Diet therapy along with nutrition education can improve renal function in people with stages 3-4 chronic kidney disease who do not have diabetes: a randomised controlled trial.

The current trial investigates the effect of renal diet therapy and nutritional education on the estimated glomerular filtration rate (eGFR), blood pressure (BP) and depression among patients with chronic kidney disease (CKD). A total of 120 CKD patients (stages 3-4) (15

Contamination of breast milk with lead, mercury, arsenic, and cadmium in Iran: a systematic review and meta-analysis.

Breast milk is a complete food for the development of the newborn, but it can also be an important route for environmental pollutants transmission to the infants. This study was aimed to evaluate the status of heavy metals including lead (Pb), mercury (Hg), cadmium (Cd) and arsenic (As) in the breast milk of Iranian mothers. The international databases including Scopus, PubMed, Web of Science and the Persian electronic databases including Scientific Information Database, IranMedex and Magiran were examined to find relevant articles published until July 2021. A total of 23 studies examined the levels of toxic metals in Iranian breast milk samples. According to the findings, the pooled average concentrations (µg/L) of Pb, Cd, Hg and As were 25.61, 2.40, 1.29 and 1.16, respectively. The concentration of Hg and Pb in colostrum milk was more than twice of mature milk. The Hg mean concentration in the breast milk of mothers with at least one amalgam-filled tooth was approximately three times that of mothers without amalgam-filled teeth. Risk assessment analysis indicated that the intake of Pb and Hg by infants through breastfeeding can be considered a health concern in Iran. It seems necessary to reduce the Pb exposure of pregnant and lactating women in Iran. However, more extensive studies are needed to clarify the toxic metals' exposure status of infants through breast milk in other parts of the country.

Assessment of the relationship between 25-hydroxyvitamin D and albuminuria in type 2 diabetes mellitus.

BACKGROUND: Diabetic nephropathy occurs in about one-third of diabetic patients. This health problem is characterized by increased urinary albumin excretion, leading to decreased glomerular filtration rate and renal failure. In this regard, previous investigations have revealed the possibility of a relationship between vitamin D deficiency and diabetic nephropathy. The present study assessed the relationship between vitamin D deficiency and albuminuria in patients with type 2 diabetes. METHODS: This study was conducted with 200 participants with type 2 diabetes mellitus from December 2019 to January 2021. The patients' 25-hydroxyvitamin D (25OHD) serum level and urinary albumin-to-creatinine ratio (UACR) were measured concurrently. Afterward, the subjects were divided into three groups based on their albuminuria level. Finally, 25OHD serum level and other clinical characteristics were compared among these albuminuria groups, and the relation between albuminuria level and 25OHD was analyzed. RESULTS: The prevalence of vitamin D deficiency in macroalbuminuric patients (UACR≥300 mg/g) was 61.8%, and in microalbuminuric (30 ≤ UACR< 300 mg/g) and normoalbuminuric groups (UACR< 30 mg/g) was 33.3% and 24%, respectively. Further analysis revealed a significant negative relationship between 25OHD and albuminuria(r = - 0.257, p-value< 0.001). According to ROC curve analysis, a 25OHD level ≤ 21 ng/ml was considered an optimal cut-off point value for having macroalbuminuria in diabetic patients. CONCLUSIONS: The current study evaluates the relation between vitamin D deficiency and the prevalence of albuminuria in the setting of diabetes. Overall, the prevalence of macroalbuminuria increased when the 25OHD serum level was less than 20 ng/ml.

Survival Rate of Colorectal Cancer in Eastern Mediterranean Region Countries: A Systematic Review and Meta-Analysis.

Colorectal cancer (CRC) is the second most common cause of cancer-related deaths worldwide. Survival rates are among the most important factors in quality control and assessment of treatment protocols. This study was aimed to assess the survival rate of colorectal cancer in Eastern Mediterranean Region Countries. In the present study we comprehensively searched 6 international databases including PubMed/Medline, ProQuest, Scopus, Embase, Web of Knowledge and Google Scholar for published articles until November 2018. The Newcastle-Ottawa Quality Assessment Form for Cohort Studies was applied to evaluate the quality of included studies. The heterogeneity of papers was assessed with the Cochran Test and I-Square statistics. Meta-regression test was performed based on publication year, sample size and Human Development Index (HDI) of each study. Among the total of 1023 titles found in the systematic search, 43 studies were eligible to be included in the present meta-analysis. According to the results, the 1-year, 3-year and 5-year survival rate of patients with Colorectal Cancer was 88.07% (95% CI, 83.22-92.92), 70.67% (95% CI, 66.40-74.93) and, 57.26% (95% CI, 50.43-64.10); respectively. Furthermore, Meta-regressions did not show significant correlations between survival rate and year, sample size or Human Development Index. Survival rates, especially the 5-year survival rate in the EMRO were less than European countries and the USA. Documented and comprehensive evidence-based findings of the present meta-analysis can be used to enhance policies and outcomes of different medical areas including prophylaxis, treatment and health related objectives in colorectal cancer.

Effect of intraosseous injection versus inferior alveolar nerve block as primary pulpal anaesthesia of mandibular posterior teeth with symptomatic irreversible pulpitis: a prospective randomized clinical trial.

OBJECTIVE: This study sought to assess the success rate, effect on blood pressure, and pain of intraosseous injection (IO) and inferior alveolar nerve block (IANB) for pulpal anaesthesia of mandibular posterior teeth with symptomatic irreversible pulpitis as the primary anaesthetic technique. MATERIALS AND METHODS: This randomized clinical trial (IRCT2013022712634N1) was conducted on 60 patients between 18 and 65 years suffering from symptomatic irreversible pulpitis of a mandibular posterior tooth. Patients were randomly divided into two groups. Group one received IO while group two received IANB with 3% mepivacaine. After anaesthetic injection, success rate of pulpal anaesthesia was assessed by pulp testing in the two groups. Systolic and diastolic blood pressures of patients were compared before and after the anaesthetic injections. Level of pain during injection was scored using a visual analogue scale. The data were analyzed using SPSS version 20, t-test and chi square test at p = .05 level of significance. RESULTS: Success rate of IO (56.7%) was significantly higher than that of IANB (23.3%) (p = .008). There was no significant difference in pain during anaesthetic injection (p = .304) or change in systolic (p = .80) and diastolic (p = .28) blood pressures following injection between the two techniques. CONCLUSIONS: IO had a higher success rate than IANB for pulpal anaesthesia of mandibular posterior teeth with symptomatic irreversible pulpitis. Neither technique provided profound pulpal anaesthesia.

Fortified synbiotic dessert for improving malnutrition in hemodialysis patients: A randomized, double-blind, controlled trial.

As dysbiosis of gut microbiota is recognized as a major risk factor for malnutrition in hemodialysis (HD) patients, we aimed to assess the effects of fortified synbiotic dessert on malnutrition, oxidative stress, inflammation, and quality of life in patients undergoing hemodialysis. A total of 50 hemodialysis patients were randomized into two groups of intervention and control to consume either 50 g of synbiotic dessert fortified with vitamin D (1000 IU) and calcium (500 mg) (FSD) or 50 g of control dessert (CD) for 8 weeks, respectively. Changes in nutritional status [Subjective Global Assessment (SGA)], anthropometric measures, malondialdehyde (MDA), total antioxidant capacity (TAC), high-sensitivity C-reactive protein (hs-CRP), ferritin, biochemistry [serum albumin, vitamin D, creatinine, blood urea nitrogen (BUN), complete blood count (CBC), and electrolytes], and quality of life were assessed before and at the end of the trial. The SGA scores and serum ferritin levels decreased significantly in the FSD group compared to the control group (p = .01 and p = .03, respectively). Regarding other markers, no statistically significant changes were found comparing the two groups. This novel fortified synbiotic dessert as a functional food may be effective in reducing the severity of malnutrition by improving SGA score in short term in hemodialysis patients. Thus, it is suggested to do further studies to elucidate the possible mechanisms related to the effects of this dessert on microbiota, skeletal muscle mass, and inflammation in HD in long term.

Case report: A case of renal arcuate vein thrombosis successfully treated with direct oral anticoagulants.

A rare case of a 35 years old woman presented with renal arcuate vein thrombosis (RAVT) and acute kidney injury (AKI) following upper respiratory tract symptoms and toxic substance ingestion. Histopathological evaluation of the patient's kidney tissue indicated a rare venous thrombosis in the renal arcuate veins. Anticoagulation with Apixaban, a direct oral anticoagulant (DOAC), was commenced, and the patient's symptoms resolved during the hospital stay. Hitherto, a limited number of studies have shown the concurrent presentation of RAVT and overt AKI in patients following ingestion of nephrotoxic agents. Further studies are necessary to elucidate the etiology, clinical presentation, and treatment of RAVT. We suggest that Apixaban be studied as a suitable alternative to conventionally used anti-coagulants such as Warfarin in patients who lack access to optimal health care facilities.

Anesthetic Success Rate of Inferior Alveolar Nerve Block for Mandibular Molars with Symptomatic Irreversible Pulpitis in Women Taking Antidepressants.

Introduction: This study sought to evaluate the success rate of inferior alveolar nerve block (IANB) during the endodontic management of mandibular molars with symptomatic irreversible pulpitis in women taking selective serotonin reuptake inhibitor (SSRI) antidepressants. Materials and Methods: Ninety adult female patients over 18 years of age who were diagnosed with symptomatic irreversible pulpitis of a mandibular molar were recruited in this study. The patients were equally assigned to SSRI user group (including citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline), who had taken an SSRI, and non-SSRI user group, who had not taken any SSRIs at all. All patients in both groups received 3.6 mL of 2% lidocaine with 1:80,000 epinephrine using conventional IANB injection. Access cavity was prepared 15 min after the injection. Lip numbness was necessary for all patients. Success was determined as no or mild pain upon access cavity preparation and/or instrumentation based on the Heft-Parker visual analog scale recordings. Data were analyzed using the chi-square test Mann-Whitney U test, and t-test. Results: The success rate was 55.6% for SSRI users and 44.4% for non-SSRI users, and no statistically significant difference was observed between the two groups (x 2=1.1, P=0.292). Conclusions: Based on the results of this study, taking SSRI antidepressants could not affect the anesthetic success rate of IANB for mandibular molars with symptomatic irreversible pulpitis in women.

The effect of Spirulina sauce, as a functional food, on cardiometabolic risk factors, oxidative stress biomarkers, glycemic profile, and liver enzymes in nonalcoholic fatty liver disease patients: A randomized double-blinded clinical trial.

OBJECTIVE: This study sought to investigate the effect of Spirulina on cardiometabolic risk factors, oxidative stress biomarkers, glycemic profile, and liver enzymes in nonalcoholic fatty liver disease (NAFLD) patients. METHODS: This randomized, double-blind clinical trial was performed on 46 NAFLD patients. Subjects were allocated to consume either Spirulina sauce or placebo, each 20 g/day for 8 weeks. Fatty liver grade, liver enzymes, anthropometric parameters, blood pressure, and serum lipids, glucose, insulin, malondialdehyde, and antioxidant capacity were assessed pre- and postintervention. RESULTS: Fatty liver grade was significantly different between the two groups. A significant change for ALT (alanine aminotransferase) and AST (aspartate aminotransferase) was seen between the two groups (p = .03 and .02, respectively), while ALP (alkaline phosphatase) serum levels were not significantly different within or between groups. Pertaining to glycemic profile, all variables, except HOMA-IR, were not significantly different within or between groups. Finally, statistically significant changes were seen in both MDA (malondialdehyde) and TAC (total antioxidant capacity) among the groups (p = .04 and <.001, respectively). CONCLUSIONS: Spirulina may improve fatty liver grade by modifying liver enzymes, oxidative stress, and some lipid profiles; however, there was effect of Spirulina on anthropometric characteristics and blood pressure.

Comparison of FOXP3 and Interleukin 35 Expression Profiles in Kidney Transplant Recipients With Excellent Long-Term Graft Function and Acute Rejection.

OBJECTIVES: Transplant tolerance is defined as graft acceptance without long-term use of immunosuppressive agents. Regulatory T cells are involved in the maintenance of peripheral self-tolerance by actively suppressing the activation and expansion of autoreactive T cells. In the present study, we compared the expression profiles of forkhead box protein P3 (FOXP3) and interleukin 35 in kidney transplant recipients who had excellent long-term graft function under immunosuppression versus recipients who had acute rejection. MATERIALS AND METHODS: The 40 kidney transplant recipients included in this study were divided into 2 groups: 27 recipients with excellent long-term graft function and 13 recipients with acute rejection. After collection of whole peripheral blood, peripheral blood mononuclear cells were isolated from the blood samples. After RNAextraction and cDNAsynthesis from each collected sample, expression levels of interleukin 35 and FOXP3 were determined using in-house SYBER green-based real-time polymerase chain reaction. We used t tests to analyze data. RESULTS: Mean ages of recipients with excellent longterm graft function and recipients with acute rejection were 42.1 and 45.5 years, respectively. We found that FOXP3 and interleukin 35 expression levels were significantly increased in recipients with excellentlongterm graftfunction comparedwith recipientswith acute rejection. FOXP3 expression levels were significantly higher in those with excellent long-term graft function with graft survivalrate of <10 years,whereas interleukin 35 expression levels were significantly higher in patients with graft survival rate >10 years (P < .05). Expression levels of FOXP3 and interleukin 35 were greater in those from 35 to 50 years old versus with those in the other age ranges. CONCLUSIONS: Expression patterns of FOXP3 and interleukin 35 may have the potential to be used as prognostic biomarkers for kidney transplant outcomes.

Bariatric surgery reduces branched-chain amino acids' levels: a systematic review and meta-analysis.

Bariatric surgery is a metabolic surgery known to be an efficient treatment for weight loss, with adequate long-term maintenance. Interestingly, some studies have reported a reduction in branched chained amino acids (BCAAs) after bariatric surgery, which putatively contributes to post-surgical metabolic improvement. The current systematic review and meta-analysis investigated the effect of bariatric surgery on the level of BCAAs. PubMed, SCOPUS, EMBASE, and Web of Science databases were searched from their inception to July 2019. All clinical trials which investigated the effect of bariatric surgery on the levels of valine, leucine, and isoleucine, for more than one week, were included. Nine studies (11 effect sizes) were analyzed via meta-analytical techniques using random-effects models. The pooled data suggested that bariatric surgery significantly reduced the valine (standardized mean difference [SMD]: -1.89, 95% confidence interval [CI]: -2.79, -0.99, I2 = 90.9%), leucine (SMD: -0.96, 95% CI: -1.48, -0.44, I2 = 72.4%), and isoleucine (SMD: -0.58, 95% CI: -0.84, -0.31, I2 = 66.3%) levels after surgery compared with before the surgery. Overall, bariatric surgery significantly reduced the levels of valine, leucine, and isoleucine compared with before the surgery. Further large-scale and homogenous trials are needed to better discern the generalizability of our findings.

Ambulatory Blood Pressure Monitoring in Hemodialysis Patients with Intradialytic Hypertension.

INTRODUCTION: It has not yet been clear whether intradialytic hypertension (IDHN) translates into the presence of high BP between dialysis sessions or not. In this study, we aimed to perform interdialytic ambulatory blood pressure monitoring (ABPM) in patients with IDHN to find whether high BP persists at home. METHODS: In this case-control study, ABPM was performed during a 44-hours interdialytic period in patients on maintenance hemodialysis (HD) with pre-dialysis systolic BP (SBP) above 130 mmHg. Bland- Altman graphs were used to investigate the magnitude of the difference between the results of ABPM records and intradialytic BP measurements in patients with and without IDHN. RESULTS: A total of 56 patients were enrolled in our study (29 in the IDHN group and 27 in the control group). The average of the pre-dialysis SBP in 6 consecutive HD treatments was 146.6 ± 11.36 vs. 146.8 ± 12.1 mmHg in IDHN and control group, respectively (P > .05). Mean post-dialysis SBP was 154.45 ± 12.6 mmHg in the IDHN group and 136.76 ± 11.50 in the control group (P < .001). Mean ± SD of 44-hour SBP was 157.31 ± 20.27 mmHg in the IDHN group, which was significantly higher than that in the control group (146.5 ± 16.67 mmHg, P < .05). No significant differences were seen in the average of interdialytic weights gain between the two groups. Compared to the pre-dialysis SBP, using Bland- Altman graphs, the post-dialysis SBP (bias of 3.5 mmHg) had closer readings to the daytime SBP in the IDHN group. CONCLUSION: Patients with IDHN had higher interdialytic BPs. Among BPs taken during HD in patients with IDHN, post-dialysis SBP had the lowest difference with the daytime SBP taken by ABPM.

Anesthetic Efficacy of Gow-Gates Nerve Block, Inferior Alveolar Nerve Block, and Their Combination in Mandibular Molars with Symptomatic Irreversible Pulpitis: A Prospective, Randomized Clinical Trial.

INTRODUCTION: The purpose of this prospective, randomized clinical trial was to evaluate the anesthetic efficacy of the Gow-Gates nerve block (GGNB), the inferior alveolar nerve block (IANB), and their combination for mandibular molars in patients with symptomatic irreversible pulpitis. METHODS: One hundred fifty patients diagnosed with symptomatic irreversible pulpitis of a mandibular molar were selected. The patients randomly received 2 GGNB injections, 2 IANB injections, or 1 GGNB injection plus 1 IANB injection of 1.8 mL 2% lidocaine with 1:80,000 epinephrine. Access cavity preparation was initiated 15 minutes after injections. Lip numbness was a requisite for all of the patients. Success was specified as no or mild pain on the basis of Heft-Parker visual analog scale recordings during access cavity preparation or initial instrumentation. Data were analyzed with the chi-square, Kruskal-Wallis, and analysis of variance tests. RESULTS: The success rates of anesthesia were 40%, 44%, and 70% for the GGNB, IANB, and GGNB + IANB groups, respectively. There was no statistically significant difference in the success rate of anesthesia between the GGNB and IANB groups (P > .05). The anesthesia success rate for the GGNB + IANB group was significantly different from those of the GGNB and IANB groups (P < .05). CONCLUSIONS: A combination of GGNB and IANB could improve the efficacy of anesthesia in mandibular molars with symptomatic irreversible pulpitis, but it would still require supplemental anesthesia. Further research may be needed to confirm the results of this study.