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Background: Recently, renal transplantation has increased worldwide. The incidence of metabolic syndrome is common after renal transplantation that might reduce renal function and increase cardiovascular complications. In this study, we compared renal function after renal transplantation in patients with or without metabolic syndrome. Methods: This cohort prospective study was conducted in 2017 among patients with renal transplantation aged more than 20 years in Isfahan City, Iran. Metabolic syndrome criteria including blood pressure, fasting blood sugar, high- and low-density lipoprotein, triglyceride, and waist circumference, as well as serum creatinine were measured in 30 patients with metabolic syndrome and 30 without metabolic syndrome in one-year follow-up period. Findings: 17 patients were women and 43 were men. The mean serum creatinine changes were not significantly different among the patients with or without metabolic syndrome (P = 0.227) in 1-year follow up. There was no significant association between serum creatinine level with metabolic syndrome criteria such as waist circumference (P = 0.214), diastolic blood pressure (P = 0.061), triglyceride (P = 0.409), high-density lipoprotein (P = 0.315), and fasting blood sugar (P = 0.284) in patients with metabolic syndrome, and only the association between serum creatinine level and systolic blood pressure was significant (P = 0.008). Conclusion: Serum creatinine did not increase significantly in patients with metabolic syndrome. We recommend to consider longer follow-up periods in future studies.

Background: This study aimed to identify the efficacy and complications of premicath catheter in patients with renal failure and rejected renal transplant as well. Methods: This descriptive-analytical study included 39 patients who had again undergone premicath catheter insertion due to rejection of renal transplant and 39 patients without renal transplant. Duration of premicath catheter performance and incidence of relevant complications in these two groups were assessed and compared using patients’ records. Findings: The mean duration of catheter performance was 12.9 ± 9.5 and 13.9 ± 11.0 months in groups of with and without renal transplantation, respectively, and there was no significant difference between the two groups (P = 0.690). The mean survival time for the catheter was 25.04 ± 2.57 and 43.43 ± 3.04 months in renal transplant and hemodialysis groups, respectively; which was significantly higher in hemodialysis group, according to the log-rank test (P = 0.020). Conclusion: Survival time of the catheter is less in patients with rejected renal transplant; and due to rejection of the transplant, they should continue hemodialysis in longer time compared to hemodialysis patients who have not received any transplant. Thus, it appears that it is associated with the patient's reactions and their immune system and lack of caring inserted catheter by patient and his/her relatives. Therefore, more care is required in patients undergoing catheter insertion again after renal transplantation. More researches are needed in this field to clarify the conclusion.

Background: Depending on the site of irradiation, about 40-80% of patients undergoing radiotherapy (RT) will experience nausea and/or vomiting. The current study aimed to investigate the efficacy of ondansetronas as a single agent and with a combination to aprepitant on preventing RT-induced nausea and vomiting (RINV). Materials and Methods: In a clinical randomized controlled trial (from September 2010 to September 2011), conducted in Radiation Oncology Department of Seyed-al-Shohada Hospital, Isfahan University of Medical Sciences, 40 abdominopelvic malignancies cancer patients were allocated into two aliquots using block randomization of size. Patients in the first group (group I) received ondansetron alone while those patients in the remaining group (group II) received ondansetron and aprepitant. Then, developing of RINV and its severity and benefit of adding aprepitant to ondansetron, in comparison with ondansetron as a single drug therapy were evaluated. Results: The average age of the patients in group I was 61.15 ± 12.27 years while in group II it was 50.1 ± 13.27 years. No statistically significant gender differences were found between the two groups. In patients treated with ondansetron single drug therapy (group I), frequency and grade of RINV were significantly more than the group treated simultaneously by aprepitant and ondansetron (group II) (odds ratio [OR] = 21.2; P < 0.01). Compared with RT alone, the patients whom underwent RT along with chemotherapy showed lower probability of experiencing RINV (OR = 0.13; P < 0.05). Conclusion: The present study indicated a significant superiority of combination of ondansetron and aprepitant in management of RINV, in patients undergoing RT, compared to ondansetron as a single agent therapy. More accurate follow-up studies are needed for the evaluation of the efficacy of ondansetron with combination to aprepitant on preventing the RINV.

Background : Hemodialysis (HD)‑associated ocular abnormalities are one of the causes of morbidity among people undergoing HD. This study evaluates the frequency of ocular abnormalities in end‑stage renal disease (ESRD) patients undergoing HD and their potential link to HD and demographic parameters. Methods : This cross‑sectional study examined 242 eyes of 121 patients with ESRD undergoing regular HD after excluding the ineligible subjects. The study was designed in two parts. Medical histories of each patient including age, gender, family history, medication history, past medical history, and duration of HD collected using a structured check list. All patients underwent complete ophthalmologic examination for evaluation of the best corrected visual acuity (BCVA), intraocular pressure (IOP), and anterior and posterior segments. Results : In total, 121 patients, including 68 (56.2%) males and 53 (43.8%) females, were enrolled in the study. The mean ± SD age of the patients and their mean duration of dialysis were 51.59 ± 16.01 and 3.40 ± 2.75 years, respectively. The most prevalent etiology for HD was diabetes mellitus (39.67%), followed by hypertension (38.84%), and the most common ocular fndings included cataract (142 eyes; 58.7%) and ectopic calcifcation of the conjunctiva and cornea (78 eyes; %32.2). There was at least one abnormal ocular fnding in 89.3% of the cases. The BCVA was equal to or less than fnger count in 70 eyes (28.92%). There was a signifcant relationship between conjunctival calcifcation and the duration of dialysis ( P = 0.02). There was signifcant association between etiology of HD and conjunctival calcifcation (adjusted odds ratio, 2.44; 95% CI, 1.05–5.67; and P value, 0.03). Such signifcant associations were present for corneal calcifcation ( P = 0.009), cataract ( P = 0.02), and optic atrophy ( P = 0.01). Conclusions : Regular ophthalmologic examinations are recommended due to the prevalence of clinical ocular abnormalities in HD patients. Keywords : Diabetic retinopathy, eye disease, kidney disease, kidney failure, renal dialysis

Background: Acute phase proteins disorders are common problems in dialysis patients. According to previous studies, carnitine can increase blood albumin levels in these patients. In this study the effect of carnitine on serum albumin level of hemodialysis patients was investigated. Methods: In this blinded placebo controlled randomized clinical trial, 51 hemodialysis patients (16, 17 and 18 patients in the drug (carnitine), placebo and control groups, respectively) aged more than 21 years, were enrolled. L-carnitine (250 mg) and placebo pills were prescribed daily in three divided doses orally for 6 months. The control group received no drug. Serum albumin level in studied patients was measured before the study and every month after intervention. Findings: The mean serum albumin level at baseline in carnitine, placebo, and control groups was 3.87 ± 0.26, 3.88 ± 0.35, and 3.96 ± 0.45 g/dl, respectively. The mean serum albumin level at the end of the study in carnitine, placebo and control groups was 4.39 ± 0.54, 4.44 ± 0.78, and 3.84 ± 0.45, respectively. The mean serum albumin changes in three studied groups were significantly different before and after intervention (P < 0.05) due to the difference of control group with placebo and carnitine groups. There was no significant difference regarding side effects and mortality in carnitine and placebo groups (P > 0.05). Conclusion: Carnitine had not significant effect in serum albumin level. But considering the improvement was observed in carnitine and placebo groups comparing with control group, it could be suggested that it may be attributed to placebo effect and improvement of patients’ mood. Similar studies with higher doses of carnitine are recommended.

• Background: Anemia is one of the major problems of dialysis patients The primary mechanism of anemia in these patients is Erythropoietin insufficient production by kidneys. Often, this kind of anemia is caused by inflammatory reactions. A large number of dialysis patients, despite receiving adequate doses of erythropoietin, are anemic. Therefore it seems the use of a pharmaceutical composition that can control the inflammatory reactions is an appropriate strategy. This study was done to investigate the effect of Pentoxyfilline on hemoglobin level and Erythropoietin dose in these patients • Methods: This study was a clinical trial that performed on anemic peritoneal dialysis patients. Study patients were randomized to two groups of 25 person recipients Pentoxyfilline and control groups. The amount of blood hemoglobin and serum albumin, iron, Total Iron Binding Capacity (TIBC), ferritin and Parathormone (PTH) were measured at the beginning and the end of the study. Collected data were analyzed by SPSS software. • Finding: 45 patients were studied (20 cases and 25 controls). The results of this study have not shown the significant differences in hemoglobin and serum albumin levels changes between two groups. According to results of this study the change of erythropoietin dose was not significant in both goups. • Conclusions: According to the results, conducted another study with higher sample size and longer time for investigation of the effect Pentoxyfilline is recommended.

BACKGROUND: The growing interest in filler injection requires a more comprehensive knowledge about the complications of this procedure. METHODS: A total of 5 cases with debilitating chronic complications following filler injection referred to Al-Zahra hospital, Isfahan are presented in this report. RESULTS: The outcome of treatment for two of the cases was satisfactory. In one case the treatment led to failure. A case committed suicide, the remaining case had received vitamin E injection which caused severe necrosis and scaring. CONCLUSIONS: All fillers are considered foreign bodies and may provoke the immune system to varying degrees. Most complications are, however, caused by the technique of injection not the filler itself. Experience of physicians along with adequate knowledge about fillers and their complications can definitely guarantee a better outcome.

Background: Considering the existence of controversies about the predictive value of inflammatory markers for cardiovascular disease (CVD), we aimed to compare the level of high?sensitivity C?reactive protein (hs?CRP) and interlukin?6 (IL?6) level in chronic hemodialysis (HD) patients with and without CVD. Materials and Methods: In this historical cohort study, HD patients with and without CVD disease were enrolled. The presence of CVD risk factors, level of inflammatory factors including IL?6 and hs?CRP as well as lipid levels, fasting blood sugar, and other biochemical factors were compared in two studied groups. Results: During the study, eighty HD patients with ( n = 40) and without ( n = 40) CVD were enrolled. Diabetes was more prevalent among HD patients with CVD than those without CVD ( P 0.05). Univariate analysis of variance test indicated that there was not any significant relationship between hs?CRP and CVD ( P > 0.05). Conclusion: The findings indicated that the level of inflammatory factors including hs?CRP and IL?6 are not significantly different in HD patients with and without CVD. However, for obtaining more definite conclusion in this field and evaluation their predicting role in this field, it is recommended to study other novel inflammatory markers as well as the additive effect of the inflammatory factors with traditional ones in larger sample size and longer follow?up. Key words: Cardiovascular disease, cardiovascular risk factor, high sensitivity C?reactive protein, interleukin?6

Bachground: Peritonitis and exit site (ES) infection are two main complications of peritoneal dialysis. There are some controversies regard to preventive strategies for ES care. In this study we compared peritonitis and ES infection rates in patients with and without dressing. Materials and Methods: This historical cohort study carried out on 72 patients under continuous ambulatory peritoneal dialysis treatment, 54 with dressing versus 18 patients without dressing, followed from October 1, 2010 to March 31, 2011 for peritonitis and ES infection. Results: A total of 17 episodes of ES infection occurred in 12 patients in dressing group, but no case was seen in no-dressing group (P = 0.02). Twenty-one episodes of peritonitis occurred in 15 patients in both groups (one episode every 20.6 patient-months). In no-dressing group two episodes occurred in only one patient (one episode every 54 patient-months), and in dressing group, 19 episode in 14 patients (one episode every 17.1 patient-months) (P = 0.03). Peritonitis was significantly more frequent in male versus female in overall patients (38% vs. 14%, P = 0.025) and in dressing group (52% vs. 15%, P = 0.003). In dressing group, peritonitis was more frequent in diabetics versus non-diabetics (48% vs. 11%, P = 0.01). Odds ratio for developing peritonitis was 9.4 in dressing group (95% confidence interval [CI] =1.05 − 84.4; P = 0.045), and 4.4 in men (95% CI = 1.26 − 15.19; P = 0.02). Conclusion: In this study, chronic ES care without dressing was associated with lower risk of peritonitis and ES infection.

Background: Hypercoagulable state is a common serious problem in patients with end-stage renal disease (ESRD). ESRD patients are in a condition of chronic inflammation. An increased level of E-selectin, “a key adhesion molecule that regulates leukocyte bindings to endothelium at damaged sites,” accompanies the higher risk of inflammation in ESRD patients. We aimed to investigate the possible correlation among E-selectin as an adhesion molecule, coagulation factors, and inflammatory factors in children with ESRD. Materials and Methods: Thirty-five child patients with ESRD who had been on regular dialysis treatment were registered in our study. Nighteen sex- and age-matched healthy volunteers were used as the control group. Laboratory tests were requested for the evaluation of hematological and biochemical parameters, and parathyroid hormone (PTH), and for coagulation state; fibrinogen, protein C, and protein S were measured. The enzyme-linked immunosorbent assay (ELISA) (Biomerica, CA, and IDS, UK). for serum E-selectin assay was provided by R and D Systems (Abingdon, UK). Results: Hemoglubolin (Hb), blood urea nitrogen (BUN), creatinine, calcium, PTH, triglyceride (TG) concentrations in serum as well as E-selectin showed significant difference between the two study groups, as indeed was expected. Serum E-selectin was significantly higher ( P value = 0.033) in dialysis patients than in healthy subjects. E-selectin was positively correlated only with phosphorus in ESRD children ( r = 0.398, P = 0.018). No association was found for other parameters. Conclusion: Although in our study circulating E-selectin concentration “as an inflammatory maker” is independently positively associated with limited blood markers, for better evaluation, well-designed cohort studies should be examined in ESRD children.

Background: Excessive body fat is associated with increasing risk of ischemic heart disease (IHD). Some fat cell mediators such as adiponectin and leptin have been recognized as possible new IHD risk factors. We assessed the association of fat cell’s size and number, serum leptin and adiponectin with IHD. Methods: The study was designed as a “case control” study in 40 to 60 years old patients with ischemic heart disease symptoms underwent coronary angiography. The cases had significant stenosis in coronary angiography. The control subjects had normal angiography. Serum lipid levels, adiponectin, leptin, and insulin were examined in all cases and controls by Enzymayic method. The biopsies from abdominal and gluteal fat tissue regions were fixed and stained using the Hematoxilin-eosin method. Slides were photographed with a microscopic digital camera. Fat cell’s size and number were assessed using Image tool V3 software. Data were analyzed with SPSS software. Findings: There were no significant difference between cases and controls in fat cell’s size and number, serum leptin and adiponectin. However, serum leptin was correlated not only to waist circumference (r = 0.31, P = 0.036), but also to body mass index (r = 0.32, P = 0.033). Conclusion: Although Leptin and adiponectin are correlated with obesity and are introduced as IHD risk factors; they showed no association with ischemic heart disease in our study. More investigation is required to confirm this relationship in the Iranian population.

We performed this study to assess whether low dose spironolactone could be admi-nistered in hemodialysis (HD) patients with moderate to severe heart failure to improve cardio-vascular function and reduce hospitalization without inducing hyperkalemia. We enrolled 16 chro-nic HD patients with moderate to severe heart failure and left ventricle ejection fraction :5 45%. In a double blinded randomized placebo controlled study, one group of 8 patients received 25 mg of spi-ronolactone after each dialysis session within six months, and the rest received a placebo. Echo-cardiography was performed on all the patients to assess ejection fraction and left ventricular mass during 12 hours after completion of hemodialysis at the beginning and the end of study. Serum potassium was measured predialysis every 4 weeks. The mean ejection fraction increased signi-ficantly more in spironolactone group during the study period than in the placebo group (6.2 ± 1.64 vs. 0.83 ± 4.9, P= 0.046). The mean left ventricular mass decreased in the spironolactone group, but increased significantly in the placebo group during the period (-8.4 ± 4.72 vs. 3 ± 7.97. 95%, P= 0.021). The incidence of hyperkalemia was not significantly increased in the study or controlled groups. In conclusion, we found in this study that administration of spironolactone in chronic HD patients with moderate to severe heart failure substantially improved their cardiac function and decreases left ventricular mass without development of significant hyperkalemia.

Introduction Although renal transplantation from cadaver is common, living donors continue to be an important source of transplanted kidneys. Recipients of living-donor kidneys demonstrate improved graft survival. In this study, we evaluated the outcomes of renal transplantation from cadaver, related donors and unrelated donors in Isfahan. Methods We evaluated all of the patients who underwent kidney transplantation in hospitals affiliated to Isfahan University of Medical Sciences in 2002. We assessed complications including hypertension, urinary tract infection, fever, transplant rejection, urinary leak, renal failure, renal vessels thrombosis and urinary tract obstruction. Donors (living related, living unrelated, cadaver) were registered and complications were compared in the three groups. Chi-square and Fisher exact tests were used for statistical analysis. Results One-hundred patients were evaluated (22 had received kidneys from cadaver, 10 from living related donors, and 68 from living unrelated donors). Transplant rejection was most common in recipients of kidneys from living unrelated donors (49.7%, P=0.02). Renal failure was most common in recipients of kidneys from cadaver (68%, P=0.02), urinary infection was most common in recipients of kidneys from living unrelated donors (26%, P=0.04). Overall, complications were most common in patients who had received kidneys from cadaver (81%, P=0.04). Conclusions Given the high transplant rejection rate in recipients of kidneys from living unrelated donors, and the complications observed in recipients of kidneys from cadaver, kidney transplant from living related donors seems to be the most favorable option. Keywords Kidney transplantation, Complication, Outcome.

Background: End stage renal disease (ESRD) is a condition that inflammation and oxidative stress plays an important role in damaging to tissues, especially, in the vascular system. The effect of omega-3 fatty acids is well-documented in some inflammatory diseases via eicosapentanoic acid and docosahexanoic acid components of fish oil. The aim of this study was to investigate the effects of dietary omega-3 fatty acid supplementation on levels of lipid peroxidation and oxidative sttress in ESRD patients. Materials and Methods: This randomized controlled double-blind clinical trial consisted of 90 patients on chronic ambulatory peritoneal dialysis (CAPD). One group was treated orally with 3000 mg omega-3, per day for 8 weeks ( n = 45) and the other matched group by placebo ( n = 45). Serum levels of lipids, iron, ferritin, Protrombin Time, Partial thromboplastin time, superoxide dismutase (SOD), and reduced glutathione (GH) were measured at the beginning and at 8 weeks. Results: Our results showed that SOD and reduced GH were not significantly changed in omega-3 group where lipid profile showed no significant changes too. Erythropoietin requirements also had no significant differences. Conclusion: Incorporation of omega-3 fatty acids to CAPD patients had no beneficial effects on oxidative stress but should evaluate more.

Kidney transplant recipients are susceptible to various infections due to the use of immunosuppressive drugs. The present study was performed as studies on the prevalence of intes-tinal fungal and parasitic infections in kidney transplant recipients are limited. A total of 150 kidney transplant recipients and 225 matched immunocompetent outpatients, who were referred to the laboratory of Noor Hospital, Isfahan, were studied. After recording demographic characte-ristics, direct test and specific laboratory cultures were carried out on the stool specimens. Patients were instructed on sanitary rules and, during each medical visit, they were reminded of the same. The overall prevalence of intestinal parasitic and fungal infections was 33.3% and 58.7%, respec-tively, in transplant recipients and 20% and 51%, respectively, in the control group; the difference was not statistically significant. The most prevalent intestinal parasite was Entameba coli, which was seen in 9.3% of the study patients and 6.7% of the controls. The most prevalent fungus was Candida sp., which was seen in 22% of the study patients and 24.4% of the control group. Co-existing infection with two or more fungi was seen in 14.8% and 3.4% in the case and control groups, respectively; P

Background: Doppler ultrasonography (DU) and measurement of its indexes, resistive index (RI) and pulsatility index (PI), is used to investigate transplanted kidney hemodynamic status and function. The aim of this study was to determine the correlation between Doppler indexes in the early phase after transplantation with long-term transplanted kidney function. Materials and Methods : In this cross-sectional study on 38 newly kidney transplant patients, we performed DU with assessment of its indexes within 48 hours, 1 week, and 6 months after kidney transplantation. Serum creatinine after stability and 6 months after kidney transplantation were assessed. Cyclosporine level was measured 1 week after kidney transplantation and compared with DU indexes. Results: About 71% of kidney transplanted patients reached their normal initial creatinine level(cr

PURPOSE: To determine ocular findings in patients with renal transplants and to correlate them with clinical characteristics related to transplantation. METHODS: This cross-sectional study was performed on 150 patients who had received a renal transplant of at least three months' duration with serum creatinine levels < 3 mg/dl. All patients underwent a complete ophthalmologic examination. Clinical variables related to the transplant included cause of renal failure, duration of hemodialysis prior to transplantation and immunosuppressive regimen. RESULTS: Overall, 91 male and 59 female subjects with mean age of 39±17.7 years were included. At least one ocular abnormality could be detected in 89.3% including visual acuity less than 20/25 (48.6%), conjunctival degeneration in the palpebral fissure (36.6%), posterior subcapsular cataracts (24%), pinguecula (17.3%), retinal pigment epitheliopathy (14%), arteriovenous crossing changes (8.6%), proliferative diabetic retinopathy (6%), central serous chorioretinopathy and retinal vein occlusions (each in 3.3%), and non-proliferative diabetic retinopathy, optic nerve atrophy and diabetic macular edema (each in 2.7%). Abnormal ocular findings were not correlated with the underlying renal disorder or use of cyclosporine and prednisolone, however they were positively correlated with transplant duration, pre-transplant dialysis duration and azathioprine or mycophenolate mofetil consumption. CONCLUSION: Ocular disorders are frequent among renal transplant patients especially with older transplants and those with a longer period of pre-transplant hemodialysis.

Background: Patients under hemodialysis are exposed to remarkable volume of water. As dialysis water is in direct contact with patients’ blood, absence of regular disinfection of pipes will facilitate the transfer of the endotoxins produced by bacteria in water to the patient's body. Thus, regular control of dialysis system and water disinfectant equipment is compulsory. This study aimed at comparing relative frequency of positive culture for microorganisms in piped water before and after filtration, culture of water after passing from pipes, and culture of dialysis fluid before entering the dialysis filter in hemodialysis section of Alzahra Medical Center (Isfahan, Iran). Methods: During 2010 and 2012, an interventional study was performed in Alzahra Hospital. Samples were taken from piped water before and after filtration and from dialysis fluid before passing from membrane. The obtained samples were cultured in tryptic soy agar (TSA) and the isolated bacteria were then evaluated. Interventions included the disinfection of pipes used for transmission of water and replacement of pipes in hemodialysis section. Findings: Purified water was studied before and after passing the pipes. Dialysis fluid was also assessed before and after the intervention. Bacteria had grown in eight out of 14 samples (57%) before the intervention. In fact, five samples developed Escherichia coli, three had pseudomonas, and one had candida. However, after the intervention, only one out of 14 samples was found to have bacteria (alcaligenes) after filtration and before entering dialysis water pipes. Conclusion: According to the results of this study, the probability of bacterial growth is very high in filtration system of dialysis water. Regular disinfection and microbial sampling and culture are hence crucial. Keywords: Hemodialysis, Dialysis fluid, Microbial contamination