Study of potential nephroprotective effects of ramipril versus alpha lipoic acid against gentamicin induced nephropathy in rats

Background: development of aminoglycosides antibiotics assisted in the cure of infective diseases, Gentamicin [GM] is a well known example that has a wide antibacterial domain.This clinical effect is restricted by the occurrence of kidney functions impairment

Aim of the work: we performed this study to examine possible protective effects of Ramipril, Alpha lipoic acid [ALA] and their combinations on kidney functions impairment caused by GM in rats

Materials and Methods: fifty male albino rats were categorized into five groups of ten rats. The first group served as control, the second group received GM, the third group received Ramipril and GM, the fourth group received ALA and GM, the fifth group received Ramipril, ALA and GM. Serum biochemical parameters and kidney homogenate oxidative stress parameters were utilized for evaluation of the nephrotoxicity

Results: pretreating rats with Ramipril or ALA or their combination attenuated GM induced nephrotoxicity

Conclusions: administration of Ramipril alone, ALA alone, or their combination possessed various degrees of nephroprotection against Gentamicin induced nephrotoxicity in rats

Lidocaine and dexamethasone for paracervical block anesthesia in women with missed abortion [randomized controlled trial]

Aim of the work: nerve block is a technique whereby local anesthetic solutions are infiltrated around a nerve [or perineurally] to provide anesthesia and analgesia. Nerve block for intraoperative and postoperative pain management is associated with improved analgesia, fewer opioid-related adverse events, earlier ambulation and shorter hospital stay when compared to intravenous opioid analgesia alone. This study aimed to assess the efficacy of adding dexamethasone to lidocaine for cervical block anesthesia for prolonging the duration and anesthetic effect in women with missed abortion undergoing vacuum evacuation

Patients and methods: this study is a randomized controlled trial and it was conducted in accordance with the ethical committee protocols and informed consent procedures of Ain Shams University Maternity Hospital during the period between Augusts to December 2016. Sample size was calculated using PASS® version 11 programs, setting the type-1 error [alpha] at 0.05 and the power [1-beta] at 0.8

Conclusion: para cervical block can be used as a safe and effective anesthetic technique in patients who need surgical uterine evacuation of missed abortion. Adding dexamethasone can increase effectiveness and duration of para cervical block. Intraoperative pain level was accepted in 80% of patients, these patients had no or mild to moderate accepted pain. We did not detect any postoperative complications in our patients including [excessive vaginal bleeding, hematoma or general manifestations of lidocaine toxicity] and It is recommended to apply PCB for cases of first trimester missed abortion who require uterine suction evacuation. Lidocaine is preferably mixed with dexamethasone to have better results as regards pain score. It is the anesthetic method of choice especially when general anesthesia is a high risk procedure

Relation between non-alcoholic fatty liver disease and epicardial fat in metabolic syndrome

Background: Non-alcoholic fatty liver disease [NAFLD] is becoming recognized as a component of the metabolic syndrome and insulin resistance. There has been recent interest in the association between epicardial fat and atherosclerotic disease with increased risk of cardiovascular mortality and morbidity

Aim of the work: In this study we investigated the relationship between the metabolic syndrome with liver involvement and epicardial fat

Patients and methods: 85 patients who had the criteria of metabolic syndrome are subjected to thorough clinical evaluation. Abdominal circumference, body mass indexand waist/hip ratio were recorded for all patients. Laboratory investigations including urine, complete blood picture, fasting and postprandial blood glucose, uric acid, blood urea and creatinine,C-reactive protein [CRP], lipid profile, liver enzymes and bilirubin were done to all patients. Ultrasonography was used to grade fatty liver and measure the thickness of epicardial fat. Results: Patients with high ALT levels have significantly higher [p<0.01] AST, fasting blood glucose [FBG], uric acid, triglyceride [TG] level, more epicardial fat and waist circumference [p<0.05] compared to those with normal levels. Patients with high grade of fatty liver have significantly higher total cholesterol, TG, FBG, AST, ALT, uric acid levels, more epicardial fat and waist circumference [p<0.01] compared to those with mild and moderate. ALT, FBG and TG are significantly higher in patients with detectable epicardial fat than those without [p<0.01]. There were significant direct correlations between epicardial fat thickness with FBG [r= 0.324; p<0.01], TG [r= 0.217; p<0.05], AST [r= 0.493; p<0.01], ALT [r= 0.561; p<0.01], and grade of fatty liver [r= 0.479; p<0.01]. Also there were significant direct correlations between FBG with waist circumference [r= 0.422; p = 0.01], TG level [r = 0.370; p<0.01], HDL-C [r = 0.284; p<0.05] and grade of fatty liver [r = 0.533; p = 0.01]. There were significant direct correlations between grade of fatty liver with waist circumference [r= 0.264; p<0.05], TG [r= 0.407; p<0.01], uric acid [r= 0.288; p<0.05], and AST levels [r= 0.642 p<0.01]. CRP was found correlated only with liver enzymes [r = 0.481;p<0.05]. Simple logistic regression analysis revealed that epicardial fat thickness [mm] showed a trend in patients with NAFLD and metabolic syndrome

Conclusion: Echocardiographic assessment of epicardial adipose tissue, abdominal ultrasound assessment of NAFLD and transaminase level might serve as a reliable marker of visceral adiposity and more severe degree of metabolic syndrome

Frequent dose of peginterferon alfa 2a evaluation in treatment-naive chronic HCV, genotype 4 Egyptian patients

More frequent dosing with decreasing time intervals between injections of pegylated interferon in the treatment of HCV genotype 4, to our knowledge, was not tested before. The purpose of reducing the intervals between doses particularly in the first 12 weeks is to decrease the peak/trough ratio of the blood concentration of interferon in order to give no chance for the virus to recover. Therefore, the aim of this study is to explore the effect of such frequent dosing in the first 12 weeks as a trial to increase the response rates of our Egyptian patients with HCV genotype 4. This study includes 28 Egyptian patients, discovered to have chronic hepatitis C genotype 4 infection within 1-11 years before enrolling to study. They include 17 males and 11 females with mean age 41.57. Patients with active HCV infection without any vascular or parenchymatous decompensation were given pegasys 180 micro g every 5 days and ribavirin according the weight [800-1400 mg/day] for the first 4 injections. PCR is then done. Those with RVR [negative PCR after 4[th] injection] were treated in usual way with pegasys given every week. Those with detectable HCV RNA continued in the same way as first month for 12 injections. PCR was then repeated. Those showing EVR continued treatment in the usual way. Those with partial or slow EVR [detected HCV but viral load decreased at least 2 logs] continued as first month for 24 injections. Those with non EVR stopped treatment. All other patients continued treatment till 48 injections. Re-evaluation was done at end of treatment and after 6 and 12 months of end of treatment. Rapid virological response with disappearance of HCV RNA after 4 injections of treatment was detected in 14 cases [50%] in whom treatment in usual way continued till the end of 48 weeks. Additional 8 patients [28.6%] showed disappearance of HCV after 12 weeks of treatment to reach total of 22 cases [78.6%] in whom treatment in usual way continued till the end of 48 weeks. Three patients showed 2 log reduction of viral load continue treatment per protocol while 3 patients showed less viral load reduction were withdrawn from treatment. Additional 2 patients showed disappearance of HCV RNA at 24 weeks of treatment to reach a total of 24 patients [85.7%] the patient showing positive RNA stopped treatment. All those patients continuing treatment to 48 weeks remain negative for HCV RNA at end of treatment. Therefore, the ETR is 85.7% using this frequent dose administration of pegylated interferon. Only one patient relapse at week 72 [after 6 months of end of treatment]. Thus, the SVR occurred in 23/28 patient [82.14%]. Dose reduction was done for Ribavirin in 3 cases during treatment due to clinically significant decrease in the hemoglobin levels, all showed SVR. No reduction of interferon dose was commenced. General side effects were as usual and controlled with paracetamol. It is concluded that the use of more frequent peginterferon is associated with the best SVR in genotype 4, and whenever possible this strategy can be used particularly in patients with early disease as indicated by absence of sever hepatic or hematological abnormalities

Pegylated interferon alfa 2a and small dose ribavirin in the treatment of HCV genotype 4 in end-stage renal disease

As hepatitis C virus [HCV] infection is a major health problem in patients with end-stage renal disease [ESRD]. Explore the response rate and adverse effects of pegylated interferon and ribavirin in treating HCV genotype 4 in patients withend stage renal disease [ESRD] waiting renal transplantation. This study included 24 patients with ESRD and active HCV infection as detected by clinical, sonographic, biochemical, serological, virological and histological examination with liver biopsy. All patients were under hemodialysis with HCV antibodies positive > 6 months. Viral genotyping and both qualitative and quantitative PCR were carried out before starting therapy. Treatment was continued for 48 weeks using pegasys 135 micro g weekly and ribavirin 200 mg daily. The biochemical and virological responses were evaluated regularly during and after treatment. The sustained virological response [SVR] being evaluated 24 weeks later. The side effects were monitored throughout the treatment period. Rapid virological response [RVR] after week 4 was achieved in 11/24 [46%] patients. The sustained virological response [SVR] was achieved in 16/24 [66.7%] patients. No break through or relapses were detected during and after treatment respectively. Correlation was found between the viral load before treatment and that at week 4 with p < 0.001and at 12 weekand between the reduction of hemoglobin and the reduction of viral load at week 12 with p < 0.045. Genotype 4 HCV patients with ESRD can be considered for therapy pre-operatively to overcome all the morbidities associated with persistence of HCV after renal transplantation provided that the general condition, the hematological parameters and all other factors of treatment allowed such therapy

Serum soluble intracellular adhesion molecules-1 [sICAM-1] and AST/ALT ratio in chronic hepatitis C are significant predictors of the disease severity judged by liver biopsy

This study was conducted to investigate the serum levels of soluble Fas [sFas] antigen, soluble intracellular adhesion molecules-1 [sICAM-1] and interleukin-18 [IL-18] in patients with chronic hepatitis C and to correlate their levels with the severity of pathological findings judged by liver biopsy interpreted as Scheuer score. The study included 30 patients with chronic hepatitis C [Study group] infection persisting for longer than 6 months with HCV antibody positive and increased serum alanine aminotransferase [ALT] values and 10 volunteers to donate blood samples as control group. After complete history taking and full clinical examination, all patients and controls gave a fasting blood sample for colorimetric estimation of serum aspartate transaminase [AST], ALT and total [TB] and direct [DB] bilirubin and for ELISA assays of serum sICAM-1, sFas and IL- 18 levels. Blind liver biopsies were done and histopathological inflammatory activity [grading, 0-4 scale] and fibrosis stage [0-4 scale] were assessed according to Scheuer classification. Pathological examination of Liver biopsy detected 21 chronic hepatitis specimens and 9 cirrhosis specimens with a significant [p<0.05] increase of Scheuer scores in patients with cirrhosis compared to patients with chronic hepatitis. Serum levels of AST and ALT were significantly [p<0.05] elevated in study compared to control group, with a non-significant [p>0.05] increase of AST/ALT ratio; however, serum AST levels and AST/ALT ratio were significantly [p<0.05] higher and serum ALT levels were non-significantly [p>0.05] higher in cirrhotic patients compared to those with chronic hepatitis. Serum sFas, sICAM-1 and IL-18 levels in study group were significantly [p<0.05] higher compared to controls levels with a significant [p<0.05] increase of sICAM-1 levels and non-significant [p>0.05] increase of sFas and IL-18 levels in cirrhotic patients compared to patients with chronic hepatitis. There was a positive significant correlation between the mean Scheuer necroinflammatory score and serum levels of ALT, sICAM-1 and AST/ALT ratio and between the mean Scheuer fibrosis score and serum levels of ALT, sFas, sICAM-1 and IL-18 and AST/ALT ratio. Logistic regression analysis showed that AST/ALT ratio [beta=0.679, p<0.001] and serum levels of sICAM-1, [beta=0.327, p=0.005] are the most significant predictors of disease severity. It could be concluded that serum levels of sICAM-1, sFas and IL- 18 and AST/ ALT ratio are closely correlated with histopathological results of liver biopsy and thus their elevated levels could be considered pathognomonic markers suggesting the severity of chronic hepatitis C

Comparative study on valsartan [angiotensin II receptor antagonist] and benazepril and captopril [two angiotensin converting enzyme inhibitors] in experimental animals

The renin angiotensin system is present in both circulating and tissue forms. Its ultimate product, angiotensin II, is among a diversity of substances that control blood pressure. In the present work, comparison between valsartan [AT[1] antagonist] and benazepril and captopril [ACE inhibitors] revealed the following: Valsartan [15 mg/kg/day], captopril [15 mg/kg/day] and benazepril [3 mg/kg/day] p.o. for 4 weeks in renovascular hypertensive rats induced significant reduction in systolic blood pressure starting from the first week of treatment. There was no significant difference among the three groups except in the fourth week when captopril and benazepril groups were significantly different from valsartan group. In isolated rabbit aorta, all the three drugs reduced the force of angiotensin-I induced contraction, significantly for valsartan and captopril and insignificantly for benazeprilat