Nitrile Imine Cyclizations and Rearrangements: N-Phenyl-C-styrylnitrile Imine and N-Phenyl-C-phenylethynylnitrile Imine.

The formation and rearrangements of nitrile imines are of ongoing synthetic and theoretical interest. In this paper, we report a computational investigation at the M06/6-311 + G(d,p) level of the formation and rearrangement of propargylic N-phenyl-C-styrylnitrile imine 3 from 2-phenyl-5-styryltetrazole 1 by flash vacuum pyrolysis (FVP). Nitrile imine 3 cyclizes to 3aH-3-styrylindazole 4, which is also generated by H-shifts in the FVP of 3-styrylindazole 8. Tautomerization of 4 and N2-elimination afford cyclohexadienylidene 14, which by cyclization followed by H-shifts yields the primary pyrolysis product, 3-phenylindene 5. An alternate path via 7aH-3-styrylindazole, phenyl(styryl)diazomethane, and phenyl(styryl)carbene is potentially possible. The analogous pyrolysis of 2-phenyl-5-phenylethynyltetrazole 1' afforded cyclopenta[fg]fluorene and cyclopenta[def]phenanthrene via N-phenyl-C-phenylethynylnitrile imine 3' and 3aH-3-phenylethynylindazole 4'. In both cases, 3 and 3', rearrangement to diazocyclohexadienes and cyclohexadienylidenes (e.g., 14) is energetically preferred over alternate aryldiazomethane and arylcarbene intermediates.

Evaluation of serum C4d levels in patients with systemic lupus erythematosus and its relation to lupus nephritis.

Background: Lupus nephritis (LN) is a debilitating complication of systemic lupus erythematosus (SLE). Renal biopsy is the gold standard for evaluating LN. Serum C4d is a potential non-invasive method for evaluating LN. The purpose of this study was to evaluate the value of C4d in the assessment of LN. Methods: This cross-sectional study was conducted on patients with LN who were referred to a tertiary hospital in Mashhad, Iran. Subjects were divided into four groups including LN, SLE without renal involvement, chronic kidney disease (CKD) and healthy controls. Serum C4d. creatinine, and glomerular filtration rate (GFR) were assessed for all subjects. Results: Forty-three subjects (11, 25.6% healthy controls, 9, 20.9% SLE patients, 13, 30.2% LN and 10, 23.3% CKD patients) participated in this study. CKD group were significantly older than other groups (p>0.05). There was a significant difference in gender distribution between groups (p<0.001). Median serum C4d were 0.6 in healthy controls and CKD group and 0.3 in SLE and LN groups. There was no significant difference in serum C4d between groups (p=0.503). Conclusion: The findings of this study indicated that serum C4d might not be a promising marker in the assessment of LN. These findings should be documented by further multicenter studies.

Association of Metabolic Syndrome and Hyperuricemia in the Recipients of Kidney Transplants: A Single-Center Study.

INTRODUCTION: The prevalence of hyperuricemia shows an increasing trend among kidney transplant recipients. The association between metabolic syndrome and hyperuricemia among the recipients of kidney transplants may consequently lead to reduction in graft survival. In this regard, the present study aimed at comparing the kidney transplant recipients with and without metabolic syndrome in terms of the prevalence of hyperuricemia. METHODS: This cross-sectional study was carried out on kidney transplant recipients who were referred to the Kidney Transplant Clinic of Montaserieh Organ Transplant Hospital, Mashhad University of Medical Sciences, from 2019 to 2020. The serum uric acid, anthropometric data, renal function, glucose levels, and lipid profile of the study participants were evaluated. RESULTS: According to our findings, higher mean uric acid levels were reported in recipients with metabolic syndrome (6.9 ± 1.51 mg/dL), compared to recipients without metabolic syndrome (6.11 ± 1.47 mg/dL; P < .001). It was also found that 55.6 and 38.5% of the cases with and without metabolic syndrome had hyperuricemia, respectively (P < .05). Additionally, the results showed no significant association between hyperuricemia and the number of metabolic syndrome criteria (P > .05). A comparison between recipients with and without hyperuricemia revealed significantly lower levels of tacrolimus in the hyperuricemia group (P < .05). Regarding serum Tacrolimus levels, no significant difference was found between recipients with and without metabolic syndrome (P > .05). Moreover, there was no significant difference between recipients with and without hyperuricemia (P > .05) or metabolic syndrome (P > .05) in terms of serum cyclosporine level. CONCLUSION: The findings of the current study indicate that kidney transplant recipients suffering from metabolic syndrome have higher mean serum levels of uric acid than those without metabolic syndrome.  DOI: 10.52547/ijkd.7141.

Investigating the strengths and weaknesses of online education during COVID-19 pandemic from the perspective of professors and students of medical universities and proposing solutions: A qualitative study.

This study aimed to explore the strengths and weaknesses of e-learning during the COVID-19 pandemic from the perspective of its primary stakeholders, namely professors and students, and to provide practical solutions. Design is a qualitative study. We enrolled 22 faculty members and 58 students purposively. Research data were collected through a data collection checklist and via email and continued until the data were saturated. The qualitative content analyses were the basis of analysis in this study. Strengths were presented in 6 themes and 26 subthemes, weaknesses in 5 themes and 23 subthemes, and solutions were presented in 5 themes and 20 subthemes. Save money, time and energy; use modern software and educational technologies; and the ability to individualize education were among the strengths of e-learning. The most important weaknesses related to e-learning include infrastructure difficulties, problems related to the ability of professors and students to use educational systems. The most beneficial solutions offered included improving and upgrading the e-learning infrastructure, empowering professors and students to use educational systems. We concluded that using online teaching has many strengths as well as some weaknesses. Identifying these strengths and weaknesses can help policymakers plan better.

Challenging Issues in Diagnosis and Screening of BK Virus Nephropathy in Kidney Transplant Recipients, A Multicenter Experience in Iranian Population.

INTRODUCTION: BK virus nephropathy (BKVN) is an important complication of kidney transplantation and kidney biopsy remains the gold standard for its diagnosis. Urine/serum polymerase chain reaction (PCR) is a more sensitive diagnostic method, although it has some potential limitations. METHODS: This study enrolled all kidney transplant recipients who underwent kidney transplant biopsy, collected from three medical centers. Urine and serum PCR results of the patients were also collected from the molecular laboratories. The cut-off value for positive viral DNA load in serum and urine were > 104 and > 107 copies/mL, respectively. Sensitivity, specifity, positive and negative predictive values (PPV, NPV) and cut off values for PCR results were compared with pathologic diagnosis among laboratories. RESULTS: Among 369 biopsy samples, 33 (8.9%) had definite diagnosis of BKVN. PCR results were available for 138 cases. Three patients with definite BKVN had negative PCR results. In 22 patients, PCR was positive without evidence of BKVN. The overall sensitivity, specificity, PPV and NPV of PCR for detecting BKVN, based on a unique cut-off value, were 88, 81, 51, and 97%; respectively. The overall accuracy of PCR in all laboratories was high (82 to 86%), however significant inter-laboratory differences in sensitivity and specificity was found . A 2-log difference in threshold value for positive results was observed in one laboratory. CONCLUSION: PCR may show a significant variability between different laboratories. Interpretation of PCR results using a single cut-off value for all laboratories, may decrease the sensitivity for the diagnosis and screening of BKVN.  DOI: 10.52547/ijkd.7143.

Correlation Between Fibroblast Growth Factor-23 and Pulmonary Arterial Hypertension in Hemodialysis Patients.

INTRODUCTION: Pulmonary artery hypertension (PAH) is common in end stage renal disease (ESRD) patients undergoing hemodialysis. Fibroblast growth factor-23 (FGF-23) increases in hemodialysis but its relationship with PAH is not completely understood. The aim of this study was to evaluate the relation between FGF-23 level and development of PAH in ESRD patients undergoing hemodialysis. METHODS: Patients undergoing hemodialysis for more than 6 months were enrolled in this cross-sectional study. Transthoracic echocardiography was performed to measure ejection fraction and pulmonary artery pressure (PAP) in all patients. Patients were grouped into normal PAP (PAP < 25 mmHg), elevated PAP (25 < PAP < 35 mmHg) and PAH (PAP > 35 mmHg). Parathormone hormone, calcium, phosphorus, vitamin D, and hemoglobin levels were also evaluated. RESULTS: Eighty-five patients (48 male, 56.47%) enrolled in this study. The mean age of the patients was 51.05 ± 16.45 years. Most of the patients (49, 57.65%) had normal PAP, 20 (23.53%) had elevated PAP and 16 (18.82%) had PAH. Serum biochemical markers and demographic characteristics were not significantly related to different PAP values (P > .05). Most of the patients (42, 49.41%) had normal FGF-23 levels. There was a significant relationship between PAP groups and FGF-23 and parathormone levels, P < .001, and P < .05; respectively. FGF-23 was significantly higher in PAH and elevated PAP groups compared with normal PAP group (P < .05). Only a significant positive correlation was observed between FGF-23 levels and PAP (P < .001). CONCLUSION: This finding highlights the possible role of FGF-23 in the development of vascular complications in ESRD patients.

Clinical features and disease severity in an Iranian population of inpatients with COVID-19.

Coronavirus disease 2019 (COVID-19) can present with a variety of symptoms. Severity of the disease may be associated with several factors. Here, we review clinical features of COVID-19 inpatients with different severities. This cross-sectional study was performed in Imam Reza hospital, Mashhad, Iran, during February-April 2020. COVID-19 patients with typical computed tomography (CT) patterns and/or positive reverse-transcriptase polymerase chain reaction (RT-PCR) were included. The patients were classified into three groups of moderate, severe, and critical based on disease severity. Demographic, clinical, laboratory, and radiologic findings were collected and compared. P < 0.05 was considered statistically significant. Overall, 200 patients with mean age of 69.75 ± 6.39 years, of whom 82 (41%) were female were studied. Disease was severe/critical in the majority of patients (167, 83.5%). Disease severity was significantly associated with age, malignant comorbidities, dyspnea, nausea/vomiting, confusion, respiratory rate, pulse rate, O2 saturation, extent of CT involvement, serum C-reactive protein (CRP), pH, pO2, and aspartate transaminase (P < 0.05). Moreover, complications including shock, coagulopathy, acidosis, sepsis, acute respiratory distress syndrome (ARDS), intensive care unit (ICU) admission, and intubation were significantly higher in patients with higher severities (P < 0.05). O2 saturation, nausea/vomiting, and extent of lung CT involvement were independent predictors of severe/critical COVID-19 (OR 0.342, 45.93, and 25.48, respectively; P < 0.05). Our results indicate O2 saturation, nausea/vomiting, and extent of lung CT involvement as independent predictors of severe COVID-19 conditions. Serum CRP levels and pO2 were also considerably higher patients with higher severity and can be used along with other factors to predict severe disease in COVID-19 patients.

The Spectrum of Glomerular Diseases in Mashhad According to Kidney Biopsy Records.

INTRODUCTION: Knowing the national statistics of glomerular diseases will help in the management and minimizing their burden in the community. The aim of this study was to assess the overall distribution of subtypes of glomerulonephritis (GN) and the prevalence of renal diseases in a subgroup of diabetic and hypertensive patients. METHODS: This cross-sectional study was conducted on 860 patients with different subtypes of GN diagnosed by percutaneous renal biopsy and histological examination. RESULTS: The most common subtype of GN was membranous GN (30.1%) followed by minimal change disease (20.1%), IgA nephropathy (9.5%) and Lupus nephritis (8.8%), as well as membranoproliferative GN (6.4%), focal segmental GN (5.6%), crescent GN (43, 5%), and DM nephropathy (36, 4.2%). IgA nephropathy and focal segmental GN were mostly common among maleswhile the most female dominant GN was Lupus nephritis. Lupus nephritis was the most common GN diagnosis among subjects who were younger than 29 years old (50%), while the diabetic nephropathy was the most common GN diagnosis among subjects who were older than 53 years old (44.4%). The most common GN among hypertensive subgroups was focal segmental GN (41.7%) followed by diabetic nephropathy (33.3%) whereas the most common subtypes of GN among diabetics was diabetic nephropathy. CONCLUSION: The most common type of GN among Iranian population in Mashhadwas membranous GN and minimal change disease. The distribution of each subtype of glomerular disease depend on the baseline determinants including age, gender and hypertensive state.

Cognitive predictors of cervical cancer screening's stages of change among sample of Iranian women health volunteers: A path analysis.

INTRODUCTION: The uptake of Pap smear among Iranian women is low, resulting in a high rate of casualties from cervical cancer in Iran. The present study used the Health Belief Model (HBM) and the Stages of Change theory as theoretical frameworks for understanding the predictors of the behaviour of Iranian Women Health Volunteers (WHVs) with respect to cervical cancer screening. METHODS: Data from the 1,253 WHVs were analyzed using path analysis to assess the effects of cognitive factors (including knowledge, perceived susceptibility to cervical cancer, perceived severity of cervical cancer, Pap smear benefits, Pap smear barriers, and Pap smear self-efficacy) on the stages of change for Pap-smear behaviour. RESULTS: The majority of the respondents (71.5%) reported that they had not taken previous Pap smear tests; only 3% had received a regular Pap test. The perceived benefits to cervical cancer screening, the perceived barriers to cervical cancer screening, and the perceived self-efficacy to perform cervical cancer screening emerged as the predictors of cervical cancer screening's stages of change; perceived threat to cervical cancer, however, did not. DISCUSSION: Uptake of regular cervical screening for Iranian WHVs was very low. Different interventions, such as media campaigns and educational interventions could provide an opportunity to improve women's knowledge on cervical cancer and Pap test benefits, address any misconceptions or fears about the procedure of the Pap test, and finally increase the cervical screening uptake by Iranian women.

Prevalence of Pulmonary Hypertension in End-stage Renal Disease Patients Undergoing Hemodialysis and Peritoneal Dialysis at a Referral Center in Mashhad, Iran, From 2015 to 2016.

INTRODUCTION: Pulmonary artery hypertension is a serious comorbidityof dialysis in patients with end-stage renal disease. The prevalence of dialysis-induced pulmonary artery hypertension is still a subject of debate. The aim of this study was to determine the prevalence of pulmonary artery hypertension in patients undergoing hemodialysis and peritoneal dialysis. MATERIALS AND METHODS: This cross-sectional study was conducted on patients undergoing either hemodialysis or peritoneal dialysis in Montaserieh Dialysis Center in Mashhad, Iran during 2015 and 2016. Pulmonary artery pressure, ejection fraction, and serum levels of calcium, phosphorus, creatinine, and parathyroid hormone were measured. RESULTS: A total of 50 patients (25 on hemodialysis and 25 on peritoneal dialysis) participated in the study. The mean age of the participants was 34 ± 12 years. The mean pulmonary artery pressure was significantly higher in the hemodialysis group compared to the peritoneal dialysis group (P < .001). Serum calcium was significantly higher in the peritoneal dialysis group compared (P = .04). Pulmonary artery hypertension was observed in 11 patients (22%), all of whom were in the hemodialysis group. There was a significant negative relationship between serum calcium and pulmonary artery pressure (P< .01). Hemodialysis was significantly related to higher pulmonary artery pressure (P < .001). CONCLUSIONS: This study revealed a high prevalence of pulmonary artery hypertension among end-stage renal disease patients undergoing dialysis. This study also found a novel significant negative relationship between serum calcium level and pulmonary artery pressure, and hemodialysis was found to be significantly related to higher pulmonary artery pressure.

Impact of FGF23 level on calcium and phosphorus levels in post-renal transplantation.

Introduction: The level of fibroblast growth factor 23 (FGF23) may be considered as a prognostic factor for assessing renal function in regulating components of phosphate and vitamin D hemostasis. Objectives: The present study aimed to evaluate the prognostic value of FGF23 level to predict renal function after renal transplantation. Patients and Methods: Fifteen consecutive patients scheduled for renal transplantation. To assess renal function status, the MDRD formula and isotope scan were applied. The study endpoint was to assess the level of FGF23 and other factors involving calcium and phosphorus metabolism before and also 3 and 12 months after transplantation and also to determine role of FGF23 to predict postoperative renal function. Results: The mean level of FGF23 was 839.51±694.56 ρg/mL at baseline that reduced to 44.31±22.01 ρg/mL and 20.13±36.50 ρg/mL, 3 and 12 months after initial assessment. The levels of FGF23 was significantly lower at 3 and 12 months after baseline (P=0.01 and P=0.02, respectively) with no difference in FGF23 level between the time points of 3 and 12 months after transplantation. Baseline level of FGF23 was found to be higher in the patients with higher glomerular filtration rate (GFR), in older patients, in males, in those patients with diabetic nephropathy, in those with acceptable renal function than in patients who suffered transplant rejection. Conclusion: The level of postoperative FGF23 is an important marker for secretion of phosphorus from kidneys emphasizing the central role of FGF23 marker to regulate calcium and phosphorus metabolism after a successful renal transplantation.

Efficacy of Compound Therapy by Ginseng and Ciprofloxacin on Bacterial Prostatitis.

OBJECTIVE: Genitourinary tract infections play a significant role in male infertility. Infections of reproductive sex glands, such as the prostate, impair function and indirectly affect male fertility. The general aim of this study is to investigate the protective effect of Korean red ginseng (KRG) on prostatitis in male rats treated with ciprofloxacin (CIPX). MATERIALS AND METHODS: In this experimental study, we randomly divided 72 two male Wistar rats into 9 groups. The groups were treated as follows for 10 days: i. Control (no medication), ii. Sham [(normal saline injection into the vas deferens and oral administration of phosphate-buffered saline (PBS)], iii. Ginseng, iv. CPIX, v. CIPX+ginseng, vi. Uropathogenic Escherichia coli (E. coli) (UPEC), vii. UPEC+ginseng, viii. UPEC+CIPX, and ix. UPEC+ginseng+CIPX. The rats were killed 14 days after the last injection and the prostate glands were removed. After sample preparation, routine histology was performed using hematoxylin and eosin staining. The terminal deoxynucleotidyl transferase mediated dUTP-biotin nick end labeling (TUNEL) method was used to determine the presence of apoptotic cells. RESULTS: The severity score for acinar changes and inflammatory cell infiltration in the UPEC+CIPX group did not significantly different from the UPEC group. However this score significantly decreased in the UPEC+CIPX+ginseng group compared to the UPEC group. Apoptotic index of all ginseng treated groups significantly decreased compared to the UPEC and CPIX groups. CONCLUSION: These results suggested that ginseng might be an effective adjunct in CIPX treatment of prostatitis. The combined use ginseng and CIPX was more effective than ginseng or CIPX alone.