Background: Cardiovascular complications represent a major contributor to morbidity and mortality among patients with chronic kidney disease (CKD), especially those undergoing maintenance hemodialysis (MHD), because of complex metabolic, inflammatory, and nutritional disturbances. Objectives: We aimed to investigate the relationship between plasma total iron-binding capacity (TIBC) concentration and low phase angle (PhA) with major adverse cardiovascular events (MACEs) and mortality in patients undergoing MHD. Methods: A retrospective cohort study was conducted in 182 patients undergoing MHD, with a mean age of 50.21 ± 15.45 years; 51.6% were male, and 48.4% were female. Plasma TIBC levels were measured using an enzyme-linked immunosorbent assay (ELISA), and PhA was determined by automatic segmental bioimpedance analysis (BIA) at 50 kHz using an InBody S10 device. Major adverse cardiovascular events were diagnosed by a cardiologist, and all-cause mortality data were collected over a 3-year follow-up period from study baseline. Results: The prevalence of MACEs was 26.4%, and all-cause mortality was 12.6%. Higher plasma parathyroid hormone (PTH) and high-sensitivity C-reactive protein (hs-CRP) levels and lower plasma TIBC and PhA values were independently associated with both MACEs and mortality. TIBC and PhA were valuable predictors of MACEs, with areas under the curve (AUCs) of 0.796 and 0.895, respectively (P < 0.001), and all-cause mortality, with AUCs of 0.843 and 0.898, respectively (P < 0.001). Conclusions: Low plasma TIBC and low bioimpedance-derived PhA are associated with a higher risk of MACEs and all-cause mortality in patients undergoing MHD.
Context: Nocturnal enuresis (NE) is a prevalent pediatric condition associated with significant psychological and social burden. Despite the availability of various treatment modalities, direct comparisons of their efficacy and safety remain limited. Objectives: This umbrella review synthesizes evidence from published systematic reviews and meta-analyses to provide a comprehensive assessment of current interventions for NE. Data Sources: A systematic literature search was conducted in Scopus, PubMed, Embase, ISI Web of Science, and Google Scholar up to September 2024, following PRISMA guidelines and a registered PROSPERO protocol. Study Selection: Eligible studies were meta-analyses or systematic reviews reporting pooled effect estimates for NE treatments in children. Data Extraction: Data extraction included efficacy outcomes (odds ratios [OR], 95% confidence intervals [CI]), adverse event profiles, and study quality, assessed using AMSTAR-2 and GRADE frameworks. Results: Five meta-analyses encompassing 45 clinical trials and 4,134 participants met the inclusion criteria. Among placebo-controlled comparisons, electrical stimulation demonstrated the highest efficacy (OR = 22.01, 95% CI: 8.62 - 56.17, P < 0.001), with only mild skin irritation reported as an adverse event. In head-to-head active treatment comparisons, Tuina showed greater efficacy than herbal medicine (OR = 11.26, 95% CI: 5.38 - 23.57, P < 0.001) and other traditional Chinese medicine modalities (OR = 6.11, 95% CI: 3.87 - 9.65, P < 0.001), with no reported adverse events. Notably, the certainty of evidence for conventional interventions (electrical stimulation, desmopressin, alarm therapy) was moderate to high, while evidence for traditional Chinese medicine modalities was low to moderate due to risk of bias in underlying studies. Combination therapies (Tuina plus acupuncture or herbal medicine) outperformed monotherapies and were well tolerated. Laser acupuncture was superior to sham laser (OR = 6.80, 95% CI: 2.15 - 21.53, P = 0.001), but not to desmopressin. Alarm therapy showed comparable efficacy to desmopressin but was associated with a moderate risk of sleep disturbance and skin irritation. Across all interventions, safety profiles were generally favorable, with most classified as low risk for adverse events. Conclusions: Electrical stimulation demonstrated the highest efficacy with moderate-to-high certainty evidence. Tuina and related traditional Chinese medicine modalities showed efficacy in head-to-head comparisons but with lower overall certainty of evidence. Most interventions exhibited favorable safety profiles. However, the heterogeneity of comparators and limited direct head-to-head evidence highlight the need for further high-quality randomized trials and network meta-analyses. These findings can inform individualized, evidence-based management of NE in pediatric populations.
Background: Zinc is an essential supplement in brain function and in inflammation, helps to regenerate damaged tissues, and regulates inflammatory cytokines. However, its relationship with diagnostic indicators such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) is controversial. Objectives: Since there are no clear results regarding its relationship with procalcitonin (PCT), this study sought to investigate this relationship and the diagnostic value of zinc. Methods: This cross-sectional study was conducted on 93 children with urinary tract infection (UTI) referred to Bandar Abbas Children’s Hospital over a one-year period (2023 - 2024). Demographic data (age, sex), clinical findings (symptoms, fever, physical examination), and laboratory parameters including complete blood count with differential, CRP, ESR, serum creatinine (Cr), sodium (Na), potassium (K), zinc, and PCT levels were collected using a researcher-designed questionnaire. Statistical analyses were performed to assess correlations between serum zinc levels and inflammatory markers. Results: The mean serum zinc level of the patients was 53.49 ± 8.95 μg/L, and the serum PCT level was 2.67 ± 0.67 ng/mL. Correlation tests showed that the relationship between zinc and PCT (ρ = 0.064, P = 0.545), zinc and CRP (ρ = 0.192, P = 0.065), and zinc and ESR (ρ = -0.103, P = 0.325) was not statistically significant. Also, comparison between different pathogens (Escherichia coli and Klebsiella) did not show significant differences in zinc and PCT levels (P > 0.05). Conclusions: In children with UTIs, serum zinc levels did not show a significant correlation with inflammatory markers such as PCT, CRP, and ESR, and there were no notable differences based on the specific pathogen involved. These results indicate that zinc may have a minimal impact on acute inflammatory responses in pediatric UTIs. It is suggested that further research with larger sample sizes and long-term studies be conducted to better understand the possible clinical significance of zinc.
Background: Male idiopathic infertility is characterized by abnormal semen parameters, including sperm concentration, motility, and morphology. Various hormonal and experimental therapies are employed to address this condition. Objectives: This study investigates the effect of sesame on sperm concentration, morphology, and motility in infertile men compared to combination drug therapy. Materials and Methods: In this retrospective cohort study, 80 infertile men with abnormal semen parameters, referred to the infertility clinics of Fatemieh Hospital and Shahid Beheshti Hospital in Hamadan, Iran, were included. Participants were divided into two groups: One receiving combination drug therapy (e.g., FertilAid, n = 40) and the other receiving black sesame seeds (30 g/day, n = 40). Semen parameters were evaluated before and three months after treatment using Computer-assisted Sperm Analysis (CASA). Statistical analysis was performed using paired t-tests and independent t-tests, with a significance level of P < 0.05. Results: Post-intervention, sperm motility was 42.6 ± 9.23% in the sesame group vs. 44.02 ± 6.61% in the combination drug group (P = 0.43), concentration was 33.82 ± 10.8 million/mL vs. 46.57 ± 9.62 million/mL (P < 0.001), and morphology was 27.22 ± 10.23% vs. 28 ± 7.59% (P = 0.58). Within-group analysis showed significant improvements in all parameters for both groups (P < 0.001). Conclusions: Both sesame and combination drug therapy improved sperm parameters, with combination drugs showing greater efficacy in enhancing sperm count and motility, while sesame significantly improved morphology.
Background: The selection of the optimal calyx for access is a critical step in percutaneous nephrolithotomy (PCNL). Whether the hydrostatic status of the accessed calyx influences outcomes remains unclear. Objectives: This study aimed to compare postoperative outcomes and complications in patients undergoing PCNL with access to hydronephrotic versus non-hydronephrotic calyces. Methods: We conducted a retrospective analytical study of 170 adult patients who underwent PCNL between January 2021 and December 2023. Patients were stratified into two groups based on calyceal status: Hydronephrotic (n = 85) and non-hydronephrotic (n = 85). Data on demographic, operative, and postoperative outcomes were collected and analyzed using appropriate descriptive and inferential statistics. Results: The two groups were comparable in baseline characteristics. Key perioperative outcomes showed no significant differences: Stone-free rate (SFR) (92.8% vs. 93.6%, P = 0.78), hemoglobin drop (2.1 ± 1.5 g/dL vs. 2.3 ± 1.7 g/dL, P = 0.35), blood transfusion rate (5.9% vs. 8.2%, P = 0.54), sepsis (9.4% vs. 12.0%, P = 0.45), and hospital stay (4.5 ± 2.1 days vs. 4.7 ± 2.3 days, P = 0.41). However, access through a hydronephrotic calyx was associated with a significantly higher incidence of chronic kidney disease (CKD) progression during (12-month) follow-up (22.4% vs. 5.9%, P < 0.001). Conclusions: Accessing a hydronephrotic calyx during PCNL is as safe and effective as accessing a non-hydronephrotic one in the immediate perioperative period. However, it is an independent and significant predictor of CKD progression, highlighting the importance of preoperative identification and long-term renal monitoring in these patients.
Background: Benign prostatic hyperplasia (BPH) is common in older men and is associated with reduced quality of life and increased healthcare costs. Transurethral resection of the prostate (TURP), as a standard surgical treatment, is associated with a significant risk of bleeding, partly due to activation of local fibrinolytic pathways. Although tranexamic acid (TXA) has been shown to reduce bleeding in various surgical settings, the efficacy of topical TXA administered via irrigation fluid during TURP remains controversial. Objectives: The aim of this study was to investigate the effect of topically administered TXA in irrigation fluid on TURP-related intraoperative and postoperative bleeding. Methods: A clinical study including 54 patients who were candidates for TURP was conducted in the urology clinic of Golestan Hospital, Ahvaz, over a period of one year. Patients were randomly divided into two groups: TXA and control. Prostate volume, hemoglobin, blood pressure, estimated intraoperative blood loss, irrigation fluid volume, operative time, and the need for transfusion during and after the procedure were recorded. Results: Baseline characteristics of the patients in the two groups were similar (age, prostate volume, hemoglobin, and blood pressure; P > 0.05). The decrease in hemoglobin at 24 hours after surgery was less in the TXA group than in the control group (P = 0.04). Intraoperative blood loss was significantly lower in the TXA group compared with the control group (P = 0.03). Conclusions: Baseline characteristics showed that the two groups were homogeneous in age, prostate volume, hemoglobin, and blood pressure. Hemoglobin decreases at 24 hours post-surgery and intraoperative bleeding were lower in the TXA group than in the placebo group, while lavage volume and operation duration did not differ. These findings suggest an association between topical TXA use and reduced perioperative bleeding during TURP; however, further studies using adjusted statistical models are required to confirm an independent effect.
Background: Percutaneous nephrolithotomy (PCNL) is the gold-standard treatment for large renal stones. The prone position, traditionally used, may impair cardiopulmonary function due to thoracoabdominal compression, whereas the supine position offers potential physiological and practical advantages. Objectives: To compare intraoperative hemodynamic and respiratory stability between supine and prone PCNL. Methods: This single-center retrospective cohort study analyzed 40 patients (supine = 20, prone = 20) undergoing PCNL between January-December 2023. Inclusion criteria were age ≥ 18 years, American Society of Anesthesiologists (ASA) I/II, and renal pelvic stones ≥ 2 cm. Groups were matched for age, sex, BMI, stone size, and ASA status. All procedures followed a standardized anesthetic protocol. Primary outcomes were intraoperative blood pressure, heart rate (HR), oxygen saturation (SpO₂), and end-tidal carbon dioxide (ETCO₂). Secondary outcomes included fluid administration, anesthesia duration, and operative time. Data were analyzed using independent t-tests; estimates are unadjusted. Results: The prone position was associated with significant hemodynamic instability, manifesting as profoundly lower SBP and DBP and a higher HR throughout the procedure (e.g., at 80 min: SBP 89.5 ± 4.6 vs. 133.3 ± 12.4 mmHg, P < 0.001; HR 114.8 ± 11.8 vs. 75.8 ± 3.4 bpm, P < 0.001). Pulmonary function was also compromised in the prone group, as evidenced by significantly lower SpO₂ (nadir: 96.8 ± 1.3% vs. 100%, P < 0.001) and elevated ETCO₂ (peak: 40.9 ± 1.2 vs. 34.9 ± 0.4 mmHg, P < 0.001). Furthermore, patients in the prone position required greater intraoperative fluid resuscitation (1950.0 ± 484.0 mL vs. 1475.0 ± 472.3 mL, P = 0.003) and experienced a longer anesthesia duration (158.3 ± 25.0 vs. 118.3 ± 18.3 min, P < 0.001). Operative time, complications, and stone-free rates (SFRs) were comparable among the groups. Conclusions: Supine PCNL may offer superior intraoperative physiological stability, with improved hemodynamics, preserved respiratory function, reduced fluid needs, and shorter anesthesia duration, without compromising surgical efficacy. These findings support supine positioning as a potentially safer alternative for selected patients, though further prospective validation is warranted.
Background: Vancomycin-induced nephrotoxicity is a well-documented adverse effect, occurring in 5 - 25% of patients, primarily due to the production of free radicals and reactive oxygen species. Objectives: This study aimed to evaluate the potential protective effect of theophylline against vancomycin-induced nephropathy. Methods: A two-group, single-blind randomized clinical trial was conducted at Heshmatieh Subspecialty Hospital in Sabzevar, Iran. Sixty-eight children were randomly assigned to either an intervention group (n = 34) or a control group (n = 34) using permuted block randomization. The primary analysis followed the intention-to-treat (ITT) principle using the last observation carried forward (LOCF) method; a per-protocol (PP) analysis was also conducted for sensitivity. Participants were divided into two groups: The intervention group received theophylline alongside vancomycin, while the control group received vancomycin alone. Serum and urine samples were collected at baseline and on the 3rd, 10th, and 30th days of treatment. Measurements included serum levels of blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR), and urinary microalbumin. Data were analyzed using the independent t-test, Mann-Whitney U test, and chi-square test. A repeated-measures ANOVA was conducted to assess changes over time, with Greenhouse-Geisser correction applied where sphericity was violated. Results: The mean urinary microalbumin levels on the 3rd, 10th, and 30th days post-treatment in the intervention group showed a notable decrease compared to the control group. The differences were statistically significant on the 10th and 30th days (P = 0.023 and P = 0.048, respectively). Additionally, the mean BUN levels decreased, and the eGFR increased in the intervention group compared to the control group over the same time points. The changes in BUN were significant on the 10th and 30th days (P = 0.031 and P = 0.045, respectively), while the changes in eGFR were significant on the 10th and 30th days (P = 0.016 and P = 0.039, respectively). No significant differences were observed on the 3rd day for BUN (P = 0.683) or eGFR (P = 0.282). It is important to note that urinary microalbumin values remained within the normal range (< 30 mg/g creatinine) in both groups throughout the study, suggesting these changes may reflect subclinical rather than clinically overt kidney injury. Conclusions: The results showed that theophylline may attenuate vancomycin-induced nephrotoxicity, as reflected by improvements in renal biomarkers. However, the clinical relevance of these biomarker changes requires further validation through trials using standardized clinical endpoints such as KDIGO-defined acute kidney injury (AKI).
Context: Up to half of multiple myeloma (MM) patients develop renal impairment from elevated free light chains (FLCs). Plasmapheresis can rapidly reduce FLCs, but its clinical benefit remains unclear. This systematic review therefore evaluated the efficacy of plasmapheresis as an adjunct to chemotherapy in treating multiple myeloma-related renal failure (MM-RF). Evidence Acquisition: A comprehensive literature search was performed covering PubMed, Web of Science, Cochrane Library, Embase, and Google Scholar databases from inception to October 2025. All steps were performed by two independent reviewers and any discrepancies between reviewers were resolved through discussion or adjudication by a third reviewer. Results: Eight studies were included, three randomized clinical trials (RCTs) (n = 147) and five observational studies (n = 157). Evidence for survival benefit was inconsistent. One small RCT reported a significant improvement in survival in the plasmapheresis group (66% vs 28%) over the reported study follow-up period, whereas the largest RCT and all observational studies with variable follow-up durations found no difference in survival between plasmapheresis plus chemotherapy and chemotherapy alone. Two RCTs showed greater reductions in serum creatinine and dialysis dependence with plasmapheresis, but these findings were not replicated in the largest RCT or in the observational studies, which showed no clear renal benefit. Conclusions: In conclusion, although plasmapheresis may offer some renal recovery benefits in select patients, the current evidence does not demonstrate a meaningful improvement in either renal outcomes or survival in MM-RF. More well-designed, large-scale randomized trials and observational prospective studies are needed to evaluate plasmapheresis in combination with modern anti-myeloma therapies.
Background: Staphylococcus aureus nasal carriage is a significant risk factor for infections in hemodialysis patients. Objectives: This study aimed to investigate the prevalence of nasal S. aureus carriers, determine antibiotic resistance patterns, and assess the association with catheter-related infections in hemodialysis patients. Methods: This retrospective cohort study included 176 hemodialysis patients at Shahid Beheshti Hospital in Hamadan, Iran, from October 2022 to October 2023, who were selected via the census method. Nasal swabs were cultured, and S. aureus isolates underwent antibiotic susceptibility testing. Patient demographics, clinical data, and history of catheter-related infections were collected. Results: Of the 176 hemodialysis patients, 31 (17.5%) were nasal S. aureus carriers. Among these isolates, 64.6% were methicillin-sensitive S. aureus (MSSA), 16.1% were methicillin-resistant S. aureus (MRSA), and 19.3% showed inducible clindamycin resistance. The highest antibiotic sensitivity was to rifampin (90.3%), followed by cefotaxime and cefazolin (80.6% each). The highest resistance was to penicillin (87.1%) and amoxicillin (77.4%). A significant association was found between positive nasal cultures and the frequency of catheter-related bloodstream infections (P = 0.009). Conclusions: The prevalence of MRSA and antibiotic resistance in hemodialysis patients is concerning. Nasal S. aureus carriage was associated with an increased risk of recurrent catheter-related infections. Regular screening, decolonization, and updated empirical antibiotic selection and infection control measures may help reduce infection rates in this vulnerable population.
Background: Hemorrhage remains a major concern during percutaneous nephrolithotomy (PCNL). The present study focused on determining the contributing factors to blood loss throughout the procedure. Methods: In this prospective study, we assessed 412 individuals who underwent PCNL at our center from June 2020 to June 2024. Hemoglobin drop post-surgery, adjusted for transfused blood volume, was used to estimate total blood loss. A stepwise multivariate regression model was applied to explore the correlations between bleeding volume or transfusion requirement and multiple patient-specific or procedural variables. Results: The average hemoglobin reduction observed was 1.57 ± 2.43 g/dL. Significant predictors of blood loss included Body Mass Index (BMI) (P < 0.05), stone dimensions (P < 0.05), presence of multiple stones (P < 0.05), upper calyceal stone location (P < 0.05), insertion of two or more nephrostomy tubes (P < 0.05), surgery duration (P < 0.05), and diabetes (P < 0.05). A transfusion was required in 3.5% of patients. Conclusions: Increased intraoperative blood loss following PCNL was significantly associated with higher BMI, greater stone burden, multiple stones, upper calyceal location, prolonged surgical time, multiple nephrostomy insertions, and diabetes mellitus.
Background: Aluminum toxicity has been a significant concern in patients with end-stage renal disease (ESRD). Most of the time, aluminum toxicity is an accidental event due to water contamination. Objectives: The present study aimed to discuss aluminum poisoning in peritoneal dialysis patients during 2024. Methods: In this cross-sectional study, patients’ demographic data were extracted from their electronic files. The frequency of signs and symptoms and the efficacy of treatment protocols, based on the national guideline for aluminum poisoning treatment, were investigated. Treatment protocols are based on serum aluminum levels: Twenty to 60 mcg/L, 60 to 200 mcg/L, and more than 200 mcg/L. These protocols include increased peritoneal dialysis sessions with different solutions, hemodialysis, intravenous deferoxamine (DFO), or a combination of these treatments. Results: The study focused on 73 patients undergoing peritoneal dialysis at Khurshid Hospital. Among the 73 patients, 49 (67.1%) were male and 24 (32.9%) were female. The primary cause of ESRD in this group was diabetic nephropathy, affecting 60.3% of the patients. The most common neurological symptom observed was tremor, affecting 21 patients (29%). Weakness and lethargy were reported in 16 patients (22%). Hallucinations occurred in four patients (5.5%), and nine patients (12.3%) experienced restlessness. Sixty-three percent of patients were symptomatic at the beginning of the study, and 93.2% were asymptomatic after eight weeks of appropriate therapy. Conclusions: In individuals with ESRD who are receiving hemodialysis or peritoneal dialysis and present with unusual neurological symptoms and hypotension, the possibility of poisoning with heavy metals or aluminum must be considered. Clinicians should be vigilant for these symptoms.
Introduction: Non-obstructive azoospermia (NOA) is often considered the most severe spectrum of male infertility. Focal spermatogenesis that occurs in NOA patients has made successful sperm retrieval very challenging. Testicular mapping biopsy is a minimally invasive sperm retrieval technique that provides significant information concerning focal spermatogenesis in NOA patients. This case series describes the early clinical experience and results of testicular mapping biopsy in Indonesian patients with NOA. It includes patients who have a history of unsuccessful testicular sperm extraction (TESE) procedures. Case Presentation: In this case series, we report the first 6 testicular mapping biopsy cases performed in Indonesia. These patients were previously screened for every possible male infertility etiology. Our patients presented with different underlying pathologies for male infertility, such as hormonal impairment, varicocele, and gr/gr deletion. Thereafter, patients were thoroughly counseled for testicular mapping biopsy. Our first experience with testicular mapping biopsy shows promising results with a 57.2% sperm retrieval rate. There were 2 out of 4 (50%) patients who had successful sperm retrieval by testicular mapping biopsy after previously failed TESE. There were no adverse effects of this procedure in all cases. Discussion: Testicular mapping biopsy is a novel sperm retrieval technique to treat NOA patients. The sperm retrieval rate of this procedure is comparable to TESE/microsurgical testicular sperm extraction (microTESE), with the advantage of minimal invasiveness and providing valuable information concerning focal spermatogenesis. Testicular mapping biopsy can also help treat NOA patients with previously failed TESE/microTESE. This procedure is well tolerated, with mild side effects such as spermatic cord hematoma, painless gross hematospermia, and pain. All complications were resolved within a week. Conclusions: Testicular mapping biopsy is a novel technique for treating NOA. It has a relatively high sperm retrieval rate comparable to TESE and microTESE. Furthermore, testicular mapping biopsy opens the possibility of sperm retrieval for patients with previously failed TESE or microTESE. The procedure is also well-tolerated by patients and does not have the adverse effect of reduced testosterone and potential hypogonadism as is the case with TESE or microTESE.
Background: Osteoporosis is characterized by decreased bone strength and a higher fracture risk. Objectives: This study aimed to compare computed tomography (CT) scans and bone densitometry for diagnosing osteoporosis and osteopenia. Methods: A descriptive-analytical cross-sectional study was conducted on 322 kidney failure patients admitted to Baqiyatallah Hospital in 2021. Descriptive statistics (mean, standard deviation, frequency, minimum, and maximum) and logistic regression analysis were utilized. Data were collected and entered into SPSS software version 24, and descriptive and inferential statistics were applied. A significance level of 5% was established. Results: The data demonstrated a significant linear relationship between CT scan-based bone density of the L1 vertebra and spine bone density measurement (Pearson’s R = 0.58, P ≤ 0.001). Although a significant linear relationship was observed between L1 bone density via CT scan and femur bone density measurement (Pearson’s R = 0.44, P ≤ 0.001), this correlation was weaker than that of spine bone density measurements. Spearman’s rank correlation test revealed a marginally significant linear relationship between L1 bone density using CT scan and forearm bone density measurement (ρ = 0.20, P = 0.05). After categorizing the data into normal, osteopenia, and osteoporosis groups, Spearman’s test indicated a significant linear relationship between L1 bone density and femur bone density (ρ = 0.48, P ≤ 0.001). Similarly, when the data were grouped into these categories, a marginally significant linear relationship was observed between L1 bone density by CT scan and forearm bone density (Spearman’s ρ = 0.20, P = 0.05). Conclusions: The findings highlight a significant relationship between CT scan-based L1 bone density and bone density measurements of the spine, femur, and forearm, with the strongest correlation observed in spine measurements. Therefore, utilizing L1 bone density assessment via CT scans — a non-invasive method often performed for other clinical purposes — can serve as an opportunistic tool for osteoporosis and osteopenia screening. This approach not only reduces costs but also facilitates early detection of osteoporosis.
Background: Vancomycin-associated acute kidney injury (AKI) is a commonly reported adverse event in pediatric patients receiving vancomycin. Objectives: This study evaluated the protective effects of montelukast on vancomycin-induced renal injury in children. Methods: This randomized, double-blind, controlled trial was conducted at Amir Kabir Hospital in Arak, Iran, involving 40 children older than 2 years who were prescribed vancomycin. Participants were randomly assigned (1:1) to receive either montelukast plus standard care or standard care alone. Randomization was performed using a computer-generated sequence, with allocation concealment ensured by sequentially numbered, opaque, sealed envelopes (SNOSE) prepared by an independent researcher. Participants, caregivers, treating physicians, and outcome assessors were all blinded to group assignments. Serum creatinine levels were measured at baseline and three days after starting vancomycin. A change in serum creatinine ≥ 0.3 mg/dL was considered indicative of AKI. This study was funded by Arak University of Medical Sciences (grant No: 6625). Results: Among 40 evaluated cases, the mean ± SD age in the montelukast group was 5.95 ± 3.42 years and in the control group was 5.42 ± 3.50 years. The male-to-female ratio in the montelukast group was 10/10 (50/50%), and in the control group was 8/12 (40/60%). In the montelukast group, creatinine before treatment was 0.68 ± 0.23 mg/dL, and after treatment was 0.39 ± 0.13 mg/dL (P = 0.0001). In the control group, creatinine before treatment was 0.55 ± 0.15 mg/dL, and after treatment was 0.48 ± 0.15 mg/dL (P = 0.080). Conclusions: The results of the present study indicate that montelukast, when administered alongside vancomycin, leads to a decrease in serum creatinine levels in pediatric patients.
Background and Objectives: This study investigates the relationship between prostate volume, blood prostate-specific antigen (PSA) concentration, and 12 hematological variables in patients with benign prostatic hyperplasia (BPH). Methods: Data for 12 hematological traits were extracted from the records of 166 hospitalized patients at Ashayer Hospital in Khorramabad during 2021 - 2022 and analyzed using correlation and regression procedures in SAS statistical software. Results: Significant correlations were identified between PSA concentration and mean corpuscular volume (MCV), platelet count, and red cell distribution width (RDW). The highest correlation coefficients for PSA were with MCV (0.316) and platelet count (0.305). Multiple linear regression models identified key variables, including patient age, white blood cell (WBC) count, platelet count, and RDW. Models for estimating PSA concentration demonstrated higher statistical validity (R2 = 0.510 to 0.540) than those for prostate volume, likely due to stronger phenotypic associations with hematological traits. Specific hematological traits with the lowest tolerance and highest variance inflation factor (VIF) included neutrophil percentage, lymphocyte percentage, red blood cell (RBC) count, hemoglobin concentration, and hematocrit percentage. Conclusions: Hematological parameters were less effective in predicting prostate volume but valuable for estimating serum PSA concentration, offering potential insights for diagnostic models in BPH. However, these findings should be interpreted cautiously given study limitations, such as the retrospective design.
Background: Primary nocturnal enuresis (PNE) is a common pediatric condition with a multifactorial etiology, involving both neurodevelopmental and nutritional factors. Recent evidence suggests that folic acid may contribute to neural maturation and bladder control. Objectives: The present study aimed to evaluate the therapeutic effect of folic acid supplementation on the frequency and severity of PNE in children. Methods: In a double-blind, randomized controlled trial, 68 children aged 5 - 18 years diagnosed with PNE were assigned to receive either folic acid supplementation or placebo over a sixty-day period. Baseline and post-treatment assessments included enuresis frequency and urinary control parameters. The number of dry nights was recorded at baseline, month 1, and month 2. Group-level means and standard deviations were compared using independent t-tests. Effect sizes (Cohen’s d) and percentage changes from baseline were calculated to assess the magnitude and clinical relevance of the intervention’s impact. Results: At baseline, there was no significant difference in the number of dry nights between groups (intervention: 19.2 ± 3.7; control: 18.9 ± 4.3; P = 0.63). By month 1, the intervention group showed greater improvement (24.5 ± 4.8 vs. 22.4 ± 5.1 dry nights; adjusted mean difference = 2.1, 95% CI: 0.9 - 3.3; P = 0.0004; Cohen’s d = 0.42). At month 2, this difference further increased (26.0 ± 4.6 vs. 23.2 ± 4.6; adjusted mean difference = 2.8, 95% CI: 1.7 - 3.9; P < 0.0001; Cohen’s d = 0.61). The intervention group achieved a 35.4% increase in dry nights from baseline, compared with 22.8% in the control group, indicating a moderate to large and clinically meaningful treatment effect. Conclusions: Folic acid supplementation may offer a safe and effective adjunctive treatment for PNE, potentially through its role in neurodevelopmental regulation. Further studies are warranted to confirm these findings and to explore the underlying mechanisms.
Context: Monosymptomatic nocturnal enuresis (MNE) is the most common type of enuresis. Desmopressin is the most widely used pharmacological treatment for MNE, while combination therapy with anticholinergics is recommended for patients who are refractory to monotherapy. Objectives: This meta-analysis aims to evaluate the efficacy and safety of combination therapy (desmopressin with an anticholinergic agent) compared with desmopressin alone in the treatment of MNE. Methods: A comprehensive search was conducted across multiple databases, including Cochrane, Scopus, ScienceDirect, PubMed, and Embase, along with manual searching. Clinical trials were included in this meta-analysis, specifically focusing on the comparison between desmopressin combined with an anticholinergic agent and desmopressin alone in pediatric patients with MNE. The primary outcomes assessed were complete remission (90 - 100% reduction in mean wet nights compared to baseline) and partial remission (50 - 90% reduction), with the latter being considered as part of total remission (sum of complete and partial remission). The secondary outcome measured adverse effects. The risk of bias was evaluated using Cochrane tools, and a forest plot was generated using Review Manager 5.4. Results: Eleven studies involving 872 pediatric patients (aged 5 to 17 years) with MNE were included in this meta-analysis. The analysis assessed the efficacy of desmopressin combined with anticholinergics compared to desmopressin as monotherapy in achieving remission of enuresis at one month and three months after initiating therapy. Results demonstrated that combination therapy yielded favorable outcomes for enuresis remission. At one month, the risk ratio (RR) for complete remission favored combination therapy (RR: 1.52, 95% CI 1.14 - 2.02), as did the RR for total remission (RR: 1.15, 95% CI 1.02 - 1.30). However, both outcomes exhibited heterogeneity (I²: 71% and 59%, respectively). At three months, the combination therapy continued to show benefits, with a RR of 1.34 (95% CI 1.11 - 1.63) for complete remission and 1.10 (95% CI 1.00 - 1.21) for total remission, although the statistical significance was weaker (P = 0.003 and P = 0.05, respectively). Both treatment groups reported minor side effects. Conclusions: Combination therapy of desmopressin and anticholinergics showed favorable outcomes for enuresis remission. Further research is required to explore the long-term benefits and potential side effects.
Background: Pauci-immune crescentic glomerulonephritis (GN) refers to a category of necrotizing GN in which there are no or only a few immune deposits by immunofluorescence. They constitute a distinct yet important cause of rapidly progressive GN. Objectives: To assess the clinical, histological, biochemical, and serological characteristics of patients diagnosed with idiopathic anti-neutrophil cytoplasmic autoantibodies (ANCAs)-negative renal-limited pauci-immune crescentic GN, the treatment outcomes, and the possible role of the alternative complement pathway in etiopathogenesis. Methods: This study included a total of 21 adult patients (≥ 18 years) with renal biopsy-proven pauci-immune crescentic GN with ANCA negativity. Patients with renal biopsy indicating more than 10% crescents were eligible for inclusion, while those with crescentic GN due to secondary causes and individuals who later tested positive for immune markers during the study period were excluded from this study. A complete remission is defined as normalization of serum creatinine, normal serum C3 levels, and 24-hour urine protein excretion of < 300 mg per day. "No remission" is defined as dialysis dependence, failure of serum creatinine, and 24-hour urine protein to decrease by > 50% from the baseline towards the end of the treatment. Anyone who showed a tendency towards remission but didn’t meet the above criteria was said to have attained partial remission. Results: A total of 11 patients (52.4%) achieved either complete or partial remission with Rituximab/plasma exchange or both. The clinical remission was more among patients with cellular and non-circumferential crescents and with crescents less than 25%. Patients who received a combined rituximab and plasma exchange therapy showed a better clinical tendency towards remission, though a statistical significance could not be attached to any of the above parameters and to the outcome, given the smaller sample size. There was involvement of the alternative complement pathway in 38% (8) of the patients. Conclusions: The ANCA-negative idiopathic pauci-immune type accounts for less than five percent of crescentic GN. Patients with cellular, non-circumferential crescents and crescents of < 25% have a better prognosis. Though being referred to as pauci-immune, the alternative complement pathway is implicated in the pathogenesis in a small percentage of this distinctive group.
Background: Radical hysterectomies are known to affect the lower urinary tract, with the intensity being directly proportional to the radicality of the hysterectomy. Currently, very few studies suggest that a reduction in the radicality of hysterectomy might decrease urological morbidity. Objectives: The present study primarily aimed to compare the uroflowmetry parameters and symptoms score (ICIQ-FLUTS) in patients before and after undergoing open abdominal hysterectomy and secondarily to compare the results in the present study with those in the literature worldwide. Methods: This prospective cohort study was conducted in Belagavi, Karnataka, India, from February 2023 to July 2024 on 30 patients. Uroflowmetry and ICIQ-FLUTS were recorded 1 day preoperatively and postoperatively on days 10, 30, 90, and 180. Data were entered in Excel and analyzed using SPSS version 22.0. Intergroup comparisons of continuous means were performed using one-way ANOVA, and intragroup comparisons were analyzed post hoc using LSD analysis. Results: In the 30 samples collected, the mean age was 51.90 ± 11.98 years, and the mean time for surgery was 1 hour 39 minutes ± 33 minutes. Twenty percent, 43.33%, and 36.7% of patients underwent Wertheim’s hysterectomy, simple hysterectomy, and total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAHBSO) + omentectomy/bilateral pelvic lymph node dissection (PLND), respectively. The mean blood transfusion required was 0.2 pints. Time for surgery and the need for blood transfusion were considered surrogates for the complexity of surgery. No statistically significant difference was noted when the results were compared as per the study protocol. Conclusions: Current nerve-sparing hysterectomies are associated with minimal urological morbidities and provide a good quality of life, and thus should be performed whenever possible. However, the results are not generalizable.
