Alteration in body water compartments following intermittent fasting in Ramadan.

Concerning the health outcomes of intermittent fasting in Ramadan, loss of fat-free mass (FFM) and changes in the content of body water are of paramount importance. In this study, we aimed to assess the concomitant alterations in body water compartment and composition following Ramadan fasting in healthy individuals. We conducted an open-label cohort with longitudinal follow-up, involving 73 healthy medical staff who planned to fast for at least 20 consecutive days during Ramadan. The primary outcomes of the cohort were changes in parameters related to body composition and water content, which were measured using bioelectrical impedance analysis by InBody S10 (InBody, Seoul, South Korea). Based on the results, the participants' weight decreased significantly by approximately 1,030 g after the fasting period (p < 0.001). There was a significant reduction in the fat mass of an average 828 g (p < 0.001), which accounted for more than 80% of the weight loss. The decline in FFM was not significant (190 g; p = 0.234). The amount of total body water (TBW) and extracellular water (ECW) did not change, while intracellular water (ICW) decreased significantly by about 160 mL (p = 0.027). A strong correlation was observed between the reduction of phase angle and the increase in ECW/TBW ratio (R = -0.71, p < 0.001). Overall, our findings revealed a minimal amount of weight loss after Ramadan fasting, which was mainly due to the loss of fat mass. The parallel decrease in ICW and phase angle indicated impaired cell membrane integrity, with subsequent movement of water from the intracellular to the extracellular compartment.

Prediction of the Fatal Acute Complications of Myocardial Infarction via Machine Learning Algorithms.

Background: Myocardial infarction (MI) is a major cause of death, particularly during the first year. The avoidance of potentially fatal outcomes requires expeditious preventative steps. Machine learning (ML) is a subfield of artificial intelligence science that detects the underlying patterns of available big data for modeling them. This study aimed to establish an ML model with numerous features to predict the fatal complications of MI during the first 72 hours of hospital admission. Methods: We applied an MI complications database that contains the demographic and clinical records of patients during the 3 days of admission based on 2 output classes: dead due to the known complications of MI and alive. We utilized the recursive feature elimination (RFE) method to apply feature selection. Thus, after applying this method, we reduced the number of features to 50. The performance of 4 common ML classifier algorithms, namely logistic regression, support vector machine, random forest, and extreme gradient boosting (XGBoost), was evaluated using 8 classification metrics (sensitivity, specificity, precision, false-positive rate, false-negative rate, accuracy, F1-score, and AUC). Results: In this study of 1699 patients with confirmed MI, 15.94% experienced fatal complications, and the rest remained alive. The XGBoost model achieved more desirable results based on the accuracy and F1-score metrics and distinguished patients with fatal complications from surviving ones (AUC=78.65%, sensitivity=94.35%, accuracy=91.47%, and F1-score=95.14%). Cardiogenic shock was the most significant feature influencing the prediction of the XGBoost algorithm. Conclusion: XGBoost algorithms can be a promising model for predicting fatal complications following MI.

Generation of18F-FDG PET standard scan images from short scans using cycle-consistent generative adversarial network.

Objective.To improve positron emission tomography (PET) image quality, we aim to generate images of quality comparable to standard scan duration images using short scan duration (1/8 and 1/16 standard scan duration) inputs and assess the generated standard scan duration images quantitative and qualitatively. Also, the effect of training dataset properties (i.e. body mass index (BMI)) on the performance of the model(s) will be explored.Approach.Whole-body PET scans of 42 patients (4118F-FDG and one68Ga-PSMA) scanned with standard radiotracer dosage were included in this study. One18F-FDG patient data was set aside and the remaining 40 patients were split into four subsets of 10 patients with different mean patient BMI. Multiple copies of a developed cycle-GAN network were trained on each subset to predict standard scan images using 1/8 and 1/16 short duration scans. Also, the models' performance was tested on a patient scanned with the68Ga-PSMA radiotracer. Quantitative performance was tested using peak signal-to-noise ratio (PSNR), structural similarity index (SSIM), and normalized root mean squared error (NRMSE) metrics, and two nuclear medicine specialists analyzed images qualitatively.Main results.The developed cycle-GAN model improved the PSNR, SSIM, and NRMSE of the 1/8 and 1/16 short scan duration inputs both18F-FDG and68Ga-PSMA radiotracers. Although, quantitatively PSNR, SSIM, and NRMSE of the 1/16 scan duration level were improved more than 1/8 counterparts, however, the later were qualitatively more appealing. SUVmeanand SUVmaxof the generated images were also indicative of the improvements. The cycle-GAN model was much more capable in terms of image quality improvements and speed than the NLM denoising method. All results proved statistically significant using the paired-sample T-Test statistical test (p-value < 0.05).Significance.Our suggested approach based on cycle-GAN could improve image quality of the 1/8 and 1/16 short scan-duration inputs through noise reduction both quantitively (PSNR, SSIM, NRMSE, SUVmean, and SUVmax) and qualitatively (contrast, noise, and diagnostic capability) to the level comparable to the standard scan-duration counterparts. The cycle-GAN model(s) had a similar performance on the68Ga-PSMA to the18F-FDG images and could improve the images qualitatively and quantitatively but requires more extensive study. Overall, images predicted from 1/8 short scan-duration inputs had the upper hand compared with 1/16 short scan-duration inputs.

COVID-19 diagnosis from routine blood tests using artificial intelligence techniques.

Coronavirus disease (COVID-19) is a unique worldwide pandemic. With new mutations of the virus with higher transmission rates, it is imperative to diagnose positive cases as quickly and accurately as possible. Therefore, a fast, accurate, and automatic system for COVID-19 diagnosis can be very useful for clinicians. In this study, seven machine learning and four deep learning models were presented to diagnose positive cases of COVID-19 from three routine laboratory blood tests datasets. Three correlation coefficient methods, i.e., Pearson, Spearman, and Kendall, were used to demonstrate the relevance among samples. A four-fold cross-validation method was used to train, validate, and test the proposed models. In all three datasets, the proposed deep neural network (DNN) model achieved the highest values of accuracy, precision, recall or sensitivity, specificity, F1-Score, AUC, and MCC. On average, accuracy 92.11%, specificity 84.56%, and AUC 92.20% values have been obtained in the first dataset. In the second dataset, on average, accuracy 93.16%, specificity 93.02%, and AUC 93.20% values have been obtained. Finally, in the third dataset, on average, the values of accuracy 92.5%, specificity 85%, and AUC 92.20% have been obtained. In this study, we used a statistical t-test to validate the results. Finally, using artificial intelligence interpretation methods, important and impactful features in the developed model were presented. The proposed DNN model can be used as a supplementary tool for diagnosing COVID-19, which can quickly provide clinicians with highly accurate diagnoses of positive cases in a timely manner.

Multi-Sensory Balance Board for Children with SPD & ADHD Disorders.

Nowadays, as technology grows, human life formation changes every second. These changes sometimes create harmful habits and affect our lifestyle, which unfortunately bring various diseases and disorders. ADHD (Attention Deficit Hyperactivity Disorder) & SPD (Sensory Processing Disorder) are common disorders in children. By giving children the right treatment at the younger ages, we can help them overcome their disabilities and not face any symptoms in their adulthood. The multi-sensory balance board is designed and developed to help medics diagnose the disorders in patients at early stages and monitor the treatment progress. The balance board uses multiple sensors to detect common human senses, visual, auditory, balance, and tactile sensing. Due to the safety issues for children during the COVID-19 pandemic, the balance board has been clinically tested for adults with stroke disorder. The research has concluded that it provides a fast low-cost with reliable results to diagnose the disorders in patients.

Comparing the Effect of Immediate versus Delayed Initiation of Tacrolimus on Delayed Graft Function in Kidney Transplant Recipients: A Randomized Open-label Clinical Trial.

OBJECTIVE: Delayed graft function (DGF) is an early complication after kidney transplantation with negative impact on allograft outcomes. This study assessed the effect of delayed initiation of tacrolimus as a nephrotoxic drug, on DGF occurrence and allograft function. METHODS: This randomized, open-label clinical trial was conducted on kidney transplant recipients with the age of at least 14 years who underwent the first kidney transplantation from deceased or living donor. Patients were randomly allocated to immediate (n = 26) or delayed tacrolimus (n = 27) groups. All patients received thymoglobulin as induction therapy and similar maintenance immunosuppression including tacrolimus, mycophenolate, and prednisolone with the difference in the time of initiation of tacrolimus either on the day of transplantation (immediate tacrolimus group) or day 3 after transplant (delayed tacrolimus group). FINDINGS: DGF incidence (46.15% vs. 37.04%; P = 0.501) and duration (9.75 ± 6.41 vs. 8.6 ± 6.16 days; P = 0.675) were not different between the immediate and delayed tacrolimus groups. Estimated creatinine clearance using Cockcroft-Gault equation (63.14 ± 18.81 vs. 58.19 ± 19.42 mL/min in immediate and delayed tacrolimus groups respectively; P = 0.373) and estimated acute rejection-free survival were also comparable between the groups over the 3 months of follow-up. Compared with the immediate group, the delayed tacrolimus group showed higher estimated 3-month grafts' survival (100% vs. 84.27%; P = 0.072). CONCLUSION: Delayed initiation of tacrolimus after kidney transplantation under the umbrella of thymoglobulin induction did not result in either lower incidence or duration of DGF or improved the level of graft function in kidney transplant recipients but non-statistically significant increased 3-month grafts' survival.

Anti-phospholipase A2 receptor antibody in idiopathic membranous nephropathy: A report from Iranian population.

BACKGROUND: Idiopathic Membranous Nephropathy (iMN) is the most common cause of nephrotic syndrome in adults. Approximately one third of patients with iMN progress to end-stage renal disease. Anti-phospholipase A2-receptor (anti-PLA2R) antibodies are present in patients with iMN and appear to play a role in the pathogenesis of iMN. OBJECTIVES: In this study, we explored the prevalence of anti-PLA2R antibodies in a cohort of patients with iMN in Iran. We also sought to determine circulating levels of anti-secretory PLA2 (anti-sPLA2) antibodies in those with anti-PLA2R antibodies. PATIENTS AND METHODS: Using an indirect immunofluorescence assay, we measured anti-PLA2R antibodies in a group of patients with iMN in Iran. The serum levels of anti-sPLA2 antibodies were also measured in those with positive results for anti-PLA2R antibodies. RESULTS: We studied 23 patients with iMN (M/F 12/11, 34±9.8 year), two patients with secondary MN and five patients  with the nephrotic syndrome of other causes.Anti-PLA2R antibodies were detected in 17/23 (74%) of patients with iMN, but not in those with secondary MN or other forms of primary glomerular diseases. We found no correlation between anti-PLA2R antibody titer and the degree of proteinuria. We found high titers of anti-sPLA2 antibodies in a subset of patients with high levels of anti-PLA2R antibodies. CONCLUSIONS: Anti-PLA2R antibodies are specific for iMN. Proteinuria may also reflect glomerular structural damage rather than immunological activity of the disease. The preliminary idea of any presumptive role of anti-sPLA2antibodies in iMN needs further  investigation.

Incidence of malignancy after living kidney transplantation: a multicenter study from iran.

Malignancy is a common complication after renal transplantation. However, limited data are available on post-transplant malignancy in living kidney transplantation. Therefore, we made a plan to evaluate the incidence and types of malignancies, association with the main risk factors and patient survival in a large population of living kidney transplantation. We conducted a large retrospective multicenter study on 12525 renal recipients, accounting for up to 59% of all kidney transplantation in Iran during 22 years follow up period. All information was collected from observation of individual notes or computerized records for transplant patients. Two hundred and sixty-six biopsy-proven malignancies were collected from 16 Transplant Centers in Iran; 26 different type of malignancy categorized in 5 groups were detected. The mean age of patients was 46.2±12.9 years, mean age at tumor diagnosis was 50.8±13.2 years and average time between transplantation and detection of malignancy was 50.0±48.4 months. Overall tumor incidence in recipients was 2%. Kaposis' sarcoma was the most common type of tumor. The overall mean survival time was 117.1 months (95% CI: 104.9-129.3). In multivariate analysis, the only independent risk factor associated with mortality was type of malignancy. This study revealed the lowest malignancy incidence in living unrelated kidney transplantation.

Prediction of long-term kidney failure in renal transplant with chronic allograft dysfunction using stage-specific hazard rates.

OBJECTIVES: The process of kidney failure in renal transplant recipients with chronic allograft dysfunction is characterized by a progressive decline in glomerular filtration rate over time that it is determined by the 5-stage model. This study used stage-based statistical survival analysis to predict graft survival in renal transplant recipients with chronic allograft dysfunction. MATERIALS AND METHODS: In a single-center, retrospective study, 214 renal transplant recipients with chronic allograft dysfunction were investigated at a university hospital in Iran from 1997 to 2005. At each patient visit, kidney function was assessed using glomerular filtration rate and stage of disease. RESULTS: The estimated stage-specific hazard rates of disease progression are stage one, 453.936; stage two, 485.040; stage three, 545.808; and stage four; 649.488 per 1000 person-years. The estimated mean times in each stage were as follows: kidney damage with normal or increased glomerular filtration rate, 26.43 months; kidney damage with mildly decreased glomerular filtration rate, 24.74 months; moderate kidney disease, 21.98 months; and severe kidney disease; 18.48 months. These estimates yield a mean time from stage 1 to kidney failure of 91.63 months. The probability of graft survival was predicted using estimated stage-specific hazard rates. The 18th, 58th, 118th, and 155th months death-censored graft survival probabilities were 0.99, 0.75, 0.25, and 0.10. CONCLUSIONS: In this method of survival analysis, we can determine a statistical model according to a real clinical model in renal transplant recipients with chronic allograft dysfunction. It enables us to determine the stage-specific hazard rates of disease progression. These findings can help nephrologists to understand the kidney disease process and better predict graft survival.

Co-administration of albumin-furosemide in patients with the nephrotic syndrome.

Generalized edema is one of the most important complications in patients with nephrotic syndrome. Diuretics like furosemide are the first choice for reducing the edema. Hypo-albuminemia reduces the effect of furosemide, and thus, this drug is co-administered with albumin to reinforce the therapeutic effect and for the correction of reduced oncotic pressure. The aim of this study was to compare urine volume and 24-hour sodium levels after using furosemide alone versus using furosemide along with albumin in patients with nephrotic syndrome. In a randomized clinical trial, ten patients with nephrotic syndrome were chosen and were randomly allocated into four groups. Three therapeutic protocols were chosen, and at the end, each patient had received all three protocols randomly. Data were gathered and analyzed using non-parametric tests in SPSS software. The average urine volume after receiving albumin alone, furosemide alone and albumin plus furosemide were 742 mL (SD = 528), 1707 mL (SD = 745) and 2175 mL (SD = 971), respectively (P = 0.015); the fractional excretion of sodium was 1.96 (SD = 0.251), 3.18 (SD = 0.25), and 4.77 (SD = 8.45), respectively (P = 0.000); the 24-hour urinary sodium levels were 18.3 (SD = 6.68), 208.4 (SD = 5.27) and 206 (SD = 8.45), respectively; while the glomerular filtration rate (GFR) was 104.5, 96.6 and 106.6 (P = 0.021), respectively, in the three therapy groups. Our study shows that albumin administration alone and with furosemide in patients with nephrotic syndrome who had normal kidney function, results in different urine volumes and sodium levels. Co-administration of albumin and furosemide increased the urine volume and sodium level, which is due to increase in the GFR as well as the diuretic effects of furosemide.

Risk factors of long-term graft loss in renal transplant recipients with chronic allograft dysfunction.

OBJECTIVES: Graft loss owing to chronic allograft dysfunction is a major concern in renal transplant recipients. We assessed the affect of immune and nonimmune risk factors on death-censored graft loss in renal transplant recipients with chronic allograft dysfunction. MATERIALS AND METHODS: We performed a retrospective, single-center study on 214 renal transplant recipients with chronic allograft dysfunction among 1534 renal transplant recipients at the Urmia University Hospital from 1997 to 2005. Data registry includes details from all renal transplants. The renal transplant recipient information is regularly updated to determine current graft function, graft loss, or renal transplant recipient's death. The selection criteria were a functional renal allograft for at least 1 year and a progressive decline in allograft function. RESULTS: Increasing donor age (RR=1.066; P < .001), recipient age (RR=1.021, P = .00), recipient weight (RR=1.024; P = .029), and waiting time on dialysis to transplant (RR=1.047; P = .006), pretransplant hypertension (RR=3.126; P < .001), pretransplant diabetes (RR=5.787; P < .001), delayed graft function (RR=6.087; P < .001), proteinuria (RR=2.663; P = .001), posttransplant diabetes (RR=2.285; P = .015), posttransplant hypertension (RR=2.047; P = .017), and AR (RR=3.125; P < .001). Patients in stage 2 at the beginning of chronic allograft dysfunction relative to stage 1 (RR=4.823; P < .001) and patients in stage 3 at the beginning of chronic allograft dysfunction relative to stage 1 (RR=123.06; P < .001) were significant risk factors for death-censored graft loss. Using mycophenolate mofetil versus azathioprine reduced death-censored graft loss (RR=0.499; P = .001). CONCLUSION: We found that age of donor, pretransplant hypertension, pretransplant diabetes, type of immunosuppression (mycophenolate mofetil vs azathioprine), delayed graft function, proteinuria, and stage of allograft dysfunction at the start of chronic allograft dysfunction are the major risk factors for late renal allograft dysfunction.

Post-transplantation diabetes mellitus; frequency and related risk factors: a single center study.

Post-transplantation diabetes mellitus (PTDM) is a serious complication after organ transplantation, which could lead to cardiovascular morbidity and mortality. The rate of PTDM increased in recent years, probably due to new immunosuppressive drugs such as Tacrolimus. In this study, we retrospectively evaluated the frequency of PTDM and related risk factors in 644 non diabetic patients who underwent renal transplantation. Data was analyzed by chi-square and Fisher's exact test in SPSS software ver11.5. Among 644 patients PTDM developed in 10.2% similar to literature. PTDM was significantly correlated to age (P value = 0.000), positive familial history (P= 0.003) and HBV infection (P= 0.046). In conclusion, PTDM is not uncommon in Iranian patients and a positive family history of diabetes, HBV infection and older age increases the likelihood to develop PTDM.

Screening for asymptomatic kidney disease in high-risk population of Urmia, Iran.

INTRODUCTION. Screening programs for chronic kidney disease (CKD) are deemed to be cost effective only when they are limited to high-risk groups. We screened a sample of high-risk population of Urima, Iran. MATERIALS AND METHODS. As a pilot study for a national project, we enrolled 905 participants who had at least one risk factor for CKD (including hypertension, diabetes mellitus, or a family history of CKD). The study population was selected from among patients with Dm or hypertension and family members of those with CKD in Urima urban area and 2 randomly selected neighbor rural areas. Urine dipstick tests were done and blood sample was obtained to detect proteinuria and measure serum creatinine concentration, respectively. RESULTS. A total of 607 participants (67.1%) were enrolled from rural areas and 298 (32.9%) from the urban area. The mean serum creatinine level was 1.27 ± 0.60 mg/dL. A high serum creatinine level was demonstrated in 343 participants (37.9%), and 212 (23.4%) were demonstrated to have proteinuria. There was a significant correlation between serum creatinine level and urinary protein excretion (P = .001). There were no significant differences between rural and urban subgroups in terms of proteinuria (P = .42) and serum creatinine level (P = .08). CONCLUSIONS. The prevalence of a high creatinine level (37.9%) is so high in the high-risk population of Urmia. Our most important goal of implementing this preliminary study was to assess probable limitations and problems of performing an extensive national screening program for CKD in the future.

Skin cancer after renal transplantation: Results of a multicenter study in Iran.

BACKGROUND: Incidence and risk factors for skin tumors following renal transplantation can vary geographically; therefore, a retrospective study was performed to determine the incidence of and potential risk factors for skin cancer at 14 Transplant Centers in Iran between 1984 and 2008. MATERIAL/METHODS: We enrolled 11,255 kidney transplant recipients who were examined for all skin tumors. All skin cancers were established by histological examination. The data collection included the patient's age and sex, immunosuppressive regimen before and after diagnosis of tumor, rejection episodes, post-transplant latency period, other concurrent neoplastic problems, renal allograft function and outcome. RESULTS: One hundred and twenty-eight (1.14%) renal recipients had skin tumor, representing half of all post-transplant malignancies (128 out of 245 cases). Kaposi's sarcoma was the most common post-transplant cancer compared with other skin tumors. Male recipients had more tumors than did females (P=0.04); the male-to-female ratio in the affected patients was 2.5:1. The age at transplantation of patients with skin tumor was higher compared to RTRs without skin tumor (47±11 vs. 38±15 years, P=0.000), and individuals older than 45 years were at higher risk (odds ratio=3.8, 95%CI 2.6-5.5) of skin cancers. Patients consuming azathioprine were at risk more of skin cancer compared with those were on MMF (odds ratio =2.9, 95%, CI 2.0-4.2). The overall mortality was low (7.8%) in cases with skin cancer. CONCLUSIONS: This study showed that male sex, increased age, prolonged immunosuppression and azathioprine increased the risk of skin tumors after renal transplantation.

Effect of an educational program on awareness about peritoneal dialysis among patients on hemodialysis.

Several years after the initial usage of continuous ambulatory peritoneal dialysis (CAPD), the percentage of patients using this continues to be very low constituting about 15% of all patients with end-stage renal disease (ESRD). In this study, we attempt to define the impact of an educational program for improving the use of CAPD. This is a quasi-experimental study (before-after) conducted with educational materials including workshop, teaching by booklet and showing educational films, performed in Urmia, Iran. We designed a questionnaire for data collection and enrolled 160 patients with an aim-based sampling method. We used descriptive statistics and Friedman test for analysis in SPSS software version 11.5. The overall patients' information about CAPD defined by total scoring was as follows: 75% had little information; 19% had moderate information and 6% of patients were well informed. All the information levels increased after intervention. Our study suggests that the poor utilization of CAPD is due to relative un-awareness about PD and/or lack of adequate facilities.

Long-term progression pattern of chronic allograft dysfunction among kidney transplant recipients.

INTRODUCTION: There is little data about the pattern of disease progression in kidney transplant recipients with chronic allograft dysfunction (CAD). Extrapolating the current classification of chronic kidney disease for CAD, we studied the pattern of progression of CAD in 5 stages among our kidney transplant recipients. MATERIALS AND METHODS: We performed a retrospective cohort study on 214 kidney transplant recipients with CAD. The selection criteria were a functioning kidney allograft for at least 1 year after transplantation and a progressive decline in allograft function. An event history analysis in survival data was carried out based on the stages of CAD at baseline and the end of the study. RESULTS: At the beginning of the study, 54.7% of the patients had CAD stage 1; 37.9%, stage 2, and 7.5%, stage 3. At the end of study, 10.3% were in stage 2; 39.7%, stage 3; 23.4%, stage 4; and 26.6%, stage 5. Patients with CAD stage 5 were 17.1% of those in stage 1, 32.1% of those in stage 2, and 67.7% of those in stage 3 at baseline. There was a significant correlation between stage of CAD at the beginning of the study and the stage of CAD at the end (r = 0.465, P < .001). CONCLUSIONS: Because the decline in kidney allograft function was relatively faster in advanced stages of CAD, strategies to increase allograft survival by improving the baseline level of allograft function can be more effective than strategies to slow down progression of advanced stages of CAD.

Seroprevalence of herpes simplex virus-2 in kidney transplant recipients: a single-center experience.

INTRODUCTION: Viral infections are a real threat in kidney transplant recipients because of their immunocompromised condition. This study aimed to evaluate herpes simplex virus-2 (HSV-2) seropositivity among kidney transplant recipients. MATERIALS AND METHODS: Serum samples of 91 kidney transplant recipients from Urmia, Iran, were examined serologically for antibodies against HSV-2 using an enzyme-linked immunosorbent assay. RESULTS: The mean time from transplantation at HSV-2 testing was 5.04 +/- 4.45 years. The anti-HSV-2 immunoglobulin G antibody was positive in 5.4% of the kidney transplant recipients. Seropositive patients did not present any clinical manifestations of genital herpes infection. There was no association between HSV-2 seropositivity and age, gender, history of hemodialysis and transplantation, blood transfusion, or immunosuppressive regimen. CONCLUSIONS: Seroprevalence of HSV-2 is not high among our kidney transplant recipients. However, it remains a source of concern, considering the compromised immune system in this specific population.

Frequency of occurrence of vesico-ureteral reflux in kidney transplanted patients with the new technique of uretero-neo- cystostomy (Barry-Taguchi).

There are several ways of performing vesico-ureteral anastomosis in kidney trans-plantation (Tx); they are broadly classified into two categories: extra-vesical and intra-vesical. Extra-vesical methods are preferred in kidney transplantation. In this study, we attempt to integrate two extra-vesical techniques of Barry and Taguchi and to evaluate the frequency of occurrence of vesico-ureteral reflux (VUR) with this technique. Also, an attempt is made to compare the results with other techniques reported in the literature. Fifty consecutive transplant recipients, who underwent uretero-neo-cystostomy (uretero-vesical anastomosis) by the new technique of Barry-Taguchi were evaluated for VUR by sonography and cystoureterography, six months after Tx. The mean age of the study subjects was 34.8 years; there were 33 males and 17 females. The mean time between Tx and evaluating for VUR was 6.6 months. Two cases of asymptomatic VUR (4%) were detected at the end of the study period. The occurrence of 4% asymptomatic VUR suggests that this technique is more acceptable compared to others. Because of the simple nature of the procedure as well as the short time required, this technique could be a suitable choice in kidney transplantation.

Gingival enlargement and its risk factors in kidney transplant patients receiving cyclosporine A.

INTRODUCTION: Gingival enlargement is one of the most cumbersome complications of cyclosporine A. It affects patient's life style by impairing the appearance and function of masticatory tract. This study was conducted on a sample of Iranian kidney transplant recipients to determine the frequency and risk factors of cyclosporine-induced gingival enlargement. MATERIALS AND METHODS: A total of 200 kidney transplant recipients (mean age, 39.7 +/- 13.2 years) were enrolled in this study. All of the participants were receiving cyclosporine for at least 12 months prior to the study. Factors including age, gender, cyclosporine dose, serum concentration of cyclosporine, duration of immunosuppressive administration, plaque, and gingival indexes were evaluated. RESULTS: Seventy kidney transplant recipients (35%) showed various degrees of gingival enlargement. Serum cyclosporine concentration and the intensity of gingival enlargement (McGraw index) had a significant correlation (r = 0.35, P < .001). Multiple regression analysis revealed an independent association between gingival enlargement and either serum concentrations of cyclosporine and plaque index (P < .05). The other variables failed to show a significant relationship with gingival enlargement. CONCLUSIONS: The prevalence of cyclosporine-induced gingival enlargement in our patients seems to be almost greater than the prevalence reported in previous studies. There was a significant relationship between cyclosporine immunosuppressive treatment and gingival overgrowth in Iranian kidney transplant recipients.

Cystic changes of breast in a family with autosomal dominant polycystic kidney disease.

Autosomal dominant polycystic kidney disease is associated with cysts in many organs including the liver, pancreas, lungs, spleen, ovaries, testes, thyroid, and uterus. However, there is no report, to our knowledge, of cystic changes of the breast along with this disease. We describe 3 members of a family with multiple bilateral breast cysts in association with autosomal dominant polycystic kidney disease.