Is Aflatoxin More in the Milk of Lactating Mothers Who Have Previously Had COVID-19?

Background: Breast milk provides the ideal nutrition for infants. It has a nearly perfect mix of vitamins, protein, and fat. Breastfeeding has many health benefits for both the mother and infant. Breast milk contains all the nutrients an infant needs in the first six months of life. The present study aimed to measure aflatoxin M1 (AFM1) levels in breast milk and identify nutritional and socio-demographic factors associated with AFM1 levels. Methods: This cross-sectional study was conducted to assess AFM1 levels in the breast milk of 100 mothers by enzyme-linked immunosorbent assay (ELISA), 20 of whom had COVID-19 in the past 4 months during June 2020-March 2021. The participants were given a questionnaire to answer nutritional and socio-demographic questions, such as age, place of residence, COVID-19, educational status, employment status, and body mass index (BMI). Results: The mean age of mothers was 29.1 ± 4.9 years. Based on the results, 39/100 samples had AFM1 more than 5 ng/l, and all 20 mothers who previously had COVID-19 had AFM1 in their milk. The mean AFM1 was 7.10 ng/l and ranged 5.37–9.01 ng/l. Consumption of milk and yogurt also significantly increased AFM1 in milk. Moreover, place of residence and BMI and COVID-19 had a statistically significant effect on the presence of AFM1. Conclusion: The AFM1 contamination was significantly associated with the consumption of milk and yogurt by the lactating mother. Breastfeeding mothers should be careful in their food intake and try to fit their BMI. The presence of aflatoxin in the lactating mothers who previously had COVID-19 indicates that their children are more vulnerable.

Isolation, characterization, and genotyping of Ornithobacterium rhinotracheale isolated from broiler and broiler breeder flocks in Mazandaran province, Northern Iran

BACKGROUND

Ornithobacterium rhinotracheale (ORT) is one of the most important pathogenic bacteria which cause significant economic losses in poultry breeder countries every year. Aims: The present study was conducted to isolate and investigate the ORT isolates' biochemical, antibiotic resistance, and genotypic characteristics of in industrial poultry flocks with respiratory signs in northern Iran.

METHODS

After sampling from 60 different flocks and cultivation of the samples on a selective medium, suspected colonies were subjected to biochemical and molecular identification of ORT. Then, confirmed isolates were aimed to antibiotic resistance assay, hemagglutination test, detection of pOR1 plasmid, and DNA fingerprinting to survey the variability of the isolates.

RESULTS

A total of 13 isolates, including seven isolates from broiler flocks (19.44%) and six isolates from broiler breeder flocks (25%) were obtained. Almost all isolates showed similar results in terms of basically important biochemical tests. The most resistance rates among all ORT isolates were obtained for ampicillin, erythromycin, ceftriaxone, and penicillin (100%). The majority of ORT isolates were susceptible to furazolidone. The pOR1 plasmid was detected in only two isolates, and analysis of the DNA fingerprinting phylogenetic tree showed four specific genotypic clusters.

CONCLUSION

According to the results, the isolates showed different antibiotic resistance profiles, and most of the strains proved multiresistant. This can indicate the circulation of various multi-drug resistant strains among poultry farms in northern Iran. Isolates from broilers and broiler breeders were grouped into different clusters by genotyping.

Carotid intima-media thickness as a marker of atherosclerosis in hemodialysis patients

Atherosclerotic changes in carotid arteries of hemodialysis (HD) patients reflect global atherosclerotic changes in vasculature. Carotid intima-media thickness (CIMT) can be used for atherosclerosis prediction and assessment of cardiovascular risks in HD patients, and thus screening high-risk patients. In this cross-sectional study, CIMT was measured using ultrasonography (B-mode with 5-10-MHz multifrequency linear probe) in HD patients in our hospitals. Additionally, we assessed the relationship between their CIMT and some cardiovascular risk factors. A total of 62 HD patients (64.5% male) were included. Age, body mass index, low-density lipoprotein, fasting blood sugar, history of diabetes mellitus and cardiovascular disease, serum albumin, and duration and adequacy of HD in study patients had significant association with their CIMT. There were no significant relationships between CIMT and patient's gender, smoking, serum calcium, phosphate, calcium x phosphate product, hemoglobin, and uric acid level. More diagnostic modalities must be performed for detecting the impact of atherosclerosis on HD patients with high CIMT.

Association of dialysis adequacy with nutritional and inflammatory status in patients with chronic kidney failure

The number of patients with dialysis-dependent renal failure has increased in the past years worldwide. Several parameters have been introduced for the quantitative assessment of dialysis adequacy. The National Cooperative Dialysis Study results indicated that Kt/V and time-averaged concentration of urea (TAC) are predictors of mortality in patients who receive maintenance hemodialysis (HD). Also, the protein catabolic ratio (PCR), which is an indicator of nutritional status, can predict patients' mortality. Our aim was to assess the impact of parameters that show dialysis adequacy on indices of nutrition or inflammation. A total of 46 patients were included in the study; eight patients were excluded during the course of the study and 38 patients were enrolled in the final analysis. All patients were receiving HD for at least for three months. HD was administered three times per week and the study lasted for two months. Kt/V, TAC and PCR were assessed at the beginning of the study based on patients' urea and blood urea nitrogen in the first week of our study; these calculations were repeated at the end of the first and second months using the mean of the mentioned values in the month. Both adequacy indices significantly and positively correlated with changes in PCR (P <0.001). However, no significant correlation was detectable between Kt/V and TAC with either body mass index and albumin or C-reactive protein. Based on the Kt/V values, patients with adequate dialysis had slower decrease in the PCR (P <0.001). Our results indicate that adequacy of dialysis is correlated with patients' nutritional status. No correlation was observed between dialysis adequacy and inflammatory status.

Nutritional Physiology of the Khapra Beetle, Trogoderma granarium Everts (Coleoptera: Dermestidae) Fed on Various Barley Cultivars

The Khapra beetle, Trogoderma granarium Everts (Coleoptera: Dermestidae), is known as one of the mostserious pests of grains in many parts of the world. In this study, the effect of nine barley cultivars (‘Bahman’,‘CB-84-10’, ‘Fajr 30’, ‘Makuyi’, ‘Nosrat’, ‘Yousof’, ‘13A1’, ‘18A1’, and ‘19 A1’) and a wheat cultivar (‘MV17’, as a control) was determined on the nutritional indices and digestive enzymatic activity of T. granarium at 33 6 1C,relative humidity of 6565%, and a photoperiod of 14:10 (L:D) h. The highest and lowest values of larval weight gain of sixth instar were detected on wheat (0.757±0.068 mg) and cultivar Bahman (0.342±0.071 mg). Also, T. granarium larvae fed on cultivar Bahman had the lowest value of efficiency of conversion of ingested food(10.90±2.09%) as compared with wheat and other barley cultivars. Also, the highest midgut amylolytic and proteolytic activities of sixth instar were on cultivar Bahman (0.364±0.024 mU/mg and 80.54±1.73 U/mg, respectively)and the lowest activities were on cultivar Nosrat (0.043±0.004 mU/mg and 7.15±0.01 U/mg, respectively).It is concluded that barley cultivar Bahman was the most unsuitable host for feeding of T. granarium.

Risk Factors for Lung Cancer Mortality in a Referral Center

BACKGROUND

Lung cancer is one of the most common causes of death that is rising in many countries including Iran. This study aimed to determine the impact of factors on survival of lung cancer patients at a referral center of lung diseases in Tehran, Iran.

MATERIALS AND METHODS

A retrospective study was conducted on adult lung cancer cases admitted to a referral center for lung diseases from 2011 to 2015. Multivariate analysis was performed to determine the risk factors for all-cause mortality.

RESULTS

Of a total 933 patients with lung cancer, 53.4% died, 49.3% of them at the hospital. Overall median follow-up time was 7 months. The most common histological type of cancer was adenocarcinoma with a 13 month median survival time. Age ≥55 and smoking remained significant for all-cause mortality on Cox analysis, whereas gender was not.

CONCLUSIONS

The survival of lung cancer patients is poor and the patients with history of smoking and age ≥55 are at increased risk of death. Having a large hospital-based registry provides a good measurement of prognostic statistics for lung cancer. Further investigations are necessary to establish reasons for mortality.

Effect of Sample Storage Temperature and Time Delay on Blood Gases, Bicarbonate and pH in Human Arterial Blood Samples

Background:

Results of arterial blood gas analysis can be biased by pre-analytical factors, such as time interval before analysis, temperature during storage and syringe type.

Objectives:

To investigate the effects of samples storage temperature and time delay on blood gases, bicarbonate and PH results in human arterial blood samples.

Patients and Methods:

2.5 mL arterial blood samples were drawn from 45 patients via an indwelling Intraarterial catheter. Each sample was divided into five equal samples and stored in multipurpose tuberculin plastic syringes. Blood gas analysis was performed on one of five samples as soon as possible. Four other samples were divided into two groups stored at 22°C and 0°C. Blood gas analyses were repeated at 30 and 60 minutes after sampling.

Results:

PaO₂ of the samples stored at 0°C was increased significantly after 60 minutes (P = 0.007). The PaCO₂ of the samples kept for 30 and 60 minutes at 22°C was significantly higher than primary result (P = 0.04, P < 0.001). In samples stored at 22°C, pH decreased significantly after 30 and 60 minutes (P = 0.017, P = 0.001). There were no significant differences in other results of samples stored at 0°C or 22°C after 30 or 60 minutes.

Conclusions:

In samples stored in plastic syringes, overestimation of PaO₂ levels should be noted if samples cooled before analysis. In samples stored in plastic syringes, it is not necessary to store samples in iced water when analysis delayed up to one hour.

Patient outcomes in a liver transplant program in Iran

OBJECTIVES

The first liver transplant program in Tehran was started at Tehran University of Medical Sciences in 2002. The purpose of this study was to evaluate patient outcomes in this program.

MATERIALS AND METHODS

From January 2002 to February 2013, there were 172 deceased-donor orthotopic liver transplants performed in 166 patients, including revision transplant in 6 patients. Outcomes were evaluated for 4 phases of the program: (1) phase 1 (2002 to 2005; 9 transplants); (2) phase 2 (2006 to 2009; 41 transplants); (3) phase 3 (2010 to 2011; 49 transplants); and (4) phase 4 (2012 to 2013; 73 transplants).

RESULTS

The most frequent indications for liver transplant included cryptogenic cirrhosis, autoimmune hepatitis, and hepatitis B and C cirrhosis. During the progression from phase 1 to 4, there were significant decreases in median cold ischemia time, operative time, and transfusions (platelets, packed red blood cells, and fresh frozen plasma). The most frequent complications included infection and acute rejection. The overall median follow-up for all patients was 26 months (range, 9-144 mo). Frequency of 1-month, 3-month, 1-year, and 2-year survival increased from phase 1 to 4. Kaplan-Meier plots showed significant improvement in patient survival from phase 1 to 4 (P ≤ .001). The most common causes of death were sepsis and bleeding.

CONCLUSIONS

Clinical outcomes with deceased-donor liver transplant may be improved with a cooperative multidisciplinary team, coordinated care from different specialties, increased experience, and modifications of anesthetic and surgical techniques. Comprehensive unified written protocols for preoperative, perioperative, and postoperative treatment may help improve outcomes after sufficient experience is achieved.

The Effects of Previous Abdominal Operations and Intraperitoneal Adhesions on the Outcome of Peritoneal Dialysis Catheters

Background

Patients with previous history of abdominal operations are sometimes excluded from consideration for peritoneal dialysis because of concerns for increased risk of complications during the implantation procedure and inadequate dialysis due to reduced peritoneal surface area. Employing a laparoscopic approach, we compared the outcome of peritoneal dialysis catheters in 2 groups of patients with and without intra-abdominal adhesions.

Methods

All data in this report were recorded prospectively. Revision-free and overall survival of catheters, the incidence of mechanical and infectious complication, and surgical revision rates were compared between the 2 groups.

Results

In 217 successful catheter implantations, there was a history of previous abdominal surgery in 42.9% of procedures; only 26.9% of them had intraperitoneal adhesions; 2.8% of patients without history of previous abdominal surgery had intraperitoneal adhesions. There were no significant differences between the 2 groups for 1- and 2-year revision-free and overall catheter survival, mechanical dysfunction, infectious complications, or surgical revision rates.

Conclusion

History of previous abdominal surgery should not be used to judge the eligibility of patients for peritoneal dialysis. Laparoscopic placement is the best way to ensure optimal catheter outcomes equivalent to patients without previous abdominal surgery.

The cost of hemodialysis in Iran

The use of dialysis in patients with end-stage renal disease (ESRD) remains one of the most resource-intensive and hence, expensive therapeutic interventions. The purpose of this study was to assess the cost of hemodialysis (HD) in Iran. This study was conducted in the Department of Nephrology at the Imam Khomeini Hospital of Tehran University of Medical Sciences, Iran, between April 2006 and June 2007. Patients with ESRD on chronic HD were involved in the study. Relevant data were collected using interview and questionnaire. Analyzed costs included: transportation plus absence from work, treatment instruments, drugs and other medical procedures, diet, staff salary, equipment and building support services, non-medical supplies, depreciation of installations and equipments, depreciation of reverse osmosis (RO) and building rent. Sixty-three patients of whom 47.7% were males and 52.3% were females, with mean age of 47 +/- 12 years were studied. The estimated cost of each HD session was about 74 US dollars by which an annual cost of $11549 could be estimated for each patient. Transportation and work leaves (28.9%), staff costs and salaries (21.5%), and treatment instruments (21.1%) were among the greatest expenses. We conclude that the annual cost of dialysis in Iran is similar to other developing countries, but significantly less than the cost in developed countries.

Pre-transplant calcium-phosphate-parathormone homeostasis as a risk factor for early graft dysfunction

While good organ quality and ideal transplant conditions eliminate many of the know factors that compromise initial graft function (IGF), poor early graft function (EGF) still occurs after living donor kidney transplantation (LDKT). Uncontrolled pre-transplant hypercalcemia and hyperparathyroidism are associated with impaired allograft function. Between April 2004 and January 2006, data were collected on 354 LDKT recipients including 252 males and 102 females, to determine risk factors for poor EGF, defined as either delayed or slow graft function (DGF or SGF). Of the 354 recipients, 318 (89%) had IGF, 22 (6.2%) had SGF and 14 (4%) had DGF. Donor female gender (P = 0.04) and duration on dialysis (P = 0.02) were associated with poor EGF. Recipients with DGF had higher serum phosphate (P = 0.07) and calcium x phosphate product ( P = 0.01) than recipients with IGF and SGF. The serum parathormone (PTH) levels were higher in recipients with SGF and DGF although the difference was not statistically significant (P = 0.1). Serum calcium levels did not correlate with the occurrence of poor EGF (P = 0.9). Our study suggests that serum phosphate and calcium x phosphate product serve as risk factors for DGF while serum PTH level may play a role as a risk factor for SGF and DGF.

Infertility among female renal transplant recipients

We studied 122 women with renal allograft transplantation to evaluate their reproductive systems. The patients were recruited from the three main kidney transplant surgery centers in Tehran, from September to October 2005. Fifteen (12%) patients were either in the menopausal stage or had hysterectomies, and the other 33(27%) were unmarried. Of the 76(62%) married women at the reproductive age, 10 (13.1%) had infertility that was defined as the failure of a married woman to conceive after 12 months of frequent intercourse without contraception. Three patients had male factor infertility, three others had ovulatory problems, and four cases were undefined. Only six cases were actively treated by ovulation induction +/- an intrauterine inducer (IUI); two patients became pregnant, while the other four refused infertility treatment. The reasons of unwillingness for infertility treatment included old age (40 years) in one patient, positive HBsAg in one, renal retransplantation in one, and previous clomiphene therapy failure in another. We conclude that the prevalence of infertility among female renal transplant recipients is the same as the general population, and the causes are mostly treatable. However, many are less motivated to be treated for this problem.

Relation of antioxidants and acute-phase reactants in patients receiving hemodialysis

INTRODUCTION

To investigate the oxidative stress and its association with antioxidants in patients on hemodialysis, we evaluated the levels of albumin, C-reactive protein (CRP), ferritin, vitamin E, glutathione, and total antioxidant capacity in these patients.

MATERIALS AND METHODS

In a cross-sectional study, we enrolled 25 patients on maintenance hemodialysis and measured the inflammatory and oxidative stress indicators consisting of the plasma concentrations of glutathione, vitamin E, and total antioxidant capacity. The acute-phase inflammatory response was assessed by determining the serum levels of CRP and albumin as well as the plasma level of ferritin. Antioxidants and acute-phase reactants in men and women and their association with age and their correlations with each other were analyzed.

RESULTS

The mean age of the patients was 53.6 +/- 14.1 years (range, 29 to 70 years). They had been on hemodialysis for a mean duration of 4.66 +/- 5.08 years. There were no association of sex or age with the levels of antioxidants and acute-phase reactants. Plasma level of glutathione significantly correlated with CRP (r = 0.48; P = .01) and serum albumin (r = 0.42; P = .04). Duration of dialysis did not correlate with the antioxidants or acute-phase reactants.

CONCLUSIONS

Although it is reasonable to see an association between acute-phase reactants and levels of antioxidants in patients on hemodialysis, we failed to show such a relation. It is recommended that other biomarkers of oxidative stress and their relation in patients with kidney failure be investigated.

Infertility among kidney transplant recipients

We studied 122 women with a transplanted kidney to evaluate their reproductive performance. 15 of the patients were either post-menopausal or underwent hysterectomy and 33 were unmarried. Of the 76 married reproductive age women, 10 (13.1%) were infertile. Three had male factor infertility, three had ovulatory problems and in four cases, the cause was uncertain. Six of these patients were actively treated by ovulation induction with or without IUI and two of these patients became pregnant. The remaining four patients refused treatment for infertility. We conclude that the incidence of infertility among kidney transplant recipients is similar to the general population, but they are less motivated to be treated for infertility.

Unwanted Pregnancy Among Kidney Transplant Recipients in Iran

To investigate the incidence of unwanted pregnancy among kidney transplant recipients, we studied 86 pregnancies in 64 women with a transplanted kidney. Twenty-five pregnancies were unwanted (29.1%). Pregnancy was terminated by induced abortion in seven patients, and four pregnancies were lost due to spontaneous abortion with one intrauterine fetal death. Only 13 (52%) pregnancies resulted in a live birth. Most of the unwanted pregnancies occurred in women using coitus interruptus (92%) as the only method of contraception. It is concluded that because fertility greatly improves after kidney transplantation, it is necessary to have a family planning counseling session before surgery. If a patient is not interested in future pregnancy, an effective method of contraception should be offered. A woman who has decided against childbearing in the future may decide to have a tubal ligation at the time of transplantation surgery.

Fertility and contraceptive issues after kidney transplantation in women

PURPOSE

Our purpose was to investigate reproductive performance among kidney transplant recipients.

MATERIALS AND METHODS

We studied 126 kidney transplanted women 15 to 68 years of age including 33 who were single and 93 who were married.

RESULTS

Infertility was seen in 10.4% of those who desired pregnancy, a rate similar to the general population. The most common method of contraception was coitus interruptus (56%), 22% of patients had tubal ligation, 6% had husbands who had vasectomies, 14% were using condoms, and only 2% used oral contraceptives. Among 33 pregnancies, 16 were unintended (48.5%). Most of the patients with unwanted pregnancy were using coitus interruptus (93.7%). In the group with unintended pregnancy, abortion was induced in three, spontaneous abortion or intrauterine fetal death occurred in six, and only seven pregnancies resulted in a live birth (43.7%).

CONCLUSION

Kidney transplantation greatly improves fertility, so those who do not desire pregnancy should be protected by an effective method of contraception.