Publications by authors named "Khadijeh Makhdoomi"

33 Publications

Treating post-renal transplant surgical site infection with combination therapy: a case study.

Br J Nurs 2021 Apr;30(8):478-483

Assistant Professor, Patient Safety Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran.

Surgical site infection (SSI) is one of the most common and debilitating complications of surgery. The risk of SSI rises if the patient has underlying health-related risk factors. This article reports on the complicated case of 61-year-old female with a history of obesity and diabetes. She was diagnosed with end-stage renal disease (ESRD) and had been receiving haemodialysis since 2012. She underwent a kidney transplant and developed a multidrug-resistant SSI following surgery. She experienced delayed wound healing with a partially dehisced incision. Despite conventional wound care, there was no progress in wound healing. The authors combined sharp debridement, irrigation and antibiotic therapy with a silver-containing antimicrobial dressing for 1 month. Her SSI improved significantly and she returned to theatre for wound closure. The patient recovered well and was discharged from the hospital after suture removal. Wound care professionals can use combination therapies to manage SSIs effectively and reduce patient and healthcare costs.
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http://dx.doi.org/10.12968/bjon.2021.30.8.478DOI Listing
April 2021

The effects of nanocurcumin supplementation on inflammation in hemodialysis patients: A randomized controlled trial.

Hemodial Int 2021 Apr 8;25(2):232-239. Epub 2021 Feb 8.

Department of Epidemiology and Biostatistics, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran.

Introduction: Serum levels of several pro-inflammatory cytokines are higher in hemodialysis patients compared to healthy people. Curcumin has been shown to be able to decrease cytokines levels in nonuremic subjects. Our goal was to evaluate the effect of nanocurcumin administration on cytokines levels in hemodialysis patients.

Methods: The study was performed over a 3 months period on 54 hemodialysis patients who had been randomized to receive either nanocurcumin or placebo. Serum levels and gene expressions of tumor necrosis factor-alpha (TNF-α) and interleukin 6 (IL-6) were evaluated using enzyme-linked immunosorbent assay (ELISA) and real-time polymerase chain reaction (RT-PCR).

Findings: Serum levels of IL-6 and TNF-α were similar in the two groups at baseline but were lower after 12 weeks of treatment with nanocurcumin compared to placebo (P = 0.024 for IL-6 and 0.02 for TNF). In the group given nanocurcumin, serum levels of both cytokines decreased substantially (P < 0.001 for each), whereas they were unchanged in the group given placebo. Gene expression for each cytokine in peripheral blood mononuclear cells (PBMCs) was reduced at 12 weeks vs. baseline in the group given nanocurcumin, and changes in gene expression correlated with changes in serum level for each of the two cytokines.

Discussion: The results indicate that nanocurcumin supplementation reduces both serum levels and gene expression of IL-6 and TNF-α in hemodialysis patients. The feasibility and potential clinical benefits of nanocurcumin treatment to reduce inflammation in hemodialysis patients warrant further study.
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http://dx.doi.org/10.1111/hdi.12911DOI Listing
April 2021

Translation of evidence into kidney transplant clinical practice: managing drug-lab interactions by a context-aware clinical decision support system.

BMC Med Inform Decis Mak 2020 08 20;20(1):196. Epub 2020 Aug 20.

Patient Safety Research Center, Urmia University of Medical Sciences, Urmia, Iran.

Background: Drug-laboratory (lab) interactions (DLIs) are a common source of preventable medication errors. Clinical decision support systems (CDSSs) are promising tools to decrease such errors by improving prescription quality in terms of lab values. However, alert fatigue counteracts their impact. We aimed to develop a novel user-friendly, evidence-based, clinical context-aware CDSS to alert nephrologists about DLIs clinically important lab values in prescriptions of kidney recipients.

Methods: For the most frequently prescribed medications identified by a prospective cross-sectional study in a kidney transplant clinic, DLI-rules were extracted using main pharmacology references and clinical inputs from clinicians. A CDSS was then developed linking a computerized prescription system and lab records. The system performance was tested using data of both fictitious and real patients. The "Questionnaire for User Interface Satisfaction" was used to measure user satisfaction of the human-computer interface.

Results: Among 27 study medications, 17 needed adjustments regarding renal function, 15 required considerations based on hepatic function, 8 had drug-pregnancy interactions, and 13 required baselines or follow-up lab monitoring. Using IF & THEN rules and the contents of associated alert, a DLI-alerting CDSS was designed. To avoid alert fatigue, the alert appearance was considered as interruptive only when medications with serious risks were contraindicated or needed to be discontinued or adjusted. Other alerts appeared in a non-interruptive mode with visual clues on the prescription window for easy, intuitive notice. When the system was used for real 100 patients, it correctly detected 260 DLIs and displayed 249 monitoring, seven hepatic, four pregnancy, and none renal alerts. The system delivered patient-specific recommendations based on individual lab values in real-time. Clinicians were highly satisfied with the usability of the system.

Conclusions: To our knowledge, this is the first study of a comprehensive DLI-CDSS for kidney transplant care. By alerting on considerations in renal and hepatic dysfunctions, maternal and fetal toxicity, or required lab monitoring, this system can potentially improve medication safety in kidney recipients. Our experience provides a strong foundation for designing specialized systems to promote individualized transplant follow-up care.
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http://dx.doi.org/10.1186/s12911-020-01196-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7439664PMC
August 2020

Identification of Novel Pathogenic Variants in Iranian Patients with Autosomal Dominant Polycystic Kidney Disease.

Rep Biochem Mol Biol 2020 Jan;8(4):401-406

Cellular and Molecular Research Center, Cellular and Molecular Medicine Institute, Urmia University of Medical Sciences, Urmia, Iran.

Background: Autosomal dominant polycystic kidney disease (ADPKD) is a delayed-onset renal disorder that results from a mutation in the or genes. Autosomal dominant polycystic kidney disease results in end-stage renal disease due to renal cystic dysplasia. The aim of this study was to evaluate, by exon sequencing, the disease-causing variants of (exons 4, 6, and 8) in Iranian ADPKD patients.

Methods: Genomic DNA was extracted from 3-5 ml of peripheral blood by the salting-out method. exons 4, 6, and 8 were PCR-amplified and sequenced.

Results: Three disease-causing variants were identified; all three were missense mutations in exon 4. The mutations were AGC → ACC (c.893G>C, cDNA.959G>C, S298T), TAC → TTC (c.1043A>T, cDNA.1109 A>T, Y348F), and GAA → GAT (c.1059A>T, cDNA.1125 A>T, E353D. These novel pathogenic variants may cause loss of the normal protein function.

Conclusion: Our results suggest that AGC → ACC (c.893G>C, cDNA.959G>C, S298T), TAC → TTC (c.1043A>T, cDNA.1109 A>T, Y348F), and GAA → GAT (c.1059A>T, cDNA.1125 A>T, E353D variants are common in Iranian ADPKD patients. These mutations modify the transmembrane domain and likely influence PC2 function.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7275831PMC
January 2020

Examining the Role of Polymorphisms in Exon 25 of the Gene in the Pathogenesis of Autosomal Dominant Polycystic Kidney Disease in ranian Patients.

Rep Biochem Mol Biol 2019 Jul;8(2):102-110

Cellular and Molecular Research Center, Cellular and Molecular Medicine Institute, Urmia University of Medical Sciences, Urmia, Iran.

Background: Autosomal dominant polycystic kidney disease (ADPKD) is a highly prevalent life-threatening monogenic disorder with high morbidity and mortality. Roughly 1:400-1000 individuals are affected with this disease worldwide. The development of ADPKD is largely attributed to mutations in the polycystic kidney disease 1 and genes. However, the pathogenicity of the different polymorphisms in PDK1 in the development of ADPKD remains unclear. The aim of this study was to further elucidate the role of the polymorphisms in exon 25 of the gene in relation to the pathogenesis of ADPKD in Iranian patients.

Methods: The genomic DNA of 36 Iranian patients with ADPKD was isolated using the standard salting out method. The PCR products were directly sequenced and analyzed.

Results: The frequencies of CAG>GAG, ATG>GTG, GTC>GTA, and GTG>ATG polymorphisms in exon 25 of the PKD1 gene were 34 (94.44%), 33 (91.67%), 26 (72.22%), and 5 (13.89%), respectively. The most frequent polymorphism associated with ADPKD was the homozygous CAG→GAG which causes an amino acid change of Q[Gln] to E[Glu] at codon 3005.

Conclusion: Our data suggests that there is potentially a common polymorphism of among the Iranian population with ADPKD. This may aid in the diagnosis and genetic screening of at-risk patients for ADPKD.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6844614PMC
July 2019

diversity in the environments of nosocomial infection cases at a university hospital.

J Med Life 2019 Apr-Jun;12(2):128-132

Cellular and Molecular Research Center, Urmia University of Medical Sciences, Urmia, Iran.

species (sp.) that causes opportunistic infections have been increasingly found in human mainly immunosuppressive patients around the world every year. The main objective was to use a rapid and cheap molecular method for monitoring infections and epidemiological approaches. In order to identity species (spp.), a number of molecular methods including restriction fragment length polymorphism (RFLP) have been employed in accordance with ribosomal RNA amplification. The focus of this study - a group of hospitalized patients with clinical and subclinical signs of infection. All of the collected clinical specimens were transported to the medical mycology lab and examined for identification. The environmental specimens were collected from air and surfaces inspected for the within the hospital sources. At first, growth characteristics and microscopic features on mycological media for the identification of sp. were performed. For the confirmation of isolates which similarly found in clinical and environmental sources, molecular method polymerase chain reaction/restriction fragment length polymorphism was carried out. From the mentioned specimens, 102 fungal isolates included spp., spp. and other fungi. (47%), (29.4%) and (23.5%) all were found as the most common clinical isolates. In addition, isolates from environmental were (43.7%), (41.7%), (14.6%). Therefore, polymerase chain reaction-restriction fragment length polymorphism with a single restriction enzyme can be very useful in the identification of spp., because of its facility in use, speed, robust, and high sensitivity of diagnosis.
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http://dx.doi.org/10.25122/jml-2018-0057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6685303PMC
October 2019

NPWT: a gate of hope for patients with diabetic foot ulcers.

Br J Nurs 2019 Jun;28(12):S6-S9

Assistant Professor, Department of Nursing, Faculty of Nursing and Midwifery, Urmia University of Medical Science, Urmia, Iran.

Non-healing diabetic foot ulcers are a common and costly complication of type 2 diabetes and can result in lower extremity amputation. This case study concerns a 51-year-old man with a 17-year history of uncontrolled type 2 diabetes. He had developed a deep ulcer to the calcaneus of his left foot, which was 12x7 cm in size and infected with multi-drug-resistant . He was admitted to hospital for the non-healing diabetic foot ulcer and uncontrollable fever and was a candidate for amputation. He was treated with wound irrigation and debridement as well as negative-pressure wound therapy and antibiotic treatment. This strategy was effective and the wound size reduced progressively. The patient recovered well. Medical and wound care teams who deal with non-healing diabetic foot ulcers can benefit from a strategy of combination therapy.
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http://dx.doi.org/10.12968/bjon.2019.28.12.S6DOI Listing
June 2019

Preventing potential drug-drug interactions through alerting decision support systems: A clinical context based methodology.

Int J Med Inform 2019 07 13;127:18-26. Epub 2019 Apr 13.

Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Rotterdam, the Netherlands.

Background: The effectiveness of the clinical decision support systems (CDSSs) is hampered by frequent workflow interruptions and alert fatigue because of alerts with little or no clinical relevance. In this paper, we reported a methodology through which we applied knowledge from the clinical context and the international recommendations to develop a potential drug-drug interaction (pDDI) CDSS in the field of kidney transplantation.

Methods: Prescriptions of five nephrologists were prospectively recorded through non-participatory observations for two months. The Medscape multi-drug interaction checker tool was used to detect pDDIs. Alongside the Stockley's drug interactions reference, our clinicians were consulted with respect to the clinical relevance of detected pDDIs. We performed semi-structured interviews with five nephrologists and one informant nurse. Our clinically relevant pDDIs were checked with the Dutch "G-Standard". A multidisciplinary team decided the design characteristics of pDDI-alerts in a CDSS considering the international recommendations and the inputs from our clinical context. Finally, the performance of the CDSS in detecting DDIs was evaluated iteratively by a multidisciplinary research team.

Results: Medication data of 595 patients with 788 visits were collected and analyzed. Fifty-two types of interactions were most common, comprising 90% of all pDDIs. Among them 33 interactions (comprising 77% of all pDDIs) were rated as clinically relevant and were included in the CDSS's knowledge-base. Of these pDDIs, 73% were recognized as either pseudoduplication of drugs or not a pDDI when checked with the Dutch G-standard. Thirty-three alerts were developed and physicians were allowed to customize the appearance of pDDI-alerts based on a proposed algorithm.

Conclusion: Clinical practice contexts should be studied to understand the complexities of clinical work and to learn the type, severity and frequency of pDDIs. In order to make the alerts more effective, clinicians' points of view concerning the clinical relevance of pDDIs are critical. Moreover, flexibility should be built into a pDDI-CDSS to allow clinicians to customize the appearance of pDDI-alerts based on their clinical context.
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http://dx.doi.org/10.1016/j.ijmedinf.2019.04.006DOI Listing
July 2019

Relationship between interstitial CD34 positive cells and active phase of lupus nephritis.

Eur J Rheumatol 2018 Dec 10;5(4):254-257. Epub 2018 Oct 10.

Department of Pathology, Urmia University of Medical Sciences School of Medicine, Urmia, Iran.

Objective: Lupus nephritis is one of the most serious and common complications of systemic lupus erythematosus. It has an unpredictable course, and the type, severity, and activity of renal lesions cannot be assessed only by clinical and laboratory findings. The aim of the present study was to determine the relationship between the expression of CD34 and the histopathological findings of lupus nephritis.

Methods: A total of 73 renal biopsy samples of patients with a diagnosis of lupus nephritis were examined for CD34 expression by immunohistochemistry. Samples without staining were considered as 0, mild staining as 1+, moderate as 2+, and strong staining as 3+. The relationship between CD34 expression and histopathological and clinical data (including activity index, chronicity index, lupus nephritis class, age, sex, blood pressure, complete blood count, renal function tests, and serological findings) was analyzed.

Results: The mean age of the patients was 29.3±11.3 years. CD34 was expressed in all of the cases but with different intensities. There was a significant relationship between the expression of CD34 and the activity index, as a strong expression was seen in lower activity indices (p<0.001). CD34 expression was correlated with patients' white blood cell (WBC) count and systolic blood pressure (SBP). Patients with strong (score 3) CD34 expression had higher SBPs and lower WBC counts (p=0.03 and 0.04, respectively).

Conclusion: A strong interstitial expression of CD34 was observed in lower activity indices. It seems that CD34 expression could play a protective role in lupus nephritis and could reduce renal activity.
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http://dx.doi.org/10.5152/eurjrheum.2018.18067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6267746PMC
December 2018

Emerging Candida species isolated from renal transplant recipients: Species distribution and susceptibility profiles.

Microb Pathog 2018 Dec 18;125:240-245. Epub 2018 Sep 18.

Department of Medical Parasitology and Mycology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran; Cellular and Molecular Research Center, Urmia University of Medical Sciences, Urmia, Iran. Electronic address:

Candidiasis is a major challenge among renal transplant recipients (RTRs) worldwide and is associated with high morbidity and mortality rates. Fluconazole is the most commonly used agent for Candida infections. However, frequent relapse and treatment failure are still reported among patients affected with this infection. In the present study, Candida species obtained from RTRs were characterized based on conventional and molecular assays. Furthermore, the antifungal susceptibility profiles of these species were determined. This study was conducted on a total of 126 RTRs within 2012-2016. The patients were categorized according to the referenced diagnostic criteria. The identification of Candida species was accomplished based on conventional examination, assimilation profile test, and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The minimum inhibitory concentrations (MICs) of amphotericin B, fluconazole, itraconazole, voriconazole, posaconazole, and caspofungin were determined based on the guidelines of Clinical and Laboratory Standards Institute. The patients with Candida infection were diagnosed with urinary tract candidiasis (n = 17), peritonitis (n = 8), intra-abdominal candidiasis (n = 6), candidemia (n = 4), hepatosplenic candidiasis (n = 3), and Candida pneumonia (n = 3). A total of 41 Candida isolates, including C. albicans (n = 18), C. famata (n = 8), C. kefyr (n = 4), C. tropicalis (n = 4), C. parapsilosis (n = 3), C. glabrata (n = 2), and C. lusitaniae (n = 2), were isolated from 32.5% (41/126) renal transplant recipients. Fluconazole-resistance was observed in seven isolates, entailing C. albicans (n = 6) and C. tropicalis (n = 1). Fluconazole MIC for C. lusitaniae isolates was above the epidemiologic cut-off value (4-16 μg/ml). Furthermore, MIC range values of fluconazole against C. famata and C. kefyr were obtained as 4-32 μg/ml and 4-8 μg/ml, respectively. Posaconazole exhibited potent activity against Candida isolates, followed by caspofungin. The identification of Candida species, together with susceptibility testing, provides important data about the geographic trends of the fluconazole-resistance profiles of Candida species. It is necessary to maintain a consistent method for the implementation of early diagnosis and adoption of treatment regimen.
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http://dx.doi.org/10.1016/j.micpath.2018.09.026DOI Listing
December 2018

The pathological evaluation of nonneoplastic kidney disorder in tumor nephrectomy specimens.

Saudi J Kidney Dis Transpl 2018 May-Jun;29(3):586-590

Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.

Renal cell carcinoma (RCC) comprises 2%-3% of all visceral and 80%-85% of all adult kidney malignancies. Nephrectomy is the treatment of choice for renal tumors. The accurate pathological evaluation of nonneoplastic renal parenchyma in nephrectomy specimens is important for subsequent management. Eighty-two patients with RCC who underwent surgery at Imam Khomeini Hospital, Urmia, Iran, from April 2006 to February 2015 were studied. Paraffin blocks of the hospital archives were stained by hematoxylin and eosin (H and E) and periodic acid-Schiff staining. Microscopic examination was performed on nontumoral portions that were in the farthest possible distance from the tumor. Out of total 82 cases, 24 (29.3%) had normal renal parenchyma and 58 (70.7%) had pathological changes in renal parenchyma. The most frequent pathological findings were vascular sclerosis with parenchymal scarring and pyelonephritis. Other findings include focal and diffuse mesangial hypercellularity, eight; focal segmental glome-rulonephritis, five; membranoproliferative glomerulonephritis, three; and membranous glome-rulonephritis, two. Parenchymal scarring and vascular change included 36% of clear cell type, 41% of papillary type, and 53.8% of chromophobe type. Although there is not any statistical relation between the gender of patients and pathological findings, there was an obvious correlation between age and pathological findings. Before the age of 55 years, vascular sclerosis with parenchymal scarring and glomerular diseases and then chronic pyelonephritis are more prevalent.Evaluation of pathological changes in nonneo-plastic renal parenchyma is an essential step in recognizing patients at risk of accelerated functional failure of the single remaining kidney, particularly in patients with a background of chronic vascular injury associated with diabetes or hypertension.
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http://dx.doi.org/10.4103/1319-2442.235170DOI Listing
October 2019

Prevalence and genotype distribution of cytomegalovirus UL55 sequence in renal transplant recipients in north west of Iran.

J Med Virol 2016 09 15;88(9):1622-7. Epub 2016 Mar 15.

Cellular and Molecular Research Center, Molecular Virology Laboratory, Urmia University of Medical Sciences, Urmia, Iran.

Cytomegalovirus (CMV) is one of the most important infections in renal transplant recipients. Kidney transplant is the last hope for the patients with end stage renal diseases. Cytomegalovirus infection can threaten patients and graft survival after transplantation. Four hundred and thirty-four renal transplant recipients contributed to this study. PCR and RFLP analyses were performed in order to determine CMV viremia and its genotypes. CMV viremia was detected in 68 (15.9%) recipients. The mean post-transplantation time in our recipients was 50 months, ranging from 1 to 354 months. Viremia was detected in 31.2%, 30.7%, 17.5%, 10.2%, and 6.4% of the recipients in 0-3, 4-6, 7-12, 13-24, and more than 24 months post-transplantation, respectively. The distribution of gB1, gB2, gB3, and gB4 genotypes was detected as 26.5%, 20.5%, 17.6%, and 5.9%, respectively. Mixed genotype infection was observed in 29.4% of the recipients. Incidence of viremia was higher in the first 6 months after the transplantation compared with the later stages. Moreover, CMV gB1 and mixed genotype infection were more common in our recipients. J. Med. Virol. 88:1622-1627, 2016. © 2016 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/jmv.24509DOI Listing
September 2016

Outcome of Kidney Transplantation From Living Donors With Multiple Renal Arteries Versus Single Renal Artery.

Iran J Kidney Dis 2016 Mar;10(2):85-90

Department of Nephrology, Nephrology and Kidney Transplant Research Center, Urmia University of Medical Sciences, Urmia, Iran.

Introduction: Receiving a kidney transplant from donors with multiple renal arteries (MRAs) is suggested to be associated with higher risk of vascular and urologic complications and poor allograft outcomes compared to the donors with single renal artery (SRA). We evaluated survival rates in the recipients from donors with MRAs compared to those from donors with SRA.

Materials And Methods: In a retrospective study on 115 kidney allograft recipients, demographic characteristics and the outcomes of kidney transplantation were compared between the recipients from donors with MRAs compared to those from donors with SRA. These included acute tubular necrosis, acute allograft rejection, hypertension, vascular complications, urologic complications, kidney function indicators, and allograft survival at 1 year.

Results: There was no significant difference in the recipients' age, sex distribution, and weight, donors' age, donor-recipient familial relation, urologic complications, and duration of hospitalization between the two groups. However, MRA was significantly associated with a higher likelihood of right-side kidney donation, longer warm and cold ischemia times, and lower glomerular filtration rate and higher serum creatinine concentrations at discharge and 12 months after transplantation, as compared to SRA transplants. No significant difference was seen in late complications including hypertension and renal artery stenosis. One-year graft survival was slightly poorer in the MRA group than the SRA group.

Conclusions: Our results demonstrate that kidney allografts with MRAs are associated with risks but have acceptable outcomes during the 1st year after transplantation, as compared to SRA kidney allografts.
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March 2016

Disseminated Kaposi's sarcoma.

Arch Iran Med 2015 Nov;18(11):793-5

Hematology and Oncology Department, Uromia University of Medical Sciences, Uromia, Iran.

Kaposi's Sarcomas (KS) have been associated with many conditions and also known as a typical complication of immunosuppression. It should be considered as an important differential diagnosis in skin lesions of patients after solid organ transplantation. This is a report of a 61-year-old man, who presented with disseminated KS and a history of renal transplantation. We suggest systemic evaluation and visceral assessment in patients with Cutaneous KS.
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http://dx.doi.org/0151811/AIM.0011DOI Listing
November 2015

Hemodialysis Adequacy Monitoring Information System: Minimum Data Set and Capabilities Required.

Acta Inform Med 2015 Aug 30;23(4):239-42. Epub 2015 Jul 30.

Department of Health Information Technology, School of Allied Medical Sciences, Urmia, University of Medical Sciences, Urmia, Iran.

Introduction: In dialysis centers both nephrologists and nurses are faced with the challenge of ensuring reliable and efficient care accordance with the clinical guideline. Hemodialysis adequacy monitoring information system therefore enable the automation of tasks, which ultimately allows doctors and nursing staff more time to dedicate to the individual treatment of patients. Development of the information systems in healthcare has made the use of the Minimum data set inevitable. The purpose of this study was determined MDS and capabilities required in hemodialysis adequacy monitoring information system.

Method And Materials: This is a cross-sectional survey conducted with participation of 320 nephrology specialists in 2015. Data were collected using an electronic questionnaire which was estimated as both reliable and valid. The data were analyzed by SPSS software descriptive statistics and analytical statistics.

Results: Overall 42 data elements were determined as final set in 4 major categories (patient demographics, medical history, treatment plan and hemodialysis adequacy). The most capabilities required of hemodialysis information system were related to calculate of dialysis adequacy Index (4.80), advice optimal dose of dialysis for each patient (4.63), Easy access to information system without restrictions of time and place (4.61), providing alerts when dialysis adequacy index below the standard (4.55) and Interchange to other information systems in hospitals (4.46) respectively.

Conclusion: In design and implementation of information systems focus on MDS and identification IS capabilities based on the users' needs, due to the wide participation users and also the success of the information system. Therefore it is necessary that MDS evaluated carefully with regard to the intended uses of the data. Also information systems based on capabilities the ability to meet the needs of their users.
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http://dx.doi.org/10.5455/aim.2015.23.239-242DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4584089PMC
August 2015

Recurrent idiopathic membranous glomerulonephritis after kidney transplantation and successful treatment with rituximab.

Iran J Kidney Dis 2015 Mar;9(2):158-62

Nephrology and Renal Transplant Center, Urmia University of Medical Sciences, Urmia, Iran.

After renal transplantation approximately forty percent of patients with membranous glomerolunephritis (MGN) had a recurrence, most commonly during the first year.We present two cases with recurrent MGN after kidney transplantation who successfully treated with ritoximab.
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March 2015

Angiosarcoma at dialysis fistula site in a patient on continuous ambulatory peritoneal dialysis.

Iran J Kidney Dis 2015 Mar;9(2):154-7

Nephrology and Renal Transplant Research Center; Division of Nephrology; Urmia University of Medical Sciences, Urmia, Iran.

Arteriovenous fistula (AVF) is the best permanent access for hemodialysis. Swelling and pain due to thrombosis and infection is common at fistula site. Angiosarcoma is one of rare but important differential diagnosis of these signs. We present a patient on CAPD with angiosarcoma at AVF.
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March 2015

Molecular characterization of Aspergillus infections in an Iranian educational hospital using RAPD-PCR method.

Iran J Basic Med Sci 2014 Sep;17(9):646-50

Esfahan Institute of Public Health, Tehran University of Medical Sciences, Esfahan, Iran.

Objectives: The nosocomial infections by Aspergillus species are associated with constructions and increased dust loads in hospital indoors. Our main object was to find the environmental sources of Aspergillus species causing hospital acquired infections.

Materials And Methods: The clinical and environmental samplings were performed during 18 months from spring 2010 to summer 2011 in Imam educational hospital, Urmia, Iran. A morphological diagnosis was performed including microscopic characterization of isolated aspergillus from cultured specimens and polymerase chain reaction - restriction fragment length polymorphism (PCR-RFLP) for the identification in the level of species. Random amplified polymorphic DNA - PCR RAPD-PCR using random primers for rDNA gene was performed to compare Aspergillus isolates of clinical cases with the relevant environmental sources.

Results: Use of RAPD method resulted various differential patterns, so that some Aspergillus isolates from the clinical and hospital indoor were completely matched (matched pairs) and some other Aspergillus isolates were not matched. In the case of matched pairs, Aspergillus niger and A. flavus isolated from broncoalveolar lavage and sinus discharge were relevant to those of air conditioner and walls surfaces, respectively.

Conclusion: The hospital sources for the Aspergillus clinical isolates included air condition and walls. RAPD-PCR analysis can play a trivial role to find the hospital sources of Aspergillus clinical isolates.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4322146PMC
September 2014

Successful treatment of Chronic Myelogenic Leukemia (CML) with imatinib after renal transplantation.

Arch Iran Med 2014 May;17(5):388-90

Resident of Internal Medicine, Uromia University of Medical Sciences, Iran.

Chronic Myelogenic Leukemia (CML) is a rare malignant disorder after solid organ transplantation, especially in renal transplant recipients. Imatinib Mesylate is currently approved as first line treatment of CML. Most reports on CML are from kidney recipients who received azathioprine  in combination with cyclosporine and prednisolone as immunosuppressive therapy. We report a case with CML who was treated with Mycophenolate Mofetil.
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http://dx.doi.org/0141705/AIM.0015DOI Listing
May 2014

Health-related quality of life in hemodialysis patients: an Iranian multi-center study.

Nephrourol Mon 2013 Sep 18;5(4):901-12. Epub 2013 Aug 18.

Department of Nephrology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.

Background: The effectiveness of health care and health policy developments are often determined by health-related quality of life (HRQOL) assessment.

Objectives: The objective of this study was to explore the potential corresponding factors and traditional biomarkers of HRQOL in a large number of Iranian hemodialysis patients.

Patients And Methods: A total of 6,930 chronic hemodialysis (HD) patients enrolled. KDCS-SF version 1.3 questionnaire was used to assess the health related quality of life (HRQOL). We pooled PCS, MCS and KDCS scores with random effect model from 19 similar studies performed between 1996 and 2010.

Results: The mean age was 54.4 ± 17.1 years. Mean PCS, MCS and KDCS scores obtained for the study cohort were 40.79 ± 20.10, 47.79 ± 18.31 and 57.97 ± 11.70, respectively; the total score of SF-36 plus KDCS was 51.12 ± 13.41 as well. The most common primary known disease was hypertension (31.9%) and the second etiology was diabetes (25.5%). In multilevel logistic regression, Kt/V between 1 and 1.2 and PCS, KDCS more than 50 were considered as a significant reduction in the risk of hospitalization.

Conclusions: This study showed that PCS and MCS score were slightly more than overall results while KDCS was slightly less than overall results. In addition, dialysis adequacy with Kt/V between 1 and 1.2 is associated with lower rate of hospitalization.
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http://dx.doi.org/10.5812/numonthly.12485DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3842562PMC
September 2013

Seventeen years' experience of peritoneal dialysis in Iran: first official report of the Iranian peritoneal dialysis registry.

Perit Dial Int 2014 Sep-Oct;34(6):636-42. Epub 2013 Jun 3.

Division of Nephrology, Shariati Hospital, and Nephrology Research Center, Tehran University of Medical Sciences, Tehran; Division of Nephrology, Modares Hospital, Shahid Beheshti University of Medical Sciences, Tehran; Division of Nephrology, Sadoughi Hospital, Yazd University of Medical Sciences, Yazd; Division of Nephrology, Ali-ebn Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan; Division of Nephrology, Imam Khomeini Hospital, Urmiah University of Medical Sciences, Urmiah; Division of Nephrology, Imam Hospital, Tabriz University of Medical Sciences, Tabriz; Division of Nephrology, Shafa Hospital, Kerman University of Medical Sciences, Kerman; Pegahsoft, Khorasan Science and Technology Park, Mashad; Division of Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran; and Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background: To facilitate planning, national renal registries provide reliable and up-to-date information on numbers of patients with end-stage renal disease (ESRD), developing trends, treatment modalities, and outcomes. To that end, the present publication represents the first official report from Iranian Peritoneal Dialysis Registry.

Methods: The prevalence, demographics, and clinical characteristics of patients on peritoneal dialysis (PD) were collected from all PD centers throughout the country.

Results: By the end of 2009, the prevalence of ESRD was 507 per million population in Iran. The most common renal replacement modality was hemodialysis (51.2%), followed by kidney transplantation (44.7%), and then PD (4.1%). The mean age of PD patients was 46 years, and the most common causes of ESRD were diabetes (33.5%), hypertension (24.4%), and glomerulonephritis (8.2%). Overall patient mortality was 25%, with cardiac events (46%), cerebral stroke (10%), and infection (8%) being the main causes of death. The 1-, 3-, and 5-year survivals were 89%, 64%, and 49% respectively. The most common cause of dropout was peritonitis (17.6%). Staphylococcus (coagulase-negative and S. aureus) was the most prevalent causative organism in peritonitis episodes; however, in more than 50% of episodes, a sterile culture was reported. Mean baseline serum hemoglobin and albumin were 10.7 g/dL and 3.6 g/dL respectively.

Conclusions: Our registry results, representing the second largest report of PD in the Middle East, is almost comparable to available regional data. We hope that, in future, we can improve our shortcomings and lessen the gap with developed countries.
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http://dx.doi.org/10.3747/pdi.2012.00054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4164408PMC
June 2015

Correlation between ankle-brachial index and microalbuminuria in type 2 diabetes mellitus.

Iran J Kidney Dis 2013 May;7(3):204-9

Nephrology and Kidney Transplant Research Center and Department of Nephrology, Urmia University of Medical Sciences, Urmia, Iran.

Introduction: Microalbuminuria is a reliable marker of diabetic nephropathy. Establishment of peripheral vascular complications leads to early diagnosis, prevention, and treatment of renal and cardiovascular complications. This study investigated the value of ankle-brachial index (ABI) for prediction of microalbuminuria in type 2 diabetic patients.

Materials And Methods: Measurement of ABI with color Doppler ultrasonography was carried out for 206 patients with type 2 diabetes mellitus. An ABI Index less than 0.9 was defined as a predictive marker for atherosclerosis. Microalbuminuria and risk factors of atherosclerosis were compared between the patients categorized based on the ABI values.

Results: The mean ABI was 1.1 ± 0.2 (range, 0.052 to 1.6), and 41 (20%) had an abnormal ABI (< 0.9). The correlations were significant between abnormal ABI and duration of disease (P = .04), cardiovascular event and cardiac care unit admission (P = .001), hypertension (P = .01), and dyslipidemia (P = .01). There was a significant correlation between ABI and microalbuminuria (odds ratio, 0.05; 95% confidence interval, 0.038 to 0.630; P < .001). A cutoff point of an ABI less than or equal to 1.04 had a sensitivity of 71.6% and a specificity of 64.2% for prediction of microalbuminuria.

Conclusions: The ABI is a noninvasive and reliable assay for detection of peripheral and cardiovascular complications, and also early stage of nephropathy in diabetic patients. In patients with an abnormal ABI, long-term follow-up for earlier detection and prevention of complications is helpful.
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May 2013

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

J Cancer 2012 5;3:246-56. Epub 2012 Jun 5.

1. Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, 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.
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http://dx.doi.org/10.7150/jca.3042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3376775PMC
October 2012

A 43 year-old woman with Fever eleven years after kidney transplantation.

Tanaffos 2012 ;11(4):73-5

Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153226PMC
September 2014

Metachronous metastasis to the spermatic cord from renal cell carcinoma presenting as a high scrotal mass: a case report.

Cancer Imaging 2011 Nov 26;11:163-5. Epub 2011 Nov 26.

Department of Radiology, Urmia University of Medical Sciences, Urmia, Iran.

Primary malignant lesions and metastatic carcinomas of the spermatic cord are extremely rare. We present the case of a 57-year-old man, who presented with a painless palpable mass in the left high scrotal area 36 months after radical nephrectomy. The patient had received chemotherapy because of disseminated metastases. There was no sign of local recurrence after 3-month follow-up.
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http://dx.doi.org/10.1102/1470-7330.2011.0029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3266586PMC
November 2011

Epidemiology of culture-negative peritonitis in Iranian patients on continuous ambulatory peritoneal dialysis.

Iran J Kidney Dis 2011 Sep;5(5):332-7

Division of Nephrology, Department of Medicine, Hasheminejad Clinical Research Development Center, Tehran University of Medical Sciences, Tehran, Iran.

Introduction: Culture-negative peritonitis is a major challenge in the treatment of peritonitis in continuous ambulatory peritoneal dialysis (CAPD). This study aimed to evaluate the culture-negative peritonitis in patients from the Iranian CAPD Registry.

Materials And Methods: Data of 1472 patients from 26 CAPD centers were analysed. Peritonitis was defined as any clinical suspicion together with peritoneal leukocyte count of 100/mL and more.

Results: The patients had been on PD for a mean of 500 ± 402 days. There were a total of 660 episodes of peritonitis observed among 299 patients (peritonitis rate of 1 episode in 34.1 patient-months). Excluding patients with both negative and positive culture results, there were 391 episodes of peritonitis in 220 patients (174 culture-positive episodes in 97 patients and 217 culture-negative episodes in 123). The 1- to 4-year patient survival rates were 85%, 75%, 69%, and 59% for the patients with culture-positive peritonitis, and 92%, 78%, 73% and 63% for the patients with culture-negative peritonitis, respectively (P = .34). The technique survival rates were 90%, 57%, 42%, and 27% and 95%, 85%, 74%, and 40%, respectively (P = .001). On follow-up, there were higher rates of active PD patients, lower rates of PD dropouts, and higher rates of kidney transplantation in patients with culture-negative peritonitis compared to those with culture-positive peritonitis.

Conclusions: In our patients, the prevalence of culture-negative peritonitis was high (55.9%). Patient survival with culture-negative peritonitis was comparable to those with culture-positive peritonitis and technique survival was higher among those with culture-negative peritonitis.
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September 2011

Seroprevalence of anti-Helicobacter pylori and anticytotoxin-associated gene A antibodies [corrected] according to ABO blood groups and rhesus status among hemodialysis patients.

Iran J Kidney Dis 2011 Mar;5(2):110-3

Department of Biochemistry, Urmia University of Medical Sciences, Urmia, Iran.

Introduction: Correlation between Helicobacter pylori infection and blood group typing has been widely evaluated in both patients and healthy population. However, data addressing this correlation in hemodialysis patients are scarce. The aim of this study was to evaluate the prevalence of anti-Helicobacter pylori and anticytotoxin-associated gene A (anti-Cag A) antigen antibodies and their correlations with ABO blood groups and rhesus blood group status in hemodialysis patients. MATERIALS AND METHODS; In a cross-sectional study, serum samples of 151 hemodialysis patients were tested for anti-Helicobacter pylori IgG antibody. Anti-Cag A antibody (IgG antibody) was tested in Helicobacter pylori-positive patients. ABO blood groups typing and rhesus status were tested by hemagglutination test.

Results: Prevalence of anti-Helicobacter pylori and anti-Cag A antibodies in Helicobacter pylori-positive patients were 65.6% (99 of 151) and 25.3% (25 of 99), respectively. Prevalence of anti-Helicobacter pylori and anti-Cag A antibodies were 69.1% and 36.8% in patients with blood group A, 42.3% and 9.1% in blood group B, 75.0 % and zero in blood group AB, 69.4% and 23.3% in blood group O, 59.0% and 30.6% in rhesus-positive status and 89.7% and 11.5% in rhesus-negative status, respectively. There was a significant correlation between the presence of anti-Helicobacter pylori and anti-Cag A antibodies and rhesus status, but no significant relation between ABO blood groups and anti-Cag A antibodies were found.

Conclusions: Rhesus status may have an impact on the presence of anti-Helicobacter pylori and anti-Cag A antibodies. More investigations to address this correlation are necessary.
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March 2011

Skin cancer after renal transplantation: Results of a multicenter study in Iran.

Ann Transplant 2010 Jul-Sep;15(3):44-50

Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.

Background: Incidence and risk factors for skin tumors following renal transplantation can vary geographically; therefore, a retrospective study was performed to determine the incidence of and potential risk factors for skin cancer at 14 Transplant Centers in Iran between 1984 and 2008.

Material/methods: We enrolled 11,255 kidney transplant recipients who were examined for all skin tumors. All skin cancers were established by histological examination. The data collection included the patient's age and sex, immunosuppressive regimen before and after diagnosis of tumor, rejection episodes, post-transplant latency period, other concurrent neoplastic problems, renal allograft function and outcome.

Results: One hundred and twenty-eight (1.14%) renal recipients had skin tumor, representing half of all post-transplant malignancies (128 out of 245 cases). Kaposi's sarcoma was the most common post-transplant cancer compared with other skin tumors. Male recipients had more tumors than did females (P=0.04); the male-to-female ratio in the affected patients was 2.5:1. The age at transplantation of patients with skin tumor was higher compared to RTRs without skin tumor (47±11 vs. 38±15 years, P=0.000), and individuals older than 45 years were at higher risk (odds ratio=3.8, 95%CI 2.6-5.5) of skin cancers. Patients consuming azathioprine were at risk more of skin cancer compared with those were on MMF (odds ratio =2.9, 95%, CI 2.0-4.2). The overall mortality was low (7.8%) in cases with skin cancer.

Conclusions: This study showed that male sex, increased age, prolonged immunosuppression and azathioprine increased the risk of skin tumors after renal transplantation.
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March 2011

Extranodal diffuse large B-cell lymphoma confined to liver in a kidney transplant recipient.

Iran J Kidney Dis 2010 Oct;4(4):336-9

Division of Nephrology, Department of Internal Medicine and Nephrourology and Transplant Research Center, Urmia University of Medical Sciences, Iran.

Posttransplant lymphoproliferative disorder (PTLD) is a well-documented complication that arises as a result of immunosuppression in the setting of solid organ or bone marrow transplantation. The disorder may be subtle and/or extranodal. We report a patient with extranodal lymphoma following kidney transplantation who had successful treatment with surgery and chemotherapy.
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October 2010

Glutathione, glutathione-related enzymes, and total antioxidant capacity in patients on maintenance dialysis.

Iran J Kidney Dis 2009 Jan;3(1):22-7

Division of Nephrology, Department of Internal Medicine, Shahid Labbafinejad Medical Center, Shahid Beheshti University (MC), Tehran, Iran.

Introduction: Oxidative stress due to overproduction of reactive oxygen species and impairment in antioxidant defense mechanisms have been suggested as possible factors contributing to the pathogenesis of atherosclerosis in patients with end-stage renal disease. We compared glutathione levels, glutathione peroxidase and glutathione reductase activities, and total antioxidant capacity between patients on hemodialysis and peritoneal dialysis and healthy individuals.

Materials And Methods: Thirty patients receiving regular hemodialysis and 12 on continuous ambulatory peritoneal dialysis were recruited as well as 25 healthy volunteers. Diabetes mellitus, recent febrile or infectious episodes, and hospitalization during the past month were the exclusion criteria. Erythrocyte glutathione level, plasma activities of glutathione peroxidase and glutathione reductase, total antioxidant capacity were determined and compared between the three studied groups.

Results: Glutathione levels and glutathione peroxidase activity were markedly lower in the patient groups than in the controls. Conversely, higher activity of glutathione reductase and total antioxidant capacity were noted in the patients than in the controls. There were no significant differences between antioxidant markers of the patients on hemodialysis and peritoneal dialysis. Strong positive correlation were observed between total antioxidant capacity and uric acid in the patients (r = 0.59, P = .045 and r = 0.63, P = .03, respectively).

Conclusions: Although total antioxidant capacity of plasma is increased in patient on dialysis, depletion of glutathione as a key antioxidant component and disturbances in its related enzymes show oxidative stress. This condition may increase the risk of developing cardiovascular disease in patients with end-stage renal disease.
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January 2009