Background Cisplatin-induced nephrotoxicity still occurs despite the intensive hydration approach adapted to prevent its occurrence. Objective Evaluation of the effect of acetazolamide (ACTZ) on minimizing cisplatin-induced nephrotoxicity compared to mannitol when added to hydration regimen. Setting Nasser Institute Cancer Center (NICC), Cairo, Egypt. Method A total of 35 patients planned to receive cisplatin were divided into two groups: 20 patients received mannitol and 15 patients received ACTZ. Both groups received standard hydration measures as well for prevention of cisplatin-induced nephrotoxicity. Main outcome measure Patients' kidney function was assessed using serum creatinine, creatinine clearance and blood urea nitrogen. Kidney injury was assessed using RIFLE criteria. Patients' liver function tests and hematological parameters were also monitored. Results Patients in the mannitol group showed higher risk of developing kidney injury (30%) whereas those in the ACTZ group showed lower risk (8.9%), relative risk (RR) 0.269, 95% CI 0.108-0.815. No statistically significant difference occurred between the two groups concerning liver function tests or hematological parameters. Conclusion Use of ACTZ in addition to intensive hydration may have more beneficial effect on minimizing cisplatin-induced nephrotoxicity compared to mannitol plus intensive hydration approach. A large multicenter randomized clinical trials is recommended to confirm study results and to assess effect of ACTZ on tumor response.

BACKGROUND: Colon surgery can cause systemic inflammatory response syndrome (SIRS). There is a recent trend towards the use of antioxidant agents in the prevention or alleviation of the severity of postoperative SIRS, but its use is controversial as studies have shown conflicting results.OBJECTIVES: Investigate the efficacy and tolerability of perioperative intravenous administration of N-acetylcysteine (NAC) as an antioxidant and anti-inflammatory agent in patients undergoing colon surgery.DESIGN: Randomized, double-blinded, and controlled clinical trial.SETTING: Surgical critical care unit in Egypt.PATIENTS AND METHODS: Sixty patients who required admission to the ICU following colon surgery were enrolled in the study between July 2015 and October 2016. Eligibility included the need for parenteral nutrition for at least 5 days due to failure of or contraindication to enteral nutrition. Patients were randomly allocated using a computer-generated list to a loading dose of NAC followed by continuous infusion started one hour prior to induction, and continued over 48 hours, or to the control group, who received the same volume of dextrose 5%. Allocation was concealed using opaque, sealed envelopes under pharmacy control. The researcher, the anesthesiologist, the surgeon, and patients were blinded to the treatment allocation.MAIN OUTCOME MEASURES: Clinical and laboratory evaluation for manifestations of SIRS, serum levels of tumor necrosis factor alpha and malondialdehyde, and occurrence of side effects in the study group.SAMPLE SIZE: 60 patients with mean (SD) ages of 56 (15.1) years in the study group (n=30) and 57.7 (12.3) years in the control group (n=30).RESULTS: There was a significant difference in the mean serum level of ALT (22.6 (9.9) U/L in the study group vs. 31.1 (17.8) U/L in the control group, P=.028) after treatment with NAC, but differences between the groups in the serum level of tumor necrosis factor alpha and malondialdehyde after treatment were not significant. Serum levels of malondialdehyde increased in both groups after treatment P<.001. There was no statistically significant difference from baseline or between the groups after treatment in other clinical data and laboratory parameters following NAC administration, and only 6.6% of the patients in the study group experienced mild side effects.CONCLUSIONS: Preoperative administration of NAC is safe, but its efficacy as an antioxidant and anti-inflammatory agent was not statistically significant and requires further investigation in a larger sample.LIMITATIONS: Single-center study, small sample size, and short duration of NAC administration.CLINICAL TRIALS REGISTRY: NCT03589495.CONFLICT OF INTEREST: None.

As expected, amikacin given once every 24 h to septic neonates of ≥ 36 weeks of gestation achieved higher peak levels and lower trough concentrations than the twice daily regimen. Treatment with once daily regimen did not lead to more nephrotoxicity than with a twice-daily regimen, and showed comparable efficacy.

Background and Study Aims: Effect of peginterferon and ribavirin treatment on chronic hepatitis C virus infection has been early established. However, predictors of treatment success need more elucidation. The present study is directed to estimate the importance of rapid virological response, and other host and viral factors in naïve Egyptian patients treated with 48 weeks of pegylated interferon and ribavirin. Patients and Methods: A total of 111 naïve Egyptian patients with chronic hepatitis C genotype 4 were randomly assigned to a treatment regimen consisting of either peginterferon-alpha-2a (180 μg/week) or peginterferon-alpha-2b (1.5 μg/Kg/week) plus oral ribavirin (10.6 mg/Kg/day). This treatment was given for 48 weeks with a 24-week follow-up. The endpoint was sustained virological response. Results: Overall, sustained virological response was achieved by 85 (70.2%) patients, while 26 (21.5%) patients relapsed. Rapid virological response occurred in 95 patients where 77 (84.6%) of them attained SVR and 14 (15.4%) of them relapsed (P<0.001). Concerning host and viral factors, age, gender and pretreatment viral load, they all did not influence the outcome of therapy. On the other hand, higher liver fibrosis stage according to Metavir score (F3) significantly modified the sustained virological response compared to stage F1 with an Odds ratio 5.9 (95% confidence interval (CI): 1.1-31.0) and compared to F2 with an Odds ratio 7.2 (95% confidence interval (CI): 1.3-40.9). Conclusion: Rapid virological response is an independent factor that influences the sustained virological response. Besides, low pretreatment fibrosis stage is a predictor of sustained virological response.

This study included Iourty chronic renal failure patients aged 37-83 years (mean 51.3±7) on thrice weekly I-IDx for 4-144 month (KtN> 1.2). Acetate dialysate with Calcium concentration of 3 mEq/L was used. All phosphate binders were discontinued for one month. Patients were divided in two groups. Group I (20 cases) received CA, while group II ('lO cases) received CC in cquimolar dose (10 m.mol, of either t.i.d.) for one month. Crossover of rrcauncnt was done for another month while keeping paticm-. on the same diet. Serum levels of total calcium (Ca), ionized Ca (iCa), phosphorus (P), alkaline phosphates (AP), urea (U). creatinine (Cr), ALT, AST, total proteins CTP) and albumin (Alb) were estimated before, and at the end of each month of CA and CC treatment. serurn Ca and iCa were significantly lower in group I after CA compared to values after CC (p0.05 in ail). We excluded 12.Yk of cases due to CA intolerance while non of cases had similar intolerance to Cc.

This study included Iourty chronic renal failure patients aged 37-83 years (mean 51.3±7) on thrice weekly I-IDx for 4-144 month (KtN> 1.2). Acetate dialysate with Calcium concentration of 3 mEq/L was used. All phosphate binders were discontinued for one month. Patients were divided in two groups. Group I (20 cases) received CA, while group II ('lO cases) received CC in cquimolar dose (10 m.mol, of either t.i.d.) for one month. Crossover of rrcauncnt was done for another month while keeping paticm-. on the same diet. Serum levels of total calcium (Ca), ionized Ca (iCa), phosphorus (P), alkaline phosphates (AP), urea (U). creatinine (Cr), ALT, AST, total proteins CTP) and albumin (Alb) were estimated before, and at the end of each month of CA and CC treatment. serurn Ca and iCa were significantly lower in group I after CA compared to values after CC (p0.05 in ail). We excluded 12.Yk of cases due to CA intolerance while non of cases had similar intolerance to Cc.

Renal allograft survival requires multiple immunosuppressive drugs. This strategy may lead to gastric complications that necessitate gastro‐protective medications, notably, proton pump inhibitors (PPI). This study aimed to compare the influence of pantoprazole and esomeprazole on serum cyclosporine trough levels (C0) in renal transplant recipients (RTR). A prospective, parallel, open‐label trial was conducted on 47 adult RTR receiving cyclosporine doses adjusted to attain trough concentrations of 100 to 150 μg/L, mycophenolate mofetil (MMF) 750 mg q12 hour and prednisolone at 5 mg daily at Nasser Institute, Cairo, Egypt from January to September 2016. Patients were randomized into the esomeprazole group (25) or pantoprazole group (22) receiving the same dose (40 mg once daily). The study outcomes included clinical signs of rejection and renal function decline, assessed by elevations in serum creatinine, caused by cyclosporine level variations in either of the two study groups. Renal function, C0 and CBC measurements were measured at baseline and monthly for 6 months. The mean C0 values were higher in the pantoprazole group than in the esomeprazole group in the sixth month only (P = .007). Serum creatinine level was lower in the sixth month than at baseline in the esomeprazole group (P = .004). There were no signs of rejection biochemical or clinical in any of the study groups. In conclusion, PPIs should be used with caution and doses should be titrated to reach the C0 targets in RTR, which is of more importance in pantoprazole than esomeprazole to avoid C0 level elevation or decline affecting the allograft function.

Renal allograft survival requires the administration of multiple immunosuppressive drugs. This strategy may lead to gastric complications that necessitate gastro-protective medications, notably, proton pump inhibitors (PPIs). This study aimed to compare the effects of pantoprazole and esomeprazole on renal function in stable renal transplant recipients. A prospective, parallel, open-label clinical trial was performed with forty-seven adult renal transplant recipients receiving immunosuppressive therapy with cyclosporine (CSA) doses adjusted to attain trough concentrations of 100-150 μg/L, mycophenolate mofetil (MMF) at 750 mg q12 h and prednisolone at 5 mg daily at Nasser Institute, Cairo, Egypt. The enrolled participants were randomized into two groups, which received either esomeprazole or pantoprazole at the same dose (40 mg once daily). Renal function was measured at baseline and monthly for 6 months. The study was conducted between January-September 2016. Main outcome measures clinical signs of rejection reflected by renal function decline, assessed by elevated levels of serum creatinine. The mean serum creatinine level was significantly lower in the sixth month than at baseline in esomeprazole group (p 0.004); interestingly there was a continuous decrease of serum creatinine levels in esomeprazole group and nearly constant values in pantoprazole group. There was no significant difference in serum creatinine levels between the two groups. From this study, it could be concluded that esomeprazole may be preferred over pantoprazole in renal transplant recipients because it decreased serum creatinine which is one of the markers of chronic allograft rejection in stable renal transplantation recipients.