PRIMARY HYPERPARATHYROIDISM: COMPARING BETWEEN SOLID AND CYSTIC ADENOMAS AND THE EFFICACY OF ULTRASOUND AND SINGLE-PHOTON EMISSION COMPUTED TOMOGRAPHY IN THEIR DIAGNOSIS.

OBJECTIVE: Primary hyperparathyroidism (PHPT) is a disorder that results from abnormal functioning of the parathyroid glands. The purpose of this study was to compare cystic and solid adenomas by analyzing different variables associated with PHPT and parathyroid adenomas (age, calcium, phosphorus, and parathyroid hormone [PTH] levels, adenoma volume) while comparing the efficacy of ultrasound and single-photon emission computed tomography in differentiating between both types of adenoma. METHODS: From 152 patients diagnosed with PHPT between January 2013 and 2014, only 109 patients who had positive ultrasonographic findings for single parathyroid adenoma were included in the study. RESULTS: A total of 26 patients had cystic adenomas and 83 patients had solid adenomas. Sestamibi (MIBI) was negative in 50% of the cystic adenoma group and 27.7% of the solid adenoma group, with an overall technetium-MIBI efficacy of 67%. Age, phosphorus level, and adenoma volume were significantly higher in patients with cystic adenomas (P = .001, P = .02, and P = .02, respectively), whereas calcium and PTH levels were significantly higher in patients with solid adenomas (P = .02, P = .038, respectively). MIBI had a significant correlation with PTH levels (P = .031) and adenoma volume (P = .05) only in patients with solid adenomas. No significant correlation was found between sex and type of parathyroid adenoma. CONCLUSION: The current study is the first to compare age, PTH levels, and adenoma volume between cystic and solid adenoma patients, providing more information for the poorly understood pathology of cystic adenomas. Our findings showed that age and calcium and PTH levels are significantly higher in patients with solid adenomas, whereas adenoma volume and phosphorus levels are significantly higher in patients with cystic adenomas.

Evaluation of the Fibromyalgia and Related Risk Factors in Patients with Advanced Kidney Failure Undergoing Hemodialysis.

BACKGROUND: Fibromyalgia syndrome (FMS) is defined as widespread and persistent pain in the musculoskeletal system. There are limited reports regarding the prevalence of fibromyalgia syndrome in patients with advanced kidney failure undergoing regular hemodialysis. Therefore, this study aimed to evaluate the prevalence of fibromyalgia syndrome and its risk factors in a large proportion of patients under the hemodialysis condition. MATERIALS AND METHODS: In this cross-sectional study, 293 patients who were admitted to the hemodialysis ward were evaluated for fibromyalgia syndrome in an educational hospital. The questionnaire was designed according to symptom severity score (SS score) and widespread pain index (WPI) criteria. The correlation between FMS and various variables, including demographic, clinical, and biochemistry biomarkers, was also precisely calculated by logistic regression. Data were analyzed using SPSS v.17 statistics software. RESULTS: The results showed that, of 293 hemodialysis patients, 130 patients (44.4%) had fibromyalgia, the mean age of patients with and without fibromyalgia was 61.09 ± 15.36 and 53.49 ± 15.38 years old, respectively (P = 0.001). Moreover, there was a significant difference in terms of gender among patients with fibromyalgia syndrome (P = 0.001). To note, there was no significant relationship between the kidney failure etiopathogenesis, duration of dialysis, body mass index (BMI), Kt/v index, history of peritoneal dialysis, and laboratory parameters with fibromyalgia in hemodialysis patients (P > 0.05). However, our findings revealed that both age and gender could be considered as the predictor variables associated with fibromyalgia in patients undergoing hemodialysis. CONCLUSION: Taken together, in this study, we found that age and gender would be the critical factors in terms of the fibromyalgia syndrome in patients undergoing hemodialysis.

Tribulus terrestris-induced severe nephrotoxicity in a young healthy male.

Herbal medications are being progressively utilized all over the world. Nevertheless, herbal remedies are not without hazards and several cases of adverse reactions have been described. Tribulus terrestris is traditionally used because of its aphrodisiac and antiurolithiatic activities with almost complete inhibition of stone formation. We report a case of T. terrestris-induced hepatotoxicity, nephrotoxicity and neurotoxicity in an Iranian male patient who used the plant's extract to prevent kidney stone formation. He presented with seizure and very high serum aminotransferases and creatinine after consuming herbal water for 2 days. Discontinuation of the herbal remedy resulted in improvement in symptoms and normalization of his liver enzymes.

Preventing potential drug-drug interactions through alerting decision support systems: A clinical context based methodology.

BACKGROUND: The effectiveness of the clinical decision support systems (CDSSs) is hampered by frequent workflow interruptions and alert fatigue because of alerts with little or no clinical relevance. In this paper, we reported a methodology through which we applied knowledge from the clinical context and the international recommendations to develop a potential drug-drug interaction (pDDI) CDSS in the field of kidney transplantation. METHODS: Prescriptions of five nephrologists were prospectively recorded through non-participatory observations for two months. The Medscape multi-drug interaction checker tool was used to detect pDDIs. Alongside the Stockley's drug interactions reference, our clinicians were consulted with respect to the clinical relevance of detected pDDIs. We performed semi-structured interviews with five nephrologists and one informant nurse. Our clinically relevant pDDIs were checked with the Dutch "G-Standard". A multidisciplinary team decided the design characteristics of pDDI-alerts in a CDSS considering the international recommendations and the inputs from our clinical context. Finally, the performance of the CDSS in detecting DDIs was evaluated iteratively by a multidisciplinary research team. RESULTS: Medication data of 595 patients with 788 visits were collected and analyzed. Fifty-two types of interactions were most common, comprising 90% of all pDDIs. Among them 33 interactions (comprising 77% of all pDDIs) were rated as clinically relevant and were included in the CDSS's knowledge-base. Of these pDDIs, 73% were recognized as either pseudoduplication of drugs or not a pDDI when checked with the Dutch G-standard. Thirty-three alerts were developed and physicians were allowed to customize the appearance of pDDI-alerts based on a proposed algorithm. CONCLUSION: Clinical practice contexts should be studied to understand the complexities of clinical work and to learn the type, severity and frequency of pDDIs. In order to make the alerts more effective, clinicians' points of view concerning the clinical relevance of pDDIs are critical. Moreover, flexibility should be built into a pDDI-CDSS to allow clinicians to customize the appearance of pDDI-alerts based on their clinical context.

Analysis of Interleukin-17 mRNA Level in the Urinary Cells of Kidney Transplant Recipients with Stable Function.

OBJECTIVES: Kidney transplantation supports patients with end-stage kidney diseases. Many factors control the allograft function in kidney transplant recipients. Interleukin-17 (IL-17) can be used as a non-invasive diagnostic biomarker of rejection. The aim of this study was to evaluate the expression of IL-17 mRNA in urinary cells of kidney transplant recipients with stable function. MATERIAL AND METHODS: A total of 40 renal transplant recipients who were admitted for surgery and 30 healthy controls were enrolled in the study. From each patient, 30 mL urine samples were collected in 50 mL tubes on days 3 and 5 after renal transplantation; also, 30 mL urine samples were obtained from controls. Quantitative Real-Time PCR (qRT-PCR) technique was used for analysis of IL-17 mRNA level in the tested groups; 2-ÄÄCT method was performed for determining the relative gene expression between tested groups. RESULTS: The mRNA expression mean ± SE of fold in patients and controls were 3.58±1.61 fold and 2.85±1.37 fold, respectively. The mRNA expression mean of IL-17 (fold) was not statistically different in tested groups (P-value = 0.63). CONCLUSIONS: In kidney transplant recipients, urinary IL-17 expression provides informative data in relation to the allograft function regardless of allograft pathology.

Recurrent idiopathic membranous glomerulonephritis after kidney transplantation and successful treatment with rituximab.

After renal transplantation approximately forty percent of patients with membranous glomerolunephritis (MGN) had a recurrence, most commonly during the first year.We present two cases with recurrent MGN after kidney transplantation who successfully treated with ritoximab.

Successful treatment of Chronic Myelogenic Leukemia (CML) with imatinib after renal transplantation.

Chronic Myelogenic Leukemia (CML) is a rare malignant disorder after solid organ transplantation, especially in renal transplant recipients. Imatinib Mesylate is currently approved as first line treatment of CML. Most reports on CML are from kidney recipients who received azathioprine  in combination with cyclosporine and prednisolone as immunosuppressive therapy. We report a case with CML who was treated with Mycophenolate Mofetil.