bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of COVID-19 on Timing of Hip-Fracture Surgeries: An Interrupted Time-Series Analysis of the Pre/Post-Quarantine Period in Northern Italy
Authors: Lenzi Jacopo , Rousset Stefano , Fantini Maria Pia , Gianino Maria Michela
Published: September 2021

Background: To assess whether the imposition of the coronavirus disease 2019 (COVID-19) national quarantine (March 10, 2020) resulted in a shift in the proportion of patients operated for hip fracture on the day of admission, the following day and two days after admission in the region of Piedmont, northern Italy. Methods: Interrupted time-series analysis (ITSA) comparing hospitalization rate and timing of hip-fracture surgeries between pre- and post-quarantine period. The same data observed in Piedmont the year before were included as a control time series with no "intervention" (quarantine) in the middle of the observation period. Results: We found that 70.3% and 69.4% of hip-fracture patients received surgery within 2 days of hospital admission in the 16 weeks before and after the national quarantine, respectively. One-day surgery went from 46.0% to 46.5%, and same-day surgery from 13.3% to 12.4%. Unchanged trends were confirmed by ITSA after controlling for the 32-week time-series observed the year before. In the second week of March 2020, there was a borderline significant decrease in weekly hospital admissions for hip fractures as compared with that of the same week of March 2019 (–1.95 per 100 000, 95% CI = –4.10 to 0.21, P value = .075), followed by a weekly significant increase in the hospitalization rate (+0.14 per 100 000, 95% CI = 0.01 to 0.27, P value = .039), although the difference-in-differences of slopes failed to achieve statistical significance (0.19 per 100 000, 95% CI = –0.03 to 0.41, P value = .090). Conclusion: Our study shows that the timing of hip-fracture surgery was unchanged during the lockdown period. This suggests that the healthcare systems can be resilient and able to guarantee a high-quality and safe healthcare to hip-fracture patients, even in the most challenging working conditions.
Health Coverage and Financial Protection in Uganda: A Political Economy Perspective
Authors: Nannini Maria , Biggeri Mario , Putoto Giovanni
Published: September 2021

Background: As countries health financing policies are expected to support progress towards universal health coverage (UHC), an analysis of these policies is particularly relevant in low- and middle-income countries (LMICs). In 2001, the government of Uganda abolished user-fees to improve accessibility to health services for the population. However, after almost 20 years, the incidence of catastrophic health expenditures is still very high, and the health financing system does not provide a pooled prepayment scheme at national level such as an integrated health insurance scheme. This article aims at analysing the Ugandan experience of health financing reforms with a specific focus on financial protection. Financial protection represents a key pillar of UHC and has been central to health systems reforms even before the launch of the UHC definition. Methods: The qualitative study adopts a political economy perspective and it is based on a desk review of relevant documents and a multi-level stakeholder analysis based on 60 key informant interviews (KIIs) in the health sector. Results: We find that the current political situation is not yet conducive for implementing a UHC system with widespread financial protection: dominant interests and ideologies do not create a net incentive to implement a comprehensive scheme for this purpose. The health financing landscape remains extremely fragmented, and community-based initiatives to improve health coverage are not supported by a clear government stewardship. Conclusion: By examining the negotiation process for health financing reforms through a political economy perspective, this article intends to advance the debate about politically-tenable strategies for achieving UHC and widespread financial protection for the population in LMICs.
The prevalence of COVID-19 in patients with rheumatoid arthritis, multiple sclerosis, or systemic lupus erythematosus receiving biologic disease-modifying antirheumatic drugs
Authors: Ahmadzadeh Arman , Farsad Faraneh , Emam Mohammad Mehdi , Rajaei Alireza , Hatami Samaneh , Gachkar Latif
Published: September 2021

Introduction: The coronavirus disease (COVID-19) became a global pandemic in 2019. Some studies have shown that the virus can cause a higher mortality in people with weakened immune systems, such as the elderly, those taking immunosuppressive drugs, and those with underlying disorders, than in the general population. Objectives: The aim of this study was to evaluate the prevalence of COVID-19 in patients with rheumatic disorders who received biologic disease-modifying antirheumatic drugs (DMARDs). The effect of precautionary self-isolation in these patients was also determined. Patients and Methods: This descriptive study involved 200 patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and multiple sclerosis (MS) who were treated with biologic DMARDs. Patients with symptoms of the coronavirus infection were invited to have a COVID-19 test that involved a COVID-19 IgG antibody test or a polymerase chain reaction (PCR) test (i.e., nasal swab). Additionally, patients were asked about their precautionary self-isolation status during this period. Results: The mean age of the patients was 51.29 years ± 13.38 years. The ratio of males to females was 27 to 173. Of the 200 patients included in the study, 156 (78%) had RA, 10 (5%) had SLE, and 34 (17%) had MS. Seventy-five percent of the patients used rituximab. Ten patients (5%) were symptomatic of COVID-19, although only four patients had a definitive diagnosis of the disease. All patients who were symptomatic of COVID-19 took rituximab. Ten percent of patients who did not observe the precautionary self-isolation period were diagnosed with COVID-19. Conclusion: Patients who receive biologic DMARDs have a lower risk of developing COVID-19 and a lower risk of mortality from the disease than the general population.
Accuracy of chest computed tomography and reverse transcription polymerase chain reaction in diagnosis of 2019 novel coronavirus disease; a systematic review and meta-analysis
Authors: Shokraee Kamyar , Mahdavi Hossein , Panahi Parsa , Seirafianpour Farnoosh , Jahromizadeh Amir Mohammad , Tofighi Rozhin , Amirkafi Ali , Moosavi Delaram , Mahdavynia Soheila , Vaziri Samira , Dehghanbanadaki Hojat , Aazami Hossein , Kabir Ali
Published: September 2021

Introduction: This study aims to measure the diagnostic accuracy of chest computed tomography (CT) and reverse transcription polymerase chain reaction assay (RT-PCR) in COVID-19 in a systematic review and meta-analysis. Methods: PubMed, Scopus, Embase, and Google Scholar, WHO, SSRN, and MedRxiv have been searched on March 26, 2020 for all the alternative names of the disease and virus. Risk of bias assessment was based on QUADAS-2. Data from English-language studies after January 12, 2019 were pooled to calculate necessary diagnostic values and underwent diagnostic test accuracy, random-effects, proportions, and subgroup meta-analysis. Results: Pooled from 27 included studies, the sensitivity of chest CT was calculated 96.6%, specificity 22.5%, diagnostic odds ratio (DOR) 8.2, positive likelihood ratio (PLR) 1.2 (95% CI: 1.1-1.4), and negative likelihood ratio (NLR) 0.15 (95% CI: 0.1-0.3). The sensitivity for initial RT-PCR was 79.7%, the specificity 100%, and NLR 0.18. Conclusion: Considering the results, in order to diagnose COVID-19 (coronavirus disease 2019), it is recommended to initially performing chest CT to rule out the uninfected people. In suspicious cases, we suggest RT-PCR to confirm the disease. Performing serial RT-PCR instead of the one-time test is highly recommended, to let the viral loads reach the diagnostic levels, especially in cases of high clinical suspicion.
Acute kidney injury due to cytokine storm in patients with COVID-19 infection
Authors: Ebrahimi-Dehkordi Sepehr , Banitalebi Hasan , Hasanpour-Dehkordi Ali
Published: September 2021

Patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) or COVID-19 represents usually a variety range of symptoms related to influenza-like syndrome and respiratory tract infections. Likewise, kidney involvement and acute kidney injury (AKI) were reported in many previous studies. Although a hypovolemic circulation would be the most common reason in patients with AKI, some strong proofs are suggesting a cytokine storm due to immune system exaggeration and inflammation-mediated tubular injury in COVID-19 infections. The inflammatory response in cytokine storm leads to the high release of cytokines mostly including TNFα, IL-1β, IL-6, INFγ, IL-2, IL-7, and endothelial mediators. The main culprits in the AKI and consequent organ failure are resident leukocytes in specific tissues, activated following the cytokine release, and systemic inflammatory response. AKI management and cytokine profile evaluation should be highly emphasized in patients with COVID-19 to prevent the progression of chronic kidney disease or permanent renal failure. Treatment options in COVID-19 regarding no specific drugs should be supportive and based on stabilizing the patients; however, combination therapy with different antiviral have shown promising outcomes. As a result, utilizing the anti-TNFα and anti-IL-1 agents should be noticed if indicated. Additionally, the hematopoietic stem cell transplantation is a curative approach.
Beneficial effects of Terminalia phillyreifolia (Van Heurck & Müll.Arg.) Gere & Boatwr. bark extract in streptozotocin induced hyperglycaemia and diabetic nephropathy in rats
Authors: Navale Archana , Patel Devanshu , Paranjape Archana
Published: September 2021

Introduction: Renal damage is a common clinical manifestation in diabetic patients. Therefore, nephroprotective effect is a desirable property for an antidiabetic agent. Natural compounds belonging to Terminalia phillyreifolia (TP) owing to their potent antioxidant and anti-inflammatory activity may prove to be such agents. Objectives: The objectives of the present study were to evaluate methanolic extract of TP bark for its antihyperglycemic, antioxidant and nephroprotective effect in streptozotocin (STZ) induced diabetes mellitus and nephropathy in rats. Materials and Methods: Diabetic male Wistar rats were divided into five groups; namely, normal control, disease control, standard (NPH insulin, subcutaneously), BE100 (bark extract 100 mg/kg, p.o.) and BE300 (bark extract 300 mg/kg, orally). Treatment was continued for 8 weeks. Plasma glucose levels, oxidative stress parameters, serum creatinine levels, blood urea nitrogen (BUN) levels, per day urine output, urinary protein excretion (UPE) and kidney hypertrophy index were determined at appropriate time points. Results: Untreated animals developed severe hyperglycemia and major disturbance in renal function. Rats in standard and BE treated groups had significantly lower plasma glucose levels and oxidative stress markers as compared to disease control animals. BE rats also exhibited nearly normal urine volumes indicating better glomerular filtration rate. They had lower urinary protein, serum creatinine, BUN levels and lower renal hypertrophy index as compared to untreated animals. Conclusion: TP Bark extract corrected the hyperglycaemia and exerted protective effect against diabetes induced renal damage in rats, which may be partly due to its anti-oxidant effect. Therefore, TP extract can be further evaluated as potential antidiabetic therapy
Successful treatment of collapsing focal segmental glomerulosclerosis in a patient
Authors: Pereira Luísa Helena , Cabrita Ana , Góis Mário , Viana Helena , Sampaio Sandra , Neves Pedro Leão
Published: September 2021

Focal segmental glomerulosclerosis (FSGS) is a recognized cause of renal disease worldwide. The collapsing variant is distinct from the others, characterized clinically by a more severe nephrotic syndrome generally resistant to immunosuppressive therapy. It is known that a great number of patients progress to end-stage renal disease. Recognizing this lesion in biopsy is frequently challenging owing to the focal nature of the process which highlights the need for keeping a high index of suspicion for the diagnosis. We report and discuss a case of a non-HIV collapsing FSGS, followed by a complete (unexpected) renal recovery after an oral corticosteroid course.
Fibrillary glomerulonephritis with a favourable prognosis of 26 years
Authors: Micarelli David , Pistolesi Valentina , Cristi Emanuela , Taddei Anna Rita , Serriello Ilaria , Morabito Santo , Giannakakis Konstantinos
Published: September 2021

Fibrillary glomerulonephritis (FGN) is a rare glomerular disease. The prognosis is usually unfavorable with nearly half of patients progressing to end-stage renal disease within 4 years. We report a case of biopsy-proven FGN characterized by an unusual benign clinical course in which a kidney biopsy, repeated after an extended follow-up of 26 years, confirmed the presence of fibrils deposition. In 1993, a 32-year-old Caucasian man was admitted to our nephrology ward because of macroscopic hematuria. Renal function was normal. Kidney biopsy displayed an FGN with mesangial pattern. The patient was treated with lisinopril, titrated for blood pressure; the therapy was maintained during 26 years of follow-up. The yearly slope of estimated glomerular filtration rate was -3.17 mL/ min). Starting from March 2018, a rapid worsening of renal function was observed and proteinuria increased up to a nephrotic range. We planned a second renal biopsy to assess the cause of the rapid change of clinical course. The diagnosis of FGN on advanced sclerosis was made, and the severity of glomerular sclerosis. We report a case of FGN with an unusually benign clinical course, characterized by a slow progression to end-stage renal disease over a very extended follow-up time; thus, to better clarify the reason for renal function worsening, a second renal biopsy was performed. The persistence of fibrils deposition confirmed the initial diagnosis of FGN, and a histological pattern characterized by global glomerular sclerosis and interstitial fibrosis has been observed.
Assessing the relationship between infantile colic and parental migraine in infants aged 4 to 12 weeks in Urmia
Authors: Abbasi Ezatolah , Ghazavi Ahad , Dehghan Kamran , Soleimani Mahsa
Published: September 2021

Introduction: Infantile colic affects 5% to 19% of infants. Objectives: This study aimed to investigate the relationship between infantile colic crying and migraine in parents. Patients and Methods: In this study, the infants referred to Urmia health centers with 4 to 12 weeks old were investigated. According to the definition of infantile colic and questioning the parents, those infants were identified who cried at least three hours a day, at least three days a week, for at least 3 weeks. By filling out a questionnaire on infantile colic and migraine in parents, the relationship between migraine in parents and colic in infants was examined. Results: In this study, 195 infants aged 4 to 12 weeks were included. Around 107 (54.9%) were male. The mean age of infants was 6.50 ± 2.10 weeks. Of the 195 infants, 65 (33.3%) had colic, 32 (49.2%) were male and 33 (50.8%) were female (P = 0.26). Around 47 (24.1%) of parents had migraine and 148 (75.9%) had no history of migraine. Of 65 infants with colic, 38 (58.5%) had migraine parents and 27 (41.5%) had no history of parental migraine. Of 130 infants without colic, 9 (6.9%) of the parents had a history of migraine and 121 (93.1%) of them had no migraine (P = 0.001). Of 65 infants with colic, 31 of the mothers had migraine, since of 130 infants without colic, none of their mothers complained about migraine (P = 0.001). Conclusion: Infantile colic was significantly associated with parental migraine and it could be an early sign of disease in infants.
Evaluation of demographic, clinical and paraclinical features of children with Guillain-Barré syndrome
Authors: Ghazavi Ahad , Abbasi Ezatolah , Mohammadi Sahar
Published: September 2021

Introduction: Guillain-Barré syndrome (GBS) is an acute polyneuropathy accompanied by muscle weakness, myalgia, and bulbar involvement. Objectives: We evaluated demographic, clinical and paraclinical features of children with this disease. Patients and Methods: In this cross-sectional study, the data of 83 patients with GBS were studied. All data about age, gender, place of residence (urban, rural), season of infection, history of infection or vaccination in the last month, clinical demonstrations and spinal magnetic resonance imaging findings with contrast, electromyography (EMG), nerve conduction velocity (NCV), cerebrospinal fluid (CSF), C-reactive protein (CRP) analysis was analyzed. Results: In this study, the highest incidence of GBS was in the summer (30.12%). Regarding clinical symptoms, 54.21% of patients were unable to walk, and around14.45 % of cases had positive Gowers’ sign. Additionally, 27.71% of patients reported pain, since 7.22% of them had severe respiratory distress with the need for mechanical ventilation. In patients who underwent EMG-NCV, findings were in favor of GBS in most cases (89.83%). In lumbar puncture, 53% of patients had normal CSF. Most patients (75.9%) had an erythrocyte sedimentation rate (ESR) below 30 mm/h. CRP of most patients (83.33%) was less than 10 mg/L. Conclusion: The predominant clinical symptoms of patients with GBS are the inability to walk, imbalance, positive Gowers’ sign, pain and respiratory distress, since ESR and CRP less than 30 and 10 mg/L are helpful, respectively.
Prevalence of biologic, behavioral and psychosocial determinant of tuberculosis in tuberculosis patients of Semnan city; a five-year cross-sectional study
Authors: Kia Naim Sadat , Nassaji Zavareh Mohammad , Sarkheil Elnaz , Ghods Elaheh
Published: September 2021

Introduction: Tuberculosis (TB) is one of the most common and lethal infectious diseases. Objectives: Due to the impact of biological, behavioral, socio-economic factors on the incidence of TB and the risks of the disease, we aimed to investigate the factors affecting TB in TB patients in Semnan. Patients and Methods: All patients with confirmed TB, who were referred to primary healthcare centers in Semnan for receiving medication, enrolled in the study (2012 to 2016). Data collected from clinical records and in-person interviews. The questionnaire consisted of two parts; the first part was demographic data and the other was related to the risk factors for TB. Results: The household crowding index was 1.86 ± 0.88. Most of patients (48.1%) were elderly (≥60 years old), female (59.7%), housewife (48.1%), had a pre-diploma education (63.6%), low-monthly income (62.3%) and married (63.6%). Around13.0% had diabetes. 20.8% drug abuser, 16.9% cigarettes and tobacco smokers, and 1.3% consumed alcoholic beverages. Besides, 40.3% were Afghans and 1.3% had the Pakistani nation. Conclusion: Identifying and controlling the social, geographical and biological factors affecting the incidence and mortality of TB in different regions can help to formulate appropriate strategies for achieving global goals. These factors differ among native and non-native population.
The changes in therapeutic and managerial protocols for patients suffering ST-segment elevation myocardial infarction in COVID-19 pandemic; a systematic review and meta-analysis
Authors: Mirfakhraee Hosna , Niksolat Maryam , Saghafian Larijani Samaneh , Zandieh Zhale
Published: September 2021

Introduction: Apart from the direct effect of COVID-19 on the incidence of ischemic heart disease, the pandemic effect of this infection on the control of ischemic heart disease and on the clinical consequences of these patients and also their hospital admission is also significant. Objectives: The present review attempted to assess the admission rate, treatment protocols, and outcome changes in patients suffering ST-segment elevation myocardial infarction (STEMI) in the COVID-19 outbreak. Materials and Methods: The included studies were identified through electronically reviewing the manuscripts databases of MEDLINE, EMBASE, Web of knowledge, and Google Scholar from inception to September 2020. The titles and abstracts of the manuscripts were screened by two blinded reviewers followed by an in-depth assessment of the full texts for assigning the inclusion appropriateness. Results: Eighteen articles (including 6225 STEMI patients hospitalized within the COVID-19 pandemic duration and 55711 STEMI patients in pre-COVID-19 periods) were desirable for the final analysis. A longer delay among symptom onset and first medical contact (FMC) in the COVID-19 lockdown period than before the COVID-19 pandemic was revealed. Comparing STEMI-related death in the COVID-19 period compared to the pre-COVID-19 duration showed a significantly higher death rate and a higher rate of thrombolytic therapy. The examined pre-COVID-19 and COVID-19 periods showed a reduction in STEMI patients’ admissions reached 30.9%. Additionally, entering the COVID-19 period resulted in a significant 44.4% reduction in the number of primary percutaneous coronary intervention. Conclusion: During the COVID-19 pandemic, the management of STEMI has undergone significant changes, including reduced hospital admissions, reduced invasive and semi-invasive treatment interventions, increased STEMI-related mortality, increased thrombolytic therapy, and delayed patients’ referral to the hospitals.
Sleep disorders and main determinants among hospital staffs in a referral hospital in Iran
Authors: Fotokian Zahra , Ebrahimi Rad Reza , Asghari Valujai Masume
Published: September 2021

Introduction: The prevalence rate of sleep disorders among hospital staff is expected to high due to shift work and its related circadian cycle disturbance. Complexity, high prevalence, and health implications related to sleep disorders are of great importance. Objectives: The present study aimed to assess the prevalence and main determinants of sleep disorders among hospital staff. Patients and Methods: This cross-sectional study was performed on 200 head nurses, nurses, midwives, operating room technicians, health care providers, service staffs of all departments, and physicians at Shaheed Rajaei hospital in Tonekabon city, Iran in 2015. The questionnaire which assessed the sleep disturbances was sourced from four scaling systems of Global Sleep Assessment Questionnaire (GSAQ), insomnia severity index (ISI), Pittsburgh Sleep Quality Index (PSQI), and Fatigue Severity Scale (FSS). Results: According to the assessment by the study adopted questionnaire, 78% (78.6% of males and 77.8% of females) suffered from work-related sleep disorders. Regarding association between work shifts and likelihood of sleep disorders, it was shown a significantly higher rate of sleep disturbances in the staffs with morning and evening shifts (100%), morning and night shifts (100%), or evening and night shifts (100%), simultaneously (P<0.001). Marital status, work experience, and gender could not affect sleep quality. Conclusion: Most of the hospital staff especially practical nurses and nurses suffered from sleep disturbances. Simultaneous and multi-sectional work shifts lead to higher likelihood of sleep problem among staffs.
World Kidney Day 2021 with the theme of living well with kidney disease; a review of current concepts
Authors: Bahadoram Mohammad , Labaykee Saeede , Lakkakula Bhaskar VKS , Keikhaei Bijan , Nekouei Shahraki Mitra , Mohammadi Jouabadi Soroush , Onuigbo Macaulay , Ahmadizar Fariba , Mahmoudian-Sani Mohammad-Reza , Peymani Payam
Published: September 2021

Since 2006, by considering one dimension of kidney disease, each year, the International Society of Nephrology (ISN) and the International Federation of Kidney Foundations (IFKF) have consistently and unanimously declared a World Kidney Day (WKD) around a specific kidney disease to increase the global awareness about kidney diseases. WKD, which is celebrated in more than 150 countries worldwide, is an international kidney health awareness campaign emphasizing the importance of the kidneys to reduce the global prevalence of kidney diseases and their related health problems by promoting patients and providing education. The present review aims to summarize the themes of previous WKD campaigns and the advocacy of the 2021 WKD campaign theme "Living well with kidney disease". The 2021 WKD Steering Committee advocates for the empowerment of CKD patients, their family members, and care partners, along with both drug and non-drug therapeutic programs to achieve better health outcomes.
Successful management of HIV infection in a patient with ulcerative colitis; a case report
Authors: Majid Zain , Ahmed Khan Shoaib , Ismail Hina , Akbar Nishat , Mandhwani Rajesh , Luck Nasir
Published: September 2021

Human immunodeficiency virus (HIV) is an infectious disease that is rarely seen in ulcerative colitis patients. Both diseases commonly involve the colon. It has been shown that treating these patients with anti-tumor necrosis factor (anti-TNF) therapy leads to remission of both conditions. We hereby present the case of a 7-year-old boy who was initially managed as a case ulcerative colitis after undergoing extensive workup and later on tested positive for HIV infection and was managed via mesalamine and highly active antiretroviral therapy (HAART). Mesalamine therapy along with HAART can be used to treat ulcerative colitis patients infected with HIV infection in resource limited countries.
Evaluation of irritable bowel syndrome prevalence in medical students
Authors: Maghsoudi Samin , Teimouri Azam
Published: September 2021

Introduction: Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder and requires early diagnosis due to its negative impacts on the quality of life. According to the lifestyle pattern of medical students, IBS has a significant prevalence in these individuals. Objectives: The present study aims to investigate the prevalence and factors associated with IBS in medical students. Patients and Methods: This cross-sectional study has been conducted on 100 medical students studying at Isfahan University of Medical Sciences in 2019-2020. The Rome IV diagnostic criteria were administered to diagnose IBS and individuals were divided into four groups of constipation-dominant (IBS-C), diarrhea-dominant (IBS-D), mixed type (IBS-M) and unspecified (IBS-U). The association of studying grade, gender and residence with IBS was evaluated. Results: The mean age of the students was 23.2±4.8 years, including 68 (68%) women. According to Rome -IV criteria, 24 (24%) ones were diagnosed with IBS. The IBS cases were dominantly in IBS-C group (54.16%). IBS was not associated with gender (P=0.498), educational grade (P=0.661) and type of residence (P=0.562) in the studied medical students. Conclusion: According to the present study, the prevalence of IBS was 24% among medical students, which was higher among women. Most patients had IBS-C, but IBS did not show a statistically significant relationship with gender, educational grade and type of residence.
Infection-related immunoglobulin A nephropathy or IgA-dominant postinfectious glomerulonephritis; what is in a name?
Authors: Ghasempoor Dabaghi Ghazal , Rabiee Rad Mehrdad , Mubarak Muhammed , Amir Sardari Romina , Holm Golnaz K , Nasri Hamid
Published: September 2021

Immunoglobulin A nephropathy (IgAN) is the most common glomerulonephritis worldwide. However, its incidence and prevalence vary depending on racial and geographical factors. IgAN is a highly heterogeneous disease with wide clinical and pathological variability. The defining and consistent feature of IgAN is the dominance or co-dominance of IgA deposits in the glomeruli on immunofluorescence (IF) microscopy. However, recent reports suggest that a number of post-infectious glomerulonephritis (PIGN) cases also exhibit dominance or co-dominance of IgA deposits on IF microscopy. Therefore, a debate has arisen on labeling these cases either as infection-related IgAN (a form of secondary IgAN) or IgA-dominant PIGN. Although the majority favors the later nosology, this issue has remained unresolved, as is the issue of labelling this condition as PIGN when, in fact, the infection is often intercurrent, and no latent period is found in this condition. This brief narrative review aims to discuss the salient features of this condition and issues related to its nomenclature.
Persistence of coronavirus disease 2019 (COVID-19) in patients with end-stage renal disease; an unrecognized phenomenon?
Authors: Onuigbo Macaulay Amechi Chukwukadibia
Published: September 2021

Since the global coronavirus disease 2019 (COVID-19) pandemic hit most parts of the world, the nephrology community has primarily focused on the associated incidence of often severe acute kidney injury (AKI) with the disease pandemic. For patients on maintenance in-center outpatient hemodialysis, the primary concern has been on prevention of the spread of COVID-19 among this vulnerable patient group. Our recent experience with one end-stage renal disease (ESRD) patient early in the Spring of 2020 has led us to speculate that ESRD patients may well exhibit an unusually prolonged period of persistence of COVID-19. This may explain the recent report of the unanticipated demonstration of a high rate of positive COVID-19 antibody testing among the staff of a Pediatric Outpatient Hemodialysis Unit in New York. Further studies are mandated as these investigations would help guide the implications of preventative measures against the spread of COVID-19 among both patients and staff of hemodialysis units around the world.
Incidence of acute kidney injury in bone marrow transplant patients; investigation of consequences within one to three years
Authors: Aref Asieh , Maleknia Mohsen , Nasrollahi Alireza , Hajifathali Abbas , Mehdizadeh Mahshid , Kazemi Hashem , Ghadiani Mohammad Hassan
Published: September 2021

Introduction: Previous studies have demonstrated that acute kidney injury (AKI) is a serious complication following hematopoietic stem cell transplantation (HSCT). The incidence of AKI in association with HSCT varies considerably because of several definitions for AKI. Objectives: In this study, we determined the rate of AKI after bone marrow transplantation (BMT) and its effects on patients’ outcomes according to modern definitions of AKI to conclude whether all these criteria can be useful for predicting AKI occurrence after BMT or not. Patients and Methods: We conducted a retrospective study of 271 patients undergoing HSCT, and after obtaining written informed consent from all patients, the required information was reviewed. AKI was defined according to RIFLE, KDIGO, and AKIN criteria. Renal function was assessed by calculating creatinine clearance, urine output, and estimated glomerular filtration rate (eGFR), determined through the MDRD equation. Results: Allogeneic and autologous transplantations were performed on 38 (14.02%) and 233 (85.97%) patients, respectively. According to the RIFLE criteria, 96 patients (35.42%) suffered from AKI, and based on AKIN, and KDIGO criteria, 101 patients (37.26%) were afflicted with it after BMT. The one-year mortality rate in allogeneic transplant patients with a history of AKI was 30.43% and 53.33% in patients without a history of AKI. The three-year mortality rate in allogeneic transplant patients with and without a history of AKI was 52.17% and 73.33% respectively, which showed no statistically significant difference. The three-year mortality rate in autologous transplant patients with and without a history of AKI was 60.27% and 22.5%, respectively. Conclusion: The one-year and three-year mortality rates, survival of patients, and AKI’s diagnosis were similar in all three criteria. Therefore, all these criteria can be useful for the prediction of AKI occurrence after BMT.
Serum uric acid and renal survival prognosis in primary glomerulonephritis patients in a retrospective single-center cohort
Authors: Stepanova Natalia , Snisar Lyudmila , Lebid Larysa , Savchenko Svitlana , Nepomnyashchii Valentyn , Kolesnyk Mykola
Published: September 2021

Introduction: The role of serum uric acid (SUA) concentration in primary glomerulonephritis (PGN) aggravation is currently under active discussion. Objectives: This study primarily aimed to analyze the association between SUA concentration and renal survival prognosis in PGN patients and secondarily to determine whether hyperuricemia is an independent risk factor for reduced glomerular filtration rate (GFR) in the presence of nephrotic syndrome. Patients and Methods: We performed a retrospective observational single-center study involving 344 patients with biopsy-proved or clinically diagnosed PGN with the mean follow-up period of 5.3 [3.8-6.2] years. The rate of annual decline in estimated GFR (eGFR) was used to assess chronic kidney disease progression. Primary outcome measures were eGFR decline or transfer to renal replacement therapy (RRT) during the 5-year follow-up period. Results: There were 78/344 (22.7%) patients who eventually progressed to eGFR <15 mL/min/1.73 m2 or started RRT. In multivariate logistic regression analysis eGFR at diagnosis, proteinuria and hyperuricemia were associated with increased renal risk in PGN patients during the 5-year follow-up period. However, a less significant effect of SUA on rapid eGFR decline was found in the patients with nephrotic-range proteinuria compared with the patients with mild proteinuria. Conclusion: Our study revealed that a higher level of SUA was significantly associated with a greater annual decline in GFR and, consequently, a worse 5-year renal survival prognosis in PGN patients. The effect of hyperuricemia on the risk of rapid CKD progression was greater in PGN patients with mild proteinuria compared with the patients with nephrotic-range proteinuria.
A systematic review of the relationship between acute tubular necrosis and kidney transplantation
Authors: Elmi Arezo , Arabsorkhi Mishabi Mohammad , Teymoori Esmaeil , Nikbakht Dorrin , Sarraf Nazanin , Jabinian Fatemeh , Khalilpour Abbas , Askarkhah Afsaneh , Rahmani Vahid
Published: September 2021

Introduction: Acute tubular necrosis (ATN) is a common syndrome following kidney transplantation. In this study, we reviewed systematically the relationship between ATN and kidney transplantation. Materials and Methods: International databases including PubMed, Web of Science and Scopus were considered for search of English articles by Aug 2019. Seven published articles were finally entered into the study. Keywords were ATN, acute kidney injury, kidney transplantation and renal transplantation or a combination of them in the title/abstracts. Results: There were seven published articles (conducted on 2,534 individuals) reviewed in this systematic review consisted of two retrospective, three prospective studies and two clinical trial studies. Conclusion: The administration of cyclosporine immediately following kidney transplantation is a predicting factor for development of ATN. According to the results, ATN can be associated with kidney transplantation, especially transplanted from deceased donors.
Plasma N-terminal pro-brain natriuretic peptide level as a marker of adverse outcome in patients with co-existing diabetes, chronic kidney disease and heart failure
Authors: Soliman Amin Roshdy , Ahmed Rabab Mahmoud , Yousry Ahmad , Abdelaziz Tarek Samy , Selem Abdel Hakem
Published: September 2021

Introduction: N-terminal pro–B-type natriuretic peptide (NT-proBNP) is a novel marker of cardiac disease and heart failure; both are in patients with diabetes and chronic kidney disease. Objectives: This study aimed to investigate the NT-proBNP and adverse outcome in patients with diabetes complicated by chronic kidney disease (CKD). Patients and Methods: We measured the serum levels of NT-proBNP. The association of this novel marker with re-hospitalization and mortality rate were prospectively compared among the studied groups. Results: Among 120 patients, baseline NT-proBNP at the time of admission was significantly elevated in patients with CKD (P= 0.001). Levels of NT-proBNP were significantly elevated in patients with diabetes and CKD than those with CKD alone (P= 0.04) at the end of follow-up. Higher proBNP levels significantly correlated with decreased glomerular filtration rate (GFR) and higher serum creatinine levels (P= 0.03, P< 0.001, respectively). In addition, increased mortality was noticed in those patients. Conclusion: NT-proBNP levels have prognostic implication in the setting of CKD, diabetes mellitus and heart failure. Adverse outcomes are; a higher rate of need for dialysis, re-hospitalization and increased mortality which are correlated with levels of NT-proBNP.
The pattern of peri-hilar and hilar arterial branching in kidney allografts of living donors
Authors: Zununi Vahed Sepideh , Asadi Yaghoob , Farnood Farahnoosh , Alimirzaloo Maryam , Rasi Hashemi Seyed Sadroddin , Niknafs Bahram , Mohamadian Habibeh , Mohajel Shoja Mohammadali , Noshad Hamid , Ardalan Mohammadreza
Published: September 2021

Introduction: Kidney transplantation gives us the opportunity to study kidney vascular anatomical variations and their probable effect on allograft survival. Objectives: The aim of this study was to evaluate the renal arteries’ branching patterns of the engrafted kidneys and their impact on transplant outcomes. Patients and Methods: Three hundred patients who received kidney transplantation between 2014 -2017 were included. Peri-hilar and hilar branching patterns of the engrafted kidney were studied by reviewing the archived CT angiographies of donors and then they categorized based on the existing knowledge in this field. Clinical data were also gathered from medical records and recipients’ latest clinical and laboratory evaluations. Results: Based on peri-hilar and their corresponding hilar branching patterns, our morphology findings were classified into 17 groups. From different peri-hilar branching patterns, the fork pattern was more common which is detected in 95% (242) while the ladder pattern was observed in 5% (13) of kidney grafts. In a later branching sub-categorization, among the fork pattern, 65.2% (158) were duplicated and 34.7% (84) had triplicated hilar branching patterns. There was not a statistically significant correlation between each of those patterns and allograft function (P > 0.05). Conclusion: Peri-hilar and hilar branching patterns of the kidney allografts’ renal artery were different, but they follow certain patterns. Although it may not influence the allograft survival, it provides us precise knowledge about renal vasculature patterns and outcome of probable vascular events meanwhile; it could be useful in the field of transplantation.
Taurolock versus saline 5% on preventing infection and dysfunction of hemodialysis catheters; a randomized, double blind controlled clinical trial
Authors: Ghorbani Ali , Hayati Fatemeh , Dargahi-MalAmir Mehrdad , Afkane Maryam
Published: September 2021

Introduction: Despite the higher rate of morbidity and mortality, the use of central venous catheters has increased significantly compared to arteriovenous fistula. So far, no ideal organic solution has been identified for the prevention of thrombosis and catheter-related infection in patients undergoing hemodialysis. Objectives: This study aimed to evaluate the efficacy of Taurolock versus saline 5% on the prevention of catheter dysfunction and catheter-related infections. Patients and Methods: Seventy patients with chronic kidney disease, who requiring hemodialysis or those with permanent hemodialysis catheters referring to hemodialysis centers of Ahvaz, were selected and randomly divided into two groups, while 68 patients remained until the end of the study. In the first group, saline 5% was inserted into the lumen of catheter after each hemodialysis, and then catheter was blocked. In the second group, Taurolock solution (TauroLock™ -Hep 500®: Taurolidine; antimicrobial agent), citrate 4% and heparin (UI/mL) were used as antibiotics. Results: No significant difference between the catheter-related infection and positive blood culture in both saline and Taurolock groups was detected (2.94% versus 2.94%; P >0.05). Moreover, the catheter-related dysfunction in the saline 5% group was 5% less than the Taurolock group (2.94% versus 11.76%, P = 0.365). Conclusion: The results showed that saline 5% is at least as effective as a Taurolock solution for prevention of infections and catheter dysfunction. Saline is an effective, inexpensive, safe and readily available in various settings. Therefore, it could be considered as a proper alternative solution for reduction of dialysis-related side effects and costs. Trial Registration: Registration of trial protocol has been approved in Iranian registry of controlled trials (identifier: IRCT20190304042918N1; https://en.irct.ir/trial/38055, ethical code# IR.AJUMS.REC.1397.412).
Lack of association between diabetic nephropathy and human leukocyte antigen type 2 (HLA II-DQ1) in patients with type 2 diabetes mellitus in west of Iran
Authors: Mohammadi Mahsa , Rajabnia Mohsen , Forghani Mohammad Saad , Rahmani Khaled , Bahadoram Mohammad
Published: September 2021

Introduction: Diabetic nephropathy (diabetic kidney disease) is one of the microvascular complications of diabetes mellitus. The human leukocyte antigen (HLA) is a group of genes that is related to autoimmune diseases, infections and inflammation. Studies regarding the association of type 2diabetes and HLA-II are negligible. Objectives: The aim of this study is to determinate association between diabetic nephropathy and HLA II-DQ1 in diabetes type 2 patients. Patients and Methods: In this study, 120 diabetes type 2 patients were divided into two groups of diabetic nephropathy (case group) and without diabetic nephropathy (control group). Blood samples were taken and DNA was isolated. Asymmetric polymerase chain reaction (PCR) was used to amplify the HLA II-DQ1 exon 2 and exon 3. PCR products were hybridized and labeled with probes on the chip. Determination of HLAII-DQ1 gene typing was conducted by scanning hybrid products and analyzed with PerkinElmer ScanArray software. Results: The results of chi-square test showed no significant difference between expression levels of HLA in the two groups (P<0.05). Conclusion: There was no significant difference between expression levels of HLA in two groups of patients. Various factors such as demographic characteristics, lifestyle, geographic region, and race are the factors influencing the relationship between diabetic nephropathy and DQ1-HLA II. Since this study is conducted in one region and one race and with limited population, it is suggested that future studies should be considered and the association between the mentioned variables with HLA should be considered.
Metformin induced acute kidney injury; a systematic review
Authors: Momenzadeh Mahnaz , Lakkakula Bhaskar VKS
Published: September 2021

Introduction: Metformin is the best proven first-line treatment for type 2 diabetes (T2DM), based on both national and international guidelines. The present systematic review is aimed to examine the acute kidney injury (AKI) risk associated with metformin. Methods: A systematic literature search was performed in MEDLINE, PubMed and google scholar, to retrieve the literature related to the metformin use. A bibliographic management software (Endnote X9) was used for managing the literature. The following keywords were used: "Acute renal injury OR ARI", "Acute kidney injury OR AKI"," Metformin", " Type 2 diabetes mellitus OR T2DM", "Diabetic patients", "Renal function", "CKD". Results: About 28 relevant articles were found during the electronic and manual search. Finally, a total of four articles that fulfill the inclusion criteria were used for this systematic literature review. There is no evidence to suggest that metformin increases the incidence of AKI and is associated with an increased survival of 28 days following AKI event. Further, there was no difference in the incidence of AKI in patients who continued metformin after arterial contrast exposure compared with the control group. Conclusion: In summary, there is no evidence that metformin increases the incidence of AKI. More clinical trials are needed in this area, to investigate more evidence so that we can better understand the outcome.
Herbal medicines in the treatment of coronavirus disease 2019 (COVID-19)
Authors: Tolouian Audrey , Khosravian Maryam , Ragati Haghi Hedieh , Bolourian Alireza , Mojtahedi Zahra , Asgharpour Masoumeh , Alirezaei Amirhesam
Published: September 2021

Coronavirus disease 2019 (COVID-19), caused by a novel coronavirus, started in livestock within the markets of Wuhan, China and was consequently spread around the world. The virus has been rapidly spread worldwide due to the outbreak. COVID-19 is the third serious coronavirus outbreak in less than 20 years after Severe Acute Respiratory Syndrome (SARS) in 2003 and Middle East Respiratory Syndrome (MERS) in 2012. The novel virus has a nucleotide identity closer to that of the SARS coronavirus than that of the MERS coronavirus. Since there is still no vaccine, the main ways to improve personal immunity against this disease are prophylactic care and self-resistance including an increased personal hygiene, a healthy lifestyle, an adequate nutritional intake, a sufficient rest, and wearing medical masks and increasing time spent in well ventilated areas. There is a need for novel antivirals that are highly efficient and economical for the management and control of viral infections when vaccines and standard therapies are absent. Herbal medicines and purified natural products have the potential to offer some measure of resistance as the development of novel antiviral drugs continues. In this review, we evaluated 41 articles related to herbal products which seemed to be effective in the prevention or treatment of COVID-19.
Immune-related adverse kidney events by immune checkpoint inhibitors; a narrative review on current studies
Authors: Sadighpour Tella , Cagnazzo Celeste , Alimohammadi Shahrzad , Emami Anahita , Khayyat Azadeh , EsmaeilPour Mohammad Ali
Published: September 2021

Chemotherapy-associated renal injury is considered one of the major concerns among nephrological and oncological practice. The use of novel anti-neoplastic therapies that target carcinomas has helped in the detection of this form of renal injury. Immune checkpoint inhibitors (ICPIs) are a group of monoclonal antibodies targeting inhibitory receptors that exist on tumor cells and T cells. ICPIs are able to suppress tumors that might have escaped from the immune surveillance. Meanwhile, although ICPIs have shown promising efficacy in cancer treatment, their immune-related side effects limit their widespread use in cancer therapy schedules. One of the major side effects limiting ICPIs’ usage is nephrotoxicity. Glomerular disease, acute interstitial nephritis (AIN), and acute tubular necrosis (ATN) are considered different infusion-related adverse events. Infiltration of eosinophils, T lymphocytes, and plasma cells, as well as interstitial inflammation and edema, leading to acute tubulointerstitial nephritis (ATIN). It is conceivable that the rupture of self-tolerance by ICPIs induces an autoimmune reaction against some specific self-antigens in the organs including kidneys. The exact nature of the antigen is unclear; however, it is possible that it is found in the renal tubular cells, as indicated by a greater frequency of ATIN in kidney biopsies. The current review paper discusses the relationship between ICPIs therapy and kidney disorders or more specifically, their possible role in renal damage along with renal toxicity profile in the setting of ICPIs treatment.