Guillain-Barre syndrome after antithymocyte globulin administration in a kidney transplant recipient: A case report and literature review.

This report describes a rare case of developing Guillain-Barre syndrome (GBS) following receiving rabbit antithymocyte globulin (ATG) after kidney transplantation to prevent acute allograft rejection in a 34-year-old man. The patient presented severe pain in the right temporomandibular joint, fever, chills, myalgia, polyarthralgia, and bone pain. Twelve hours later, he developed quadriplegia, paresthesia, and a limited range of active motions in all extremities. No antecedent viral or bacterial infection was identified. The EMG/NCV evaluation displayed acute inflammatory sensory-motor polyneuropathy. After the administration of GBS treatment, the neurologic symptoms started to improve. Over a few days, the reflexes came back completely, and the patient was able to walk. To our knowledge, this is the second case report of ATG-related GBS after kidney transplantation.

Relapsing anemia associated with parvovirus B19 infection in a kidney transplant recipient: A case report and review of the literature.

Key clinical message: PB19 infection should be considered an uncommon cause of posttransplant anemia in renal transplant recipients, particularly those whose anemia is not associated with common etiologies. IVIG treatment and reduced immunosuppression could be beneficial. Abstract: Parvovirus B19-associated relapsing anemia is rare in kidney transplant recipients. Herein, we report a case of relapsed anemia due to parvovirus B19 infection in a 53-year-old woman 18 months after kidney transplantation. The patient presented with palpitations, shortness of breath, dizziness, weakness, and lethargy. Early laboratory findings showed a WBC count of 6.000/µL, RBC count of 1.89/µL, hemoglobin (Hb) 3.5 g/dL, hematocrit (Hct) 15%, platelet count 266.000/µL, MCV 89, reticulocyte count 0.8%, and serum iron 221 µg/dL. Upon further evaluation, the RT-PCR test for BK polyomavirus and cytomegalovirus (CMV) was negative, while the parvovirus B19 RT-PCR was positive. The patient was treated with blood transfusion and IVIG 25 g daily for 5 days. Two months after discharge, the patient presented, complaining of palpitation, shortness of breath, and dizziness, with RBC 2.7/µL, Hb 6.5 g/dL, Hct 25%, and MCV 85. Again, the CMV RT-PCR was negative, while the parvovirus B19 RT-PCR was positive. Tacrolimus and mycophenolic acid were stopped, and IVIG 25 g daily for 5 days was administered. Consequently, her Hb level increased to 9 g/dL, and the patient was discharged with prednisolone 5 mg daily and cyclosporine 50 mg daily instead of tacrolimus. Viral infection, particularly PB19 infection, should be considered in the differential diagnosis of posttransplantation anemia in KTRs. IVIG treatment and modification of immunosuppressive medications are suggested standard therapies for such patients. The function of transplanted kidneys should be carefully monitored during treatment.

Pseudohyperkalemia associated with essential thrombocytosis; a hint for better clinical practice.

A 75-year-old man was admitted with a diagnosis of diabetic ketoacidosis and hyperkalemia. During the treatment, he developed refractory hyperkalemia. Following our review, diagnosis of pseudohyperkalaemia secondary to thrombocytosis was made. We report this case to remind the importance of clinical suspicion of this phenomenon to prevent its serious consequences.

Adherence to low carbohydrate diets and non-alcoholic fatty liver disease: a case control study.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is defined as the excessive accumulation of fat in the liver cells of people who do not drink alcohol. The aim of study is investigated the association between low carbohydrate diets (LCDs) and NAFLD. METHODS: This age and gender-matched case-control study was conducted on 120 patients newly diagnosed with NAFLD and 120 adults without NAFLD. Diagnosis of NAFLD based on laboratory tests and abdominal ultrasound. Low carbohydrate diets score calculated on the percentage of energy as carbohydrate, fat, and protein. Participants in the highest rank intake of fat and protein and lowest intake of carbohydrate received 10 points. Multivariable logistic odds ratio was used for examine the relation between LCDs and NAFLD. RESULTS: This study showed subjects in the highest tertile of LCD has more intake of zinc and vitamin B12 compare to lowest. Also, intake of protein (p = 0.02) carbohydrate (p < 0.02) and cholesterol (p = 0.02) were significantly higher in patient with NAFLD compare to control subjects. There was no significant association between LCD and risk of NAFLD (OR: 1.36; 95% CI: 0.97-1.92; P-trend = 0.13) in crude and adjusted (OR: 1.31; 95% CI: 0.84-2.04; P-trend = 0.23) model. CONCLUSION: However, we showed that intake of protein, carbohydrate and cholesterol are higher in NAFLD, but our results of study showed that LCDs with higher proportion intakes of protein and fat was not associated with NAFLD. Further prospective studies are required for confirm these associations.

Carboxylated Graphene Oxide as a Nanocarrier for Drug Delivery of Quercetin as an Effective Anticancer Agent

Background: Enhancing the therapeutic profile of hydrophobic drugs using the development of biocompatible drug delivery systems is an urgent need. Many types of research have been conducted on graphene derivatives owing to their unique characteristics. Methods: In this survey, quercetin (QUER), a natural medicine, was loaded on carboxylated graphene oxide (GO), and cytotoxicity assay and the uptake of QUER into prostate cancer cells (PC3) were evaluated. Results: The release behavior of QUER was temperature- and pH-sensitive. Although QUER was loaded with high efficiency, the released rate was low (23.25% at pH 5.5 and 42 °C). The toxicity and intensity of fluorescence in the FREE QUER were higher than the loaded form. Conclusion: High-capacity loading and controlled release of GO QUER can be recognized as a proper candidate in treating cancer.

Acquired thrombotic thrombocytopenic purpura after AstraZeneca vaccine: A case report.

Background: Rare cases of acquired thrombotic thrombocytopenic purpura (aTTP) have been reported since the administration of the COVID-19 vaccination. Based on our information, the present study provides the first case report of aTTP developed after the COVID-19 vaccination in Iran. Case presentation: A 22-year-old Iranian woman presented with symptoms of ataxia, dysphasia, paresthesia, and acute numbness of her left upper limb four weeks after the AstraZeneca COVID-19 vaccination. Laboratory data suggested hemolytic anemia and thrombocytopenia. Also, schistocytes were noted on her peripheral blood smear. Acquired thrombotic thrombocytopenic purpura (aTTP) was diagnosed in accordance with clinical manifestations along with initial blood test results and was confirmed later through findings of ADAMTS-13 low level activity and the ADAMTS-13 positive inhibitor. She underwent 22 sessions of plasma exchange, receiving corticosteroid and rituximab. Finally, the treatment was successful. Conclusion: Despite the presence of rare complications such as aTTP, vaccination is one of the best ways to prevent COVID-19 disease. The present case report describes the potential, but unproven, role of the AstraZeneca COVID-19 vaccine in aTTP pathogenesis. Vaccine-associated aTTP can be successfully treated with plasma exchange, corticosteroids, and rituximab.

Evaluating the Effects of Separate and Concomitant Use of MK-2206 and Salinomycin on Prostate Cancer Cell Line.

Background: Prostate cancer is known as one of the most prevalent health disorders in the male population globally. The aim of the current study was to evaluate the effects of separate and concomitant use of MK-2206 and salinomycin on prostate cancer cell line. Methods: The antitumor potential of separate and concomitant use of MK-2206 and salinomycin was evaluated in a panel of prostate cancer cell line (PC-3). To get insights into the underlying mechanism of action, different assays including the rate of apoptosis, cell viability, and gene expression were performed in treated prostate cancer cells. Results: A significant reduction was detected in the viability percentage of prostate cancer cells (p< 0.001) and the rate of Akt expression (p< 0.001) in all salinomycin, MK-2206, and salinomycin+MK-2206 groups compared to the negative control group. Furthermore, in comparison with the negative control group, there was a notable increase in both the rate of Bad expression (p< 0.001) and prostate cancer cells apoptosis after salinomycin, MK-2206, and salinomycin+MK-2206 treatments. Moreover, the concomitant use of salinomycin+MK-2206 revealed synergistic improvements regarding the viability of prostate cancer cells and the rate of the Akt and Bad expressions compared to the separate administration of salinomycin and MK-2206 (all p< 0.05). Conclusion: The findings of the present study may contribute to improving the efficacy of the therapies regarding the management of prostate cancer and providing a beneficial strategy in clinical trials.

A functionalized graphene oxide with improved cytocompatibility for stimuli-responsive co-delivery of curcumin and doxorubicin in cancer treatment.

Nowadays, the usage of nanoparticles in various fields such as drug delivery, attracts the attention of many researchers in the treatment of cancers. Graphene oxide (GO) is one of the novel drug delivery systems which is used broadly owing to its unique features. In this survey, doxorubicin (DOX) was accompanied by natural medicine, curcumin (CUR), to diminish its side effects and enhance its efficiency. Cytotoxicity assay in human gastric cancer (AGS), prostate cancer (PC3), and ovarian cancer (A2780), was evaluated. Also, the uptake of DOX and CUR into cells, was assessed using a fluorescence microscope. Moreover, real-time PCR was applied for the evaluation of the expression of RB1 and CDK2 genes, which were involved in the cell cycle. In both separate and simultaneous forms, DOX and CUR were loaded with high efficiency and the release behavior of both drugs was pH-sensitive. The higher release rate was attained at pH 5.5 and 42 °C for DOX (80.23%) and CUR (13.06), respectively. The intensity of fluorescence in the free form of the drugs, was higher than the loaded form. In the same concentration, the free form of CUR and DOX were more toxic than the loaded form in all cell lines. Also, free drugs showed more impact on the expression of RB1 and CDK2 genes. Co-delivery of CUR and DOX into the mentioned cell lines, was more effective than the free form of CUR and DOX due to its lower toxicity to normal cells.

Severe maternal outcome in Afghan immigrant women: A study in Tehran, Iran.

OBJECTIVE: To evaluate the risk factors for severe maternal outcome (SMO) in Afghan immigrant women. METHODS: Women with potentially life-threatening conditions (PLTC) were selected. Then risk factors for those PLTC which led to SMO (maternal near-miss or maternal death) were evaluated. In addition, risk factors for those SMOs occurring on hospital admission or during the first 12 hours after admission to the hospital (SMO12) were evaluated. RESULTS: Parity ≥3 (adjusted odds ratio [aOR] 3.24, 95% confidence interval [CI] 1.62-6.50, P = 0.03), low literacy level in mother (aOR 2.99, 95% CI 1.16-5.01, P = 0.03), inadequate prenatal care (aOR 2.74, 95% CI 1.2-3.87, P = 0.01), multigravidity (gravidity ≥5: aOR 2.62, 95% CI 1.31-4.53, P = 0.03), lack of health insurance (aOR 2.52, 95% CI 1.25-4.02, P = 0.01), and low literacy level in husband (aOR = 1.49, 95% CI 1.15-2.9, P = 0.02) were the risk factors for SMO in women with PLTC. Inadequate prenatal care (aOR 4.2, 95% CI 2.05-8.25, P = 0.04), low literacy level in mother (aOR 3.38, 95% CI 1.32-6.65, P = 0.04), parity ≥3 (aOR 2.69, 95% CI 1.16-4.7, P = 0.04), and lack of health insurance (aOR 2.13, 95% CI 1.25-3.67, P = 0.03) were risk factors for SMO12. CONCLUSION: There was a higher rate of SMO and SMO12 cases among Afghan immigrant women.

Changes in spatio-temporal distribution of AgMERRA-derived agro-climatic indices and agro-climatic zones for wheat crops in the northeast Iran.

This study evaluates the potential of gridded AgMERRA (the Modern-Era Retrospective Analysis for Research and Applications) to estimate aridity index (AI), growing degree days (GDD), and temperature seasonality (TS) for six land stations across northeast Iran. The researcher investigated the spatiotemporal variation of the AgMERRA-derived agro-climatic indices for the entire period 1981-2010 and three 10-year sub-periods for the 347 wheat harvested grid cells (0.25° × 0.25°) and their utility for agro-climate zoning in northeast Iran. Results indicated a good agreement between AgMERRA daily solar radiation, maximum and minimum temperatures, and annual total precipitation with corresponding land observations for the six studied sites. AgMERRA-derived evapotranspiration (ETo), AI, GDD, and TS also exhibited good agreement (R2 and d > 0.7) with the land station-derived indices for most of the locations. Annual analysis of the AI indicated a negative trend for all of the wheat harvested grid cells, but the decrease was significant (p < 0.05) only for 14.70% of grid cells, which were located in the southwest part of the studied region. The magnitude of the significant decreasing trends in annual AI was (-)0.0011 per year. The increase in aridity was due to the concurrent occurrences of positive ETo trends and negative precipitation trends. All of the wheat harvested grid cells showed a significant increasing trend (p < 0.05) for GDD at the rate of 24.10 °C d year-1. The TS series demonstrated an apparent increasing trend for 99.2% of wheat harvested grid cells; however, only 16.9% of them had the significant positive trend (p < 0.05) with the average rate of 0.023 °C year-1. The wheat harvested grid cells with increasing trend for TS were mainly distributed in the arid mountainous southern part of the study area. The 10 years sub-periods revealed that the best conditions in terms of most of the studied agro-climatic indices were found in sub-period 1981-1990 and the north Khorasan had better conditions in all three sub-periods. Based on AI, GDD, and TS, 13 major gridded agro-climatic zones were recognized in northeast Iran.

Performance of predicted evapotranspiration and yield of rainfed wheat in the northeast Iran using gridded AgMERRA weather data.

High quality of long-term daily weather data is essential for simulating crop production and its variability. However, daily weather data with adequate duration and required quality are not available in many regions. This study has evaluated the suitability of AgMERRA (The Modern-Era Retrospective Analysis for Research and Applications) weather data for simulating rainfed wheat evapotranspiration (ETc) and yield. Daily AgMERRA were compared with corresponding observed weather data of 11 land stations across the northeast Iran, considering the different periods from 1980 to 2010. Cropwat and CSM-CERES-Wheat models were used to simulate ETc and yield of rainfed wheat, respectively. The comparison of daily AgMERRA with observations resulted in the highest correlation (r2 > 70%) and good agreement (d > 0.77 and NRMSE < 30%) between climate variables, except for daily wind speed and precipitation at all locations. However, when daily precipitation data were aggregated into 15-day periods, agreement and correlation improved. According to the monthly comparison, the largest bias between AgMERRA temperature and radiation with land observations was obtained from June to August (summer season). Results also indicated that the distribution of simulated ETc and yield using AgMERRA was within 10% of the simulated yield using observations at 73% and 100% of locations, respectively. The degree of variation of AgMERRA-simulated ETc and yield was very similar to the calculated coefficient of variation in simulated ETc and yield based on observations at 73% of locations. However, simulation of ETc and yield using AgMERRA for single years was more uncertain when compared with simulated ETc and yield based on observations for the same year. It is concluded that AgMERRA can provide a robust estimate of long-term average ETc and yield of wheat than the ETc and yield of a single year in regions that there is no long-term weather data available.

The effect of coenzyme Q10 supplementation on oxidative stress: A systematic review and meta-analysis of randomized controlled clinical trials.

Some evidence exists in supporting the beneficial effects of coenzyme Q10 (CoQ10) on oxidative stress. Since the findings of studies over the impact of CoQ10 supplementation on oxidative stress are contradictory, this study was conducted. The aim was to evaluate CoQ10 supplementation effect on total antioxidant capacity (TAC), malondialdehyde (MDA), glutathione peroxidase (GPx), superoxide dismutase (SOD), and catalase (CAT) levels using data collected from randomized controlled trials (RCTs). Several databases including PubMed, Web of Science, Google Scholar, and Scopus were comprehensively searched up to 23 January 2019 to identify RCTs. A random-effects model, standardized mean difference (SMD), and 95% confidence interval (CI) were applied for data analysis. According to the meta-analysis results on 19 eligible studies, CoQ10 increased the levels of TAC (SMD = 1.29; 95% CI = 0.35-2.23; p = .007), GPX (SMD = 0.45; 95% CI = 0.17-0.74; p = .002), SOD (SMD = 0.63; 95% CI = 0.29-0.97; p < .0001), and CAT (SMD = 1.67; 95% CI = 0.29-3.10; p = .018) significantly. This supplementation also caused a significant reduction in MDA levels (SMD = -1.12; 95% CI = -1.58 to -0.65; p < .0001). However, the results of SOD and CAT should be stated carefully due to the publication bias. In conclusion, this research indicated that CoQ10 supplementation had beneficial effects on oxidative stress markers. However, further studies are needed to confirm these findings.

Percutaneous biopsy of kidney; comparison between prone position and sitting position.

INTRODUCTION: Percutaneous kidney biopsy has been established as a safe, reliable and minimally invasive method. This study aims to describe the author's experience with biopsy of the kidney and to compare the results in sitting position versus prone in terms of the complication rate. MATERIALS AND METHODS: Patients were divided into two groups: prone and sitting position according to the clinician's and patient's preference. Followed by kidney biopsy, a questionnaire was completed. Then, data and the mean number of glomeruli in each group were compared. RESULTS: Apart from sweat, presumably due to the prone position, no significant differences were found regarding the side effects including dizziness, seizure, nausea, and vomiting between the two groups. The number of glomeruli was not significantly different between two groups. CONCLUSION: In comparison with the prone position, kidney biopsy at sitting position is more comfortable at least for patients who seems couldn't tolerate prone position. We recommend sitting position for kidney biopsy owing to the low side effects rate of this diagnostic technique.

Paraneoplastic proteinuria in papillary renal cell carcinoma; a case report.

We report a 55-year-old man presented with anemia and weakness, history of flank pain, hematuria and nephrotic syndrome. Spiral abdominopelvic computerized tomography (CT) scan showed multiloculated cystic mass (120 ×100 ×80 mm) in lower portion of left kidney with internal enhancing solid components and coarse peripheral calcifications. Radical nephrectomy of left kidney was done and biopsy confirmed renal cell carcinoma (RCC), papillary type, sarcomatoid foci, Fuhrman grade III. We assumed that, presence of nephrotic syndrome and paraneoplastic glomerulopathy leaded to heavy proteinuria in this case. Secondary, paraneoplastic glomerulopathy such as immunoglobulin A nephropathy and focal segmental glomerulosclerosis as a paraneoplastic syndrome of RCC have been reported previously. RCC can present with a wide range of signs and symptoms. Atypical presentations of papillary RCC such as proteinuria should be considered for patients presenting with nephrotic syndrome.

A study on the association of serum fibroblast growth factor-23 with various indices of chronic kidney disease patients not yet on dialysis.

INTRODUCTION: Fibroblast growth factor-23 (FGF23) is found as a bone derived hormone which can influence the serum levels of parathormone, phosphorous and 1, 25-dihydroxyvitamin D. FGF23 may be a cardiovascular biomarker in patients with chronic kidney disease (CKD). While, FGF23 is inversely correlated with serum adiponectin level, thus it is possible that FGF23 is correlated to fat mass and related to dyslipidemia in CKD. OBJECTIVES: In this investigation, we studied the association of serum levels of FGF23 with serum lipid profile, body mass index (BMI), and various cardiovascular risk factors in patients with CKD. PATIENTS AND METHODS: This is a cross-sectional study, which was conducted on 80 non-dialysis patients (glomerular filtration rate [GFR] <60 cc/min) with CKD. Laboratory results and demographic information recorded in pre-defined data sheets and their relationship with FGF23 were analyzed. RESULTS: Eighty patients were studied. Mean ± standard deviation (SD) of serum creatinine and FGF23 were 2.18 ± 0.73 mg/dl and 15.028 ± 20.20 RU/ml respectively. The correlation between FGF23, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), ApoA, ApoB, intact parathyroid hormone (iPTH), calcium, phosphorous, alkaline phosphatase, 25-hydroxyvitamin D, BMI, waist girth, serum triglyceride and cholesterol was not significant (P > 0.05). In this study, the correlations of FGF23, with serum albumin (P = 0.036) and systolic blood pressure (P = 0.001) were significant. CONCLUSION: Our study showed that there are not any significant correlations among FGF23, BMI and lipid profile. There are not any significant correlations between FGF23 and age, sex, and level of calcium, phosphorous, vitamin D. However, the relationships between FGF23 and serum albumin was negatively significant. Additionally we detected a positive significant correlation of FGF23 with level of systolic blood presure.

The Effects of Extending of Co-planarity in a Series of Structurally Relative Polypyridyl Palladium(II) Complexes on DNA-binding and Cytotoxicity Properties.

In depth interaction studies between calf thymus deoxyribonucleic acid (CT-DNA) and a series of four structurally relative palladium(II) complexes [Pd(en)(HB)](NO3)2 (a-d), where en is ethylenediamine and heterocyclic base (HB) is 2,2'-bipyridine (bpy, a); 1,10-phenanthroline (phen, b); dipyridoquinoxaline (dpq, c) and dipyridophenazine (dppz, d) (Figure 1), were performed. These studies have been investigated by utilizing the electronic absorption spectroscopy, fluorescence spectra and ethidium bromide (EBr) displacement and gel filtration techniques. a-d complexes cooperatively bind and denature the DNA at low concentrations. Their concentration at midpoint of transition, L1/2, follows the order a >> b > c > d. Also the g, the number of binding sites per 1000 nucleotides, follows the order a >> b ~ c > d. EBr and Scatchard experiments for a-d complexes suggest efficient intercalative binding affinity to CT-DNA giving the order: d > c > b > a. Several binding and thermodynamic parameters are also described. The biological activity of these cationic and water soluble palladium complexes were tested against chronic myelogenous leukemia cell line, K562. b, c and d complexes show cytotoxic concentration (Cc50) values much lower than cisplatin.