Urinary polymerase chain reaction for diagnosis of urogenital tuberculosis

Introduction: The aim of this study was to evaluate diagnostic value of urinary polymerase chain reaction (PCR) in urogenital tuberculosis (UTB). Materials and Methods: In 33 patients with confirmed diagnosis of UTB by urine culture and/or acid-fast staining, clinical symptoms and laboratory and radiological findings were evaluated. For each patient, 3 consecutive urine samples were examined by PCR for Mycobacterium tuberculosis and the results were compared with the standard microbiological methods and radiological findings. Results: The mean interval between the appearance of the symptoms and the diagnosis was 12.3 ± 12.2 months. Symptoms were irritative bladder symptoms such as dysuria and diurnal or nocturnal frequency (51.5%), flank pain (27.3%), microscopic hematuria (18.2%), gross hematuria (9.1%), and suprapubic pain (9.1%). The laboratory findings included hematuria (27.3%), pyuria (12.1%), and hematuria with pyuria (48.5%). Diagnosis of UTB was made in 19 patients by positive urine culture for MT in 19 patients (57.6%), positive acid-fast staining in 6 (18.2%), and both in 8 (24.2%). Intravenous urography showed abnormal findings in 16 patients (61.5%), including pyelocaliceal dilatation (26.9%), ureteral stricture and hydroureter (23.1%), multiple small caliceal deformities (15.4%), severe parenchymal destruction (11.5%), autonephrectomy (11.5%), and calcification (7.7%). Urinary PCR was positive in 16 patients (48.5%) and in 10 (62.5%) with abnormal findings on intravenous urography. Conclusion: A high index of suspicion is necessary for diagnosis of UTB even in patients with nonspecific manifestations. Urinary PCR is recommended for instant diagnosis and screening before further examinations, but it cannot be the sole diagnostic modality for diagnosis of UTB

Allopourinol effect on reducing proteinuria in diabetic retinopathy

Background: Diabetic nephropathy is the most prevalent cause of end stage renal disease (ESRD). Besides, factors such as angiotensin-II, cytokines, and vascular endothelial growth factor (VEGF), uric acid may play a role as the underlying cause of diabetic nephropathy. Therefore, decreasing serum level of uric acid can be effective in treatment of diabetic nephropathy. Methods: This was a double-blinded, randomized, clinical trial in which 40 patients with type 2 diabetes mellitus (DM) and diabetic nephropathy with proteinuria (at least 500 mg/24h) and serum creatinine (Cr) level 0.05). Serum level of uric acid and 24 hour urine protein were significantly lower in control group, after four months of receiving allopurinol, compared with control group (P < 0.05). Conclusion: Low dose allopurinol (100mg/day) reduces severity of proteinuria after four months of taking, which is probably due to decreasing the serum level of uric acid. So, allopurinol can be administered as an adjuvant, cheap, and low side-effect therapy for patients with diabetic nephropathy

Effect of Allopurinol in Decreasing Proteinuria in Type 2 Diabetic Patients

Introduction. Diabetic nephropathy is the most prevalent cause of end-stage renal disease. Besides factors such as angiotensin II, cytokines, and vascular endothelial growth factor, uric acid may play a role as the underlying cause of diabetic nephropathy. We evaluated allopurinol effects on proteinuria in diabetic patients with nephropathy. Materials and Methods. In a double-blinded randomized controlled trial on 40 patients with type 2 diabetes mellitus and diabetic nephropathy (proteinuria, at least 500 mg/24 h and a serum creatinine level less than 3 mg/dL), allopurinol (100 mg/d) was compared with placebo. Administration of antihypertensive and renoprotective drugs (angiotensin-converting enzyme inhibitors and angiotensin receptor blockers continued for both groups, without changes in dosage. Proteinuria was compared at baseline and 2 and 4 months between the two groups. Results. Each group consisted of 9 men and 11 women. There were no difference between two groups regarding age, body mass index, duration of diabetes mellitus, systolic and diastolic blood pressure, fasting blood glucose, blood urea nitrogen, serum creatinine, serum potassium, and urine volume. Serum levels of uric acid (P = .02) and 24-hour urine protein (P = .049) were significantly lower in the patients on allopurinol, after 4 months of receiving allopurinol, compared with the control group. Conclusions. Low-dose allopurinol can reduce severity of proteinuria after 4 months of drug administration, which is probably due to decreasing the serum level of uric acid. Thus, allopurinol can be administered as an adjuvant cost-effective therapy for patients with diabetic nephropathy

Cone Beam CT Study of Temporal Crest Canal

Statement of the Problem: It is crucial for clinicians to be certain about the location of mandibular canal and determine any anatomical variants relevant to it. The temporal crest canal (TCC) is a rare anatomical variant of mandibular canal that lack of awareness about its presence can complicate surgical procedures. Purpose: This study investigated the anatomical characteristics and prevalence of the TCC using CBCT. Materials and Method: This descriptive cross-section study evaluated 327 CBCTs (654 sides) from all the patients with various problems. TCC on sagittal and axial plans were identified and then classified into two types based on their configuration. The prevalence of TCC was calculated amongst men and women. Results: Six TCC (0.91%) were observed in 654 sides. We observed all 6 TCCs in females. One case (0.30%) was bilateral TCC, and the remaining four (1.22%) cases were unilateral TCC (two on the left and two on the right side). Considering the classification of TCC, five sides had presentation of type I and one case was type II based on Kawai et al. study. Conclusion: Three-dimensional images of CBCT data are useful in confirming the presence of TCC. TCC is considered as a clinically significant structure; therefore, this variation should be carefully investigated using reconstructed CBCT images

Effect of Pentoxifylline on Microalbuminuria in Diabetic Patients: A Randomized Controlled Trial

Background. Pentoxifylline is a nonspecific phosphodiesterase inhibitor with anti-inflammatory properties. Human studies have proved its antiproteinuric effect in patients with glomerular diseases, but this study was designed to assess the effects of add-on pentoxifylline to available treatment on reduction of microalbuminuria in diabetic patients without glomerular diseases. Methods. In a double-blind placebo-controlled, randomized study we evaluated the influence of pentoxifylline on microalbuminuria in type 2 diabetic patients. 40 diabetic patients with estimated glomerular filtration rate (eGFR) of more than 60 mL/min/1.73 m2 in eight weeks and microalbuminuria were randomized to two groups which will receive pentoxifylline 1200 mg/day or placebo added to regular medications for 6 months. albuminuria; eGFR was evaluated at three- and six-month follow-up period. Results. Baseline characteristics were similar between the two groups. At six months, the mean estimated GFR and albuminuria were not different between two groups at 3- and 6-month follow-up. Trend of albumin to creatinine ratio, systolic and diastolic blood pressure, and eGFR in both groups were decreased, but no significant differences were noted between two groups (P value > 0.05). Conclusion. Pentoxifylline has not a significant additive antimicroalbuminuric effect compared with placebo in patients with type 2 diabetes with early stage of kidney disease; however, further clinical investigations are necessary to be done

Assessment of hemodialysis adequacy and its relationship with individual and personal factors

Background: Hemodialysis is the most common renal replacement therapy in the world, and hemodialysis adequacy is an important and influencial factor in the reduction of various complications experienced by these patients. Multiple factors influence hemodialysis adequacy. This study was conducted to determine hemodialysis adequacy and its relationship with individual and personal factors in patients undergoing hemodialysis in three hemodialysis centers of Isfahan, Iran. Materials and Methods: This descriptive, cross-sectional study was conducted in partnership with 202 patients undergoing hemodialysis in three hemodialysis centers of Isfahan. The data were collected using a researcher-made questionnaire, and hemodialysis adequacy was measured using the urea reduction ratio (URR). Data analysis was conducted using Spearman's correlation coefficient, Mann–Whitney and Kruskal–Wallis tests, and descriptive statistics (frequency distribution). In this study, the level of significance was considered to be 0.05. Results: Hemodialysis adequacy in 56.4% of patients was optimal, in 29.7% near optimum, and in 13.9% less than optimal. Statistical tests showed a significant correlation between hemodialysis adequacy and age (P = 0.05), prehemodialysis systolic blood pressure (BP) (P = 0.02) and diastolic BP (P = 0.04), the duration of hemodialysis in months (P = 0.02), and patients' sex (P = 0.01). There was no significant correlation between hemodialysis adequacy and the number of hemodialysis cessations per week (P = 0.20), interdialytic weight gain (P = 0.40), prehemodialysis blood urea nitrogen (P = 0.40), creatinine (P = 0.10), hemoglobin (P = 0.20), hematocrit (P = 0.08), venous access type (P = 0.30), needle distance and direction (P = 0.70), underlying causes of end-stage renal disease (P = 0.50), and personnel's shift (P = 0.90). Conclusions: The results of the study showed that approximately half of the patients did not have an optimal level of hemodialysis adequacy, and multiple individual and personnel factors affect hemodialysis adequacy directly or conversely

Incidence of nonmelanoma skin cancer in renal transplant recipients: A systematic review and meta-analysis

Background: Nonmelanoma skin cancer (NMSC) in renal transplant recipients is common and associated with significant morbidity and mortality. The aim of the present systematic review and meta-analysis was to estimate the incidence of NMSC among renal transplant recipients. Materials and Methods: We systematically searched PubMed, Medline, Scopus, and Web of Science databases for studies that assessed the incidence of NMSC in renal transplant recipients using a combination of relevant keywords. Two independent investigators included studies and extracted necessary information. Random effect meta-analysis was used to estimate pooled incidence of NMSC with 95% confidence intervals (CIs). Results: Twenty-nine studies comprising 36,021 patients meet the criteria for the systematic review. The pooled incidence of NMSC in renal transplant recipients was 12.6% (95% CI: 12%–14%) with a majority of squamous cell carcinoma (SCC) 55% (95% CI: 47%–63%). The pooled estimate of the incidence rates of SCC and basal cell carcinoma was 2.7% (95% CI: 2%–3.4%) and 2.2% (95% CI: 1.5%–2.8%), respectively. Subgroup analysis per geographic location showed that pooled incidence of NMSC was 39.1% (95% CI: 26.3%–51.8%), 12.4% (95% CI: 8.8%–16%), and 1.2% (95% CI: 0.4%–2%) in Australia and New Zealand, Europe, and Middle East, respectively. Conclusion: The results of the current meta-analysis demonstrated that the incidence of NMSC in renal transplant recipients varies widely. Regarding the high incidence of NMSC among renal transplant recipients, awareness of associated risk factors and early diagnosis of the malignancy in the population is a major clinical need

Ganciclovir use evaluation in kidney transplantation departments

Objective: In this study, we evaluated certain aspects of the usage and administration of one lifesaving, high-cost medication, i.e., Ganciclovir for the prevention and treatment of cytomegalovirus (CMV) infection in transplant patients. Methods: This study was performed from 2013 to 2015 by conducting a medication use evaluation (MUE) program in the kidney transplantation departments of two tertiary care hospitals in Isfahan, Iran. The MUE criteria for the drug were developed by applying drug information references. In every category of data, the number (percent) of cases, in which drug therapy was in accordance with the predetermined criteria, was calculated. Findings: During the study period, 67 cases were observed. The only documented drug interaction was the minor interaction of Ganciclovir with mycophenolate mofetil in 77% of the patients. In all patients, intravenous (IV) infusion was the route of administration, mainly in the peripheral veins. Four patients showed adverse drug reaction, which leads to Ganciclovir discontinuation. Ganciclovir was administered despite contraindication in 34.3% of the patients. Conclusion: In this study, we faced a relatively unacceptable situation, in which Ganciclovir is handled somehow inappropriately. It seems necessary to develop an updated local guideline to approximate the administering pattern of such costly medications to standard protocols

Development, Implementation, Monitoring and Evaluation of Performance Improvement Components of Isfahan Medical School Departments

Introduction: Departments are the major sub-system of university and quality improvement of the universities rides on the quality improvement of the departments. The researchers developed, implemented, and evaluated the appropriate components based on the results of self-assessment and external evaluation of institutional accreditation. Methods: In a case study on 32 departments of Medical Schools, based on accreditation standards, department promotion components were identified. The components were prioritized in terms of importance, measurability and viability with proper scale and weighted by the experts with a focus group. The components' validity was determined by the expert opinion and implemented in the departments after training. A valid and reliable instrument was developed for monitoring and evaluating the fulfillment of the components. Results: The components of improvement in the department performance including formulation and implementation of the operational plan, website, training areas, faculty members' viewpoints about the department leader, faculty management viewpoints on department accountability, along with a gudline for measuring these components were reached. The mean of the components was 79%. The lowest achievement was related to the component of school participation in the activities of the department and timely presentation of the operational plan (72%) as well as the achievement highest was observance of clinical education standards (92%). Conclusion: Promotion of website, operational plan, areas of education, increased faculty participation, increased order in the formation of department councils, and increased department accountability were the main results of this study. Evaluation of the department was done on the basis of the realization of the interventions as a chief factor for promoting the executive guarantee. Due to the continuous follow-up and direct supervision of the Faculty Board, the results revealed that the components were in a favorable condition

Comparison of the scores in essay part and MCQ part of renal pathophysiology exam and surveying students’ views about the effect of such exams on their study

Introduction: In order to benefit from the advantages of essay exams, one must be sure to reliably judge students based on essay test scores. The aim of this study was to examine the correlation of scores in the essay and MCQ parts of renal pathophysiology final exam and students’ views about the effect of the type of test on their study. Methods: This descriptive correlational survey was performed in Isfahan School of Medicine from fall 2015 to winter 2017. Three groups of students (n=455) participated in the renal pathophysiology and took a test consisting of 36 multiple-choice and 10 essay questions. The MCQ part was graded in OPSCAN software. The correlation of MCQ and essay scores was investigated via bivariate correlation and paired t-test was used to compare the mean scores. Students’ views about the type of test and its effect on their study were surveyed by means of a Likert-scale questionnaire. Results: There was a strong positive correlation between the scores in essay and MCQ parts in the three groups (group 1: r=0.631 n=151 p<0.0005; group 2: r=0.710 n=136 p<0.0005; group3: r=0.716 n=168 p<0.0005). More than 50 percent of students stated that they had spent more time for studying this course than for those courses with MCQ-only mode of exam. Conclusion: Considering the high and positive correlation between the scores in the MCQ and essay parts of the exam, essay tests can be used along with MCQ tests to assess students’ level of learning in renal pathophysiology and to increase their motivation for deeper study