The role of hemodialysis machines dedication in reducing Hepatitis C transmission in the dialysis setting in Iran: A multicenter prospective interventional study

BACKGROUND: Hepatitis C virus (HCV) infection is a significant problem among patients undergoing maintenance hemodialysis (HD). We conducted a prospective multi-center study to evaluate the effect of dialysis machine separation on the spread of HCV infection. METHODS: Twelve randomly selected dialysis centers in Tehran, Iran were randomly divided into two groups; those using dedicated machines (D) for HCV infected individuals and those using non-dedicated HD machines (ND). 593 HD cases including 51 HCV positive (RT-PCR) cases and 542 HCV negative patients were enrolled in this study. The prevalence of HCV infection in the D group was 10.1% (range: 4.6%– 13.2%) and it was 7.1% (range: 4.2%–16.8%) in the ND group. During the study conduction 5 new HCV positive cases and 169 new HCV negative cases were added. In the D group, PCR positive patients were dialyzed on dedicated machines. In the ND group all patients shared the same machines. RESULTS: In the first follow-up period, the incidence of HCV infection was 1.6% and 4.7% in the D and ND group respectively (p = 0.05). In the second follow-up period, the incidence of HCV infection was 1.3% in the D group and 5.7% in the ND group (p < 0.05). CONCLUSIONS: In this study the incidence of HCV in HD patients decreased by the use of dedicated HD machines for HCV infected patients. Additional studies may help to clarify the role of machine dedication in conjunction with application of universal precautions in reducing HCV transmission

Cardio-renal syndromes: report from the consensus conference of the Acute Dialysis Quality Initiative

A consensus conference on cardio-renal syndromes (CRS) was held in Venice Italy, in September 2008 under the auspices of the Acute Dialysis Quality Initiative (ADQI). The following topics were matter of discussion after a systematic literature review and the appraisal of the best available evidence: definition/classification system; epidemiology; diagnostic criteria and biomarkers; prevention/protection strategies; management and therapy. The umbrella term CRS was used to identify a disorder of the heart and kidneys whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction in the other organ. Different syndromes were identified and classified into five subtypes. Acute CRS (type 1): acute worsening of heart function (AHF–ACS) leading to kidney injury and/or dysfunction. Chronic cardio-renal syndrome (type 2): chronic abnormalities in heart function (CHF-CHD) leading to kidney injury and/or dysfunction. Acute reno-cardiac syndrome (type 3): acute worsening of kidney function (AKI) leading to heart injury and/or dysfunction. Chronic reno-cardiac syndrome (type 4): chronic kidney disease leading to heart injury, disease, and/or dysfunction. Secondary CRS (type 5): systemic conditions leading to simultaneous injury and/or dysfunction of heart and kidney. Consensus statements concerning epidemiology, diagnosis, prevention, and management strategies are discussed in the paper for each of the syndromes

Extreme hypofractionated radiosurgery in recurrent inoperable High-Grade Ultra-Large gliomas

Background: To elucidate the efficacy and toxicity of brain re-radiotherapy for recurrent large inoperable gliomas using radiosurgery. Materials and Methods: Between 2014 and 2018, extreme hypofractionated radiosurgery was performed using Accuray's Cyberknife (R) system on 14 lesions (12 patients) grade 4 recurrence lesions of 6 patients with anaplastic astrocytoma and 6 patients with glioblastoma who had previously undergone surgery and cranial radiotherapy and had a local-regional recurrence. Six patients (8 lesions) were given a biologic effective dose (BED10) of 48 Gy and lower, and six patients were given a BED10 of 59.5 Gy and higher. The Response Assessment in Neuro-Oncology Criteria (RANO) were used for tumor response, and the Common Terminology for Adverse Events (CTCAE) was used for adverse effect assessment. The primary endpoint was determined as overall survival, and first treatment and salvage treatment time. Results: The median age of the patients was 43 years, and the median Karnofsky Performance Status (KPS) was 70. The median time from the first radiotherapy to death was 34 months. The median time from the previous radiotherapy was 29.5 months (R:17-40). The median survival was 10 months for those with recurrence before 29.5 months and 11 months for those with recurrence after 29.5 months. The median total tumor volume was 29.224 mL (similar to 30 mL). One grade 4 toxicity was observed. Conclusion: Radiosurgery can be used effectively as salvage therapy in ultra-large inoperable gliomas