Treatment of snakebite complications is challenging, as it is difficult to distinguish what kind ... more Treatment of snakebite complications is challenging, as it is difficult to distinguish what kind of antivenins should be used. Kidney failure as a result of rhabdomyolysis or hemolysis may happen due to accumulated fluids that increase the pressure in the abdomen. This case report describes acute kidney failure probably due to intra-abdominal hypertension following an unknown bite.
INTRODUCTION. Helicobacter pylori infection can be diagnosed by biopsy-based or noninvasive metho... more INTRODUCTION. Helicobacter pylori infection can be diagnosed by biopsy-based or noninvasive methods. Our aim was to identify H pylori-positive patients on hemodialysis by the noninvasive method of H pylori stool antigen (HPSA) and investigate its diagnostic accuracy for assessment of the eradication of infection after treatment in comparison with urea breath test (UBT). MATERIALS AND METHODS. Serology, HPSA, and UBT were performed on 87 hemodialysis patients. Infection with H pylori was confirmed if at least 2 tests were positive. Patients with H pylori infection received a 2-week course of triple therapy. To evaluate success of eradication HPSA and UBT were done after 8 weeks. RESULTS. Eighty-seven patients were enrolled in the study, of whom 39 (44.8%) were proved to have H pylori infection. The HPSA was positive in the stool specimens of 37 patients (42.5%) and the serology test was positive in 39 (44.8%). The HPSA had a 87.1% sensitivity and a 93.7% specificity for detection of H pylori infection. Thirty-seven patients completed the treatment period. Success of H pylori eradication was documented in 30 of the 37 patients (81.1%) based on UBT. After the treatment, the HPSA was negative in 32 of 37 of the stool specimens (86.4%), showing a 42.8% sensitivity and a 93.3% specificity to detect the failure of eradication of H pylori. CONCLUSIONS. Helicobacter pylori stool antigen assay is a noninvasive reliable tool to screen H pylori infection before therapy and assess the success of eradication in patients on hemodialysis.
Gitelman syndrome (GS) is an autosomal recessive disease characterized by hypokalemia, hypomagnes... more Gitelman syndrome (GS) is an autosomal recessive disease characterized by hypokalemia, hypomagnesemia, metabolic alkalosis, and hypocalciuria. It is caused by mutations in gene SLC12A3 (located in chromosome 16q) encoding NaCl cotransporter. GS is usually asymptomatic for several years and is diagnosed in late childhood or adulthood. The association between GS and diabetic ketoacidosis (DKA) is rare. We present a case of a 25-year-old man with newly diagnosed diabetes mellitus and DKA with profound hypokalemia and hypomagnesemia who was provisionally found to have GS.
Osmotic demyelination syndrome (ODS) is a demyelinating disorder of the central nervous system. I... more Osmotic demyelination syndrome (ODS) is a demyelinating disorder of the central nervous system. It usually occurs with rapid correction of severe chronic hyponatremia. ODS is rarely seen as a complication of hyperglycemia. Herein, we report a rare presentation of ODS secondary to hyperosmolar hyperglycemic state. A 28-year-old female with type 1 diabetes, hypertension, seizure disorder, and end-stage renal disease on hemodialysis was brought from a shelter with two days of unresponsiveness and developed ODS after hyperosmolar hyperglycemic state in long-standing uncontrolled diabetes with normal serum electrolyte levels.
Background Interdialytic weight gain (IDWG) is a marker of higher pre-dialysis blood pressure, nu... more Background Interdialytic weight gain (IDWG) is a marker of higher pre-dialysis blood pressure, nutrition, and survival in hemodialysis (HD) patients. However, this relationship is incompletely characterized. In this study, we seek to define the association of IDWG/dry weight x100 (IDWG%) on blood pressure (BP), and the nutritional status of an HD population. Material and Methods This study was performed on 300 HD patients. The data was collected over four weeks, including total IDWG, IDWG%, and blood pressure. Normalized protein nitrogen appearance (nPNA), and serum albumin were used as markers of nutritional status. Participants were divided into three groups according to the mean of the IDWG% between two sessions of HD (group A < 3%, group B = 3%-3.9%, and group C ≥ 4%); they were then compared on various aspects. Student t-test, analysis of variance (ANOVA), and linear regression analysis were used as statistical tools. Results The mean (± standard deviation (SD)) age was 61.7 ± 14.2 years with 57.7% of the patients being male and 42.3% being female. The mean IDWG% for the whole studied population was 3.72% ± 1.73%. Between these three groups, a higher IDWG% was associated with younger males (p = 0.032), lower dry weight (p = 0.009), and longer duration on HD therapy (p = 0.009). IDWG% was directly associated with lower pre-dialysis serum sodium (p = 0.04), higher pre-dialysis serum creatinine (P = 0.002), and lower body mass index (BMI) (p= 0.003). Between these three groups, interdialytic variations in weight gain were not associated with increased BP. There was no significant difference between the three groups in terms of nPNA and serum albumin. Conclusions The most important associations of IDWG% are age, weight, pre-dialysis sodium, serum creatinine, and duration of dialysis (months). There was no association between IDWG% and increased systolic BP. IDWG% had no association with nutritional status.
Saudi Journal of Kidney Diseases and Transplantation, 2014
To compare a triple-therapy regimen based on change of antibiotic (azithromycin and clarithromyci... more To compare a triple-therapy regimen based on change of antibiotic (azithromycin and clarithromycin) for the eradication of Helicobacter pylori in hemodialysis (HD) patients, we studied in a prospective, randomized, double-blinded clinical trial 39 patients who had dyspepsia and showed two positive results from the diagnostic tests of H. pylori infection including anti-H. pylori serology and stool antigen (HpSAg) and urease breath test (UBT). The patients were divided into two groups: Group-A received omeprazol 20 mg, amoxycilin 500 mg and clarithromycin 500 mg twice a day and Group-B received omeprazol 20 mg, amoxicillin 500 mg and azithromycin 250 mg twice a day. The adverse events and compliance with triple therapy were reviewed at one visit per week. Both groups were prescribed their medications for 14 days. Of the 39 patients, only 37 patients completed the treatment schedule (20 men and 19 women, with the mean being 59 years). Two patients died due to myocardial infarction before the start of treatment and were out of the study. The eradication rate of H. pylori, evaluated by negative results of UBT, was 82.4% in Group-A and 80% in Group-B (P-value = 1.0). The results of our study showed no significant difference of azitromycin versus claritromycin in the eradication of H. pylori infection in HD patients.
This application would help to chose a specific medication for eradication of H.Pylori infection ... more This application would help to chose a specific medication for eradication of H.Pylori infection in HD patients. Background: Helicobacter pylori eradication with clarithromycin is more expensive than with azithromycin. Objectives: This study aimed to compare the effectiveness of these two antibiotics in eradicating H. pylori in hemodialysis (HD) patients. Patients and Methods: This is a prospective, randomized, double-blinded clinical trial analysis of HD patients. Patients who had dyspepsia and showed positive results for two of three tests, anti-H. pylori serology, H. pylori stool antigen (HpSAg), or Urease Breath Test (UBT), were included in the study. The subjects consisted of 39 dialysis patients who were randomly divided into two groups that received medication twice daily. Group OAC received 20 mg omeprazol, 500 mg amoxycilin, and 250 mg clarithromycin, and Group OAAz received 20 mg omeprazol, 500 mg amoxicillin, and 250 mg azithromycin. Both regimens were administered for 14 days. Eradication was investigated by performing the UBT and the HpSAg test eight weeks later. Results: This study began with 39 patients, 37 of which completed the treatment schedule (20 males and 17 females, mean age 59 years). Two patients died due to MI before beginning treatment. In the OAC group, negative results on the UBT and HpSAg tests were found in 82.4% and 88.2% of the participants, respectively. In the OAAz group, these values were 80% and 85%, respectively. The data showed that the difference between the two regimens was not significant (P = 1.0). Conclusions: According to the data, no differences in eradication rates were apparent between the azitromycin and the claritromycin regimens. However, lower cost and fewer complaints could be considered as an advantage of the triple therapy with azithromycin.
In HD patients, ascorbic acid (AA) has an influence on improving sensitivity to EPO, either by in... more In HD patients, ascorbic acid (AA) has an influence on improving sensitivity to EPO, either by increasing iron mobilization from tissue storage or by way of antioxidant effects. [6-10] In this study, we assessed whether short term treatment with intravenous AA (INAA) could diminish the high level of ferritin and raise Hb level.
In HD patients, ascorbic acid (AA) has an influence on improving sensitivity to EPO, either by in... more In HD patients, ascorbic acid (AA) has an influence on improving sensitivity to EPO, either by increasing iron mobilization from tissue storage or by way of antioxidant effects. [6-10] In this study, we assessed whether short term treatment with intravenous AA (INAA) could diminish the high level of ferritin and raise Hb level.
INTRODUCTION We aimed to assess the effects of different types of diabetes mellitus (DM) on patie... more INTRODUCTION We aimed to assess the effects of different types of diabetes mellitus (DM) on patients receiving living donor kidney allografts. MATERIALS AND METHODS A total of 111 kidney transplant patients with DM and 111 randomly selected kidney transplant recipients without DM were enrolled in the study. The characteristics of the kidney allograft recipients and the allograft and patient outcomes were assessed and compared between 4 groups of kidney recipients without DM and patients with type 1 DM, type 2 DM, and posttransplant DM. RESULTS Of the 111 patients with DM, 36 (32.4%), 20 (18.0%), and 55 (49.6%) had been diagnosed with type 1 DM, type 2 DM, and posttransplant DM, respectively. Diabetic patients had significantly higher rates of rejection episodes (P = .049) and suffered more frequently from delayed graft function (P = .03) compared to the kidney recipients in the control group. Patient and allograft survival rates were significantly lower in the patients with DM (rega...
We sought to compare an azithromycin-based regimen with an already established clarithromycin-bas... more We sought to compare an azithromycin-based regimen with an already established clarithromycin-based regimen in the eradication of Helicobacter pylori infection. A prospective, randomized, blinded comparative analysis was performed on 56 patients with upper GI symptoms who presented to the Gastroenterology Department at the Naval Medical Center Portsmouth. All patients had documented H. pylori infection on endoscopy via rapid urease test and histopathology. Patients were randomized to a treatment arm, which consisted of bismuth, clarithromycin, amoxicillin, and lansoprazole (B-LAC) or one consisting of bismuth, azithromycin, amoxicillin, and lansoprazole (B-LAA). To assess eradication, patients then received repeat endoscopy at 8 wk from entrance into the study. Rapid urease test and histopathology were again used to evaluate infection. Patients recorded all side effects. Comparison between the two groups was made using the chi2 method. Of the 56 patients included in the study, 27 we...
Background: Previous studies in Jordan showed a considerably high prevalence of metabolic syndrom... more Background: Previous studies in Jordan showed a considerably high prevalence of metabolic syndrome (MeS) and its individual components. However, data about the association between MeS and coronary artery disease (CAD) in Jordan are lacking. Therefore, this study aimed to determine the association between MeS and CAD among Jordanians. Methods: This case-control study included 269 patients diagnosed with CAD and 1026 subjects without CAD. Data collected from cases and controls included socio-demographic and clinical characteristics and anthropometric measurements. Patients were diagnosed with MeS based on the criteria of the National Cholesterol Education Program (NCEP) adult treatment panel (ATP) III. Results: MeS was present in 65.1% of patients with CAD and in 44.0% of those with no CAD (p<0.0005). After adjusting for the important variables in the multivariate analysis, those with MeS were twice more likely to have CAD (OR = 1.94, 95% CI: 1.29, 2.93, p = 0.002) compared to thos...
The Lewis antigen expression on the membrane of H. pylori for antigenic mimicry may create persis... more The Lewis antigen expression on the membrane of H. pylori for antigenic mimicry may create persistent colonisation and surviving of bacteria in the stomach mucosa. In addition, expression of Le b antigens in gastric mucosa may play as a receptor for bacterial adhesion. It seems blood group antigen b-binding adhesion (babA) on the outer membrane of H. pylori has a major role in persistent colonisation of the bacteria with attachment to Le b antigens of gastric mucosa. 13,14 Binding of H. pylori to H and Le b antigens in gastric mucosa probably describes higher incidence of chronic gastritis and gastric adenocarcinoma in O blood group phenotype and secretors (expressing Le b antigen). 15,16 Some other reports, however, have not determined any association between the infection and the Lewis 5 and ABO blood groups. 17 Some heterogeneity has been characterised in expression of the outer membrane protein, especially babA, that describes various capacities of different H. pylori for adhesion to Le b antigen on the gastric mucosa, a factor determining some differences in clinical outcomes of the infection. 18,19 Based on controversial associations between
Background and Aims: Helicobacter pylori (H. pylori) has been reported to play an important role ... more Background and Aims: Helicobacter pylori (H. pylori) has been reported to play an important role in the development of gastritis and gastric ulcer. Here we report the prevalence of H. pylori infection in 87 hemodialysis (HD) patients. Methods: In the present study we investigated the prevalence of H. pylori infection in 87 HD patients by three methods: serum anti-H. pylori IgG, H. pylori stool antigen (HpSAg) and Urease Breath Test (UBT). All the three methods confirmed each other and when 2 out of the 3 methods showed positive findings, patients were regarded as H. pylori -positive. We also assessed the relationship between clinical factors, serum urea nitrogen, creatinine levels, and duration of dialysis, age and gender with the prevalence H. pylori in these patients. Results: Eighty seven HD patients (48 male and 39 female) with the mean age of 54.4±16.7 years old and mean dialysis duration of 36.2±33.5 months were assessed. Fifty five (63.2%) of them had dyspepsia. The prevalenc...
Osmotic demyelination syndrome (ODS) is a demyelinating disorder of the central nervous system. I... more Osmotic demyelination syndrome (ODS) is a demyelinating disorder of the central nervous system. It usually occurs with rapid correction of severe chronic hyponatremia. ODS is rarely seen as a complication of hyperglycemia. Herein, we report a rare presentation of ODS secondary to hyperosmolar hyperglycemic state. A 28-year-old female with type 1 diabetes, hypertension, seizure disorder, and end-stage renal disease on hemodialysis was brought from a shelter with two days of unresponsiveness and developed ODS after hyperosmolar hyperglycemic state in long-standing uncontrolled diabetes with normal serum electrolyte levels.
INTRODUCTION The role of metabolic syndrome (MS) in hemodialysis population has not been thorough... more INTRODUCTION The role of metabolic syndrome (MS) in hemodialysis population has not been thoroughly studied. This study aimed to determine the prevalence of MS and to identify its correlates among hemodialysis patients. MATERIALS AND METHODS This cross-sectional study was conducted on patients in a hemodialysis center. The MS was defined according the Adult Treatment Panel III criteria. Clinical data of the patients were collected and blood samples were studied to measure fasting blood glucose and lipid profile. RESULTS Eighty hemodialysis patients, including 47 men (58.8%) and 33 women (41.2%) with a mean age of 55.6 ± 15.6 years, were enrolled in this study. Metabolic syndrome was diagnosed in 23 patients (28.7%). Hypertension was present in 55 patients (68.8%). Fifteen patients (18.8%) were diabetic, 24 (30.0%) had a high serum triglyceride, 22 (27.5%) had a low high-density lipoprotein cholesterol, and 20 (25.0%) had evidence of abdominal obesity. Patients with MS had significan...
Background: Metabolic syndrome (MS) has prominent effect on different aspects of the health. The ... more Background: Metabolic syndrome (MS) has prominent effect on different aspects of the health. The aim of this study was to identify whether interdialytic weigh gain (IDWG) has any effect on prevalence of MS and blood pressure (BP) in hemodialysis (HD) population. Material and Methods: Study was performed on 300 patients in four HD centers in Iran. Inclusion criteria: age ≥16 years, at least 6 month on HD, and availability of all requested demographic and laboratory parameters. Exclusion criteria: incomplete data at analysis time and anticipated life expectancy less than 6 months. Participants were divided into two groups according to IDWG between two sessions of HD; Group-A had IDWG<3 kg and Group-B had IDWG ≥3 kg. First, prevalence of MS and its components were evaluated, then they were compared with each group. Results: Three hundred HD patients were enrolled for the study, 173 men (57.7%) and 127 women (42.3%) with mean age of 61.7±14.2 years. Prevalence of MS was 50.3 %( 151),...
Gitelman syndrome (GS) is an autosomal recessive disease characterized by hypokalemia, hypomagnes... more Gitelman syndrome (GS) is an autosomal recessive disease characterized by hypokalemia, hypomagnesemia, metabolic alkalosis, and hypocalciuria. It is caused by mutations in gene SLC12A3 (located in chromosome 16q) encoding NaCl cotransporter. GS is usually asymptomatic for several years and is diagnosed in late childhood or adulthood. The association between GS and diabetic ketoacidosis (DKA) is rare. We present a case of a 25-year-old man with newly diagnosed diabetes mellitus and DKA with profound hypokalemia and hypomagnesemia who was provisionally found to have GS.
INTRODUCTION. Helicobacter pylori infection in gastric mucosa may cause systemic inflammatory rea... more INTRODUCTION. Helicobacter pylori infection in gastric mucosa may cause systemic inflammatory reaction. We investigated the inflammatory effect of H pylori infection on nutritional factors such as serum albumin in hemodialysis patients and influence of eradication of H pylori on this association. MATERIALS AND METHODS. Ninety-eight patients on hemodialysis were divided into 2 groups according to H pylori infection. Eradication of H pylori, 8 weeks after treatment, was confirmed by urease breath test and H pylori stool antigen. Serum albumin, lipid profile, and metabolite levels were checked before and after 8 weeks and 6 months of eradication of H pylori. RESULTS. Thirty-nine patients (39.8%) were infected with H pylori. There were no significant differences between the two groups in age, dialysis duration, serum albumin, serum creatinine, blood urea nitrogen, hemoglobin, serum calcium, serum phosphorus, and lipid profile. Thirty-seven patients with H pylori completed the treatment ...
Treatment of snakebite complications is challenging, as it is difficult to distinguish what kind ... more Treatment of snakebite complications is challenging, as it is difficult to distinguish what kind of antivenins should be used. Kidney failure as a result of rhabdomyolysis or hemolysis may happen due to accumulated fluids that increase the pressure in the abdomen. This case report describes acute kidney failure probably due to intra-abdominal hypertension following an unknown bite.
INTRODUCTION. Helicobacter pylori infection can be diagnosed by biopsy-based or noninvasive metho... more INTRODUCTION. Helicobacter pylori infection can be diagnosed by biopsy-based or noninvasive methods. Our aim was to identify H pylori-positive patients on hemodialysis by the noninvasive method of H pylori stool antigen (HPSA) and investigate its diagnostic accuracy for assessment of the eradication of infection after treatment in comparison with urea breath test (UBT). MATERIALS AND METHODS. Serology, HPSA, and UBT were performed on 87 hemodialysis patients. Infection with H pylori was confirmed if at least 2 tests were positive. Patients with H pylori infection received a 2-week course of triple therapy. To evaluate success of eradication HPSA and UBT were done after 8 weeks. RESULTS. Eighty-seven patients were enrolled in the study, of whom 39 (44.8%) were proved to have H pylori infection. The HPSA was positive in the stool specimens of 37 patients (42.5%) and the serology test was positive in 39 (44.8%). The HPSA had a 87.1% sensitivity and a 93.7% specificity for detection of H pylori infection. Thirty-seven patients completed the treatment period. Success of H pylori eradication was documented in 30 of the 37 patients (81.1%) based on UBT. After the treatment, the HPSA was negative in 32 of 37 of the stool specimens (86.4%), showing a 42.8% sensitivity and a 93.3% specificity to detect the failure of eradication of H pylori. CONCLUSIONS. Helicobacter pylori stool antigen assay is a noninvasive reliable tool to screen H pylori infection before therapy and assess the success of eradication in patients on hemodialysis.
Gitelman syndrome (GS) is an autosomal recessive disease characterized by hypokalemia, hypomagnes... more Gitelman syndrome (GS) is an autosomal recessive disease characterized by hypokalemia, hypomagnesemia, metabolic alkalosis, and hypocalciuria. It is caused by mutations in gene SLC12A3 (located in chromosome 16q) encoding NaCl cotransporter. GS is usually asymptomatic for several years and is diagnosed in late childhood or adulthood. The association between GS and diabetic ketoacidosis (DKA) is rare. We present a case of a 25-year-old man with newly diagnosed diabetes mellitus and DKA with profound hypokalemia and hypomagnesemia who was provisionally found to have GS.
Osmotic demyelination syndrome (ODS) is a demyelinating disorder of the central nervous system. I... more Osmotic demyelination syndrome (ODS) is a demyelinating disorder of the central nervous system. It usually occurs with rapid correction of severe chronic hyponatremia. ODS is rarely seen as a complication of hyperglycemia. Herein, we report a rare presentation of ODS secondary to hyperosmolar hyperglycemic state. A 28-year-old female with type 1 diabetes, hypertension, seizure disorder, and end-stage renal disease on hemodialysis was brought from a shelter with two days of unresponsiveness and developed ODS after hyperosmolar hyperglycemic state in long-standing uncontrolled diabetes with normal serum electrolyte levels.
Background Interdialytic weight gain (IDWG) is a marker of higher pre-dialysis blood pressure, nu... more Background Interdialytic weight gain (IDWG) is a marker of higher pre-dialysis blood pressure, nutrition, and survival in hemodialysis (HD) patients. However, this relationship is incompletely characterized. In this study, we seek to define the association of IDWG/dry weight x100 (IDWG%) on blood pressure (BP), and the nutritional status of an HD population. Material and Methods This study was performed on 300 HD patients. The data was collected over four weeks, including total IDWG, IDWG%, and blood pressure. Normalized protein nitrogen appearance (nPNA), and serum albumin were used as markers of nutritional status. Participants were divided into three groups according to the mean of the IDWG% between two sessions of HD (group A < 3%, group B = 3%-3.9%, and group C ≥ 4%); they were then compared on various aspects. Student t-test, analysis of variance (ANOVA), and linear regression analysis were used as statistical tools. Results The mean (± standard deviation (SD)) age was 61.7 ± 14.2 years with 57.7% of the patients being male and 42.3% being female. The mean IDWG% for the whole studied population was 3.72% ± 1.73%. Between these three groups, a higher IDWG% was associated with younger males (p = 0.032), lower dry weight (p = 0.009), and longer duration on HD therapy (p = 0.009). IDWG% was directly associated with lower pre-dialysis serum sodium (p = 0.04), higher pre-dialysis serum creatinine (P = 0.002), and lower body mass index (BMI) (p= 0.003). Between these three groups, interdialytic variations in weight gain were not associated with increased BP. There was no significant difference between the three groups in terms of nPNA and serum albumin. Conclusions The most important associations of IDWG% are age, weight, pre-dialysis sodium, serum creatinine, and duration of dialysis (months). There was no association between IDWG% and increased systolic BP. IDWG% had no association with nutritional status.
Saudi Journal of Kidney Diseases and Transplantation, 2014
To compare a triple-therapy regimen based on change of antibiotic (azithromycin and clarithromyci... more To compare a triple-therapy regimen based on change of antibiotic (azithromycin and clarithromycin) for the eradication of Helicobacter pylori in hemodialysis (HD) patients, we studied in a prospective, randomized, double-blinded clinical trial 39 patients who had dyspepsia and showed two positive results from the diagnostic tests of H. pylori infection including anti-H. pylori serology and stool antigen (HpSAg) and urease breath test (UBT). The patients were divided into two groups: Group-A received omeprazol 20 mg, amoxycilin 500 mg and clarithromycin 500 mg twice a day and Group-B received omeprazol 20 mg, amoxicillin 500 mg and azithromycin 250 mg twice a day. The adverse events and compliance with triple therapy were reviewed at one visit per week. Both groups were prescribed their medications for 14 days. Of the 39 patients, only 37 patients completed the treatment schedule (20 men and 19 women, with the mean being 59 years). Two patients died due to myocardial infarction before the start of treatment and were out of the study. The eradication rate of H. pylori, evaluated by negative results of UBT, was 82.4% in Group-A and 80% in Group-B (P-value = 1.0). The results of our study showed no significant difference of azitromycin versus claritromycin in the eradication of H. pylori infection in HD patients.
This application would help to chose a specific medication for eradication of H.Pylori infection ... more This application would help to chose a specific medication for eradication of H.Pylori infection in HD patients. Background: Helicobacter pylori eradication with clarithromycin is more expensive than with azithromycin. Objectives: This study aimed to compare the effectiveness of these two antibiotics in eradicating H. pylori in hemodialysis (HD) patients. Patients and Methods: This is a prospective, randomized, double-blinded clinical trial analysis of HD patients. Patients who had dyspepsia and showed positive results for two of three tests, anti-H. pylori serology, H. pylori stool antigen (HpSAg), or Urease Breath Test (UBT), were included in the study. The subjects consisted of 39 dialysis patients who were randomly divided into two groups that received medication twice daily. Group OAC received 20 mg omeprazol, 500 mg amoxycilin, and 250 mg clarithromycin, and Group OAAz received 20 mg omeprazol, 500 mg amoxicillin, and 250 mg azithromycin. Both regimens were administered for 14 days. Eradication was investigated by performing the UBT and the HpSAg test eight weeks later. Results: This study began with 39 patients, 37 of which completed the treatment schedule (20 males and 17 females, mean age 59 years). Two patients died due to MI before beginning treatment. In the OAC group, negative results on the UBT and HpSAg tests were found in 82.4% and 88.2% of the participants, respectively. In the OAAz group, these values were 80% and 85%, respectively. The data showed that the difference between the two regimens was not significant (P = 1.0). Conclusions: According to the data, no differences in eradication rates were apparent between the azitromycin and the claritromycin regimens. However, lower cost and fewer complaints could be considered as an advantage of the triple therapy with azithromycin.
In HD patients, ascorbic acid (AA) has an influence on improving sensitivity to EPO, either by in... more In HD patients, ascorbic acid (AA) has an influence on improving sensitivity to EPO, either by increasing iron mobilization from tissue storage or by way of antioxidant effects. [6-10] In this study, we assessed whether short term treatment with intravenous AA (INAA) could diminish the high level of ferritin and raise Hb level.
In HD patients, ascorbic acid (AA) has an influence on improving sensitivity to EPO, either by in... more In HD patients, ascorbic acid (AA) has an influence on improving sensitivity to EPO, either by increasing iron mobilization from tissue storage or by way of antioxidant effects. [6-10] In this study, we assessed whether short term treatment with intravenous AA (INAA) could diminish the high level of ferritin and raise Hb level.
INTRODUCTION We aimed to assess the effects of different types of diabetes mellitus (DM) on patie... more INTRODUCTION We aimed to assess the effects of different types of diabetes mellitus (DM) on patients receiving living donor kidney allografts. MATERIALS AND METHODS A total of 111 kidney transplant patients with DM and 111 randomly selected kidney transplant recipients without DM were enrolled in the study. The characteristics of the kidney allograft recipients and the allograft and patient outcomes were assessed and compared between 4 groups of kidney recipients without DM and patients with type 1 DM, type 2 DM, and posttransplant DM. RESULTS Of the 111 patients with DM, 36 (32.4%), 20 (18.0%), and 55 (49.6%) had been diagnosed with type 1 DM, type 2 DM, and posttransplant DM, respectively. Diabetic patients had significantly higher rates of rejection episodes (P = .049) and suffered more frequently from delayed graft function (P = .03) compared to the kidney recipients in the control group. Patient and allograft survival rates were significantly lower in the patients with DM (rega...
We sought to compare an azithromycin-based regimen with an already established clarithromycin-bas... more We sought to compare an azithromycin-based regimen with an already established clarithromycin-based regimen in the eradication of Helicobacter pylori infection. A prospective, randomized, blinded comparative analysis was performed on 56 patients with upper GI symptoms who presented to the Gastroenterology Department at the Naval Medical Center Portsmouth. All patients had documented H. pylori infection on endoscopy via rapid urease test and histopathology. Patients were randomized to a treatment arm, which consisted of bismuth, clarithromycin, amoxicillin, and lansoprazole (B-LAC) or one consisting of bismuth, azithromycin, amoxicillin, and lansoprazole (B-LAA). To assess eradication, patients then received repeat endoscopy at 8 wk from entrance into the study. Rapid urease test and histopathology were again used to evaluate infection. Patients recorded all side effects. Comparison between the two groups was made using the chi2 method. Of the 56 patients included in the study, 27 we...
Background: Previous studies in Jordan showed a considerably high prevalence of metabolic syndrom... more Background: Previous studies in Jordan showed a considerably high prevalence of metabolic syndrome (MeS) and its individual components. However, data about the association between MeS and coronary artery disease (CAD) in Jordan are lacking. Therefore, this study aimed to determine the association between MeS and CAD among Jordanians. Methods: This case-control study included 269 patients diagnosed with CAD and 1026 subjects without CAD. Data collected from cases and controls included socio-demographic and clinical characteristics and anthropometric measurements. Patients were diagnosed with MeS based on the criteria of the National Cholesterol Education Program (NCEP) adult treatment panel (ATP) III. Results: MeS was present in 65.1% of patients with CAD and in 44.0% of those with no CAD (p<0.0005). After adjusting for the important variables in the multivariate analysis, those with MeS were twice more likely to have CAD (OR = 1.94, 95% CI: 1.29, 2.93, p = 0.002) compared to thos...
The Lewis antigen expression on the membrane of H. pylori for antigenic mimicry may create persis... more The Lewis antigen expression on the membrane of H. pylori for antigenic mimicry may create persistent colonisation and surviving of bacteria in the stomach mucosa. In addition, expression of Le b antigens in gastric mucosa may play as a receptor for bacterial adhesion. It seems blood group antigen b-binding adhesion (babA) on the outer membrane of H. pylori has a major role in persistent colonisation of the bacteria with attachment to Le b antigens of gastric mucosa. 13,14 Binding of H. pylori to H and Le b antigens in gastric mucosa probably describes higher incidence of chronic gastritis and gastric adenocarcinoma in O blood group phenotype and secretors (expressing Le b antigen). 15,16 Some other reports, however, have not determined any association between the infection and the Lewis 5 and ABO blood groups. 17 Some heterogeneity has been characterised in expression of the outer membrane protein, especially babA, that describes various capacities of different H. pylori for adhesion to Le b antigen on the gastric mucosa, a factor determining some differences in clinical outcomes of the infection. 18,19 Based on controversial associations between
Background and Aims: Helicobacter pylori (H. pylori) has been reported to play an important role ... more Background and Aims: Helicobacter pylori (H. pylori) has been reported to play an important role in the development of gastritis and gastric ulcer. Here we report the prevalence of H. pylori infection in 87 hemodialysis (HD) patients. Methods: In the present study we investigated the prevalence of H. pylori infection in 87 HD patients by three methods: serum anti-H. pylori IgG, H. pylori stool antigen (HpSAg) and Urease Breath Test (UBT). All the three methods confirmed each other and when 2 out of the 3 methods showed positive findings, patients were regarded as H. pylori -positive. We also assessed the relationship between clinical factors, serum urea nitrogen, creatinine levels, and duration of dialysis, age and gender with the prevalence H. pylori in these patients. Results: Eighty seven HD patients (48 male and 39 female) with the mean age of 54.4±16.7 years old and mean dialysis duration of 36.2±33.5 months were assessed. Fifty five (63.2%) of them had dyspepsia. The prevalenc...
Osmotic demyelination syndrome (ODS) is a demyelinating disorder of the central nervous system. I... more Osmotic demyelination syndrome (ODS) is a demyelinating disorder of the central nervous system. It usually occurs with rapid correction of severe chronic hyponatremia. ODS is rarely seen as a complication of hyperglycemia. Herein, we report a rare presentation of ODS secondary to hyperosmolar hyperglycemic state. A 28-year-old female with type 1 diabetes, hypertension, seizure disorder, and end-stage renal disease on hemodialysis was brought from a shelter with two days of unresponsiveness and developed ODS after hyperosmolar hyperglycemic state in long-standing uncontrolled diabetes with normal serum electrolyte levels.
INTRODUCTION The role of metabolic syndrome (MS) in hemodialysis population has not been thorough... more INTRODUCTION The role of metabolic syndrome (MS) in hemodialysis population has not been thoroughly studied. This study aimed to determine the prevalence of MS and to identify its correlates among hemodialysis patients. MATERIALS AND METHODS This cross-sectional study was conducted on patients in a hemodialysis center. The MS was defined according the Adult Treatment Panel III criteria. Clinical data of the patients were collected and blood samples were studied to measure fasting blood glucose and lipid profile. RESULTS Eighty hemodialysis patients, including 47 men (58.8%) and 33 women (41.2%) with a mean age of 55.6 ± 15.6 years, were enrolled in this study. Metabolic syndrome was diagnosed in 23 patients (28.7%). Hypertension was present in 55 patients (68.8%). Fifteen patients (18.8%) were diabetic, 24 (30.0%) had a high serum triglyceride, 22 (27.5%) had a low high-density lipoprotein cholesterol, and 20 (25.0%) had evidence of abdominal obesity. Patients with MS had significan...
Background: Metabolic syndrome (MS) has prominent effect on different aspects of the health. The ... more Background: Metabolic syndrome (MS) has prominent effect on different aspects of the health. The aim of this study was to identify whether interdialytic weigh gain (IDWG) has any effect on prevalence of MS and blood pressure (BP) in hemodialysis (HD) population. Material and Methods: Study was performed on 300 patients in four HD centers in Iran. Inclusion criteria: age ≥16 years, at least 6 month on HD, and availability of all requested demographic and laboratory parameters. Exclusion criteria: incomplete data at analysis time and anticipated life expectancy less than 6 months. Participants were divided into two groups according to IDWG between two sessions of HD; Group-A had IDWG<3 kg and Group-B had IDWG ≥3 kg. First, prevalence of MS and its components were evaluated, then they were compared with each group. Results: Three hundred HD patients were enrolled for the study, 173 men (57.7%) and 127 women (42.3%) with mean age of 61.7±14.2 years. Prevalence of MS was 50.3 %( 151),...
Gitelman syndrome (GS) is an autosomal recessive disease characterized by hypokalemia, hypomagnes... more Gitelman syndrome (GS) is an autosomal recessive disease characterized by hypokalemia, hypomagnesemia, metabolic alkalosis, and hypocalciuria. It is caused by mutations in gene SLC12A3 (located in chromosome 16q) encoding NaCl cotransporter. GS is usually asymptomatic for several years and is diagnosed in late childhood or adulthood. The association between GS and diabetic ketoacidosis (DKA) is rare. We present a case of a 25-year-old man with newly diagnosed diabetes mellitus and DKA with profound hypokalemia and hypomagnesemia who was provisionally found to have GS.
INTRODUCTION. Helicobacter pylori infection in gastric mucosa may cause systemic inflammatory rea... more INTRODUCTION. Helicobacter pylori infection in gastric mucosa may cause systemic inflammatory reaction. We investigated the inflammatory effect of H pylori infection on nutritional factors such as serum albumin in hemodialysis patients and influence of eradication of H pylori on this association. MATERIALS AND METHODS. Ninety-eight patients on hemodialysis were divided into 2 groups according to H pylori infection. Eradication of H pylori, 8 weeks after treatment, was confirmed by urease breath test and H pylori stool antigen. Serum albumin, lipid profile, and metabolite levels were checked before and after 8 weeks and 6 months of eradication of H pylori. RESULTS. Thirty-nine patients (39.8%) were infected with H pylori. There were no significant differences between the two groups in age, dialysis duration, serum albumin, serum creatinine, blood urea nitrogen, hemoglobin, serum calcium, serum phosphorus, and lipid profile. Thirty-seven patients with H pylori completed the treatment ...
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Papers by Mojgan Jalalzadeh