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Introduction: Vitamin D deficiency is a common clinical finding in the general population and hospitalized patients, including patients in the intensive care unit (ICU). Acute kidney injury (AKI) occurs in more than 50% in ICU admitted patients. Objectives: There are few studies regarding AKI in COVID-19 patients, therefore we investigated the relationship between vitamin D3 deficiency and the occurrence of AKI in COVID-19 patients. Patients and Methods: This cross-sectional study was conducted on 69 COVID-19 patients who were hospitalized in the ward for 12 months. Their serum vitamin D3 levels were measured in the first 24 hours of hospitalization in the ward. Patients were divided into three groups based on the serum levels of vitamin D3: >50 ng/mL as normal, 20-50 ng/mL as insufficient and 50 ng/mL. The frequencies of AKI in groups of vitamin D350 ng/mL were 46%, 28%, and 23%, respectively. A significant relationship was observed between AKI and our study groups (P=0.011). Furthermore, there was a significant association between our study groups and mortality (P=0.014), ICU admission (P=0.041) and hospital length of stay (P=0.017). In another division in patients with different levels of vitamin D3 in the presence or absence of AKI, there were significant associations between patients with vitamin D3

Background: Magnesium (Mg) deficiency is a common clinical electrolyte abnormality in critically ill patients, which is related to higher mortality and is easily ignored. Objectives: We aimed to investigate the association of Mg levels with mortality and comorbidity in patients admitted to the intensive care unit (ICU) based on COVID-19 infection classification. Methods: A total of 69 patients admitted to the ICU of Shahid Mohammadi Hospital, Bandar Abbas, Iran, from June to December 2021were included in the present study. The serum Mg was measured in these patients. Data from sequential organ failure assessment (SOFA), acute physiologic assessment and chronic health evaluation (APACHE), ICU stay length, mechanical ventilation duration, mortality, and comorbidity were determined. Moreover, the COVID-19 infection was detected by PCR. Results: The mean ± SD age of patients (34.8% male) was 52.56 ± 16.43 years. Out of 69 patients, 18 (26.1%) died during hospitalization, and 24 (34.8%) required mechanical ventilation. The prevalence of COVID-19 was 39.1% (27 patients). Our results showed no difference in serum Mg between patients based on mortality and comorbidity status. However, the Mg level of patients with kidney failure was significantly higher than patients without kidney failure (P < 0.05). Based on the COVID-19 classification, there was only a positive correlation between hypomagnesemia and the length of ICU hospitalization in patients without COVID-19 (P < 0.05). Conclusions: Our findings showed no difference in the Mg levels of patients based on mortality status. Patients with kidney failure had higher serum Mg than those without kidney failure. Furthermore, our results showed no difference in the Mg levels of critically ill patients based on COVID-19 infection status.

Background: This study aimed to investigate the demographic factors, comorbidities, and laboratory results of diabetic patients with coronavirus disease 2019 (COVID-19) severity. Materials and Methods: This cross-sectional study enrolled 171 diabetic patients with COVID-19 admitted based on chest CT scan findings to the COVID-19 ward of Shahid Mohammadi Hospital in Hormozgan, Iran from 1 March to 1 June, 2020. Reverse-transcriptase polymerase chain reaction (RT-PCR) test was performed, and the patients were divided into three groups (mild, moderate, and severe) based on the severity of disease. Then we investigated the demographic factors, comorbidities, and laboratory results of diabetic patients with severe COVID-19 severity. Results: Regarding comorbidities, there was no significant difference between the three groups. Moreover, there was a significantly lower lymphocyte count in the severe group compared to moderate and mild groups (P = 0.001). We showed the increase in blood urea nitrogen (BUN) and creatinine to be significantly associated with increased disease severity (P = 0.001 and P = 0.009, respectively). We also showed a significant difference in aspartate aminotransferase (AST) levels between different groups of patients (P = 0.002) with a higher level of AST in the severe group (P = 0.020). Lactate dehydrogenase (LDH) and troponin were also significantly associated with an increase in COVID-19 severity in patients with diabetes (P = 0.013 and P = 0.002, respectively). Conclusion: There was a significant association between disease severity and BUN, creatinine, AST, LDH, and troponin levels in diabetic patients with COVID-19. There was no significant association between different groups regarding severity of disease and comorbidities.

Objectives Severe acute respiratory infection (SARI) caused by the SARS-CoV-2 virus may cause lung failure and the need for mechanical ventilation. Infection with SARS-COV-2 can lead to activation of inflammatory factors, increased reactive oxygen species, and cell damage. In addition to mucolytic effects, N-Acetylcysteine has antioxidant effects that we believe can help patients recover. In this study, we evaluate the efficacy of N-Acetylcysteine in patients with severe COVID-19. Trial design This is a prospective, randomized, single-blinded, phase 3 controlled clinical trial with two arms (ratio 1:1) parallel-group design of 40 patients, using the placebo in the control group. Participants All severe COVID-19 patients with at least one of the following five conditions: (respiration rate > 30 per minute), hypoxemia (O2 ≤ saturation, arterial oxygen partial pressure ratio 50% of lung area during 24 48 h), Lactate dehydrogenase (LDH) > 245 U / l, Progressive lymphopenia, and admitted to the intensive care unit of Shahid Mohammadi Hospital in Bandar Abbas and have positive PCR test results for SARS-Cov-2 and sign the written consent of the study will be included. Patients will be excluded from the study if they have a history of hypersensitivity to N-Acetylcysteine, pregnancy, or refuse to participate in the study. Intervention and comparator After randomization, participants in the intervention group receive standard of care (SOC) according to the National Committee of COVID-19 plus N-acetylcysteine (EXI-NACE 200mg/mL, in 10mL ampules of saline for parenteral injection (EXIR pharmaceutical company)) at a dose of 300 mg/kg equivalent to 20 gr as a slow single intravenous injection on the first day of hospitalization. In the control group patients receive SOC and placebo ( Sterile water for injection as the same dose). The placebo is identical in appearance to the N-acetylcysteine injection (EXIR pharmaceutical company as well). Main outcomes The primary endpoint for this study is a composite endpoint for the length of hospitalization in the intensive care unit and the patient's clinical condition. These outcomes were measured at the baseline (before the intervention) and on the 14th day after the intervention or on the discharge day. Randomisation Eligible participants (40) will be randomized in two arms in the ratio of 1: 1 (20 per arm) using online web-based tools and by permuted block randomization method. To ensure randomization concealment, random sequence codes are assigned to patients by the treatment team at the time of admission without knowing that each code is in the intervention or comparator group. Blinding (masking) All participants will be informed about participating in the study and the possible side effects of medication and placebo. Patients participating in the study will not be aware of the assignment to the intervention or control group. The principal investigator, health care personnel, data collectors, and those evaluating the outcome are aware of patient grouping. Numbers to be randomised (sample size) A total of 40 patients participate in this study, which are randomly divided; 20 patients in the intervention group will receive SOC and N-acetylcysteine, 20 patients in the control group will receive SOC and placebo. Trial status First version of the protocol was approved by the Deputy of Research and Technology and the ethics committee of Hormozgan University of Medical Sciences on February 14, 2021, with the local code 990573, and the recruitment started on March 2, 2021 and the expected recruitment end date is April 1, 2021. Trial registration The protocol was registered before starting participant recruitment entitled: Evaluation of the efficacy of N-Acetylcysteine in severe COVID-19 patients: a randomized controlled phase III clinical trial, IRCT20200509047364N3, at Iranian Registry of clinical trials on 20 February 2021. Full protocol The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).

Objective: Chronic kidney disease (CKD) and diabetes mellitus can influence coronary artery disease (CAD) independently. The aim of this study was to evaluate the association of glomerular filtration rate (GFR) and CAD in type 2 diabetic patients (T2DM). Materials and Methods: This cross sectional study evaluated 3624 T2DM patients with clinical presentation of CAD whose documents were registered in angiography center of Shahid Mohammadi Hospital in Bandar Abbas, Iran during 18 months. GFR was measured by MDRD method and divided into 5 subgroups: GFR< 15, 15≤ GFR< 30, 30≤ GFR< 60, 60≤ GFR< 90 and GFR≥ 90. Then the association of 5 subgroups of GFR with coronary angioplasty in T2DM patients was evaluated. T-test was used to compare the mean of quantitative variables, and chi-squared test for qualitative variables. Using SPSS- 22 the collected data were analyzed and P-value< 0.05 was significant. Results: Among 3624 T2DM patients, 36% had GFR< 60 (ml/min/1.73m2).The highest frequency percentage of coronary angioplasty (53%) was observed in the GFR stage 3 (30-60) ml/min/1.73m2. A significant inverse association was observed between the GFR of T2DM patients and the frequency of CAD. (P-value< 0.001). There was also a significant association between GFR< 60 and history of hypertension and dyslipidemia. (P-value< 0.001). Conclusion: A reduced GFR in patients with diabetes has associations with CAD.

IntroductionAs the first randomized clinical trial, this study evaluated the effect of Famotidine on the improvement of outcomes of hospitalized patients with COVID-19.MethodThis phase III randomized clinical trial was designed with two parallel arms, placebo-controlled, single-blind, and concealed allocation, and recruited 20 patients. Oral Famotidine 160 mg four times a day was given to patients until the discharge day or for a maximum of 14 days. Patients’ temperature, respiration rate, oxygen saturation, lung infiltration, lactate dehydrogenase (LDH) level and complete blood count (CBC) were measured at the baseline (before the intervention) and on day 14 after the intervention or on discharge day. Length of stay in the hospital and length of stay in the ICU were also measured as secondary outcomes of the study.ResultsThe results showed a significant decrease in LDH (P = 0.01), mean WBC (P = 0.04) and length of stay (P = 0.04) of patients with COVID-19 in the group treated with Famotidine compared to the control group. There was also a significant increase in oxygen saturation (P = 0.01) in the group treated with Famotidine compared to the control group. Cough improvement was also higher in the oral Famotidine group compared to the control group (P = 0.02).ConclusionThis was the first clinical trial on the effect of Famotidine on the improvement of hospitalized COVID-19 patients, which indicated that high-dose Famotidine improves patients’ clinical signs and reduces the severity of the disease and duration of hospitalization.

The high risk of lipid abnormalities in type 2 diabetic (T2D) patients with uncontrolled hyperglycemia may be associated with an increased risk of cardiovascular complications. The aim of the current study was to investigate the association between glycated hemoglobin )HbA1c( and lipid profile levels in T2D patients. This cross-sectional study was conducted on 802 T2D patients, aged≥ 40 years, visiting the Abu Reyhan Clinic of Shahid Mohammadi Hospital in Bandar Abbas, Iran. Serum lipid profiles were measured by the enzymatic method. Diabetes was defined based on the criteria of the American Diabetes Association. The association of HbA1c and estimated glomeruli filtration rate (eGFR) with lipid profile indices was assessed using the Spearman correlation coefficient test and linear regression model. The mean±SD age of participants (27.7% of men) was 53.55±5.56 years. The mean±SD of HbA1c and eGFR for all subjects were 8.97±2.14 and 86.30±17.48, respectively. In this study,a positive association was observed between HbA1c and fasting blood glucose (r=0.619, β=0.635), total cholesterol (r=0.165, β=0.188), triglycerides (r=0.103, β=0.095), and low-density lipoprotein cholesterol (r=0.162, β=0.173), (P

COVID-19 may have various radiological manifestations on the patient’s chest computed tomography (CT) scan. Few cases with COVID-19 and pneumomediastinum have been reported to date. Here we present a patient with COVID-19, pneumomediastinum and emphysema.

Objectives This study aims to investigate the effect of Famotidine on the recovery process of COVID-19 patients. Trial design This phase III randomized clinical trial was designed with two parallel arms, placebo-controlled, single-blind, and concealed allocation. Participants All COVID-19 patients admitted to Shahid Mohammadi Hospital in Bandar Abbas whose PCR test results are positive for SARS-Cov-2 and sign the written consent of the study are included in the study and immunocompromised patients, end-stage renal disease, moderate renal failure (clearance Creatinine 30 to 50 ml/min) or stage 4 severe chronic kidney disease or need for dialysis (creatinine clearance lesser than 30 ml/min), history of liver disease, hepatitis C infection or alcoholism, Glucose 6 phosphate dehydrogenase deficiency(G6PD), the ratio of Alanine transaminase to Aspartate transaminase 5 times above the normal limit, history or evidence of long QT segment on Electrocardiogram, psoriasis or porphyria, pregnancy, use of oral contraceptives, Dasatinib, Neratinib, Ozanimod, Pazopanib, Rilpivirine, Siponimod and/or Tizanidine and allergies to any study drug are excluded. Intervention and comparator Intervention group receives standard pharmacotherapy according to the treatment protocols of the National Committee of COVID-19 and oral famotidine 160 mg (Manufactured by Chemidarou Pharmaceutical Company) four times a day until the day of discharge, for a maximum of fourteen days. Comparator group receives standard drug therapy according to the treatment protocols of the National Committee of COVID-19 and placebo in the same dosage. Main outcomes Patients’ temperature, respiration rate, oxygen saturation, lung infiltration, lactate dehydrogenase and complete blood count were measured at the baseline (before the intervention) and on day 14 after the intervention or on the discharge day. Randomisation The person who has no role in admitting patients and assigning patients to random codes preparing random sequences using online tools and by permuted block randomization method. Eligibility criteria are monitored by the person responsible for admitting patients. Codes in a random sequence are assigned to patients by the treatment team without knowing that each code is in the intervention or comparator group. Patient codes are then matched to randomly generated sequence information for interventions. Blinding (masking) All participants are unaware of which group of this study they are in and after grouping patients in the groups, Patients receive Famotidine in the treatment group and receive a placebo in the control group. The lead researcher, care givers, data collectors, and outcome assessors are aware of the grouping of patients. Numbers to be randomised (sample size) As there is no prior work on this research question, so no assumptions for the sample size calculation could be made. A total of 20 patients participate in this study, which are randomly divided into two groups of 10 as intervention or control groups. Trial status Version 3 of the protocol was approved by the Deputy of Research and Technology and the ethics committee of Hormozgan University of Medical Sciences on August 2, 2020, with the local code 990245, and the recruitment started on August 17, 2020. recruitment ended on August 31, 2020. Since the recruitment ended earlier than expected (the expected recruitment end date was 21/12/2020), we submitted post recruitment but prior to publication of the results. Trial registration The protocol was registered before starting subject recruitment under the title: The effect of Famotidine on the improvement of patients with COVID-19, IRCT20200509047364N2, at Iranian Registry of clinical trials (https://www.irct.ir/trial/49657) on 17 August 2020. Full protocol The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).

Background: No specific study has investigated the effect of non-steroidal anti inflammatory drugs (NSAIDs) and especially the effects of Ibuprofen on COVID-19, so far. Objectives: The purpose of this study was to investigate the effect of Ibuprofen on the severity of COVID-19 and mortality caused by the disease. Methods: This study was conducted on 158 patients with COVID-19 who had consumed Ibuprofen, Gelofen, and Novafen for at least one week in the last three months. Patients were divided into three groups (mild, moderate and sever). The relationship among the severity of the disease and the history of ibuprofen consumption, diabetes, history of cardiovascular problems, hypertension, and GFR was investigated. Also, the association between the history of ibuprofen consumption, GFR ≤ 60 mL/min, hypertension, LDH ≥ 500 U/L, lymphocyte count ≤ 1500, and mortality was examined. Results: Our findings showed a significant relationship between the history of Ibuprofen before COVID-19 and the severity of COVID-19, as well as the mortality rate (P value < 0.001, adjusted odd ratio: 2, respectively). This study also showed a significant relationship among the severity of the disease and the history of smoking, diabetes, hypertension, history of cardiovascular diseases, and GFR. In addition, a significant relationship was found among GFR ≤ 60 mL/min mortality, diabetes, LDH ≥ 500 U/L, and lymphocyte count ≤ 1500. Conclusions: Our study showed a significant relationship between the history of the consumption of ibuprofen and its compounds before COVID-19 and the severity of COVID-19, as well as the mortality rate of the patients with this disease, and accordingly, this result can suggest health policies during the epidemic of COVID-19.

Dyslipidemia is a common metabolic abnormality in Type 2 diabetic Mellitus (T2DM) patients with kidney dysfunction. Therefore, the current study was conducted to assess the association between serum lipid levels and estimated glomerular filtration rate (eGFR) in T2DM patients.This cross-sectional study was performed on 802 participants, aged 40 years or more who had referred to the Abu Reyhan Clinic of Shahid Mohammadi Hospital in Bandar Abbas, Hormozgan province, Iran. Biochemical variables including FBS, triglycerides, total cholestrol, LDL-C, and HDL-C levels were measured using the enzymatic method. The association between serum lipid profile and eGFR was assessed using the Spearman correlation coefficient test and linear regression model.Mean ± SD age of the subjects (72.3% females) was 53.55 ± 5.56 years old. Mean ± SD of eGFR-EPI and eGFR-MDRD was 86.30 ± 17.48 and 86.80 ± 23.29, respectively for all the subjects. In the current study, a negative association was observed between eGFR-EPI and FBS (r = -0.123, β = -0.172) and TGs (r = -0.080, β = -0.096) (P.01). Also, there was an inverse association between the eGFR-MDRD and FBS (r = -0.123, β = -0.172) and TGs levels (r = -0.074, β = -0.086) (P.05). However, the concentration of other lipid profiles was not associated with the eGFR level (estimated by EPI and MDRD methods).Our findings suggested that the patients with reduced eGFR level are more likely to have greater TG serum level. Therefore, high TG levels can be considered as a potential biomarker for predicting renal complications in the patients with T2DM.

We tested the hypothesis whether microRNA-21 (miR-21) can detect CSA-AKI earlier than serum creatinine (sCr). A total of 103 patients scheduled to undergo cardiac surgery. CSA-AKI was defined as sCr > 0.3 mg/dl 24 h after surgery. The patients were divided into two groups according to whether or not developing AKI after surgery. Serum and urinary miR-21 were measured prior to, and 6, 12 and 24 h after surgery. Baseline serum and urinary levels of miR-21 in AKI group were lower than in non-AKI group. Moreover, the levels of miR-21 were significantly lower 6 h after surgery for serum, and 6 and 12 h after surgery for urine samples than those before surgery in AKI group. Area under the curve (AUC) of the receiver operating characteristic (ROC) values were 0.81 (95% CI: 0.65-0.97) for serum miR-21 (6 h after surgery), 0.90 (95% CI: 0.79-0.99) for urine (6 h after surgery), and 0.86 (95% CI: 0.71-0.98) for urine (12 h after surgery). While both postoperative serum and urinary miR-21 levels can predict AKI development, urinary miR-21 especially 6 h after surgery is a more reliable marker than serum miR-21 for detection of established CSA-AKI (Tab. 1, Fig. 3, Ref. 43).

Introduction Cytokine storm is one of the consequences of the severe forms of COVID-19 due to excessive immune response. In this study, we investigated the therapeutic effect of plasmapheresis and its role on the inflammatory cytokines levels in patients suffering from severe COVID-19 Methods In plasmapheresis group, 22 severe cases of COVID-19 receiving three cycles of plasmapheresis with time interval of 24 to 36 hours and 22 COVID-19 patients as the control group were enrolled. Clinical history and laboratory parameters as well as IL-1, IL-6, IFN-γ and IL-17 cytokines serum levels in the time points of before and after plasmapheresis were studied. Results In severe COVID-19 patients, plasmapheresis significantly improved clinical and laboratory parameters such as cough, weakness, fever, blood oxygen saturation and CRP levels. Serum levels of IL-1, IL-6, IFN-γ and IL-17 in the group of patients receiving plasmapheresis, had a significant decrease following plasmapheresis courses. Although only IL-6 level in the control group had a significant decrease between the days1 to 14 of disease. Also, at both time points of before and after plasmapheresis, serum levels of IL-1, IL-6, IFN-γ and IL-17 were inversely correlated to blood oxygen saturation. Conclusion Based on the obtained results, plasmapheresis therapy in severe forms of COVID-19 can effectively improve the clinical symptoms of the disease and reduce inflammatory markers. Therefore, it is suggested that plasmapheresis can be evaluated in standard treatment protocols for severe forms of COVID-19.

Introduction: Kidney transplant is one of the treatments in patients with ESRD (end stage renal disease) that increases the quality of life in patients. Following kidney transplant, patients need glucocorticoid and immunosuppressant drugs. These drugs put patients in risk of hip avascular necrosis. The purpose of this study was to evaluate the prevalence of asymptomatic avascular necrosis of the hip in patients with kidney transplantation. Methods: This prospective descriptive cross-sectional study was conducted on all patients referred to the Shahid Mohammedi Hospital, Bandar Abbas, Iran, who had a kidney transplant at least six month before our study. All patients’ information was collected with a questionnaire consisting of demographic information including age, sex, weight, height, history of hemodialysis, history of peritoneal dialysis, history of smoking, alcohol intake, history of prednisolone and the main variable data of the disease, including the causes of ESRD such as diabetes, hypertension and diabetes combined, polycystic kidney disease, IgA nephropathy reflux disease, focal segmental glomerulonephritis and time elapsed after the transplant. Magnetic resonance imaging (MRI) was used for the detection of avascular necrosis. Diagnosis of avascular necrosis was confirmed by two separate radiologists. Data was analyzed using IBM SPSS 21.0 software. Results: In this study, 83 patients were studied. Among these patients, 45 (54.2%) were male and 38 (45.8%) were female. The average age of the subjects was 41.29 ± 13.72 years. Demographic variables were similar in two groups. There was no relation among the vertebrae and overall results densitometry with avascular necrosis (p>0.05). Based on this chart, prevalence of avascular necrosis in patients with osteoporotic hip based on densitometry, was significantly more than other people (p = 0.008). Conclusion: According to results, prevalence of femoral head avascular necrosis is not higher in patients after transplant and it has no significant relation to age, sex, BMI, time passed after transplant, CMV infection, hospitalization, history of dialysis or type of donator. Also, there was no significant correlation between the vertebra densitometry and the overall results of densitometry with avascular necrosis on MRI. The only factor associated with avascular necrosis in this study, was osteoporosis in the hip densitometry.

Introduction: Contrast-induced acute kidney injury (CI-AKI) is a known complication of cardiac interventions. Remote ischemic preconditioning (RIPC) is a non-pharmacological method which has a nephroprotective effect. Serum cystatin C (CysC) is a suitable biomarker for the early diagnosis of AKI. Objectives: This study aimed to evaluate the incidence of CI-AKI after RIPC in patients undergoing coronary angiography, through assessment of CysC. Patients and Methods: Around 140 patients with stable coronary artery disease undergoing angiography were randomly allocated to two groups of RIPC and control groups. In each group, the following biomarkers were assessed: serum creatinine (Cr) and CysC at baseline, 24-hour and 48-hour serum Cr and 24-hour CysC. The endpoint was the development of AKI based on either the KDIGO criteria or a 15% increase in serum CysC. Results: No significant difference was observed between two groups regarding the incidence of AKI according to either KIDIGO criteria or by the increase of serum CysC (P =0.116 and P =0.392, respectively). Moreover, a 46.99% increase in CysC level was observed among patients with AKI during the first 24 hours after the procedure, while at the same interval, it increased only 16.01% in patients without AKI. Conclusion: RIPC with three cycles of 5-minute ischemia and 5-minute reperfusion, did not decrease serum CysC based CI-AKI or alter renal biomarkers course in patients with low risk, who underwent coronary angiography.

Introduction: Contrast-induced acute kidney injury (CIN-AKI) is a serious complication of coronary angiography. Given the weaknesses in the common protective methods used to prevent CIN-AKI, a safe and effective strategy is needed. RIPC has been shown to have a nephroprotective effect. Objectives: We aimed to determine the protective effect of RIPC on CIN-AKI after angiography or percutaneous coronary intervention (PCI) in low-risk patients. Patients and Methods: In our study, 140 low-risk patients who needed angiography or PCI, were assigned to either RIPC or control group. In each group, serum creatinine and urinary neutrophil gelatinaseassociated lipocalin (uNGAL) were measured before the procedure. Serum creatinine was measured daily for 2 days and uNGAL was measured 6 and 24 hours after the procedure. Diagnosis of AKI was, according to the Kidney Disease; Improving Global Outcomes (KDIGO) criteria (2012). Results: The mean age in the remote ischemic preconditioning (RIPC) group was 56.8 ± 11.4 years and 56.3 ± 11.8 years in the control group. We observed no significant difference regarding patient’s characteristic and renal biomarkers at baseline. There was no significant difference in the incidence of AKI (P = 0.116). The uNGAL increased by 36.2% 6-hour after the procedure in patients with AKI, while at the same time, this biomarker increased only by 4.3% in patients without AKI. Conclusion: We concluded that RIPC, with 3 cycles of 5-minute ischemia and 5-minute reperfusion, did not decrease CIN-AKI or altering renal biomarkers course in low-risk patients undergoing coronary angiography or PCI. Additionally, uNGAL, seems to be an appropriate biomarker for early diagnosis of CIN-AKI, 6 hours after contrast media exposure.

uremic individuals. Objectives: The aim of this study was to detect undiagnosed ischemic heart disease (IHD) using dipyridamole myocardial perfusion imaging (MPI) in HD patients. Patients and Methods: In this cross-sectional descriptive study, HD patients who met the inclusion criteria were selected. Demographic, clinical, and paraclinical data were obtained via interviews and medical records. Bedside electrocardiography, resting echocardiography, and nuclear MPI with dipyridamole were done. The data were analyzed using descriptive statistical methods for detecting the prevalence of undiagnosed IHD in the HD patients. The chi-square test and the independent t-test were used to identify the high-risk HD patients. Results: Sixty-nine HD patients were studied using dipyridamole MPI with Tc 99 m sestamibi. The mean age, body mass index, and mean duration of HD were 52.1 ± 13.8 years, 21.23 ± 4.79 kg/m2, and 48.2 ± 34.9 months, respectively. The patients were divided into two groups based on MPI: IHD-positive group (21.7%) and IHD-negative group (78.3%). IHD was more prevalent in the patients with diabetes mellitus, hypertension, positive family history of CAD, low HD adequacy index (Kt/V < 1.2), left ventricular hypertrophy, high intact parathyroid hormone levels, electrocardiographic abnormalities, and low ferritin levels. A statistically significant correlation was also detected between IHD and aging (P < 0.05). Conclusions: The prevalence of undiagnosed IHD in the HD patients was considerable. We, therefore, suggest that IHD be assessed in HD patients, especially those at high risk due to positive family history of CAD, hypertension, left ventricular hypertrophy, diabetes mellitus, Kt/V < 1.2, low ferritin levels, and high levels of intact parathyroid hormone.

Malignancy is a common complication after renal transplantation. However, limited data are available on post-transplant malignancy in living kidney transplantation. Therefore, we made a plan to evaluate the incidence and types of malignancies, association with the main risk factors and patient survival in a large population of living kidney transplantation. We conducted a large retrospective multicenter study on 12525 renal recipients, accounting for up to 59% of all kidney transplantation in Iran during 22 years follow up period. All information was collected from observation of individual notes or computerized records for transplant patients. Two hundred and sixty-six biopsy-proven malignancies were collected from 16 Transplant Centers in Iran; 26 different type of malignancy categorized in 5 groups were detected. The mean age of patients was 46.2±12.9 years, mean age at tumor diagnosis was 50.8±13.2 years and average time between transplantation and detection of malignancy was 50.0±48.4 months. Overall tumor incidence in recipients was 2%. Kaposis' sarcoma was the most common type of tumor. The overall mean survival time was 117.1 months (95% CI: 104.9-129.3). In multivariate analysis, the only independent risk factor associated with mortality was type of malignancy. This study revealed the lowest malignancy incidence in living unrelated kidney transplantation.

Kaposi's sarcoma (KS) is one of the most common tumors to occur in kidney recipients, especially in the Middle East countries. Limited data with adequate sample size exist about the development of KS in living kidney recipients.Therefore, we made a plan for a multicenter study, accounting for up to 36% (n = 7,939) of all kidney transplantation in Iran, to determine the incidence of KS after kidney transplantation between 1984 and 2007.Fifty-five (0.69%) recipients who developed KS after kidney transplantation were retrospectively evaluated with a median follow-up of 24 (1-180) months. KS occurred more often in older age when compared to patients without KS (49 +/- 12 vs. 38 +/- 15 years, P = 0.000). KS was frequently found during the first 2 years after transplantation (72.7%). Skin involvement was universal. Furthermore, overall mortality rate was 18%, and it was higher in patients with visceral involvement compared to those with mucocutaneous lesions (P = 0.01). However, KS had no adverse affect on patient and graft survival rates compared to those without KS. Forty-four patients with limited mucocutaneous disease and four with visceral disease responded to withdrawal or reduction of immunosuppression with or without other treatment modalities. Renal function was preserved when immunosuppression was reduced instead of withdrawn in patients with and without visceral involvement (P = 0.001 and 0.008, respectively).The high incidence of KS in this large population studied, as compared to that reported in other transplant patient groups, suggests that genetic predisposition may play a pathogenetic role.

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.A questionnaire was sent to the reference hospitals. The resulting database of 2,086 traumatized patients hospitalized in the first 10 days was analyzed.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 (P0.001). 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; P0.001). These patients were hospitalized later (3.1 +/- 2.8 versus 1.5 +/- 1.7 days after the disaster; P0.001) and longer (16.7 +/- 12.8 versus 12.5 +/- 11.3 days; P0.001). 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 (P0.001 for all).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.

Acute kidney injury (AKI) is a risk factor for increased mortality in critically ill patients. To assess the incidence, risk factors and outcome of patients who develop AKI in the intensive care units (ICUs), we retrospectively studied 235 patients admitted to the ICU of Shahid Mohamadi Hospital, Hormozgan, Iran, and compared those who developed AKI and those who did not. There were 31.1% of patients who developed AKI during ICU admission. There was a significant difference in the mean age, serum sodium (Na), potassium (K), urea, blood urea nitrogen (BUN) and creatinine (Cr) levels and also platelets, on admission, between patients with and without AKI. Acute physiology and chronic health evaluation (APACHE) II score on admission was significantly higher in AKI patients and Glasgow coma scale (GCS) was significantly lower. The mortality of AKI patients (72.6%) was significantly higher than non-AKI patients (25.91%). The number of underlying diseases and GCS and APACHE II score on admission were significantly different between the expired and survived patients. We conclude that age, first serum K level and APACHE II score on admission time were powerful independent predictors of developing AKI in ICU patients. The GCS on admission and the presence of two or more underlying diseases accurately predict the mortality in AKI positive ICU patients.

There are various reports of ocular abnormalities in metabolic disorders. This study was done with the aim to investigate the relationships between the amounts of serum calcium, phosphorus, and parathyroid hormone concentrations and ocular findings in patients undergoing hemodialysis. Fifty eight patients with end stage renal failure undergoing hemodialysis were randomly selected and enrolled in this prospective study. Demographic data, history of diabetes mellitus and hypertension, and duration of hemodialysis were recorded. Serum calcium, phos-phorus, alkaline phosphatase (ALP), and parathyroid hormone (PTH) concentrations were mea-sured. Also, blood urea nitrogen (BUN) and weight of the patient was measured just before and three minutes after the hemodialysis. Patients also underwent a complete ocular examination including visual acuity, intraocular pressure (IOP), biomicroscopic examination, and fundoscopy. In univariate analysis, adverse relationships were found between the ocular hypertension and ALP concentration (P = 0.017) and also between the visual acuity and phosphorus concentration (P = 0.033). However, in multivariate regression analysis and with regard to the patients′ charac-teristics and medical history in a multivariate model, no relationships were found between ocular findings and serum calcium, phosphorus, ALP, and PTH concentrations. No relationships were found between the serum concentrations of calcium, phosphorus, ALP, and PTH and ocular findings in patients with end stage renal failure undergoing hemodialysis.