Tehran University Medical Journal

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Conclusion: Despite the long history of surgical treatment in syndactyly repair, this reconstructive operation has still special complexities.

Materials and Methods: In order to evaluation of results of our surgical reconstructions, we studied 77 patients (40 boys and 37 girls) with hand syndactyly (mean age at operation: 5.8±4.3 years) in Imam Khomeini Hospital from 1994 to 2003. All of these patients had been operated by standard surgical methods. Post-operative complications and functional, sensational, and cosmetic results have been assessed by patient records and physical examination after an average follow-up of 4.6±2.1 years.

Results: Syndactylies were simple in 71 patients (92.2%), complex in 2 (2.6%), and mixed in 4 (5.2%). In 45 patients (58.4%), surgical repair had been performed without graft. The overall results of operations were good in 81.8%, moderate in 13%, and poor in 5.2%. The most common complications were: web migration in 9.1%, scar contracture in 7.8%, infection in 5.2%, necrosis in 3.9%, and angular deformity in 2.6%.

Conclusion: In this study we shown that the standard methods in our center for correction of syndactyly, at least in recent 10 years, have been efficient and with good results.

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Background: In this study we evaluated the treatment of giant cell tumor (GCT) of long bones using cryosurgery combined with curettage and polymethylmetacrylate (PMMA) cementing.
Material and methods: From January 1999 to December 2004, twenty patients (mean age at the time of surgery 29.2 years) 13 females and 7 males were included in the study. Cortical disruption were presented in 7 patients 4 with soft tissue extension, but none of them had intra-articular extension of tumor, 3 patients presented with pathologic fracture of distal femoral lesions. These tumors were located in distal femur in 6 patients, proximal tibia in 7, distal radius in 3, proximal femur in 2, and each of proximal humerus and distal ulna in one patient. In each case diagnostic biopsy was done and surgical procedure performed including curettage, power burr of the wall, cryosurgery with liquid nitrogen and finally filling the space with PMMA cementing. The mean follow-up was 34 months (7 to 61 ).
Results: During follow-up, we observed one recurrence of GCT of proximal tibia. Secondary Aneurysmal bone cyst was reported at the site of one primary distal femoral lesion, without any finding in favor of a recurrence. Neurapraxia of the proneal nerve was occurred in one patient with proximal tibia tumor improved after 8 months.
Conclusion: Cryosurgery combined with power burr and PMMA cementing in the treatment of GCT could be an effective approach in tumor eradication. This method obviates the need for extensive resections and reconstructive procedure.

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Background and Aim: Osteoblastoma is one of the rarest primary bone tumors. Although, small bones of the hands and feet are the third most common location for this tumor, the hand involvement is very rare and few case observations were published in the English-language literature.                     

Materials and Methods: In this study, we report five cases of benign osteoblastoma of the hand, 3 in metacarpals and two in phalanxes. The clinical feature is not specific. The severe nocturnal, salicylate-responsive pain is not present in patients with osteoblastoma. The pain is dull, persistent and less localized. The clinical course is usually long and there is often symptoms for months before medical attention are sought. Swelling is a more persistent finding in osteoblastoma of the hand that we found in all of our patients. The radiologic findings are indistinctive, so preoperative diagnosis based on X-ray appearance is difficult. In all of our 5 cases, we fail to consider osteoblastoma as primary diagnosis. Pathologically, osteoblastoma consisting of a well-vascularized connective tissue stroma in which there is active production of osteoid and primitive woven bone. Treatment depends on the stage and localization of the tumor. Curettage and bone grafting is sufficient in stage 1 or stage 2, but in stage 3 wide resection is necessary for prevention of recurrence. Osteosarcoma is the most important differential diagnosis that may lead to inappropriate operation.

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Background: Tibial and femoral fractures, commonly seen in emergency departments, may be associated with various knee ligament injuries. The aim of this study was to determine the prevalence of such fracture-associated knee ligament problems, with especial attention to rapid diagnosis.
Methods: This study was carried out in patients with femoral or tibial fractures who were operated on in Imam Khomeini Medical Center from March 2003 to March 2005. All patients underwent surgical repair immediately after acute fracture, followed by a thorough knee examination. Patients with positive clinical findings were further evaluated using the stress view and arthroscopy.
Results: We enrolled 470 cases in this study, of which 266 were tibial and 204 were femoral fractures. There were 404 men and 67 women, with an average age of tibial fracture patients was 34.5 and 44.6 years for those with femoral fractures. Of all fractures, 66% were due to car accidents, 16% to industrial accidents and 8% due to falling. The overall prevalence of ligament injuries in tibial fractures was as follows: 6.58% ACL tearing, 2.5% PCL, 21.95% MCL and 14.63% LCL. The overall prevalence of ligament injuries in femoral fractures was as follows: 6% ACL tearing, 3% PCL, 14% MCL and 8% LCL.
Conclusion: The prevalence of ligament injuries of the knee was highest in distal femoral and tibial plateau fractures. It is prudent to perform a thorough knee examination once the fracture is stabilized in the operating room for the early detection of ligament injuries and prevention of further complications.

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Background: People vary greatly in their response to painful stimuli, from those with a low pain threshold to those with indifference to pain. However, insensitivity to pain is a rare disorder, characterized by the lack of usual subjective and objective responses to noxious stimuli. Patients who have congenital indifference to pain sustain painless injuries beginning in infancy, but have sensory responses that are otherwise normal on examination. Perception of passive movement, joint position, and vibration is normal in these patients, as are tactile thresholds and light touch perception.
Case report: A twelve-year-old boy was admitted to the hospital for a painless deformity, degeneration in both knees and a neglected femoral neck fracture that was inappropriately painless. Further examination revealed normal sensory responses, perception of passive movement, joint position, vibration tactile thresholds and light touch perception. Spinal cord and brain MRI were normal as was the electromyography and nerve conduction velocity (EMG/NCV) examination. There was no positive family history for this disorder.
Conclusion: The deficits present in the different pain insensitivity syndromes provide insight into the complex anatomical and physiological nature of pain perception. Reports on pain asymbolia, in which pain is perceived but does not cause suffering, and related cortical conditions illustrate that there can be losses that independently involve either the sensory-discriminative component or the affective-motivational component of pain perception, thus highlighting their different anatomical localization. The paucity of experience with this entity and the resultant diagnostic problems, the severity of the associated disabling arthropathy and underscore the importance of this case report of indifference to pain.

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Background: Pigmented villonodular synovitis is a tumor that arises from the synovial membrane of the joint or tendon sheaths. Two main forms include a diffuse form that involves the whole synovial lining of a joint, bursa, or tendon sheath, and a less common localized form. The diffuse form typically involves the large joints, while the localized one typically occurs around the small joints of the hands and feet. Usually involving the knee joint, the occurrence of pigmented villonodular synovitis in the foot, especially in the metatarsophalangeal joint of the great toe, is very rare, and is therefore often mistaken for other foot pathologies. Although it seems histopathologically benign, it has a known tendency to recur after surgery.
Case report: Here, we report a 42 year old woman who had experienced pain in the right great toe for 1.5 years. She was treated conservatively with shoe modification and NonSteroidal Anti-Inflammatory Drugs, and two injections of Corticosteroid.
Results: The failure of long-term conservative therapy and the bony erosion revealed in her radiograph led us to surgically excise the lesion of the first metatarsophalangeal joint. Histopathological examination revealed the diagnosis of pigmented villonodular synovitis. For the 18 months following surgery, she had no complaint except minimal pain in her toe after activity. No sign of recurrence was observed either clinically or radiologically.
Conclusion: We conclude that pigmented villonodular synovitis should be noted in the differential diagnosis of chronic monoarticular synovitis in order to provide an earlier diagnosis and more effective treatment.

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Background: Infectious diseases are problematic in all around the world especially in the developing countries and early diagnosis of infections and one etiologic agents has a major role in the treatment of one patients. There are some culturing methods consist of conventional, semiautomatic and automatic. One of automatic methods is BACTEC system worked by fluorescent technology and Co2 production of organisms in culture media.
Methods: This study is based on observational-descriptive method with simple convenient sampling. We analyzed 262 samples of body sterile fluids of patients admitted in pediatric and internal wards of a university (Rasol- Acram) Hospital. They are consisting of 150 blood, 46 synovial, 32 CSF, 24 pleural, and 10 peritoneal samples.
Results: There were no differences between two sex in BACTEC and Conventional methods. Average age of patients with positive and negative culture in two methods had not differences. 72 (27.5%) samples were positive that 32 (12.2%) samples only in BACTEC method, 4 (1.5%) in conventional method and 36 (13.7%) in two methods had statistical differences (p=0.003). That means positive cultures are seeing in BACTEC more than Conventional method. Comparison of two methods in positive blood culture samples had statistical differences (p=0.02) but no statistical differences in other body fluids were seen. i. e. positive cultures were seen in BACTEC more than Conventional method. Positive culture in these two methods had statistical differences in antibiotic utilization (p<0.001). Positive culture in antibiotic utility were seen in BACTEC more than Conventional method. The average time of culture to become positive were 17.5+ 5.88 hours in BACTEC against 62.36+ 13.98 hours in Conventional method. Contamination was seeing in 4 samples in BACTEC and 2 in Conventional method that had no significant differences.
Conclusion: According to these data organism detection in BACTEC culture media from body sterile fluids overall and specially from blood is more successful than Conventional method. It is a better method in antibiotic utilization. BACTEC can isolate organism in shorter duration than Conventional method. BACTEC can facilitate early and accurate diagnosis of infectious etiology, shorten duration of hospital stay and decrease mortality and morbidity and cost.

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Background: Reflex Sympathetic Dystrophy Syndrome (RSDS) is a rarely described complication which characterized by pain, edema, movement and vasomotor disorders, trophic changes in the skin and patchy demineralization of bone in extremities. There are numerous risk factors such as trauma, surgery, myocardial infraction and drugs. Cyclosporine (CsA) is one of the drugs which can induce RSDS.

Case report: Herein we described a 33- years old man (known case of ALL) with severe painful and edematous extremities, which was being treated with cyclosporine because of Graft Versus Host Disease (GVHD) after bone marrow transplantation. His laboratory tests were normal except for AST and ALT. With impression of Reflex Sympathetic Dystrophy Syndrome triple-phase bone scan was done, Increased uptake and delayed wash-out in vascular and bony phase is considered typical for RSDS. Due to clinical and triple-phase bone scan findings the diagnosis was established. Symptoms of RSDS improved when CsA was discontinued.

Conclusion: According to this case report and the other ones, Cyclosporine should be considered as the etiology of Reflex Sympathetic Dystrophy Syndrome.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: During recent three decades, parallel to the improvement of arthroscopic techniques, intra-articular block by direct injection of anesthetics into the joint has been used in knee arthroscopy. In this study the efficacy of intra- articular block by complex of bupivacaine, lidocaine and adrenaline in knee arthroscopy has been assessed.
Methods: Forty one healthy adults (age range: 18-55 years) with knee problems selected for diagnostic arthroscopy. Anesthesia was induced by direct injection of 10ml 2% bupivacaine, 10ml 0.5% lidocaine plus 1/100000 adrenaline into the knee joint.  Duration of operation and volume of serum used for irrigation during the procedure pain and analgesics requirement, during and after arthroscopy VAS (Visual Analogue Scale) score, at time of discharge from recovery and also patient's and surgeon's satisfaction were assessed.
Results: Sixty eight percent and 29% of cases reported mild and moderate degree of pain perception during arthroscopy, respectively, and only one case for which general anesthesia was performed, reported severe pain. VAS mean was 2.78. Seventy eight percent of cases and the surgeon in 80% of procedures had excellent or good satisfaction with intra-articular block.
Conclusions: Considering high level of satisfaction in both patients and surgeon and mean of VAS, complications of other modalities of anesthesisa and simplicity of the technique, intra-articular block can be used as an easy, safe and efficient method for knee arthroscopy.

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Background: Finding a reliable diagnostic method for brucellosis is the most challengeable problem. In this study we determined the optimal diagnostic cut-off point for ELISA test.
Methods: We gathered 56 confirmed cases of brucellosis. Furthermore blood samples from 126 controls including 73 healthy controls and 53 without brucellosis febrile patients were collected. In all of the cases and controls ELISA Ig G and ELISA Ig M levels were measured and compared with each other by Box plot graph and the Receiver Operating Characteristic (ROC) curve. The sensitivity and specificity of ELISA Ig G and Ig M were fixed in different cut-off values and Ig G and Ig M levels yielding maximal sensitivity plus specificity were selected for determination of optimal cut-off point.
Results: The nineteen patients had positive blood cultures for Brucella melitensis. The standard agglutination test results were 1/160 or more in 54 patients. The Box plot graph indicated a high degree of dispersion for Ig G and Ig M data in patients with brucellosis compared with febrile patients without brucellosis and healthy controls. We observed partial overlap for Ig M data (not for Ig G) between cases and controls. The area under ROC curve for discrimination of cases and healthy controls was more for Ig G than Ig M.
Conclusions: The ELISA Ig G is more reliable test than ELISA Ig M in diagnosis of brucellosis. Using cut-off of 10 IU/ml and 50 IU/ml have the most sensitivity (92.9%) and specificity (100%) for ELISA Ig G test, respectively.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: The mechanisms by which fetal weight are regulated during pregnancy are poorly understood. The relation between hormones such as leptin and adiponectin and intrautrine growth is still under investigation. The aim of this study was to ascertain whether fetal growth restriction is associated with alterations of leptin and adiponectin  concentrations in venous umbilical cord blood and maternal serum.
Methods: Maternal serum and venous umbilical cord blood leptin and adiponectin concentrations were determined by ELISA after 36 week of gestational age in 22 women with uncomplicated singleton pregnancies with AGA fetuses (group A) and in 22 women with singleton pregnancies complicated by fetal growth restriction but without fetal distress (group B), all with normal body mass index and without history of diabetes, hypertention or maternal cardiac disease.
Results: Venous umbilical cord leptin levels were significantly lower in group B compared with group A (8.1±0.8ng/ml versus 39.45±6.8ng/ml p=0.001). Venous umbilical cord adiponectin levels were also significantly lower in group B compared with group A (28.8±3.5μg/ml versus 43.6±3.7μg/ml p=0.007). Maternal serum leptin and adiponectin did not differ between SGA and AGA groups.maternal BMI, gestational age and maternal age did not differ between these two groups. Neither leptin nor adiponectin correlated with gender difference.
Conclusion: In this study we confirmed that growth restricted fetuses show venous umbilical cord blood leptin and adiponectin concentrations were significantly lower than those in normal fetuses indicating that these two adipokines have an independent role in growth restriction pathogenesis. Maybe in future we can administer recombinant human leptin and adiponectin to growth restricted fetuses for treatment.

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Background: Radioactive synoviorthesis by injection of safe radioisotopes into the joints affected to chronic arthritis is accounted as a novel method to treat haemophilic arthropathy. The main goal of this therapy would be decrease in frequency of hemarthrosis and consumption of coagulation factors. In this study we assessed the effect of radioactive synoviorthesis on the frequency of hemarthrosis, factor consumption and other related parameters.

Methods: In an interventional study in Imam Khomeini Hospital in Tehran, Iran, after meeting of inclusion criteria and taking written consent, colloid 32p radiosynovectomy was performed for 56 joints with haemophilic arthropathy. After local anesthesia of injection site, one mci of 32P for large joints (knee) and 0.5 mci for small joints (ankle and elbow) was injected, respectively. Half of these doses were considered for children (age <12 years).

Results: The mean of age was 16.78 year old (Range: 2.5-36 SD: 7.46) and 98.2% of cases were male. Injected were knee 80.35%, ankle 12.5%, and elbow 7%. The mean of follow-up was 43.63 months (range: 3-102) that at the end, the result was 62% decrease in frequency of hemarthrosis (p=0.0001) and 84% decrease in factor consumption (p=0.0001). However, the involvement of other (non injected) joints during follow-up could lower the decrease of mean of total factor consumption.

Conclusions: Radioactive synoviorthesis can be a cost-effective alternative to decrease hemarthrosis and factor consumption in haemophilic arthropathy.

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Background: The effects of growth hormone (GH) on bone density in healthy adults is controversial. This study was performed to evaluate the effects of GH administration on bone density under controlled conditions in healthy adult rabbits.

Methods: Twenty healthy adult New Zealand white rabbits of both sexes were included in the study. The rabbits were divided into two groups. The experiment group received human GH and the controls placebo for three months. The density of femur and humerus were measured at proximal epiphysis, mid shaft and distal epiphysis by radiography, aluminum step-wedge and appropriate software. Measurements were performed in five stages, once before and four times after the administration of GH or placebo, with 3-week intervals.

Results: The mean concentration of serum insulin-like growth factor I (IGF-I) increased significantly after GH administration (P<0.05) in the experiment group. Bone density generally increased in all regions except the distal epiphysis of femur in the test group, but significant difference were only seen in the midshaft of femur in comparison to the controls (P<0.05). In the second stage, bone density decreased slightly in all regions except distal epiphysis of femur, but it increased in the next stages.

Conclusion: GH can increase bone density (mostly cortical bone) in adult rabbits. According to the similarities seen between growth hormone effects in rabbit and humans, this study suggests rabbits as a model for studying GH effects on bone density in acromegaly, growth hormone deficiency and even in healthy adult humans.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: One of the difficulties in acetabulum surgery is appropriate exposure of the site of surgery. Trochanteric flip osteotomy is one of the surgical methods for superoposterior and posterior acetabulum exposure. However, due to possible complications some surgeons prefer to avoid this procedure. This study was undertaken to determine the outcome of surgical treatment of acetabular fracture using trochanteric flip osteotomy.
Methods : In this prospective cohort study, 14 patients with acetabular fracture who had been admitted in Imam Khomeini Hospital in Tehran, Iran, during 2003-2006 underwent trochanteric flip osteotomy. The patients were followed for at least one year post-surgically. Demographics, radiologic findings, intensity of pain using visual analogue scale (VAS), Harris hip score (HHS), force of hip abductors and complications were noted. Data analysis was performed using SPSS ver. 13.
Results : The mean HHS was 82.5 (55-95). Heterotopic ossification was observed in three patients. There were no cases of postoperative infection or non::::union::::. Only two patients showed displacement of osteotomized fragments. Reduction was anatomic in 10 patients. In one patient, the force of hip abductors was three-fifth. The mean hip pain was 3.4 based on VAS. There were no cases of femoral head osteonecrosis. With respect to HHS, the final hip status was excellent and good in four and six patients, respectively. Three patients had fair and only one patient had poor condition.
Conclusion: It seems that trochanteric flip osteotomy has much fewer complications in comparison to other methods justifying its use in such cases.

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Background: Achillea millefolium or yarrow is a native plant in Europe and Iran. Yarrow has been used as a medicine historically, mainly because of its astringent effects. It is reported to be associated with the treatment of several ailments. Nowadays use of plants for medical purpose has become very common. Achillea millefolium L, Yarrow, is being used in traditional and modern medicine due to various chemical compounds. Considering the importance of birth control, finding a drug with less side effects inhibiting spermatogenesis seems to be necessary. The aim of the present study was to investigate the effect of ethanol extract of Achillea millefolium L. on spermato-genesis of male wistar rats.
Methods: In this study, 32 adult male wistar rats were used. The animals were divided to four groups of eight rats. The first group, received 200 mg/kg Achillea millefolium L. interaperitoneally, the second and third groups received 400, 800 mg/kg Achillea millefolium L. interaperitoneally, respectively. In the fourth group (control) distilled water was administered. After 20 days, the rats were sacrificed and testis tissues were histologically evaluated.
Results: Comparing to control group, in the experimental groups received the high doses of the extract, thickening of seminiferous tubules basement membrane, loss of germinal epithelium and testicular hyperemia were demonstrated (P<0.001).
Conclusion: Based on the results, high concentrations of Achillea millefolium L. leaded to structural and spermatogenesis changes in testis tissue.

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Background: Colorectal cancer is a major cause of morbidity and mortality throughout the world, and its treatments include surgery, chemo-radiotherapy. Despite improvements in clinical outcomes of patients with this tumor over the past decades, prognosis remains poor with a 5-year survival rate of <10%. Angiogenesis inhibitor agents have been recently added to the treatment regimen of this disease. In the past two decades, it has been recognized that selective inhibitors of the cyclooxygenase -2 (Cox-2) enzyme result in the regression in the size of colorectal tumor, and one of its reasons is attributed to angiogenesis inhibition. The present study aimed at identifying the molecular pathways of angiogenesis inhibition by celecoxib. Methods: HCT-116, which is one of the cell lines of Colorectal cancer (separated from human colorectal adenocarcinoma) was provided by the National Cell bank of Iran (NCBI) affiliated to Pasteur Institute. It was then cultured in DMEM (high glucose) culture medium containing 10% FBS, and then treated in the active substance of celecoxib at pharmacological concentrations of 50 mM (C50) and 100 mM (C100). Afterwards, RNA was extracted and cDNA was prepared. The oligonucleotide of HIF-1 Alpha gene (angiogenesis initiator) was prepared and the level of HIF-1 alpha gene expression was assessed with a real-time PCR device in three control, C50 and C100 groups. Results: HIF-1 alpha gene expression significantly decreased in the celecoxib treatment group (compared with control group) with the concentration of C100 (P< 0.001), but no change was observed in the concentration of C50. Conclusion: Angiogenesis is a key factor in the carcinogenesis process and FDA today approved bevacizumab as a first-line treatment for patients with metastatic colorectal cancer. The results of this study showed one of the causes of angiogenesis reduction in celecoxib-treated colorectal cancer. According to clinical findings and basic studies, celecoxib will be hopefully used as a first-line therapy along with chemotherapy in the near future in colorectal cancer. The advantages of this treatment method include its low cost and low side effects.

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Background: The relationship between skin, neuron system and mental status is complicated. Pemphigus is severe and painful autoimmune skin disorder that occurs in 0.5-1 person in 100000. Regarding the critical role of mental status in autoimmune diseases such as pemphigus, the aim of this research was to investigating psychiatric comorbidity in patient with pemphigus.

Methods: This research was a descriptive survey study. The society of this research included the patients with pemphigus referred to Razi Dermatology University Hospital in Tehran. Participants were 200 persons who were selected through available sampling. Finally, 198 persons filled out the demographic questionnaire and symptom checklist-90 (SCL-90).

Results: This research showed that the prevalence of psychiatric disorders in this sample was 62.62%. 28.78% (57 persons) of patients were male and 33.84% (67 persons) were female. In both genders the symptoms of paranoia were the most prevalent disorders (45% in female and 60% in male) and phobia was the least prevalent in our sample (8.2% in female and 24% in male). The upper grade in education, the less prevalent disorders. 81.45% of participants with mental disorders were married and 18.55% of them were single. Of patients only 26.32% had visited the psychiatrist or psychologist and 95.15% of them had used medications. This research also showed that there was a significant difference between two genders. Men showed higher rate of prevalence in psychiatric symptoms than women.

Conclusion: The results showed that psychiatric disorders in patients with pemphigus are high compared to general population. This research congruent with other researches showed that higher age, lower grade of education and marriage related to worse prognosis in psychological status in patient with pemphigus. Thus dermatologists must recognize and manage these psychiatric comorbidities to treat patients effectively and to improve the quality of life in patients with autoimmune diseases such as pemphigus. 

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Results: According to the predefined criteria, a total of ten studies (parallel group or cross-over trials, and case-control studies) were included and screened for data extraction by two reviewers, separately. The preliminary results extracted from meta-analysis have shown that pentoxifylline can significantly increase transferrin saturation (SMD: 0.348; CI95%: 0.008, 0.688), but there were no conclusive effects of pentoxifylline on hemoglobin (SMD: 0.171; CI95%: -0.390, 0.732), hematocrit (SMD: 0.466; CI95%: -1.426, 2.357), ferritin (SMD: -0.010; CI95%: -0.346, 0.326), and administered dose of erythropoietin (SMD: 0.114; CI95%: -0.232, 0.460), in pooled analyses. Conclusion: There is uncertainty about therapeutic effects of pentoxifylline on anemia of CKD patients. Since these patients has many diverse complications and receive multiple drug therapy, the results of such meta-analysis regarding outcomes of pentoxifylline therapy may have beneficial effects on rational drug prescription.

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Background: Millions of deaths occur around the world each year due to lack of access to appropriate treatment for chronic kidney disease patients. Given the importance and mortality rate of this disease, early and low-cost prediction is very important. The researchers intend to identify chronic kidney disease through the optimal combination of techniques used in different stages of data mining.
Methods: This cross-sectional research was conducted from February 1999 to May 2014. The used data set included 4145 samples and 32 attributes, where Each sample corresponded to a patient and each attribute corresponded to the demographic and clinical traits. There were several eligibility criteria for the patients for clinical testing. These criteria for the clinical testing included having 18 years of age and older, living in Isfahan city, willing to participate in the study, lack of fever and cold during laboratory tests, no strenuous exercise 48 hours before laboratory tests, and fasting. Individuals who had an incomplete questionnaire or were unwilling to perform accurate tests were excluded from the study. The target variable is kidney disease, the values of which include sick and healthy. Four data mining techniques have been used in the dataset. These techniques are support vector machine (SVM), random forest (RF), artificial neural network (ANN) and Chi-square automatic interaction detection (CHAID).
Results: Accuracy is the evaluation criteria for comparing available data mining methods. Based on the accuracy criterion, the support vector machine performed better than other techniques (random forest, neural network and CHAID). The best rule is that if the patients consume salt in their diet, their age is between 50 and 69, and they have diabetes. they are 82% more likely to develop chronic kidney disease.

Conclusion: The derived rules also showed that if we use salt and we have diabetes, we are at the risk of developing chronic kidney disease. Moreover, having diabetes can increase the risk of mortality in chronic kidney patients. Aged people should also be more careful about getting chronic kidney disease. Because, they are more prone to develop chronic kidney disease.

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Results: The best performance in terms of accuracy is related to support vector machine techniques in uric acid class, support vector machine in oxalate class and neural network in cysteine class. The worst performance is related to the random forest technique in the citrate class. The safest rules with a 66% confidence level are for the citrate and sodium classes, and the least reliable rule with a 50% confidence level is for the oxalate class.