Renal function assessment in adults with recurrent calcium kidney stone disease

The prevalence of nephrolihiasis and chronic kidney disease has risen over the past three decades, we sought to determine if person with a history of kidney stones have lower renal function relative to non stone formers. Methods: We conducted a case-control study utilizing 138 recurrent calcium kidney stone formers and 127 age and gender matched controls with no history of renal disease, all subjects were aged 30-55 years old, with no history of hypertension, diabetes mellitus, congestive heart failure and liver disease and also no urinary tract obstruction and medications can affect Glomerular Filtration Rate (GFR). We estimated GFR by Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EP I) equations and categorized using cut points suggested by Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines. Results: Mean GFR in case group and control group was: 80.17(18.45) ml/min/1.73m2 and 83.80(15.75) ml/ min/1.73m2 respectively (P value: 0.09). Distribution of subjects among stone formers in stage I, II, III was 59(42.8%), 71(51.4%) and 8(5.8%) and in control group was 67(52.8%), 59(46.4%) and 1(0.8%) respectively, (p: 0.03). There was an inverse correlation between GFR and number of passed stone but there was no significant correlation between history of extracorporeal shock wave lithotripsy (ESWL) or percutaneous nephrolithotomy (PCNL) and estimated GFR. Conclusion: Recurrent calcium stone disease may be associated with nephron damage and an increased risk of chronic kidney disease

The relationship between anthropometric parameters and bone mineral density in an Iranian referral population

Osteoporosis is a common health concern in both developed and developing countries. In this study the association between anthropometric measures and osteoporosis was investigated in 3630 males and females visiting BMD clinic of Shariati Hospital, Tehran, Iran, a teaching hospital and referral center for osteoporosis affiliated to the Tehran University of Medical Sciences. Anthropometric measurements obtained and also Bone Mineral Density (BMD) measurement was done using a Lunar DPXMD densitometer. Data were analyzed using SPSS with Chi-square and ANOVA with post-hoc tests. Results showed that the weight, BMI and age had the strongest correlation with the BMD values in the studied people. While age is negatively correlated with BMD in all the studied people, a positive association was noted between weight, height and BMI and BMD parameters (P<0.01). It was concluded that certain anthropometric parameters (BMI and weight) can considerably affect one's risk of developing osteoporosis. Further research on the effect of these variables on the association of weight and BMD is needed

A comparison of antibiotic disks from different sources on Quicolor and Mueller-Hinton agar media in evaluation of antibacterial susceptibility testing

Background and Objectives: Antibacterial susceptibility testing of clinical bacterial isolates through disk diffusion method plays a major role in antibacterial treatment. One of the main factors affecting the result of these tests is the type, structure and quality of the disks. The main objective of this study was to compare the agreement of antibiotic disks originated from three companies on Quicolor and Mueller-Hinton agar. Materials and Methods: Quicolor and Mueller-Hinton agar media were used in disk diffusion method. Seventy clinical isolates from Enterobacteriaceae family (21 Klebsiella spp., 36 Escherichia coli, 1 Enterobacter spp. and 12 Shigella spp.) were investigated in the study. After obtaining data, the results were interpreted as resistant, sensitive or intermediate. Kappa coefficient measured the agreement of two media. Coefficient of variation (CV) was also calculated for antibiotic disks. Results: The kappa agreement values for three types of antibiotic disks on Quicolor and Mueller-Hinton agar plates were good or excellent for all the examined antibiotics. CV values were also very satisfactory in the majority of cases. Conclusion: Antibiotic disks from three manufacturers can successfully be used on both Quicolor and Mueller-Hinton agar plates

Malaria elimination in Iran, importance and challenges

Background: The aim of study is to assess the importance and challenges of Malaria elimination (ME) in Iran's health system. Material: Opinion of experts from Ministry of Health and Medical Education and the chancellors of medical universities affected by malaria were gathered using Focus Group Discussions and in­depth interviews. We asked them about the importance and main challenges of ME in Iran. Results: Main factors on importance of ME were: it's a struggle to reach to equity in the poorest regions of county, prevention of emerging disease in susceptible regions, lowering the cost of control and its effects on the region's socioeconomic condition. Main challenges were Iran's long border with malaria­endemic countries Pakistan and Afghanistan and illegal immigrants, underdevelopment in rural areas, system's insensitivity and diagnosis problem due to reduction of cases. Conclusion: Quantitative and holistic researches are needed for assessing the consequences of ME

Is a Low Sacral Ratio Associated with Primary Vesicoureteral Reflux in Children?

Introduction: The association of sacral anomalies with fecal incontinence and lower urinary tract dysfunction is known. The sacral ratio is proposed as a tool for evaluation of sacral development. The aim of this cross-sectional study was to evaluate the prevalence and severity of vesicoureteral reflux in children with a low sacral ratio.Materials and Methods: Six hundred and sixty nine children who were referred to a radiology clinic for a standard (fluoroscopic) VCUG to detect vesicoureteral reflux and other anomalies of the lower urinary tract after an episode of urinary tract infection were included in the study and their sacral ratios were measured. Results: All children were younger than 14 years of age (mean 3.44±3.20). Of 669 children, 593 (88.6%) had normal sacral ratios out of whom 423 (71.3%) did not have VUR and 170 (28.7%) had VUR. Seventy-six (11.3%) children out of 669 cases had low sacral ratios; 49 (64.5%) of them had no VUR and 27 (35.5%) had VUR. There was no significant difference in the prevalence of VUR between children with and without a low sacral ratio (p value=0.217). Also, there was no significant difference or trend between a low sacral ratio and the severity of reflux (Chi2 for trend).Conclusions: Although sacral anomalies may be related to some cases of VUR by producing lower urinary tract dysfunction, the sacral ratio is not associated with VUR.Keywords: Sacral agenesis; Vesico-Ureteral Reflux; Urination Disorders; Anorectal Anomalies; chil

Cost-effectiveness of treating hepatitis C in Seychelles

Introduction: approximately eighty million people around the world are living with hepatitis C, and 700,000 people die every year, due to hepatitis C related complications. In Seychelles, a total of 777 cases of hepatitis C were reported from 2002 to 2016, but up to mid of 2016, the cases were not being treated. Treatment with Harvoni, a combination of sofosbuvir and ledipasvir (SOF/LDV), is now being offered on the condition that the patient does not, or has stopped, injecting drugs. This paper is the first to establish the cost effectiveness of treating all cases of hepatitis C in Seychelles with Harvoni, as compared to no treatment. Methods: data extracted from literature was used to populate an economic model to calculate cost-effectiveness from Seychelles' Government perspective. The model structure was also informed by the systematic review and an accompanying grading of economic models using the Consolidated Health Economic Evaluation Reporting Standard (CHEERS) checklist. A Markov model was developed, employing a lifetime horizon and costs and benefits were analysed from a payer's perspective and combined into incremental cost effectiveness ratios (ICERs). Results: the direct-acting antiviral (DAA), Harvoni, was found to be cost-saving in Seychelles hepatitis C virus (HCV) cohort, as compared to no treatment, with an ICER of € 753.65/QALY. The treatment was also cost-saving when stratified by gender, with the ICER of male and female being € 783.74/QALY and € 635.20/QALY, respectively. Moreover, the results obtained from acceptability curves showed that treating patients with Harvoni is the most cost-effective option, even for low thresholds. Conclusion: treating hepatitis C cases in Seychelles is cost-saving. It is worth developing a treatment programme to include all cases of hepatitis C, regardless of status of drug injection

Relationship between breast feeding and obesity in children with low birth weight

Background: Breast feeding appears to play a role in determining obesity and abdominal obesity during childhood, specifically in children with a history of low birth weight. Objective: The purpose of this study is to investigate the relation of breast-feeding with either of abdominal obesity and obesity among Iranian school children. Materials and Methods: A total of 1184 students (625 girls and 559 boys), aged 10 to 13 years old, were selected from 112 governmental elementary schools in Iran. Height, weight, waist circumference and blood pressure were measured using standard instruments and a pretested standardized questionnaire was performed for compiling information about family economics and educational level, first–degree family history of obesity, history of breast feeding, food pattern and birth weight, as well. Results: 13.68% (n = 160) of students had a history of low birth weight, and 26.41% of them had abdominal obesity. Of all participants, 22.04% were overweight and 5.32% were obese which was more prevalent in girls than in boys (P = 0.03). First-degree family history of obesity (P = 0.001), excessive gestational weight gain (P = 0.001) and birth weight (P = 0.01) were significantly correlated with the prevalence of obesity and abdominal obesity during childhood. Moreover the prevalence of abdominal obesity in children with low birth weight was significantly correlated with breast feeding (P = 0.04); But this relation was not significantly about obesity in our participants (P = 0.9). Furthermore duration of breast feeding was significantly and inversely correlated with obesity and abdominal obesity in schoolchildren with low birth weight (P = 0.01). Conclusions: The results suggest that Breast feeding and its long-term consequences were important factors for preventing metabolic syndrome criteria in childhood and later years of life span. With regard to the increasing prevalence of obesity in children, more research is urgently needed to clarify whether breast feeding have negative consequences for the risk of chronic disease in children, especially in children with low birth weight

Effects of intrathecal opioids use in cesarean section on breastfeeding and newborns’ weight gaining

Objective: To assess the association between intrapartum intrathecal opioid use and breastfeeding and weight gain following cesarean section. Materials and methods: The prospective double-blinded study was conducted on term pregnant women, undergoing elective cesarean section under spinal anesthesia. They divided into two groups. In the first group, intrathecal Morphine was used to achieve analgesia during or after the operation. The remainder divided into two subgroups, those who did not receive any opioid or those received systemic opioids. Following labor breastfeeding accessed in a follow-up, two month latter. Results: There was no difference between the demographic variables of the mothers and newborns APGAR score and weight at the time of birth. Breastfeeding rate was similar in intrathecal group in compare with other patents (P value = 0.518). While, the infants’ weight at the end of second month was lower in spinal opioid group (P value = 0.036). Conclusion: The present study was the first to suggest that spinal (intrathecal) opioids do not have any impact on breastfeeding. However the relationship between spinal anesthesia on weight gaining needs more investigation

A cost-utility analysis of different antiviral medicine regimens in patients with chronic hepatitis C virus genotype 1 infection

Background: Despite the introduction of new drug regimens with high effectiveness for the hepatitis C virus (HCV) patients, especially in HCV genotype 1, no cost-effectiveness study on the selection of the superior drug strategy in Iran has been conducted yet. Objectives: This study is aimed to assess the cost-effectiveness of the three drug regimens of pegylated interferon and ribavirin (PR), sofosbuvir (SOF) + PR and ledipasvir and sofosbuvir (LDV/SOF) in patients with HCV genotype 1 in Iran in the year 2014. Methods: A Markov micro-simulation model was used to evaluate the cost-effectiveness of the three drug strategies for a cohort of 10000 patients. Quality-adjusted life-years (QALYs) were extracted from published studies. Cost data was estimated through the review of medical records and obtaining experts opinion. Results: The results showed that the SOF + PR drug compared with PR had a lower cost and was more effective, but compared with the LDV/SOF, in spite of its lower cost, it was less efficient. The QALY values obtained for PR, SOF + PR and LDV/SOF, respectively, were 10.98, 12.08 and 12.28 and their costs were $41,741,$ 7,676 and $46,993. Moreover, the results obtained from acceptability curves showed that SOF + PR were the most cost-effective treatment for thresholds below$ 45,270 PPP. Conclusions: The use of SOF + PR regimen or LDV/SOF can significantly reduce the incidence of complications associated with the disease. For example, short and long-term outcomes are better than the current drug regimens for HCV genotype 1 patients in all stages of the disease

The reliability and validity of the persian version of sinonasal outcome test 22 (Snot22) questionnaires

Background: The quality of life (QOL) is an important indicator for disease-severity classification and outcome measurement in obtaining treatment sinonasal diseases. The sinonasal outcome test 22 (SNOT 22) questionnaire has been introduced as the best specific sinonasal instrument for QOL measurement. Objectives: To prepare a valid and reliable Persian language version of SNOT 22 questionnaire. Patients and Methods: After forward and backward translation of the original version of SNOT 22 questionnaire from English to Persian, a group of patients with nasal septal deviation who need septal surgery and another group of healthy volunteers answered the Persian version of the questionnaire. The responsiveness rate, validity (Pearson correlations and differential validity) and reliability (internal consistency and test-retest reliability) of the 22 items of the questionnaire was calculated. P value < 0.05 was considered significant. Results: Thirty adults with nasal septal deviation need surgical correction and 30 healthy volunteers were included (mean age 30.4 ± 7.1 vs. 33 ± 6.7, P value = 0.148). The questionnaire was introduced to subjects two times with a two-week-period gap. Total responsiveness rate for 22 items was more than 97%. The total Cronbach's Alfa coefficient was 0.898 (ranging 0.890-0.903). The Pearson correlations were 0.85 and 0.96 for patients and healthy volunteers, respectively. The mean total score were 25.6 ± 13.3 (range 6-52) and 7.6 ± 9.1 (range 0-45) in patients and healthy volunteers, respectively (P < 0.0001). The subscales scores were also significantly different between two groups. Conclusions: The Persian version of SNOT 22 questionnaire is a valid and reliable instrument for accessing sinonasal diseases in Persianspeaking people