فهرست مطالب roghayeh akbari

 Patients with Chronic Kidney Disease (CKD) undergoing hemodialysis experience psychological symptoms due to the stressful process and are likely to engage in fewer health-promoting behaviors.

 This study aimed to compare health-promoting behaviors and psychological distress in hemodialysis patients and healthy individuals during the COVID-19 pandemic.

 This case-control study was conducted on 139 hemodialysis patients who visited the dialysis unit of Shahid Beheshti Hospital in Iran County and 139 healthy controls between 2020 and 2021. A demographic form, the Hospital Anxiety Depression Scale (HADS), the Health Promoting Lifestyle Profile II (HPLPII), and the Coronavirus Anxiety Scale (CAS) were used to collect data. Data analysis was performed in SPSS version 22, and a P-value of less than 0.05 was considered statistically significant.

 The mean age of the hemodialysis participants was 56.79 ± 13.97, and that of healthy participants was 56.89 ± 13.87 (P = 0.99). The mean score of health-promoting behaviors was significantly lower in hemodialysis patients than in healthy participants (120.53 ± 20.35 vs. 125.92 ± 6.76) (P = 0.005). Furthermore, hospital anxiety-depression (20.49 ± 5.20 vs. 15.28 ± 2.95) and coronavirus anxiety (22.83 ± 7.19 vs. 20.77 ± 4.71) were significantly higher in hemodialysis patients than in healthy participants (P<0.001 and P = 0.001, respectively).

 Hemodialysis patients exhibited lower health-promoting behaviors and higher coronavirus anxiety and depression than healthy individuals.

End-stage renal disease (ESRD) is a serious chronic disease that affects many organ systems. Skin manifestations that are commonly seen in ESRD can significantly impair the quality of life in these patients. Early recognition and management of mucocutaneous disorders can improve quality of life and decrease morbidity. This study aimed to evaluate the skin manifestations in ESRD patients undergoing hemodialysis.

In this cross-sectional study 150 patients undergoing hemodialysis in the Nephrology Department of Shahid-Beheshti Hospital in Babol were enrolled. The demographic and clinical data were assessed. Analysis was done by SPSS 22 and significance level was under 0.05.

The mean duration of hemodialysis was 8.7 months. The most common skin findings in patients include xerosis 84.7%, pallor 82.7%, pruritus 67.3%, hyperpigmentation 40%, purpura 28%. Skin infections were detected in 36% of patients (fungal 28%, bacterial 10.7%, and viral 5.3%). Nail, hair and mucosal changes were observed among 65.3%, 38% and 17.3% of patients respectively. No significant correlation was detected between skin findings and duration of dialysis.

The findings of the present study showed that skin manifestations are highly prevalent among patients with ESRD. Prompt diagnosis and management of the dermatological disorders may improve the quality of life in the affected patients.

In hemodialysis patients, changes in dialysis adequacy are recorded at regular intervals and studied longitudinally. The aim of this study was to determine the factors affecting dialysis adequacy using the generalized estimating equation (GEE) and to compare them with the quadratic inference function (QIF).

This longitudinal study examined the records of 153 end-stage renal diseases (ESRD) patients. Longitudinal data on the dialysis adequacy index and demographic and clinical characteristics were obtained from the patient files. The first-order GEE (GEE1), second-order GEE (GEE2), and QIF models were fitted with different correlation structures, and then the best correlation structure was selected using the quasi-likelihood information criterion (QIC), Akaike information criterion (AIC), and Bayesian information criterion (BIC). Then, the selected models were compared based on the relative efficiency of the estimated regression coefficients.

The majority of patients (59.5%) had unfavorable dialysis adequacy (KT/V<1.2). Women had more favorable dialysis adequacy than men, and patients <60 years had more favorable dialysis adequacy than older. In the GEE1, GEE2, and QIF models, the coefficients of dialysis history, dialysis duration, weight, gender, and age showed a significant relationship with dialysis adequacy (p<0.05) The relative efficiencies of GEE2 versus GEE1,  and QIF versus GEE1  and GEE2 were 1.163, 1.13, and 1.028, respectively.

Dialysis adequacy is not optimal in most hemodialysis patients. The different models yield quite similar coefficient estimates, but GEE2 with unstructured correlation is more efficient than GEE1, and QIF is more efficient than both GEE1 and GEE2.

Information on the coronavirus infection 2019 (COVID-19) which can clinically range from asymptomatic infection to severe pneumonia, in transplant recipients is still low. Infections are a major cause of death in kidney transplant recipients, and kidney transplant recipients, like other organ recipients, appear to be more vulnerable to a variety of infections due to comorbidities and immunosuppressive drugs that predispose them to infection.

In this study, we reviewed 10 transplant recipients with a mean age of 50.3±11.25 years who were admitted to Ayatollah Rouhani Hospital in Babol due to COVID-19 From April 2019 to September 2019. Four patients were female and six ones were male. Fever (100%) and cough (60%) were the most common symptoms in patients. All patients used standard immunosuppressive drugs (tacrolimus, corticosteroids, mycophenolate, and cyclosporine). The mean level of oxygen saturation at the time of admission in these patients was 87.9±11.3 and in two patients with death outcomes of 57% and 95%, it was at the beginning of hospitalization. The mean leukocytes of patients at the beginning of hospitalization was10470±5784.08 per ml and the mean lymphocytes of these patients were 1081.5±516.05. In the studied patients, the mean of previous years of transplantation was 8/05±7.13 and two patients died 20 years and 5 years after their kidney transplantation. Two patients (20%), aged 57 and 50 years, died from progressive respiratory symptoms and the other eight patients recovered and were discharged from the hospital.We reported COVID-19 infection in ten kidney transplant recipients with different clinical outcomes and periods, which may be a reference for the management of COVID-19 in such patients.

It seems that more information is needed to better understand the effect of anti-transplant immunosuppressive therapy on the outcome of COVID-19 infection in kidney transplant recipients. Long-term follow-up studies and more cases are needed to clarify the diagnosis, outcome, and treatment options for COVID-19 in these patients.

Clinical reasoning is one of the important categories in medicine and teaching it in different ways can accelerate the student's ability to approach expert professional thinking. In addition, complementary trainings, along with clinical training, can promote clinical training in pandemics and situations where contact with the patient is reduced for some reason.

This is an semi-experimental, case observation study in which the case group was trained in clinical reasoning by scenario writing method, and after the test, 2 groups were compared with KF and DTI tests. The two were identical based on their basic science test scores before the study.

In this study, 60 people in two groups of case and control (30 people in each group) were compared with DTI and KF tests. The average DTI score in the case group was 151.4±15.3 and the average score in the control group was 151.8±17.2, the scores in both the case and control groups were not significant (P-value=0.922). The KF scores were 36.3±4.5 in the control group and 30.2±8.2 in the case group, and the scores in the case group were significantly higher than the control group (P-value=0.001)

The results of the study showed that short-term scenario writing training can be effective in improving the KF score and clinical reasoning, but increasing the DTI score requires more training time.

Coronavirus disease 19 (COVID-19), has recently emerged as a great health challenge. The novel corona virus may affect the kidneys mainly as acute kidney injury (AKI). Also, the outcome of COVID-19 may be different in patients with underlying kidney disease. The aim of this study was to compare the outcome of COVID-19 in patients with and without underlying kidney disease.

This was a retrospective study on 659 hospitalized COVID-19 patients in six centers of Iran. Patients were classified into kidney (chronic kidney disease (CKD), end-stage kidney disease (ESKD) or kidney transplantation) and non-kidney groups. The clinical conditions and laboratory data were extracted from the charts. Outcome was defined as death during hospitalization or within 30 days of discharge.

Among 659 COVID-19 patients (mean age: 60.7 ± 16.4, 56% male), 208 were in the kidney group (86 ESKD, 35 kidney transplants, and 87 CKD patients). AKI occurred in 41.8%. Incidence of AKI was 34.7% in non-kidney, 74.7% in CKD, and 51.4% in kidney transplant patients (P < .001). Totally 178 patients (27%) died and mortality rate was significantly higher in CKD patients (50.6 vs. 23.4%, P < .001). AKI was associated with increased mortality rate (OR = 2.588, CI: 1.707 to 3.925). Initial glomerular filtration rate (GFR) < 44.2 mL/min and elevated lactate dehydrogenase (LDH) and C-reactive protein (CRP) had significant association with mortality.

We showed a higher mortality rate in COVID-19 patients with AKI and CKD. Low initial GFR and elevated LDH and CRP were associated with high mortality in COVID-19 patients.

Family caregivers are important sources of care for hemodialysis patients. Althoughcaring for a family member is a pleasant feeling, experiencing lots of physical and psychologicalcaregiving burden influences the quality of life among family caregivers of hemodialysis patients.This study aimed to design and validate the quality of life inventory for family caregivers of patientson hemodialysis. A sequential-exploratory mixed method was conducted in Tehran, Iran, in 2017-2018. In thequalitative phase, the researcher conducted in-depth semi-structured interviews with 19 participants.Finally, a pool of 93 items was extracted from this phase. Then, psychometric properties such as facevalidity (Impact Score>1.5), content validity ratio (CVR>0.63), content validity index (Item ContentValidity Index: ICVI>0.78 , Scale Content Validity Index/Average: SCVI/Ave>0.8) and Kappa value(Kappa>0.7, internal consistency (Cronbach’s alpha>0.7), relative reliability (ICC:interclass correlationcoefficient),absolute reliability (Standard Error of Measurement: SEM and Minimal DetectableChanges: MDC), convergent validity (Correlation Coefficient between 0.4-0.7), interpretability,responsiveness, feasibility, and ceiling and floor effects were assessed The quality of life inventory for family caregivers of hemodialysis patients was developedwith 34 items and five factors (namely patient care burden, conflict, positive perception of situations,self-actualization, fear, and concern). The findings confirm that the scale is acceptable regardingvalidity, reliability and other measurement features. This inventory is consistent with the health care status in Iran. Therefore, it can be usedto measure the quality of life among family caregivers of hemodialysis patients.

Sarcoidosis is a systemic disorder affecting multiple organs. We presented a 56-year old woman with renal impairment who was diagnosed with sarcoidosis accompanied by IgA nephropathy. Treatment with methylprednisolone was started for the patient. After treatment, the patient was discharged with good general condition and resolved proteinuria

Chronic kidney disease (CKD) is a common disease in the world that has adverse outcomes. Immune system and its components have important role in the initiation, progression and complications of this disease by systemic inflammation. Regarding the role of kidneys in the body’s natural homeostasis and its relationship with other organs, CKD causes impairments in other organs. Patients with chronic renal failure have variety of complications, such as cardiovascular disease, anemia, bone disorders, immune dysfunction and etc., together which culminate in the morbidity and mortality of these patients. Immune dysfunction is one of the most important and serious complications in CKD patients. These patients often suffer from immune suppression and are susceptible to some infections. In this review, we describe some major findings of interactions between the kidney and immune system in CKD

Clinical reasoning as a critical and high level of clinical competency should be acquired during medical education, and medical educators should attempt to assess this ability in medical students. Nowadays, there are several ways to evaluate medical students’ clinical reasoning ability in different countries worldwide. There are some well-known clinical reasoning tests such as Key Feature (KF), Clinical Reasoning Problem (CRP), Script Concordance Test (SCT), and Comprehensive Integrative Puzzle (CIP). Each of these tests has its advantages and disadvantages. In this study, we evaluated the reliability of combination of clinical reasoning tests SCT, KF, CIP, and CRP in one national exam and the correlation between the subtest scores of these tests together with the total score of the exam.

A total of 339 high ranked medical students from 60 medical schools in Iran participated in a national exam named “Medical Olympiad”. The ninth Medical Olympiad was held in Shahid Beheshti University of Medical Sciences, Tehran, Iran, under the direct supervision of the Ministry of Health and Medical Education in summer 2017. The expert group designed a combination of four types of clinical reasoning tests to assess both analytical and non-analytical clinical reasoning. Mean scores of SCT, CRP, KF, and CIP were measured using descriptive statistics. Reliability was calculated for each test and the combination of tests using Cronbach’s alpha. Spearman’s correlation coefficient was used to evaluate the correlation between the score of each subtest and the total score. SPSS version 21 was used for data analysis and the level of significance was considered <0.05.

The reliability of the combination of tests was 0.815. The reliability of KF was 0.81 and 0.76, 0.80, and 0.92 for SCT, CRP, and CIP, respectively. The mean total score was 169.921±41.54 from 240. All correlations between each clinical reasoning test and total score were significant (P<0.001). The highest correlation (0.887) was seen between CIP score and total score.

The study showed that combining different clinical reasoning tests can be a reliable way of measuring this ability.

Irisin is a myokine that regulates energy metabolism by inducing browning of adipose tissue. The aim of this study was to evaluate the relationship between irisin level and biochemical parameters of chronic kidney disease (CKD) patients in stage 2 and stage 4.
The research was a cross-sectional study; the study population included patients with CKD who were over 18 years of age, included 90 individuals with CKD, of these participants, 45 were in the second stage of the CKD while the other 45 subjects were in the fourth stage. Serum irisin concentration plus the level of glucose (Glu), urea, creatinine (Cr) and hemoglobin (Hb) were measured.
In the present study, the serum irisin level of patients in stage 4 was significantly reduced (13.00 ng / ml) compared with patients in stage 2(21.41 ng / ml).
With the progression of CKD from stage 2 to stage 4, parameters such as serum Cr, TG, LDL, FBS, BUN and urea levels significantly increased. Inversely, factors such as irisin, GFR, Alb, HDL and Hb levels significantly decreased. These findings suggest that irisin may be involved in the regulation of biochemical factor levels in CKD patients through the progression from stage 2 to stage 4.

The aim of this study was to describe the one-decade experience in Percutaneous Nephrolithotomy surgery in children with kidney stones in Tehran, Iran.
All patients (less than 18 years old) undergoing Percutaneous Nephrolithotomy at our referral medical center, were reviewed in this cross-sectional study. All the demographics, surgical data and post-operative information were obtained to identify the stone free rates and complications.
In a total, 119(56.4%) cases of 211 patients who underwent Percutaneous Nephrolithotomy in our study were male and 92(43.6%) cases were female. The mean age of participants was 137.15±60.11 months (range: 9-204). The most common presenting symptom was pain (62.6%). The mean stone burden was 23.5 ± 9.68mm and the mean operative time was 109.95±37.1 min. Overall, stone clearance rate was 73.9% after single PNL. Among those patients who had renal malformation, the stone free rate was (13/19) 68.4% for PCNL. The postoperative complication rate was 5/47 (10.6%) during all procedures and there were no major operative or postoperative complications.
According to the findings, pediatric PCNL with the acceptable stone free rates could be considered as a safe and effective procedure among children with complex stones and renal malformation.

Cytomegalovirus (CMV) disease is an important cause of death and possibly transplant rejection in kidney transplant (KT) patients. This study was conducted to investigate the incidence and risk factors of CMV disease in kidney transplant patients.
All end-stage renal disease (ESRD) patients who underwent kidney transplantation during 1998-2014 and their donors were assessed. All samples were followed-up for approximately 70 months. CMV was identified by polymerase chain reaction (PCR) and/or PP65 antigen in peripheral blood leukocytes along with clinical manifestations.
A total of 1450 cases participated in the current study. CMV was diagnosed in 178 out of 725 (24.6%) kidney recipients. The annual incidence of CMV disease was 4.2%. Patients older than 40 years had a higher incidence of CMV disease. The level of CMV disease incidence in the 41-60 age group was 4 fold compared to those under 20 of age group (P=0.001).
This study demonstrated that the incidence of CMV disease in our region is relatively low and also age more than 40 years and EBV infection are the important risk factors in kidney transplant patients. So care and monitoring of these patients are crucial in the first 5 months.

Both vitamin D deficiency and hypertension are prevalent in the general population. Several observations indicate an association between vitamin D deficiency and high blood pressure. The present case-control study aimed to compare serum 25-hydroxyvitamin D (25-OHD) in hypertensive patients versus healthy controls.
One hundred patients aged 30-60 years with hypertension (HTN) and 100 healthy controls without history of hypertention were compared regarding serum 25-OHD. Blood pressure was measured using standard method and the systolic and diastolic blood pressure more than140 mmHg and 90 mmHg respectively were considered as HTN. Patients and controls with coexistent morbidities, vitamin D supplementation were excluded. The serum levels of 25-OHD, PTH and calcium were measured after obtaining a written informed consent from the patients and taking their blood pressure under standard conditions. In statistical analysis, the two groups were compared using independent t test and chi-square test using SPSS Version 18.
The mean age of patients and controls was comparable (53.7±6.4 vs 52.3±7.54 years, P=0.17). Serum 25-OHD in HTN was significantly higher than controls (P=0.001).
In the present study, serum 25-OHD level in hypertension was higher than controls. The results contradict with earlier studies indicating an association of HTN with vitamin D deficiency. This issue warrants further investigations in particular the follow-up of serum 25-OHD deficient and sufficient subjects with regard to the development of HTN.

The increased susceptibility to infection in patients with end-stage renal disease is probably secondary to the impaired immune defense in uremia. Mannose-binding lectin (MBL) has an important role in host defense through activation of the lectin complement pathway. The aim of this study was to measure serum MBL level in peritoneal dialysis patients and compare it with a healthy group. Seventy peritoneal dialysis patients and 70 healthy individuals were enrolled in this study. Serum MBL levels were measured by an enzyme-linked immunosorbent assay kit using the mannan molecule. In addition, serum C-reactive protein and albumin levels were measured to determine whether there is a correlation between serum MBL level and these two parameters. The mean serum MBL level was 2.32 ± 2.54 µg/mL (range, zero to 6.93 µg/mL) in the patients group and 1.80 ± 2.14 µg/mL (range, zero to 6.97µg/mL) in the control group (P =. 19). No significant correlation was detected between age and serum MBL level in either the groups. In the patients group, no significant correlation was found between serum MBL and C-reactive protein levels or MBL and albumin levels. There were no correlation between duration of peritoneal dialysis and MBL or dialysis adequacy and MBL, either. This study did not find MBL deficiency in peritoneal dialysis patients as compared to the healthy individuals.

Inflammatory process has a substantial contribution in the development of anemia in chronic hemodialysis patients. Low serum albumin in hemodialysis patients is considered a marker of inflammation. The present longitudinal study aimed to determine the relationship between low baseline serum albumin and future development of anemia. The population of this study consisted of all patients on standard maintenance hemodialysis for at least three months or longer. Patients were classified as high or low serum albumin level (≥ or < 3.9 gr/dl). All patients received the standard treatment of anemia. The main objective of this study was to compare the prevalence of anemia defined as hemoglobin levels < 11 gr/dl between the two study groups at the end of the study period. A total of 82 patients (50% females) with mean±SD age of 55±16.8 years and mean dialysis duration of 5.2±4 years were followed-up for an average period of 10±1 (range, 8-11) months, however 48 patients with high serum albumin and 24 patients with low serum albumin group completed the study. At baseline, the two groups were similar regarding hemoglobin (9.8±1.2 vs 9.16±1.6 gr/dl, P=0.95) levels. At endpoint, prevalence of anemia in high albumin group was significantly lower than the low albumin group (50% versus 83.3% P=0.005). The findings of this study indicate that low serum albumin in hemodialysis patients is a predictor of anemia indicating unresponsiveness to conventional treatment of anemia.

Ongoing measurement of quality of life especially in patients with chronic diseases، maybe the basis of health care evaluation. This study aimed to assess and identify factors affecting quality of life in hemodialysis patients in Kermanshah city.

This is a cross sectional study carried on 98 cases of hemodialysis patients referred to two of teaching hospitals (Imam Khomeini and Imam Reza affiliated to Kermanshah University of Medical Sciences. Available sampling applied to patients who started dialysis at least three months before. Demographic data collected and SF-36 questionnaire of quality of life performed which its validity and reliability has been confirmed previously in Iran.

The physical health score decreased with increasing age (P<0. 05) and increased with increasing education level (P<0. 005). In addition، physical health in those who did not exercise any time were less than the other (P<0. 001). Overall mental health scores increased with increasing education level (P<0. 001) and increasing household income was associated with increasing mental health score (P<0. 05). The overall score of mental health for those who had always exercised was more than the others and for those who did not exercise any time was less than (P<0. 001). The overall score of mental health in people who had dialysis twice a week was the highest (P<0. 05).

Considering the impact of physical activity and socioeconomic status on patients'' quality of life accounting، these factors in order to promoting the quality of life will be effective.

Cardiovascular mortality and morbidity are high in chronic renal failure (CRF) patients. Increased dispersion of QT intervals is known to predispose to ventricular arrhythmias and sudden cardiac death. This study was conducted to assess the effect of hemodialysis (HD) on corrected QT (QTc) intervals and their dispersions (QTd) in chronic hemodialyzed patients. Fifty-eight patients (mean age 54.2±15.8 years) with chronic renal disease on chronic hemodialysis (HD) were assessed by standard examination including blood pressure, body weight, heart rate, 12–lead electrocardiography and laboratory tests like electrolytes (Na +, K +, Ca ++, phosphate), urea, and creatinine 30 minutes before and after HD. The QT intervals and QTc QTc= QT R-R/ (in milli seconds [ms]) for each lead were measured manually by one observer using calipers. The difference between the maximum and the minimum of QT interval was noted as QT dispersion (QT d). The mean of pre and post dialysis R-R intervals was 859.22±96.85 ms and 870.43±91.45 ms, respectively (p>0.05). The mean of corrected QT cmax intervals increased significantly from 423.45±24.10 to 454.41±30.25 ms (p<0.05). The mean of QT dispersions and the corrected QT interval dispersions changed from 51.56±12.45 to 63.21±14.43 ms (p<0.05) from 59.40±13.58 to 68.33±14.55 ms (p<0.05), respectively. The changes in serum potassium and calcium levels were related with QT interval prolongation. QT and QTc interval and dispersion increase in HD patients. Prolonged QT interval indices had relation with K+ and Ca++ ions before but not after HD.

Thymoglobuline (TG)، is used for both induction and rejection therapy in kidney transplantation (TX). This study was conducted to compare between adding TG or not to the conventional drugs to evaluate the rate of rejections، infections and costs. In two groups of patients، each of 45 cases; group A received conventional drugs (cyclosporine، mycophenolate and prednisolone) and in group B، TG was added; both groups were then compared. TG was administered for 5 doses (1. 5 mg/kg/d for the first 3 days and 1 mg/kg/d for the last 2 days. Suspicious signs of rejection (fever، graft tenderness، graft enlargement and increase in length and depth)، creatinine rise، diethylene triamine penta-acetic acid scan (DTPA) results and urinary tract infections (UTI) with counts > 105 CFU/ml were recorded. The duration of the first hospitalization، the CMV incidence of infection in the first 6 months and their costs were finally compared. There was no difference for age، duration of hospitalization and CMV infection between the two groups. UTI occurred more frequently in TG group (p=0. 049). Creatinine rise، suspicious signs of rejection occurred more frequently in TG group (p<0. 05). Creatinine rise and suspicious signs of rejection occurred more frequently in conventional group (p=0. 020، p<0. 000، respectively). The need for additional steroid pulses was more frequent in conventional group (p<0. 000). The total costs of TG، ganciclovir، antibiotics and steroid pulses in both groups were similar. The results show that the posttransplantation problems (signs of rejection، rise of creatinine، graft losses and delayed graft function) occurred rarely in TG group. The incidence of infection and the cost of both regimens were similar. We strongly recommend this protocol as induction therapy.

Introduction. Mannose-binding lectin (MBL) is a part of the innate immune system. Many studies showed an association of low serum MBL levels with decreased host defense against various infectious agents. Considering paradoxical reports about the serum level of MBL in hemodialysis patients, this study aimed to measure and compare serum MBL levels in hemodialysis patients and healthy individuals.Materials and Methods. In a cross-sectional study, 70 hemodialysis patients and 70 volunteers with normal routine laboratory tests and physical examination were assessed for serum MBL level (measured by an enzyme-linked immunosorbent assay). In addition, serum C-reactive protein levels in hemodialysis patients were measured to rule out correlation of increased serum MBL level with inflammation.Results. In hemodialysis patients, 32 (45.7%) were men and 38 (54.3%) were women. In the control group, 34 (48.6%) were men and 36 (51.4%) were women (P =. 87). The mean age showed no significant difference in hemodialysis (44.5 ± 13.5 year) and control (46.4 ± 12.4 years) groups. Serum level of MBL was significantly higher in hemodialysis patients (2.12 ± 1.49? g/mL) than that in the controls (1.49 ± 2.12? g/mL; P <. 001). No significant correlation was found between serum MBL and C-reactive protein levels (r = 0.002, P =. 98) among the hemodialysis patients.Conclusions. Serum MBL level in hemodialysis patients was significantly higher than that in the control group of healthy individuals. This may have some implications in management of patients and prediction of kidney allograft survival.