Introduction: COPD is a common preventable and treatable disease characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. Exacerbations and co-morbidities contribute to overall severity in individual patients. Oxidative stress represents one of the key pathogenic mechanisms in the development of COPD. MDA increased production of interleukin (IL)-8 and tumor necrosis factor-a (TNF-a), both attract inflammatory cells and increase oxidant production by these cells. Attenuation of oxidative stress would be expected to result in reduced pulmonary damage and a decrease in local infections, contributing to attenuation of the progression of COPD.Aim of the study: To compare the effects of high dose NAC versus regular dose on inflammatory response, oxidative stress, pulmonary functions and clinical outcome in patients with COPD acute exacerbations.Patients and methods: This randomized controlled study included 45 COPD acute exacerbation patients. All patients received standard COPD exacerbation treatment and were randomly assigned to either; control group (A) with no add on therapy, low dose group (B) received NAC 200 mg sachets TID, high dose group (C) received NAC 400 mg sachets TID for 10 days. IL8, malondialdehyde (MDA), arterial blood gases and spirometric parameters were evaluated at baseline and after treatment.Results: IL8 levels significantly decreased (p < 0.001) in group C (3.47 ± 0.81), versus Group B (5.57 ± 1.66) and group A (8.33 ± 1.69). MDA levels significantly decreased (p < 0.001) in group C and group B over time. Pulmonary functions (FEV 1 , FVC and FEV 1 /FVC) and partial pressure of oxygen PaO 2 significantly improved (p < 0.001) in group C versus group B and A over time. The P/F ratio significantly improved (p < 0.001) in group C versus group A. No side effects were reported with NAC administration.Conclusion: High dose NAC improves clinical outcome of COPD exacerbation patients by ameliorating oxidative stress and inflammatory response thereby improving lung spirometry and pulmonary oxygenation.

Background. Major depressive disorder (MDD) affects approximately 10% of the world population and leads to significant disability. The current study aimed to evaluate the impact of Omega3 polyunsaturated fatty acids (PUFAs) administration on the clinical outcome and inflammatory markers of patients with depression. Patients and Methods. A prospective, randomized controlled study conducted at the outpatient clinics of Alzahraa University Hospital, Cairo, Egypt on patients diagnosed with depression according to a strict inclusion and exclusion criteria. Forty-two patients were randomly assigned to either; Group1; (intervention n=21); received the prescribed antidepressant + omega3 (2100mg) for 8 weeks, or Group 2; (control, n=21); received the prescribed antidepressant only for 8 weeks. Baseline evaluation and 8-week assessment included; patient demographic data collection, history taking and clinical assessment of Diagnostic statistical manual for mental disorders, fifth edition (DSM-5) criteria & Hamilton rating scale for depression (HAM-D score). Laboratory assessment included tumor necrosis factor-α (TNF-α) levels. Patients were followed up regularly every week for 8 weeks for the occurrence of side effects due to antidepressants/ Omega 3 and compliance with medications. Results. The 2 groups were comparable at baseline. The test group showed a significant improvement in the HAM-D score & a reduction in TNF-α levels from baseline values and versus the control. There was no significant difference in the reported side effects between the 2 groups. Conclusion. Omega -3 PUFAs administration at a dose of 2100 mg for 8 weeks, improved depression symptoms and reduced inflammatory markers & was well tolerated.