Methadone Replacement Therapy and Sexual Disorders among Opium Dependent Iranian Men: A Meta-Analysis Study

Background: Evaluation of sexual disorders among persons receiving methadone replacement therapy is of great importance, because these problems may lead to non-compliance and relapse. This study aimed to estimate the effect of methadone maintenance therapy (MMT) on sexual function among addicted Iranian men using met-analysis.Methods: Investigating the available data banks, relevant studies were identified. After exclusion of duplicates, irrelevant papers and low quality articles, eligible papers were entered into the meta-analysis. Prevalence and standardized mean difference of sexual function scores were illustrated by forest plots based on sexual desire, orgasm and erectile function.Findings: During the primary search, 5341 evidences were identified. After application of the inclusion/exclusion criteria and quality assessment, nine papers were detected eligible for final meta-analysis. Total prevalence [95% confidence intervals (CI)] of sexual disorders and erectile dysfunction among Iranian men under methadone therapy were estimated as 66.3% (27.1-105.5) and 77.5% (61.9-93.1), respectively. The standardized mean differences (95% CI) of Sexual desire, orgasm and erection before and after methadone therapy were estimated as 0.16 (-0.68, 0.99), -0.01 (-0.75, 0.74) and 0.11 (-0.41, 0.64), respectively.Conclusion: This meta-analysis showed that methadone therapy did not significantly influence the sexual desire, erectile function and orgasm among opium dependent men

Enabling informed policymaking for chronic kidney disease with a registry:Initiatory steps in Iran and the path forward

Objectives: Chronic kidney disease (CKD) registries have been used for more than half a century. Iran lacks a comprehensive registry to capture data of all CKD patients for an informed care planning and policy making. We aimed to identify the objectives and possible challenges for developing a CKD registry and also to define its minimum data set (MDS) in our healthcare context.Methods: This was a mixed-method study conducted in Iran from fall 2016 till summer 2017. The qualitative part included document analysis and 26 semi-structured interviews with 17 clinicians and managers involved in CKD care. This data was analyzed using the "grounded theory". Then, a modified Delphi survey was conducted. Percentages and mode values were used for analysis.Results: Our participants' leading interest in a CKD registry was centered on providing a coordinated, good-quality care for all CKD stages with particular emphasis to capture events and monitor trends for patients in earlier stages. They highlighted the required financial, technical and human resources as main challenges for a smooth registry implementation. Furthermore, a clinically oriented MDS comprising of 168 elements (with a majority having more than 90% agreement with mode 2) was extracted. It mainly collects demographics, medical history, encounter sessions, diagnostic examinations, medications, vaccinations and mortality data.Conclusions: We reported the initiatory steps taken to establish a CKD registry in an Iranian healthcare context. We focused on the information needs and priorities of our main stakeholders and based our intended registry on addressing those needs. We hope this approach will facilitate its endorsement and advance the efforts for a sustainable, good-quality CKD care. (C) 2018 Fellowship of Postgraduate Medicine. Published by Elsevier Ltd. All rights reserved

Enabling informed policymaking for chronic kidney disease with a registry:Initiatory steps in Iran and the path forward

Objectives: Chronic kidney disease (CKD) registries have been used for more than half a century. Iran lacks a comprehensive registry to capture data of all CKD patients for an informed care planning and policy making. We aimed to identify the objectives and possible challenges for developing a CKD registry and also to define its minimum data set (MDS) in our healthcare context.Methods: This was a mixed-method study conducted in Iran from fall 2016 till summer 2017. The qualitative part included document analysis and 26 semi-structured interviews with 17 clinicians and managers involved in CKD care. This data was analyzed using the "grounded theory". Then, a modified Delphi survey was conducted. Percentages and mode values were used for analysis.Results: Our participants' leading interest in a CKD registry was centered on providing a coordinated, good-quality care for all CKD stages with particular emphasis to capture events and monitor trends for patients in earlier stages. They highlighted the required financial, technical and human resources as main challenges for a smooth registry implementation. Furthermore, a clinically oriented MDS comprising of 168 elements (with a majority having more than 90% agreement with mode 2) was extracted. It mainly collects demographics, medical history, encounter sessions, diagnostic examinations, medications, vaccinations and mortality data.Conclusions: We reported the initiatory steps taken to establish a CKD registry in an Iranian healthcare context. We focused on the information needs and priorities of our main stakeholders and based our intended registry on addressing those needs. We hope this approach will facilitate its endorsement and advance the efforts for a sustainable, good-quality CKD care. (C) 2018 Fellowship of Postgraduate Medicine. Published by Elsevier Ltd. All rights reserved

Appendix graft as a ureter substitution in recurrent ureter stenosis in horse -shoe kidney; a case report

Background: A horseshoe kidney is the most common renal fusion anomaly and occurs in 0.2% to 0.3% of the population. Horseshoe kidneys are fused by the formation of an isthmus between the lower poles of the left and right kidneys during development. The insertion of the ureter in the renal pelvis is displaced super-laterally, probably as the result of incomplete renal rotation, and is associated with a significant rate of ureteropelvic junction (UPJ) obstruction. Case Presentation: We report a patient with single kidney at right side with obstruction in upper ureter. Before the surgery our plan was transureteroureterostomy according to failure of previous surgeries, dismembered pyeloplasty and ureterocalicostomy, but after mobilizing the proximal ureter we noticed that transureteroureterostomy was impossible because of short fibrotic ureter. Other choices such as Boari flap technique with psoas hitch is impossible because of small fibrotic bladder, so we decided to use appendix as ureter substitute. Conclusions: According to our experience and previous studies, we can use appendix as a ureter substitution in refractory proximal and middle ureter stenosis, but in our case we anatomized proximal ureter to appendix instead of anastomosis of pelvic to appendix

Determinant Factors in Graft Rejection Using Cox Regression, among the Recipients of Second Renal Transplant in Imam Khomeini Hospital in Urmia, 1988-2000

Background: The objective of this study was to evaluate graft survival among the recipients of second renal transplant in Imam Khomeini centre hospital in Urmia. Methods: The study population consisted of 50 patients receiving renal grafts for the second time between 1988 and 2008 in Imam Khomeini centre hospital in Urmia. Two survival outcomes, first and second graft survival, were analyzed. Graft survival was defined from date of transplant until its rejection. For the purpose of graft survival analysis, graft failure was defined as return to dialysis, and death due to the functioning graft. Data were collected through individual patient questionnaires. Demographic and clinical factors, transfusion history, type of immunosuppressive drugs, levels of serum creatinine, triglyceride, cholesterol, and LDL at 3 and 6 months after transplantation were collected. Cox-proportional hazard model and Kaplan-Meier were used to data analysis. Results: First graft survival at 1, 2, 3, and 5 years was 74%, 66%, 53%, and 41%, respectively. Second graft survival at 1, 2, 3, and 5 years was 81%, 74%, 70%, and 61%, respectively. Causes of graft loss in first renal transplantation were 6% sever acute graft rejection, 12% acute graft rejection and 82% chronic graft rejection. In the multivariate analysis, only serum creatinine, blood pressure, and immunosuppressive drugs predicted first graft loss and serum creatinine, immunosuppressive drugs, and related donor family predicted second graft rejection. Conclusion: The serum creatinine and immunosuppressive drugs including cyclosporine, cellcept, and prednisolone are the most influential factors on graft survival

Enabling informed policymaking for chronic kidney disease with a registry: Initiatory steps in Iran and the path forward

Objectives: Chronic kidney disease (CKD) registries have been used for more than half a century. Iran lacks a comprehensive registry to capture data of all CKD patients for an informed care planning and policy making. We aimed to identify the objectives and possible challenges for developing a CKD registry and also to define its minimum data set (MDS) in our healthcare context. Methods: This was a mixed-method study conducted in Iran from fall 2016 till summer 2017. The qualitative part included document analysis and 26 semi-structured interviews with 17 clinicians and managers involved in CKD care. This data was analyzed using the "grounded theory". Then, a modified Delphi survey was conducted. Percentages and mode values were used for analysis. Results: Our participants' leading interest in a CKD registry was centered on providing a coordinated, good-quality care for all CKD stages with particular emphasis to capture events and monitor trends for patients in earlier stages. They highlighted the required financial, technical and human resources as main challenges for a smooth registry implementation. Furthermore, a clinically oriented MDS comprising of 168 elements (with a majority having more than 90% agreement with mode 2) was extracted. It mainly collects demographics, medical history, encounter sessions, diagnostic examinations, medications, vaccinations and mortality data. Conclusions: We reported the initiatory steps taken to establish a CKD registry in an Iranian healthcare context. We focused on the information needs and priorities of our main stakeholders and based our intended registry on addressing those needs. We hope this approach will facilitate its endorsement and advance the efforts for a sustainable, good-quality CKD care