Cerebral Oximetry: Is It A New Method For Detection of Tissue Perfusion After Transplantation?

This short letter to editor discuss about cerebral oximetery and its impact on tissue perfusion after transplantation

Effects of Intravenous Fluid Therapy on Clinical and Biochemical Parameters of Trauma Patients

Introduction: The administration of crystalloid fluids is considered as the first line treatment in management of trauma patients. Infusion of intravenous fluids leads to various changes in hemodynamic, metabolic and coagulation profiles of these patients. The present study attempted to survey some of these changes in patients with mild severity trauma following normal saline infusion. Methods: This study comprised 84 trauma patients with injury of mild severity in Shahid Rajaei Hospital, Shiraz, Iran, during 2010-2011. The coagulation and metabolic values of each patient were measured before and one and six hours after infusion of one liter normal saline. Then, the values of mentioned parameters on one and six hours after infusion were compared with baseline measures using repeated measures analysis of variance. Results: Eighty four patients included in the present study (76% male). Hemoglobin (Hb) (df: 2; F=32.7; p<0.001), hematocrit (Hct) (df: 2; F=30.7; p<0.001), white blood cells (WBC) (df: 2; F=10.6; p<0.001), and platelet count (df: 2; F=4.5; p=0.01) showed the decreasing pattern following infusion of one liter of normal saline. Coagulation markers were not affected during the time of study (p>0.05). The values of blood urea nitrogen (BUN) showed statistically significant decreasing pattern (df: 2; F=5.6; p=0.007). Pressure of carbon dioxide (PCO2) (df: 2; F=6.4; p=0.002), bicarbonate (HCO3) (df: 2; F=7.0; p=0.001), and base excess (BE) (df: 2; F=3.3; p=0.04) values showed a significant deteriorating changes following hydration therapy. Conclusion: It seems that, the infusion of one liter normal saline during one hour will cause a statistically significant decrease in Hb, Hct, WBC, platelet, BUN, BE, HCO3, and PCO2 in trauma patients with mild severity of injury and stable condition. The changes in, coagulation profiles, pH, PvO2, and electrolytes were not statistically remarkable.

Investigating the Association between Gender and Age Distribution with Severity of COVID-19: A Single-Center Study from Southern Iran

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused a highly contagious disease, which led to a pandemic health emergency. However, age distribution and sex, regarding factors affecting the severity of COVID-19, are controversial. Therefore, this study is designed to investigate the effect of gender difference on the severity of COVID-19 infection in the studied age groups.Methods: Patients with COVID-19 of Valiasr Hospital (Khorrambid, Fars, Iran) from February 20, 2020, to February 20, 2021, are included in this retrospective study. The inclusion criteria were the age of above 15 years old and being residents of Khorrambid. COVID‐19 severity was classified as mild and moderate/severe according to the WHO standards. The obtained demographical and clinical data from the patient registry forms were analyzed using SPSS-24; P value <0.05 was considered as the level of significance. Chi-square and independent t-test were used to assess the variables.Results: Herein, 218 patients were recruited with a mean age of 45.6±17.2 and a relatively equal distribution of men and women population. Out of this population, 23.8% had comorbid diseases, 48.2% had mild, and 51.8% had moderate/severe infections. Our results indicated that male gender and the age range of 25-64 years in men are the most important risk factors associated with the disease severity (P<0.0001).Conclusions: The current study revealed that the leading risk factor of the disease severity was higher age (≥65 years) in the studied women. Meanwhile, in the men group, this factor was the age range of 25-64 years. These results suggest that further research is required to identify the possible impacts of gender and age on various aspects of the ongoing epidemic

Case report: A case of renal arcuate vein thrombosis successfully treated with direct oral anticoagulants

A rare case of a 35 years old woman presented with renal arcuate vein thrombosis (RAVT) and acute kidney injury (AKI) following upper respiratory tract symptoms and toxic substance ingestion. Histopathological evaluation of the patient's kidney tissue indicated a rare venous thrombosis in the renal arcuate veins. Anticoagulation with Apixaban, a direct oral anticoagulant (DOAC), was commenced, and the patient's symptoms resolved during the hospital stay. Hitherto, a limited number of studies have shown the concurrent presentation of RAVT and overt AKI in patients following ingestion of nephrotoxic agents. Further studies are necessary to elucidate the etiology, clinical presentation, and treatment of RAVT. We suggest that Apixaban be studied as a suitable alternative to conventionally used anti-coagulants such as Warfarin in patients who lack access to optimal health care facilities

Impact of obesity on development of chronic renal allograft dysfunction

Obesity in nontransplant patients has been associated with hypertension, hyperlipi-demia, diabetes, and proteinuria. To determine whether renal transplant recipients with an elevated BMI have worse long term graft survival, we prospectively studied 92 patients transplanted between April 1999 and July 2000. Weight (Wt) and height of the patients were recorded prior to transplantation and two weeks, one, two and three years post transplantation. Blood urea nitrogen (BUN), creatinine (Cr) and blood pressure were checked monthly, while triglyceride, cholesterol, high den-sity lipoprotein (HDL), and low density lipoprotein (LDL) were obtained 3 monthly for 3 years post transplantation. Graft dysfunction was defined as serum Cr &gt; 1.8 mg/dL. While BMI and Wt of the patients before transplantation did not show any significant correlation with chronic renal allograft dysfunction (CRAD), patients with higher Wt and BMI two weeks after transplantation showed an increased risk of developing CRAD during the three year post transplant independent of other risk factors (P&lt; 0.05). Patients with greater Wt loss in the first two weeks post transplantation showed a decreased risk of developing CRAD in the following 3 years (P&lt; 0.001). Our study suggests that high Wt and BMI are significantly associated with worse graft survival 3 years post renal trans-plantation

The association between blood pressure level and serum uric acid concentration in hemodialysis patients

Background: High blood pressure is a common condition in hemodialysis patients. Uric acid, which is high in these patients due to decreased clearance, had been shown to positively correlate with blood pressure in animal studies. Objectives: The goal of this investigation was to evaluate the impact of high uric acid level on blood pressure in these patients. Patients and Methods: Ninety-one patients, on three times weekly hemodialysis, were studied. Uric acid levels were measured just before and after hemodialysis along with blood pressures before, during and after each session. Data were analyzed by SPSS 15. A P value less than 0.05 was considered significant. Results: 40 (44%) of patients had serum uric acid ≥6 mg/dl. Before dialysis 51 (61%) and 19 (21%) had high systolic blood and diastolic blood pressures respectively. Also, 50 (55%) were with wide pulse pressure and 63 (69%) had high mean arterial pressure (MAP). Additionally 62 (68%) developed inter-dialysis hypotension. After measuring odds ratio for hyperuricemia in each group, we observed low risk of hypruricemia in the group with high systolic pressure (OR = 0.352; 95% CI: 0.147-0.844; P = 0.01), the high MAP group (OR = 0.382; 95% CI: 0.153-0.955; P = 0.03) and wide pulse pressure group (OR = 0.416; 95% CI: 0.177-0.975; P = 0.04). There was no association between high uric acid level and diastolic pressure (P = 0.11) and inter-dialysis hypotension (P = 0.33). No relationship was found between serum uric acid and KT/V (P = 0.2), normalized protein catabolic rate (nPCR) (P = 0.07) and body mass index (BMI) (P = 0.4). Conclusions: This study showed paradoxical association between high uric acid level and high systolic pressure, high MAP and wide pulse pressure and these effects were independent of dialysis duration, dialysis efficacy and nutrition, assuming that these relationships could be due to reverse epidemiology in dialysis patients

Remote ischemic per-conditioning protects against renal ischemia-reperfusion injury via suppressing gene expression of TLR4 and TNF-α in rat model

The pathogenesis of renal ischemic reperfusion injury (IRI) involves both inflammatory processes and oxidative stress in the kidney. This study determined whether remote ischemic per-conditioning (RIPerC) is mediated by toll-like receptor 4 (TLR4) signaling pathway in rats. Materials and Methods: Renal I/R injury was induced by occluding renal arteries for 45 min followed by 24 h reperfusion. RIPerC included four cycles of 2 minutes ischemia of left femoral artery followed by 3 minutes reperfusion performed at the start of renal ischemia. Rats were grouped into sham, I/R, and RIPerC. At the ending of reperfusion period, urine, blood and tissue samples were gathered. Results: I/R created kidney dysfunction, as ascertained by significant decrease in creatinine clearance, and significant increase in sodium fractional excretion. This was occurred with a decrease in the activities of gluthatione peroxidase, catalase and superoxidae dismutase with an increment in malondialdehyde levels, mRNA expression levels of Toll-like receptor 4 (TLR4) and tumor necrosis factor-alpha (TNF-Îą) and histological damages in renal tissues. RIPerC treatment diminished all these changes. Conclusion: This study demonstrated that RIPerC has protective effects on the kidney after renal I/R, which might be related with inhibition of TLR4 signaling pathway and augmentation of anti-oxidant systems.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author