Can bloodstream infection be predicted by nasal culture in hemodialysis patients?

The blood and drainage cultures are suggested for early diagnosis of bloodstream infection (BSI), which are time consuming and laborious. Nasal colonization of bacteria is one of the modalities, occasionally can predict BSI. We hypothesized that nasal culture, as an accessible fluid may be helpful to predict future BSI in hemodialysis patients. The present prospective study evaluated 63 patients undergoing maintenance hemodialysis at the Pars hospital dialysis center, Tehran, Iran, from November 2015 until February 2016. Nasal fluid of patients were collected from the 1–cm internal anterior part of both nostrils of patients by a sterile swab and cultured in Trypticase soy agar. All patients were followed for three months for BSI. The results of first nasal fluid sample revealed that 33.3% in first sampling and 27.0% in sampling had positive nasal fluid culture. The type of bacteria in all positive cases was Staphylococcus aureus. The rate of BSI infection in the patients with positive and negative first nasal fluid culture was 9.5% and 2.4% respectively with no significant difference. We found also no significant association between BSI positivity and nasal culture results so that positive BSI was revealed in 5.9% of patients with positive nasal fluid culture and 4.3% in those with negative nasal fluid culture with no meaningful difference. None of the baseline variables including age and gender, underlying risk factor, access, or duration of dialysis was associated with BSI positivity. In hemodialysis patients, BSI may not be predicted by nasal fluid culture positivity

The effect of the Iranian family approachspecific course (IrFASC) on obtaining consent from deceased organ donors’ families

Background : A family approach and obtaining consent from the families of potential brain-dead donors is the most important step of organ procurement in countries where an opt-in policy applies to organ donation. Health care staff’s communication skills and ability to have conversations about donation under circumstances of grief and emotion play a crucial role in families’ decision-making process and, consequently, the consent rate. Methods : A new training course, called the Iranian family approach-specific course (IrFASC), was designed with the aim of improving interviewers’ skills and knowledge, sharing experiences, and increasing coordinators’ confidence. The IrFASC was administered to three groups of coordinators. The family consent rate of participants in the same intervals (12 months for group 1, 6 months for group 2, and 3 months for group 3) was measured before and after the training course. The Wilcoxon signed-rank test was used to make comparisons. Results : The family consent rate was significantly different for all participants before and after the training, increasing from 50.0% to 62.5% (P=0.037). Furthermore, sex (P=0.005), previous training (P=0.090), education (P=0.068), and duration of work as a coordinator (P=0.008) had significant effects on the difference in families’ consent rates before and after IrFASC. Conclusions: This study showed that the IrFASC training method could improve the success of coordinators in obtaining family consent

Prevalence and determinants of chronic kidney disease in northeast of Iran: Results of the Golestan cohort study.

BackgroundThe burden of chronic kidney disease (CKD) is increasing globally in particular in fast emerging economies such as Iran. Population-based studies on prevalence of CKD in Iran are scarce. The objective of the current study was to explore the prevalence and determinants of CKD in the setting of Golestan Cohort Study (GCS), the largest prospective cohort in the Middle East.MethodsIn this observational study, 11,409 participants enrolled in the second phase of GCS were included. Sex, age, literacy, residence, anthropometric measurements, smoking, opium use, self-reported history of cardiovascular diseases (heart disease and/or stroke), hypertension, diabetes, and lipid profile were the predictors of interest. The outcomes of interest were eGFR and CKD defined as eGFR< 60 ml/min/1.73m2.ResultsMean (SD) of GFR was 70.0 ± 14.7 ml/min/1.73m2 among all participants, 68.2 ± 14.2 among women, and 72.0 ± 15.0 among men. Prevalence of CKD was 23.7% (26.6% in women, 20.6% in men). The prevalence of CKD stages 3a, 3b, 4, and 5 were 20.0%, 3.3%, 0.4% and 0.1%, respectively. Female sex, older age, urban residence, history of CVD, hypertension or diabetes, larger body mass and surrogates of body fat and opium use were all associated with CKD. Opium had a significant positive association with CKD in adjusted model. All anthropometric measurements had positive linear association with CKD. Being literate had inverse association. Sex had significant interaction with anthropometric indices, with higher odds ratios among men compared with women. A significantly high association was observed between the rate of change in waist circumference and systolic blood pressure with risk of CKD.ConclusionOne in four people in this cohort had low eGFR. Obesity and overweight, diabetes, hypertension, and dyslipidemia are major risk factors for CKD. Halting the increase in waist circumference and blood pressure may be as important as reducing the current levels

Comparing adjusted ORs for deciles of anthropometric measurements.

<p>The fifth decile serves as the reference group. Each decile includes approximately 1,100 participants. BMI: Body Mass Index, WHR: Waist to Hip Ratio, WHT: Waist to Height Ratio.</p

Association of anthropometric measurements with chronic kidney disease (CKD) defined as eGFR<60 ml/min/1.73m² using restricted cubic splines.

<p>(A) Body Mass Index: using knots from 15 to 45 by 2.5 unit intervals and the reference point of 22.5 kg/m². (B) Waist Circumference (cm) with knots ranging from 60 to 140 by 10 unit intervals and the reference point of 90 cm. (C) Waist to hip ratio (WHR): using knots ranging from 0.7 to 1.4 with 0.1 unit intervals and the reference point of 0.9. (D) Waist to height ratio (WHT): using knots ranging from 0.4 to 0.9 with 0.1 unit intervals and the reference point of 0.6.</p

Association of anthropometric measurements with chronic kidney disease stratified by sex.

<p>Association of anthropometric measurements with chronic kidney disease stratified by sex.</p

Association of systolic blood pressure and high density lipoprotein with chronic kidney disease.

<p>(A) Association of systolic blood pressure measurements with Chronic Kidney Disease using restricted cubic splines, with knots from 60 to 240 mmHg by 20 mmHg unit intervals and the reference point of 120 mmHg. (B) Association of High Density Lipoprotein (HDL) with Chronic Kidney Disease using restricted cubic splines, with knots from 20 to 140 mg/dL by 10 unit intervals and the reference point of 50 mg/dL.</p