Ultra-mini Percutaneous Nephrolithotomy (UM-PCNL) with a Semi-rigid Ureteroscope in Preschool Children: An Innovative Experience in Southern Iran.

PURPOSE: Percutaneous nephrolithotomy (PCNL) has undergone extensive modification to reduce complications. One of the recent advances in minimally invasive procedures is the advent of ultra-mini PCNL (UM-PCNL), which provides miniaturized access to the kidney. However, the specific instruments applied in UM-PCNL may not be found in centers with limited resources. This study evaluated the safety, feasibility, results, and short-term complication rates of performing UM-PCNL using a semi-rigid ureteroscope in preschool children. MATERIALS AND METHODS: Between September 2013 and September 2021, a total of 68 patients, including 42 boys and 26 girls with a mean age of 3.2 ± 2.4 years, underwent UM-PCNL with a 4.5French tip ureteroscope instead of an ultra-mini nephroscope in children aged less than 7 years old. The procedure was done under general anesthesia in the prone position. The nephrostomy tract was dilated to 12F. Stones were fragmented using a pneumatic lithotripter. Irrigation was done with normal saline. RESULTS: The early stone-free rate (SFR) was 91%, and the short-term total SFR was 97%. No statistically significant difference was found in pre-operative and post-operative Hb, BUN, Cr, Na+, and K+. Fever (11 patients) and ileus (5 patients) constituted the majority of complications, and only one patient required a blood transfusion. None of the cases undergoing UM-PCNL with this method required a re-do PCNL. CONCLUSION: Our experience shows that with sufficient experience in handling semi-rigid ureteroscopes, urologists practicing in centers with limited resources could perform UM-PCNL with relatively favorable outcomes.

Zeolite-supplemented diets in the prenatal period affected postpartum reproductive parameters, colostrum production, and body condition score of dairy cows.

Objective: The effect of zeolite on Ca plasma concentration, reproductive parameters, body condition score (BCS), and colostrum properties was evaluated in Holstein dairy cows during the postpartum period. Materials and Methods: Sixty pregnant cows were allocated to three experimental groups, including 1) a control (CON) diet; 2) a CON diet + 0.75% dry matter (DM) zeolite (100 gm/day/cow); and 3) a CON diet + 1.5% DM zeolite (200 gm/day/cow). Experimental diets were fed to cows during the last 4 weeks of pregnancy. Blood sample evaluation for Ca concentration was done. The prevalence of hypocalcemia and reproductive parameters, including BCS and colostrum properties, was also measured. Results: Total Ca and ionized calcium (Ca++) concentrations in plasma at 6 and 12 h after calving were higher in zeolite-consuming cows than those in CON s (p < 0.01). Mean frequencies for severe and subclinical hypocalcemia in zeolite-consuming cows were 11.64% and 19.36% lower than those in the CON group, respectively (p < 0.01). The mean pregnancy efficiency of these cows was also 12.94% higher than the CON (p < 0.01). The mean BCS (p ≤ 0.05) and colostrum quality (p < 0.01) of zeolite-consuming cows were at maximum, but their mean colostrum yield was lower than that of the CON group (p < 0.01). Conclusion: Zeolite dietary supplementation at levels of 0.75% and 1.5% DM of the preparturient diet is recommended for better CON of hypocalcemia, improved BCS and colostrum quality, and better prevention of postpartum reproductive disorders in dairy cows.

Effect of Anionic and Zeolite Supplements and Oral Calcium Bolus in Prepartum Diets on Feed Intake, Milk Yield and Milk Compositions, Plasma Ca Concentration, Blood Metabolites and the Prevalence of Some Reproductive Disorders in Fresh Dairy Cows.

Hypocalcaemia is an important disorder associated with an increased risk of metabolic diseases, and many studies have been going on for decades. This study investigated the effects of anionic and zeolite with an oral Ca bolus in the prepartum phase on milk yields and compositions, and plasma Ca concentrations, blood metabolites and the prevalence of some reproductive disorders in dairy cows after parturition. Ninety pregnant non-lactating Holstein-Friesian cows were randomly assigned to three isoenergetic diets and their counterparts using an oral Ca bolus: (1) Control (CON): low Ca (0.44%); (2) Anionic (ANI): high Ca (1.00%); (3) Zeolite (ZEO): low Ca (0.44%). The feed and energy intakes of the CON and ZEO groups were higher than the ANI group. The raw milk yield, Pr%, and feed efficiency did not differ between the groups, while the corrected milk yield, fat% and total corrected milk yield at 305 days differed between groups. Total plasma and the ionized Ca concentration of the ANI and ZEO groups, at calving time and in 6, 12, 24 and 48 h after that, were higher than in the CON group. The frequencies of hypocalcaemia and reproductive disorders in the ANI and ZEO groups were lower than in the CON. The blood metabolite levels in the CON group were higher than in other groups. In conclusion, the ANI and ZEO diets and their counterparts supplemented with an oral Ca bolus improved the milk production traits, plasma calcium and metabolites concentration and also effectively prevented reproductive disorders.

Evaluation of the in vivo and in vitro safety profile of Cuscuta epithymum ethanolic extract.

OBJECTIVE: Cuscuta epithymum (CE) is one of the most popular medicinal plants in the world. However, detailed information about its toxicity is not available. Hence, this study aimed to evaluate the safety profile of CE ethanolic extract in vitro and in vivo. MATERIALS AND METHODS: The extract's in vitro toxicity profile was investigated on normal fibroblast and cervical cancer cells by cytotoxicity test. In the next step, acute oral and intraperitoneal (i.p.) toxicity of the CE extract was evaluated in Wistar rats and BALB/c mice, respectively. Sub-acute oral toxicity was also examined by administering repeated oral doses of the CE extract (50, 200, and 500 mg/kg) to Wistar rats for 28 days. RESULTS: The CE extract exhibited a significant cytotoxicity on both normal (IC50 0.82 mg/ml, p<0.001) and cancer cells (IC50 1.42 mg/ml, p<0.001). Acute oral administration of a single dose of CE extract (175-5000 mg/kg) did not cause mortality; however, its i.p. administration caused mortality at doses greater than 75 mg/kg (i.p. LD50 154.8 mg/kg). In the sub-acute toxicity test, no significant effects in terms of weight change, organ weights, blood chemistry, or kidney pathology were observed. However, at 200 and 500 mg/kg doses, the CE extract significantly increased liver pathological scores compared to the control group (p<0.05 and p<0.01, respectively). CONCLUSION: CE exhibited toxicities in i.p. acute and repeated oral dose administrations. It showed identical cytotoxicity against normal and cancer cells. This herb must be prescribed cautiously by traditional medicine practitioners.

Therapeutic and Preventive Effects of Aqueous Extract of Date Palm (Phoenix dactylifera L.) Pits on Ethylene Glycol-Induced Kidney Calculi in Rats.

INTRODUCTION: Urinary tract stones are one of the most common diseases in the urinary tract. Lack of kidney stone treatment causes irreparable damages to the kidneys, which has many harmful effects. Date palm pits are recommended in traditional medicine as an effective drug in the treatment of kidney stones. The aim of this study was to investigate the effect of aqueous extract of date palm pits on kidney stones induced by ethylene glycol in male rats. METHODS: In this study, 40 rats were classified into five groups (n = 8), including the healthy group receiving normal water, the negative control group, the therapeutic groups with doses of 150 mg/kg and 300 mg/kg, and the prevention group with a dose of 300 mg/kg. In order to induce kidney stones, ethylene glycolated water (1%) was used as drinking water in the studied groups. Blood and urine of rats were collected on days 14 and 28 of the study to assess urinary parameters of calcium, creatinine, uric acid and phosphorus, and serum parameters of blood urea nitrogen, creatinine, uric acid, calcium, and phosphorus. Also, the kidneys of rats were removed from the body on day 28 of the study and were given to a pathologist for examination. RESULTS: Results of serum parameters shows that the use of date palm pits extract in the treatment and prevention groups with a dose of 300 mg/kg significantly (P < .05) has reduced the levels of blood urea nitrogen, uric acid, calcium, creatinine and phosphorus. Also, the results of urinary parameters show that the use of the extract caused a significant decrease (P < .05) in creatinine, uric acid and calcium in the prevention group and a significant decrease (P < .05) in creatinine and uric acid in the therapeutic group with a dose of 300 mg/kg. Pathological results show a decrease in the number and size of calcium oxalate crystals in renal tubules in the treatment and prevention groups in a dose-dependent manner. CONCLUSION: The results of this study showed that the use of aqueous extract of date palm pits has been effective in the treatment and prevention of kidney stones induced by ethylene glycol in rats.

Crocin and Metformin suppress metastatic breast cancer progression via VEGF and MMP9 downregulations: in vitro and in vivo studies.

Metastatic breast cancer remains a serious health concern and numerous investigations recommended medicinal plants as a complementary therapy. Crocin is one of the known anticancer bio-component. Recently, the inhibitory effect of metformin has been studied on the various aspects of cancer. However, no study reported their combination effects on metastatic breast cancer. In the present study, we have assessed their anti-metastatic effects on in vitro and in vivo breast cancer models. Using MTT assay, scratch, and adhesion tests, we have evaluated the cytotoxic, anti-invasive and anti-adhesion effects of crocin and metformin on 4T1 cell line, respectively. Their protective effects and MMP9 as well as VEGF protein expression levels (Western blotting) investigated in the 4T1 murine breast cancer model. Our results showed that both crocin and metformin reduced cell viability, delayed scratch healing and inhibited the cell adhesion, in vitro. While crocin alone restored the mice's weight reduction, crocin, metformin, and their combination significantly reduced the tumor volume size and enhanced animal survival rate in murine breast cancer model, responses that were associated with VEGF and MMP9 down-regulation. These findings suggest that a combination of crocin and metformin could serve as a novel therapeutic approach to enhance the effectiveness of metastatic breast cancer therapy.

The compliance of surgical prophylactic antibiotics with standard protocols in Imam Reza teaching hospital of Birjand, Iran.

BACKGROUND AND OBJECTIVES: Taking unnecessary or inappropriate prophylactic antibiotics can cause infections with resistant organisms. The present study aimed to investigate administration prophylactic antibiotics in surgery ward and its compliance with standard protocol in Imam Reza teaching hospital of Birjand, Iran. MATERIALS AND METHODS: This descriptive-analytical study was performed to evaluate the pattern of prophylactic antibiotics on patients who underwent surgical operations from October to December 2019. A checklist including demographic information, type of prophylactic antibiotics, dose and duration of using drug, type of surgery, and compliance with standard protocol was used. The validity and reliability of the checklist were evaluated and confirmed prior to the study. All eligible patients were enrolled and the information of the prescribed drugs in the surgical wards was compared with the Schwartz's principles of surgery as standard protocol. RESULTS: Out of a total of 300 patients, 187 (62.3%) were male. Among the patients, 155 (51.7%) cases underwent general surgery, 119 (39.6%) cases orthopedic surgery, and 26 (8.7%) cases neurosurgery. The most popular prescribed antibiotics were cefazolin (170 cases) and ceftriaxone + metronidazole (67 cases). Furthermore, the maximum antibiotic administrations were two days (127 cases) and one day (93 cases). More importantly, 67.7% and 92.3% of the patients were in compliance with the standard protocol in terms of the type and time of administration, respectively. CONCLUSION: Our results showed that duration and route of administrating antibiotics were consistent with the standard protocol, but the type of drugs and indication did not match.

Ethanolic extract of Iris songarica rhizome attenuates methotrexate-induced liver and kidney damages in rats.

OBJECTIVE: The long-term sequelae of methotrexate (MTX) remain the major cause of concern for both patients and therapists. Therefore, new approaches to decrease MTX side effects are needed. The study was carried out to evaluate the effects of Iris songarica Schrenk (IS) rhizome extract against MTX-induced hepatic and renal injuries in rats. MATERIALS AND METHODS: Forty male Wistar rats were randomly divided into five groups (n=8) including control, MTX, IS50, IS150 and IS300. Control and MTX groups were only treated orally with saline; whereas, IS50, IS150 and IS300 groups were treated with IS extract at three different doses (50, 150, and 300 mg/kg, respectively). Besides, the MTX and experimental groups were received a single dose of MTX (20 mg/kg) intraperitoneally on day 4. On the ninth day, animals were sacrificed, blood transaminases, urea and creatinine were assessed and the concentration of malondialdehyde (MDA) and the activity of super-oxide dismutase (SOD) were determined in both liver and kidney tissues. Moreover, hepatic and renal damages were evaluated histopathologically. RESULTS: MTX by increasing oxidative stress (MDA) and decreasing antioxidant capacity (SOD) induced hepatic and renal damages as confirmed by biochemical and histological parameters analyses. However, treatment with IS caused significant improvements in hepatic and renal histological architectures and SOD activity (p<0.01) along with reducing liver enzymes, urea, creatinine and MDA (p<0.01). CONCLUSION: The results of the present study showed that IS extract through antioxidant and probably anti-inflammatory activities, could effectively limit MTX-induced hepatic and renal injuries in rats.

The quality of life of the patients with diabetes type 2 using EQ-5D-5 L in Birjand.

BACKGROUND: Due to high prevalence of diabetes and its complications, evaluating of the patients' quality of life is critical. EQ-5D-5 L is a valid tool for assessing the quality of life in chronic diseases including diabetes. The present study conducted to illustrate the quality of life for the patients who referred to the Diabetes clinic and determine its relationship with their demographic and clinical characteristics in Birjand in 2017. METHODS: In this cross-sectional study, 300 patients with type 2 diabetes were selected through a systematic sampling in 2017. Data were collected using a checklist including patients' demographic, clinical and laboratory information and the EQ-5D-5 L. Data were entered the SPSS (22) software, analyzed by independent sample T-test, ANOVA, Chi-Square and logistic regression tests. Statistical significance was inferred at α = 0.05. RESULTS: Mean age for the participants was 58.1 ± 9.6 years. The mean score for the quality of life based on the EQ-5D-5 L and VAS scale were 0.89 ± 0.13 and 65.22 ± 9.32, respectively. Moderate and severe problems were found in the anxiety/depression dimensions in 12% of the patients, while these numbers for the presence of pain/discomfort and mobility were slightly higher (13.7 and 13.6%, respectively). The mean scores for quality of life and VAS were significantly higher in the men, employed and patients < 50 years age. CONCLUSION: The quality of life for the type 2 diabetes patients is affected by numerous factors including sex, occupation, duration of the disease and the presence of complications such as neuropathy and nephropathy.

Evaluation of vancomycin use in university-affiliated hospitals in Southern Khorasan Province (East Iran) based on HICPAC guidelines.

BACKGROUND: Vancomycin resistance has raised concerns about its effectiveness prospect in the treatment of patients with Gram-positive infections. The Healthcare Infection Control Practices Advisory Committee (HICPAC) has recently established guidelines to delineate improper use of vancomycin. In this light, we sought out to determine the appropriateness of vancomycin prescription using the HICPAC guidelines. SETTING: The study was carried out in two university-affiliated hospitals, Valiasr and Imam Reza, with 297 and 234 beds, respectively, from May 2012 to May 2013. METHODS: This retrospective study evaluated the vancomycin prescription and usage in the hospitals. Total vancomycin use was determined and expressed as vancomycin courses per 298 admitted patients. The patient information was collected on a data collection sheet as follows: demographic variables, etiology and localization of infection, microbiological data, duration of vancomycin treatment, reasons for vancomycin prescription, prescribed antibiotic dosing, and patient regimen. RESULTS: The average age of the patients and vancomycin treatment duration were 55.965 years and 10.5 days, respectively. Septicemia (15.7%) was the most common cause of vancomycin administration. Vancomycin use was documented to be appropriate and inappropriate in 236 (89.4%) and 28 (10.6%) patients, respectively. No statistically significant differences were found among the wards and hospitals (P values =0.66 and 0.54, respectively) in terms of appropriateness of vancomycin use based on the HICPAC criteria. In addition, 29.21% and 62% of all patients exhibited complete and partial recovery, respectively. We found that 90% of the cases showed compliance with the HICPAC recommendations. CONCLUSION: Comprehensive programs are required to improve the vancomycin use in the hospitals. Vancomycin use should be monitored due to its large-scale empiric use. The rate of improper use of vancomycin in the infection and intensive care unit services may be high, and pharmacists must take appropriate action to optimize the use of the drug.

Ceftriaxone-associated nephrolithiasis and gallstone in adults.

BACKGROUND: Ceftriaxone (CTX) is widely used for the treatment of bacterial infections; however, side effects such as gallstone and nephrolithiasis have been reported in children. There is limited information about urinary tract calculi as CTX side effects in adults. Therefore, the present study was aimed to evaluate the incidence of gallstone and nephrolithiasis following CTX administration. METHODS: The present study was conducted in the Vali-e-Asr Hospital. Eighty-four patients with various infectious diseases with different daily treatment (mean ± SD: 4.19±2.54) were included in this study, consisting of 49 females and 35 males. The mean of total doses used in patients was 10.2143 (SD: 5.8585). To detect possible gallstone, gallbladder sludge, and urolithiasis, patients were evaluated by serial ultrasound before and after CTX treatment. Patients with renal and hepatobiliary dysfunction were excluded from the study and did not receive any nephrotoxic drugs during this study. Demographic parameters including age, sex, body mass index, dosage of CTX, as well as the duration of treatment and hospitalization were determined. Statistical significances were determined using Fisher's exact test and independent t-test. RESULTS: Results from our study showed that the incidence of gallstone and nephrolithiasis were 8.8% and 1.5% following CTX administration, respectively. Surprisingly, we found a significant correlation in terms of age between patients with and without gallstone (P=0.03). CONCLUSION: Our findings suggest that the patients' age might play a role in the development of such a complication. This indicates the need for a close monitoring of CTX-treated patients to assess the possible formation of gallstone and nephrolithiasis.

Anti-proliferative and apoptotic effects of Ziziphus Jujube on cervical and breast cancer cells.

OBJECTIVE: Ziziphus Jujube (Jujube) plant has exhibited numerous medicinal and pharmacological properties including antioxidant and anti-inflammatory effects. This study was carried out to investigate its anti-cancer and pro-apoptotic abilities in human cervical and breast cancer cells in vitro. MATERIALS AND METHODS: The cervical OV2008 and breast MCF-7 cancer cells were incubated with different concentrations of Jujube aqueous extraction (0-3 mg/ml) for various times (0-72 h). Cell viability was assessed by Trypan Blue and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The expression of two apoptosis-related genes in treated cells evaluated by quantitative Real Time -PCR analysis. RESULTS: Jujube significantly inhibited cancer cell viability in a dose- and time- dependent manner. Herb-induced apoptosis was associated with enhanced expression of Bax and decreased Bcl2 gene leading eventually to a time-dependent six fold increase in the Bax/Bcl-2 ratio. CONCLUSION: These results indicated that Jujube may be a natural potential and promising agent to prevent or treat human cancers.

"Ziziphus jujuba": A red fruit with promising anticancer activities.

Ziziphus jujuba Mill. (Z. jujuba) is a traditional herb with a long history of use for nutrition and the treatment of a broad spectrum of diseases. It grows mostly in South and East Asia, as well as in Australia and Europe. Mounting evidence shows the health benefits of Z. jujuba, including anticancer, anti-inflammation, antiobesity, antioxidant, and hepato- and gastrointestinal protective properties, which are due to its bioactive compounds. Chemotherapy, such as with cis-diamminedichloroplatinium (CDDP, cisplatin) and its derivatives, is widely used in cancer treatment. It is an effective treatment for human cancers, including ovarian cancer; however, drug resistance is a major obstacle to successful treatment. A better understanding of the mechanisms and strategies for overcoming chemoresistance can greatly improve therapeutic outcomes for patients. In this review article, the bioactive compounds present in Z. jujuba are explained. The high prevalence of many different cancers worldwide has recently attracted the attention of many researchers. This is why our research group focused on studying the anticancer activity of Z. jujuba as well as its impact on chemoresistance both in vivo and in vitro. We hope that these studies can lead to a promising future for cancer patients.

Nintinol self-expandable metallic stenting in management of malignant obstructive jaundice: a case series.

BACKGROUND AND AIMS: Palliation therapy is the only available therapeutic method for most patients with tumor-induced obstructive jaundice. Metallic stents are now performed percutaneously as an alternative route to the endoscopic approach. It is widely accepted because of its safety, good patency rate, and minimal invasiveness. This study was designed to evaluate the long-term results of metallic self-expandable stent insertion in patients with malignant stenosis of the biliary tree. METHODS: It is a longitudinal study of patients with percutaneously biliary stenting from September 2005 to March 2009. The patients had unresectable malignant biliary obstruction with unsuccessful endoscopic stenting and access. Percutaneous transhepatic cholangiogram performed after adequate local anesthesia, under sonographic or fluoroscopic guidance. Stenting or balloon dilation was performed through the hydrophilic guide wire. Among 50 patients, 45 stents were placed in biliary tree stenosis sites. Patients' follow-up was during the first, second, third, and then the sixth month after insertion of biliary stents. Stent patency was considered successful in our patients, when there were no lab results or sonographic appearance of biliary tree obstruction. RESULTS: 10(20%) patients' stent placement treatment failed because of unsuccessful technical procedure. The stenosis of biliary tract was complete and passage of guide wire was not possible through the tumor growth. 6 (15 %) patients with successful stent placements died within one month (mean, 22 days). Total serum bilirubin resolved to below 1.5 mg/dl within 30 days for 36 (90%) patients with successful stent placements. Early complications not leading to death occurred in 28% of cases. The mean survival time for all patients who underwent stent placement was 140 days (16-420days). The mean patency rate for all stents was 147 days. CONCLUSIONS: Percutaneous biliary stenting is a safe procedure with few technical complications and a high success rate of palliation for patients with malignant biliary jaundice. Early complications are mostly managed conservatively and death is mainly due to systemic effects of the malignant disease.