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Bajaj JS, Kamath PS, Reddy KR, Asrani SK, Keaveny AP, Tandon P, Duarte-Rojo A, Kappus M, Verna E, Biggins SW, Vargas HE, Albhaisi S, Shaw J, Dahiya M, Filipek N, Fallahzadeh MA, Wegermann K, Cabello R, Bera C, Thuluvath P, Bush B, Thacker LR, Wong F. Predictors of Respiratory Failure Development in a Multicenter Cohort of Inpatients With Cirrhosis. Am J Gastroenterol 2024; 119:712-718. [PMID: 37938163 DOI: 10.14309/ajg.0000000000002574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/18/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Hospitalized patients with cirrhosis can develop respiratory failure (RF), which is associated with a poor prognosis, but predisposing factors are unclear. METHODS We prospectively enrolled a multicenter North American cirrhosis inpatient cohort and collected admission and in-hospital data (grading per European Association for the Study of Liver-Chronic Liver Failure scoring system, acute kidney injury [AKI], infections [admission/nosocomial], and albumin use) in an era when terlipressin was not available in North America. Multivariable regression to predict RF was performed using only admission day and in-hospital events occurring before RF. RESULTS A total of 511 patients from 14 sites (median age 57 years, admission model for end-stage liver disease [MELD]-Na 23) were enrolled: RF developed in 15%; AKI occurred in 24%; and 11% developed nosocomial infections (NI). At admission, patients who developed RF had higher MELD-Na, gastrointestinal (GI) bleeding/AKI-related admission, and prior infections/ascites. During hospitalization, RF developers had higher NI (especially respiratory), albumin use, and other organ failures. RF was higher in patients receiving albumin (83% vs 59%, P < 0.0001) with increasing doses (269.5 ± 210.5 vs 208.6 ± 186.1 g, P = 0.01) regardless of indication. Admission for AKI, GI bleeding, and high MELD-Na predicted RF. Using all variables, NI (odds ratio [OR] = 4.02, P = 0.0004), GI bleeding (OR = 3.1, P = 0.002), albumin use (OR = 2.93, P = 0.01), AKI (OR = 3.26, P = 0.008), and circulatory failure (OR = 3.73, P = 0.002) were associated with RF risk. DISCUSSION In a multicenter inpatient cirrhosis study of patients not exposed to terlipressin, 15% of patients developed RF. RF risk was highest in those admitted with AKI, those who had GI bleeding on admission, and those who developed NI and other organ failures or received albumin during their hospital course. Careful volume monitoring and preventing nosocomial respiratory infections and renal or circulatory failures could reduce this risk.
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Affiliation(s)
- Jasmohan S Bajaj
- Virginia Commonwealth University and Central Virginia Veterans Healthcare System, Richmond, Virginia, USA
| | - Patrick S Kamath
- Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | | | | | - Andrew P Keaveny
- Mayo Clinic College of Medicine and Science, Jacksonville, Florida, USA
| | | | - Andres Duarte-Rojo
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Northwestern University, Chicago, Illinois, USA
| | | | | | | | - Hugo E Vargas
- Mayo Clinic College of Medicine and Science, Phoenix, Arizona, USA
| | - Somaya Albhaisi
- Virginia Commonwealth University and Central Virginia Veterans Healthcare System, Richmond, Virginia, USA
| | - Jawaid Shaw
- Virginia Commonwealth University and Central Virginia Veterans Healthcare System, Richmond, Virginia, USA
| | | | | | | | | | | | | | - Paul Thuluvath
- Mercy Medical Center & University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Brian Bush
- Virginia Commonwealth University and Central Virginia Veterans Healthcare System, Richmond, Virginia, USA
| | - Leroy R Thacker
- Virginia Commonwealth University and Central Virginia Veterans Healthcare System, Richmond, Virginia, USA
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Moosavi SA, Mashhadiagha A, Taherifard E, Fallahzadeh MA, Motazedian N, Sayadi M, Azarpira N, Rahimi RS. Frailty as a predictor of poor outcomes among patients awaiting liver transplant: a systematic review and meta-analysis. Gastroenterol Hepatol Bed Bench 2023; 16:364-377. [PMID: 38313349 PMCID: PMC10835093 DOI: 10.22037/ghfbb.v16i4.2795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/07/2023] [Indexed: 02/06/2024]
Abstract
Aim This review sought to evaluate the significance of a functional assessment for liver transplant candidates, i.e., frailty, in the pre-transplant setting and its association with mortality and morbidities. Background Liver transplantation (LT) remains the treatment of choice for patients with end-stage liver disease. Due to the shortage of organs for LT, a careful selection of suitable recipients is essential. Frailty, a measure of physiologic reserve and increased vulnerability to stressors, was initially used in geriatrics and then introduced to the field of transplantation for better patient selection. Methods PubMed, Scopus, and Web of Science databases were reviewed up until January 2023. The search terms included: "frail*", "liver", and "transplant*". A Meta-analysis was conducted for the hazard ratios (HRs) obtained from the COX regression models. Fifty-five studies were included in this review; ten were included in the meta-analysis. Results The prevalence of frailty varied from 2.82% to 70.09% in the studies. Meta-analysis showed that overall frailty had a significant association with mortality (pooled adjusted HR [95%CI]: 2.66 [1.96-3.63]). Subgroup analyses revealed that both the Liver Frailty Index and Fried Frailty Index were significantly associated with mortality. Furthermore, these studies have demonstrated that this population's frailty is associated with ascites, hepatic encephalopathy, and esophageal varices. Conclusion According to emerging evidence, frailty is associated with increased morbidity and mortality of the patients on the LT waiting list. Further randomized trials are required to determine the efficacy and safety of variable interventions in the frail population.
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Affiliation(s)
- Seyed Ali Moosavi
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- These authors contributed equally
| | - Amirali Mashhadiagha
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- These authors contributed equally
| | - Erfan Taherifard
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Nasrin Motazedian
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrab Sayadi
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Negar Azarpira
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Robert S Rahimi
- Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas, United States
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Fallahzadeh MA, Asrani SK, Vahhab E, Ebrahim VS, Saracino G, Elwir S, Trotter JF. Prediction of long-term morbidity and mortality after liver transplantation using two-dimensional shear wave elastography compared with liver biopsy. Liver Transpl 2022; 28:1618-1627. [PMID: 35255183 DOI: 10.1002/lt.26450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/23/2022] [Accepted: 03/01/2022] [Indexed: 12/12/2022]
Abstract
The role of noninvasive liver disease assessment by two-dimensional shear wave elastography (2D-SWE) to diagnose fibrosis is well described in patients with chronic liver disease. However, its role in prognosis, especially after liver transplantation (LT) has not been adequately examined. We hypothesized that elevated liver stiffness measurement (LSM) as measured by 2D-SWE after LT predicts future morbidity and mortality independent of fibrosis by liver biopsy. In a prospective cohort study, consecutive LT recipients underwent concomitant protocol 2D-SWE and protocol liver biopsy (2012-2014), with the assessor blinded to biopsy findings. We examined the baseline correlation of LSM with fibrosis stage and the association between elevated LSM and the development of subsequent clinical outcomes and all-cause mortality. A total of 187 LT recipients (median age 58 years, 38.5% women, median body mass index 26.5 kg/m2 , 55.1% hepatitis C virus, 17.6% nonalcoholic steatohepatitis/cryptogenic) were examined. Median time between LT and biopsy/2D-SWE assessment was 4.0 years, and the median follow-up time after LSM determination was 3.5 years. Median LSM was 9 kPa (8 kPa [F0/F1], 11.5 kPa [F2], 12 kPa [F3/F4]). There was a positive correlation between LSM and fibrosis stage (rs = 0.41; p < 0.001). LSM ≥11 kPa was associated with lower survival within 3 years (84.8 vs. 93.7%; p = 0.04). After adjusting for age, sex, and fibrosis stage, LSM ≥11 kPa was independently associated with mortality (hazard ratio, 2.45; 95% confidence interval, 1.08-5.60). Elevated LSM by 2D-SWE is associated with increased mortality after LT independent of hepatic fibrosis. Given the overall decrease in the use of liver biopsy in the current era, 2D-SWE may serve as a novel noninvasive prognostic tool to predict relevant outcomes late after LT.
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Affiliation(s)
| | | | - Elham Vahhab
- Baylor University Medical Center, Dallas, Texas, USA
| | | | | | - Saleh Elwir
- Baylor University Medical Center, Dallas, Texas, USA
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Fallahzadeh MA, Asrani SK, Tapper EB, Saracino G, Rahimi RS. Nonselective beta-blocker use is associated with increased hepatic encephalopathy-related readmissions in cirrhosis. World J Clin Cases 2022; 10:8097-8106. [PMID: 36159543 PMCID: PMC9403687 DOI: 10.12998/wjcc.v10.i23.8097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/13/2022] [Accepted: 07/11/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatic encephalopathy (HE) is a neurocognitive condition in cirrhosis leading to frequent hospitalizations. Nonselective beta-blockers (NSBBs) are the mainstay of pharmacologic treatment in cirrhotic patients. We hypothesized that since NSBBs decrease cardiac output and portal flow, the decreased metabolic filtering process of liver parenchyma may lead to increased HE-related hospitalizations.
AIM To evaluate the impact of NSBB administration on HE-related readmissions in cirrhotic patients.
METHODS In this retrospective cohort study, we included 393 patients admitted to Baylor University Medical Center for liver-related portal hypertension indications between January 2013 and July 2018. Independent predictors of the first HE-related readmissions were identified using Cox proportional hazards analysis. The cumulative incidence of the first HE-related readmissions between patients receiving NSBBs and not receiving NSBBs was examined using Fine-Gray modeling to account for the competing risk of death or liver transplantation.
RESULTS The mean age was 58.1 ± 10.2 years and most patients fell into Child class C (49.1%) or B (43.8%). The median Model for End-Stage Liver Disease-Sodium score was 22 (IQR: 11). The cumulative incidence of the first HE-related readmissions was significantly higher in patients taking NSBBs compared to patients not receiving NSBBs (71.8% vs 41.8%, P < 0.0001). In multivariate analysis, after adjusting for demographics, markers of liver disease severity, selective beta-blocker, lactulose and rifaximin use, NSBB use [Hazard ratio: 1.74 (95%CI: 1.29-2.34)] was independently associated with the first HE-related readmissions over a median follow-up of 3.8 years.
CONCLUSION NSBB use is independently associated with increased HE-related readmissions in patients with cirrhosis, regardless of liver disease severity.
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Affiliation(s)
| | - Sumeet K Asrani
- Division of Hepatology, Baylor University Medical Center, Dallas, TX 75246, United States
| | - Elliot B Tapper
- Division of Hepatology, University of Michigan, Ann Arbor, MI 48109, United States
| | - Giovanna Saracino
- Division of Hepatology, Baylor University Medical Center, Dallas, TX 75246, United States
| | - Robert S Rahimi
- Division of Hepatology, Baylor University Medical Center, Dallas, TX 75246, United States
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Fallahzadeh MA, Rico NT, Vahhab E, He H, Elhamahmi DA, Sandkovsky U. Strongyloides stercoralis and cytomegalovirus coinfection in a patient with a transplanted kidney. Proc AMIA Symp 2021; 35:190-192. [DOI: 10.1080/08998280.2021.1997262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
| | - Nina T. Rico
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
- Transplant Nephrology, Baylor University Medical Center, Dallas, Texas
| | - Elham Vahhab
- Department of Pathology, Baylor University Medical Center, Dallas, Texas
| | - Huang He
- Department of Pathology, Baylor University Medical Center, Dallas, Texas
| | - Dina Abdelwahab Elhamahmi
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
- Transplant Nephrology, Baylor University Medical Center, Dallas, Texas
| | - Uriel Sandkovsky
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
- Division of Infectious Diseases, Baylor University Medical Center, Dallas, Texas
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Fallahzadeh MA, Hansen DJ, Trotter JF, Everson GT, Saracino G, Rahimi RS, Helmke S, Boutte J, Asrani SK. Predicting clinical decompensation in patients with cirrhosis using the Hepquant-SHUNT test. Aliment Pharmacol Ther 2021; 53:928-938. [PMID: 33556192 DOI: 10.1111/apt.16283] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/23/2020] [Accepted: 01/17/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Early identification of risk for decompensation in clinically stable cirrhotic patients helps specialists target early interventions and supports effective referrals from primary care providers to specialty centres. AIMS To examine whether the HepQuant-SHUNT test (HepQuant LLC, Greenwood Village, Colorado, USA) predicts decompensation and the need for liver transplantation, hospitalisation or liver-related death. METHODS Thirty-five compensated and 35 subjects with a previous episode of decompensation underwent the SHUNT Test and were followed for a median of 4.2 years. The disease severity index (DSI) (range 0-50) was examined for association with decompensation in compensated patients; and liver transplantation, liver-related death, and the number and days of liver related hospitalisations in all. DSI prediction of decompensation was also evaluated in 84 subjects with compensated cirrhosis from the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis Trial (HALT-C) followed for a median of 5.8 years. RESULTS At baseline, subjects with prior decompensation had significantly higher DSI than compensated subjects (32.6 vs 20.9, P < 0.001). DSI ≥24 distinguished the decompensated from the compensated patients and independently predicted adverse clinical outcomes (hazard ratio: 4.92, 95% confidence interval: 1.42-17.06). In the HALT-C cohort, 65% with baseline DSI ≥24 vs 19% with DSI <24 experienced adverse clinical outcomes (relative risk 3.45, P < 0.0001). CONCLUSIONS The SHUNT test is a novel, noninvasive test that predicts risk of decompensation in previously compensated patients. DSI ≥24 is independently associated with risk for clinical decompensation, liver transplantation, death and hospitalisation.
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Affiliation(s)
| | | | | | - Gregory T Everson
- University of Colorado Denver School of Medicine, Aurora, CO, USA.,HepQuant LLC, Greenwood Village, CO, USA
| | | | | | - Steve Helmke
- University of Colorado Denver School of Medicine, Aurora, CO, USA.,HepQuant LLC, Greenwood Village, CO, USA
| | - Jodi Boutte
- Baylor University Medical Center, Dallas, TX, USA
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Abstract
Hepatic encephalopathy (HE) is a potentially reversible neurocognitive condition seen in patients with advanced liver disease. The overt form of HE has been reported in up to 45% of patients with cirrhosis. This debilitating condition is associated with increased morbidity and mortality and imposes a significant burden on the caregivers and healthcare system. After providing an overview of HE epidemiology and pathophysiology, this review focuses on the interaction of HE and frailty, nutrition requirements and recommendations in cirrhotic patients with HE, and current dietary and pharmacologic options for HE treatment.
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Affiliation(s)
- Mohammad Amin Fallahzadeh
- Division of Hepatology, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas, USA
| | - Robert S Rahimi
- Division of Hepatology, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas, USA
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8
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Fallahzadeh MA, Salehi A, Naghshvarian M, Fallahzadeh MH, Poustchi H, Sepanlou SG, Gandomkar A, Malekzadeh R. Epidemiologic Study of Opium Use in Pars Cohort Study: A Study of 9000 Adults in a Rural Southern Area of Iran. Arch Iran Med 2017; 20:205-210. [PMID: 28412823 DOI: 0172004/aim.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Opium is one of the most common substances used worldwide with variable epidemiologic features in different regions. This study was performed in southern Iran, to find the epidemiology of opium use and its association with different factors and diseases. METHODS This cross-sectional study was performed on baseline data extracted from Pars Cohort Study performed in Valashahr, a rural area in southern Iran. For any subject, information was collected about demographic factors, some common diseases including heart disease, stroke and hypertension and the state of using opium, other substances and cigarettes. RESULTS There were 4276 males and 4988 females, with a mean age of 52.6 ± 9.7 years of whom 8.4% reported opium use (17.3% of males and 0.7% of females). In men, the history of stroke and heart disease were significantly more common in opium users (12.6% vs. 8.8%, P = 0.001 and 2.8% vs. 1.5%, P = 0.01, respectively) while the history of hypertension was significantly more common in non-opium users (7.8% vs. 10.3%, P = 0.04). Younger age, male gender, being non-married and positive history of joint pain, cigarette smoking and alcohol consumption were the factors associated with opium use. CONCLUSION Opium use is common in non-married men who have a positive history of cigarette smoking and alcohol consumption in the rural population of southern Iran. It is associated with increased risk of heart disease and stroke and decreased risk of hypertension in males. Global interventional and preventive measures are required to control this complicated social problem.
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Affiliation(s)
| | - Alireza Salehi
- 1)MPH Department, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran. 4)Non-Communicable Disease Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojtaba Naghshvarian
- MPH Department, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Hossein Poustchi
- Liver, Pancreatic, and Biliary Diseases Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sadaf G Sepanlou
- Liver, Pancreatic, and Biliary Diseases Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdullah Gandomkar
- Non-Communicable Disease Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Malekzadeh
- Liver, Pancreatic, and Biliary Diseases Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Fallahzadeh MA, Hassanzadeh J, Fallahzadeh MH. What do we know about pediatric renal microlithiasis? J Renal Inj Prev 2017; 6:70-75. [PMID: 28497077 PMCID: PMC5423286 DOI: 10.15171/jrip.2017.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/25/2016] [Indexed: 11/09/2022] Open
Abstract
Renal or calyceal microlithiasis is a common disorder with increasing prevalence especially in infants and younger children. The main presenting symptoms and the underlying metabolic abnormalities of renal microlithiasis are similar to renal stone. Although renal microlithiasis is considered as a main problem of the health system with diverse etiologies, our information about its natural course is very limited. Hence, further investigations to make an appropriate clinical approach to this entity is mandatory. Also, general practitioners, pediatricians, nephrologists and urologists have to be well educated regarding renal microlithiasis for early diagnosis, appropriate evaluation and proper management of this entity. In this review study, we focused on collection of the present information about different aspects of renal microlithiasis in children.
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Affiliation(s)
| | - Jafar Hassanzadeh
- Department of Biostatistics and Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
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10
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Fallahzadeh MA, Dormanesh B, Fallahzadeh MK, Roozbeh J, Fallahzadeh MH, Sagheb MM. Acetazolamide and Hydrochlorothiazide Followed by Furosemide Versus Furosemide and Hydrochlorothiazide Followed by Furosemide for the Treatment of Adults With Nephrotic Edema: A Randomized Trial. Am J Kidney Dis 2016; 69:420-427. [PMID: 28043731 DOI: 10.1053/j.ajkd.2016.10.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 10/09/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Nephrotic edema is considered refractory if it does not respond to maximum or near-maximum doses of loop diuretics. This condition can be treated with loop diuretics and thiazides. However, animal studies show that the simultaneous downregulation of pendrin with acetazolamide and inhibition of the sodium-chloride cotransporter with hydrochlorothiazide generates significant diuresis, and furosemide administration following a pendrin inhibitor potentiates furosemide's diuretic effect. Therefore, we performed this study to compare the efficacy of acetazolamide and hydrochlorothiazide followed by furosemide versus furosemide and hydrochlorothiazide followed by furosemide for treatment of refractory nephrotic edema. STUDY DESIGN Randomized, double-blind, 2-arm, parallel trial. SETTING & PARTICIPANTS 20 patients with refractory nephrotic edema despite treatment with 80mg of furosemide daily and creatinine clearance > 60mL/min. INTERVENTION Patients were randomly assigned to 2 groups: group 1 (n=10) received 250mg of acetazolamide and 50mg of hydrochlorothiazide daily and group 2 (n=10) received 40mg of furosemide and 50mg of hydrochlorothiazide daily for 1 week in phase 1. In phase 2, both groups received 40mg of furosemide daily for 2 weeks. OUTCOMES The primary outcome was absolute change in weight before and at the end of each phase. MEASUREMENTS Weight and 24-hour urine volume at baseline and the end of each phase. RESULTS The mean weight decrease was of significantly larger magnitude in group 1 compared with group 2 at the end of phase 1 (-1.4±0.52 [SD] vs -0.65±0.41kg; P=0.001) and phase 2 (-1.6±0.84 vs -0.5±0.47kg; P=0.005). The increase in 24-hour urine volume was also significantly higher in group 1 at the end of phase 2. LIMITATIONS Small sample size, short follow-up duration, and lack of serum bicarbonate and chloride measurement. CONCLUSIONS Acetazolamide and hydrochlorothiazide followed by furosemide is more effective than furosemide and hydrochlorothiazide followed by furosemide for the treatment of refractory nephrotic edema.
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Affiliation(s)
- Mohammad Amin Fallahzadeh
- AJA University of Medical Sciences, Tehran, Iran; Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Jamshid Roozbeh
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mohammad Mahdi Sagheb
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Sagheb MM, Fallahzadeh MA, Moaref A, Fallahzadeh MH, Dormanesh B. Comparison of Hemoglobin Levels Before and After Hemodialysis and Their Effects on Erythropoietin Dosing and Cost. Nephrourol Mon 2016; 8:e38495. [PMID: 27713870 PMCID: PMC5045528 DOI: 10.5812/numonthly.38495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 05/18/2016] [Accepted: 05/30/2016] [Indexed: 11/20/2022] Open
Abstract
Background Hemoglobin levels measured after hemodialysis, as compared to hemoglobin levels measured before hemodialysis, are suggested to be a more accurate reflection of the hemoglobin levels between hemodialysis sessions, and to be a better reference point for adjusting erythropoietin dosing. Objectives The aim of this study was to compare the hemoglobin levels before and after hemodialysis, to calculate the required erythropoietin doses based on these levels, and to develop a model to predict effective erythropoietin dosing. Patients and Methods In this cross-sectional study, the hemoglobin levels of 52 patients with end-stage renal disease were measured before and after hemodialysis. The required erythropoietin doses and the differences in cost were calculated based on the hemoglobin levels before and after hemodialysis. A model to predict the adjusted erythropoietin dosages based on post-hemodialysis hemoglobin levels was proposed. Results Hemoglobin levels measured after hemodialysis were significantly higher than the hemoglobin levels before hemodialysis (11.1 ± 1.1 vs. 11.9 ± 1.2 g/dL, P < 0.001, 7% increase). The mean required erythropoietin dose based on post-hemodialysis hemoglobin levels was significantly lower than the corresponding erythropoietin dose based on pre-hemodialysis hemoglobin levels (10947 ± 6820 vs. 12047 ± 7542 U/week, P < 0.001, 9% decrease). The cost of erythropoietin was also significantly lower when post-hemodialysis levels were used (15.96 ± 9.85 vs. 17.57 ± 11.00 dollars/patient/week, P < 0.001). This translated into 83.72 dollars/patient/year in cost reduction. The developed model for predicting the required dosage is: Erythropoietin (U/week) = 43540.8 + (-2734.8) × Post-hemodialysis Hb* (g/dL). [(R2) = 0.221; *P < 0.001]. Conclusions Using post-hemodialysis hemoglobin levels as a reference point for erythropoietin dosing can result in significant dose and cost reduction, and can protect hemodialysis patients from hemoconcentration. The prediction of the erythropoietin adjusted dosage based on post-hemodialysis Hb may also help in avoiding overdosage.
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Affiliation(s)
- Mohammad Mahdi Sagheb
- Shiraz Nephrourology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Mohammad Amin Fallahzadeh
- Shiraz Nephrourology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding author: Mohammad Amin Fallahzadeh, Shiraz Nephrourology Research Center, Shiraz University of Medical Sciences, Zand Avenue, Shiraz, IR Iran. Tel: +98-7136466976, Fax: +98-71 36474298, E-mail:
| | - Alireza Moaref
- Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | | | - Banafshe Dormanesh
- Department of Pediatrics, AJA University of Medical Sciences, Tehran, IR Iran
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Fallahzadeh MA, Abdehou ST, Hassanzadeh J, Fallhzadeh F, Fallahzadeh MH, Malekmakan L. Pattern of in-hospital pediatric mortality over a 3-year period at University teaching hospitals in Iran. Indian J Crit Care Med 2015. [PMID: 26195856 PMCID: PMC4478671 DOI: 10.4103/0972-5229.158257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Introduction: Causes of death are different and very important for policy makers in different regions. This study was designed to analyze the data for our in-patient children mortality. Materials and Methods: In this cross-sectional study from March 2011 to March 2013, all patients from 2 months to 18 years who died in pediatric intensive care unit, emergency room or medical pediatric wards in the teaching hospitals were studied. Results: From a total of 18,915 admissions during a 2-year-period, 256 deaths occurred with a mean age of 4.3 ± 5 years and mortality 1.35%. An underlying disease was present in 70.7% of the patients and in 88.5% of them the leading causes of death were related to the underlying diseases. The most common underlying diseases were congenital heart disease and cardiomyopathy in 50 (27.6%). The four main causes of deaths were sepsis (14.8%), pneumonia (14.5%), congestive heart failure (9.8%), and hepatic encephalopathy (9.8%). Conclusion: We may conclude that after sepsis and pneumonia, congestive heart failure, and hepatic encephalopathy are the leading causes of death. Most patients who died had underlying diseases including malignancies, heart and liver diseases as the most common causes.
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Affiliation(s)
| | - Sophia T Abdehou
- Department of Pediatric, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jafar Hassanzadeh
- Department of Pediatric, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mohammad Hossein Fallahzadeh
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran, John C. McDonald Regional Transplant Center, Shreveport, Louisiana, USA
| | - Leila Malekmakan
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran, John C. McDonald Regional Transplant Center, Shreveport, Louisiana, USA
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Pirouzi S, Motealleh AR, Fallahzadeh F, Fallahzadeh MA. Effectiveness of treadmill training on balance control in elderly people: a randomized controlled clinical trial. Iran J Med Sci 2014; 39:565-70. [PMID: 25429180 PMCID: PMC4242992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 06/01/2013] [Accepted: 07/07/2014] [Indexed: 11/29/2022]
Abstract
UNLABELLED Physical exercise would improve postural stability, which is an essential factor in preventing accidental fall among the elderly population. The aim of this study is to examine the effectiveness of treadmill walking on balance improvement among the elderly people. A total of 30 community dwelling older adults with a Berg Balance Scale score of 36-48 and the ability to walk without aid were considered and divided into control (n=15) and experimental (n=15) groups. Individuals in the experimental group participated in 30 minutes of forward and backward treadmill training based on three times a week interval for a period of four weeks. Individuals in the control group were instructed to continue with their daily routine activity. Before and after training, gait speed was measured by six-minute walk test and balance ability was evaluated by Fullerton Advanced Balance Scale (FABS) and Berg Balance Scale (BBS) tests. Postural sway items such as the Center of Pressure (COP), average displacement and velocity were evaluated by using a force platform system. Data were collected in quiet standing, tandem position and standing on foam pads before and after intervention. After intervention, balance variables in the experimental group indicated a significant improvement in quiet standing on firm and foam surfaces, but no considerable improvement was shown in tandem position. A between-group comparison showed a significant reduction in COP velocity in the sagittal plane (P=0.030) during quiet standing and in the frontal plane (P=0.001) during standing on foam, whereas no significant reduction in COP parameters during tandem position was found. It is recommended that twelve sessions of forward and backward treadmill walk are effective in balance improvement in elderly people. TRIAL REGISTRATION NUMBER IRCT201209199440N2.
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Affiliation(s)
- Soraya Pirouzi
- Department of Physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran;
| | - Ali Reza Motealleh
- Department of Physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran;
| | - Fatemeh Fallahzadeh
- Department of Physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran;
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Fallahzadeh MA, Fallahzadeh MK, Derakhshan A, Shorafa E, Mojtahedi Y, Geramizadeh B, Fallahzadeh MH. A case of atypical hemolytic uremic syndrome. Iran J Kidney Dis 2014; 8:341-343. [PMID: 25001143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 11/05/2013] [Indexed: 06/03/2023]
Abstract
A 9-year-old boy presented with fever not responding to antibiotic therapy and elevated blood urea and serum creatinine levels. The patient developed microangiopathic hemolytic anemia and thrombocytopenia during the hospital stay. Kidney biopsy confirmed the diagnosis of atypical hemolytic uremic syndrome (HUS). The patient had sufficient urine output, normal blood pressure, and no evidence of peripheral edema during the whole course of his disease. Serum levels of anti-Epstein-Barr virus immunoglobulin M was elevated, indicating the possible role of Epstein-Barr virus infection in inducing atypical HUS in this patient. The patient underwent hemodialysis with dramatic response. He was discharged with normal kidney function after a few days. Kidney function and platelet count were normal 12 months after the initial presentation. This case report shows that atypical hemolytic uremic syndrome could have unusual presentations such as the absence of oliguria, hypertension, and edema, with rapid recovery and good prognosis.
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Fallahzadeh MK, Fallahzadeh MA, Mojtahedi Y, Dehghani SM, Shorafa E, Basiratnia M, Geramizadeh B, Fallahzadeh MH. Granulomatous liver involvement in a child with systemic lupus erythematosus: a case report and review of the literature. Lupus 2013; 22:1388-93. [PMID: 24003081 DOI: 10.1177/0961203313504146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Systemic lupus erythematosus (SLE) is uncommon in young children and unusual in infancy. Although a variety of liver pathologies have been reported in SLE, presentation of this disease with granulomatous liver involvement is very rare. In this article, for the first time, we report an infant girl presenting with unexplained hepatosplenomegaly and non-necrotizing granulomatous liver involvement at the age of six months who later developed pancytopenia and proteinuria and was finally diagnosed with SLE at the age of three years. Therefore, we suggest that SLE could be considered as one of the possible differential diagnoses when infants or children present with unexplained granulomatous liver involvement.
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Affiliation(s)
- M K Fallahzadeh
- 1Department of Pediatrics, Shiraz University of Medical Sciences, Iran
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Fallahzadeh MH, Zare J, Al-Hashemi GH, Derakhshan A, Basiratnia M, Arasteh MM, Fallahzadeh MA, Fallahzadeh MK. Elevated serum levels of Vitamin D in infants with urolithiasis. Iran J Kidney Dis 2012; 6:186-191. [PMID: 22555482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 01/28/2012] [Indexed: 05/31/2023]
Abstract
INTRODUCTION The pathophysiology of urolithiasis in infancy is not well known. The aim of this study was to investigate whether infants with urolithiasis have higher serum levels of vitamin D, as a possible risk factor for urolithiasis, compared to infants without urinary calculi. MATERIALS AND METHODS In this case-control study, 36 infants with urolithiasis (age range, 2.5 to 24 months) were enrolled as well as 36 age- and sex-matched infants without urolithiasis. Random urine samples were tested for calcium, phosphorous, oxalate, citrate, uric acid, sodium, potassium, magnesium, and creatinine levels, and also nitroprusside test was done on the samples. Serum levels of potassium, urea nitrogen, creatinine, 25-hydroxyvitamin D3, parathyroid hormone, calcium, phosphorous, and uric acid were measured in all of the infants with urolithiasis. Serum levels of 25-hydroxyvitamin D3 were also measured in the control group. RESULTS Serum levels of 25-hydroxyvitamin D3 were significantly higher in the infants with urolithiasis than in the controls (33.85 ± 14.78 ng/mL versus 18.26 ± 7.43 ng/mL, P < .001). Nine infants in the urolithiasis group (25%) were found to have hypercalcemia; 3 of these cases also had hypervitaminosis D. Hypercalciuria was detected in 10 infants with urolithiasis (27.8%), hypocitraturia in 6 (16.7%), hypomagnesiuria in 3 (8.3%), and hyperoxaluria in 1 (2.8%). Nineteen infants with urolithiasis had at least one metabolic disorder. CONCLUSIONS High serum levels of vitamin D may play an important role in the pathogenesis of urolithiasis in infants with hypercalcemia. We recommend evaluation of vitamin D levels in these infants.
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Fallahzadeh MK, Fallahzadeh MH, Derakhshan A, Basiratnia M, Hoseini Al-Hashemi G, Fallahzadeh MA, Mahdavi D, Malek-Hosseini SA. Urinary tract infection after kidney transplantation in children and adolescents. Iran J Kidney Dis 2011; 5:416-419. [PMID: 22057075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Accepted: 05/17/2011] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Urinary tract infection (UTI) is common after pediatric kidney transplantation. The purpose of this study was to evaluate the prevalence of UTI and its risk factors in children and adolescents with kidney transplantation in Shiraz Transplant Center. MATERIALS AND METHODS All children with kidney transplantation from 1992 to 2008 who were under regular follow-up were included in this retrospective study. Confirmed episodes of UTI after the 1st month of kidney transplantation were reviewed. RESULTS Of the 216 patients younger than 19 years at the time of transplantation, 138 were included. The mean age at the time of kidney transplantation was 13.6 ± 3.5 years. Urinary tract infection was documented in 24 patients (15 girls and 9 boys), of whom 12 experienced 1 episode, 4 had 2 episodes, and 8 had more than 2 episodes, during a median follow-up period of 54 months. Of the patients with UTI, 14 (58%) had urinary reflux-obstruction disorders as the primary kidney disease, 6 (25%) had suffered hereditary diseases, 3 (12.5%) had glomerular disease, and 1 (4.5%) had a urinary calculus. Occurrence of UTI was not significantly different among children with different primary kidney disease (P = .22). Despite using prophylactic antibiotics after the 1st month of kidney transplantation in all 5 patients with neurogenic bladder, they all experienced recurrent UTI. CONCLUSIONS Despite discontinuation of antibiotic therapy, UTI was uncommon in children after the first month of transplantation. Two significant risk factors for UTI were female gender and neurogenic bladder in this transplant population.
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Fallahzadeh MH, Fallahzadeh MK, Shahriari M, Rastegar S, Derakhshan A, Fallahzadeh MA. Hematuria in patients with Beta-thalassemia major. Iran J Kidney Dis 2010; 4:133-136. [PMID: 20404424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Our information about renal involvement in beta-thalassemia major is limited. Recently, few studies have reported proteinuria, hypercalcuria, phosphaturia, and oversecretion of tubular damage markers; however, hematuria has not yet been meticulously studied in these patients. We investigated hematuria in patients with beta-thalassemia major. MATERIALS AND METHODS Urinalysis was performed in 500 patients with beta-thalassemia major under a regular blood transfusion program. In those with hematuria (at least 3 to 5 erythrocytes per high-power field) a second urinalysis was done at the next transfusion time. RESULTS The patients ranged in age from 6 months to 32 years. The male-female ratio was 1.05:1. Hematuria was detected in 55 (10.6%), including 9.8% of those younger than 20 years and 20.0% of those older than 20 years. Hematuria was persistent in 79.2% of the second urinalyses. Sixty-four percent of the patients with hematuria were females. A blood transfusion program had been started during the first year of life in 81% percent of the patients with hematuria. Sterile pyuria was detected in 4% and proteinuria in 16% of the patients with hematuria, while these figures in patients without hematuria were 2.1% (P = .56) and 1.4% (P = .002), respectively. CONCLUSIONS We found that in patients with beta-thalassemia major, the risk of hematuria rises with age. Moreover, proteinuria seems to be more common in those with hematuria. Further studies are needed to ascertain the importance of these findings.
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Affiliation(s)
- Mohammad Hossein Fallahzadeh
- Shiraz Nephro-urology Research Center and Department of Pediatric Nephrology, Shiraz University of Medical Sciences, Shiraz, Iran
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