Introduction: Contrast-induced acute kidney injury (CI-AKI) is a known complication of cardiac interventions. Remote ischemic preconditioning (RIPC) is a non-pharmacological method which has a nephroprotective effect. Serum cystatin C (CysC) is a suitable biomarker for the early diagnosis of AKI. Objectives: This study aimed to evaluate the incidence of CI-AKI after RIPC in patients undergoing coronary angiography, through assessment of CysC. Patients and Methods: Around 140 patients with stable coronary artery disease undergoing angiography were randomly allocated to two groups of RIPC and control groups. In each group, the following biomarkers were assessed: serum creatinine (Cr) and CysC at baseline, 24-hour and 48-hour serum Cr and 24-hour CysC. The endpoint was the development of AKI based on either the KDIGO criteria or a 15% increase in serum CysC. Results: No significant difference was observed between two groups regarding the incidence of AKI according to either KIDIGO criteria or by the increase of serum CysC (P =0.116 and P =0.392, respectively). Moreover, a 46.99% increase in CysC level was observed among patients with AKI during the first 24 hours after the procedure, while at the same interval, it increased only 16.01% in patients without AKI. Conclusion: RIPC with three cycles of 5-minute ischemia and 5-minute reperfusion, did not decrease serum CysC based CI-AKI or alter renal biomarkers course in patients with low risk, who underwent coronary angiography.

Introduction: Primary hyperparathyroidism (PHPT) is a rare condition in the pediatric population. Parathyroid carcinoma (PC) is a very uncommon cause of PHPT, accounting for < 1% of pediatric PHPT cases. It is challenging to distinguish between parathyroid adenoma (PA), the most common cause of PHPT, and PC. In this report, we described a young female who presented with a history of progressive limping and was finally diagnosed with PC. Case Presentation: A 15-year-old girl presented with progressive limping and bone pain for 8 years. She was referred by an orthopedic surgeon because of elevated intact parathyroid hormone (iPTH) for further evaluation. Physical examination revealed a large, firm, and non-tender neck mass, left hip tenderness, and limited range of motion. The initial biochemistry tests showed a borderline high calcium level of 10.8 mg/dl, an elevated iPTH level of 2876 pg/mL, and a decreased phosphorus level of 2.4 mg/dL. The 99mTechnetium (Tc) sestamibi scan displayed early intense activity in the right thyroid lobe persisting in the three-hour repeat scan, compatible with a parathyroid lesion. The patient underwent right-sided neck exploration and parathyroidectomy. Intraoperative and pathology findings confirmed the diagnosis of PC. Immunohistochemistry (IHC) staining revealed creatine kinase (CK) and CD31 in endothelial cells of the tumor. Ki67 staining was also positive in 2% - 3% of tumor cells. The whole exome sequencing (WES) study was negative for cell division cycle 73 (CDC73) and multiple endocrine neoplasia 1 (MEN1) genes. Conclusions: PC should be considered as a differential diagnosis of PHPT in the pediatric population, even in the presence of mild hypercalcemia.

BACKGROUND The Crohn’s Disease Endoscopic Index of Severity (CDEIS) and the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) are two validated endoscopic scoring system to evaluate patients with inflammatory bowel diseases (IBD). We conducted this study to evaluate the correlation between clinical symptoms and lab tests with these indexes in patients with Crohn’s disease (CD) and ulcerative colitis (UC). METHODS In this analytical study, 373 consecutive patients referred to Shahid Mohammadi Hospital with IBD were enrolled. All patients underwent complete ileocolonoscopy, and the endoscopic severity indexes (CDEIS and UCEIS) were calculated, and their relation with clinical symptoms and lab tests was evaluated. RESULTS Fever observed only in six patients (1.6%). It was associated with significantly higher CDEIS and UCEIS (p = 0.02 and p < 0.001, respectively). Also, diarrhea was correlated with significantly higher UCEIS (p < 0.001). The mean fecal calprotectin was 647.64 ± 409.37 µg/g in CD and 567.30 ± 342.49 µg/g in UC patients. Higher calprotectin level was observed in patients with higher CRP level (p = 0.001), erythrocyte sedimentation rate (ESR) level, CDEIS, and UCEIS (r = 0.438; 0.473; and 0.517; respectively, all with p < 0.001). CONCLUSION Our study showed that although fever and diarrhea are associated with higher endoscopic severity scores in patients with IBD, no clinical symptom could reliably predict the endoscopic results, alone. Furthermore, higher fecal calprotectin level is associated with higher ESR and C reactive protein levels, CDEIS, and UCEIS.

Introduction: Contrast-induced acute kidney injury (CIN-AKI) is a serious complication of coronary angiography. Given the weaknesses in the common protective methods used to prevent CIN-AKI, a safe and effective strategy is needed. RIPC has been shown to have a nephroprotective effect. Objectives: We aimed to determine the protective effect of RIPC on CIN-AKI after angiography or percutaneous coronary intervention (PCI) in low-risk patients. Patients and Methods: In our study, 140 low-risk patients who needed angiography or PCI, were assigned to either RIPC or control group. In each group, serum creatinine and urinary neutrophil gelatinaseassociated lipocalin (uNGAL) were measured before the procedure. Serum creatinine was measured daily for 2 days and uNGAL was measured 6 and 24 hours after the procedure. Diagnosis of AKI was, according to the Kidney Disease; Improving Global Outcomes (KDIGO) criteria (2012). Results: The mean age in the remote ischemic preconditioning (RIPC) group was 56.8 ± 11.4 years and 56.3 ± 11.8 years in the control group. We observed no significant difference regarding patient’s characteristic and renal biomarkers at baseline. There was no significant difference in the incidence of AKI (P = 0.116). The uNGAL increased by 36.2% 6-hour after the procedure in patients with AKI, while at the same time, this biomarker increased only by 4.3% in patients without AKI. Conclusion: We concluded that RIPC, with 3 cycles of 5-minute ischemia and 5-minute reperfusion, did not decrease CIN-AKI or altering renal biomarkers course in low-risk patients undergoing coronary angiography or PCI. Additionally, uNGAL, seems to be an appropriate biomarker for early diagnosis of CIN-AKI, 6 hours after contrast media exposure.

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Introduction: Vitamin D deficiency is a common clinical finding in the general population and hospitalized patients, including patients in the intensive care unit (ICU). Acute kidney injury (AKI) occurs in more than 50% in ICU admitted patients. Objectives: There are few studies regarding AKI in COVID-19 patients, therefore we investigated the relationship between vitamin D3 deficiency and the occurrence of AKI in COVID-19 patients. Patients and Methods: This cross-sectional study was conducted on 69 COVID-19 patients who were hospitalized in the ward for 12 months. Their serum vitamin D3 levels were measured in the first 24 hours of hospitalization in the ward. Patients were divided into three groups based on the serum levels of vitamin D3: >50 ng/mL as normal, 20-50 ng/mL as insufficient and <20 ng/mL as deficiency status. The patients were studied until the occurrence of acute renal injury or the occurrence of death. Results: Out of 69 hospitalized patients in the ward with COVID-19, there were 39 patients in group vitamin D3<20 ng/mL, 21 patients in group vitamin D3 of 20-50ng/mL and 9 patients in group of vitamin D3>50 ng/mL. The frequencies of AKI in groups of vitamin D3<20 ng/mL, 20-50 ng/mL, and >50 ng/mL were 46%, 28%, and 23%, respectively. A significant relationship was observed between AKI and our study groups (P=0.011). Furthermore, there was a significant association between our study groups and mortality (P=0.014), ICU admission (P=0.041) and hospital length of stay (P=0.017). In another division in patients with different levels of vitamin D3 in the presence or absence of AKI, there were significant associations between patients with vitamin D3<20 ng/mL and the presence of AKI and also with mortality (P=0.042), ICU admission (P=0.024) and additionally with hospital length of stay (P=0.027). Conclusion: Our study showed significant association between vitamin D deficiency and AKI in ICU-admitted COVID-19 patients. Moreover, there were relationships between vitamin D deficiency and mortality, ICU admission and hospital length of stay. These results suggest the correction of vitamin D deficiency may be beneficial to reduce AKI in patient with COVID-19.

Background: Magnesium (Mg) deficiency is a common clinical electrolyte abnormality in critically ill patients, which is related to higher mortality and is easily ignored. Objectives: We aimed to investigate the association of Mg levels with mortality and comorbidity in patients admitted to the intensive care unit (ICU) based on COVID-19 infection classification. Methods: A total of 69 patients admitted to the ICU of Shahid Mohammadi Hospital, Bandar Abbas, Iran, from June to December 2021were included in the present study. The serum Mg was measured in these patients. Data from sequential organ failure assessment (SOFA), acute physiologic assessment and chronic health evaluation (APACHE), ICU stay length, mechanical ventilation duration, mortality, and comorbidity were determined. Moreover, the COVID-19 infection was detected by PCR. Results: The mean ± SD age of patients (34.8% male) was 52.56 ± 16.43 years. Out of 69 patients, 18 (26.1%) died during hospitalization, and 24 (34.8%) required mechanical ventilation. The prevalence of COVID-19 was 39.1% (27 patients). Our results showed no difference in serum Mg between patients based on mortality and comorbidity status. However, the Mg level of patients with kidney failure was significantly higher than patients without kidney failure (P < 0.05). Based on the COVID-19 classification, there was only a positive correlation between hypomagnesemia and the length of ICU hospitalization in patients without COVID-19 (P < 0.05). Conclusions: Our findings showed no difference in the Mg levels of patients based on mortality status. Patients with kidney failure had higher serum Mg than those without kidney failure. Furthermore, our results showed no difference in the Mg levels of critically ill patients based on COVID-19 infection status.