The prevalence of intestinal parasites in hemodialysis patients in Bushehr, Iran

Hemodialysis patients, due to a dysfunction of the immune response, are prone to a variety of opportunistic infections. Studies of intestinal parasitic infections in these patients are limited. Therefore, the present study was performed to determine the prevalence of these infections in patients on hemodialysis in Bushehr. In this cross-sectional study, fecal samples have been collected from all hemodialysis patients who were continuously referred from September 2011 to September 2012 to the dialysis center at Bushehr and tested using routine parasitological methods. From a total of 88 patients studied, 25 patients (28.4%) were infected with one or more intestinal parasites. Blastocystis hominis and Entamoeba coli with 13.6% and 6.7% prevalence had the highest prevalence among the patients, respectively. The age group 51–70 years had the highest rates of infection. Statistical analysis showed no relationship between sex and the risk of intestinal parasites. Seventeen percent of infected patients showed up with diarrhea and this relationship was statistically significant. Considering the high prevalence of intestinal parasitic infection among hemodialysis patients in Bushehr and also the high probability of infection in these patients, it is recommended that periodic examinations and screening patients during dialysis and before kidney transplantation should be a part of routine medical care

Stratigraphy, Petrology, and Depositional Analysis of the Wolfcampion, Shafer Limestone Member, of the Elephant Canyon Formation, East-Central Utah

The Shafer Limestone is the upper-most member of the Wolfcampian Elephant Canyon Formation in east-central Utah. The unit is exposed at the Shafer Trail area and forms a marine carbonate tongue that thins eastward. The unit is conformable with underlying and overlying units but displays fairly sharp contacts. Fossils, oolites, pellets and terrigenous particles form the grains in the Shafer Limestone. The unit consists of light-gray to brownish limestone comprising mainly fossil grains at the Goose Neck, Dead Horse Point and Pyramid Butte areas to the west and terrigenous grains at the Potash area to the east. Brachiopods, crinoids, gastropods, and pelecypods are principal components of the fauna. Mineral composition includes calcite, dolomite, opaques, clay minerals, and ferromagnesian minerals in order of decreasing importance. Microspar and micrite, with minor amounts of spar, form the matrix and cement and both grain and non- grain supported fabric are present. The unit was deposited under a variety of shallow marine conditions when an arm of the sea transgressed from the Oquirrh Basin, which lay to the northwest of the area and reached as far southeast as the Potash area. The strata on the west side of the Shafer Trail area were deposited mainly in quiet subtidal environments, but deposition above the wave base, probably in a near-shore environment, is suggested for the eastern strata. Ecological conditions of the Shafer Sea as suggested by paleontological and sedimentological criteria indicate that clear, warm, shallow, normal marine conditions prevailed. These data suggest good circulation with moderate to high hydrodynamic energy. Abundant burrowing organisms, mainly gastropods and pelecypods, suggest that the bottom was soft

Assessment of Enalapril Effect on Inducing Anemia In Non-Azotemic Diabetic Patients

Background: Angiotensin converting enzyme inhibitors (ACEIs) are known to induce anemia following renal transplantation, dialysis and in renal failure patients. It seems that ACEIs cause anemia via inhibition of erythropoietin synthesis or inhibiting normal proliferation of early erythroid progenitors, which are normally stimulated by angiotensin converting enzyme. There are few reports on how ACEIs induce anemia in non-azotemic diabetic patients. We studied the effect of enalapril on inducing anemia in non-azotemic diabetic patients.
 Methods: This study included 94 diabetic non-azotemic patients (serum creatinine (sCr) ?1.5 mg/dl by jaffe reaction). Patients were divided into two groups, the first; with clinical proteinuria (P+ ) having a 24 hour urine protein ?300 mg or positive urine dipstick for protein, at least on two of three times tested, with an interval of 1 month and the second group without any signs of clinical proteinuria (P- ). Only 32 patients completed the course of study; 17 as P+ and 15 as P-. Patients in both groups received 10 mg enalapril daily; and every 3 months, the dose was doubled until the dose of 40 mg/day was reached, unless any side effects emerged. Hemoglobin concentration (Hb), sCr and serum potassium (K+) were also checked regularly. Data were analyzed using t-Student test, paired t test, and chi-square test. A p value < 0.05 was considered as significant.
 Results: Both groups of patients were matched from the standpoint of age and sex. The average baseline sCr in P+
 and P- groups were 0.8 ± 0.19 mg/dl and 0.8 ± 0.18 mg/dl respectively.( p = 0.97) After the study was completed, the average baseline sCr rose to 0.99±0.19 and 0.92±0.22 mg/dl in P+ and P- groups respectively. In P+ group, mean Hb was 14.1 ±1.30 g/dl and 13.9 ± 0.99g/dl before and after the study respectively.(p = 0.28) The same parameter for the P- group was measured as 14.1±1.00 and 12.9±3.30 before and after the study respectively.(Conclusion: This study shows that enalapril has no significant effect on inducing anemia in non-azotemic diabetic patients.
 Keywords: Enalapril, Anemia, Diabetes, Proteinuri

Facies analysis of the Asmari Formation in central and north-central Zagros basin, southwest Iran: Biostratigraphy, paeleoecology and diagenesis

Three sections of the Oligocene-Miocene Asmari Formation, crossing central and north-central Zagros foreland basin in SW Iran, were measured and studied in order to interpret the biostratigraphy, paleoecology (based on distribution of benthic foraminifera) and diagenesis. Forty-three foraminifer genera and species were encountered in the studied areas and the following assemblage zones have been defined: 1) Nummulites vascus-Nummulites fichteli, 2) Lepidocyclina-Operculina-Ditrupa, 3) Archaias asmaricus-Archaias hensoni-Miogypsinoides complanatus, 4) Miogypsina-Elphidium sp. 14 - Peneroplis farsenensis, and 5) Borelis melo curdica-Borelis melo melo. According to this study, deposition of the Asmari Formation with association of hyaline, lamellar, perforate large and flat foraminifera first started in the basin and slope environments during the Rupelian in Dehdez and Tufe-Sefid areas. Lagoon depositional environment colonized by sea-grass epiphytic foraminifera was encountered during Chattian and Aquitanian in Bagh-e Malek and Dehdez areas and mostly lagoon and slope environments prevailed during Burdigalian in Bagh-e Malek and Dehdez areas, respectively. The main diagenetic processes that affected the Asmari Formation were dolomitization (replacement and cementation), compaction (stylolitization) and dissolution. The extent of these diagenetic overprinting seems to be mainly facies controlled.Tres secciones de la Formación Asmari del Oligoceno-Mioceno, que cruza la region central y nor-central de la Cuenca de Zagros en el SE de Irán, fueron medidas y estudiadas, a fin de interpretar su bioestratigrafía, paleoecología (con base en la distribución de foraminíferos bentónicos) y diagénesis. Cuarenta y tres géneros y species de foraminíferos fueron encontrados en las áreas de estudio, y las siguientes zonas de composición fueron definidas: 1) Nummulites vascus-Nummulites fichteli, 2) Lepidocyclina- Operculina�Ditrupa, 3) Archaias asmaricus-Archaias hensoni-Miogypsinoides complanatus, 4) Miogypsina-Elphidium sp. 14 - Peneroplis farsenensis y 5) Borelis melo curdica-Borelis melo melo. De acuerdo con este estudio, el depósito de la Formación Asmari, en asociación con grandes foraminiífe- ros aplanados, hialinos, lamelares y perforados, comenzó inicialmente en ambientes de cuenca y talud continental durante el Rupeliano en las áreas de Dehdez and y Tufe-Sefid. Un ambiente de depósito de laguna, colonizada por foraminíferos epifíticos de pastos marinos, fue encontrado durante el Chattiano y Aquitaniano en las áreas de Bagh-e Malek y Dehdez, y principalmente ambientes lagunares y de talud continental prevalecieron durante el Burdigaliano en las áreas de Bagh-e Malek y Dehdez, respectivamente. Los principales procesos diagenéticos que afectaron a la Formación Asmari fueron dolomitización (reemplazamiento y cementación, compactación (stilolitización) y disolución. La extensión de estos efectos diagenéticos, parece haber sido controlada principalmente por los tipos de facies

A prospective double-blind randomized placebo-controlled clinical trial to evaluate the safety and efficacy of spironolactone in patients with advanced congestive heart failure on continuous ambulatory peritoneal dialysis

Congestive heart failure (CHF) is frequent in patients with chronic renal failure, and may contribute to high cardiovascular morbidity and mortality. There is little data in the literature about the safety and efficacy of use of spironolactone in patients with end-stage renal disease with heart failure. In this study, we evaluated the safety and efficacy of spironolactone in patients on continuous ambulatory peritoneal dialysis (CAPD) with CHF. This randomized pros-pective double-blind placebo-controlled clinical trial was performed at the St. Al-Zahra peritoneal dialysis center. Eighteen CAPD patients with New York Heart Association (NYHA) class III or IV heart failure, ejection fraction (EF) ≤45%, serum potassium level ≤5.5 mEq/L and who were eligible, were randomly assigned to taking either spironolactone (25 mg every other day) or placebo for six months. The serum potassium was measured monthly and echocardiography was repeated at the end of the study period. The serum potassium levels rose in both groups, and there was no statistically significant difference intragroup and between the groups during the study period. Only in one patient in the spironolactone group did the serum potassium level reach above the critical level (5.70 mEq/L) at the end of the second month of study, necessitating patient exclu-sion. The EF did not change significantly in the placebo group (33.3 ± 11.7 vs. 34.2 ± 11.6, F = 1, P = 0.363), but in the spironolactone group the EF rose significantly (25.7 ± 7.3 vs. 33.3 ± 7.8, F = 27.45, P = 0.002). Our study suggests that spironolactone could be used in CHF patients on CAPD to improve their cardiac function, but close monitoring of their serum potassium level is required

Correlation of kidney biopsy findings and clinical manifestations of primary focal and segmental glomerulosclerosis

To evaluate the correlation of clinical, laboratory, and pathological features at pre-sentation of focal segmental sclerosis (FSGS), we reviewed in a cross sectional study the patholo-gical findings of kidney biopsies in 64 cases of primary FSGS, and correlated them with the clinical and laboratory data obtained at the time of the biopsies. The data included blood pressure, glome-rular filtration rate (GFR), serum albumin, and the level of proteinuria. The mean level of serum crea-tinine was significantly higher in the biopsies′ findings of synechiae (adhesions) in the Bowman′s capsule, interstitial fibrosis, and global scars (P< 0.05), and mean level of GFR was significantly lower with the presence of interstitial fibrosis (P< 0.05). Furthermore, there was a positive correlation between the level of serum creatinine and global sclerosis (r= 2.21, P= 0.04), and a negative correlation between the level of GFR and global sclerosis(r= 2.01, P= 0.02). All the patients with renal insufficiency had interstitial fibrosis in their biopsies in comparison of only the 24 patients (48%) of the group without renal insufficiency (P< 0.05). There was no significant difference bet-ween patients with and without hypertension and nephritic-ranged proteinuria. We conclude that we found a correlation of renal insufficiency in primary FSGS patients with interstitial fibrosis, global scars and the synechiae of Bowman′s capsule in their biopsies