Background/aim: Cisplatin-induced nephrotoxicity in large proportion of patients. The aim of this work is to clarify the effect of combination of sildenafil and gemfibrozil on cisplatin-induced nephrotoxicity either before or after cisplatin treatment and determination of nephrotoxicity predictors among the measured tissue markers.Methods: Thirty two adult male albino rats were divided into four equal groups (G) GI control, GII received cisplatin, GIII received sildenafil and gemfibrozil before cisplatin, GIV received sildenafil and gemfibrozil after cisplatin. Creatinine and urea were measured and animals were sacrificed and kidney was taken for histopathology. The following tissue markers were measured, heme oxygenase-1 (HO-1) activity, reduced glutathione, quantitative (real-time polymerase chain reaction) RT-PCR for gene expression of tumor necrosis factor alpha (TNF-α) and endothelial nitric oxide synthase (ENOS) level.Results: GII developed AKI demonstrated by significantly high urea and creatinine and severe diffuse (80–90%) tubular necrosis. TNF-α was highly and significantly elevated while the rest of tissue markers were significantly reduced in GI1 compared to other groups. GIV showed better results compared to GIII. There was a significant positive correlation between creatinine and TNF-α when combining GI and GII while there were significant negative correlation between creatinine and other tissue markers in same groups. Linear regression analysis demonstrated that HO-1 was the independent predictor of AKI demonstrated by elevated creatinine among GI and GII.Conclusions: Combination of sildenafil and gemfibrozil can be used in treatment of cisplatin-induced nephrotoxicity. HO-1 is a promising target for prevention and/or treatment of cisplatin-induced nephrotoxicity.

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Background: Virga and colleagues derived a glomerular filtration rate (GFR) equation which demonstrated a superior performance over Cockcroft-Gault (C-G) and modified diet in renal disease-isotope dilution mass spectrometry (MDRD-IDMS) formulas in chronic kidney disease (CKD) patients. Aim: To validate the performance of the Virga equation on 103 renal transplant patients. Methods: We compared the performances of the MDRD-IDMS, C-G and Virga equations using inulin clearance as a reference test. Error, accuracy, relative accuracy, precision, scatter, and coefficient of variance of each equation were tested. Results: The mean absolute percentage error in estimated GFR by the new equation was 39.8 ± 36.34% (mean ± SD). Relative accuracy at 10, 30 and 50% range were 18.44, 48.54 and 73.78%, respectively. It has a bias of 0.09 ± 0.169 and a precision of 19.69. Inulin clearance (GFR) in stages 1–4 were 106.19 ± 14.11, 71.17 ± 7, 42.37 ± 8.40 and 22.92 ± 3.48 ml/min/1.73 m², respectively. Comparative statistics in the overall population and in patients with transplant CKD stage 3T showed that the MDRD-IDMS equation had better accuracy. The performance of MDRD-IDMS over the Virga equation was clearly superior for males. In patients with CKD stage 2T, the Virga equation showed superiority over MDRD-IDMS. In the overall and subpopulations, the Virga equation performed better than the C-G equation. Conclusion: Among renal transplant patients, the results suggest that the best GFR estimate is probably obtained using the MDRD-IDMS equation in moderate kidney failure whilst the Virga formula was superior to MDRD-IDMS for patients with mild kidney failure. As in untransplanted patients, estimating GFR with the MDRD-IDMS equation is not advisable in the range of normal renal function because of its known underestimation of renal function.

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Many challenges had faced medical schools worldwide after the beginning of the COVID-19 pandemic. From these challenges, training of the next generation of physicians and academic staff. Adoption of online education and training with getting the benefit of technology had introduced. Egypt has another special challenge, which is the adoption of a new undergraduate competency-based program since September 2018. Hence, there is a necessity to complete the ongoing capacity building of the academic staff regarding the development of all domains of medical education. Here is a case report of interactive training assessment online courses, which proved promising. Although there is fear about the rapid, unexpected transformation, in fact, it may lead to the emergence of a new model for teaching and learning, which is a mixture between the regular and electronic methods.