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Background Cardiovascular diseases (CVDs) and erectile dysfunction (ED) frequently co-occur, significantly affecting the quality of life of individuals. Aim To assess the impact of cardiac rehabilitation (CR) on ED in patients with CVD through a systematic review and meta-analysis. Methods This study analyzed randomized controlled trials and other studies comparing CR with usual care for adult males (≥18 years) with any cardiac disease. Literature searches were extensive, and the risk of bias was evaluated by the Cochrane Collaboration tool. Data from 6 studies involving 668 participants were included in the meta-analysis. Outcomes The primary outcome was the improvement in ED, as measured with the International Index of Erectile Function. Results A statistically significant improvement in erectile function was observed across 6 studies, with a Morris dppc2 effect size of 0.38 (95% CI, 0.17-0.59). Despite initial high heterogeneity (I 2 = 95.7%), identification and correction for selective outcome reporting bias mitigated this issue. Clinical Translation CR has a modest but statistically significant impact on improving ED in patients with CVD, indicating its potential positive contribution to the quality of life of this group. Strengths and Limitations The study's strengths include a comprehensive literature search and a rigorous methodological approach. Limitations involve high heterogeneity among studies and a low level of evidence due to small sample sizes and study quality; however, the source of heterogeneity was identified and mitigated following risk-of-bias assessment. Conclusion The results suggest that CR has a statistically significant but modest impact on improving ED in patients with CVD. Clinicians should consider the integration of CR into the clinical management of these individuals. This study underscores the potential for CR to contribute positively to the quality of life for patients with CVD by addressing associated ED (PROSPERO: CRD42022374625). [ABSTRACT FROM AUTHOR]

Background: This article introduces the first national guidelines for the management including diagnosis, treatment, and secondary prevention of acute coronary syndrome (ACS) in Iran. Materials and Methods: The members of the guideline development group (GDG) were specialists and experts in fields related to ACS and were affiliated with universities of medical sciences or scientific associations in the country. They carefully examined the evidence and clinical concerns related to ACS management and formulated 13 clinical questions that were sent to systematic review group who developed related evidence using Grade method. Finally the GDG developed the recommendations and suggestions of the guideline. Results: The first three questions in the guideline focus on providing recommendations for handling a patient who experience chest pain at home, in a health house or center, during ambulance transportation, and upon arrival at the emergency department (ED) as well as the initial diagnostic measures in the ED. Subsequently, the recommendations related to the criteria for categorizing patients into low,intermediate and high-risk groups are presented. The guideline addressed primary treatment measures for ACS patients in hospitals with and without code 247 or having primary percutaneous coronary intervention (PCI) facilities, and the appropriate timing for PCI based on the risk assessment. In addition, the most efficacious antiplatelet medications for ACS patients in the ED as well as its optimal duration of treatment are presented. The guideline details the recommendations for therapeutic interventions in patients with ACS and acute heart failure, cardiogenic shock, myocardial infarction with nonobstructive coronary arteries (MINOCA), multivessel occlusion, as well as the indication for prescribing a combined use of anticoagulants and antiplatelet during hospitalization and upon discharge. Regarding secondary prevention, while emphasizing the referral of these patients to rehabilitation centers, other interventions that include pharmaceutical and nonpharmacological ones are addressed, In addition, necessary recommendations for enhancing lifestyle and posthospital discharge pharmaceutical treatments, including their duration, are provided. There are specific recommendations and suggestions for subgroups, such as patients aged over 75 years and individuals with heart failure, diabetes, and chronic kidney disease. Conclusion: Developing guidelines for ACS diagnosis, treatment and secondary prevention according to the local context in Iran can improve the adherence of our health care providers, patients health, and policy makers plans. [ABSTRACT FROM AUTHOR]

Nephrolithiasis is a common disease entity around the world, with an increasing prevalence and incidence. There is no consolidated information available on the cause of kidney stones in Iranian patients. As a result, we decided to review the etiology of kidney stones in Iran. PubMed, Scopus, Web of Science, Google scholar, and Scientific Information Database (SID) were searched with the following keywords "Nephrolithiasis", "Renal stone", "Kidney stone", "Urolithiasis", "Etiology", "Metabolic abnormalities", and "Iran". There was no time period limit for selection of the papers. The inclusion criteria included any paper on evaluation of urine biochemistry regarding stone formation in Iranian adult patients (with or without children) with nephrolithiasis. We found 217 articles, of which 9 were eventually included. In conclusion, 1896 patients with nephrolithiasis from 6 provinces and 7 cities of Iran with different climates from 2000 to 2019 were evaluated collectively. The results showed that in contrast to western countries, hypercalciuria was not the most common biochemical disorder of patients with nephrolithiasis (18.2% vs. 30 to 60%). Low urine volume (49.6%) and hypocitraturia (27%) were the most frequent urine abnormalities in our country.  DOI: 10.52547/ijkd.7055. [ABSTRACT FROM AUTHOR]

Introduction. Sirolimus (Rapamune) is an important immunosuppressive drug in kidney transplant patients. The usual maintenance dose of Sirolimus in these patients is 2 to 5 mg/d and its optimal maintenance trough level is 5 to 10 ng/mL. The required Sirolimus doses may differ markedly from patient to patient. It is because of high inter and intrapatient variability in its pharmacokinetics. There have been no studies in Iran on the correlation of Sirolimus blood level and its target dose. This study has been done to show the target dose of Sirolimus in kidney transplanted patients in Isfahan. Methods. This is a longitudinal cross-sectional study conducted from June 2018 to September 2019. The study population included all kidney transplanted patients treated with Sirolimus in a nephrology private clinic. Inclusion criteria were age (equal or more than 18 years old) and the existence of complete data in the patient's file. The participants were excluded if there were not at least two Sirolimus levels in the patient's file. Demographics and other variables were extracted from the patient's files. Results. Sirolimus was prescribed for seventy-three patients. Sixteen patients did not have the inclusion criteria. Fifty-seven renal transplanted patients were included in the study. The mean starting dose of Sirolimus in these patients was 2 ± 0.19 mg/d. The mean of the Sirolimus dose was 1.2 ± 0.44 mg/d. There was more than 20% GFR improvement in 68% of the patients after changing the Calcineurin Inhibitor to Sirolimus (P < .05). Conclusion. In a significant number of patients changing CNI to Sirolimus accompanied by GFR improvement. Contrary to the recommended dose of Sirolimus in the references (2 to 5 mg/d) Iranian kidney transplant recipients needed lower daily doses of Sirolimus (1.2 mg/d) to achieve the desired whole blood level. Further studies are recommended to confirm it. [ABSTRACT FROM AUTHOR]