Cytomegalovirus infection among Iranian kidney graft recipients.

BACKGROUND: Cytomegalovirus (CMV) infection is one of the most common infectious problems following kidney transplantation. In this study we sought to investigate CMV infection in the setting of renal transplant recipients in Urmia, Iran, using polymerase chain reaction (PCR) detection. METHODS: Ninety-six randomly selected renal transplant recipient were enrolled in a cross-sectional study. Blood sampling via venipuncture, yielded sera investigated for anti-CMV IgM. Seropositive as well as 14 randomly selected seronegative cases were investigated with PCR assays. RESULTS: Thirty-three patients (34.3%) were seropositive for anti-CMV IgM; 3 (3.1%) borderline, and 60 (62.5%) seronegative. Considering borderline anti-CMV IgM levels as seropositive, 37.5% were seropositive for anti-CMV IgM. Among the 36 seropositive cases, a CMV infection was confirmed in 19 (52.7%) using PCR. Age (P = .40), educational status (P = .77), history of pretransplantation dialysis (P = .52), prior blood transfusion (P = .52), and immunosuppressive regimen were not significantly different among positive versus negative CMV PCR recipients. CONCLUSIONS: The seroprevalence of CMV infection was high among renal transplant recipients of Urmia, Iran, as confirmed by PCR study.

Is there any correlation between hypercalciuria and nocturnal enuresis?

Nocturnal enuresis is a common problem among children. Hypercalciuria has been proposed as an important etiology of bedwetting. We investigated the incidence of hypercalciuria among children with nocturnal enuresis and age- and sex-matched healthy controls. In this case-control study 118 children with nocturnal enuresis and 100 age-, sex-, and educational district-matched healthy controls were recruited. Urine samples were obtained from each subject twice: immediately after awakening and 2 hours later at school. Urinary calcium and creatinine levels were measured and the subjects with a urinary calcium/creatinine ratio more than 0.2 were considered as hypercalciuric. Serum Ca, P, Na, K, and PTH levels were measured for all hypercalciuric subjects. The mean urine calcium to creatinine ratio in the second urine sample was 0.070±0.06 mg/mg and 0.050±0.046, respectively in the case and control groups (P=0.008). There were 12/118 and 3/100 hypercalciuric subjects in the case and control groups respectively (P=0.032). The serum Ca, P, Na, K, and PTH levels were in normal range in all hypercalciuric subjects. In our study there was a significant difference in the frequency of hypercalciuria among children with nocturnal enuresis and healthy controls, so we can suggest adding the measurement of urine electrolytes especially the calcium level in patients with nocturnal enuresis.

The seroprevalence of Helicobacter pylori infection in renal transplant recipients.

BACKGROUND: Helicobacter pylori (HP), a small gram-negative spiral bacillus living in the mucus layer of the human stomach, mediates some gastrointestinal disorders. Considering the immunocompromised nature of transplant recipients due to immunosuppression, they are generally prone to viral and bacterial infectious diseases. In this study we sought to investigate the seroprevalence of HP infection among Iranian kidney transplant recipients. METHODS: We selected randomly 91 kidney transplant patients who were examined for anti- HP Immunoglobulin G (IgG) using an enzyme-linked immunosorbent assay method (Lake Success, NY, USA). RESULTS: Forty-three subjects (47.3%) were seropositive for anti-HEV IgG. There was no difference by age (P=.49), sex (P=.22), blood transfusion history (P=.19), or hemodialysis history (P=.46) between seropositive and seronegative groups, but there was a significant difference regarding the educational status of the subjects (P=.03), The difference was not confirmed by considering diploma as the cut point to categorize subjects (P>.05). Comparing age groups, Pearson chi-square analysis revealed no significant correlation between HP seropositivity and increasing age (P=.963), even when controlled for sex, educational status, history of blood transfusion, or hemodialysis. CONCLUSION: The frequency of transplant recipients with anti-HP IgG antibodies in our institution (47.3%) was not higher than that in the general population (almost 60% in Urmia). This rate was lower than reports from developing countries possibly due to better health and sanitation.

Esophageal cancer in northwestern Iran.

BACKGROUND: Esophageal cancer (EC) is one of the most frequent and serious cancers worldwide, but its geographic distribution is disparate. Northern Iran is known as one of the hot spots for EC, but there is inadequate evidence available regarding its characteristics in northwestern region of Iran. Therefore, this study aimed to describe some demographic and histopathologic features of EC in this region of Iran. MATERIALS AND METHODS: 166 hospital referral patients from a hospital in the northwestern region of Iran who underwent endoscopic biopsy for the chief complaint of dysphagia or odynophagia, and were admitted with the pathologic diagnosis of esophageal cancer during 3 years were enrolled in this study. RESULTS: The mean age of the patient was 61.8 ± 12.0 years old. Male/female ratio was 0.84. With respect to the site of tumor, tumor was located in cervical esophagus in 7 cases (4.2%), upper thoracic in 5 patients (3%), middle thoracic in 64 patients (38.6%), lowers thoracic in 68 cases (41%), and cardia in 22 cases (13.2%). There was a significant difference among the site of tumor in different age groups (P = 0.021) and different sex groups (P = 0.001). In men, EC usually involves the lower parts, whereas in women it usually involves the upper parts of esophagus. Squamous cell carcinoma was the most common type of EC in all age groups, but the prevalence rate of adenocarcinoma seems to increase with age (P = 0.045). CONCLUSIONS: Demographic and histopathologic pattern of esophageal cancer in northwestern region of Iran is different from its histopathologic pattern in western countries in accordance with other reports from Golestan province in north-eastern region of Iran.

Sildenafil citrate can improve erectile dysfunction among chronic hemodialysis patients.

Erectile dysfunction (ED) is common among patients with end-stage renal disease (ESRD), who undergo hemodialysis (HD). The aim of this study was to evaluate the safety and effectiveness of sildenafil in male HD patients with ED. Twenty-seven HD patients were recruited for this prospective, randomized, double-blind, placebo-controlled, clinical trial study of sildenafil during a period of 1 week. Efficacy was assessed by using the International Index of Erectile Function (IIEF) before and 1 week after treatment. Baseline demographic and clinical features were similar in both the groups. There was a weak correlation between ED and duration of undergoing dialysis (P = 0.073). There was significant relationship between sildenafil usage and improvement in erectile function (P < 0.0001). Placebo improved significantly the erectile function (P = 0.016), perhaps by psychological way. However, sildenafil had a more significant effect than placebo in increasing IIEF score among HD patients (P = 0.00 compared to 0.016). Sildenafil is effective and safe for treating ED among HD patients.

Cadaveric renal transplantation: a single-center experience.

INTRODUCTION: Renal transplantation remains the treatment of choice for end-stage renal disease (ESRD) in regard to patient survival. Iran was one of the first countries in the Middle East that began renal transplantation. METHODS: In a follow-up study, we enrolled all of our cadaveric renal transplant recipients from 2001 to 2007, namely, 39 cases. Related variables collected through checklists were entered into SPSS software version 16 and analyzed using the Kaplan-Meier method and by descriptive statistics. RESULTS: The mean age of the recipients was 35.18 +/- 14.27 years. Twenty-one patients (53.8%) were men. The underlying disease for development of ESRD was diabetes (7 cases, 21.2%), hypertension (24.2%), glomerulopathies (36.4%), polycystic disease (PKD; 2.6%), and 5 (15.2%) were unknown. Four recipients (10.3%) were hospitalized again because of acute tubular necrosis after transplantation. An acute rejection episode was diagnosed in 7 (17.9%) graft recipients. Surgical complications after transplantation were as follows: urinoma, lymphocele, and surgical site leakage (each 1 case). One-year patient survival rate was 89.7% in this study; 4 recipients died within 1-9 months after transplantation. Death-censored 1-year graft survival rate was 100%. DISCUSSION: The survival rate of cadaveric transplant was in an acceptable range.

Osteoporosis and related risk factors in renal transplant recipients.

Decreased bone mineral density is a common problem after kidney transplantation. Osteoporosis has a major role in morbidity in these patients. We evaluated the incidence of osteoporosis and determined risk factors in 77 patients aged 17 to 50 years who had undergone renal transplantation 6 months to 2 years previously. Bone mineral densitometry was performed using dual-energy x-ray absorptiometry. The incidence of osteoporosis was 26% (20 of 77 patients). Mean (SD) age of affected patients was 34.6 (8.7) years. The most common sites of osteoporosis were the hip (osteoporotic in 19 patients [24.7%] and osteopenic in 42 [54.5%]) and the spine (osteoporotic in 6 patients [7.8%] and osteopenic in 52 [67.5%]). There was a significant relationship between posttransplantation creatinine concentration and hip osteoporosis (P = .01). No relationship was observed between osteoporosis and age, sex, body mass index, duration of hemodialysis therapy, cumulative dosage of any drugs, or use of pulsed methylprednisolone therapy. A hip or spine z score of 1 or less had no relationship to the number of steroid pulse sessions but was significantly related to the total dosage of cyclosporine (P < .001), prednisolone (P < .001), and mycophenolate mofetil (P < .05). A hip z score of less than 1 was related to the posttransplantation period (P = .02). In conclusion, osteoporosis is a frequent complication that requires detection and treatment to reduce morbidity.