فهرست مطالب

  • Volume:10 Issue:6, 2018
  • تاریخ انتشار: 1397/08/14
  • تعداد عناوین: 6
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  • Harmandeep Singh Chahal , Sunil Kumar Juneja , Simran Kaur , * , Bakul Kochar Kapoor , Sandeep Sharma , Vikas Makkar Page 1
    Background
    Pregnancy related-acute kidney injury (PR-AKI) and urological complications are potentially preventable causes of maternal morbidity and mortality. An in-depth knowledge of their risk in various maternal conditions can assist in getting closer to the ambitious target of zero preventable death from AKI, by 2025. The aim of the current research was to study the incidence of acute kidney injury and urological complications in morbidly adherent placenta (MAP), a rare maternal condition now being increasingly encountered worldwide, due to increasing incidence of cesarean deliveries.
    Methods
    This was a prospective study, done over a period of four years. Pregnant patients with morbidly adherent placenta, with normal baseline renal function and no past history of renal disease or diabetes were included in the study after obtaining a written informed consent. Patients with pre-eclampsia/eclampsia and history of urological surgery in the past were excluded. Baseline parameters (demographic, antenatal and perinatal parameters) and operative details (obstetric, urological, and hemostatic procedures) were recorded in detail for each patient. Outcome parameters, including acute kidney injury (Acute Kidney Injury Network criteria), urological complications, and maternal outcome were studied during the peri-operative and post-operative period, daily, till the end of the hospital stay and followed up weekly for six weeks after delivery. Patients with AKI were compared to those without AKI and those needing a urological intervention were compared to those without urological complications. All statistical calculations were done using SPSS 21 with P value < 0.05 considered as significant.
    Results
    A total of 5475 deliveries were conducted during the study period, out of which 64 patients had adherent placenta (incidence 12.8 per 1000 deliveries; 31-accreta, 13-increta, 20-percreta), none needing exclusion. Furthermore, AKI occurred in 39.1% of patients (nMAP-AKI = 25), most of them had mild AKI (AKIN-1 in 11 patients), with severe AKI (AKIN-2, 3) in 10.9% (nAKIN-2 = 9, nAKIN-3 = 5) and one required two sessions of slow low efficacy dialysis. On univariate analysis, AKI was higher in placenta percreta (P = 0.021, RR -2.34), urological injuries (0.001, RR 2.86), and higher blood loss (P = 0.001). On multivariate analysis, placenta percreta was independently associated with higher incidence of AKI (P = 0.049). Urological involvement/injuries requiring intervention were seen in 22 patients (nMAP-Ur = 22) with significantly higher incidence in placenta previa (P = 0.023, RR1.62) and placenta percreta (P = 0.000, RR 17.18), and patients undergoing hysterectomy (P = 0.000, RR -2.01) on univariate analysis, but on multivariate analysis, placenta percreta was found to be the most significant factor (P = 0.017). Significantly higher number of MAP-Ur had AKI (15/22, P = 0.001, RR -2.87, 95% CI 1.55 - 5.28). Acute Kidney Injury and urological injuries significantly increased the need for intensive care and days of hospital stay. At the end of six weeks follow-up all AKI patients had complete recovery of renal function and no urinary leak or vesico-vaginal fistula was seen in urologically intervened patients. No maternal mortality was seen.
    Conclusions
    There is an alarmingly high incidence of pregnancy-related acute kidney injury and urological complications in adherent placentation, posing a great threat to their worldwide improving statistics. Awareness of this condition among renal fraternity and its multidisciplinary management can significantly improve maternal renal and overall prognosis
    Keywords: Morbidly Adherent Placenta, Pregnancy Related-Acute Kidney Injury, Acute Kidney Injury, Urological Complications
  • Mohsen Sarkarian , Alireza Kheradmand , Hamed Haghiabi , *, Mohammad Kolbadinezhad Page 2
    Background
    Prostate cancer is the second most common cancer among men in the world. Due to the slow growth of this cancer, its early detection can lead to definitive treatment and mortality reduction. Based on the lower diagnostic ability of conventional methods, imaging methods have been paid attention in recent years.
    Objectives
    The aim of this study was to evaluate the value and accuracy of diffusion MRI in the prostate cancer as a diagnostic method.
    Methods
    This was a descriptive cross-sectional study conducted in a 15-month period in patients with prostate cancer who had lower urinary tract symptoms, high PSA (higher than 4 ng/mL), or an abnormal finding in the digital rectum examination. The patients were evaluated by MRI of the whole prostate gland with T2 weighted and diffusion images. Patients’ conditions were determined by a urologist with standard 12-fold transrectal sonography-guided biopsy of the prostate. Then, by a histologic examination, healthy or cancerous tissues, Gleason score, and the positive blind numbers were determined by a pathologist. In the end, the results were compared.
    Results
    We observed 80 patients among whom, 25 cases (31.2%) had malignancies in DW-MRI, including 22 cases that had a malignancy in biopsy and three cases whose biopsy indicated the benign pathology. MRI findings in 55 cases (68.7%) were benign (BPH, prostatitis) that in four cases, malignancy was seen in the biopsy. The sensitivity of DW-MRI was 84% and specificity was 94%, indicating a high diagnostic capability for DW-MRI. The positive and negative predictive values of DW-MRI for prostate cancer were 88% and 92%, respectively. We also observed that older age leads to the lower sensitivity of the MRI. Gleason score, PSA level, and tumor burden had a direct relationship with the accuracy of DW-MRI. However, prostate volume did not have a significant relationship with the detection of cancer in MRI.
    Conclusions
    DW-MRI can be used for better diagnosis and staging of prostate cancer in patients with prostate lesions. Accordingly, it can upgrade cancer diagnosis in patients with negative biopsies and high suspicion of cancer.
    Keywords: Magnetic Resonance Diffusion, Diagnosis, Prostate Cancer
  • Fatih Aygun* Page 3
    Background
    Acute kidney injury (AKI) is a serious clinical condition in children admitting to the pediatric intensive care unit. Beside having the risk of significant morbidity and mortality, AKI has also increased the risk for chronic kidney disease. However, there is paucity of data regarding AKI epidemiology in children. Herein, we aimed to describe the incidence, risk factors, and outcome of AKI in critically ill children.
    Methods
    The records of patients, who were hospitalized in our pediatric intensive care unit between October 2016 and March 2018 were investigated retrospectively. The relationship between AKI and the need of invasive mechanical ventilation and non-invasive mechanical ventilation, inotropic and nephrotoxic drug use, initial laboratory findings, continuous renal replacement need, pediatric risk of mortality-III score (PRISM-III), duration of hospitalization, and mortality rate were investigated.
    Results
    Totally, 447 patients were found to have been included in the study. The AKI developed in 111 patients. The sepsis was the most common underlying disease with 27 patients (24.3 %). There was a statistical significance between development of AKI and the need of invasive mechanical ventilation, inotropic and nephrotoxic drug use, PRISM-III score, continuous renal replacement need, plasma exchange, blood component transfusion, duration of hospitalization, and mortality.
    Conclusions
    The AKI is associated with prolonged hospitalization and increased mortality. AKI should be considered as a medical emergency that should be diagnosed and managed accurately
    Keywords: Pediatric Intensive Care Unit, Acute Kidney Injury, Hemodialysis, Prognosis
  • Mohammad Taghi Najafi , Omid Nasiri , Azam Alamdari , Farzanehsadat Minoo , Mehrshad Abbasi , Saeed Farzanefar , Mohammad Reza Abbasi Page 4
    Background
    The assessment of body composition during the course of treatment of hemodialysis patients is crucial for optimal treatment. We intended to assess the diagnostic performance of bioelectrical impedance analysis (BIA), which could be used at the bedside in dialysis wards, and compare it with the results of dual-energy X-ray absorptiometry (DEXA).
    Methods
    In a cross-sectional study, 43 patients with end-stage renal disease (ESRD) after hemodialysis sessions underwent direct segmental multi-frequency BIA. Volume status and body composition indices with eight electrodes connected to four limbs were measured at 1, 5, 50, 250, 500, and 1000 kHz frequencies. Then, the patients were sent to the nuclear ward for the corresponding assessments by DEXA. The results of the two methods were compared by a paired t-test and the correlations were assessed using general linear models and regression analyses. For the assessment of agreements, Bald-Altman plots were used.
    Results
    The whole body values for bone, fat, and lean body mass were different between BIA (3.4, 22, and 44.5 kg, respectively) and DEXA (1.5, 28.5, and 40.4 kg, respectively). However, the results were strongly linearly correlated even after adjustment for age and sex (r = 0.67, P = 0.001 for bone mass; r = 0.93, P = 0.001 for fat mass; and r = 0.96, P = 0.001 for lean body mass). The same strong correlation was found for the segmental values.
    Conclusions
    The results of BIA and DEXA are correlated strongly and are interchangeable. As the BIA is more easily available and less expensive, the routine use of BIA at hemodialysis departments is reasonable
    Keywords: Dual-Energy X-Ray Absorptiometry (DEXA), Bioelectrical Impedance Analysis (BIA), Hemodialysis, Body Composition, Fat Mass, Bone Mass, Lean Body Mass
  • Shirin Salajegheh , Ali Asghar Ketabchi* Page 5
     
    Objectives
    To evaluate the effect of acupuncture on the semen quality of patients with clinical varicocele and their fertility outcomes.
    Methods
    A total of 158 men, with the primary infertility and clinical varicocele were randomized into two groups. The study group underwent a subinguinal microscopic varicocelectomy, and control group without operation. Then, each group was randomized to two sub groups; the first subgroups from them (sub group study 1 and sub group control 1) underwent acupuncture treatment twice a week for 2 months, the next subgroups (sub group study 2 and sub group control 2) underwent sham acupuncture. All subgroups were evaluated by performing spermogramms after 6 months and notifications were made by phone call for the results of their wives pregnancy.
    Results
    The pre-treatment sperm parameters were statistically similar in all groups, however, post treatment results were significantly improved in varicocelectomized and acupuncture subgroups in comparison to control sub groups. The pregnancy rate after 24 months follow up in study subgroups were significantly better than control subgroups.
    Conclusions
    According to our results, in this study acupuncture procedures in primary infertile clinical varicocele patients with semen abnormalities was effective, especially if combined by varicocelectomy
    Keywords: Acupuncture, Clinical Varicocele, Infertility, Pregnancy Rate
  • Farzanehsadat Minoo , , Elham Ramezanzade , * , Mehrzad Mojarad , Azam Alamdari , , Mohammad Taghi Najafi Page 6
    Background
    Fibroblast growth factor-23 (FGF23) is a phosphaturic factor that is released from bone. A variety of bone diseases can occur in renal diseases.
    Objectives
    This study aimed to investigate the association of FGF23 with mineral factors, PTH, and 25-hydroxyvitamin D among hemodialysis patients.
    Methods
    This cross-sectional multicenter study was performed on 135 patients aged 18 years or over with end-stage renal disease treated with hemodialysis maintenance. FGF-23, phosphorus, Ca, Mg, PTH, 25-hydroxyvitamin D, Uric Acid, Na, and K were measured in each patient’s fasting blood sample. We used univariate and multivariate linear regressions.
    Results
    The mean age of patients was 56.45 ± 13.64 years. The mean and median FGF23 concentration in patients were 855.07 ± 43.33 and 762.6 (IQR = 456.6 - 1430.3) pg/mL, respectively. Different variables did not show any significant difference between the two sexes. After adjustment for age, sex, dialysis time, uric acid, Na, K, and kt/V, FGF23 had a linear association with 25-hydroxyvitamin D and every 10-unit (pg/mL) increase in FGF23 was significantly associated with a 0.03 mg/mL increase in 25-hydroxyvitamin D (P = 0.04). In addition, other variables showed no significant association with FGF23.
    Conclusions
    According to the results, FGF23 had a linear association with vitamin D and an increase in FGF23 was significantly associated with an increase in vitamin D. In addition, there was no significant association between mineral factors and PTH, and FGF23
    Keywords: Fibroblast Growth Factor-23, Mineral Factors, Parathyroid Hormone, 25-hydroxyvitamin D, Hemodialysis Patients