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Background and purpose: Laparoscopic donor nephrectomy is an appropriate alternative for open donor nephrectomy in kidney transplant. The latter has been applied in most health centers for 50 years and it has been proven that unilateral nephrechtomy (laparotomy) is safe for the doner and so the remaining kidney can handle its function well. Since the former method for the kidney doner has been recently used as well, it seems necessary to compare the long-term function of the transplanted kidney in the two methods. Materials and methods: In this description study, the function of transplanted 133 kidneys including 75 cases of laparatomic donor nephrectomy and 58 cases of laparascopic were evaluated a with creatinin one years Post transplantion. Results: After one year of transplantation, no significant differences were observed in the creatinine level of the two groups. This research showed that the nephrectomy method, either laparoscopy or laparotomy, has no influence on the kidney function after one year. Conclusion: Laparoscopic nephrectomy is recommended because it has few side effects for the kidney donor and it can be used in clinical settings.

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Background and purpose: After anemia thrombocytopenia is the most common disorder in pregnancy which is encountered in 10% of pregnancies. Thrombocytopenia in pregnant women may lead to maternal and neonatal morbidity. This condition could involve some complications in pregnancy, so diagnosing its causes is important for treatment. This study was performed to determine the incidence, causes and complications of thrombocytopenia in pregnancy. Materials and methods: In this prospective study, all pregnant women with gestational age of ≥ 24weeks and also those in pregnancy termination stage who referred to two teaching hospitals in Babol, during 2008-2009 were selected. Among this population those with platelet count less than 150,000/ µL were chosen. Causes of thrombocytopenia, method of delivery, maternal and neonatal complications in these patients were recorded. Platelet count less than 100,000/ µL was considered severe thrombocytopenia. Results: During the study period, 4589 pregnant women were examined and thrombocytopenia was reported in 239 cases. The incidence of thrombocytopenia in pregnancy was 5.2%. The causes of thrombocytopenia were gestational thrombocytopenia in 222 patients (92.9%), ITP in 11 patients (4.6%), preeclampsia in five patients (2.1%) and HELLP syndrome in one patient (0.4%). Six pregnancies (2.5 %) resulted in IUFD and bleeding occurred only in one patient with ITP during and after delivery. No neonatal complication was seen in newborns of women with thrombocytopenia. Conclusion: The results showed that gestational thrombocytopenia was the most common cause of thrombocytopenia in pregnancy which revealed no complication for patients and their fetuses. However, differential diagnosis should be made to avoid diagnosis of HELLP syndrome or preeclampsia that require urgent termination of pregnancy to prevent further complications.

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Background and purpose: One of the most common complications of catheter in hemodialysis patients is infections and many methods have been proposed to prevent it. This study compared the effects of heparin lock-antibiotics and heparin to prevent infections in patients undergoing hemodialysis. Materials and methods: This single blind clinical trial included 122 patients who were randomly assigned to receive heparin lock (group A) or heparin-antibiotic lock (group B). The subjects in each group were matched for the presence or absence of risk factors. Occurrence of any of the four symptoms of fever, chills (if no other obvious source of infection was found), redness, purulent discharge was considered catheter-site infection. The medication regimens were cefazolin (5 mg/dl) and heparin 2500 IU/ml. Results: The mean age of patients in Group A and B were 57.12 ± 17.34 and 57.61 ± 19.64 years, respectively (P= 0.088). The patients who developed infections included 22 (36%) patients in group A and 11 (18%) patients in group B (P= 0.02). Conclusion: Heparin-cefazolin lock in group B considerably decreased the incidence of catheter infection. Therefore, it could be used as an effective method to prophylaxis of hemodialysis catheter infection.

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Background and purpose: Hyponatremia is the most common electrolyte disorder in hospitalized patients and different report exists about its prevalence. This study aimed at determining the frequency of hyponatremia and its associated factors in hospitalized tuberculosis (TB) patients in Razi hospital, Iran. Materials and methods: This cross-sectional study was done using the existing data and the study population included all TB patients admitted in Razi Hospital during 2006 to 2011. TB was diagnosed based on clinical symptoms, positive sputum culture, positive radiographic finding and anti TB treatment. Variables included level of Na, age, sex, and drug regimen (standard / second line). Hyponatremia were sodium levels less than 135 in two consecutive tests. The data was analyzed by SPSS and Chi-square test. Results: The cases were 200 TB patients including 115 (57.5%) male. The mean age of patients was 51.2 ± 20.8 years. Hyponatremia was seen in 36(18%) patients (CI 95%: 12.6% -23.4%). Distribution of mortality was not significantly different in patients with and without hyponatremia (P>0.05). No significant difference was seen in frequency of hyponatremia according to the type of tuberculosis. Conclusion: Hyponatremia was considerably higher in patients with TB which should receive more attention for proper management and follow up.

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Background and purpose: Hemodialysis is the most common treatment that is used in end-stage renal disease. Since there is not a clear picture of how the adequacy of hemodialysis treatment at this center, this study aimed to determine the adequacy of dialysis in hemodialysis patients at Qaemshar Razi Hospital in 2012. Material and methods: This was a cross-sectional study. The samples were selected from 60 hemodialysis patients of Razi Hospital, Ghaemshahr, three months after their last dialysis. The data were collected through a questionnaire by the researchers. The adequacy of dialysis as measured by Kt/v and URR overall nutrition was calculated by standard PCR. Data analysis was conducted using descriptive and analytical statistical tests in SPSS (Version 18) software. Results: Dialysis adequacy indices mean Kt/v, 1.15 ± 0.31, the mean URR 60.81±10.73, and the average amount of PCR-21.63 ± 9.57 was. According to the criteria Kt/v, 41.7 the percentage of patients were good dialysis adequacy. The Kt/v greater than 1.2, 43.3 the percentage Close to the optimal rate. The fraction ratio of urea 20 percent of patients with URR of 65% (with optimal dialysis adequacy), close to the optimal level of URR of 15% of patients had between 64-55 gain. Conclusion: The standard Kt/v and URR high percentage Patients of the center had inadequate dialysis. It is therefore necessary to investigate and eliminate its causes.

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Background and purpose: Hepatotoxicity and elevated serum aminotransferase is a severe side effect of anti-Tuberculosis therapy and some cases could even develop hepatitis. This study aimed at determining the prevalence of drug induced hepatitis and predisposing factor after anti-Tuberculosis therapy in Razi hospital. Materials and methods: In this cross-sectional study we used the medical records of all confirmed cases of tuberculosis admitted at the infectious disease ward of Ghaemshahr Razi hospital between 2006-2011. Variables included age, sex, type of TB, other medications, basal levels of liver enzymes, enzyme changes during treatment, and co-infection (such as hepatitis B - HIV). The diagnosis of drug induced hepatitis was done with at least five-fold increase of aminotransferase levels. Data was analyzed using SPSS17, chi square tests and Fisher's exact test. Results: Of 230 patients, 56.5% were male. The frequency of pulmonary TB and extra pulmonary TB was 91.7% and 8.3%, respectively. Standard treatment was used in 92.5% of patients with tuberculosis. 23.5% of patients had an underlying disease. Prevalence of drug-induced hepatitis in this study was 9.5%. There was no significant correlation between gender, type of tuberculosis and type of drug treatment with drug-induced hepatitis, but there was a significant relationship between age and druginduced hepatitis. Conclusion: The results showed that old age was the only significant risk factor for druginduced hepatitis in the treatment of tuberculosis, hence, elderly patients must be placed under regular clinical and laboratory evaluation.

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Background and purpose: There is a high incidence of urinary tract infection (UTI) and the resistance rate of infectious organisms to antibiotics is increasing. In this study we aimed to investigate the frequency and pattern of antibiotic resistance of pathogens in urinary tract infections in hospitalized patients.

Materials and methods: This cross-sectional study was conducted using 107 urine samples with positive urine cultures form patients with urinary tract infections admitted to the department of infectious diseases in Razi Hospital (an educational hospital in Quemshar), 2011. Then the minimal inhibitory concentration (MIC) of antibiotics was determined by E-Test. Data was analyzed in SPSS (V. 18).

Results: The mean age of the samples was 61.63 ± 18.38 years (age range 10-91 years) and there were 27% male and 73% female. E. coli was found as the most common gram-negative organism (68.2%) that showed a high sensitivity to nitrofurantoin (90.4%) and imipenem (79.5%) and a high resistance against ampicillin (93.2%) and cotrimoxazole (76.7%). Among all infections, the highest antibiotic susceptibility was to nitrofurantoin (81.3%), imipenem (78.5%) and the highest resistance was observed against ampicillin (94.4%).

Conclusion: Antimicrobial therapy should be performed according to the results of urine culture and antimicrobial susceptibility testing.

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Complement component 3 glomerulopathy (C3G) defines a group of newly classified disorders that is due to C3 deposition in glomeruli. Very few outbreaks of this disease have been reported in the world. In this study, a 56 year old woman is reported who had complaints of weakness, abdominal pain, and skin petechiae and purpura. Laboratory tests revealed mild anemia and high serum creatinine level. Complementary studies were performed and the patient was suspected of having some form of vasculitis, especially PAN and Henoch Schonlein. Negative differential diagnosis of the most common reviews were obtained and due to lack of response to conventional therapy including corticosteroids and endoksan, kidney biopsy was done to detect the diagnosis. The patient was diagnosed with C3G. She had loss of consciousness, severe anemia, and rectorhalgia and transferred to Intensive Care Unit but died despite therapeutic efforts.

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Schmidt syndrome is a polyendocrinopathy characterized by multiple organ failures. Patients with two or more of the following characteristics are diagnosed with this syndrome: Graves' disease, adrenal insufficiency, autoimmune thyroiditis, and type I diabetes. The present case report concerns a Schmidt syndrome patient (polyglandular autoimmune syndrome type II). The patient is a 42-year-old woman with type I diabetes and complaints of imbalance, weakness and lethargy, weight loss, darkened skin, blood pressure drop, hypoglycemia, and hyperkalemia who visited the Hospital frequently and was discharged every time after intravenous potassium chloride and dextrose injections and orders to reduce insulin consumption at home. Her blood cortisol level was measured in her last visit with suspicion of adrenal insufficiency, which was revealed to be low (less than 0.5 μg/dL). A high ACTH, low aldosterone, and normal renin were also reported, indicating secondary adrenal insufficiency. Furthermore, T4 and TSH tests were performed, reporting a TSH lower than 0.2 in the initial TSH test, which was revealed to be normal after the test was repeated. Subclinical hyperthyroidism was indicated, given the high TRAb figure. The patient underwent treatment with fludrocortisone and prednisolone, which improved her condition. This report accentuates that diabetic patients with reduced insulin requirements must be checked for adrenal insufficiency immediately to prevent potential complications.

 

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Background and purpose: Acute hepatitis is an acute inflammation of liver cells that can occur due to viral, bacterial, fungal, and medicinal causes. This study investigated the final diagnosis of inpatients with the initial diagnosis of acute hepatitis in Qaemshahr Razi Hospital.
Materials and methods: In this descriptive cross-sectional study, the medical records of all patients (n=120) admitted with the initial diagnosis of acute hepatitis in 2014-2019 were studied. Data, including demographic information, clinical signs, and laboratory test results were obtained and analyzed in SPSS V21.
Results: The patients were 120 and there were significant differences between place of residence, family history, previous history of hepatitis, blood transfusion, smoking and drugs, alcohol, high-risk sexual relationships, and having HIV (P<0.05). The most common causes of acute hepatitis were hepatitis B and A.
Conclusion: Due to the high prevalence of hepatitis B and drug-induced hepatitis, it is possible to reduce the incidence of acute hepatitis by reviewing and paying more attention to hepatitis B vaccination as well as following up of patients receiving hepatotoxic drugs.
 

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Background and purpose: One of the possible factors for the continuation of hepatitis B infection in hemodialysis adults is the presence of hidden hepatitis B. Considering the risk of occult hepatitis B infection in people with immunodeficiency disorders, especially hemodialysis patients, the aim of this study was to investigate the frequency of occult hepatitis B among dialysis patients in Sari.
Materials and methods: This cross-sectional descriptive research was conducted in Sari, 2018. Blood samples were taken from dialysis patients before dialysis. Then, HBV serology tests (HBs-Ab, HBs-Ag, HBV PCR, and HBc-Ab) were performed using ELISA method. Data analysis was done using SPSS V20. Chi-square test was used to find correlation between qualitative variables. Also, the differences were compared using independent t-test, and P<0.05 was considered significant.
Results: A total of 279 dialysis patients were investigated in this study. The chi-square test showed that there was no significant difference between the two groups in terms of gender (P>0.05), but significantly, the majority of the studied patients had a previous history of diabetes and high blood pressure (P<0.05). The findings revealed that there was no significant relationship between latent hepatitis B and demographic information (P>0.05). Independent t-test showed that the average age of people with latent hepatitis B was significantly higher than the rest of dialysis patients. (P=0.030). Of the patients, nine (3.23%) had positive HBs-Ag, of whom seven were under treatment and two did not need any treatment. Despite two complete series of vaccination against hepatitis B, six patients (2%) with negative HBs-Ag and HBs-Ab were reported to have positive HBc-Ab. Two cases of them (0.71%) were PCR positive, which were real latent hepatitis, and four others were recorded as old recovered hepatitis.
Conclusion: The findings suggested that HBs-Ag was a necessary but not sufficient factor in patients with End-Stage Renal Disease (ESRD); therefore, it was recommended to evaluate HBc-Ab and to test PCR for positive cases.

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Background and purpose: Hospital infections remain a significant health concern despite advancements in treatment methods. The emergence and spread of pathogens with multiple resistance remain a global health issue. The purpose of this study was to investigate the prevalence of nosocomial infections and determine the antibiotic resistance pattern in Razi Ghaemshahr Hospital, Mazandaran.
Materials and methods: This descriptive cross-sectional study was carried out at Razi Ghaemshahr Hospital in Mazandaran province during 2016-2017. Positive cultures from hospitalized patients were used as samples and subjected to antibiotic resistance pattern analysis using the disk diffusion method.
Results: Out of the 672 hospitalized patients in different wards, the infectious ward had the highest frequency distribution of patients (40%). The most commonly isolated pathogens were Escherichia coli (26.2%), Acinetobacter baumannii (14.7%), Enterobacter (14.1%), Pseudomonas aeroginosa (13.5%), and Citrobacter (12.8%). The pathogens were highly resistant to cephalosporins, fluoroquinolones, beta-lactamase inhibitors, and carbapenems.
Conclusion: It was found that the most frequently isolated pathogen was Escherichia coli. The emergence of Citrobacter with high antibiotic resistance can possibly be attributed to a shift in the prevalence pattern of microorganisms within this hospital
 

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Background and purpose: Chronic kidney disease or CKD is defined as functional failure or structural abnormality of the kidney. Diabetes and high blood pressure are the primary causes of this illness. Because the underlying causes of chronic kidney disease are more common now, the disease's financial burden on health systems around the globe has gone up. This disease can cause a wide range of complications, including changes in electrolytes and other known indicators in the blood. One of the less investigated indicators is the serum level of phosphorus in these patients. Therefore, we designed and implemented a study to investigate the relationship between serum phosphorus levels and kidney dysfunction in chronic kidney patients.
Materials and methods: This study was a descriptive and retrospective study that was conducted on 110 patients with chronic kidney disease admitted to Imam Khomeini Teaching Hospital in Sari. The census sampling method and data collection tool was a checklist. Phosphorus values ​​obtained by blood tests and recorded in patients' files were studied. The comparison between the grouped variables was done with the chi-score test and Fisher's exact test. Quantitative variables were compared between 2 groups with a t-test and in more than 2 groups with an analysis of variance or their non-parametric equivalent. Also, the correlation between serum phosphorus level and GFR was done with Pearson or Spearman correlation coefficient. Partial Correlation was used to adjust the effect of confounding variables. Also, the normality of quantitative variables was evaluated with Shapiro-Wilks and based on skewness and kurtosis indices. Data analysis was done with SPSS software version 25
Results: Of the 110 individuals that were examined, 51 (46.4%) were female and 59 (53.6%) were male. Of the 110 individuals, 95.5%, or 105 patients, had underlying medical conditions. During their time in the hospital, 21 patients (19.1%) were admitted to the intensive care unit. 19 individuals were in the G3 stage, 41 in the G4 stage, and 50 were in the G5 stage of CKD. Also, 69 patients were diagnosed with diabetes. Of these, 13 patients were in the G3 stage, 28 patients were in the G4 stage, and 28 patients were in the G5 stage of chronic kidney disease. The average level of blood urea and creatinine was reported to be 125.0255 mmol/L and 4.2975 mg/dL, respectively. Also, the calcium serum level was 8.9109 mg/dL and the phosphorus serum level was 4.6873 mg/dL. Also, the average eGFR among 110 evaluated patients was 19.2345 mL/min/1.73m^2. Serum phosphorus levels and eGFR in men are correlated, and this link is significant (P=0.000). However, the P-value of 0.087 indicates that there is no significant association between eGFR and blood phosphorus levels in women. This connection was significant in hypertensive individuals (P=0.003). Furthermore, in contrast to systolic blood pressure, there is a substantial correlation between patients' diastolic blood pressure and eGFR.
Conclusion: Phosphorus serum level plays a role in determining the severity and prognosis of chronic kidney disease. Also, there is a direct relationship between diastolic blood pressure and the severity of this disease.