Is there a protective effect with remote ischemic preconditioning on contrast-induced acute renal injury after coronary angiography in low-risk patients?

Introduction: Contrast-induced acute kidney injury (CIN-AKI) is a serious complication of coronary angiography. Given the weaknesses in the common protective methods used to prevent CIN-AKI, a safe and effective strategy is needed. RIPC has been shown to have a nephroprotective effect. Objectives: We aimed to determine the protective effect of RIPC on CIN-AKI after angiography or percutaneous coronary intervention (PCI) in low-risk patients. Patients and Methods: In our study, 140 low-risk patients who needed angiography or PCI, were assigned to either RIPC or control group. In each group, serum creatinine and urinary neutrophil gelatinaseassociated lipocalin (uNGAL) were measured before the procedure. Serum creatinine was measured daily for 2 days and uNGAL was measured 6 and 24 hours after the procedure. Diagnosis of AKI was, according to the Kidney Disease; Improving Global Outcomes (KDIGO) criteria (2012). Results: The mean age in the remote ischemic preconditioning (RIPC) group was 56.8 ± 11.4 years and 56.3 ± 11.8 years in the control group. We observed no significant difference regarding patient’s characteristic and renal biomarkers at baseline. There was no significant difference in the incidence of AKI (P = 0.116). The uNGAL increased by 36.2% 6-hour after the procedure in patients with AKI, while at the same time, this biomarker increased only by 4.3% in patients without AKI. Conclusion: We concluded that RIPC, with 3 cycles of 5-minute ischemia and 5-minute reperfusion, did not decrease CIN-AKI or altering renal biomarkers course in low-risk patients undergoing coronary angiography or PCI. Additionally, uNGAL, seems to be an appropriate biomarker for early diagnosis of CIN-AKI, 6 hours after contrast media exposure

The Efficacy of Famotidine in Improvement of Outcomes in Hospitalized COVID-19 Patients: A Phase III Randomized Clinical Trial

Background & Aims:  As the first randomized clinical trial, this study evaluated the effect of Famotidine on the improvement of outcomes of hospitalized patients with COVID-19. Materials & Methods: This phase III randomized clinical trial which was designed with two parallel arms, is a placebo-controlled, single-blind, and concealed allocation study, and recruited 20 patients (10 of them received Famotidine as treatment group and 10 received Placebo as control group). Oral Famotidine 160 mg four times a day was given to the COVID-19 patients until the discharge day or for a maximum of 14 days. Patients’ temperature, respiration rate, oxygen saturation, lung infiltration, lactate dehydrogenase (LDH) level, and complete blood count (CBC) were measured at the baseline (before the intervention) and on day 14 after the intervention or on discharge day. Length of stay in the hospital and length of stay in the ICU were also measured as secondary outcomes of the study. Results: The results showed a significant decrease in LDH (P=0.01), mean WBC (P=0.04) and length of stay (P=0.04) of patients with COVID-19 in the group treated with Famotidine compared to the control group. There was also a significant increase in oxygen saturation (P=0.01) in the group treated with Famotidine compared to the control group. Cough improvement was also higher in the oral Famotidine group compared to the control group (P=0.02). Conclusion: This was the first clinical trial on the effect of Famotidine on the improvement of hospitalized COVID-19 patients, which indicated that high-dose Famotidine improves patients’ clinical signs and reduces the severity of the disease and duration of hospitalization

A comparison of the Effects of Low and High Doses of Corticosteroids on Recovery of the Patients with Covid-19

Background & Aims: SARS-CoV-2 is a new coronavirus type that first appeared in Wuhan, China, and caused a pandemic of respiratory diseases from the end of 2019. Severe infections of this virus can cause incorrect adjustments of cytokine and chemokine responses, which ultimately causes damage to the lung tissue. Corticosteroids are a class of drugs that reduce inflammation and immune system activities in the body. For this reason, many doctors and researchers thought of using corticosteroid treatments to control the cytokine storm. Materials & Methods: In this retrospective descriptive cross-sectional study, the files of Covid-19 patients who were admitted to Shahid Mohammadi Hospital, Bandar Abbas, Iran, were examined. On the basis of the severity, the patients were grouped into two groups of moderate and severe patients. Patients in each group were then sub-categorized into high dose and low dose, according to the received dose of corticosteroids. Then we investigated the effect of different doses of corticosteroids on the course of recovery of Covid-19 cases. Results: In the severe group, the patients who received high-dose of corticosteroids had a higher mortality rate as compared to the low-dose group. In both the severe and moderate groups, the LDH level of the patients who received low doses of corticosteroids at the time of discharge were significantly less compared to those who received high doses. In the moderate group, the percentage of lymphocytes in the low-dose corticosteroid group was considerably higher compared to the high-dose corticosteroid group at the time of discharge. Conclusion: According to the results, in the case of patients with moderate clinical severity, a low dose of corticosteroids improved the disease, but in the case of patients with severe clinical severity, the results were contradictory, which may be caused by interference of other factors such as underlying diseases, the severity of the illness, etc. in the severe group