A systematic review and bioinformatic study on clinical, paraclinical, and genetic factors predisposing to stent restenosis following percutaneous coronary intervention.

BACKGROUND: Stent restenosis is a relatively common phenomenon among patients with coronary heart disease undergoing percutaneous coronary intervention (PCI). It seems that a set of clinical, laboratory, and even genetic factors make people susceptible to such a phenomenon and in fact, this is multi-factorial. We aimed to first determine the underlying clinical and laboratory risk factors for the occurrence of stent re-stenosis after PCI based on a systematic review study, and after that, through a bioinformatics study, to evaluate the related genes and microRNAs with the occurrence of stent re-stenosis. MAIN TEXT: In the first step, the manuscript databases including Medline, Web of Knowledge, Google Scholar, Scopus, and Cochrane were deeply searched by the two blinded investigators for all eligible studies based on the considered keywords to introduce clinical and laboratory determinants of stent re-stenosis. In the bioinformatic phase, and following a review of the literature to identify genes and microRNAs involved in restenosis, the interaction of each gene with other genes associated with stent re-stenosis was determined by GeneMANIA network analysis and Cytoscape software. Overall, 67 articles (including 40,789 patients) on clinical and biochemical predictors for stent restenosis and 25 articles on genetic determinants of this event were eligible for the final analysis. The predictors for this event were categorized into four subgroups patient-based parameters including traditional cardiovascular risk profiles, stent-based parameters including type and diametric characteristics of the stents used, coronary lesion-based parameters including several two target lesions and coronary involvement severity and laboratory-based parameters particularly related to activation of inflammatory processes. In the bioinformatic phase, we uncovered 42 genes that have been described to be involved in such a phenomenon considering a special position for genes encoding inflammatory cytokines. Also, 12 microRNAs have been pointed to be involved in targeting genes involved in stent re-stenosis. CONCLUSIONS: The incidence of stent re-stenosis will be the result of a complex interaction of clinical risk factors, laboratory factors mostly related to the activation of inflammatory processes, and a complex network of gene-to-gene interactions.

Smoking waterpipe, cigarette, and heart disease: a cross-sectional analysis of baseline data from the Kong Cohort Study in the South of Iran.

Previous studies have shown the association between smoking and increased risk of cardiovascular diseases, but long-term effects of waterpipe use are unknown and more research is needed. The present study explored the relationship between cigarette and waterpipe smoking and heart disease in southern Iran. This cross-sectional study used the basic data of Bandar Kong Cohort Study (KCS) to test the relationship between waterpipe and cigarette smoking and heart disease in 4009 participants. A multivariate binary logistic regression was run to estimate adjusted odds ratios (ORs) in SPSS 16. The prevalence of tobacco use was 27.7%. The frequency of heart disease was 7.8% percent (n = 314). There was a statistically significant relationship between cigarette smoking and heart disease (OR = 2.11; 95% CI:1.41-3.16). In individuals who only smoked waterpipes, the odds of heart disease were higher than non-smokers. This relationship was not statistically significant (OR = 1.25, 95% CI:0.88-1.78). In those who smoked cigarettes and waterpipe at the same time, the odds of heart disease were higher than non-smokers (OR = 1.42; 95% C.I: 0.83-2.59). In general, cigarette smoking increases the risk of heart disease. As well as waterpipe smoking was associated with heart disease. However, this association was not statistically significant. More studies are required to validate the association between waterpipe smoking and heart disease. Also, waterpipe use was more common at younger ages, and on the other hand, heart diseases have a long latent period, so in this age group, high incidence of heart disease is likely in the future.

The value of neutrophil-to-lymphocyte ratio in predicting severity of coronary involvement and long-term outcome of percutaneous coronary intervention in patients with acute coronary syndrome: a systematic review and meta-analysis.

BACKGROUND: The value of counting inflammatory cells and especially their counting ratio in predicting adverse clinical outcomes in patients with acute coronary syndrome (ACS) undergoing revascularization has been shown, but the results of studies have been very diverse and paradoxical. The aim of the current study was to systematically review the studies that investigated the role of increased neutrophil-to-lymphocyte ratio (NLR) in predicting long-term clinical outcomes in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). METHODS: Data abstraction was independently performed by both un-blinded reviewers on deeply assessing Medline, Web of Knowledge, Google Scholar, Scopus, and Cochrane Central Register of Controlled Trials and using the relevant keywords. The risk of bias for each study was assessed using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions and the QUADAS-2 tool. Statistical analysis was performed using the Stata software. Overall, 14 articles published between 2010 and 2021 were eligible for the final analysis. RESULTS: A total of 20,846 ACS patients undergoing PCI were included. Higher values of NLR were associated with higher numbers of involved coronaries (RR: 1.175, 95%CI 1.021-1.353, P = 0.024). Increasing the value of NLR was associated with a 3.4 times increase in long-term death (RR: 3.424, 95%CI 2.325-5.025, P = 0.001). Similarly, higher values of NLR were significantly associated with a higher likelihood of long-term MACE (RR: 2.604, 95%CI 1.736-3.906, P = 0.001). CONCLUSIONS: NLR has a high value in predicting both the severity of coronary artery involvement and long-term adverse clinical outcomes following the PCI procedure.

Approach to a target value for 2-hours post dose cyclosporine (C2) during the first week post renal transplantation.

BACKGROUND: There is not a wide consensus on whether recommended target ranges for 2-hours post dose cyclosporine (CsA) blood level (C2) are generalizeable to all kidney recipient populations worldwide. In this study we aimed to assess in which C2 level we can obtain the least acute rejection (AR) episodes in our kidney transplanted patients. MATERIAL/METHOD: In a retrospective cross-sectional study, we investigated all our renal recipients with at least a valid C2 blood level at the days between 5-9 post transplantation. All patients were under immunosuppressive therapy with CsA (Neoral), prednisolone and MMF. RESULTS: Hundred forty-four patients were eligible for inclusion in the study. Mean age of the study subjects at the time of transplantation was 36.8+/-16.6 years. 99 (69%) of the patients were male. Overall, 16 (11%) patients experienced AR during the first two weeks post-transplantation. Mean C2 blood levels for patients experiencing AR was 793+/-335 compared with 1028+/-391 for patients without AR (p=0.023). We found that none of the patients with a C2 level of higher than 1300 ng/mL experienced an episode of AR. CONCLUSIONS: According to our findings, we recommend that for minimization purpose of the incident AR episodes among LURD kidney, a C2 blood level of higher than 1300 ng/mL to be obtained during the first week post-transplantation. Alongside, approaching specific C2 targets for patients with different drug regimen or genetic polymorphisms seem necessary.

Minimally invasive open dismembered pyeloplasty technique: Miniature incision, muscle-splitting dissection, and nopelvis reduction in children.

OBJECTIVE: To report the outcomes and complications of open dismembered Anderson-Hynes pyeloplasty with miniature incision in treating children's ureteropelvic junction obstruction. METHODS: Between March 2007 and April 2011, 109 children with a mean age of 2 years and 8 months old with ureteropelvic junction obstruction underwent open dismembered pyeloplasty. Clinical manifestations, radiographic assessments, incision size, surgery time, hospital stay, and complication rate were recorded. All patients had a documented ureteropelvic junction obstruction (having T1/2 more than 20 min in diethylenetriaminepentaacetic acid [DTPA] scan) with symptomatic stenosis or decreased kidney function (differential function <40%). Pyeloplasty was done by a retroperitoneal flank approach with miniature incision without pelvis reduction. One surgeon did all the surgeries. Success rate and complications were assessed in a 3-year follow-up. RESULTS: Mean surgery time was 52 min (47-60 min). Incision size was 18-28 mm. Mean hospital stay was 3 days (2-8 days). The surgery was successful in 98.2% of patients with a mean follow-up time of 36 months (success was defined as disappearance of symptoms, if present, with improved ultrasound imaging results or Reno graphic parameters). The complication rate was 7.33%, including urinary leakage, double-J urethral stent dislocation and infection. CONCLUSION: Open dismembered pyeloplasty is a safe, technically feasible and effective therapy in treatment of children's ureteropelvic junction obstruction. It takes a short time to do, requires a small incision and has few complications and a short recovery period.

Laparoscopic decortication of symptomatic renal cysts: experience from a referral center in Iran.

OBJECTIVE: To present our experience with laparoscopic management of symptomatic simple renal cysts. METHODS: From April 2004 to November 2006, 21 patients (10 men; 11 women) underwent laparoscopic decortication for simple renal cysts at our department and were included in the analysis. All procedures were carried out by one surgeon using a transperitoneal approach. Patients underwent radiological follow-up with computerized tomography and/or ultrasonography. Procedural success was defined as no recurrence of the cyst and complete pain relief. Symptomatic success was defined as a significant pain decrease. RESULTS: All 21 procedures were completed laparoscopically, without major complications or conversion to open surgery. Estimated mean blood loss during surgery was about 50 mL. Patients were hospitalized for a mean of 1.9 +/- 1.1 (range: 1-5) days. Age of the patients and size and location of the cysts, had no relationship with the duration of operation as well as the length of hospital stay (P > 0.05). Patients who experienced complete pain relief had significantly larger cyst sizes compared with patients with a partial pain decrease (7.3 +/- 1.1 vs 9.1 +/- 2.0, respectively; P = 0.023, F = 0.606). All patients had negative cytological and pathological findings for malignancy or any other abnormalities. At 16.6 months of mean follow up, none of the patients reported symptomatic and/or radiologic failure. CONCLUSIONS: Laparoscopic transperitoneal decortication represents an effective and safe treatment option in the management of symptomatic renal cysts.

"Transplantation" research output by Muslim nations: current status, trends and future outlook.

Bibliometric measurement of scientific research production is one of the most practical methods for evaluating scientific situations of any nations. In this study, we assessed the number of scientific publications by authors from Muslim nations in journals indexed in Pubmed under "transplantation" subject. We found that Muslim nations have relatively very low publication rate in the field of transplantation. Moreover, except for Turkey, we did not detect an uplifting trend for the surveyed nations. Iran had quiet irregular trend with a very sharp missile like upwarding trend in 2007. In summary, Muslim nations with notable practice in transplantation should more fund and concentrate on scientific aspects of the practice for resolving local health dilemmas as well as exploring basic science for improving prognosis and quality of life of renal transplant patients.

Relationship between hysterectomy and severity of female stress urinary incontinence.

BACKGROUND: Stress Urinary Incontinence (SUI) is one of the most reported health dilemmas of women suffering from lower urinary tract symptoms. AIM: To determine the relation between hysterectomy and severity of female SUI using Valsalva Leak Point Pressure (VLPP). METHODS: This case-control study was conducted at a public urology clinic in Tehran in 2015. The study population was all female with SUI complaints who visited the clinic during 2015. We compared Valsalva leak point pressure in two groups of female SUI patients with and without hysterectomy history. The inclusion criteria were: not taking any alpha-blocker or anti-cholinergic medicines two weeks prior to the urodynamic test as well as no history of pelvic surgery or cesarean delivery in their lifetime. All qualified patients were invited to participate in the study randomly, and among them, 120 qualified patients agreed to participate by filling out the informed consent form. Data was gathered through direct interview, and double checked by patients' medical records. All the study variables including age, BMI, delivery number, hysterectomy and UTI history were entered and analyzed by estimating ordered logistic regression and by using Stata14.1 software. RESULTS: The mean of VLPP was 70.17 cmH2O in the group with hysterectomy history, and 94.55 cmH2O in those without hysterectomy history. The difference of VLPP pressure between the two studied groups were significant (p<0.05), even after control of confounding variables. Also, the odds of severe SUI among hysterectomy group patients was 6.3 times more than no hysterectomy (OR=6.32, p<0.001). CONCLUSIONS: Our study confirms significant relation between hysterectomy and SUI severity measured by Valsalva leak point pressure. Hysterectomy patients are more likely to suffer from more severe grades of SUI.

Preoperative Hemoglobin A1c and the Occurrence of Atrial Fibrillation Following On-pump Coronary Artery Bypass Surgery in Type-2 Diabetic Patients.

BACKGROUND: We investigated the association of the preoperative hemoglobin A1c (HbA1c) with occurrence of postoperative atrial fibrillation (POAF) in type-2 diabetic patients who underwent isolated coronary artery bypass grafting. METHODS: We prospectively studied 708 type-2 diabetes patients [433 men ([61.2%)], candidate for isolated coronary artery bypass grafting. Biochemistry profile was measured on the day of operation. All patients were telemonitored for 72 hours after operation for the occurrence of atrial fibrillation. The role of HbA1c as a predictor for the occurrence of atrial fibrillation was then evaluated. RESULTS: A total of 109 (15.3%) patients developed POAF. Patients in the atrial fibrillation group tended to be older, with prolonged longer diabetes, and have renal failure, chronic obstructive pulmonary disease, and hypertension. In the univariable and multivariable regression model, HbA1c was not a predictor for POAF. CONCLUSIONS: Serum level of HbA1c could not be used as a predictor for the development of POAF.

Association between prostate specific antigen levels and coronary artery angioplasty.

Introduction: Prostate-specific antigen (PSA) is a protein, whose serum levels changes during various physiologic and pathologic situations. Recently, the relationship between PSA and cardiologic disorders has been assessed. Objectives: The purpose of this study was to assess the association of percutaneous coronary intervention (PCI) complications with PSA serum levels. Patients and Methods: In this study, 100 eligible patients undergoing PCI were included. The total PSA serum values were analyzed pre- and post-procedure. The association between PSA levels with age, gender, inflammatory (C-reactive protein [CRP] and white blood cell [WBC]), cardiogenic (troponin, CK-MB, echocardiography and angiography results), and nephrology (creatinine) properties was investigated. Results: Changes in the level of PSA pre- and post-PCI was not significant (P=0.2). However, based on the pathology, patients with acute coronary syndrome (ACS) had a significant difference in the levels of PSA compared to cases of stable ischemic heart disease (SIHD) (P=0.008). Moreover, the effect of gender on the changes in PSA level following PCI was conclusive. There was no association between the direct effect of PCI parameters or PCI complications on PSA level changes. Conclusion: The results showed that PSA levels were affected by the etiology of cardiac disorders instead of therapeutic methods like PCI.

The relationship between dialysis adequacy and serum uric acid in dialysis patients; a cross-sectional multi-center study in Iranian hemodialysis centers.

Introduction: Uric acid is one of the most significant uremic toxins accumulating in chronic renal failure patients treated with standard dialysis. Its clearance has not any exact relation with urea and creatinine clearance. Objectives: The aim of this study was to investigate the relationship between adequacy of dialysis and serum level of uric acid in dialysis patients of some dialysis centers in Iran. Patients and Methods: In this study 1271 hemodialysis patients who have been treated for more than 3 months were evaluated. Their information and examinations from their files in all over the country were gathered and analyzed using SPSS versin18.0. Results: In this study, a significant relationship between dialysis duration and serum level of uric acid was not detected, however, a significant relationship between patients Kt/V and uric acid (R=0.43, P=0.029) was seen. Patients who had higher adequacy of dialysis had a higher level of plasma uric acid. Conclusion: For better controlling of plasma uric acid level of hemodialysis patients, increasing of the adequacy of dialysis or its duration is not effective. Other modalities of decreasing of serum uric acid like, changing diet or lifestyle or medical therapy may be necessary.

On demand urethral dilatation versus intermittent urethral dilatation: results and complications in women with urethral stricture.

BACKGROUND: The treatment of urethral stricture in female patients is through dilatation of the urethra by tubes of increasing diameter. There are two main methods: intermittent dilatation and on demand dilatation. OBJECTIVES: The main aim of this study was to compare the results of these two methods, and to determine the best one. PATIENTS AND METHODS: In this clinical trial study, we reviewed the documents of women diagnosed with urethral stricture, who came to the Baqiyatallah Clinic from 2007 and 2012. According to the method of dilatation, the patients were divided into two groups: intermittent dilatation and on demand dilatation. Patients' data were then collected and analyzed. RESULTS: Eighty-six patients were enrolled in the study. The mean age of the participants was 48.13 years (between 44 and 79 years). The mean urinary residual and maximum urinary flow speed changes, before and after on demand dilatation, were higher than in the intermittent method. CONCLUSIONS: For treating urethral stricture, on demand urethral dilatation is more effective than intermittent dilatation.

Incidence of malignancy after living kidney transplantation: a multicenter study from iran.

Malignancy is a common complication after renal transplantation. However, limited data are available on post-transplant malignancy in living kidney transplantation. Therefore, we made a plan to evaluate the incidence and types of malignancies, association with the main risk factors and patient survival in a large population of living kidney transplantation. We conducted a large retrospective multicenter study on 12525 renal recipients, accounting for up to 59% of all kidney transplantation in Iran during 22 years follow up period. All information was collected from observation of individual notes or computerized records for transplant patients. Two hundred and sixty-six biopsy-proven malignancies were collected from 16 Transplant Centers in Iran; 26 different type of malignancy categorized in 5 groups were detected. The mean age of patients was 46.2±12.9 years, mean age at tumor diagnosis was 50.8±13.2 years and average time between transplantation and detection of malignancy was 50.0±48.4 months. Overall tumor incidence in recipients was 2%. Kaposis' sarcoma was the most common type of tumor. The overall mean survival time was 117.1 months (95% CI: 104.9-129.3). In multivariate analysis, the only independent risk factor associated with mortality was type of malignancy. This study revealed the lowest malignancy incidence in living unrelated kidney transplantation.

Kaposi's sarcoma after renal transplantation.

In this study, we aimed to evaluate the incidence, features and outcome of post transplant KS among Iranian recipients of living kidney allograft. We studied 2211 kidney allograft recipients who underwent living renal transplantation at our center between January 1984 and August 2007. All patients in our study received cyclosporine based immunosuppressive agents. The diagnosis of KS was confirmed with pathological evaluations of tissue biopsy specimens. There were 10 of 2211 (0.45%) incident cases of KS kidney transplant population at our center during a mean follow up of 57 +/- 38 months. Of the 10 KS patients, 8 were males and two were females with a median age of 52 years. The median time from transplantation to the development of KS was 8 months. Overall, two (20%) patients developed visceral involvement (one eye, one bladder), and eight patients manifested only KS restricted to the skin. Immunosuppression was reduced in 5 patients and thoroughly withdrawn in the remainder (including two cases of visceral involvement); KS did not abate in the patient with bladder involvement. All the KS patients remained alive after a mean of 35.6 +/- 39.3 months of follow up; two patients lost their allograft and underwent dialysis (one after 3 months and one another after 4 months of KS diagnosis). The KS patients were significantly older at their transplantation time (P= 0.008; [Table 1]). Survival analysis using Kaplan Meier method and log-rank test revealed no difference in graft and patient survival between both groups. In conclusion, we found low incidence of KS in our living renal transplant recipients. The outcome of the KS patients was excellent with low morbidity and mortality. The incidence of KS was significantly associated with an older age at transplantation time for the allograft recipients. Further studies with larger patient population are warranted to confirm our results.

Bladder tumor in women with microscopic hematuria: an Iranian experience and a review of the literature.

AIM: In this study we report our experience with microhematuria and its relation with bladder tumors in Iranian women. MATERIALS AND METHODS: Overall 249 women were evaluated. Microscopic hematuria was defined as three or more red blood cells per high-power field on at least two different occasions. Patients with a history of gross hematuria or coagulation disorders, having organic diseases, urinary stones, urinary tract infections, nephrological diseases, and local lesions such as urethral caruncle were excluded from the study population. Final diagnosis of malignant tumors was done with cystoscopy and biopsy specimen pathological assessment in all cases. RESULTS: Age for the study population was 49.7 +/- 11.8 years. 95 (38%) of patients were identified during routine check up and presenting symptoms in other patients were frequency, dysuria, stress urge incontinence, urge incontinence, feeling of incomplete urine emptying, and flunk pain, respectively. Finally, 7 (2.8%) of study subjects were confirmed as having bladder tumors. One of tumor cases was diagnosed 24 months after initial assessments. Patients with bladder tumor were significantly older; more frequently had diverticulum in their bladder wall (P < .05). CONCLUSION: Female microscopic hematuria is relevant and deserves evaluations, especially in elderly patients. Patients whose reason for microhematuria would not be diagnosed at the initial evaluations should be followed.

Burden among care-givers of kidney transplant recipients and its associated factors.

Burden among care-givers of chronically ill patients has been widely investigated. However, there is no study evaluating perceived pressure on care-givers of kidney transplant recipients. This study aimed to evaluate the effect of care-giving to renal transplant recipients in Iranian Muslim population and to analyze factors associated with it. A cross-sectional study was carried out involving 41 care-givers of renal recipients. The Care-giver Burden Scale (CB Scale) was used to evaluate the care-giver's perceived burden and its correlates. Statistical analysis was performed using software SPSS v.13.0. P (p 0.05), and being a parent or spouse to the patient (p 0.05). We also found significant adverse effects of patients' second transplantation and gender (male) on care-givers' burden. There was no significant relationship between care-giver burden score and patients' marital status, education level, operation time, age, donor type (cadaveric or living), and dialysis history before and after transplantation. In conclusion, care-givers experience strain, which has implications for research and service provision. Service providers need to identify those care-givers at risk of greater strain and help them in situations that cannot be altered. Future research should be conducted to identify the effects of interventions, on care-givers' burden perception.

Percutaneous nephrostomy for treatment of posttransplant ureteral obstructions.

INTRODUCTION: We report our experience with percutaneous management of urologic complications following kidney transplantation. MATERIALS AND METHODS: Of 1402 consecutive kidney transplant recipients from living donors at our hospital, 21 required percutaneous nephrostomy (PCN) for the treatment of obstructive lymphocele (n = 11), urinary calculus (n = 8), and stricture of the ureterovesical junction anastomosis (n = 2). We had also 11 kidney recipients with urine leakage from the ureter who were treated only by indwelling ureteral catheter. Urinary complications were diagnosed based on the clinical symptoms, elevated serum creatinine levels, ultrasonography and renal scintigraphy. Patients with ureteral obstruction or urine leakage were compared with kidney recipients without urologic complications. RESULTS: A mean decline of 3.1 +/- 3.0 mg/dL (range, 0.1 to 10.7 mg/dL) in serum creatinine level was detected (P < .001) after PCN. All of the patients remained symptom free for a mean follow-up period of 34.2 +/- 20.1 months (range, 3 to 81 months). Patient and graft survival rates were not different between the patients undergoing PCN and other kidney recipients. The only difference was the history of using antilymphocyte globulin which was significantly more frequent in the patients of the PCN group (P = .01). CONCLUSION: In our experience, PCN is a safe and effective method for the treatment of ureteral obstructions in kidney allograft recipients. This method provided long-term success with few recurrences and low morbidity and mortality rates.