مجله علوم پزشکی رازی
سال شانزدهم شماره 9 (پیاپی 66، آذر 1388)

Nephrotoxicity is the most important and the most frequent adverse effect of Aminoglycosides, which restricts its usage despite its availability and effectiveness. It seems that L-carnitine with an inhibitory effect on free radical production and some antioxidant effect, may have a supportive role against the potential renal damage due to ischemia. The recent study was designed to compare the serum ACE and serum and urine NAG activities in patients on L-carnitine and Gentamicin treatment with the control group.

The recent study is a randomized clinical trial conducted on patients admitted in the Orthopedic ward of Hazrat-e-Rasool Akram hospital in 2006. Sixty-four patients were allocated randomly to the case and control groups. The control group received 80 mg of intravenous (IV) Gentamicin, three times a day for 3 days. The case group was under the same treatment plus 1 gram of oral L-carnitine, for 3 days, three times a day. Serum ACE and serum and urine NAG activities were compared within the two groups. Data were analyzed using SPSS V.11.05 software, Paired sample t-test, Independent sample t-test and ANOVA.

Serum and urine NAG activity on the first day showed no significant difference among the two groups, but there were significant differences at the end of the treatment period (4th day). Serum ACE activity in both the case and control groups showed no significant differences prior and after the treatment period.

The results of the recent study showed significant changes in serum and urine NAG activity during the short course of the treatment. These may show early renal tubular injury prior to any BUN and creatinine changes. On the other hand, although urine NAG activity in patients receiving L-carnitine showed an increase on the fourth day of treatment, but the increase is less than the control group. The above findings may support the supportive role of L-carnitine in tubular damages.

Acute appendicitis is a common cause of abdominal pain and it can be difficult to diagnose, especially during the early stages. The role of inflammatory markers in the diagnosis of acute appendicitis has not been clearly defined. The aims of this prospective audit were to define the role of C-reactive protein and the other serum markers of inflammation, total white cell and neutrophil count in the diagnosis of acute appendicitis in adult. Patients and

In a prospective analytic setting, 100 patients with the probable diagnosis of acute appendicitis (Alvarado score ≤5) that had referred to Tabriz Pediatric Hospital during 2007-08 were studied. The CRP, WBC count and neutrophil percentage were checked on admission in all patients and were compared between the patients with and without definite diagnosis of acute appendicitis according to the result of histopathologic study or follow up (as the gold standard methods) via Student t-test, Mann-Whitney U test, Chi-Square test and Fisher’s Exact test.

A total of 52 males and 48 females with the mean age of 20.6±4.1 years were recruited. Fifty four (54%) patients revealed to have definite acute appendicitis. Patients with final diagnosis of acute appendicitis had significantly greater values of inflammatory markers. Elevated CRP had sensitivity (62.7%), specificity (68.3%), positive predictive value (74%) and negative predictive value (56%) which are not enough for diagnosis. Only 2 patients with normal markers had acute appendicitis.

This study showed that despite the elevation of these inflammatory markers in patients with acute appendicitis, mere reliance on laboratory findings in managing the patients with equivocal appendicitis would not make sense. Combination of the clinical suspicion with these laboratory data is recommended. Normal values of all of these markers are very unlikely in pathologically confirmed appendicitis in adult.