Long-term complications of continent catheterizable channels: a problem for transitional urologists.

A majority of the transitional urology patient population have neurogenic bladder and many of these patients have undergone creation of continent catheterizable channels (CCCs) to facilitate bladder emptying. Transitional urologists will be faced with revision of these channels due to a variety of possible complications. We performed a comprehensive literature review to the data regarding the incidence, timing, and predisposing factors that lead to complications of CCCs as well as surgical revision techniques and their outcomes. Long-term channel complications and related revisions are common (25-30%) and likely underestimated. While many predictors for revision have been posited, the only predictor that has been significant in robust multivariable analysis is channel type, with appendicovesicostomies having a lower chance of requiring revision compared to Monti channels. Channels created in adults have high likelihood of requiring revision, even within a relatively short follow-up period. We review techniques for management of channel complications and their outcomes. As patients with congenital urologic conditions requiring CCCs are gaining longer lifespans, transitional urologists will be faced with revision and/or replacement of these channels. While some of these patients may require supravesical diversion in the future, data show that revision is feasible with good outcomes. Longer-term follow-up data is needed to understand the life-span and best practices of new CCCs created among the transitional population

Correlation of serum magnesium with dyslipidemia in maintenance hemodialysis patients.

One of the factors involved in accelerated atherosclerosis in hemodialysis patients is dyslipidemia. In this study we considered factors involved in intensification of dyslipidemia in hemodialysis patients. This study was done on 36 maintenance hemodialysis patients. Serum lipoprotein (a), Triglyceride, Cholesterol, HDL-C,LDL-C and also serum Intact parathormone(iPTH), Calcium, Phosphorus, Magnesium were measured. In statistical analysis there was not any correlation between serum lipids and iPTH. There was not correlation between serum calcium with serum lipids (p > 0.05). There was not correlation between CaxP product with serum lipids (p > 0.05). There was a positive correlation between serum Magnesium and Lipoprotein(a) (P < 0.05) and also positive correlation between serum magnesium with triglyceride level (P < 0.05) was seen too. Magnesium doesn't increase the lipoprotein synthesis. It may involve in the regulation of some enzymes responsible for lipoprotein synthesis. Correlation of serum magnesium with serum triglycerides can be due to changes in hepatic triglyceride metabolism. Lipoprotein(a) is a non traditional factor of premature atherosclerosis, its association with serum magnesium needs more attention in hemodialysis patients

Positive correlation of serum leptin with blood lymphocytes in maintenance hemodialysis patients

Objective: The objective of this study was to find the association of serum leptin with blood lymphocyte and polymorphonuclear (PMN) percentages as the markers of immune system function as well as nutritional status in maintenance hemodialysis patients. Design: In a group of maintenance hemodialysis patients, serum leptin, albumin, creatinine, blood urea nitrogen, and white blood cell counts consisting of lymphocytes and PMN cells were measured. Results: A significant positive correlation of serum leptin with body mass index, a significant positive correlation of serum leptin with lymphocyte percentage, and a significant inverse correlation of serum leptin with PMN percentage were seen. Near significant inverse correlations of white blood cell counts with duration and dosage of dialysis, a near significant inverse correlation of white blood cell counts with hemodialysis adequacy, and a significant inverse correlation of white blood cell counts with serum albumin were seen. Conclusion: Generally, increased neutrophil counts and reduced lymphocyte counts are independent predictors of increased mortality risk in hemodialysis patients. Although this study and others showed positive association of serum leptin with lymphocytes and an inverse correlation of serum leptin with PMNs, the authors conclude a protective role for leptin in decreasing mortality in hemodialysis patients; therefore, serum leptin in hemodialysis has a reverse epidemiology role for maintaining immune system function in hemodialysis

Association of serum lipoprotein(a) with ultrasonographically determined early atherosclerotic changes in the carotid and femoral arteries in kidney transplanted patients

Objectives. To evaluate the association of serum lipoprotein(a) Lp(a)] with carotid intimal media thickness (IMT) and carotid femoral plaque occurrence in kidney transplant patients. Patients and Methods. Fifty-four subjects included 29 group 1 normal healthy persons and 25 group 2 kidney transplant patients underwent carotid IMT measurements and carotid femoral plaque assessment by B-mode ultrasonography. Also we measured cholesterol, triglyceride, HDL-C, LDL-C and Lp(a) as well as BUN and creatinine. Results. There was a significant difference between Lp(a) in the two groups (P = .016). There was a significant difference between carotid IMT of the two groups (P .05). There was a significant correlation between carotid IMT with age in Group 1 (P = .035). No correlation between carotid IMT and serum Lp(a) was seen in the two groups. No significant correlations between plaque score and serum Lp(a) were observed. There was no correlation between duration of transplant and thickening of intimal media complex in this group. In this group a positive correlation was demonstrated between carotid IMT with serum LDL-C (P < .001). Conclusions. Age was the most important factor associated with thickening of intimal media complex in normal subjects and in plaque formation in the renal transplant group. Serum LDL-C may be associated with thickening of intimal media complex in kidney transplant patients. Serum Lp(a) may not be a significant factor in thickening of the intimal media complex or plaque occurrence in kidney transplant patients

Histopathological study of the combination of metformin and garlic juice for the attenuation of gentamicin renal toxicity in rats.

INTRODUCTION Tubular toxicity is one of the most important side effects of aminoglycoside antibiotics, especially gentamicin. OBJECTIVES We histopathologically studied the effect of garlic extract and metformin co-administration, in attenuation of genetamicin induced tubular toxicity in rats. MATERIALS AND METHODS In this study seventy rats were divided into seven equal groups and except group 1 (control) were injected 100 mg/kg/day gentamicin (GM) intraperitoneally (i.p.) for 10 days. Other than GM, group III received 20 mg/kg garlic (i.p.), group IV metformin (MF) (100 mg/kg, orally), group V a combination of MF with garlic juice (100 and 20 mg/kg/day, respectively) and group VI a combination of MF and garlic juice (50 and 10 mg/kg/day, respectively) for following 10 days. Group VII received a combination of MF and garlic juice (100 and 20 mg/kg, respectively) along with GM. Animals were sacrificed on the 20(th) day of the experiment and the kidneys were removed for histological examinations. RESULTS GM induced nephrotoxicity and garlic or MF alone and a combination of both with high doses (not low doses) significantly abolished the kidney tubular injury induced by GM. In addition, co-administration of GM, MF and garlic (group 7) prevented the GM- induced tissue damage more than the groups in which MF and garlic were injected 10 days post GM administration. CONCLUSION Garlic extract and Metformin, alone or in a combination, might be safely used to ameliorate GM induced tubular toxicity

Association of body mass index and serum vitamin D level in healthy Iranian adolescents

Introduction: In studies of obese adolescents in various countries, vitamin D deficiency has been correlated with greater weight and elevated BMI. However, there is insufficient data on the relation between vitamin D status and body fat indexes in adolescence. The aim of this study was to investigate the association of serum (25OHD) concentrations with body mass index of healthy Iranian subjects to understand whether specific data on the relation between vitamin D status and body mass index is common in all populations. Material and methods: Data was collected from 259 ambulant medical staff adults, students and other subjects who met the inclusion criteria of the study. Body mass index and fasting 25-Hydroxy vitamin D level were measured. Vitamin D deficiency was defined as having a 25(OH)D concentration &lt; 25 nmol/L. Results: Participants were aged 20-64 years, mean age 34 ± 9 years, and about 57.5% of the participants were women. The mean (± SD) body mass index (kg/m 2) was 24.2 ± 3.8 kg/m2 (median = 23.7 kg/m 2), the mean (± SD) vitamin D level of the participants was 29 ± 16 nmol/L (median = 26 nmol/L), and 48% of the participants had vitamin D deficiency. In this study, there was no significant association between vitamin D level and BMI (r = 0.064; p = 0.307) (age adjusted). Moreover, there was no association between vitamin D level and sex of the participants. In addition, no association between BMI and sex of the adolescents was seen (p; NS), but a significant association between age and vitamin D level was found (r = 0.002). Conclusion: Our data suggests that various mechanisms could potentially contribute to the robust association of vitamin D with adiposity; in normal or near normal BMI, vitamin D status may not be correlated with age

Lipids in association with leptin in maintenance hemodialysis patients

To consider the association of serum leptin with dyslipidemia in hemodialysis patients. For maintenance hemodialysis patients levels of serum pre and post dialysis blood urea nitrogen, lipid profiles and serum Leptin were measured. For the adequacy of hemodialysis the urea reduction rate was calculated. A significant difference of serum leptin between males and females of diabetics with more values in female dialysis patients was seen. In total patients a near significant and inverse correlation of serum leptin with serum LDL was seen. In male hemodialysis group a significant positive correlation of serum leptin with duration of hemodialysis and with the ages of the patients were seen, in this group also a near significant positive correlation of serum leptin with serum triglyceride levels was seen too. In total patients there was a near significant positive correlation of serum leptin with serum cholesterol of patients who had a cholesterol levels of more than 100 mg dL-1. Present data supports the hypothesis that in patients on hemodialysis, the association of leptin with cholesterol and triglyceride levels could show the positive effects of leptin on nutrition in hemodialysis patients which is in contrast to normal population