Endoscopic findings in hemodialysis patients upon workup for kidney transplantation.

Upper gastrointestinal (GI) abnormality is believed to be higher in patients with end-stage renal disease (ESRD) which can make a big trouble for whom undergo kidney transplant. We conducted this study to assess upper GI findings of patients with ESRD. In the present retrospective study we recorded upper GI endoscopy results in hemodialysis patients who were candidate for renal transplantation during a 10-year period. We reviewed files of 1256 patients with a mean age of 37.6 ± 13.4 years. Half of patients (50.6%) had an abnormal endoscopy. Two most common abnormalities were mild gastritis (35.6%) and gastro-esophageal reflux disease (16.7%). GI ulcers were observed in 11% of patients. Duodenal ulcer was the most common ulcer which was seen in 6.8% of patients. Helicobacter pylori was positive in 32.9% of patients and correlated with GI lesions (P = 0.000, r = 0.371). Longer dialysis duration and older patients revealed more upper GI abnormality (P = 0 .032, <0.001). As long as more than half of our patients have at least one upper GI involvement, we recommended that endoscopy must be done as a pretransplantation evaluation for patients without symptoms who have risk factors for ulcers.

Trends in age at first marriage in women and related factors: A population-based study in southwestern Iran.

Marriage and related processes seem to show individual tendencies but are in fact social phenomena. The aim of this study was to identify, among women, trends in age at first marriage and its related factors. In this cross-sectional study, the target population was women in households in Fars Province, Iran. To identify main effects of variables associated with age at marriage, multiple linear regression modeling was used without interactions. Women's age, women's and their husbands' occupations and educational levels, and place of residence were included in multiple linear regression modeling. A total of 3074 ever-married women were interviewed. A steep upward trend over time in age marriage was observed. The mean age at first marriage was 16.9 ± 3.4 years in women who married during the period from 1954 to 1974, and 21.9 ± 4.1 years among those who married during 2005-2014. Age at first marriage was significantly positively associated with women's and men's educational levels and with husband's employment status as laborers (p = 0.017) and negatively associated with husbands being employees (compared to being unemployed) (p < 0.001). Health providers should focus on increasing public awareness of factors associated with early and with delayed marriage.

End-stage Renal Disease in the Middle East: a Systematic Review and Meta-analysis.

INTRODUCTION: End-stage renal disease (ESRD) results in unpleasant consequences for patients, their families, and also society. Annually, each country expends a huge amount for ESRD treatment. In addition, its prevalence is dramatically growing, though it can be prevented. Many countries do not have accurate epidemiologic data about this disease. We conducted this study to measure a pooled prevalence of ESRD in the Middle East. MATERIALS AND METHODS: Included articles were prospective and retrospective cross-sectional and editorial studies from January 1990 till January 2015 from the Middle East area that reported the prevalence of ESRD and renal replacement therapy. To measure pooled prevalence of ESRD we used a random effect model. For evaluating publication bias and heterogeneity, we used the Egger test and I squared test, respectively. RESULTS: After excluding duplicates and irrelevant studies, 18 articles remained in our study. The prevalence reported in these studies varied from 55 pmp to 818 pmp. The pooled prevalence of ESRD was 360 pmp (95% confidence interval, 290 pmp to 430 pmp; I2 = 100%; P < .001). CONCLUSIONS: Most of the countries in the Middle East are categorized as developing countries. We believe that the prevalence in this region is much higher than what we measured. They lack a data registry system for most of diseases like ESRD, while it is needed for better prevention and treatment of these diseases.

Treatments of uremic pruritus: A systematic review.

Till now many treatments attempted to relieve uremic pruritus (UP) though none of them are definite treatment. In this study, we gathered all studies conducted on UP treatment since 2000-2016. We conducted a systematic review by searching the electronic databases (PubMed, Scopus, and Google scholar). Patients were with chronic kidney disease who complained of UP. Clinical trials and pilot studies in English and Persian which were done on patients with ESRD who complained of itching between 2000 till 2016 were gathered. A total of 166 articles were collected. After excluding articles 41 articles were remaining. Then UP treatments classified into two main groups: Medical (chemical and herbal medicine) and non-medical. Most studies measured UP by VAS scoring system in which patients described the severity. This scoring system is individual dependent. There are lots of studies on UP treatment though there are lots of controversies in studies. Finding a definite cure for this unpleasant symptom can improve patients' quality of life. Conducting further studies for each treatment on larger population is essential to improve quality of life among the end stage renal disease patients.

Who is sleeping more efficient? Patients on peritoneal dialysis or hemodialysis.

Sleep disorder, a common complaint among patients with the end-stage renal disease can affect most aspects of life. Therefore, we aimed to compare sleep quality of patients with peritoneal dialysis (PD) and hemodialysis (HD). This cross-sectional study was conducted on patients on dialysis who were referred to three major centers of Shiraz. The Pittsburgh Sleep Quality Index (PSQI) was used to compare sleep quality between patients on PD and HD. We also assessed some baseline characteristics to find out if they were independent predictors of sleep quality. Spearman correlation coefficients, one and two sample t-test, Chi-square, or Fisher's exact test were used to analyze the data. P <0.05 was considered statistically significant. The Statistical Package for Social Sciences version 18.0 for Windows was used for data analyzing. A total of 144 patients including 63 (43.8%) men and 81 (56.2%) women with the mean age of 54.4 ± 11.8 years completed the questionnaire survey. The total PSQI score showed that 77 (54.6%) of all patients had sleep disturbances without statistical difference between genders (P >0.05). On the other hand, the prevalence of sleep disturbance in HD patients (70.1%) was significantly higher than PD patients (35.9%), (P <0.001). HD patients had a higher rate of poor sleep quality than PD patients. Further studies are necessary to investigate the causes of poor quality of sleep in these patients and also to investigate methods to improve sleep quality in this population.

Posttransplant Outcomes of Patients With Autosomal Dominant Polycystic Kidney Disease Versus Other Recipients: A 10-Year Report From South of Iran.

OBJECTIVES: Autosomal dominant polycystic kidney disease is the most common hereditary disorder resulting in end-stage renal disease that can affect other organs besides kidneys. Extrarenal involvement may increase mortality and morbidity. Approximately 50% of patients with this disorder require renal transplant. Posttransplant complications have been reported to be equal in these patients versus other recipients. We conducted this study to determine and compare characteristics and outcomes of transplanted patients with this disease versus other recipients at the only transplant center in southern Iran. MATERIALS AND METHODS: Detailed data of patients with autosomal dominant polycystic kidney disease were collected from medical records from the Shiraz Organ Transplantation Center. We also gathered data on a matched control group of transplant recipients who had end-stage renal disease due to other reasons, including other congenital kidney diseases and type 2 diabetes mellitus. Medical records of patients before and after transplant were reviewed. Statistical analyses were performed with SPSS software version 19 (Chicago, IL, USA). RESULTS: We collected data from 2002 to 2012 on 101 patients with autosomal dominant polycystic kidney disease and 100 control patients, including 74 female (36.8%) and 127 male patients (63.2%). Average duration of pretransplant dialysis was 14.9 ± 10.3 months in study patients and 12.8 ± 8.1 months in control patients. Rejection rate was statistically greater in recipients with this disease (30 patients; 68%) versus controls (14 patients; 32%) (P = .010). CONCLUSIONS: Short- and long-term survival rates of patients with autosomal dominant polycystic kidney disease were not statistically different from control patients. However, graft survival was significantly lower. In short- and long-term follow-up of autosomal dominant polycystic kidney disease patients, hemoglobin and hematocrit levels were slightly higher than those of the control group. Autosomal dominant polycystic kidney disease is not a risk factor for posttransplant diabetes mellitus.

Sertraline can reduce uremic pruritus in hemodialysis patient: A double blind randomized clinical trial from Southern Iran.

INTRODUCTION: Uremic pruritus is an undesirable complication of end stage renal disease (ESRD). In spite of introduction of many treatments for this complication, it has no certain cure. The aim of this study was to assess sertraline effect on uremic pruritus. METHODS: In the present clinical trial study, we randomly divided our patients into two groups; trial group that received sertraline and control group that consumed placebo. We measured the severity of pruritus by two scoring systems (visual analogue scale and DUO) at the beginning and during the study with a-2-week interval. Data were analyzed by SPSS 18.0 and a P value < 0.050 considered as significant. FINDINGS: The mean age of our patients was 44.1 ± 16.1 years. Pruritus intensity significantly decreased in both groups (P < 0.001) and both scoring systems. Although the amount of decrease in trial group was significantly more than control group (P < 0.001). We found a direct relation between blood urea nitrogen and phosphorus and the degree of itching in VAS system (P < 0.009). There was a reverse significant relation between itching and calcium in both scoring systems (P < 0.012). Also pruritus intensity was directly correlated with C-reactive protein in both scoring systems (P < 0.05). DISCUSSION: Depends on present study and previous ones, inflammation appears to play a significant role in uremic itching. Sertraline is an effective drug in reducing this complaint possibly due to its effect on reducing inflammatory cytokines. In addition there is no need to adjust sertraline dosage in patients with ESRD. Sertraline might be a treatment for patients with ESRD who do not respond to other routine drugs.

Inter-observer agreement on varicoceles diagnosis among patients referred to Shiraz Namazi Hospital.

BACKGROUND: Varicocele is the collection of dilated veins of pampiniform plexus which is the most common cause of infertility occurred in 35-40% of infertile men. Despite all the diagnostic tools exist for varicocele diagnosis; still, a physical examination is the first step. OBJECTIVE: This study was done to determine the inter-observer agreement on varicoceles diagnosis. MATERIALS AND METHODS: In this cross-sectional study, two expert examiners evaluated 93 men with infertility, scrotal pain, and enlarged scrotum for the presence of varicocele. The urologists examined patients independently in two separate rooms. The inter-observer agreement on varicocele grading analyzed by the Spearman Rho correlation coefficient. RESULTS: The grading of varicocele were similar in 34 (36.5%) and 59 (63.4%) cases in the left and right side, respectively with correlation coefficient of 0.65 (0.51-0.75) and 0.25 (0.04-0.43), respectively. It implies that inter-observer agreement was substantial for left varicocele assessment and moderate for right varicocele assessment. CONCLUSION: Physical exam is the essential diagnostic tool for varicocele. As long as the observers educated with the same standard method the disagreements reduced to the negligible extent.