Patients with chronic renal failure (CRF) due to various mechanisms are prone to significant pulmonary comorbidities. With the improvements in renal replacement therapy (RRT), patients with CRF are now expected to live longer, and thus may develop complications in the lung from these processes. The preferred treatment of CRF is kidney transplantation and patients who are selected to undergo transplant must have a thorough preoperative pulmonary evaluation to assess pulmonary status and to determine risk of postoperative pulmonary complications. A MEDLINE ^® /PubMed ^® search was performed to identify all articles outlining the course of pre-surgical pulmonary evaluation with an emphasis on patients with CRF who have been selected for renal transplant. Literature review concluded that in addition to generic pre-surgical evaluation, renal transplant patients must also undergo a full cardiopulmonary and sleep evaluation to investigate possible existing pulmonary pathologies. Presence of any risk factor should then be aggressively managed or treated prior to surgery.

Background: The reports on efficacy of oral hydration treatment for the prevention of contrast-induced acute kidney injury (CIAKI) in elective radiological procedures and cardiac catheterization remain controversial. Aims: The objective of this meta-analysis was to assess the use of oral hydration regimen for prevention of CIAKI. Materials and Methods: Comprehensive literature searches for randomized controlled trials (RCTs) of outpatient oral hydration treatment was performed using MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials Systematic Reviews, and clinicaltrials.gov from inception until July 4 ^th , 2014. Primary outcome was the incidence of CIAKI. Results: Six prospective RCTs were included in our analysis. Of 513patients undergoing elective procedures with contrast exposures,45 patients (8.8%) had CIAKI. Of 241 patients with oral hydration regimen, 23 (9.5%) developed CIAKI. Of 272 patients with intravenous (IV) fluid regimen, 22 (8.1%) had CIAKI. Study populations in all included studies had relatively normal kidney function to chronic kidney disease (CKD) stage 3. There was no significant increased risk of CIAKI in oral fluid regimen group compared toIV fluid regimen group (RR = 0.94, 95% confidence interval, CI = 0.38-2.31). Conclusions: According to our analysis,there is no evidence that oral fluid regimen is associated with more risk of CIAKI in patients undergoing elective procedures with contrast exposures compared to IV fluid regimen.This finding suggests that the oral fluid regimen might be considered as a possible outpatient treatment option for CIAKI prevention in patients with normal to moderately reduced kidney function.

Background: Diabetes mellitus is a real pandemic of the modern world and the incidence of the disease is increasing at a tremendous rate with a number of complications involving major systems of the human body. The renin angiotensin system (RAS) is considered to be involved in most of the pathological processes that result in diabetic nephropathy and retinopathy. Aim: The study was designed to evaluate and compare effects of ramipril (angiotensin-converting enzyme inhibitor-ACEI) and telmisartan (angiotensin II receptor blocker - ARBs) combinations on the progression of retinopathy and nephropathy in the streptozotocin (STZ) induced diabetic model. Materials and Methods: Diabetic state in rats was induced by chemical method using STZ 55 mg/kg intraperitoneally. Diabetic renal tubulopathy and interstitial inflammatory changes were done. Diabetic retinopathy manifested in the form of vacuolar changes in the inner plexiform and the ganglionic layers of the retina was observed. Results: Treatments with ACEI and ARBs reduced the incidence of the occurrence of cataract. The effect of combinational drugs of ACEI (ramipril) and AT1 receptor blocker (Telmisartan) was evaluated. The drugs used in combinations showed improvement in the histopathological and biochemical changes of the diabetic animals, both for the retina and kidney. Conclusion: The efficacy of the drugs suggests a pivotal role of the local RAS system in the pathogenesis of tubulopathy in the kidney and neuronal damage in the retina of the diabetic animals.

Background: The pathological hallmark of Parkinson's disease (PD) is the appearance of intracytoplasmic inclusions known as Lewy bodies in which its principal component is α-synuclein. Aim: This study aimed to determine salivary α-synuclein and the extinction coefficient of the saliva protein as biomarkers of PD. Materials and Methods: This observational study was done in Department of Pharmacology, College of Medicine in cooperation with Department of Oral Medicine, College of Dentistry at Al-Mustansiriya University in Baghdad, Iraq from September 2013 to March 2014. A total number of 20 PD patients and 20 healthy subjects were enrolled in the study. Unstimulated saliva obtained from each participant obtained for determination of salivary flow rate, saliva protein and α-synuclein using enzyme linked immune sorbent assay (ELISA) technique. Results: Total saliva protein and uncontaminated protein with nucleic acids are significantly higher in PD compared with healthy subjects. The mean extinction coefficient of that protein is 27.25 M.cm ^-1 which significantly (P < 0.001) less than corresponding value of healthy subjects (33.48 M.cm⁻¹ ). Saliva α-synuclein level is significantly less in PD (65 ± 52.2 pg/ml) than healthy subjects (314.01 ± 435.9 pg/ml). Conclusions: We conclude that saliva α-synuclein serves as a biomarker for PD if its level compared with healthy subjects, and a specific protein with extinction coefficient 27.25 M.cm-1 is detected in saliva of Parkinson's patients.

Background: Nephrolithiasis is of the most prevalent urinary tract disease. It seems worthwhile to replace the conventional treatments with more beneficial and safer agents, particularly herbal medicines which are receiving an increasing interest nowadays. Aims: In this study, we investigated the protective and curative effects of Achillea millefolium L. on ethylene glycol (EG)-induced nephrolithiasis in rats. Materials and Methods: The extract of A. millefolium was prepared by soxhlet method. Forty male Wistar rats were randomly divided into five groups (N = 8) as follows. The negative control (group A) received tap drinking water. Rats in sham (positive control group B), curative (group C and D), and preventive (group E) groups all received 1% EG in drinking water according to the experimental protocol for 30 days. In the curative groups, dosages of 200 and 400 mg/kg body weight (BW) of A. millefolium extract were administered orally from day 15 to the end of the experiment, group C and D, respectively. Group E received 200 mg/kg A. millefolium extract from the 1 ^st day throughout the experiment. Urinary oxalate and citrate concentrations were measured by spectrophotometer on the first and 30 ^th days. On day 31, the kidneys were removed and examined histopathologically for counting the calcium oxalate (CaOx) deposits in 50 microscopic fields. Results: In the curative and preventive groups, administration of A. millefolium extract showed significant reduction in urinary oxalate concentration (P < 0.05). Also, urinary citrate concentration was significantly increased in group C, D, and E. The CaOx deposits significantly decreased in group C to E compared with the group B. Conclusions: According to our results, A. millefolium extract had preventive and curative effects on EG-induced renal calculi.

Background: Trachyspermum ammi is a plant of umbelliferae family and has been traditionally used in the treatment of many gastrointestinal disorders such as indigestion, colic, and diarrhea. Our previous study demonstrated that aqueous extract of Trachyspermum ammi reduced the contractile activity of rat's ileum. Aims: This study was designed to examine the effect of Trachyspermum ammi essence on acetylcholine-induced contraction in isolated rat's ileum. Materials and Methods: In this experimental procedure, the tissue samples were suspended from the transducer lever and mounted on the organ bath containing Tyrode's solution. Isotonic responses were recorded by using an isotonic transducer and the amplitude of contractions. This process was induced by cumulative logarithmic concentrations of acetylcholine before and after exposing tissue by saline and different concentrations of essence. Results: The chemical constituents of the essence from distillate extract of Trachyspermum ammi seeds were studied by gas chromatography mass spectrometry (GC-MS) and the chemical analysis showed many components in which thymol was the main constituent. Our findings showed that the essence derived from the extract in all concentrations used in this study (0.002, 0.005, and 0.01% V/V) significantly reduced acetylcholine-induced contractions (47.34, 60.46, and 86%, respectively, P < 0.05). The same concentrations of the essence also exhibit a significant anti-spasmodic action on acetylcholine-induced contractions (0.1,88.3, and 90.7%, respectively, P < 0.05). Conclusion: Since thymol was the major constituent of our samples of Trachyspermum ammi, the relaxant effect observed in this study is probably due to this agent which can exert an anti-cholinergic property.

Context: Short bowel syndrome is a rare and devastating complication in chronic inflammatory bowel disease following functional or anatomic loss of extensive segments of the intestine. Case Report: A 60-year-old male patient with Crohn's disease had undergone multiple resections of the intestine and developed short bowel syndrome. Despite up to 4-5 liters of orally fluid, sufficient calcium and magnesium intake, he suffered from recurrent acute kidney injury due to profound volume depletion and those electrolyte deficiencies. Administration of intravenous fluid and electrolyte repleacement treatment at regular intervals prevented further kidney injuries. Conclusion: We present a case of recurrent acute kidney failure in a patient with Crohn's disease, and aimed to remark importance of receiving sufficient parenteral fluid and electrolyte support in those with short bowel syndrome.

Context: Kaposi's sarcoma (KS), a vascular tumor that manifests as nodular lesions on the skin and to a lesser extent, the visceral organs, is the most common neoplasm encountered in human immunodeficiency virus (HIV)-infected patients. It consists of an angiosarcomatous change of not only the epithelial and mucous membrane-associated connective tissue in various sites, for example, skin, gastrointestinal system, lungs, and so on, but may also involve non-epithelial organs, such as lymph nodes. Surgical excision is the line of management for the tumor. Case Report: We present one case of a 65-year-old heterosexual Indian male, clinically unsuspected for acquired immunodeficiency syndrome (AIDS) who presented with multiple non-blanching, bluish-red nodules on all extremities, chest, back and bilateral submandibular and cervical lymphadenopathy. Fine needle aspiration cytology (FNAC) was performed from subcutaneous nodule and lymph node. Smears showed hypercellular plump spindle cell groups in a hemorrhagic background. Diagnosis was given as low-grade spindle cell neoplasm consistent with KS, which was later confirmed on histopathology. Conclusion: The first line diagnostic aid of FNAC has several advantages over the traditional biopsy in testing such vascular tumors. The latter is generally needed for confirmation of KS. However, FNAC of such vascular tumors has advantages of better patient compliance, ease of procedure, no recurrences, and safety in immuno-compromised patients. Ancillary studies can be done on aspirates along with polymerase chain reaction (PCR) amplification techniques in confirming the detection of associated human herpes virus-8 (HHV-8) infection with KS.

Context: Distant metastases of primary malignancies to the skeletal muscle tissue are a very rare event. Distant metastases that affect the rotator cuff are even rarer, and only a few of cases have been reported so far. Case Report: The present article reports two cases that presented to our hospital with the complaint of shoulder pain and had a soft tissue mass affecting the muscles of the rotator cuff and invading the neighboring bone compartments. One of the patients developed mucoepidermoid cancer metastasis of the submandibular gland, and the other was found to have a malignant epithelial tumor metastasized from the lower lobe of the right lung, whose primary origin could not be diagnosed until the imaging examinations were employed. Ultrasound and magnetic resonance imaging findings are presented in this paper. Conclusion: Metastases to the muscle tissues could be misdiagnosed as primary sarcomas. Because the therapy regiments and prognoses are fairly different for these two entities, the possibility of a metastasis to the muscle tissue must be considered as a differential diagnosis for case of painful soft tissue mass. Ultrasound is very useful in detection of the lesion and acts as a very important tool during guidance for biopsy. Magnetic resonance imaging, however, is a very valuable asset in the evaluation of the borders of the soft tissue mass and its invasive effect on the bony tissues. Particularly when the features such as lobulated contours, peripheral edema, and intratumoral necrosis exist, the possibility of metastases must be considered.