Is pulmonary histoplasmosis a risk factor for acute renal failure in renal transplant recipients?

Prolonged use of immunosuppressive medication is associated with an increased sus-ceptibility to viral, bacterial and fungal infections. This paper reports a 42 year old kidney transplant recipient with 10 years of stable allograft function who developed pulmonary histoplasmosis and consequently lost his kidney. This report corroborates the previously proposed threat of infection with H. capsulatum for kidney allograft rejection

Laboratory Variables and Treatment Adequacy in Hemodialysis Patients in Iran

This study aims to evaluate the laboratory variables in Iranian hemodialysis pa-tients. We studied 338 patients in 6 dialysis centers around the country. Sixty four percent of the patients were anemic, and the mean of hemoglobin levels in the patients was 9.6 &#x00B1; 1.9 g/dL. Women had a significantly higher prevalence of anemia (p= 0.004); however, considering the absolute hemoglobin values, there was no significant difference between genders (p> 0.05). The mean urea reduction ratio (URR) and Kt/V in the patients were 62.6 &#x00B1; 12.8 and 1.17 &#x00B1; 0.31, respectively. Hyperphosphatemia and hyperkalemia were observed in <i> 50&#x0025; </i> and <i> 58&#x0025;, </i> respectively. We conclude that our study demonstrated a relatively high prevalence of anemia and hyper-phosphatemia, however, a surprisingly good dialysis urea clearance in the Iranian hemodialysis patients. We should exploit more effort to maintain hemoglobin and serum phosphate levels with-in the target ranges

Is the lower cyclosporine concentration at 2 hours after dosing safe in kidney transplant recipients?

Objective: To determine the correlation between cyclosporine blood concentration at 2 hours after dosing (C2) and renal allograft function. Materials and Methods: From 2008 to 2010, 1191 kidney transplant recipients (718 male and 473 female patients) were studied. The correlation between serum creatinine concentration and C2 blood concentration was stratified as 400, 600, 800, and 1000 ng/mL. Results: The mean (SD) C2 was 620 (235) ng/mL, and serum creatinine concentration was 1.49 (0.68) mg/dL. At multivariate regression analysis, no significant correlation was observed between serum creatinine concentration and C2 blood concentrations of 600, 800, or 1000 ng/mL (P = .18, .57, and .76, respectively); however, it was associated at 400 ng/mL (P = .03). Moreover, 36.1 of 3159 samples demonstrated satisfactory renal allograft function despite low C2 blood concentration between 400 and 600 ng/mL. Conclusion: During maintenance therapy, C2 blood concentration between 400 and 600 ng/mL is effective and safe for providing prophylaxis against rejection, and can improve long-term survival by decreasing cyclosporine toxicity. © 2011 by Elsevier Inc. All rights reserved

Hepatitis C virus infection among patients on hemodialysis: A report from a single center in Iran

The aim of this study is to evaluate the incidence of hepatitis C virus (HCV) infec-tion among the hemodialysis (HD) patients at the Nephrology and Urology Research Center, Tehran, Iran, and identify the potential risk factors. A total of 112 patients on HD in our two dia-lysis units were studied. The mean duration of follow-up was 27 &#x00B1; 27 months (range, 6-132). All study subjects were HCV-negative at entry to the study and were tested for anti-HCV antibody by ELISA II every six months thereafter. Positive samples were re-examined by RT/PCR for confir-mation. Factors that might be implicated in HCV transmission were evaluated. Six patients (5.3&#x0025;) were labeled as HCV infected, at the end of the follow-up period. Thus, the incidence of HCV infection in our dialysis units was 1.8 per 100 person years. A total of 64.5&#x0025; of the study popu-lation had previous history of blood transfusion(s) and 8&#x0025; had undergone prior transplantation. Univariate analysis showed a significant relationship between number of blood transfusions and duration on dialysis and HCV infection. Multivariate analysis revealed that only duration on HD was significantly associated with HCV positivity (OR: 1.03, p=0.008). Our study further suggests that nosocomial transmission plays a major role in HCV transmission among patients on HD. Meticulous practice of preventive measures is essential to eradicate the spread of HCV in HD units

Burden among care-givers of kidney transplant recipients and its associated factors

Burden among care-givers of chronically ill patients has been widely investigated. However, there is no study evaluating perceived pressure on care-givers of kidney transplant recipients. This study aimed to evaluate the effect of care-giving to renal transplant recipients in Iranian Muslim population and to analyze factors associated with it. A cross-sectional study was carried out involving 41 care-givers of renal recipients. The Care-giver Burden Scale (CB Scale) was used to evaluate the care-giver&#x2032;s perceived burden and its correlates. Statistical analysis was performed using software SPSS v.13.0. P &lt; 0.05 was considered significant. We found that increased care-giver burden was related to being married (p&lt; 0.02), having lower education level <i> (p&lt; </i> 0.05), and being a parent or spouse to the patient <i> (p&lt; </i> 0.05). We also found significant adverse effects of patients&#x2032; second transplantation and gender (male) on care-givers&#x2032; burden. There was no significant relationship between care-giver burden score and patients&#x2032; marital status, education level, operation time, age, donor type (cadaveric or living), and dialysis history before and after transplantation. In conclusion, care-givers experience strain, which has implications for research and service provision. Service providers need to identify those care-givers at risk of greater strain and help them in situations that cannot be altered. Future research should be conducted to identify the effects of interventions, on care-givers&#x2032; burden perception

Prevalence of panic attacks in the patients with migraine headache at neurologic clinic of Baqiyatallah Hospital

Background: Migraine headache is one of the most common causes of headache which influences on th quality of life and performance of the patients. Migraine headache has some co-morbidities like depression and anxiety. The aim of this study was to evaluate the frequency of panic attacks in migraine patients of Baqiyatallah Hospital in 2004. Materials and Methods: In a cross-sectional study in Baqiyatallah Hospital, 85 patients who according to Internal Headache Society criteria had migraine headache, were evaluated for panic attack. Diagnosis of panic attack was made through interview and questionnaire according to DSM-IV criteria. T -Test and Chi-Square were used to analyze the data. Results: The patients consisted of 23 males and 62 females. 41 patients (48.2%) had panic attacks 36 of whom were female. 29 patients were married. 27 patients (69%) with education of less than diploma, 10 patients (41%) with diploma and only 4 patients (18.2%) with education higher than diploma had panic attack (p<0.05). Conclusion: The prevalence of panic attack in the patients with migraine is higher than what was expected (48.2%). The higher education, the less panic attack