Bone Density Reduction and Its Associated Factors in Kidney Transplant Recipients: A Cross-Sectional Study.

Background: Decreased bone mineral density (BMD) is one of the complications of kidney transplantation, which is associated with many factors. However, the findings of relevant studies are inconsistent and contradictory. Objective: To investigate the prevalence of BMD reduction and its associated factors in kidney transplant recipients. Methods: All kidney transplant recipients (n=69), referred to Shahid Mostafa Khomeini Hospital in Ilam, southwest of Iran, were included in this study between 2016 and 2018. The BMD of the lumbar spine and femoral neck was examined using dual-energy X-ray absorptiometry. According to the Z-score and T-score, the patients were divided into two age groups: <50 years and >50 years. All patients' demographic characteristics, background variables, and laboratory parameters were evaluated. Descriptive statistics were measured, and binary and multinomial logistic regression analyses were performed. Results: The overall prevalence of osteoporosis in the femur and lumbar spine was 38% and 32%, respectively. In patients aged <50 years, femoral head osteoporosis showed a significant relationship with the vitamin D level and sex. In patients aged >50 years, advancing age and duration of prednisolone consumption were associated with an increased risk of osteoporosis and osteopenia at the femoral neck (P<0.05). Besides, the duration of prednisolone use was associated with osteoporosis at the lumbar spine (RRR=1.02, P<0.05). Conclusion: Various factors, including prednisolone consumption, affect BMD reduction in kidney transplant recipients. Regular monitoring of BMD, maximum reduction of prednisolone dose, training on the use of effective supplements, and other preventive and supportive measures can be helpful for this group.

The roles played by IL-10, IL-23 and IL-17A in term delivery.

BACKGROUND: The immune system significantly participates in the development of the successful delivery process. The roles played by cytokine molecules in the induction of term delivery are yet to be clarified. The aim of this project was to explore the serum levels of interleukin-10 (IL-10), IL-17A, and IL-23 in the mothers with term and prolonged pregnancy and their infants. MATERIALS AND METHODS: In this study, 60 samples were collected from either mothers with term and prolonged pregnancy or their infants, collectively 240 samples. Serum levels of IL-10, IL-17A and IL-23 were explored using enzyme linked immunosorbent assay (ELISA) technique. RESULTS: IL-10 serum levels significantly decreased in the neonates with prolonged pregnancy when compared to their mothers. Serum levels of IL-23 were increased either in term or prolonged pregnancy neonates when compared to their corresponded mothers. Serum levels of IL-10 and IL-23 significantly decreased and increased, respectively, in the female in comparison to male in the prolonged pregnancy neonates. IL-10 also significantly decreased in the term mothers who had higher gravidity. CONCLUSION: Although, IL-17A does not play a key role in the delivery mechanism, IL-10 and IL-23 may be considered as potential factors in the modulation of term delivery.

The barriers against initiating insulin therapy among patients with diabetes living in Yazd, Iran.

INTRODUCTION: The decision to start insulin therapy is often difficult. Determining the barriers against insulin therapy initiation can facilitate care and treatment strategies. The aim of this study was to evaluate the barriers against initiating insulin therapy among patients with diabetes living in Yazd, Iran. METHODS: This descriptive study was conducted on 214 patients referred to the Diabetes Center of Yazd University of Medical Sciences in 2015. Participants were randomly selected, and then they completed the insulin noncompliance questionnaire (20 questions). The percentage of adherence and the factors contributing to nonadherence to insulin therapy were analyzed using descriptive statistics, the Kruskal-Wallis test, and the Mann-Whitney test. RESULTS: The most prevalent reason for insulin therapy refusal was expecting a new method of diabetes treatment (54.7%), followed by requiring someone else to administer the injection (19.2%), fear of needles, cost, traveling (18.7%), and stress/emotional problems (18.2%). Lack of trust in the physician was the least restrictive reason for nonadherence to insulin therapy. CONCLUSION: The most common reason given for insulin therapy refusal was the lack of adequate education. Therefore, specialized educational interventions can help minimize barriers and improve patients' outcomes.

Novel calcified gum Arabic porous nano-composite scaffold for bone tissue regeneration.

The aim of this study was to investigate the biomechanical and biological properties of a nanocomposite scaffold containing both mineral and polysaccharide constituents. Hydroxyapatite nanoparticles (n-HA) was synthesized from dead abra ovata shells using wet chemical methods and was used in different ratios in concert with gum Arabic, a branched plant polysaccharide. N-HA/gum nanocomposite was fabricated with freeze-drying process and characterized by FTIR and SEM for chemical structure and morphology. Porosity was estimated using liquid substitution method. The scaffold mechanical properties were evaluated by compressive test measurement. Osteogenic differentiation was assessed using alkaline phosphatase production and biomineralization was evaluated using Alizarin red assay. Results demonstrated that the hydroxyapatite/gum Arabic nanocomposite had favorable biocompatibility and a similar structure to natural bone matrix. Porous nanocomposite possessed macropore networks with a porosity 87-93% and mean pore size ranging between 164 and 230 µm. The gum/HA with a ratio of 50% w/w HA had the highest compressive modulus of ∼75.3 MPa Pa (MPa) and the ultimate compressive stress of ∼16.6 MPa. C2C12 cells cultured on a scaffold with higher percentage (40 and 50 w/w) of HA demonstrated increased ALP levels and calcium deposition. The data from the present study demonstrated significant changes to the biomechanical properties and osteoconductivity of the nanocomposite scaffold by modulating its mineral content. Nanocomposite scaffolds containing gum and n-HA of 40-50% exhibited highest mechanical properties, as well as supported increased biomineralization.