The relationship between spirituality and aggression in the workplace during the COVID-19 pandemic: A cross-sectional study among Iranian nurses.

BACKGROUND: Aggression towards nurses in the workplace arises from various reasons, reportedly increasing during the COVID-19 pandemic. Where aggression can be maintained by spiritual well-being, as it is said that spirituality is a coping skill and psychological well-being maintainer-but there is little known, especially during the pandemic. Thus, this study explored the effect of spirituality on aggression among the nurses working in the COVID-19 wards. METHODS: This cross-sectional data from 200 nurses involved in the COVID-19 patient treatment were collected using a random sampling method from four hospitals in East Mazandaran province, Iran. Responses were collected based on socio-demographics, Buss-Perry Aggression Questionnaire, and Paloutzian & Ellison Spiritual Well-being Scale. T-test, ANOVA, Pearson correlation coefficient, and multiple linear regression were applied for data analysis. RESULTS: The mean age of nurses was 31.49±6.88 (range: 21-48) years. Nurses working in the COVID-19 wards have a mean score of spiritual health of 67.21±12.84 (out of 120), whereas 51.77±10.96 (out of 116) was for aggression. The results showed a significant negative weak correlation between aggression and spiritual health (r = -.285, p<0.01). As per regression analysis, spiritual health [ß = -.264], age [ß = -.374], and working experience [ß = 4.156] were the significant factors associated with aggression (p<0.05). CONCLUSIONS: It is evident that nurses who consider spirituality in their life actions are in a state of reduced negative emotions, such as aggression. Thus, policymakers and managers of the healthcare settings are suggested to promote spirituality among the nurses through spiritual care education, providing the ground for promoting spirituality and a positive attitude towards it.

Evaluation of patient satisfaction with nursing services before and after implementation of the Health System Transformation Plan in Iran: A cross-sectional study.

Background and Aims: How healthcare service delivery is achieved after implementing the Health System Transformation Plan (HSTP) is investigated in the present study by assessing the patients' satisfaction with nursing care services compared to before HSTP. Methods: This cross-sectional study was conducted in Iranian hospitals during two periods, that is, before (N = 300) and after (N = 279) HSTP, whereas the Patient Satisfaction Instrument was used to assess the satisfaction with nursing services. Results: About 57.7% and 4.7% of the patients were dissatisfied with nursing care services, whereas 34% and 77.4% for moderate satisfaction, and 8.3% and 17.9% for total satisfaction, before and after HSTP, respectively. The mean score of overall satisfaction was 57.33 (±11.17) and 70.84 (±11.99) before and after HSTP, respectively (p < 0.001), which represents there is an improvement in healthcare services delivery after HSTP. Although none of the sociodemographic factors were significantly associated with satisfaction, higher satisfaction was found among the coronary care unit (CCU) hospitalized patients. Conclusion: The patients' overall satisfaction with nursing care services after HSTP was increased, although higher satisfaction was observed in the patients of special wards such as CCU. Therefore, using more care facilities and equipment and engaging more skilled nursing staff in other wards is highly recommended.

Happiness and Moral Courage Among Iranian Nurses During the COVID-19 Pandemic: The Role of Workplace Social Capital.

Background: COVID-19 has become a major global health problem, and healthcare professionals are facing lot of pressure and stress. Accumulated resources and energy obtained via interpersonal relationships is called social capital, which can reduce the negative effects of pressure and stress related to the workplace by impacting happiness and moral courage. This study explored the effect of workplace social capital on moral courage and happiness in nurses working in the COVID-19 wards. Methods: In this cross-sectional study, using a random sampling method, 169 nurses from three hospitals in East Mazandaran province, Iran, participated who worked in COVID-19 wards. The Onyx and Bullen Social Capital Questionnaire, the Sekerka's Moral Courage Scale, and the Oxford Happiness Inventory were used in this study. Descriptive analysis, Pearson correlation analyses, and stepwise multiple regression were performed for data analysis. Results: The mean age of nurses was 31.38 ± 6.82 years. Socio-demographic factors such as age, gender, educational level, and employment status were significant predictors of workplace social capital. Social capital was positively correlated with moral courage (r = 0.29, p < 0.01) and happiness (r = 0.32, p < 0.01). In addition, social capital explained 6.8 and 8.6% variance in predicting moral courage and happiness, respectively. Conclusions: Workplace social capital is a vital organizational phenomenon affecting nurses' moral courage and happiness, especially during the COVID-19 pandemic. Thus, hospitals should be aware of the importance of social capital; they should ensure that all the practices and policies are in place to develop and increase it.

Personality traits and sexual self-efficacy in diabetic women: The mediating role of marital satisfaction and sexual function.

INTRODUCTION: Although the relationship between personality traits and sexual self-efficacy has received theoretical and empirical support, there is little information on how personality affects the sexual self-efficacy of diabetic women. This study aimed to investigate the mediating role of marital satisfaction and sexual function in the relationship between personality traits and sexual self-efficacy in diabetic women. METHODS: Using a two-stage sampling method, 410 reproductive-aged Iranian women with type 2 diabetes were recruited in this descriptive-analytical study. The participants completed self-administered questionnaires, including the Vaziri Sexual Self-Efficacy Questionnaire, the Female Sexual Function Index, ENRICH Marital Satisfaction Scale, and the Goldberg's Big Five Questionnaire. To analyze the data, structural equation modeling was employed in Amos software version 24. RESULTS: Results indicated an acceptable fit of the model to the data. Personality trait of openness to experience was associated with sexual self-efficacy directly (ß = .02, p = .030) and indirectly through the mediators of marital satisfaction (ß = .06, p = .009) and sexual function (ß = .18, p = .014). Furthermore, sexual function was associated with sexual self-efficacy directly (ß = .50, p = .025) and indirectly through the mediator of marital satisfaction (ß = .36, p = .012). CONCLUSION: Due to the mediating role of marital satisfaction and sexual function, this study has some practical implications for improving the sexual self-efficacy of diabetic women with different personality traits.

The Effect of Children's Sexual Health Education Program on Knowledge and Attitude of Primary School Health Care Providers.

School involvement is essential for providing Children's Sexual Health (CSH), but Health Care Providers (HCPs) responsible for children's health at schools are not sufficiently competent. This study aimed to determine the effect of the Children's Sexual Health Education Program (CSHEP) on the knowledge and attitude of HCPs in elementary schools. Sixty HCPs were randomly assigned to two groups. The intervention was held in four 90-minute training sessions. Questionnaires were completed by the intervention and control groups in three stages (before, immediately after, and 4 weeks after the intervention). At the end of the intervention, a training session was held in the control group. CSHEP has been effective in improving the knowledge and attitude of HCPs about CSH. Given the important role of HCPs in CSH and their need for education, planning for continuing education courses to promote their knowledge and attitude seems essential.

The Effects of Exercise Training on Physical Performance and Self-efficacy in Hemodialysis Patients: A Randomized Controlled Clinical Trial.

BACKGROUND: Hemodialysis patients are faced with challenges in carrying out their daily activities. Self-efficacy is a social cognitive concept that can affect behavioral control in these patients. Hence, the purpose of the present study was to investigate the effects of exercise training on physical performance and self-efficacy in hemodialysis patients. MATERIALS AND METHODS: This randomized controlled clinical trial was conducted on 60 hemodialysis patients who visited hospitals affiliated to Mazandaran University of Medical Sciences in Sari, Iran. The participants were randomly divided into two groups. The patients in the intervention/exercise group received the 8-week exercise program. Patients in the control group received routine care. The Six-Minute Walk Test (6MWT) was used to assess the patients' functional ability and the Exercise Self-Efficacy Scale (ESES) and Chronic Disease Self-Efficacy Scale (CDSES) were used to assess their self-efficacy before and 2 and 8 weeks after the intervention. For statistical analysis, independent t-test and paired t-test were used. RESULTS: The comparison of self-efficacy between the exercise group and control group after 8 weeks of intervention showed a significant difference between the groups in terms of the CDSES (F1,43= 22.92, p < 0.001) and ESES (F1,38= 10.84, p < 0.001) results. Moreover, the comparison of mean distance walked based on the 6MWT showed significant changes in this variable (F1= 2.05, p = 0.015). CONCLUSIONS: The designed exercise program can improve self-efficacy and physical performance in hemodialysis patients. This intervention is recommended for hemodialysis patients due to its effectiveness, simplicity, and uncomplicated characteristics.

The effect of inhalation aromatherapy with rose essential oil on the anxiety of patients undergoing coronary artery bypass graft surgery.

BACKGROUND AND PURPOSE: Anxiety is one of the most common responses of patients awaiting coronary artery bypass graft (CABG) surgery to stressful conditions before surgery. This study is intended to examine the effect of inhalation aromatherapy with rose essential oil on the anxiety of patients undergoing CABG surgery. MATERIALS AND METHODS: This was a single-blind randomized clinical trial of 66 patients undergoing CABG surgery. The experimental group inhaled three drops of 4% rose essential oil for 10 minutes one night and one hour before surgery. The control group did not receive any intervention from the research team. RESULTS: The level of anxiety was measured before and 30 minutes after the intervention using the Spielberger's Anxiety Inventory. Prior to surgery, an independent t-test showed that the mean score of anxiety was not significantly different between the experimental and control groups (p = 0.41). Aromatherapy with rose essential oil did not cause any significant differences in state anxiety (P = 0.41), trait anxiety (P = 0.90), and total anxiety (P = 0.69). CONCLUSION: Our results revealed that inhalation aromatherapy with rose essential oil could not significantly reduce anxiety in CABG patients. Future research with larger sample sizes and using different concentrations of rose essential oil are needed to achieve more definitive conclusions.

HER2 Expression Status and Prognostic, Diagnostic, and Demographic Properties of Patients with Gastric Cancer: a Single Center Cohort Study from Iran

Background: The fourth most prevalent cancer worldwide and a major cause of death in developing countries is gastric cancer (GC). Human epidermal growth factor receptor 2 (HER2), is a proto-oncogene expressed in different solid tumors. This study aimed to evaluate possible associations of HER2 expression status with survival rate, age, sex, tumor grade, histopathological type, and primary tumor location in patients with GC. Methods: Subjects were enrolled in this cohort study after consideration of inclusion and exclusion criteria. Biopsy specimens were stained using immunohistochemistry. Samples with a score of 3+ were considered to exhibit HER2 overexpression. The mentioned variables were extracted from patients' files as well as by clinical evaluation. The Kaplan-Meier method was applied for analyzing the survival rate and Chi square for possible factor associations. Results: A total of 210 patients (25.2% female and 74.8% male) were enrolled. In a 5-year follow-up (adherence rate: 45.7%), the average survival was 9.4±10.9 months. HER2 overexpression was evident in 24%. There was no statistically significant association found between HER2 expression and primary tumor location (p-value=0.63), histopathological type (p-value=0.72), or tumor grade (p-value=0.051). Furthermore, no statistically significant links were apparent with tumor grade in either male or female groups as well as patients aged ≥60 and ˂60 years (all p-values >0.05). Moreover, no statistically significant association was detected between HER2 expression status (p-value=0.88), sex (p-value=0.31), and age (p-value=0.055) with patient survival. Conclusions: No statistically meaningful association was found between all parameters examined and HER2 expression status. Divergence of the results from earlier studies might be due to genetic variation. Thus, performing a meta-analysis on certain races might be helpful for clarification.

The Prevalence of Metabolic Syndrome in Iran: A Systematic Review and Meta-analysis.

BACKGROUND: Metabolic syndrome (MS) is a collection of metabolic disorders which leads to early cardiovascular disease and diabetes type II. Regarding the wide range of its prevalence in Iran, this systematic review and meta-analysis determined the overall prevalence of the metabolic syndrome in Iran. METHODS: In this systematic review and meta-analysis, the Medline, ISI, IranMedex, and SID were searched using "metabolic syndrome", "syndrome X", "prevalence", and "Iran" keywords from 2002 to 2012. A total of 223 articles were found in which 14 studies were considered for meta-analysis. Data were analyzed using fixed and random model and meta-regression in STATA. RESULTS: The prevalence of MS for those who were 20 yr and older was 23.8% (95%CI: 18.99-28.67) and in under 20 was 10.98% (95%CI: 7.75-14.2). Metabolic syndrome was more frequent in women (25.5%) than in men (17.16%) and was increased with increasing age. The most frequent component of metabolic syndrome was low HDL cholesterol (59.7%) followed by hypertriglyceridemia (39.5%). CONCLUSION: Regarding a high prevalence of metabolic syndrome and some of its components such as low HDL and high triglyceride in our country, implementation of programs for metabolic syndrome prevention is necessary.

The impact of acute rejection in kidney transplantation on long-term allograft and patient outcome.

BACKGROUND: Patients with end stage renal disease (ESRD) can be sustained with dialysis therapy. OBJECTIVES: In this study, we followed up the effect of early acute and late acute rejections on survival rates of patients' grafts. PATIENTS AND METHODS: We investigated the timing and frequency of acute rejection episodes related to long-term patient-graft survival in Taleghani hospital between 1990 and 2011. Recipients were divided into three groups as Group-1 (no rejection), Group-2 (early acute rejection [EAR]: less than 3-months) and Group-3 (late acute rejection [LAR]: after 3 months of transplant). RESULTS: One and five-year patient's survival rates were 94.87% and 93.8%, and graft survival (GS) rates were 92.6% and 81.9%. EAR and LAR occurred in 125 (18.8%) and 77 (11.7%) patients, respectively. Graft and patient survival rates at one and five years were as follows; Group-1 (Graft 96.7% and 94.5% patient: 97.4% and 96.8%), Group-2 (Graft: 72% and 61%, patient: 85.6% and 84%), Group-3 (Graft: 84.4% and 36.8%, patient: 92.2% and 89.4%). Recipient age, type and length of dialysis, number of transplantations and the status of panel reactivity antibody (PRA) had no effect on the type of rejection. LAR was more commonly associated with males (P = 0.001) and donors' age was associated with rejection (P = 0.0002). Five-year GS rate among the three groups was lower in the LAR group (P < 0.0001). CONCLUSIONS: LAR had a negative impact on long-term renal allograft survival and the risk of chronic graft dysfunction increased in patients with a history of LAR.

Association between metabolic syndrome and coronary heart disease in patients on hemodialysis.

BACKGROUND: The metabolic syndrome (MeS) is a common risk factor for coronary heart disease (CHD) in the general population. OBJECTIVES: We examined the association between MeS and its risk in terms of CHD in patients on hemodialysis (HD). PATIENTS AND METHODS: This study was conducted on 300 patients on HD in six HD centers during March 2012. Patients were divided in two groups regarding presence of MeS. The rate of CHD were evaluated in each group and compared with each other. RESULTS: A total of 300 patients on HD, 173 males and 127 females with mean age of 61.7 ± 14.2, were enrolled in the study. Prevalence of MeS was 50.3%; hypertension, 83.7%; diabetes mellitus, 52%; high triglyceride level, 34%, low HDL cholesterol, 48.3%; and abdominal obesity, 41.3%. During the study, the CHD was more frequent in patients with MeS (27.8%) than was in those without MeS (14.1%) (P = 0.004). In addition, stroke happened more frequently in the MeS group than in those without MeS (30.5% vs. 17.4%; P = 0.008). The mean number of criteria for MeS was not significantly associated with mortality causes (CHD, 2.7 ± 1.3; stroke, 2.8 ± 0.9; other causes, 2.9 ± 1.3 P = 0.78). However, hypertension (89.3%) and diabetes mellitus (53.8%) were associated with increased risk for mortality. In the group of MeS, CHD were not significantly associated with serum albumin, calcium, phosphate, blood urea nitrogen, creatinine, ferritin, C-reactive protein, and KT/V; but there was significant association with white blood cells count (P < 0.0002). CONCLUSIONS: These findings suggested MeS might be an important risk factor for CHD, but not for mortality due to CHD in patients on HD.

Higher expression of HSP70 and LOX-1 in the placental tissues of pre-eclampsia pregnancies.

BACKGROUND: Pre-eclampsia, a hypertensive disorder of pregnancy is the main cause of fetal and maternal morbidity and mortality. Growing evidences suggest that placental oxidative stress involves in the pathogenesis of pre-eclampsia. The HSP70 is a novel marker of oxidative stress which binds with high avidity to LOX-1. The aim of this study was to evaluate the co-expression of HSP70 and LOX-1 in the placental tissues of normotensive and pre-eclamptic pregnancies. MATERIALS AND METHODS: The placental tissues were collected from 35 healthy women with normal pregnancies and 33 women with pre-eclampsia disorder. Expression of HSP70 and LOX-1 on the placental tissues was examined by using immunohistochemistry technique. The intensity of the molecules' expression was determined by semi-quantitative scoring. RESULTS: The 34.3% and 37.1% of the healthy women did not express the HSP70 and LOX-1 on their placenta, respectively. All pre-eclamptic patients expressed HSP70 and LOX-1 with various scores. Indeed, the majority of the pre-eclamptic subjects had ≥3+ scores of the expression of HSP70 and LOX-1 on their placenta (60.6% and 66.7%, respectively). The percentage of the ≥3+ scores of the expression of HSP70 and LOX-1 was significantly higher in patients than those in healthy women (p<0.0001 for both). Similarly, the majority of the pre-eclamptic subjects had ≥3+ scores of the co-expression of HSP70 and LOX-1 molecules (57.6%) which was significantly higher in patients than those in control group (p=0.0001). CONCLUSIONS: These results showed higher expression of HSP70 and LOX-1 in the placental tissues of pre-eclampsia patients which represent the possible contribution of these molecules in the disease pathogenesis. Further studies need to clarify their role in the pathogenesis of preeclampsia disorder.

Life skills training effectiveness on non-metastatic breast cancer mental health: a clinical trial.

BACKGROUND: Patients with breast cancer are predisposed to some psychiatric symptoms and mental disorders due to their life styles or disease conditions. These problems cause patients to deal with daily stress, feeling guilty, anxiety, dysphoric mood, and impaired social relations. Such problems would lead to serious mental disorders. OBJECTIVES: Therefore, life skills training may help patients to cope better with their condition, and improve their mental health. MATERIALS AND METHOD: In an experimental study, 50 patients with breast cancer were selected randomly and assigned to 2 experimental and control groups. The experimental group attended life skills training classes for 10 weeks continuously (each class lasting 2 hours). Participants in both the experimental and control groups completed a GHQ-28 questionnaire form before the commencement of classes, and again after 2 weeks to 2 months of the course completion. T-test was used as the statistical method. RESULTS: In life skills training group, depressive and anxiety symptoms, somatization disorders, sleep disorders and disorders of social functioning were significantly decreased (p<0.0001). These changes were not observed in the control group. CONCLUSIONS: The results showed that life skills training is an effective method in reducing symptoms of depression, anxiety, sleep and somatic disorders. Also, it would be useful in reducing problems of social dysfunction.

Effect of cold application in combination with Indomethacin suppository on chest tube removal pain in patients undergoing open heart surgery.

BACKGROUND: Chest tube removal is a painful procedure. The goal of this study was to evaluate the effect of cold application in combination with Indomethacin suppository on chest tube removal pain in patients undergoing open heart surgery. MATERIALS AND METHODS: This single-blind, double-group clinical trial was performed on 66 patients aged 18-68 years with the chest tube in pleural space. The Indomethacin suppository (100 mg) was administered 1 h before the chest tub removal in both groups. In the intervention group, we applied a 4°C cold pack in the chest tube side for 20 min. In the placebo group, the applied pack was at room temperature. Pain intensity was measured by Visual Analog Score 20 min before, immediately after, and 15 min after the chest tube removal. RESULTS: Immediately after the CTR, the mean pain score was 2.67 ± 0.79 and 3.9 ± 0.76 in the intervention and placebo groups, respectively. The pain scores measured before and 15 min after the CTR were not statistically different between the two groups. CONCLUSION: Application of cold in combination with Indomethacin suppository during the CTR was a suitable, low-risk, and easy method for pain control in open heart patients.

Defining a cutoff point for vitamin D deficiency based on insulin resistance in children.

BACKGROUND: Vitamin D deficiency is a common worldwide problem. Low levels of serum 25-hydroxy vitamin D [25(OH)D], as a marker of vitamin D deficiency, have been linked to a wide field of health problems, including metabolic diseases such as insulin resistance, type 1 and type 2 DM. There is no universal definition for cutoff value of vitamin D deficiency and it seems that it varies in different populations. OBJECTIVE: Most previous studies have used a start rise of PTH as a criteria to detect threshold of serum 25(OH)D, However, the aim of this study was to determine a cutoff point of serum 25(OH)D for vitamin D deficiency based on HOMA-IR. MATERIALS AND METHODS: Two hundred and ninety seven healthy children (aged 7-11 years) were enrolled. Serum 25(OH)D and PTH were measured and HOMA-IR was calculated. The ROC curve was utilized to obtain a cutoff of vitamin D deficiency based on HOMA-IR. RESULTS: 25(OH)D concentrations were inversely correlated with HOMA-IR levels (Spearman's r=-0.14, p=0.016). Serum 25(OH)D cutoff point was 11.6ng/mL (29nmol/L) in relation with HOMA-IR >2.1. By using this cutoff value, the prevalence of vitamin D deficiency was 43.4% in this study population of healthy children. CONCLUSION: We found that serum 25(OH)D levels are inversely associated with insulin resistance. These results suggest that in MetS patients it may benefit to determine cutoff value of 25(OH)D levels based on HOMA-IR.

Acylated ghrelin and leptin concentrations in patients with type 2 diabetes mellitus, people with prediabetes and first degree relatives of patients with diabetes, a comparative study.

BACKGROUND: Ghrelin is known as a new endocrine component supposed to have an influence in control of feeding behavior and energy balance. Recent studies have shown that ghrelin concentration in the subjects with diabetes mellitus type 2 (DM 2) is lower than normal. To clarify the relationship between ghrelin and insulin resistance and also DM 2, a cross-sectional study was designed. METHODS: In a cross-sectional study, 87 subjects were enrolled in three groups, 29 with DM2, 29 pre-diabetes state and 29 normoglycemic subjects of first-degree relatives of diabetic group. After clinical examination, blood samples were taken to measure fasting blood glucose, HbA1c, lipids, insulin, leptin and acylated ghrelin concentrations. RESULTS: Mean serum concentrations of acylated ghrelin in all groups (47.4 ± 27.9 pg/ml) were lower than normal values (150.3 ± 56.4 pg/ml) (P: 0.006) without significant difference within groups comparison(P: 0.1). A significant correlation was found between ghrelin concentration with body mass index (BMI) (r: -0.23, p <0.02) and abdominal circumference (AC) (r: -0.28, P < 0.008). Also inverse relationship between ghrelin level and insulin resistance (HOMA-IR) (r: -.032, p: 0.002) was seen in all subjects. Leptin level has a significant correlation with abdominal circumference (AC) and BMI (P < 0.0001) but not with ghrelin. CONCLUSION: This study showed that obesity has a strong association with the reduced level of ghrelin concentration. It seems that the process of ghrelin reduction is initiated in earlier stages of insulin resistance prior to the onset of overt DM.

Determinants of developing diabetes mellitus and vascular complications in patients with impaired fasting glucose.

AIMS: To detect the risk factors of diabetes mellitus (DM) and cardiovascular complications in subjects with impaired fasting glucose (IFG). MATERIALS AND METHODS: One hundred and twenty three subjects with proved IFG in Zanjan Healthy Heart Study (2002-2003) were recalled and participated in this study (2009-2010). Demographic and laboratoryinformation of the participants were collected.Ischemic heart disease (IHD) was assessed by the exercise tolerance test (ETT). All the subjects with abnormal ETT or documented past history of IHD confirmed by angiographic evaluation. Ophthalmic complications including cataract, glaucoma, and diabetic retinopathy were estimated by an ophthalmologist. RESULTS: Incidence of DM was 19.5%. All the diabetic and pre-diabetic patients had at least one of the other components of metabolic syndrome. Obesity (P: 0.04, OR: 1.8, 95%CI: 1.2-9) and low physical activity (P < 0.001, OR: 9.6, 95%CI: 3.4-32) were the only independent prognostic risk factors for progression to DM in patients with IFG. Total incidence of IHD was 14.6% and had a strong correlation with sex (P: 0.01, OR: 1.8, 95%CI: 1.2-1.5), age (P < 0.001, OR: 23, 95%CI: 2.1-67) and cigarette smoking (P < 0.001, OR: 36.5, 95%CI: 3.9-337). Non-proliferative diabetic retinopathy was shown in 2 (1.6%) subjects who were all women. CONCLUSION: Obesity and low physical activity are the main factors of developing DM and its macrovascular complications in subjects with IFG.

Response rates to HB vaccine in CKD stages 3-4 and hemodialysis patients.

BACKGROUND: Hepatitis-B virus (HBV) infection is a big problem in chronic kidney disease (CKD) population. We attempted to compare the response rate to HB vaccine in CKD stages3-4 patients with that in hemodialysis (CKD stage-5; HD patients) and medical staff. MATERIALS AND METHODS: Three hundred and three participants were enrolled into the study to test the seroconversion rate after vaccination. Participants formed three groups: Group-A:HD patients, Group-B: diagnosed with CKD stages 3-4, and Group-C: healthy medical staff. CKD stages 3-4 participants were vaccinated from February to November 2010. HD patients were vaccinated at the time of initial HD. While the medical staffs were vaccinated at the time they started working at the hospital. Group-A, Group-B and Group-C received four 40µg (in 0,1,2 and 6 months), three 40µg (0, 1 and 6 months) and three 20µg (0, 1and 6 months) doses of HB vaccine, respectively. Three months after completion of the vaccination schedule, seroconversion and seroprotection rates in each group were investigated. RESULTS: Seroconversion rates were 44.3%, 89.7%, and 96.2% for groups A, B and C, respectively. CKD stages 3-4 patients showed higher response rate than dialysis patients [χ(2)(1):30.6, P <0.001]. But a significant difference in the seroconversion rate between CKD stages 3-4 patients and medical staffs was not observed [χ(2)(1):3.4, P = 0.064]. Multivariate analyses showed patients with more advanced CKD and who were older had less seroconversion rates [odds ratio: 0.09(95%CI: 0.04 - 0.25) and [odds ratio: 0.39(95% CI: 0.18-0.85)], respectively. But sex was not associated with seroconversion (P>0.05). CONCLUSION: Stages 3-4 patients with higher dosages of routine HB vaccine had higher seroconversion rate than HD patients. Future studies should evaluate the recommended dosage of HB vaccine among these patients.

Association between helicobacter pylori infection and body mass index, before and after eradication of infection in hemodialysis batients.

BACKGROUND: In dialysis patients, chronic infections have been associated with cachexia and anorexia. OBJECTIVES: This study was carried out to determine the association between Helicobacter pylori (HP) infection and body mass index (BMI) in hemodialysis (HD) patients. PATIENTS AND METHODS: Ninety eight patients were divided into two groups of negative (group 1) and positive (group 2), for HP. BMI of all patients was measured at the beginning and in group2 after six months following eradication of HP. Before dialysis, various paraclinical parameters were checked at the same intervals. RESULTS: Fifty-nine patients were enrolled in group 1 and 39 patients in group 2. The means of BMI in groups 1 and 2 were 23.4±3.7 and 25.8±4.4kg/m², respectively. Prior to the study, there was no significant difference for BMI, duration of HD and paraclinic data between two groups. Group 2 took anti HP therapy and eradication occurred in 30 of them. In this group six months after eradication of HP, the BMI was significantly decreased from 25.02±4.4 to 24.4±4.0 kg/m² (P = 0.001). Also six months following the eradication of HP, the mean of serum albumin level was significantly declined from 4.2 to 3.7 g/L (P<0.001). There was also significant decrease in cholesterol (P=0.001), blood urea nitrogen (P=0.005) and calcium (P=0.02). However, significant increase in hemoglobin level was also seen (P=0.03). CONCLUSIONS: The results of this study show that eradication of HP has an impact on BMI. The results need to be investigated with larger cases.

The effect of allopurinol on lowering blood pressure in hemodialysis patients with hyperuricemia.

BACKGROUND: Hyperuricemia has been associated with the development of high blood pressure (BP). We studied the effects of allopurinol therapy in hyperuricemic hemodialysis (HD) patients with high BP. MATERIALS AND METHODS: This single-blind, randomized cross-over clinical study involved 55 HD patients with serum uric acid level > 6.5 (men) and > 5.5 mg/dL (women). They were randomly divided in two groups, each of which went through two phases. Group-1 in phase-1 received 100 mg/day orally of allopurinol for three months; while Group-2 was given whatever medication they received prior to the study. After two months of washing period, the groups were crossed-over. The BP levels were measured before and after HD during the eight months study period. RESULTS: Fifty-three patients completed the study (33 men and 20 women, with mean age of 55.8 years). Uric acid levels decreased significantly during the12 weeks of allopurinol therapy (7.71 ± 1.53 to 5.2 ± 1.2 P < 0.005). Overall, after the 12 weeks of allopurinol therapy, systolic and diastolic BP also significantly decreased in allopurinol group, 15.8% (139 to 117, P < 0.0005) and 8.6% (81 to 74, P <.0005), respectively. There were not significant changes in body mass index, blood urea nitrogen, creatinine, albumin, cholesterol, triglyceride, hemoglobin, liver enzymes and serum electrolytes level after treatment. Patients treated with allopurinol had a significant increase in the quality of dialysis (KT/V) (P: 0.043). CONCLUSIONS: In HD patients, allopurinol treatment reduced BP. The results indicate a new potential therapeutic approach for controlling BP in HD patients.