Comparison of hyperbilirubinemia incidence between the newborns of zinc-taking and non-zinc-taking mothers during the third trimester of pregnancy.

BACKGROUND: Identification and control of the risk factors for hyperbilirubinemia can reduce the incidence and complications of this condition. Serum zinc level in newborns is reported to be one of the factors affecting the severity and incidence of neonatal hyperbilirubinemia. Therefore, the present study was conducted to compare hyperbilirubinemia incidence in neonates of zinc-taking and non-zinc-taking mothers. METHODS: In this observational study, we compared the incidence of hyperbilirubinemia during the first week of birth between newborns whose mothers had received zinc supplement during the third trimester of pregnancy (case group) with those whose mothers had not taken zinc supplement (control group). The checklist of newborns' conditions in both case and control groups was completed based on the obtained data regarding the infants, mothers, and laboratory findings. Data was analyzed using chi-squared test and t-test. RESULTS: The mean serum levels of zinc were 79.76±15 mg/dl and 70.93±15.67mg/dl in mothers who had received zinc during the third trimester and those who had not taken zinc supplement, respectively. The mean serum level of zinc in newborns who underwent phototherapy was 41.68±9.21 mg/dl, while it was 68.53±20.85 mg/dl in neonates who did not receive phototherapy. In addition, 36% of the neonates whose mothers had not received zinc required phototherapy, while only 11% of newborns whose mothers had taken zinc supplement received phototherapy. CONCLUSION: Zinc consumption during the third trimester of pregnancy increased the serum zinc level in both newborns and mothers and reduced the incidence and severity of idiopathic hyperbilirubinemia requiring treatment.

Investigating the effect of several factors on concentrations of bioaerosols in a well-ventilated hospital environment.

This study characterized and quantified the bacterial and fungal bioaerosols in nine wards of the Razavi Hospital (Mashhad, Iran) that is equipped with an advanced heating, ventilating, and air conditioning (HVAC) system including HEPA filters for air cleaning. In this study, 432 samples were taken from the indoor air of multiple hospital wards during the morning and afternoon shifts during summer and autumn. The particle number concentrations with sizes of > 0.3, > 0.5, > 1, > 2, > 5, and > 10 µm were measured using a 6-channel handheld particle counter. A greater diversity of bioaerosol types were observed during the morning shifts and during summer. The microbial load was not affected significantly by the temperature, relative humidity, working shift, season, and number of visitors, indicating the effectiveness of a well-designed ventilation system to eliminate site-specific variations. For microbial number concentrations, a significant correlation was only observed between the number of particles with a diameter of > 10 µm and the airborne microbial loading. Thus, passive sampling may not properly reflect the actual concentrations of smaller bioaerosols. In conclusion, HEPA filters in the HVAC system successfully decreased the bioaerosol concentrations in the hospital environment. Additionally, we recommend that active sampling be used in cases where a well-functioning HVAC system exists.

Silver Nanoparticles Synthesized Coating with Zataria Multiflora Leaves Extract Induced Apoptosis in HeLa Cells Through p53 Activation.

The biosynthesis of nanoparticles is widely considered today. This investigation was aimed at the biosynthesis and coating of Ag.NPs with Zataria multiflora (Zm-Ag.NPs) leaf extract and assessment of its apoptosis promoting effects. The Zm-Ag.NPs was characterized by UV-visible and FTIR spectroscopy, TEM, EDS, DLS, and measurement of zeta-potential. Apoptosis induction effects of Zm-Ag.NPs were assessed using acridine orange - propidium iodide (AO/PI), DAPI staining, caspase3/9 activation assay, and annexinV/PI assay. Changes in P53, matrix metalloproteinases 2 (MMPs), and vascular endothelial growth factor A (VEGF-A) genes expression were also assessed with semi-quantitative RT-PCR. The UV-visible spectroscopy results showed that the surface plasmon resonance band (SRP) for Zm-Ag.NPs was about 440 nm, also, FTIR spectroscopy indicated that plant material embedded around Zm-Ag.NPs. The TEM images of the samples revealed that the Ag.NPs varied in morphology and also, the presence of silver element was monitored with EDS. The mean size of Zm-Ag.NPs was 30 nm. The Zm-Ag.NPs reduced cell viability in a dose and time dependent manner (IC50 = 15 µg/mL). AO/PI and DAPI staining indicated chromatin fragmentation and annexinV externalization assay using flow cytometer, confirmed promotion of programmed cell death in the treated cells. Apoptosis was induced through caspase 3/9 activation pathway. This promotion of apoptosis effects is not related with P53 gene up regulation. Finally, it was found that Zm-Ag.NPs inhibited cancer cell metastasis through a decrease in MMP and VEGFA expression. Zm-Ag.NPs acts as carrier of the plant material compound, and can be applied as anticancer agents.

Influence of membrane cholesterol on monocyte chemotaxis.

Cholesterol content influences several important physiological functions due to its effect on membrane receptors. In this work, we tested the hypothesis that cellular cholesterol alters chemotactic response of monocytes to Monocyte Chemoattractant Protein-1 (MCP-1) due to their effect on the receptor, CCR2. We used Methyl-ß-cyclodextrin (MßCD) to alter the baseline cholesterol in human monocytic cell line THP-1, and evaluated their chemotactic response to MCP-1. Compared to untreated cells, cholesterol enrichment increased the number of monocytes transmigrated in response to MCP-1 while depletion had opposite effect. Using imaging flow cytometry, we established that these differences were due to alterations in expression levels, but not the surface distribution, of CCR2.

Induction of Apoptosis by Green Synthesized Gold Nanoparticles Through Activation of Caspase-3 and 9 in Human Cervical Cancer Cells.

BACKGROUND: Gold Nanoparticles (GNPs) are used in imaging and molecular diagnostic applications. As the development of a novel approach in the green synthesis of metal nanoparticles is of great importance and a necessity, a simple and safe method for the synthesis of GNPs using plant extracts of Zataria multiflora leaves was applied in this study and the results on GNPs' anticancer activity against HeLa cells were reported. METHODS: The GNPs were characterized by UV-visible spectroscopy, FTIR, TEM, DLS and Zeta-potential measurements. In addition, the cellular up-take of nanoparticles was investigated using Dark Field Microscopy (DFM). Induction of apoptosis by high dose of GNPs in HeLa cells was assessed by MTT assay, Acridin orange, DAPI staining, Annexin V/PI double-labeling flow cytometry and caspase activity assay. RESULTS: UV-visible spectroscopy results showed a surface plasmon resonance band for GNPs at 530 nm. FTIR results demonstrated an interaction between plant extract and nanoparticles. TEM images revealed different shapes for GNPs and DLS results indicated that the GNPs range in size from 10 to 42 nm. The Zeta potential values of the synthesized GNPs were between 30 to 50 Mev, indicating the formation of stable particles. As evidenced by MTT assay, GNPs inhibit proliferation of HeLa cells in dose-dependent GNPs and cytotoxicity of GNPs in Bone Marrow Mesenchymal Stem Cell (BMSCs) was lower than cancerous cells. At nontoxic concentrations, the cellular up-take of the nanoparticles took place. Acridin orange and DAPI staining showed morphological changes in the cell's nucleus due to apoptosis. Finally, caspase activity assay demonstrated HeLa cell's apoptosis through caspase activation. CONCLUSION: The results showed that GNPs have the ability to induce apoptosis in HeLa cells.

The effect of gabapentin on muscle cramps during hemodialysis: A double-blind clinical trial.

Hemodialysis-associated muscle cramps (HAMC) are a common complication during hemodialysis (HD) sessions. A number of pharmacologic agents have been evaluated to prevent and or diminish HAMC; however, none of them has an established role. To the best of our knowledge, this is the first study to evaluate the possible effect of gabapentin on HAMC. In a double-blinded clinical trial, we compared the possible effect of gabapentin with a placebo in prevention and or diminishing episodes of HAMC in HD patients who had experienced frequent intradialytic muscle cramps. At first, placebo was given before each dialysis session for four weeks and then, after a two-week washout period, 300 mg of gabapentin was given before each dialysis session for four weeks to verify the effect of gabapentin on HAMC. Overall, 15 patients (seven men and eight women; mean age, 52.02 years) with frequent intradialytic muscle cramps were enrolled in the study. The incidence of symptomatic muscle cramp decreased in the gabapentin group compared with the placebo group, with a significant difference between them (P = 0.001). The intensity of muscle cramps also decreased in the gabapentin group (P = 0.001). There was no significant association between HAMC in male and female patients (P = 0. 397), mean age of HD patients (P = 0.226) and cause of end-stage renal disease (P = 0.551). According to the results of our study, gabapentin prescription before each HD session significantly reduced the frequency and the intensity of muscle cramps during HD without any major side-effects.

Comparison of survival in patients with end-stage renal disease receiving hemodialysis versus peritoneal dialysis.

Although the life expectancy of patients with end-stage renal disease (ESRD) has improved in recent years, it is still far below that of the general population. In this retrospective study, we compared the survival of patients with ESRD receiving hemodialysis (HD) versus those on peritoneal dialysis (PD). The study was conducted on patients referred to the HD and PD centers of the Emam Khomini Hospital and the Aboozar Children's Hospital from January 2007 to May 2012 in Ahvaz, Iran. All ESRD patients on maintenance HD or PD for more than two months were included in the study. The survival was estimated by the Kaplan-Meier method and the differences between HD and PD patients were tested by the log-rank test. Overall, 239 patients, 148 patients on HD (61.92%) and 91 patients on continuous ambulatory PD (CAPD) (38.55%) with mean age of 54.1 ± 17 years were enrolled in the study. Regardless of the causes of ESRD and type of renal replacement therapy (RRT), one-, two- and three-year survival of patients was 65%, 51% and 35%, respectively. There was no significant difference between type of RRT in one- (P-value = 0.737), two- (P-value = 0.534) and three- (P-value = 0.867) year survival. There was also no significant difference between diabetic and non-diabetic patients under HD and CAPD in the one-, two- and three-year survival. Although the three-year survival of diabetic patients under CAPD was lower than that of non-diabetic patients (13% vs. 34%), it was not statistically significant (P-value = 0.50). According to the results of the current study, there is no survival advantage of PD during the first years of initiation of dialysis, and the one-, two- and three-year survival of HD and PD patients is also similar.

Silver nanoparticles biosynthesized using Achillea biebersteinii flower extract: apoptosis induction in MCF-7 cells via caspase activation and regulation of Bax and Bcl-2 gene expression.

Silver nanoparticles (Ag-NPs), the most popular nanoparticles, possess unique properties. Achillea biebersteinii is a plant of the Asteraceae family rich in active antitumor components. The aim of this research was the characterization and investigation of the cytotoxic properties of Ag-NPs synthesized using A. biebersteinii flower extract, on a human breast cancer cell line. The Ag-NPs were synthesized after approximately 180 min of reaction at 40 °C, then they were characterized by UV-visible spectroscopy, Fourier transform infrared spectroscopy (FTIR), transmission electron microscopy (TEM) and dynamic light scattering (DLS). The anti-apoptosis effect of Ag-NPs on the MCF-7 cell line was investigated by MTT assay, DAPI and acridine orange staining and caspase activity. The transcriptional expression of bax, bcl-2, caspase-3, -8 and -9 were also evaluated by RT-PCR. The TEM images revealed that the Ag-NPs morphology had a different shape. The DLS indicated that the average hydrodynamic diameter of the biosynthesized Ag-NPs was around 12 nm. By UV-visible spectroscopy the strongest absorbance peak was observed at 460 nm. The FTIR results also showed interaction between the plant extract and Ag-NPs due to the similarity in the peak patterns. The EDS results showed that Ag-NPs display an absorption peak at 3 keV, indicating the presence of the element silver. The Ag-NPs caused a dose-dependent decrease in cell viability, fragmentation in nucleic acid, inhibited the proliferation and induction of apoptosis on MCF-7 by suppressing specific cell cycle genes, and simulation programmed cell dead genes. Further investigation is required to establish the potential of this novel and promising approach in cancer therapy.

The anti-proliferative and anti-angiogenic effect of the methanol extract from brittle star.

BACKGROUND: Anti-angiogenic therapy is a crucial step in cancer treatment. The discovery of new anti-angiogenic compounds from marine organisms has become an attractive concept in anti-cancer therapy. Because little data correlated to the pro- and anti-angiogenic efficacies of Ophiuroidea, which include brittle star, the current study was designed to explore the anti-angiogenic potential of brittle star methanol extract in vitro and in vivo. METHODS: The anti-proliferative effect of brittle star extract on A2780cp cells was examined by MTT assays, and transcriptional expression of VEGF and b-FGF was evaluated by RT-PCR. In an in vivo model, 40 fertilized Ross eggs were divided into control and three experimental groups. The experimental groups were incubated with brittle star extract at concentrations of 25, 50 and 100 µg/ml, and photographed by photo-stereomicroscopy. Ultimately, numbers and lengths of vessels were measured by Image J software. Data were analyzed with SPSS software (p<0.05). RESULTS: Results illustrated that the brittle star extract exerted a dose- and time-dependent anti-proliferative effect on A2780cp cancer cells. In addition, VEGF and b-FGF expression decreased with brittle star methanol extract treatment. Macroscopic evaluations revealed significant changes in the second and third experimental group compared to controls (p<0.05). CONCLUSION: These finding revealed the anti-angiogenic effects of brittle star methanol extract in vitro and in vivo confer novel insight into the application of natural marine products in angiogenesis-related pathologies.

Anti-angiogenesis effect of biogenic silver nanoparticles synthesized Using Saliva officinalis on chick chorioalantoic membrane (CAM).

Angiogenesis, which is required for physiological events, plays a crucial role in several pathological conditions, such as tumor growth and metastasis. The use of plant extracts is a cost effective and eco-friendly way to synthesize nanoparticles. In the present study, we investigated the anti-angiogenesis properties of silver nanoparticles synthesized using Saliva officinalis extract on chick chorioalantoic membrane. The production of nanoparticles was confirmed by the color change from yellow to brown observed after approximately 3 h at 37 °C. Then, the nanoparticles were characterized by UV-visible spectroscopy, FTIR, and TEM. The UV-visible spectroscopy results showed that the surface plasmon resonance band for AgNPs was around 430 nm. The intensity of the AgNP-specific absorption peak improved with an increase of 0.5 mL of extract into 10 mL of AgNO3 (2.5 mM). The FTIR results showed good interaction between the plant extracts and AgNPs. The TEM images of the samples revealed that the NPs varied in morphology and size from 1 to 40 nm; the average was recorded at 16.5 ± 1.2 nm. Forty Ross fertilized eggs were divided into four groups; the control and three experimental groups. On the 8th day, gelatin sponges containing albumin were placed on the chorioalantoic membrane and soaked with different concentrations of NPs. On the 12th day, all the cases were photographed using a photostereomicroscope. The number and the lengths of the vessels were measured using Image J software. The crown rump (CR) and weight of the embryo were also recorded. Then the hemoglobin content was measured using Drabkin's reagent kit for quantification of the blood vessel formation. According to the data analysis, the number and length of the blood vessels, as well as the CR and weight of the embryos reduced significantly compared to the control (p < 0.05), dose dependently. The total hemoglobin was quantified as an indicator of the blood vessel formation. The hemoglobin content in the treated samples with AgNPs decreased, which showed its inhibitory effect on angiogenesis.

Epidemiology of hepatitis e virus infection in patients on chronic hemodialysis.

BACKGROUND: Many studies have been done on the epidemiology of Hepatitis E on general population, but the data among patients with end stage renal disease (ESRD) are few and give conflicting results. OBJECTIVES: The aim of this study was to investigate the prevalence of hepatitis E virus (HEV) infection and its relationship in ESRD patients undergoing maintenance hemodialysis (HD). PATIENTS AND METHODS: This cross-sectional study was carried out on ESRD patients treated with HD in Imam Khomeini Hospital, Ahvaz city, Southwest of Iran. Blood sampling of patients was collected immediately before the dialysis session and the serum were evaluated for anti-HEV IgG titers by enzyme-linked immunosorbent assays. The statistical package for social sciences (SPSS) version 15 software was used for data analysis. RESULTS: Out of 47 ESRD patients, 27 were male (57.4%) and 20 were female (42.6%), with mean age of 55.27 ± 8.1 years. The prevalence of anti-HEV antibody was 10.6 % (five patients, four male and one female). The mean age of HEV positive and negative patients were 58 ± 5.52 and 53.82 ± 15.55 years, respectively without any significant difference (P = 0.058). There also was no significant association between HEV and gender (P = 0.28). The mean time of HD in HEV positive and negative patients were 1224.2 and 1168.5 days, respectively with no significant association (P = 0.88). In addition, there also was no association between HEV and HCV (P = 0.61). CONCLUSIONS: According to the present study, the prevalence of anti-HEV IgG antibody was 10.63 % among chronic HD patients and there was no association between HEV, age, gender, duration of HD and HCV antibody titer.

The Synergic Effects of Crocus Sativus L. and Low Frequency Electromagnetic Field on VEGFR2 Gene Expression in Human Breast Cancer Cells.

BACKGROUND: Angiogenesis, which is required for embryonic development and many physiological events, plays crucial role in many pathological conditions such as tumor growth and metastasis. Recent studies indicate anticancer and antitumor properties of saffron against human cancers. Many processes are affected by Electromagnetic Field (EMF) and its effect on proliferation and gene expression were examined. In this experimental study, the synergic effects of saffron and EMF on VEGFR2 gene expression in MCF7 cells were investigated. METHODS: Saffron was extracted using freeze dryer. MCF7 cells were grown in RPMI 1640 medium supplemented with 10% FBS and incubated at 37°C with 5% CO2. After 24 hr cells were treated with saffron extract at concentrations of 100, 200, 400 and 800 µg/ml. Forty eight hr after treatment all flasks were exposed with EMF (50 Hz, 0.004 T). Then total RNA was extracted and cDNA was synthetized using specific primer. Synthetized products were analyzed by Real Time PCR to determine expression level of VEGFR2. Data were analyzed by SPSS (ANOVA & Tukey). RESULTS: Critical inhibitory effect on VEGFR2 gene expression was 20% at 400 µg/ml. Synergic use of EMF and saffron extract showed most reduction (38%) at 100 µg/ml. On the other hand synergic use of 200, 400 and 800 µg/ml saffron aqua extract and EMF decline noticeably the VEGFR2 level of gene expression to 29, 35 and 36%, respectively. EMF itself also reduced VEGFR2 up to 25% in comparison with control group which is remarkable at p < 0.001. CONCLUSION: Results indicate a decrease in the expression of vascular endothelial growth factor receptor in the treated samples with saffron extract compared to control. This reduction in VEGFR2 level induced by synergic treatment of saffron and EMF which reveals induction of inhibitory effects of saffron on angiogenesis and could be also considered as a promising chemotherapeutic agent in breast cancer treatment.

Epidemiology of end-stage renal disease in Iran: a review article.

The prevalence and incidence of end-stage renal disease (ESRD) are increasing in developed and developing countries, and this will place an enormous financial burden for health-care systems. The exact reasons of the rising prevalence of ESRD patients are unknown, but it can be attributed to an increase in the prevalence of diabetes mellitus and hypertension as the most common causes of ESRD. However, in contrast to the developed countries, the etiology of ESRD in the significant percent of patients with ESRD in Iran is unknown. In our country, the patients with chronic kidney diseases present themselves to the hospital only when they have severe symptoms of uremia, and, at this time, determining the primary cause of ESRD is often not possible. In addition, although the prevalence and incidence of ESRD are also significantly increasing in Iran in recent years, they are still lower compared with developed countries, which may also be due to poor referral resulting in the under diagnosis of ESRD. The aim of this review is to evaluate the epidemiologic aspects of ESRD in Iran, including demographic data, cause of ESRD, kind of renal replacement therapies implemented and their survival.

The protective effect of theophyline in cisplatin nephrotoxicity.

Cisplatin is a potent and a major anti-neoplastic drug in the treatment of a broad spectrum of malignancies. However, its clinical use is limited by renal tubular dysfunction that occurs in a significant percent of patients. The aim of the present study was to evaluate the possible protective effect of theophyline in the prevention of cisplatin-induced nephrotoxicity. The trial design was prospective, randomized, double-blinded and placebo controlled. Chemotherapeutic patients who received cisplatin at a dosage of at least 50 mg/m 2 alone or in combination with other chemotherapy agent(s) were included in the study. There were a total of 76 patients who were randomly divided into two groups. In group 1 (n = 38), placebo was advised; in group 2 (n = 38), patients received 4 mg/kg aminophyline as an intravenous loading dose, followed by theophyline in a dose of 200 mg three times daily orally for four consecutive days. The placebo group had 22 males and 16 females and the theophyline group had 26 males and 12 females. The mean age was 51 ± 17.6 years and the mean dose of cisplatin was 86.71 ± 43.18 mg. The prevalence of cisplatin nephrotoxicity in groups 1 and 2 was 7.9 and 5.3%, respectively, and the difference was not significant (P = 1). In addition, there was no significant association of cisplatin nephrotoxicity with age (P = 0.1), gender (P = 0.64) and mean dose of cisplatin (P = 0.8). These results indicate that prophy-lactic application of aminophyline and theophyline does not have a protective effect against cisplatin nephrotoxicity.

A review article: access recirculation among end stage renal disease patients undergoing maintenance hemodialysis.

BACKGROUND: The presence of arterio-venous (A-V) fistula recirculation among hemodialysis (HD) patients markedly decrease adequacy of dialysis. OBJECTIVES: The present article summarize some of observations about clinical significance, causes, the most common techniques for measurement, and main source of pitfall in calculation of access recirculation. MATERIALS AND METHODS: A variety of literature sources such as PubMed, Current Content, Scopus, Embase, and Iranmedex; with key words such as inadequate dialysis and arterio-venous fistula access recirculation were used to collect current data. Manuscripts published in English language as full-text articles or as abstract form were included in our review study. RESULTS: Any access recirculation among HD patients should be considered abnormal and if it presents prompt investigation should be performed for its causes. There are two most common techniques for accurate assessment of access recirculation: Urea (or chemical) and nonurea-based method by ultrasound dilution technique. The most common causes of access recirculation are the presence of high-grade venous stenosis, inadequate arterial blood flow rate, close proximity, or misdirection of arterial and venous needles placement by HD staff especially in new vascular accesses due to a lack of familiarity with the access anatomy. CONCLUSIONS: The presence of access recirculation among HD patients can lead to significant inadequate dialysis thereby resulting in reducing the survival of these patients. Therefore, periodic assessment of access recirculation should be performed in HD wards.

Dose kidney transplant nephrectomy stop disease progression in plasma exchange resistant post transplant hemolytic uremic syndrome? A case report.

BACKGROUND: Two different case reports, which have been published previously, suggested that bilateral nephrectomy can improve sever and refractory hemolytic uremic syndrome (HUS) in adults without a history of transplantation. At this study, kidney transplant nephrectomy in a patient with sever post transplant HUS was investigated. CASE: Patient was a 55 years old man with a single small size kidney and end-stage renal disease (ESRD). He had received a kidney from an unrelated donor three months before admission. The patient was admitted with fever and acute renal failure. Clinical and laboratory evaluation wereconsistent with sever De novo hemolytic uremic syndrome (HUS). Different therapeutic regimens administered in this patient including intensive plasma exchange, plasma infusion, empirical antibiotics, and high doses of corticosteroid. Although Cyclosporine was changed to Tacrolimus. After 45 days of treatment, patient's condition did not improve and sever thrombocytopenia (10000-15000/µL) developed. Patient was also suffered from severe hypersensitivity reaction (fever, chills, and itching) following each plasma exchange. Kidney transplant nephrectomy was done. However, sever post operativebleedingoccurred.HUS and thrombocytopenia did not improve and patient died two days after operation. CONCLUSIONS: According to this experience, Kidney transplant nephrectomy may not be an effective treatment and is not recommended in the treatment of severe and refractory post transplant HUS.

Long-term survival of patients with end-stage renal disease on maintenance hemodialysis: a multicenter study in Iran.

INTRODUCTION: Although maintenance dialysis in patients with end-stage renal disease prevents death from uremia, patient survival remains an important issue. This study is the first in Iran to evaluate long-term survival of patients with ESRD. MATERIALS AND METHODS: This retrospective study was conducted on 1861 patients with ESRD referred to 12 hemodialysis centers in Khuzestan province, Iran. The period of study was 21 years, which was between 1989 to may 2010. The median follow-up duration was 46.0 months. Patients who died within 90 days of commencing dialysis were excluded. The patient's death as outcome measure was recorded and the survival was estimated by the Kaplan-Meier method. RESULTS: The mean age of 1861 patients at initiation of hemodialysis was 51.2 ± 17.2 years, and 1120 were men (60.2%). Diabetes mellitus (32.9%) and hypertension (24.1%) were the most common known causes of ESRD in our patients. Regardless of the cause of ESRD, 1-, 5-, 10-, and 15-year survival of hemodialysis patients was 83%, 25.2%, 3.8%, and 1.0% respectively. Survival of diabetic patients was significantly lower than nondiabetic patients (P <.001) and no one of diabetic patients survived up to 10 years. CONCLUSIONS: Based on our findings, the survival of ESRD patients undergoing hemodialysis in Iran is relatively poor, especially among diabetics. This can be explained by socioeconomic differences and the fact that dialysis patients who are otherwise healthy and are more likely to survival for a longer time have higher chances of receiving a kidney transplant in Iran.

Effect of intranasal DDAVP in prevention of hypotension during hemodialysis.

INTRODUCTION: The development of intradialytic hypotension during hemodialysis (HD) in which fluid removal is the primary goal, contributes to the excessive morbidity that is associated with the dialysis procedure. MATERIALS AND METHODS: In a double blinded clinical trial, we compared the possible effect of intranasal DDAVP with intranasal distilled water as a placebo in prevention of intradialytic hypotension (IDH) in patients with known symptomatic IDH. In the first month of the study, nasal spray of distill water were administrated 30 minutes before all HD session (Placebo Group, Group 1) and then after a 30-day washout period we were used intranasal DDAVP 30 minutes before HD session (Vasopressin Group, Group 2). Blood pressure was measured just before HD, two hours later and after termination of HD. A hypotensive episode was defined as a decline of systolic blood pressure of more than 10mm Hg. RESULTS: In overall Seventeen patients (nine men, eight women; mean age, 47.5 years) with known symptomatic IDH were enrolled in the study. The kind of dialysis membranes, mean of blood flow rate, dialyzate flow rate and ultrafiltration rate were the same in both groups. Each group has 204 HD session (17 * 12). Hypotensive episode occurred 18 times (8.82%) in vasopressin group compared with 125 times (61.27%) in placebo group and there was a significant association between them (p=0.0001). In addition mean arterial blood pressure in vasopressin group was 80.77 and in placebo group was 73.92 and also there was a significant association (p=0.0001). The mean Kt/v in group 1 and 2 were 1.29 and 1.28 without any differences between them (p=0.896). CONCLUSION: These results indicate that Compared with placebo, Vasopressin is significantly associated with a decreased incidence of intradialytic hypotension episodes during hemodialysis.

Effect of Intranasal DDAVP in Prevention of Hypotension during Hemodialysis

Introduction: The development of intradialytic hypotension during hemodialysis (HD) in which fluid removal is the primary goal, contributes to the excessive morbidity that is associated with the dialysis procedure. Materials and Methods: In a double blinded clinical trial, we compared the possible effect of intranasal DDAVP with intranasal distilled water as a placebo in prevention of intradialytic hypotension (IDH) in patients with known symptomatic IDH. In the first month of the study, nasal spray of distill water were administrated 30 minutes before all HD session (Placebo Group, Group 1) and then after a 30-day washout period we were used intranasal DDAVP 30 minutes before HD session (Vasopressin Group, Group 2). Blood pressure was measured just before HD, two hours later and after termination of HD. A hypotensive episode was defined as a decline of systolic blood pressure of more than 10mm Hg. Results: In overall Seventeen patients (nine men, eight women; mean age, 47.5 years) with known symptomatic IDH were enrolled in the study. The kind of dialysis membranes, mean of blood flow rate, dialyzate flow rate and ultrafiltration rate were the same in both groups. Each group has 204 HD session (17 * 12). Hypotensive episode occurred 18 times (8.82%) in vasopressin group compared with 125 times (61.27%) in placebo group and there was a significant association between them (p=0.0001). In addition mean arterial blood pressure in vasopressin group was 80.77 and in placebo group was 73.92 and also there was a significant association (p=0.0001). The mean Kt/v in group 1 and 2 were 1.29 and 1.28 without any differences between them (p=0.896). Conclusion: These results indicate that Compared with placebo, Vasopressin is significantly associated with a decreased incidence of intradialytic hypotension episodes during hemodialysis (AU)

Introduction: The development of intradialytic hypotension during hemodialysis (HD) in which fluid removal is the primary goal, contributes to the excessive morbidity that is associated with the dialysis procedure. Materials and Methods: In a double blinded clinical trial, we compared the possible effect of intranasal DDAVP with intranasal distilled water as a placebo in prevention of intradialytic hypotension (IDH) in patients with known symptomatic IDH. In the first month of the study, nasal spray of distill water were administrated 30 minutes before all HD session (Placebo Group, Group 1) and then after a 30-day washout period we were used intranasal DDAVP 30 minutes before HD session (Vasopressin Group, Group 2). Blood pressure was measured just before HD, two hours later and after termination of HD. A hypotensive episode was defined as a decline of systolic blood pressure of more than 10mm Hg. Results: In overall Seventeen patients (nine men, eight women; mean age, 47.5 years) with known symptomatic IDH were enrolled in the study. The kind of dialysis membranes, mean of blood flow rate, dialyzate flow rate and ultrafiltration rate were the same in both groups. Each group has 204 HD session (17 * 12). Hypotensive episode occurred 18 times (8.82%) in vasopressin group compared with 125 times (61.27%) in placebo group and there was a significant association between them (p=0.0001). In addition mean arterial blood pressure in vasopressin group was 80.77 and in placebo group was 73.92 and also there was a significant association (p=0.0001). The mean Kt/v in group 1 and 2 were 1.29 and 1.28 without any differences between them (p=0.896). Conclusion: These results indicate that Compared with placebo, Vasopressin is significantly associated with a decreased incidence of intradialytic hypotension episodes during hemodialysis (AU)

Tuberous sclerosis, deep vein thrombosis and lack of C and S proteins: A case report.

INTRODUCTION: Tuberous sclerosis, an autosomal dominant disorder, is characterized by hamartomas in different organs of body. Kidney involvement is quite common in this disorder and sometimes it is accompanied by adult polycystic kidney disease. CASE: A 46-year-old woman who was being treated for adult polycystic kidney disease and systemic hypertension was admitted to this hospital because of acute lower limb edema. Color Doppler sonography study showed deep vein thrombosis of lower limbs and also left iliac vein. Despite the initiation of hourly heparin infusion, the patient involved by pulmonary emboli on the 2(nd)day of admission. Lab tests revealed protein C and S deficiency. The patient had already experienced episodes of pneumothorax too. Cutaneous lesions due to sebaceous adenoma were seen on her cheeks, nose and neck. She had also periungual fibroma suggestive of tuberous sclerosis. CONCLUSION: Although, according to our patient with both tuberous sclerosis and protein C and S deficiency, a significant relation between these two diseases, cannot confirmed, however, evaluation of other patients who have tuberous sclerosis can help to confirm or rule out this relation.