Efficacy of Intracavernosal Injections of 50-Unit versus 100-Unit Doses of AbobotulinumtoxinA (Masport®) in Vasculogenic Erectile Dysfunction with Phosphodiesterase Type 5 Inhibitors Resistant

Background: We aimed to evaluate the safety and efficacy of 50-unit dose against 100-unit dose of intracavernosal injection (ICI) of AbobotulinumtoxinA (BTX-A) (Masport®) in patients with vascular erectile dysfunction (ED) resistant to first-line therapies, including phosphodiesterase type 5 inhibitors (PDE5I). Methods: In this double-blind randomized controlled trial (RCT), 40 patients with ED resistant to PDE5I were randomly divided into two groups: ICI of a single dose of Masport® 50 units and single dose of 100 units. Peak systolic velocity (PSV) confirmed arterial insufficiency vascular disorder. For all patients, IIEF (International Index of Erectile Function), SHIM (Sexual Health Inventory for Men), and EHS (Erection Hardness Score) questionnaires were completed. Six weeks after the treatment, the subjects were re-examined. Results: Our results showed an acceptable clinical efficacy and safety of ICI of Masport® six weeks after injection. No systemic complications in patients were seen. Three patients complained of brief penile pain shortly after injection, but there were no other local complications. The increase in mean PSV in the 100-unit group due to treatment was significant (P-value < 0.0001). Also, there was a significant difference between the two groups of 50- and 100-unit (P-value < 0.0001). In addition, the increase in mean IIEF-EF, SHIM score, and EHS due to treatment was significant between the two groups. For the 100-unit group, P-value < 0.0001 and the difference between the two groups was also significant (P-value < 0.0001), which indicated a better response to treatment in the 100-unit group. The mean increase of IIEF score (EF domain) was 4.3 (mean IIEF: 9.4 and 13.7 after and before, respectively) in the 100-unit group and (mean IIEF: 8.1 and 9.1 after and before, respectively) in the 50-unit group. Conclusions: The results of this study showed that ICI of AbobotulinumtoxinA, especially at a dose of 100 units, in patients with refractory vasculogenic ED is safe and effective in improving sexual function and ultrasound indices.

Evaluation of the Correlation Between Cardiac Troponin I Versus Causes of Admission and In-Hospital Mortality in End-Stage Renal Disease Patients

Objectives: There are arguments regarding the relationship between the level of cardiac troponin I (cTnI) and presence of cardiac diseases in end-stage renal disease (ESRD) patients. This study aimed to determine the relationship between positivity of cTnI and cause of admission and patients’ outcome in ESRD patients. Methods: In this cross-sectional study, all ESRD patients who had checked cTnI and admitted to two university hospitals in Isfahan, Iran were enrolled. The patients’ demographic characteristics, cause of admission, and outcome were correlated with cTnI positivity. Results: Out of a total of 348 ESRD patients, 100 subjects had positive cTnI. There was a positive correlation between age and admission in Al-Zahra hospital with positive cTnI. In contrast, vascular access complication and hypertension had a negative correlation with positivity of cTnI. The results of multiple logistic regression analysis showed that factors including age (OR: 1.04; 95% CI: 1.01 - 1.07; P: 0.004) and infections (OR: 3.1; 95% CI: 1.3 - 7.3; P: 0.009) were associated with increased risk of in-hospital mortality. In contrary, exit site infection (OR: 0.11; 95% CI: 0.01 - 0.8; P: 0.03) and hypertension (OR = 0.32; 95% CI: 0.14 - 0.77; P = 0.01) were associated with decreased risk of mortality. Although cTnI positivity correlated with patients’ in-hospital mortality (OR = 2.038). Conclusions: Although positive cTnI had a borderline association with in-hospital mortality in ESRD patients, further multicenter studies with larger sample size are required to confirm the results.

A Randomized Controlled Trial Examining the Effect of Aromatherapy Using the Damask Rose Essential Oil on Pre-operative Anxiety Levels

Background: Non-pharmacological care interventions like aromatherapy can be cost-effective and efficient ways to reduce anxiety and adverse results before surgery. Objectives: In this study, the efficacy of aromatherapy on pre-operative anxiety in patients undergoing Percutaneous Nephrolithotomy (PCNL) referring to Peymaniyeh Hospital in Jahrom-Iran was the main goal. Methods: This controlled-randomized trial was conducted on 38 patients that were randomly assigned to two groups: Control and Aromatherapy (Rosa damascena). The anxiety levels were recorded for all two groups the night before the surgery. On the day of surgery and after re-communication, patients were approached in a pre-operative holding area, and the intervention was performed. Data were collected over 11 months from June 2015 to May 2016. Results: The statistically significant difference after the intervention between the control and intervention groups indicated that Aromatherapy with Rosa damascene reduced the patient’s anxiety. Conclusions: This survey prepares evidence for the use of Damask rose as an anti-anxiety intervention. Using Damask rose as a nursing intervention helps nurses provide individualized care and helps patients control their anxiety.

Investigating the Effect of Cold Water Bags on the Severity of Restless Leg Syndrome and Sleep Quality in Hemodialysis Patients

Background: Restless legs syndrome is a neurological disorder in hemodialysis patients that causes disturbance and disability in rest, discomfort, sleep disturbance, fatigue, and stress. Objectives: This study was done to evaluate the effect of cold water bags on the severity of restless leg syndrome and sleep quality in hemodialysis patients. Methods: This is a quasi-experimental study (before and after) performed on patients referring to three hospitals in Yazd province. In this study, 40 patients with restless legs syndrome were selected from all patients who were referred to the hemodialysis ward by simple random sampling. The samples completed the Restless Legs Syndrome Symptoms Severity Questionnaire before and after using the cold water bag. Data were analyzed by SPSS 20 software and descriptive statistics and paired t-test at the significance level of < 0.05. Results: This study showed a significant difference between the mean score of restless leg syndrome and sleep quality before and after the interventions (P = 0.000). Furthermore, the mean scores of restless leg syndrome and sleep quality were different between the two intervention groups and statistically significant (P = 0.000). Conclusions: Based on the results, using a water bag reduces the symptoms of restless leg syndrome. Therefore, it is suggested that cold water bags should be used as an effective, safe, low-cost method.

Association of Electrolyte Changes and Inflammatory Markers with Renal Involvement in Children with Febrile UTI

Background: We need some simpler, cheaper, and less burdensome tools to investigate the severity of renal parenchymal involvement in children with clinical pyelonephritis. Objectives: The present study was designed to investigate the relationship between electrolyte changes with renal involvement as documented by dimercaptosuccinic acid (DMSA) scan in children with febrile urinary tract infection (UTI). Methods: This is a retrospective cohort study, involving 158 children aged two months to 14 years with febrile UTI admitted to Taleghani Hospital in Gorgan from 2018 to 2019. Their documents in hospital were analyzed. They were divided into two groups with positive or negative defects on DMSA scan. Clinical and laboratory data were studied. Statistical analysis was performed using SPSS version 18. Data were analyzed using independent t-test with normal distribution of variables, otherwise chi-square test was used. The statistical significance level of the study was considered 0.05. Results: Among the 158 children, 78 patients (49.4%) had normal DMSA scan results, and 80 patients (50.6%) had an abnormal result. The mean age in month was not different between the two groups. In patients with positive renal cortical defects on DMSA Scintigraphy (group 2), ESR was significantly higher than the first group (P < 0.05). The mean serum Na level in the second group was lower than in the first group; however, it was only slightly significant (P = 0.058). The two groups showed no difference with respect to serum potassium, urine specific gravity (SG), WBC count, and the duration of fever (P > 0.05). The frequency distribution of proteinuria was not different between the two groups (P = 0.836). Conclusions: We suggest that increased ESR, positive CRP, and the presence of reflux can predict renal parenchymal involvement in children with febrile UTI as evidenced by a positive finding on DMSA scan, and the presence of hyponatremia has a little predictive value in this regard.

Association of Postoperative Urinary Output in the First 24 Hours with Delayed Graft Function After Living and Deceased Donor Kidney Transplant: A Systematic Review

Context: Delayed graft function (DGF) is an important clinical outcome following renal transplantation; therefore, it is important to be correctly diagnosed. The DGF is thought to correlate with the first 24-hour urine output (UOP1), and this clinical sign is expected to predict DGF. Objectives: This study aimed to discover whether the UOP1 correlates significantly to the DGF incidence and can be a DGF predicting factor. Data Sources: This study compared the incidence of DGF with the UOP1 reported by studies obtained from the electronic databases, namely MEDLINE, Cochrane, and EBSCO. Studies that performed multivariate or bivariate analysis and/or reported sensitivity and specificity were included in this review. Results: A total of 1719 studies were obtained from the database search, and 2 studies were enrolled from other sources. Out of 1721 studies, 9 studies were recruited in this review, 5 of which reported sensitivity and specificity. Overall, nine of these studies had a low to moderate risk of bias. Almost all studies reported a significant relationship between the UOP1 and DGF. All studies agreed that the UOP1 is a sensitive predictive factor in predicting DGF. The specificity reported by the studies examined in this review varied greatly. The use of optimum cut-off in each study is considered to be the cause of this variability. Conclusions: The UOP1 is significantly related to the incidence of DGF and is a proper parameter for the prediction of DGF events.

Causes and Risk Factors of Hemodialysis Catheter Infection in Dialysis Patients: A Prospective Study

Objectives: Infectious central venous catheter (CVC) complications, including mortality and care and hospitalization costs, are still a major clinical concern. This study aimed to determine the prevalence of hemodialysis catheter infection and its risk factors among hemodialysis patients. Methods: The present research was a descriptive, prospective cross-sectional study on hemodialysis patients in Babol hospitals during 2020 - 21. The participants' demographic information and some relevant data on clinical variables (namely underlying diseases, cause of dialysis, and cause of catheter removal) and catheter-related variables (namely catheter location, frequency of catheter placement, and apparent signs of catheter site) were collected and recorded directly and systematically during surgery post-surgery. Results: One hundred and twenty-two patients with temporary double-lumen acute hemodialysis catheters for dialysis, including 56 women (45.9%), were included in this study, the mean age of whom was 58.9 ± 16.4 years. Twenty-two patients (18%) developed a catheter-induced systemic infection. There was no significant relationship between the catheter site and its removal inducing infection (P > 0.05). The frequencies of microorganisms causing catheter infection included gram-positive Staphylococcus epidermis (59%) and Staphylococcus aureus (31.8%). Moreover, there was no significant correlation between demographic variables and clinical history with systemic infection induced by catheterization. Conclusions: The rate of catheter-induced infection is relatively high among patients since sterile instructions were observed during catheterization; therefore, it is recommended to pay more attention to the care and dressing of the catheter site.