Plasma Concentration of Taurine Changes following Acetaminophen Overdose in Male Patients during Hospitalization.

Changes in plasma concentration of taurine during hospitalization of acetaminophen poisoned patients have not been studied. Hepatotoxicity is a common consequence of acetaminophen overdose that may lead to acute liver failure. Numerous biomarkers for drug-induced liver injury have been explored. All biomarkers are usually obtainable 48 h following acetaminophen overdose. We have already introduced taurine as a non-specific early biomarker of acetaminophen overdose. This study aimed to follow up changes in plasma concentration of taurine during the first three days of acetaminophen overdose. Sixty-four male patients suffering from acetaminophen overdose were selected for the study. Four blood samples were taken from the patients every 12 h. Sixty blood samples were also taken from sixty healthy humans. The plasma concentration of taurine in both groups was analyzed an already developed HPLC method. Analysis of regression showed a significant correlation between means of plasma concentrations of taurine and acetaminophen, aspartate aminotransferase, Alanine aminotransferase, glutathione peroxidase, and prothrombin time during hospitalization. The high plasma concentration of taurine, 6 h or more after acetaminophen overdose, could be a useful early indicator of liver damage.

Detection and Management of Common Medication Errors in Internal Medicine Wards: Impact on Medication Costs and Patient Care.

Purpose: Medication errors (MEs) are a leading cause of morbidity and mortality, yet they have remained as confusing and underappreciated concept. The complex pharmacotherapy in hospitalized patients necessitates continued report and surveillance of MEs as well as persistent pharmaceutical care. This study evaluated the frequency, types, clinical significance, and costs of MEs in internal medicine wards. Methods: In this 8-month prospective and cross-sectional study, an attending clinical pharmacist visited the patients during each physician's ward round at the morning. All MEs including prescription, transcription, and administration errors were detected, recorded, and subsequently appropriate corrective interventions were proposed during these rounds. The changes in the medications' cost after implementing clinical pharmacist's interventions were compared to the calculated medications' cost, assuming that the MEs would not have been detected by clinical pharmacist and continued up to discharge time of the patients. Results: 89% of the patients experienced at least one ME during their hospitalization. A mean of 2.6 errors per patient or 0.2 errors per ordered medication occurred in this study. More than 70% of MEs happened at the prescription stage by treating physicians. The most prevalent prescription errors were inappropriate drug selection, unauthorized drugs and untreated indication. The highest MEs occurred on cardiovascular agents followed by antibiotics, and vitamins, minerals, and electrolytes. The net effect of clinical pharmacist's contributions in medication therapy management was to decline medications' costs by 33.9%. Conclusion: The role of clinical pharmacy services in detection, prevention and reducing the cost of MEs is of paramount importance to internal medicine wards.

The effects of vitamin D supplementation on lipid profiles and oxidative indices among diabetic nephropathy patients with marginal vitamin D status.

AIMS: Diabetic nephropathy is one of the major microvascular complications of type 2 diabetes which insufficient vitamin D might -have a role in it's incidence. This study evaluated the effects of vitamin D supplementation on lipid profiles and oxidative/anti-oxidative indices in marginal vitamin D status patients with diabetic nephropathy. METHODS: For the current paralleled, randomized, double-blinded, placebo-controlled clinical trial, 50 diabetic nephropathy patients with marginal serum vitamin D were selected. Intervention group received 1,25-dihydroxycholecalciferol (50000 IU/week, n = 25), and placebo group (n = 25) received an identical placebo, for 8 weeks. Lipid profiles (LDL, HDL, TG and TC) and oxidative/anti-oxidative markers (TAC, SOD, CAT, GPX and MDA) were measured. RESULTS: Vitamin D supplementation significantly increased vitamin D status in the intervention group, compared to the control group (P = 0.001). The reductions in the serum levels of TG, LDL and TC were significant (P = 0.04, P = 0.006 and P = 0.02, respectively) in the intervention group. The changes in oxidative/anti-oxidative markers and HDL levels were not significant after intervention. CONCLUSION: In conclusion, vitamin D supplementation for 8 weeks among diabetic nephropathy patients has beneficial effects on serum vitamin D status and dyslipidemia.

Efficacy and Safety of Mycophenolate Mofetil Versus Intravenous Pulse Cyclophosphamide as Induction Therapy in Proliferative Lupus Nephritis.

INTRODUCTION: Lupus nephritis is a common and severe manifestation of systemic lupus erythematosus that can lead to end-stage renal disease and death. The aim of this study was to compare the efficacy and safety of mycophenolate mofetil (MMF) and cyclophosphamide as induction therapy and subsequently as maintenance therapy for lupus nephritis. MATERIALS AND METHODS: In this retrospective case-control study, 67 patients with proliferative lupus nephritis who were treated with MMF (n = 45) and pulse of intravenous cyclophosphamide (n = 22) were included. Remission of the kidney disease, mortality, and adverse events were evaluated and compared between the two groups. RESULTS: The 45 patients treated with MMF had a mean age of 33.8 ± 10.6 years and 17.1% of them were males. The 22 patients treated with pulse of intravenous cyclophosphamide had a mean age of  38.1 ± 11.1 years and 18.2% of them were males. Complete and partial kidney remission occurred in 40% and 42.2% of the patients treated with MMF and in 31.8% and 59.1% of the patients treated with cyclophosphamide, respectively. No significant differences were observed in complete and partial remission between the two groups. No mortality was reported in the studied patients. There were no significant differences in the frequency of adverse events between the two groups. CONCLUSIONS: The efficacy of MMF in long-term treatment of lupus nephritis was comparable to that of cyclophosphamide, and there is no significant differences in the rate of side effects between the two regimens.

Demographic and clinical features of Behcet's disease in Azerbaijan.

AIM: Behcet's disease (BD) is a multisystem inflammatory disease characterized by recurrent aphthous ulcers, genital ulcers and uveitis. Demographic and clinical features of BD are different in various countries. Due to these ethnic discrepancies, we decided to consider the clinical picture of BD in the Azeri population of Iran and compare it with other ethnic groups. METHODS: This cross-sectional cohort study was carried out at the Connective Tissue Diseases Research Center of Tabriz University of Medical Sciences, Tabriz, Iran from 2006 to 2013. We considered the demographic and clinical findings in 166 patients with BD. Disease activity was measured by the Iranian Behcet's Disease Dynamic Activity Measure (IBDDAM) and Total Inflammatory Activity Index (TIAI). RESULTS: The male-to-female ratio was 1.7 : 1.0; the age of disease onset was 25.8 ± 8.9 years. Recurrent oral aphthous ulcers were the initial manifestations of BD in 83.1% of patients. Panophthalmitis and panuveitis were the most common ophthalmic manifestations of disease. Blindness occurred in 7.1% of patients. This study showed no difference between the two genders in mean age of disease onset and clinical manifestations. However, IBDDAM in men was higher than women. Retinal vasculitis in men was more common than women. CONCLUSIONS: BD in the Azeri population of Iran starts in the third decade and has a male predominance. The activity of the disease and retinal vasculitis in men is more predominant than women in Azerbaijan.

Therapeutic Effects of Omega-3 Fatty Acids on Chronic Kidney Disease-Associated Pruritus: a Literature Review.

Uremic pruritus remains one of the most tormenting, frequent and potentially disabling problem in chronic kidney disease (CKD) patients. However, an area of substantial etiological interest with relation to uremic pruritus is the essential fatty acids deficiency. So we performed a literature review to elucidate the efficacy of omega-3 fatty acids on uremic pruritus. This review evaluated all of the studies published in English language, focusing on the clinical effects of omega-3 fatty acids on uremic pruritus. The literature review was conducted in December 2015 and carried out by searching Scopus, Medline, Cochrane central register of controlled trials, and Cochrane database of systematic reviews. The search terms were "kidney injury", "kidney failure", "chronic kidney disease", "end-stage renal disease", "dialysis", "hemodialysis", "peritoneal dialysis", "pruritus", "itch", "skin problems", "fish oil", "omega 3", "n-3 fatty acids", "polyunsaturated fatty acids", "docosahexaenoic acid", and "eicosapentaenoic acid". Four small studies investigating potential benefits of omega-3 fatty acids on symptoms of uremic pruritus were found. Among them, three small randomized controlled trials have shown a significant improvement in pruritus symptoms (evaluated by a standard questionnaire) in CKD patients who took omega-3 supplement compared to omega-6, omega-9, and placebo supplementation. Despite numerous limitations of the studies, it is worth noting that even minor reduction in itching symptoms may be clinically significant for CKD patients. Therefore, and considering multiple health benefits of omega-3 fatty acids in advanced CKD and negligible risk profile, omega-3 intake can wisely be applied to CKD patients with uremic pruritus.

Evaluation of a biosimilar recombinant alpha epoetin in the management of anemia in hemodialysis patients.

BACKGROUND: The efficacy of human recombinant erythropoietins (rHuEPOs) in the treatment of anemia with different etiologies is proven. Development of biosimilar rHuEPO products with lower cost and wider availability is important for the care of anemic patients. OBJECTIVE: The aim of the present study was to determine the bioequivalence and safety of a biosimilar rHuEPO (Pastopoitin(®)) and compare it with the innovator product Eprex(®), as a standard rHuEPO. METHODS: One hundred and seven anemic patients on stable hemodialysis were recruited to this randomized double-blind comparative trial and assigned to either subcutaneous Pastopoitin (n = 50) or Eprex (n = 57). Each study group received rHuEPO at a dose of 80-120 IU/kg/week in 2-3 divided doses for a period of 3 months. Hematologic parameters including Hemoglobin, hematocrit, RBC, EBC, platelet, MCV, MCH and MCHC were checked every 2 weeks. Blood iron, ferritin, TIBC, creatinine, BUN and electrolytes (Na, K, Ca and P) were evaluated monthly over the 3 months. RESULTS: A significant increase in hemoglobin, hematocrit and RBC was observed by the end of study in both Pastopoitin and Eprex groups (p < 0.001). However, these factors were not significantly different between the groups, neither at baseline nor at the end of study (p > 0.05). Likewise, the groups were comparable regarding MCV, MCH, MCHC, iron, ferritin, TIBC, creatinine, BUN and electrolytes at baseline as well as at the end of trial. Adverse events were not serious and occurred with the same frequency in the study groups. CONCLUSION: Pastopoitin showed comparable efficacy and safety profile with Eprex in anemic patients on hemodialysis. Hence, Pastopoitin may be considered as a rHuEPO with a lower cost and wider availability compared with the innovator product Eprex.

Effect of Fresh Royal Jelly Ingestion on Glycemic Response in Patients With Type 2 Diabetes.

BACKGROUND: Type 2 diabetes is the fourth major public health problem worldwide. Royal Jelly (RJ) insulin-like activity and blood glucose modulating properties have been reported in animal and healthy volunteers. OBJECTIVES: This study aimed to investigate the effect of a single dose of fresh RJ as a complementary therapy on glycemic response in patients with type 2 diabetes. PATIENTS AND METHODS: In this randomized clinical trial, 40 patients with type 2 diabetes were assigned into the RJ (n = 20) and placebo (n = 20) groups and received either 10 g fresh RJ or placebo after overnight fasting. Serum glucose, insulin and C-peptide concentrations were determined at 0, 60, 120 minutes after the intervention. Independent t-tests and repeated measures ANOVA were used to analyze data. RESULTS: The mean serum glucose levels were significantly decreased in RJ and placebo groups; however, mean serum level was different but not statistically. (P = 0.77). One hour after RJ ingestion the mean serum insulin concentrations were increased and after 2 hours it was decreased insignificantly (P = 0.54, P = 0.20). The mean C-peptide concentrations were significantly increased after 1 and 2 hours of RJ ingestion; however, in the placebo group we observed a slight but insignificant reduction at the time of 1 and 2 hours in the mean C-peptide serum levels (P = 0.40). Moreover, there was no significant difference in none of the glycemic control parameters between both studied groups (P > 0.05). CONCLUSIONS: It seems that RJ does not appear to have significant immediate effects on glycemic factors in patients with type 2 diabetes. However, further studies with larger sample sizes and different doses of RJ are needed to achieve more precise results.

Serum and tissue endothelin-1 are independent from intima-media thickness of peripheral arteries in patients with chronic kidney disease.

AIM: We aimed to study the relationship of peripheral arteries' atherosclerosis with serum and tissue endothelin-1 in chronic kidney disease patients. METHODS: Ninety patients were enrolled, including 35 patients with chronic kidney disease (case group), 31 patients with coronary artery diseases who were candidates for coronary artery bypass grafting (positive control group), and 24 living kidney donors (negative control group). Intima-media thickness of the common carotid and femoral arteries was determined by ultrasonography. Serum and tissue endothelin-1 were measured by ELISA method. RESULTS: The mean serum and tissue endothelin-1 levels in the donor group were significantly lower than other groups (p < 0.001 for both). The coronary artery bypass grafting group had higher carotid and femoral intima-media thickness than other groups (p < 0.001), and the chronic kidney disease group had higher carotid and femoral intima-media thickness than the donor group (p < 0.001). Regression analysis in all groups did not reveal any correlation between the carotid intima-media thickness/femoral intima-media thickness and the serum/tissue endothelin-1. There was a direct linear correlation between the carotid and femoral intima-media thickness (p < 0.001) in all groups. CONCLUSIONS: Endothelin-1 level and intima-media thickness were higher in the chronic kidney disease patients and coronary artery bypass grafting candidates, without any correlation between endothelin-1 and peripheral arteries' intima-media thickness of both groups. Perhaps endothelin-1 rises and remains high upon endothelial damage and initiation of atherosclerosis.

Alendronate Effect on the Prevention of Bone loss in Early Stages of Ankylosing Spondylitis: A Randomized, Double-Blind, Placebo-Controlled Pilot Study.

BACKGROUND: Ankylosing spondylitis (AS) is an inflammatory rheumatic disease that leads to a progressive ankylosis of vertebras and ossification of paravertebral ligaments. Bone loss and osteoporosis are amongst the important complications of AS, treatment of which is a challenging issue. OBJECTIVES: This study aimed to clarify the effect of alendronate on the prevention of bone loss in patients with early AS. PATIENTS AND METHODS: In a randomized, double-blind, placebo-controlled study, 24 patients with early stages of AS were recruited in Emam Reza Hospital, Tabriz University of Medical Sciences. The diagnostic criteria of early AS were Schober's index ≥ 5, normal hip joint in pelvic radiography, and absence or rarity of syndesmophytes in spine radiography (Taylor index ≤ 1). The participants were randomly allocated to the treatment and control groups and received 70 mg/week of alendronate and the same dose of placebo, respectively, for 12 months. Before and 12 months after the intervention, bone densitometry was performed from lumbar and pelvic region using the dual-energy X-ray absorptiometry (DEXA) method with Hologic QDR model instrument. Patients, physicians who prescribed the medications and those who interpreted the outcomes, and densitometry technicians were unaware of the assigned medication to each patient. Both groups received supplemental calcium (1000 mg/day) and vitamin D (400 mg/day). RESULTS: After 12 months of treatment, hip and lumbar bone mineral density differences were not statistically significant between study groups (P = 0.061 and P = 0.112, respectively). No case of clinically apparent vertebral and nonvertebral fracture were observed in the treatment and control groups. CONCLUSIONS: Our results suggested that applying alendronate was ineffective in preventing bone loss in patients with early stages of AS.

Effect of hemodialysis on pulmonary function tests and plasma endothelin levels.

End-stage renal disease (ESRD) is a complex illness that involves different organs including the lungs. We studied the pulmonary function tests, arterial blood gases (ABG) and plasma endothelin-1 (ET-1) levels to check whether there is any change in their levels after hemodialysis (HD) in patients with ESRD. In this cross-sectional study (from July 2009 to April 2010), 20 patients with ESRD were evaluated. ABG, spirometric parameters and plasma ET-1 were measured before and after HD in these patients. Student's t-test was performed to clarify the differences and Pearson's test was used for correlations. P <0.05 was considered statistically significant. Significant reduction was seen in oxygen saturation (O2sat), partial pressure of carbon-dioxide (PaCO2) and oxygen (PaO2) after a HD session (P <0.001). Also, improvement was seen in all spirometric parameters except forced expiratory volume (FEV1)/forced vital capacity (FVC) after HD. Plasma ET-1 levels decreased significantly after HD. Mean ET-1 before HD was 6.88 + 5.81 pg/mL while it was 3.91 + 2.76 pg/mL after HD (P = 0.009). Based on the plasma levels of ET-1, the patients were divided into two groups. The mean level of ET-1 was higher in the first group. Significant increase was seen in spirometric parameters in the second group. Our study suggests that, in patients with ESRD, plasma ET-1 level is higher than in the normal population, and this is closely related to deterioration of pulmonary function tests. Significant reduction of plasma ET-1 may be an important factor in the improvement of spiro-metry parameters after HD.

QT dispersion in the electrocardiogram in hemodialysis and peritoneal dialysis patients.

To evaluate QT dispersion (QTd) in dialysis patients in an analytic cross-sectional study, three groups were enrolled: Hemodialysis (HD), peritoneal dialysis (PD) and control (30 patients in each group) to study QT parameters in 12-lead electrocardiograms (ECGs). QTd was calculated (maximum QT interval minus minimum QT interval in different leads in each ECG). In dialysis patients, left ventricle mass index (LVMI) was also evaluated using the ECG of the patients. QT, corrected QT (QTc), QTd and QTc dispersion were significantly higher in the HD and PD groups than in controls, but there was no difference between the dialysis groups. There was no difference between the HD and the PD groups in LVMI and ejection fraction. In the PD group, there was a positive correlation of LVMI and QTd (r = 0.5, P = 0.004) and QTc dispersion (r = 0.54, P = 0.004). We conclude that the QT changes were more prominent in HD and PD patients than in controls, which could be due to electrolyte changes. Further studies to evaluate the causes of the QT changes in a larger population are needed.

Mental health status of women with rheumatoid arthritis in iran.

BACKGROUND: Chronic diseases are usually accompanied by psychological abnormalities. Anxiety and depression occur in a significant number of patients with rheumatoid arthritis (RA). These psychological problems are likely, to be the results of chronic physical symptoms such as pain and disability. OBJECTIVES: The aim of this study was the evaluation of mental health in patients with rheumatoid arthritis in Iran. PATIENTS AND METHODS: One hundred women with definite diagnosis of RA were evaluated in the outpatient clinic of the Tabriz University of Medical Sciences during one year period. Activity of RA disease was determined according to the Disease Activity Score-28 (DAS-28) scaling system and mental health was evaluated using the General Health Questionnaire-28 (GHQ-28). Based on the cut of point score of 22, prevalence of psychological problems was determined and a comparison was made the between two groups (with and without psychological problems). RESULTS: GHQ28 screening test showed that psychological problems were seen in 49% of studied patients. There were significant difference between duration of disease and DAS-28 score between the two groups (P = 0.001 and P = 0.001, respectively). Somatic symptoms were more frequent in patients with psychological problems (P = 0.001). Somatic symptoms in patient with high disease activity was also more frequent than the other group (P = 0.002). There was a significant positive correlation between the scores of DAS-28 and GHQ-28 (r = 0.329, P = 0.001). CONCLUSIONS: This study showed that a considerable portion of patients with RA may have mental problems. The probability of these problems increased with more severe and more prolonged disease.

Blood pressure increase after erythropoietin injection in hemodialysis and predialysis patients.

INTRODUCTION: Anemia is among the most important complications of chronic kidney disease (CKD) and a lot of symptoms and signs are due to this problem. Erythropoietin injection may improve anemia, but it may cause hypertension in these patients. The aim of this study is to evaluate erythropoietin injection effects on blood pressure of hemodialysis and predialysis patients. MATERIALS AND METHODS: Forty hemodialysis patients and 40 predialysis patients with end-stage renal disease were enrolled in the study. The studied patients were comparable in terms of age, sex, hemoglobin, serum calcium, and baseline blood pressure. Erythropoietin was injected for all of the patients with anemia (4000 U, twice weekly). The effect of erythropoietin on their blood pressure was evaluated for each group by comparison of systolic, diastolic, and mean arterial blood pressure values before and 1 hour after the injection. RESULTS: After erythropoietin injection, systolic, diastolic, and mean arterial blood pressure values increased significantly in the hemodialysis group, and the increases were significantly greater in this group than the predialysis group (P = .02, P = .01, and P = .02, respectively). Blood pressure increase was significant only for the systolic component in the predialysis group. CONCLUSIONS: Erythropoietin injection increases blood pressure levels in both groups. However, this is more significant in the hemodialysis patients as compared with patients with end-stage renal disease who have not started dialysis. Monitoring of blood pressure after erythropoietin injection is recommended.

Thrombolytic therapy for cerebral vein thrombosis in antiphospholipid syndrome secondary to systemic lupus erythematosus.

A 20-year-old woman was admitted to a Gynecology Hospital in her 6(th) month of pregnancy for high blood pressure and tonic-clonic seizure. Primary diagnosis was eclampsia, and for that reason she underwent cesarean section. She also had headache on frontal and parietal areas without nausea or vomiting. There was not a focal neurological sign. Rheumatology consultation was requested. Systemic lupus erythematosus and secondary antiphospholipid (APS) was confirmed. The patient had headache that continued several days after cesarean section, therefore, brain magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) were performed, and cerebral vein thrombosis was documented. Distal segment of right lateral sinus and sigmoid sinus were not appeared in brain MRV. Abnormal hypersignal intensity of right lateral sinus/coronal T2 was detected. Thrombolytic therapy with 20 mg tissue plasminogen activator on right sigmoid and transverse sinus was performed by an interventional neurologist. After this procedure, the patient(')s headache healed and she was discharged in a good condition.

Neuropathy in type 1 diabetic renal transplanted patients.

This study was undertaken to study the changes in neuropathy in type 1 diabetic patients with end-stage renal disease (ESRD) after renal transplantation. From April 2007 to June 2010, 30 renal transplanted patients with type 1 diabetes mellitus (RT) and 30 type 1 diabetic patients with ESRD were enrolled in this study. Electroneurodiagnostic tests of peroneal, sural, ulnar, and median nerves were performed. Nerve conduction velocity (NCV), compound motor action potentials (CMAPs), and sensory nerve action potentials (SNAPs) were analyzed at 6, 12, and 18 months after renal transplantation. The NCV improved in the RT group in 18 months of the follow-up period (P <0.01 versus baseline). This parameter worsened significantly in the control group throughout the study period (P = 0.03), but in the cross-sectional analysis between the groups, we could not find any remarkable differences (P = 0.07). Both SNAP and CMAP amplitudes improved in the RT (SNAP Sural = 0.04, SNAP Median = 0.01 and CAMP Peroneal = 0.03, CAMP Ulnar = 0.02) but worsened in the control group (SNAP Sural < 0.001, SAP Median < 0.01 and CAMP Peroneal < 0.01, CAMP Ulnar < 0.01). Comparison of both groups did not show any significant statistical changes. Electroneurodiagnostic values improved after renal transplantation in type 1 diabetic patients with ESRD, but cross-sectional analysis did not reveal statistically significant differences between the studied groups.

Familial rheumatoid arthritis in patients referred to rheumatology clinics of Tabriz, Iran.

BACKGROUND: The familial clustering of rheumatoid arthritis (RA) in first and second degree relatives of patients supports the role of genetic factors. The proportion of heredity in its development is roughly 60%; however, most individuals closely related to someone with RA do not get the disease. Considering the lack of sufficient data on the familial aggregation of RA in Iran, we designed this study for clarifying the familial prevalence of RA. OBJECTIVE: To determine the prevalence of RA among relatives of patients with RA and to evaluate the mean disease onset age in relatives. METHODS: In a longitudinal study from July 2008 to July 2010, we followed 210 unrelated patients with RA and their first and second degree relatives (FDR+ and SDR+), by interviewing and physical examination of those with symptoms, to ascertain prevalence. Familial RA was defined by presence of at least two siblings fulfilling the 1987 ACR criteria for RA. RESULTS: We demonstrated that 17.6% of patients have at least one affected relative. The prevalence of RA in the family of studied patients was 0.83% (42 people). Thirty-two in FDR+ and 10 people in SDR+ (2.53% and 0.26% of all family), also 1.12% in female relatives and 0.39% in male relatives had RA. The odds ratio for FDR/SDR was 2.52. The mean age at disease onset in relatives was 42.30 ± 1.51 years in FDR+ and 34.40 ± 2.10 years in the SDR+ group (0.03). CONCLUSION: The risk of RA is greatest in FDR+ and is likely to be due to a combination of inherited and environmental factors.

Angiotensin receptor blocker and N-acetyl cysteine for reduction of proteinuria in patients with type 2 diabetes mellitus.

INTRODUCTION: Proteinuria and albuminuria are established risk factors for progressive renal damage. Albuminuria can be effectively controlled by antihypertensive drugs that interrupt the renin-angiotensin-aldosterone system. However, the efficiency of N-acetyl cysteine (NAC) in preventing diabetic nephropathy is uncertain. Renoprotective effects of angiotensin receptor blockers and NAC in preventing or reducing of proteinuria in patients with diabetic nephropathy was studied. MATERIALS AND METHODS: In a randomized controlled trial, 70 patients with type 2 diabetic nephropathy (proteinuria and renal insufficiency) were studied. The patients were randomly divided into two groups and were treated with losartan, 25 mg, twice per day, with and without NAC, 600 mg twice daily (study and control groups, respectively; 35 patients in each group). Urine protein was checked before treatment and after 2 months of treatment. RESULTS: The two groups were comparable regarding gender, age, serum creatinine, and urine protein excretion levels. Proteinuria improved in both groups. The mean proteinuria level decreased more in patients with losartan and NAC; however, comparison of proteinuria between the two groups showed no significant difference after 2 months. CONCLUSIONS: Angiotensin receptor blockers reduced proteinuria due to diabetic nephropathy, and this study failed to detect additional effect when NAC was combined with these medications.

The effects of milk thistle on hepatic fibrosis due to methotrexate in rat.

BACKGROUND: Extracts of milk thistle (MT), Silybum marianum, have been used as medical remedies since the time of ancient Greece. Methotrexate is a potentially hepatotxic drug. OBJECTIVES: To clarify the hepatoprotective effects of MT on methotrexate. MATERIALS AND METHODS: From January 2010 to April 2010, 30 male rats were recruited into three 10-rat subgroups in Tabriz University of Medical Sciences. Normal saline was injected intraperitoneally in the first group (A; the controls); intraperitoneal methotrexate plus oral MT extract were administered to the second group (B) and intraperitoneal methotrexate alone was given to the third group (C). Pre- and post-interventional measuring of serum parameters were carried out every 15 days. After six weeks, the rats were decapitated and histopathological evaluation of liver was done. RESULTS: Serum liver enzymes (AST, ALT), alkaline phosphatase, total and direct bilirubin, creatinine and BUN were measured on days 0, 15, 30, 45. They were significantly higher in the group C, comparing with other two groups. Serum albumin was the least in group C animals as well. There were no significant differences between groups A and B. The mean±SD fibrosis score using semi-quantitative scoring system (SSS) was 1.25±0.46, 1.40±0.52 and 6.70±0.82, in groups A, B and C, respectively (p<0.001). CONCLUSIONS: MT extract can effectively prevent methotrexate-induced liver dysfunction and fibrosis in rats.