ORIGINAL ARTICLE |
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Year : 2016 | Volume
: 32
| Issue : 1 | Page : 1-6 |
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Intravenous L-alanyl-L-glutamine: an adjuvant in the management of immunocompromised patients with invasive fungal rhinosinusitis
Noha M Elsharnouby1, Mohamed M Elsharnouby MD 2, Gamal Elewa1, Mohamed A Elgendy1
1 Department of Anaesthesia and Intensive Care, Faculty of Medicine, Ain Shams University, Cairo, Egypt 2 Department of Otorhinolaryngology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Correspondence Address:
Mohamed M Elsharnouby Department of Otorhinolaryngology, Faculty of Medicine, Ain Shams University, 8 Moktar Elmasry Street, El-Golf Land, Heliopolis, Cairo Egypt
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/1012-5574.175792
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Background
Invasive fungal rhinosinusitis is a potentially fatal infection in immunocompromised patients. Glutamine, a conditionally essential amino acid, is an energy source for rapidly dividing cells, particularly those of the immune system. This randomized, double-blind, placebo-controlled, two-group parallel study was designed to investigate intravenous l-alanyl-l-glutamine as an immune adjuvant in the management of patients with invasive fungal rhinosinusitis.
Patients and methods
Fourteen patients with invasive fungal rhinosinusitis undergoing endoscopic debridement and with postoperative admission to the ICU were included in this study. Group D (n = 7) received the standard protocol therapy and l-alanyl-l-glutamine 0.5 mg/kg/day infusion postoperatively for 10 days; group C (n = 7) received only the standard protocol therapy with the same volume and rate of saline postoperatively for 10 days as well. The primary outcome measure was patient response, either cure or persistence, whereas secondary outcome included length of ICU stay, ICU survival, hospital survival, and complications.
Results
In group D there was significant improvement in response rate as all five patients who survived in group D had a complete cure (100%), whereas in group C among the three patients who survived only one (33%) patient was completely cured. There was significant decrease in length of ICU stay (P = 0.003) and incidence of complications (P = 0.03) in group D compared with group C. The incidence of intracranial extension, renal impairment, and septic shock as well as ICU and hospital survival, was decreased in group D compared with group C but did not reach statistical significance.
Conclusion
Intravenous l-alanyl-l-glutamine 0.5 mg/kg/day infusion postoperatively for 10 days in patients with invasive fungal rhinosinusitis undergoing endoscopic debridement resulted in a better response accompanied with a decrease in ICU length of stay and complication rate. |
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