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

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

Prophylactic fluid therapy in crushed victims of Bam earthquake

Background: Acute kidney injury (AKI) is a severe and preventable problem of crushed earthquake victims. Early hydration therapy started before fully removing earthquake rubbles has been claimed to play a decisive role in AKI prevention, which saves the necessity of later dialysis. However, the extent, quality, and appropriateness of its know-how are controversial. Methods: Processing clinical and paraclinical data gathered from Bam earthquake victims older than 15 years, we tried to determine correlations between the time of being under the rubbles (TUR), the level of serum creatine phosphokinase (CPK), the delayed onset of fluid therapy (DFT), and finally the volume of intravenous fluid received per day (VFR) with the formation of AKI and the need for dialysis. Results: There is a direct and significant relation between the intensity of the trauma (TUR and CPK) and DFT with the occurrence of AKI and need for dialysis (P 6 L) are required, whereas in less-traumatized patients, lower volumes (3-6 L) would be effective. © 2011 Elsevier Inc

Epidemiologic aspects of the Bam earthquake in Iran: the nephrologic perspective

Background: Acute renal failure is a serious, preventable, and potentially reversible midterm complication after mass disasters. In 2003, an earthquake struck Bam, Iran. This article studies the epidemiologic aspects of the earthquake from a nephrologic perspective. Methods: A questionnaire was sent to the reference hospitals. The resulting database of 2,086 traumatized patients hospitalized in the first 10 days was analyzed. Results: Mean age was 29.0 +/- 15.6 years. Compared with the resident population, the percentage of patients was lower among children and teenagers younger than 15 years and higher among young and middle-aged adults (P<0.001). There was no significant difference between mean ages of patients with acute renal failure and other patients. Time under the rubble was longer for patients with acute renal failure (6.2 +/- 4.1 versus 2.1 +/- 3.9 hours; P<0.001). These patients were hospitalized later (3.1 +/- 2.8 versus 1.5 +/- 1.7 days after the disaster; P<0.001) and longer (16.7 +/- 12.8 versus 12.5 +/- 11.3 days; P<0.001). Sepsis (11.6% versus 0.5%), disseminated intravascular coagulation (7.3% versus 0.3%), adult respiratory distress syndrome (9.1% versus 1.4%), fasciotomy (38.9% versus 1.9%), amputation (6.1% versus 0.5%), and death (12.7% versus 1.9%) were markedly more frequent among patients with acute renal failure (P<0.001 for all). Conclusion: Hospitalized patients were mostly young and middle-aged adults. Patients with acute renal failure were entrapped longer and hospitalized later and for longer periods. Medical complications, surgical procedures, and mortality were greater in the latter group. Early extrication and quick hospitalization with appropriate multidisciplinary care are cornerstones to prevent acute renal failure and Its subsequent mortality In earthquake conditions