Effect of Serum Zinc Levels on Humoral Immune Response to Hepatitis B Vaccination in Patients on Dialysis

Introduction: Zinc deficiency causes abnormalities in immune response. In chronic hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients, impaired immune responses to vaccination have been reported. Therefore, we performed a study to determine the correlation between serum zinc levels and immune response to hepatitis B vaccination in patients on dialysis. Methods: A cross-sectional study including 95 CRF patients on dialysis (70 HD and 25 CAPD), (63 male and 32 female) with three dose regimens of vaccination against HBV was performed. Results: Four months after vaccination, there were 34 (36%) patients with sufficient HBs Antibody response (HBs Ab≥ 10 mU/mL ) and 61 ( 64% ) patients with insufficient HBs antibody response( HBs Ab< 10mU/mL ). The mean serum zinc level was 23.35±3.87 micmol/L (13.20-33 micmol/L). The mean serum zinc concentration was significantly higher in patients with sufficient HBs antibody level than patients with insufficient HBs antibody levels ( 24.94±4.17 versus 22.15±3.46, P= 0.005 ). In logistic regression analysis, independent variables that correlated with sufficient HBs Ab level ≥ 10 mU/mL included higher mean serum zinc level [OR=1.44 (1.02-2.02), P=0.006 ] and female gender [OR=1.8 (1.01-4.01), P=0.048] . Factors found to be insignificant included type of dialysis, age, diabetes mellitus as a cause of ESRD, serum creatinine and albumin levels. Conclusion: We conclude that failure to respond to HBV vaccination is significantly related to a low levels of serum zinc. However, clinical trial studies should be performed in order to confirm this finding

Measurement of Anterior–Posterior Diameter of Ivc By Ultrasonography: a Non Invasive Method for Estimation of Central Venous Pressure.

Introduction:The assessment of intravascular volume in severely traumatized patients or patients admitted in ICU is very essential. At present the accurate method for estimating the intravascular volume requirement is by measuring the CVP which is an invasive method. The measurement of IVC diameter by ultrasound has been suggested as an easily available and simple method for measuring the intravascular volume status. The purpose of this study was to compare the results of IVC diameter measurement by ultrasonography and CVP measurement for calculating the intravascular volume in ICU admitted patients. Methods: This was a descriptive and prospective study including 50 patients admitted in ICU with a central venous catheter placed for any reason whatsoever and no signs of increased right atrial pressure. CVP was measured in supine position by CVP manometer. The anterior- posterior IVC diameter was assessed by ultrasonography during inspiration and expiration. Data analysis was performed by SPSS and evaluated statistically with Pearsons regression and linear correlation test. Results: The mean CVP at inspiration and during expiration was 11.35+ 5.53, 12.20 + 5.65 cmH2O, respectively. The mean of inspiratory and expiratory IVC diameter was 7.71 + 3.5 , 11.37 + 3.28 mm, respectively. There was significant correlation between CVP and IVC diameter both during inspiration (r= 0.64 , p-value= 0.001) and expiration (r=0.495 , p-value=0.001) Conclusion: The result of this study suggests that IVC diameter measurement by ultrasound can be used as a reliable and non- invasive method for estimating the intravascular volume

Presenting A Case with Tubulointerstitial Nephritis and Uveitis (TINU- Syndrome)

Concurrence of interstitial nephritis and uveitis named tubulointestitioal nephritis and uveitis syndrome (TINU) are unusual and uncommon presentations of interstitial nephritis. This syndrome is considered after ruling out other differential diagnoses. A-38-year old man presented with acute renal failure and uveitis. The histologic findings of renal biopsy showed acute tubulointestitioal nephritis. The patient had no clinical and paraclinical manifestations of other etiologies of interstitial nephritis and uveitis such as Wegener's granulomatosis , Sjogren's syndrome or sarcoidosis. The diagnosis of TINU-Syndrome was therefore considered. The patient was treated by oral and ophthalmic prednisolone and had a good response to treatment

Epidemiology of culture-negative peritonitis in iranian patients on continuous ambulatory peritoneal dialysis

Introduction. Culture-negative peritonitis is a major challenge in the treatment of peritonitis in continuous ambulatory peritoneal dialysis (CAPD). This study aimed to evaluate the culture-negative peritonitis in patients from the Iranian CAPD Registry. Materials and Methods. Data of 1472 patients from 26 CAPD centers were analysed. Peritonitis was defined as any clinical suspicion together with peritoneal leukocyte count of 100/mL and more. Results. The patients had been on PD for a mean of 500 ± 402 days. There were a total of 660 episodes of peritonitis observed among 299 patients (peritonitis rate of 1 episode in 34.1 patient-months). Excluding patients with both negative and positive culture results, there were 391 episodes of peritonitis in 220 patients (174 culturepositive episodes in 97 patients and 217 culture-negative episodes in 123). The 1- to 4-year patient survival rates were 85, 75, 69, and 59 for the patients with culture-positive peritonitis, and 92, 78, 73 and 63 for the patients with culture-negative peritonitis, respectively (P =.34). The technique survival rates were 90, 57, 42, and 27 and 95, 85, 74, and 40, respectively (P =.001). On follow-up, there were higher rates of active PD patients, lower rates of PD dropouts, and higher rates of kidney transplantation in patients with culture-negative peritonitis compared to those with culture-positive peritonitis. Conclusions. In our patients, the prevalence of culture-negative peritonitis was high (55.9). Patient survival with culture-negative peritonitis was comparable to those with culture-positive peritonitis and technique survival was higher among those with culturenegative peritonitis