possible cytoprotective role of L-arginine and misoprostol in some radiocontrast media induced toxicity

Despite recent medical progress in supportive medical therapy, the frequency of hospital aquired acute renal failure has increased in recent years.Of the multiple etiologies which can cause such renal impairment, radiocontrast media are recorded to be the third common cause of hospital aquired acute renal failure.In attempts to minimize the radiocontrast induced nephrotoxicity, L-arginine and misoprostol were used as cytoprotective agents against such toxicity. This study was conducted on 180 adult male albino rats. They were classified into: negative control group I distilled water group II, gum acacia group III, L-arginine group IV, misoprostol groupV, diatrizoate group VI, iopromide group VII, L-arginine and diatrizoate group VIII, misoprostol and diatrizoate group IX, L-arginine and iopromide group X, misoprostol and i opromid group Xl, gentamicin group XII, gentamicin and diatnzoate group XIII, gentamicin and iopromide grou XIV, gentamicin, L-arginine and diatrizoate group XV, gentamicin, misoprostol and diatrizoate group XVl, gentamicin, L-arginine and iopromide group XVll. The last group was gentamicin, misoprostol and iopromide group XVIII. At the end of the experimental period the animals were sacrificed, BUN and serum creatinine and urinary beta2 microglobulin and gamma glutamyl transpeptidase [GGT] analyses as well as histopathological examination of the kidney sections were carried out. The results revealed that in groups VI and VII there was significant increase in BUN, serum creatinine, urinary beta2 microglobulin and GGT with degeneradive changes in the proximal convoluted tubules in comparison with group I. These changes were more observed in group VI than in group VII.While in group XIII, there was marked increase in BUN and serum creatinine with aggravation in the renal histopathological changes in comparison with group XII. Moreover misoprostol appeared more effective than L-arginine in nephroprotection when it was given five days before the radiocontrast media either in groups with health kidney [VIII, IX, X and XI] or groups with compromized kidney [XV, XVI, XVII and XIII]

Randomized comparison of glycerol trinitrate and misoprostol for cervical ripening at term

The study was undertaken to assess efficacy and adverse effects of glycerol trinitrate compared with misoprostol for cervical ripening at term. The study was conducted on sixty term pregnant females with unfavorable cervices, Bishop score < 6, referred for induction of labor. They were randomly assigned, and divided into 2 groups: Group [A]: Includes thirty cases where Misoprostol [Cytotec] 200 micro g/tablets will be used vaginally, 50 micro g/6 hours maximally. Group [B] includes thirty cases where Nitroglycerine [Dinitra 5 mg] tablets/ 6 hours, vaginally, two doses maximally. Women were sent to the labor ward for amniotomy or oxytocin, if their Bishop scores improved more than 6 or their cervices were not ripe 24 hours after treatment, then the adverse effects, changes in Bishop scores, progress and outcome of labor were assessed. This study indicated that there was no significant difference as regards Bishop score in between both groups, but the median of Bishop scores 12 hours after PGE[1] analogue [Misoprostol] was higher than glycerol trinitrate. PGE[1] analogue [Misoprostol] group A had shorter mean duration from the start of medication till the start of pain than glycerol trinitrate [group B], the mean was 12.33, 12.12 hours respectively. Also, the time elapsed from induction till delivery was also significant in this group. P=0.001. There was highly significant tachysystole in group A, while headache, dizziness and palpitations were seen only in group B.10%, 10%, 13.3% of cases respectively, low Apgar score after 1 minute was significantly evident in group A compared to group B. Glycerol trinitrate is less effective than PGE[1] analogues [misoprostol] for ripening at term. It causes less tachysystole than misoprostol but headache, dizziness, palpitation are more in glycerol trinitrate group. Further study is needed to determine optimal dose and effectiveness of glycerol trinitrate for cervical ripening