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Background: Renal maldevelopment, interstitial fibrosis, ischemic atrophy, decreased glomerular filtration rate (GFR), and renal blood flow (RBF) are inevitable consequences of chronic kidney obstruction that only partially improve after early intervention. There are only few studies that evaluated urine osmolality in affected kidney and its correlation with short-term outcome., Materials and Methods: Thirty patients (age<1 year) with unilateral ureteropelvic junction obstruction (UUPJO) were enrolled in this study. UUPJO was confirmed using Technetium 99 isotope scans and the patients were indicated to be operated afterward. Urine and blood samples were obtained before, 24, 48, and 72 h after the surgery. The serum level of blood urea nitrogen, creatinine, and glucose were measured. GFR, urine osmolality (measured and calculated), and urine specific gravity were determined too., Results: Cortical thickness of hydronephrotic kidney was significantly increased 6 months after the surgery. GFR was significantly increased 72-h postsurgery compared to before operation. Neither means of calculated nor of measured urine osmolalities were significantly different in various stages. The last calculated urine osmolality (72 h) had significant correlation with the last measured osmolality (72 h); r=0.962, P=0.0001. The last GFR (72 h) had positive significant correlation with GFR before the surgery and GFRs at 24 and 48 h postsurgery. Using regression tests, only the before surgery GFR was the predictor of the last GFR(72 h)., Conclusion: In UUPJO the measured and calculated urine osmolality of the affected kidney did not differ. In addition, GFR before surgery should be considered as the predictor of the GFR shortly after repair.

Objectives. To investigate the effectiveness of extracorporeal shock wave therapy (ESWT) for symptoms alleviation in chronic pelvic pain syndrome (CPPS). Materials and Methods. 40 patients with CPPS were randomly allocated into either the treatment or sham group. In the first group, patients were treated by ESWT once a week for 4 weeks by a defined protocol. In the sham group, the same protocol was applied but with the probe being turned off. The follow-up assessments were done at 1, 2, 3, and 12 weeks by Visual Analogue Scale (VAS) for pain and NIH-developed Chronic Prostatitis Symptom Index (NIH-CPSI). Results. Pain domain scores at follow-up points in both treatment and sham groups were reduced, more so in the treatment group, which were significant at weeks 2, 3, and 12. Urinary scores became significantly different at weeks 3 and 12. Also, quality of life (QOL) and total NIH-CPSI scores at all four follow-up time points reduced more significantly in the treatment group as compared to the sham group. Noticeably, at week 12 a slight deterioration in all variables was observed compared to the first 3 weeks of the treatment period. Conclusions. our findings confirmed ESWT therapy as a safe and effective method in CPPS in short term.

Purpose: To investigate the incidence and presentations of ureteral obstruction following periureteral injection of polyacrylate polyalcohol copolymer (PPC) for the treatment of vesicoureteral reflux (VUR)., Materials and Methods: From Jan 2010 to Dec 2012, 88 patients (28 male, 60 female) with 128 renal refluxing units (RRU), 131 ureters and a mean age of 6.7 ± 5.9 years (range: 4 months to 32 years) underwent endoscopic correction of their VUR, using PPC. Exclusion criteria were dysmorphic appearing distal ureter, extravesical position of the ureteral orifice, persistent urethral obstruction (e.g. after previous valve ablation) and severe bladder trabeculation, making ureteral orifice unidentifiable. Patients were followed up by ultrasound one month after the injection and then every three months. Cystography was performed 3 months post-operation. Mean follow-up time was 13.1 ± 6.8 months (range: 3-27 months)., Results: Two patterns of obstruction were observed: early, during the first 3-4 days post-operation, in four patients (4 ureters; 3%) which was associated with transient hydroureteronephrosis (HUN) in 2 patients (2 ureters; 1.5%); and late-onset obstruction in 3 patients (4 ureters; 3%) which appeared 3 months to 1 year after surgery. It manifested itself by urinary tract infection and uremia in one patient with bilateral obstruction but was asymptomatic in the other two. Early obstruction was managed expectantly and resolved in 3-12 months; however, late-onset obstruction needed catheter placement or open ureteroneocystostomy., Conclusions: Patients who undergo endoscopic treatment for their VUR using PPC need long-term follow up until the safety of this substance is confirmed., (Copyright © 2012. Published by Elsevier Ltd.)

Background: Coronary artery disease (CAD) is the result of the accumulation of athermanous plaques within the walls of coronary arteries, which supply the myocardium with oxygen and nutrients. CAD leads to heart attacks or strokes and is, thus, one of the most important causes of death worldwide. Angiography, an imaging modality for blood vessels, is currently the most accurate method of diagnosing artery stenosis. However, the disadvantages of this method such as complications, costs, and possible side effects have prompted researchers to investigate alternative solutions., Objectives: The current study aimed to use data analysis, a non-invasive and less costly method, and various data mining algorithms to predict the stenosis of arteries. Among many people who refer to hospitals due to chest pain, a great number of them are normal and as such do not need angiography. The objective of this study was to predict patients who are most probably normal using features with the highest correlations with CAD with a view to obviate angiography costs and complications. Not a substitute for angiography, this method would select high-risk cases that definitely need angiography., Patients and Methods: Different features were measured and collected from potential patients in order to construct a dataset, which was later utilized for model extraction. Most of the proposed methods in the literature have not considered the stenosis of each artery separately, whereas the present study employed laboratory and echocardiographic data to diagnose the stenosis of each artery separately. The data were gathered from 303 random visitors to Rajaie Cardiovascular, Medical and Research Center. Electrocardiographic (ECG) data were studied in our previous works. The goal of this study was, therefore, to seek the accuracy of echocardiographic and laboratory features to predict CAD patients that require angiography., Results: Bagging and C4.5 classification algorithms were drawn upon to analyse the data, the former reaching accuracy rates of 79.54%, 61.46%, and 68.96% for the diagnosis of the stenoses of the left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA), respectively. The accuracy to predict the LAD stenosis was attained via feature selection. In the current study, features effective in the stenosis of arteries were further determined, and some rules for the evaluation of triglyceride, hemoglobin, hypertension, dyslipidemia, diabetes mellitus, and ejection fraction were extracted., Conclusions: The current study presents the highest accuracy value to diagnose the LAD stenosis in the literature.

Background: The aim of this study is to evaluate the outcome of an innovative, minimally invasive sling technique with autologous tissue in women with concomitant incontinence and anterior vaginal wall prolapse (AVWP)., Materials and Methods: Fifty-six women with stress urinary incontinence (SUI) or mixed urinary incontinence and AVWP were randomly assigned into two groups: In Group A (26 patients), anterior colporrhaphy (Kelly placation) and sling placement using a strip of anterior vaginal wall were performed, and in Group B (30 patients), transvaginal mesh correction of AVWP and tension-free vaginal tape (TVT) insertion (retropubic - craniocaudal route) using polypropylene mesh were carried out. The patients were followed-up for over 18 months and were assessed objectively using a 48 h frequency-volume chart, a 48 h pad test and a standardized stress test. Related surgical complications and outcomes were recorded and compared., Results: Surgical cure rates for Group A and Group B at the first (3 days) and last (18 months) post-operative visits were 62% and 84%; and 54%, and 72%, respectively (P = 0.09 and 0.31). Complications occurred in 9 patients (44%) of Group B, but only 3 patients (12%) in Group A., Conclusion: Vaginal sling surgery using an anterior vaginal wall strip can improve SUI and in comparison with propylene mesh is associated with lower complication rates. Although, the surgical success rate of this technique is lower than T-Sling, larger studies with selected patients will help assess the suitable patients for this pelvic reconstructive surgery.

Glomerular involvement occurs as a rare form of renal manifestation in Plasmodium falciparum malaria. Here, we report a rare case of falciparum malaria-associated IgA nephropathy. A 28-year-old man was admitted because of fever and abdominal pain. Ultrasound and computed tomography (CT) showed right kidney pyonenphrosis. Despite placing a nephrostomy tube, fever continued. Repeated CT was in favor of focal pyelonephritis. In addition, peripheral blood smear suggested malaria. Anti-malarial drugs were initiated and right nephrectomy was performed. One year after recovery from malaria, a persistent rise in serum creatinine was detected. A left kidney biopsy showed mesangial proliferation and dominant IgA deposits in immunofluorescence study while C1q was not deposited. The impression was IgA nephropathy with M1E0S0T0 of Oxford classification. The patient was prescribed a combination of low dose prednisolone and angiotensin converting enzyme inhibitor. Six months after treatment serum creatinine decreased from 1.6 mg/dL to 1.3mg/dL and urine abnormalities were disappeared. Our findings suggest that malaria infection might be associated with IgA nephropathy.

Background: To investigate the effect of polyacrylate polyalcohol copolymer (Vantris) injection for the correction of VUR in children according to ureteral orifice shape and VUR grade., Materials and Methods: Forty children (29 girls and 11 boys) with 61 renal refluxing units (RRU) and primary VUR underwent endoscopic correction of their reflux, using Vantris. Under general anesthesia, routine cystoscopy was performed and ureteral orifice configuration and dynamic hydro distention grade were determined. The injection technique was STING, HIT or a combination of them. Ultrasound scan was performed one and 3 months after injection and radionuclide cystography (RNC) was performed 3 months after the operation., Results: The mean volume of injected Vantris was 0.62 cc. Reflux was corrected in 52 (85.2%) of the 61 RRU after single injection and this equates reflux correction in 37 of the 40 patients. No significant correlation was observed between ureteral orifice shape and VUR correction rate., Conclusions: Our results showed that there was no correlation between the ureteral orifice configuration and the success rate of endoscopic surgery for VUR in short term.

Background: Urinary incontinence is relatively common in women and is usually associated with pelvic organs prolapse. Our aim was to determine the relationship between type and intensity of urinary incontinence and different grades and types of pelvic organ prolapse among women., Materials and Methods: One-hundred female patients with the chief complaint of incontinence, who were diagnosed with pelvic organ prolapse participated in this study. Intensity of prolapse, stress and urge incontinence were evaluated using POP-Q (Pelvic Organ Prolapse Questionnaire), SEAPI (Stress related, Emptying ability, Anatomy, Protection, Inhibition) and Freeman criteria, respectively., Results: Patients' mean age was 51.95 ± 12.82 years. The most common type of incontinence was stress incontinence (53%) and the most common prolapse type was cystocele (76%). Cystocele and rectocele had a significant relationship with stress (P value = 0.012) and urge incontinence (P value = 0.035), respectively; however, no relationship was observed between different grades of cystocele, rectocele and enterocele with different types of urinary incontinence (P value > 0.05). In patients with urge and mixed incontinence, prolapse grade significantly increased with age, but no such relationship was found in patients with stress incontinence. The number of vaginal deliveries had a significant relationship only with cystocele and rectocele grade; however, the relationship between other variables such as intensity of different types of urinary incontinence and enterocele grade with the number of deliveries was not significant., Conclusion: Pelvic organ prolapse had a significant relationship with urinary incontinence regardless of intensity and POP should be examined in all of these patients.

Background: Tumor growth requires expansion and development of vascular network. An increase in Gleason score is representative of an increase in tumor invasion and extent. In this study, the relationship between Gleason score and vascular characteristics of needle biopsy samples in prostate cancer patients has been evaluated., Materials and Methods: We evaluated vascular characteristics including density and size of vessels; and percentage of vessels with irregular shape in 62 cancer-positive samples obtained by prostate needle biopsy under ultrasound guide, and compared them to Gleason score., Result: Gleason scores of 23 patients were ≤6; Gleason scores of 18 patients were 7 and 21 patients had their Gleason score from 8 to 10. An increase in Gleason score was associated with increased vascular density (P < 0.0001), increased percentage of vessels with irregular shape (P < 0.02) and decreased average vascular diameter (P < 0.015), from which the relationship with vascular density was clearer and more evident., Conclusion: Vascular morphological characteristics can be representative of angiogenic potential of prostate cancer which is required for tumor progression. As Gleason score can prognosticate the behavioral characteristics of prostate cancer in future, vascular characteristics may also be able to express tumor behavior. With attention to vascular characteristics in biopsy samples and apart from Gleason score, we may also be able to divide patients into other subtypes in a way being helpful for the establishment of treatment plan.

Purpose: To review different aspects of the bladder involvement in Behcet's disease as a rare complication., Materials and Methods: We searched PubMed, Ovid, and Google Scholar for Behcet's and neuro-Behcet's disease and neurogenic and neuropathic bladder, bladder involvement, voiding dysfunction, and urologic manifestations. Fourteen full-texts and one abstract were retrieved., Results: Most involved patients are young to middle-aged men. Both bladder filling and emptying problems can be seen, with the storage symptoms being the most common finding. Sphincter function could be normal, dyssynergic, or deficient. The most common urodynamic finding is detrusor overactivity. In cystoscopic examination, ulcers or nodules due to vasculitis can be seen, which along with neurologic causes give rise to the voiding symptoms. The rate of cancers does not increase in Behcet's disease. Surgery and chemotherapy are tolerated well. However, radiotherapy may be associated with increased complication rates., Conclusion: Treatment plan should be tailored according to the specific type of the bladder involvement. Periodic re-evaluation is required because of the changing nature of the bladder behavior.

Purpose: To compare blind and nerve stimulation guided transurethral obturator nerve block (ONB) in transurethral resection of bladder tumor (TURBT) to prevent obturator reflex., Patients and Methods: One hundred and twelve patients with lateral bladder wall tumors and at high risk for general anesthesia were categorized randomly in three groups. In the first group (34 patients), after spinal analgesia was administered, the exact site of the obturator nerve was determined by nerve stimulation and 15 mL of lidocaine HCl 2% was injected around the nerve. In the second group (31 patients), we determined the obturator nerve using nerve stimulation (like the first group), then 20 mL of saline was injected. In the third group (47 patients), the obturator nerve was determined based on anatomic landmarks and blocked subsequently. Leg jerking was reported and compared in the three groups., Results: The median ages in the three groups were 55.4, 59.4, 57.8 years in the first, second, and third groups, respectively. Male/female ratios were 79.5% in the first, 80.7% in the second, and 80.9% in the third group (P=0.986). Leg jerking was reported in 5.8%, 34%, and 6.3% of patients in the first, second, and third groups, respectively (P=0.0001). ONB took 6.7 minutes in the first, 6.1 minutes in the second, and 5.2 minutes in the third group, on average. There was no report of adverse effects of lidocaine HCl in this study., Conclusion: Transvesical ONB is a safe and effective method of ONB before TURBT. This method is feasible by urologists and promising even without nerve stimulation and only by anatomic landmarks.

The purpose of the present study was to determine (1) whether simvastatin (SV) modifies the rate-dependent conduction time and refractoriness of the atrioventricular (AV) node and (2) how it can change the protective mechanism of the AV node during atrial fibrillation (AF). Predefined stimulation protocols were applied to detect the electrophysiological parameters of the AV node, including atrial-His conduction time, effective refractory period (ERP), functional refractory period (FRP), concealed conduction, excitable index, and fatigue in two groups of isolated, perfused rabbit AV nodal preparations (N=16). The stimulation protocols (fatigue, recovery) were carried out during control and in the presence of SV (0.5, 0.8, 3, and 10 μM). Simulated AF was executed in a separate group (N=8), and specific indexes, including H-H mean, zone of concealment (ZOC), and concealed beats were recorded. SV, in a concentration-dependent manner, prolonged ERP, FRP, and Wenckebach cycle lengths. It (10 μM) significantly increased fatigue and the excitable index. In addition, SV elicited prolongation of ZOC and H-H mean at 3 and 10 μM. SV-evoked prolongation of nodal refractoriness and concealed conduction caused rate-dependent ventricular slowing effects during AF. The ability of simvastatin to decrease the excitable gap by its heterogeneous effects on nodal dual pathways proposes its protective role in AF.

Objectives: Schizophrenia (SCZ) is a severe psychiatric disorder with a lifetime prevalence of approximately 1% in most of the populations studied. SCZ is multifactorial with the contribution of multiple susceptibility genes that could act in conjunction with epigenetic processes and environmental factors. There is some evidence supporting the association between genetic variants in dysbindin (DTNBP1) gene and SCZ in populations. In this study, we investigated the association between polymorphisms P1635 and P1655 in dysbindin gene with SCZ., Methods: Totally, 115 unrelated patients with SCZ and 117 unrelated healthy volunteers were studied. Genomic DNA was extracted from blood. Genotyping was done with the PCR-RFLP method. The allele and genotype associations were analysed with X 2 test. The Benjamini-Hochberg procedure was used to correct p values for multiple comparisons., Results: The results showed no significant difference between patients and controls in allelic frequencies or genotypic distributions of SNP P1635 (p = 0.809), but a significant difference between the case and control groups for SNP P1655 (p = 0.009) was found. We could also find a significant positive association between A-C haplotype and SCZ (OR = 1.7, 95% CI 1.18-2.42; p = 0.004, p c = 0.02) and a protective effect for A-G haplotype (p = 0.003, OR = 0.57, 95% CI 1.18-2.42; p = 0.003, p c = 0.02)., Conclusion: This study may provide further support for the association between SNP polymorphisms in DTNBP1 and SCZ in the Iranian population. Studies with more markers and subjects for various populations will be necessary to understand the genetic contribution of the gene to the development of SCZ.

Background: To investigate the effectiveness of bladder mucosal autograft for the treatment of vesicovaginal fistulae., Materials and Methods: Between March 2005 and June 2011, 21 patients with a single vesicovaginal fistula above the trigone, not involving the ureters, underwent surgery. Bladder was approached extraperitoneally and opened in the midline. The mucosa around the fistula was incised and inverting sutures were placed over the fistula opening. The mucosal defect was covered by a free mucosal graft from the edge of cystotomy incision., Results: After catheter removal at 2 weeks, 18 patients (85 %) remained dry while one patient experienced urge incontinence, which resolved in a few days and another one still had urine leakage (although less than before the operation) that improved after another 3 weeks of bladder drainage. Only in one patient, the operation failed., Conclusion: Short duration of hospitalization, simplicity of the procedure, avoidance of extensive bladder dissection, and extraperitoneal nature of the operation, along with a high success rate are the advantages of this procedure. This technique could be recommended for single fistulae not involving the ureters and not secondary to malignancies.

Candida albicans is an opportunistic human pathogen with the ability to differentiate and grow in filamentous forms and exist as biofilms. The biofilms are a barrier to treatment as they are often resistant to the antifungal drugs. In this study, we investigated the antifungal activity of allicin, an active compound of garlic on various isolates of C. albicans. The effect of allicin on biofilm production in C. albicans as compared to fluconazole, an antifungal drug, was investigated using the tetrazolium (XTT) reduction-dependent growth and crystal violet assays as well as scanning electron microscopy (SEM). Allicin-treated cells exhibited significant reduction in biofilm growth (p<0.05) compared to fluconazole-treated and also growth control cells. Moreover, observation by SEM of allicin and fluconazole-treated cells confirmed a dose-dependent membrane disruption and decreased production of organisms. Finally, the expression of selected genes involved in biofilm formation such as HWP1 was evaluated by semi-quantitative RT-PCR and relative real time RT-PCR. Allicin was shown to down-regulate the expression of HWP1., (Copyright © 2011 Elsevier GmbH. All rights reserved.)

One of the main factors for virulence of fungus such as Candida albicans is the ability to change its morphology from yeast to hyphae. Allicin, one of the volatile sulfur-oil compounds from freshly crushed garlic, has a variety of antifungal activities. In this study, the effect of allicin on growth and hyphae production in C. albicans as compared to fluconazole, an antifungal drug was investigated using survival time in vitro and microscopic image at different time intervals. Additionally, the expression of selected genes involved in hyphae formation and development such as SIR2 and SAP1-4 was evaluated by semi-quantitative RT-PCR and relative real time RT-PCR. Allicin was shown to down-regulate the expression of SIR2 (5.54 fold), similar to fluconazole (3.48 fold) at 2x MIC concentrations. Interestingly, allicin had no effect on SAPs1-4 expression, whereas fluconazole was able to suppress SAP4 expression. Our findings showed that allicin was effective in suppressing hyphae development of C. albicans to an extent that is sometimes equal or more than fluconazole. Moreover, allicin and fluconazole seemed to share a common anti-Candida mechanism through inhibition of SIR2 gene, while fluconazole appeared to also exert its fungistatic effect through another pathway that involved SAP4 suppression.

Purpose: To evaluate the efficacy of fibrin sealant for repair of urethrocutaneous fistula after multiple failed hypospadias and epispadias surgeries., Materials and Methods: The study population comprised 11 boys (mean age 12.18 years) with history of hypospadias or epispadias and at least two failed fistula repair operations leading to recurrent urethrocutaneous fistula. During the operation, single-donor fibrin glue, either from the patient (7) or a parent (4), was applied over the suture lines and beneath the skin. A urethral catheter was kept in place for 7-10 days. Follow up ranged from 6 to 24 months (mean 12.63 months)., Results: Nine patients had an uneventful postoperative course. In one patient with a large fistula, partial wound dehiscence occurred. In another patient with complete hypospadias, hematoma formation caused skin dehiscence but the urethra remained intact. Both cases recovered after 6 months with no further intervention. No fistula recurrence was reported during follow up., Conclusion: Single-donor fibrin glue could be a useful adjunct to surgical management of patients after multiple failed attempts at hypospadias or epispadias fistula repair. Moreover, this product improves the safety margin regarding the risk of disease transmission., (Copyright © 2010. Published by Elsevier Ltd.)

The expression profiles of Δ9 stearoyl-acyl carrier protein desaturase (SAD1 and SAD2) and type 3 metallothionein (MT3-A and MT3-B) were investigated in seedlings of oil palm (Elaeis guineensis) artificially inoculated with the pathogenic fungus Ganoderma boninense and the symbiotic fungus Trichoderma harzianum. Expression of SAD1 and MT3-A in roots and SAD2 in leaves were significantly up-regulated in G. boninense inoculated seedlings at 21 d after treatment when physical symptoms had not yet appeared and thereafter decreased to basal levels when symptoms became visible. Our finding demonstrated that the SAD1 expression in leaves was significantly down-regulated to negligible levels at 42 and 63 d after treatment. The transcripts of MT3 genes were synthesized in G. boninense inoculated leaves at 42 d after treatment, and the analyses did not show detectable expression of these genes before 42 d after treatment. In T. harzianum inoculated seedlings, the expression levels of SAD1 and SAD2 increased gradually and were stronger in roots than leaves, while for MT3-A and MT3-B, the expression levels were induced in leaves at 3d after treatment and subsequently maintained at same levels until 63d after treatment. The MT3-A expression was significantly up-regulated in roots at 3d after treatment and thereafter were maintained at this level. Both SAD and MT3 expression were maintained at maximum levels or at levels higher than basal. This study demonstrates that oil palm was able to distinguish between pathogenic and symbiotic fungal interactions, thus resulting in different transcriptional activation profiles of SAD and MT3 genes. Increases in expression levels of SAD and MT3 would lead to enhanced resistance against G. boninense and down-regulation of genes confer potential for invasive growth of the pathogen. Differences in expression profiles of SAD and MT3 relate to plant resistance mechanisms while supporting growth enhancing effects of symbiotic T. harzianum., (Copyright © 2011 Elsevier GmbH. All rights reserved.)

The efficacy of allicin compared with fluconazole in alleviating systemic Candida albicans infections was evaluated both in vitro and in vivo through a systemic candidiasis mouse model. Determination of in vitro minimum inhibitory concentrations (MICs) for different C. albicans isolates revealed that both allicin and fluconazole showed different MICs that ranged from 0.05 to 12.5 μg mL(-1) and 0.25 to 16 μg mL(-1) , respectively. A time-kill study showed a significant effect of allicin (P<0.01) against C. albicans, comparable to that of fluconazole. Scanning electron microscopy observation revealed that, similar to fluconazole, allicin produced structural destruction of C. albicans cell surface at low MIC and lysis or puncture at high MIC concentrations. Treatment of BALB/c mice systemically infected with C. albicans showed that although the allicin treatment (at 5 mg kg(-1) day(-1) ) was slightly less efficacious than fluconazole treatment in terms of the fungal load reduction and host survival time, it was still effective against C. albicans in terms of mean survival time, which increased from 8.4 to 15.8 days. These results demonstrate the efficacy of anticandidal effects of allicin both in vitro and in an animal model of candidiasis and affirm the potential of allicin as an adjuvant therapy to fluconazole., (© 2010 Federation of European Microbiological Societies. Published by Blackwell Publishing Ltd. All rights reserved.)

Cerebrovascular accident and renal hypertension secondary to ureteropelvic junction obstruction (UPJO) are extremely rare. A 6-year-old girl presented with intracranial hemorrhage because of hypertension secondary to the bilateral UPJO. This was successfully treated with craniotomy and subsequent percutaneous nephrostomy placement and bilateral pyeloplasty. Brain computerized tomography revealed right-sided intracranial hemorrhage, and renal ultrasonography confirmed bilateral severe hydronephrosis. Craniotomy with evacuation of intracerebral hematoma and bilateral nephrostomy under ultrasound guidance were performed. One week later, she underwent bilateral pyeloplasty in 2 stages. The patient has been well with normalized renal function and is completely cured of her hypertension in long-term follow-up., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Objectives: In clinical practice, internal urethrotomy is an easy procedure and is offered as a first modality for treatment of short urethral strictures. Internal urethrotomy refers to any procedure that opens the stricture by incising or ablating it transurethrally. The most common complication of internal urethrotomy is stricture recurrence. The curative success rate of internal urethrotomy is approximately 20%. Triamcinolone has antifibroblast and anticollagen properties. This study evaluated the efficacy of triamcinolone in the prevention of anterior urethral stricture recurrence after internal urethrotomy., Methods: Fifty male patients with anterior urethral stricture were randomized to undergo internal urethrotomy with or without urethral submucosal injection of triamcinolone. Using general anesthesia urethrotomy was performed. Triamcinolone (40 mg) was injected submucosally at the urethrotomy site in 25 patients. The patients were followed for at least 12 months and the stricture recurrence rate was compared between the two groups., Results: 23 patients in the triamcinolone group and 22 in the control group completed the study. There were no significant differences in the baseline characteristics of the patients or the etiology of the stricture between the two groups. Mean follow-up time was 13.7 ± 5.5 months (range: 1-25 months). Urethral stricture recurred in five patients (21.7%) in the triamcinolone group and in 11 patients (50%) in the control group (P = 0.04)., Conclusions: Injection of triamcinolone significantly reduced stricture recurrence after internal urethrotomy. Further investigations are warranted to confirm its efficacy and safety.

Candidiasis is a term describing infections by yeasts from the genus Candida, and the type of infection encompassed by candidiasis ranges from superficial to systemic. Treatment of such infections often requires antifungals such as the azoles, but increased use of these drugs has led to selection of yeasts with increased resistance to these drugs. In this study, we used allicin, an allyl sulfur derivative of garlic, to demonstrate both its intrinsic antifungal activity and its synergy with the azoles, in the treatment of these yeasts in vitro. In this study, the MIC(50) and MIC(90) of allicin alone against six Candida spp. ranged from 0.05 to 25 microg/ml. However, when allicin was used in combination with fluconazole or ketoconazole, the MICs were decreased in some isolates. Our results demonstrated the existing synergistic effect between allicin and azoles in some of the Candida spp. such as C. albicans, C. glabrata and C. tropicalis, but synergy was not demonstrated in the majority of Candida spp. tested. Nonetheless, In vivo testing needs to be performed to support these findings.

Introduction: We evaluated the safety of sterile water as an irrigation solution for percutaneous nephrolithotomy (PCNL)., Materials and Methods: Forty-four patients with kidney calculi were enrolled in this study and randomly divided into two groups for PCNL. Approaches to the calculi were through a single subcostal access with an Amplatz sheath, and either sterile water or isotonic saline solution was used as the irrigation fluid. Serum hemoglobin, haptoglobin, sodium, potassium, and creatinine were measured before and 12 hours after the procedure. The patients were evaluated for signs of transurethral resection of the prostate syndrome during the operation for 24 hours afterwards., Results: The mean calculus size, irrigation volume, irrigation time, and age were not significantly different between the two groups. Hemolysis occurred in 10 and 9 patients in sterile water and saline groups, respectively. The mean change in haptoglobin level was -1.7 +/- 59 mg/dL in the sterile water and 11 +/- 55 mg/dL in the saline group. Also, the mean change in plasma sodium level was -2.2 +/- 4.7 and -0.4 +/- 3.8 in sterile water and saline groups, respectively. None of these values were significantly different between the two groups, nor were other laboratory values. None of the patients developed transurethral resection of the prostate syndrome or needed transfusion., Conclusion: Sterile water is an inexpensive alternative to isotonic saline for irrigation during PCNL. We did not find any difference between the two irrigation solutions regarding the safety; however, this should be confirmed further, especially for larger calculi.

The aim of this study was to compare activity patterns and leisure time between matched groups of patients with cardiovascular disease and individuals without a heart disease. The study included 100 patients recruited from those referred to cardiology department of 5th Azar General Hospital of Golestan University of Medical Sciences in Gorgan (South East of Caspian Sea) and 100 matched control subjects during the period 2007-2008. Odds ratios (OR), together with 95% confidence intervals (95% CI), were calculated using logistic regression, as estimates of relative risks. Listening to music OR = 8.800 (95% CI: 2.717-28.499, p<0.05), meditation OR = 6.111 (95% CI; 2.616-14.274, p<0.05) were independent risk factors. Subjects who performed 2 h per week and 2-4 h per week physical activity, the odds ratios were 0.038 (95% CI: 0.012-0.124, p<0.05) and 0.079, (95% CI: 0.024-0.260, p<0.05), respectively. Low physical activity and use of long time relaxation are associated with cardiovascular disease in these patients. Regular participation in physical activity such as walking 2 h per week and 2-4 h per week, are associated with reduced risk of cardiovascular disease. This study suggests the importance of both leisure-time physical activity and sedentary behaviors in the prevention of CVD.

Objective: This study aims to estimate the prevalence of psychological stress and association between the levels of stress and study variables among Gorgan medical students., Materials and Methods: All three year medical students (129 basic sciences students) in Gorgan Faculty of Medicine, Golestan University of Medical Sciences, were asked to complete the Kessler 10 questionnaire., Results: The findings showed mild, moderate and severe stress among 26.22%, 20.50% and 14.75% study subjects. 39.35% of medical students had no stress. There was statistically significant association between year of study and stress levels (p= 0.040)., Conclusion: The results indicate that there is a decrease in the psychological health of first year medical students. Provided that stress management courses are organised by medical schools, when the students arrive, they will cope up with the stress in coming years. These courses may reduce the negative effects of stress on medical students. By providing such courses and reducing stress level, medical students may improve their medical education.

Background and Aims: Childhood obesity has been associated with high refined sugar intake. The relationship between sucrose intake and development of dental caries has been established. The aim of this study was to determine the association between age-specific body mass index (BMI-for-age) and dental caries in children., Materials and Methods: In this cross-sectional study a total of 1003 children were screened. Weight, height, BMI-for-age and dental caries of 633 (317 boys, 316 girls) 6-11-year-old children were clinically examined for dental caries using the World Health Organization criteria by a dentist on a dental chair. Decayed and filled teeth (DFT/dft) indices were used. BMI-for-age and dental caries were analyzed with multiple linear regression, chi-square, and t-tests using SPSS computer software., Results: The findings showed that 16% of the children had a normal weight, 16.9% were at risk of overweight, and 67.1% were overweight. In the normal weight, at risk of overweight, and overweight groups, the mean ± SE for DFT were 0.34 ± 0.08, 1.23 ± 0.13 and 0.73 ± 0.05, respectively; and 2.01 ± 0.19, 2.76 ± 0.18 and 2.59 ± 0.13 respectively, for dft. Multiple linear regression showed that there was no statistically significant association between BMI-for-age and DFT (R = 0.06) and dft (R = 0.07) indices. 27.7%, 14% and 37.2% of children with normal weight, at risk of overweight and with overweight were caries free, respectively. There was statistically significant association between BMI-for-age and being caries free (p = 0.0001)., Conclusion: There was no association between BMI-for-age and DFT/dft indices. In addition, a high prevalence of at risk of overweight and overweight was seen among 6-11-year-old children in Isafahan, Iran.

Objectives: To assess the efficacy of lubricating jelly instillation proximal to the upper ureteral calculi during lithotripsy on the prevention of retrograde stone displacement and the stone-free rate., Methods: Thirty-four patients with upper ureteral calculi of less than 2 cm were randomized into two groups: jelly instillation (n = 16) and controls (n = 18). Ureteroscopy was performed using a 9.8F semirigid ureteroscope. A 5F ureteral stent was advanced beyond the stone. Lidocaine jelly (2 mL) was instilled, and lithotripsy was done with a Swiss Lithoclast. A 5F ureteral catheter was left in place for 24 hours, and patients were followed up at 24 hours with radiography of the kidneys, ureters, and bladder and at 2 weeks with intravenous urography., Results: Both groups were comparable in terms of mean age and stone size. Stone or stone fragment migration occurred in 12.4% of the treatment group and 44.4% of the controls, statistically significantly different (P = 0.046). The stone-free rate was 93.7% and 83.3% in the treatment and control groups, respectively. The rates did not improve after 2 weeks, and the difference was not statistically significant between the two groups (P = 0.384). The mean operative time was also comparable between the two groups., Conclusions: Lidocaine jelly instillation proximal to the ureteral calculi during lithotripsy is an effective method to prevent retrograde stone displacement, but its effect on improving the stone-free rate was not significant in our study. Larger studies are needed to disclose more details about the efficacy of this method.

Objective: To determine the efficacy of terazosin as a facilitator agent for the passage of lower ureteral stones., Methods: Since February 2004 to December 2004, 64 patients with lower ureteral stones who came to the emergency department were enrolled in this study. Exclusion criteria were the presence of urinary tract infection, severe hydronephrosis, elevated serum creatinine, hypertension, history of peptic ulcer disease and history of spontaneous stone passage. Patients were randomized into 2 groups of 32. Group 1 patients received terazosin tablets, 10 mg daily and analgesic (indomethacin capsules) for a maximum of 4 weeks, but patients in Group 2 received only analgesic. In cases of incomplete pain control, intravenous pethidine was administered. The 2 groups were compared with regard to stone passage rate, time to stone passage, the amount of received pethidine and the need for intervention. Statistical analysis was performed by student t-test., Results: The mean age of Group 1 was 44 years and Group 2 was 39 years. The median stone size was 6.9 +/- 2.3 mm in Group 1 and 6.6 +/- 3.1 mm in Group 2, which was not significantly different. Stone expulsion rate was 90.62% in Group 1 and 62.5% in Group 2, with a significant statistical difference (p=0.041). The mean expulsion time was 76.3 +/- 60 hours and 141 +/- 64 hours in Groups 1 and 2, (p=0.001). Extra analgesic (pethidine) requirement averaged 34.4 +/- 12.7 mg and 62.1 +/- 10.5 mg in Groups 1 and 2 (p=0.036). Seven patients in Group 1 and 15 patients in Group 2 required ureteroscopy after 4 weeks due to lack of the stone passage., Conclusion: Terazosin is a safe and effective treatment for lower ureteral stones. By using this medication, stone passage rate increases and the time of stone passage and the need for intervention decreases.

Objective: To assess the efficacy of a vacuum device as a noninvasive method for penile elongation., Patients and Methods: Between September 2003 and November 2004, 37 sexually active men with a stretched penis length of <10 cm were given vacuum treatment three times a week, for 20 min on each occasion, for 6 months., Results: After 6 months, the mean penile length had increased from 7.6 cm to 7.9 cm (no significant difference). The efficacy of vacuum treatment was approximately 10%, and the patient satisfaction rate was 30%. There was one case of haematoma of the penis and one of glans numbness, both resolved spontaneously without any intervention., Conclusion: Vacuum treatment of the penis is not an effective method for penile elongation, but provides psychological satisfaction for some men.

The goal of physical mapping of the genome is to reconstruct a strand of DNA given a collection of overlapping fragments, or clones, from the strand. We present several algorithms to infer how the clones overlap, given data about each clone. We focus on data used to map human chromosomes 21 and Y, in which relatively short substrings, or probes, are extracted from the ends of clones. The substrings are long enough to be unique with high probability. The data we are given is an incidence matrix of clones and probes. In the absence of error, the correct placement can be found easily using a PQ-tree. The data are never free from error, however, and algorithms are differentiated by their performance in the presence of errors. We approach errors from two angles: by detecting and removing them, and by using algorithms that are robust in the presence of errors. We have also developed a strategy to recover noiseless data through an interactive process that detects anomalies in the data and retests questionable entries in the incidence matrix of clones and probes. We evaluate the effectiveness of our algorithms empirically, using simulated data as well as real data from human chromosome 21.