Enabling informed policymaking for chronic kidney disease with a registry: Initiatory steps in Iran and the path forward

Objectives

Chronic kidney disease (CKD) registries have been used for more than half a century. Iran lacks a comprehensive registry to capture data of all CKD patients for an informed care planning and policy making. We aimed to identify the objectives and possible challenges for developing a CKD registry and also to define its minimum data set (MDS) in our healthcare context.

The effects of maternal exposure to second-hand smoke on breast-feeding duration: A prospective cohort study

Aim

Encouraging exclusive breastfeeding up to 6 months is one of the main priorities for public health. However, the rate of exclusive breastfeeding is decreasing in Iran. Moreover, there have been few studies conducted on the effects of maternal exposure to cigarette smoke on breastfeeding duration in Iran. Considering the importance of breast milk for infant development, the future health of the baby and ultimately the family, this study was designed to assess the effect of maternal exposure to second-hand smoke on exclusive breastfeeding duration.

Subjects and methods

The effect of smoke exposure on exclusive breastfeeding was investigated in a prospective cohort study. The study included 170 mothers in the exposed group and 170 mothers in the non-exposed group. There were losses to follow-up (12 %), so a statistical analysis was carried out on a total of 299 women. Breastfeeding duration and maternal exposure to second-hand smoke were recorded in three follow-up interviews, including 3–5 days, 3 months and 6 months after delivery. Maternal exposure to second-hand smoke was assessed by self-reports. A Kaplan-Meier survival analysis and Cox regression model were used for data analysis.

Results

Maternal exposure to second-hand smoke during the postpartum period can cause a significant reduction in exclusive breastfeeding during a 6-month period (p?<?0.001). According to the Cox regression model, heavily exposed (hazard ratio?=?2.22, 95 % confidence interval: 1.45–3.39) and lightly exposed mothers (hazard ratio?=?1.65, 95 % confidence interval: 1.25–2.42) were more likely to stop exclusive breastfeeding earlier compared with non-exposed women.

Conclusion

Maternal exposure to second-hand smoke is associated with an increased risk of discontinuation of exclusive breastfeeding before 6 months. A stance of no smoking at home and avoidance of passive smoking could possibly improve the rate of breastfeeding in Iran.     

Intracranial neurenteric cyst with post-operative chemical meningitis and vagal nerve palsy

Intracranial neurenteric cysts are rare congenital lesions that, though benign, are difficult to diagnose radiologically given their similar imaging appearance to other intracranial cystic lesions. We present a case of a 21-year-old female with a pathologically proven, symptomatic neurenteric cyst in the premedullary cistern. Superimposed on this uncommon diagnosis were also rare post-operative complications of chemical meningitis and vagal nerve injury. We review the current literature surrounding intracranial neurenteric cysts, their imaging characteristics, differential diagnosis, therapeutic options, and potential complications related to their resection.     

Maternal death due to COVID‐19 and high BMI: A case report from Hamadan,Iran

Pregnant women suffering chronic illness or obstetric complications such as obesity are prone to severe pneumonia and COVID‐19. Obesity in pregnancy is associated with many complications for both mother and fetus. Here, we report the death of an obese mother with COVID‐19.     

Involvement of dopamine D2-like receptors in the antiepileptogenic effects of deep brain stimulation during kindling in rats

Aims

Deep brain electrical stimulation (DBS), as a potential therapy for drug resistive epileptic patients, has inhibitory action on epileptogenesis. In the present investigation, the role of dopamine D₂-like receptors in the antiepileptogenic action of DBS was studied.

Methods

Seizures were induced in adult rats by stimulating the perforant path in a semi-rapid kindling method. Five minutes after the last kindling stimulation, daily DBS was applied to the perforant path at the pattern of low frequency stimulation (LFS; 1 Hz; pulse duration: 0.1 ms; intensity: 50–150 μA; 4 trains of 200 pulses at 5 min intervals). Sulpiride (10 μg/1 μl, i.c.v.), a selective dopamine D₂-like receptor antagonist, was administered prior to the daily LFS application.

Results

Kindling stimulations increased cumulative daily behavioral seizure stages, daily afterdischarge duration (dADD), and population spike amplitude (PS) in dentate gyrus following perforant path stimulation, while applying LFS decreased the kindled seizures' parameters. In addition, kindling potentiated the early (at 10–50 ms inter-pulse interval) and late (at 150–1000 ms inter-pulse interval) paired-pulse inhibition and decreased the paired-pulse facilitation (at 70–100 ms inter-pulse interval). These effects were also inhibited by applying LFS. All inhibitory effects of LFS on kindling procedure were prevented by sulpiride administration.

Conclusion

These data may suggest that LFS exerts its preventive effect on kindling development, at least partly, through the receptors on which sulpiride acts which are mainly dopamine D₂-like (including D₂, D₃, and D₄) receptors.     

Three-dimensional digital assessment of typodont activations

Objectives

Wax typodonts are widely used as pre-clinical teaching tools to test and research the complex force systems created by archwire activations, however, a limitation is the inability to quantify the resultant statically indeterminate tooth movements. The aim of this study was to develop an analogue-to-digital typodont system to quantify the effects of archwire activations on individual typodont teeth in three dimensions.

Methods

The typodont system was developed using CAD/CAM technology. Posterior expansion, squared, tapered, asymmetrical arch forms and reversed curve of Spee activations were tested with three repeats. The resulting three-dimensional movements of individual typodont teeth were assessed with six degrees of freedom (df). Cartesian coordinate systems were set for each tooth. Mesio-distal, bucco-lingual and intrusive–extrusive movements were assessed as changes in the location of the geometrically estimated centre of resistance in the x, y and z axes, respectively. Torque, tip and rotation movements were assessed as the rotations around the mesio-distal, bucco-lingual and intrusive–extrusive axes, respectively.

Results

Individual typodont tooth displacements from each activation could reliably be described with six df. The transversal-to-sagittal movement ratio ranged from 2:1 to 7:1, depending on the activation. Asymmetrical arch form activations caused a midline shift and affected the lateral overjet. Reversing the curve of Spee led to intrusion of incisors and second molars, extrusion of premolars and first molars and pronounced first and third order effects.

Conclusion

The digital typodont system is a promising teaching tool. The tested activations have implications in three dimensions, which should be considered when planning tooth movements.