OR) found for having a smoker sister in girls (OR = 4.5, 95%CI, 2.5, 8.2), and having a smoker brother in boys (OR = 2.4, 95%CI, 2.03, 3.05). CONCLUSION: Smoking is becoming as a major public health threat among Iranian youths. Control measures should be considered not only for cigarette smoking, but also for the socially accepted habit of water pipe use that is revived in traditional teahouses.