OBJECTIVES:Bacterial vaginosis (BV) and abnormal vaginal flora (AVF) are associated with maternal discomfort and preterm labour. Oral metronidazole and clindamycin are acceptable treatments during pregnancy for their eradication; however, direct comparative data between them during pregnancy are lacking. We compared the efficacy of metronidazole and clindamycin in eradicating BV/AVF among women at high risk for preterm labour. METHODS:In this multicentre randomized controlled trial, pregnant women at high risk for preterm labour were screened for BV/AVF using the Nugent criteria on vaginal smears. BV/AVF were defined as Nugent scores ≥4. Women diagnosed with BV/AVF were randomly allocated to receive either oral metronidazole 500 mg twice daily or oral clindamycin 300 mg twice daily for 1 week. After treatment, a repeat vaginal smear was obtained. If BV/AVF persisted, the alternative treatment was administered for an additional week, after which eradication was reassessed by vaginal smear. The primary outcome was the rate of BV/AVF eradication after first-line treatment. RESULTS:Of the 914 women screened, 170 (19%) tested positive for BV/AVF, and 82 and 84 women were analysed in the metronidazole and clindamycin groups, respectively. There were no significant differences between the metronidazole and clindamycin groups in the rate of BV/AVF eradication after first-line treatment (48 [60%] vs. 47 [56%]), total eradication rate after second-line treatment (63 [77%] vs. 63 [79%]), or the rate of preterm delivery/late miscarriage (30% vs. 24%), respectively. Among women who received metronidazole or clindamycin (as first- or second-line treatment), adverse effects were reported in 36 of 115 (31%) and 31 of 117 (26%), respectively, and treatment discontinuation because of adverse effects occurred in only 3% and 5%, respectively (p >0.05 for all comparisons). CONCLUSIONS:In pregnant women at high risk for preterm labour, oral metronidazole and clindamycin for the treatment of BV/AVF demonstrated similar efficacy, adverse effect profiles, and preterm delivery rates.

Objective: During pregnancy, vulvovaginal infections (VVIs), including abnormal vaginal flora (AVF), bacterial vaginosis (BV), and vulvovaginal candidiasis (VVC), are associated with serious complications and discomfort. We aimed to elucidate the effectiveness of oral probiotics in secondary prevention of VVIs in pregnant women. Study design: A multicenter prospective randomized, double-blind, placebo-controlled trial was conducted at three medical centers between 2016 and 2021. Women who complained of vaginal symptoms with positive smear for AVF/BV and/or candida were treated with antibiotics or an antimycotic agent, respectively. After confirmation of VVI eradiation by repeated vaginal smear, the women were divided into a research group, receiving two capsules/day of oral probiotic formula containing Bifidobacterium bifidum, Bifidobacterium lactis, Lactobacillus (L.) acidophilus, L. paracasei, L. rhamnosus and Streptococcus thermophilus (>6 × 109 CFU/capsule), and a control group, receiving a placebo (two capsules/day) until delivery. At least once a month or following complaints, a vaginal smear was taken to assess vaginal microbiota. If VVIs were found, they were treated with antibiotics/antimycotics, and eradication was assessed by a repeated vaginal smear. Lactobacilli vaginal colonization, including the specific strains from the probiotic capsules, were detected using the matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI TOF-MS). The primary outcome was the rate of women who developed VVI during the study period until delivery. Results: Twenty-three and twenty-four women were analyzed in the probiotic and placebo cohorts, respectively. There was no difference in the rate of any VVI between the probiotic and placebo cohorts (16 (67%) versus 11 (48%), respectively; p = 0.19), time until first infection or pregnancy outcomes. The lactobacilli strains that colonized the vagina were similar at baseline and following probiotic or placebo administration. No woman was detected with vaginal colonization of the strains from the capsule, although the probiotics were taken for about 4 months. Conclusions: The oral probiotic product tested in this study did not reduce the recurrence rate of VVIs in pregnant women following eradication.

Apixaban, a direct oral anticoagulant is administered for stroke prevention in atrial fibrillation patients. Dosing adjustment is guided by renal function, age, and body weight. However, no data exist on its pharmacokinetics in patients with a body mass index (BMI) ≥ 35 kg/m2. The aim was to investigate the effects of BMI ≥ 35 kg/m2 on trough plasma concentrations of apixaban in patients with atrial fibrillation. This prospective study compared steady-state trough concentrations of apixaban in patients with a BMI ≥ 35 kg/m2 and patients with a BMI < 35 kg/m2. Sixty patients were included. In patients receiving 5 mg apixaban twice daily, the median trough plasma concentration was 29

BackgroundThe current study attempted to replicate the original findings regarding the effects of power posing on testosterone and cortisol levels, risk-taking behavior, and perceived power. We further extended the investigation by testing the effect of power posing on estradiol and progesterone levels.MethodsA sample of 92 young adults (30 males; 32 females taking oral contraceptives; and 30 females not taking oral contraceptives who were in their midluteal phase) were randomly assigned to high-power-pose or low-power-pose conditions and asked about their feelings of power. They completed a risk-taking task, and their neuroendocrine levels were measured both at baseline and following the power manipulation.ResultsPower posing was not found to replicate the original results regarding effects on testosterone levels or feelings of power; however, our findings partially supported the original results regarding effects on cortisol levels and risk-taking. Among high-power posers, a decrease in cortisol levels was associated with risk tolerance. Power posing was not found to influence progesterone levels. However, among females taking oral contraceptives, high-power posing increased estradiol levels.ConclusionsThese preliminary findings suggest that estradiol is influenced by short-term exposure to social cues under specific hormonal profiles.

BACKGROUND/OBJECTIVE:This study aimed to investigate the efficacy of oral probiotic supplementation in preventing vulvovaginal infections (VVIs) in pregnant women, specifically focusing on abnormal vaginal flora (AVF), bacterial vaginosis (BV), and vulvovaginal candidiasis (VVC). METHODS:A multicenter-prospective-randomized, double-blind, placebo-controlled trial was conducted during 2016-2019. Women with normal vaginal flora (Nugent score < 4 and no candida) were divided into a research group, receiving 2 capsules/day of oral probiotic formula containing Bifidobacterium bifidum, Bifidobacterium lactis, Lactobacillus acidophilus, Lacticaseibacillus paracasei, Lacticaseibacillus rhamnosus, and Streptococcus thermophilus, or a control group, receiving a placebo until delivery. Once a month and following complaints, a vaginal smear was taken to assess vaginal flora. Vaginal colonization with the specific lactobacilli from the probiotic capsules was detected using the matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. The primary outcome was the rate of women who developed VVI. RESULTS:Forty-nine and fifty-one women were analyzed in the probiotic and placebo cohorts, respectively. There was no difference in the rate of VVI between probiotic and placebo groups (14 (29%) versus 14 (27%), respectively; p = 0.80). No woman had vaginal colonization with lactobacilli from the probiotic capsule. CONCLUSIONS:The tested oral probiotic product did not reduce the rate of VVI in pregnant women with normal vaginal flora.

Background Sepsis is a life-threatening condition that impacts 49 million people annually and causes 11 million deaths worldwide. Surviving bloodstream infections (BSIs) depends on the rapid administration of effective antimicrobial treatment, underscoring a need for rapid antimicrobial susceptibility testing (AST). Aim To evaluate the performance of Quantamatrix's dRAST v2.5 system (Seoul South Korea) for AST directly from positive blood cultures as compared to the Disk-Diffusion (DD) and VITEK 2 methods. Methods The study included 191 positive blood cultures from clinical samples and spiked blood culture bottles. Following Gram staining and species-level identification, AST was performed by VITEK 2 and standard DD methods using CLSI (2021) interpretation. Results dRAST demonstrated very good AST performance for a Gram-negative isolate, and good performance for Gram-positive isolates, meeting CLSI criteria for the acceptance of a new method. Antimicrobials that were not considered verified compared to VITEK 2 and DD were cefazolin, ceftazidime, meropenem, and trimethoprim/sulfamethoxazole for Gram-negatives and clindamycin, erythromycin, penicillin, and oxacillin for Gram-positives. dRAST ESBL detection results were strongly correlated with the ESBL phenotypes obtained with other methods. Additional resistance mechanisms were in concordance with traditional tests. Conclusions dRAST demonstrated good AST performance, meeting CLSI criteria for most relevant antibiotics. dRAST was associated with a significant reduction in time-to-results, labor, and the subjectivity of result analyses, making it a valuable addition to efforts supporting the treatment of patients with bacteremia.AST (antimicrobial susceptibility test), blood culture, dRAST, rapid methods, sepsis, turnaround time (TAT).

Since January 2022 in Israel, high-risk populations with underlying health conditions were advised to receive a fourth dose of the BNT162b2 vaccine (Pfizer-BioNTech) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We monitored vaccine-induced immunity among oncology patients undergoing systemic anti-cancer therapy before and after the 4th-BNT162b2-dose. Three groups of patients were included in the study: those who received 3rd-BNT162b2-dose and had no breakthrough infection (control), those who received 3rd-BNT162b2-dose and had the breakthrough infection, and those who received the 4th-BNT162b2-dose and had no breakthrough infection. Anti-SARS-CoV-2 immunoglobulin-G (IgG) levels of the control group exhibited a rapid decrease over time, whereas IgG titers of patients with breakthrough-infections or patients vaccinated with the 4th-BNT162b2-dose were considerably elevated, consistent with the capacity of the second booster to induce anti-SARS-CoV-2 IgG levels. Additionally, oncology patients' humoral immune response was significantly greater after breakthrough-infection than in response to the 4th dose of BNT162b2.

Procrastination is prevalent among students, as well as the general population, and has negative impacts on various domains. Several models aimed to understand factors associated with procrastination, with some suggesting that anxiety plays a significant role. Biological factors have been shown to contribute to individual differences in procrastination; however, little attention has been paid to the role of neuroendocrine factors on procrastination. The primary question addressed in the present study is whether neuroendocrine factors (testosterone and cortisol) moderate the association between state anxiety and procrastination. Eighty-eight participants (29 men; 32 women using oral contraceptives; and 27 women not using oral contraceptives and in their luteal phase) were tested for biomarkers and completed questionnaires. Results show that state anxiety is positively correlated with procrastination. Furthermore, testosterone levels moderate the correlation between state anxiety and procrastination. As testosterone levels drop, the positive correlation between state anxiety and procrastination becomes stronger, but when testosterone levels are higher, no significant association between state anxiety and procrastination is found. Cortisol levels do not moderate the relationship between state anxiety and procrastination. The role of neuroendocrine factors for psychological outcomes is discussed.

The extensive and improper use of antibiotics has led to a dramatic increase in the frequency of antibiotic resistance among human pathogens, complicating infectious disease treatments. In this work, a method for rapid antimicrobial susceptibility testing (AST) is presented using microstructured silicon diffraction gratings integrated into prototype devices, which enhance bacteria-surface interactions and promote bacterial colonization. The silicon microstructures act also as optical sensors for monitoring bacterial growth upon exposure to antibiotics in a real-time and label-free manner via intensity-based phase-shift reflectometric interference spectroscopic measurements (iPRISM). Rapid AST using clinical isolates of Escherichia coli (E. coli) from urine is established and the assay is applied directly on unprocessed urine samples from urinary tract infection patients. When coupled with a machine learning algorithm trained on clinical samples, the iPRISM AST is able to predict the resistance or susceptibility of a new clinical sample with an Area Under the Receiver Operating Characteristic curve (AUC) of ∼ 0.85 in 1 h, and AUC > 0.9 in 90 min, when compared to state-of-the-art automated AST methods used in the clinic while being an order of magnitude faster.

Background Chronic kidney disease patients are at increased risk of mortality with cardiovascular diseases and infections as the two leading causes of death for end-stage kidney disease treated with hemodialysis (HD). Mortality from bacterial infections in HD patients is estimated to be 100-1000 times higher than in the healthy population. Methods We comprehensively characterized highly pure circulating neutrophils from HD and healthy donors. Results Protein levels and transcriptome of HD patients' neutrophils indicated massive neutrophil degranulation with a dramatic reduction in reactive oxygen species (ROS) production during an oxidative burst and defective oxidative cellular signaling. Moreover, HD neutrophils exhibit severely impaired ability to generate extracellular NET formation (NETosis) in NADPH oxidase-dependent or independent pathways, reflecting their loss of capacity to kill extracellular bacteria. Ectopic hydrogen peroxidase (H2O2) or recombinant human SOD-1 (rSOD-1) partly restores and improves the extent of HD dysfunctional neutrophil NET formation. Conclusions Our report is one of the first singular examples of severe and chronic impairment of NET formation leading to substantial clinical susceptibility to bacteremia that most likely results from the metabolic and environmental milieu typical to HD patients and not by common human genetic deficiencies. In this manner, aberrant gene expression and differential exocytosis of distinct granule populations could reflect the chronic defect in neutrophil functionality and their diminished ability to induce NETosis. Therefore, our findings suggest that targeting NETosis in HD patients may reduce infections, minimize their severity, and decrease the mortality rate from infections in this patient population.

Dear Editor On July 29, 2021, the Israeli Ministry of Health approved the third anti-Coronavirus disease 2019(COVID-19) vaccination (3rd-BNT162b2-booster-dose), leading to a sharp daily drop in diagnosed positive COVID-19 cases and mortality rates in Israel [1]. The booster dose increased severe acute respiratory syndrome coronavirus-2(SARS-CoV-2) neutralization efficiency approximately a hundred-fold compared to individuals receiving only the second dose, providing significant protection against infection [2]. Due to their immunocompromised condition, cancer patients may be more susceptible and generally more vulnerable to infections [3]. Indeed, due to the chronic weakening of their immune system, cancer patients are at higher risk of developing severe clinical outcomes from SARS-CoV-2 infection and are associated with an increased risk of morbidity and mortality [3]. Cancer patients treated with anticancer drugs or undergoing major surgery have double the risk of developing a severe illness, hospitalization, and death due to COVID19 [3, 4]. Early studies on cancer patients in Israel who received the second BNT162b-booster-dose indicated a noticeable lag in antibody production compared to controls, despite the comparable seroconversion rate tested four weeks after administration [5]. No adverse effects or interaction between immunoglobulin G (IgG) levels and active anticancer therapies, such as chemotherapy or radiation, were reported [4]. Recently, a study evaluating immune response 4-weeks after administration by cancer patients receiving the 3rd-BNT162b2-boosterdose indicated an efficient anti-COVID-19 immunity when neither gender nor chemotherapy status was associated

During pregnancy, abnormal vaginal flora (AVF), bacterial vaginosis (BV), and vulvovaginal candidiasis (VVC) are associated with serious complications and discomfort. We aimed to elucidate the effectiveness of oral probiotics in secondary prevention of BV/AVF and VVC in pregnant women. A multicenter prospective randomized, double blind, placebo controlled trial was conducted at three medical centers between 2016 and 2021. Women who complained on vaginal symptoms with positive smear for AVF/BV or candida were treated with antibiotics or antimycotic agent, respectively. Following normal vaginal flora in repeated vaginal smear, women were divided into a research group, receiving 2 capsules/day of oral probiotic formula containing Bifidobacteriumbifidum, Bifidobacteriumlactis, Lactobacillus (L) acidophilus, L. paracasei, L. rhamnosus and Streptococcus thermophilus ( >6X109/capsule), and a control group, receiving a placebo (2 capsules/day) until delivery. At least once a month or following complaints a vaginal smear was taken to assess vaginal flora. If positive, BV/AVF or VVC were treated with antibiotics or antimycotic agent, respectively. Eradication was assessed by a repeated vaginal smear. Vaginal colonization with the specific lactobacilli from the probiotic capsules was detected using the matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI TOF-MS).The primary outcome was the rate of women who developed any vaginal infection (BV/AVF/VVC) during the study period until delivery. Twenty-three and 24 women were analyzed in the probiotic and placebo cohorts, respectively. Baseline characteristics are presented in table 1. There was no difference in the rate of any vulvovaginal infection between the probiotic and placebo cohorts (11 (48%) versus 16 (67%), respectively; P=0.19; table 2). No woman was detected with vaginal colonization of the lactobacilli from the capsule. Oral probiotic product tested in this study did not colonized in the vagina and did not reduce the rate of repeated vulvovaginal infection in pregnant women.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Inflammatory states are associated with anemia of chronic disease and acute infection. Hepcidin, a regulator of iron metabolism, is involved in iron pathophysiology during inflammation. We investigated biochemical characteristics in children with anemia from different causes. Four patient groups (n = 38; mean age: 12.44 ± 4.35 years) were studied: (1) inflammatory bowel disease (IBD, 10 patients); (2) iron deficiency anemia (IDA, 12); (3) celiac disease (CD, 8); (4) acute infection (AI, 8). Laboratory measurements were evaluated at diagnosis: blood count, serum iron, transferrin, ferritin, vitamin B12, folic acid, CRP, erythropoietin, hepcidin and soluble transferrin receptor (sTfR). IDA patients had the lowest Hgb (6.9 ± 1.7 g/dL), MCV (63.2 ± 7.2 fL), iron (16.8 ± 13.5 µg/dL), ferritin (4.5 ± 4.5 ng/mL) and hepcidin (3.1 ± 0.8 ng/mL) values, and the highest transferrin and sTfR values. AI patients had the highest ferritin (156.2 ± 124.5 ng/mL), CRP (144.6 ± 94 mg/L) and hepcidin (74.67 ± 12.3 ng/ml) values. Overall, hepcidin levels correlated with CRP and with ferritin (r = 0.83 and 0.85, respectively). Elucidating specific etiology-related biochemical profiles in pediatric patients with anemia from different causes using a combination of laboratory biomarkers, including hepcidin, can help physicians treat the anemia.

Abstract Apixaban, a direct oral anticoagulant (DOAC) is administered in a fixed-dose regimen for atrial fibrillation patients. Dosage adjustment is based on renal function, age, and body weight (less than 60 kg). No data exist on the pharmacokinetics of apixaban in patients with body mass index (BMI) ≥ 35 Kg/m2, nor about treatment efficacy and safety in this population. Aims: To reveal whether BMI ≥ 35 kg/m2 affects trough plasma concentrations of apixaban in patients with atrial fibrillation and whether dose adjustment is required in this population. Methods: This prospective study compared steady state trough concentrations of apixaban in patients with BMI ≥ 35 kg/m2 and patients with BMI < 35 kg/m2. Results: Sixty patients were included in the study. In patients on 5 mg twice daily dose, the median trough plasma concentration was 29% lower in the high BMI group (BMI ≥ 35 kg/m2) compared with the lower BMI group (BMI < 35 kg/m2) (148.9 ng/ml, IQR: 94.5-205.6, compared to 209.1 ng/ml IQR: 167- 266.8 ng/ml respectively). P = 0.044. However, median trough concentrations were within the manufactures predicted steady-state apixaban exposure range. A similar trend was found among patients treated with 2.5 mg apixaban twice daily, but the results did not reach statistical significance. According to multivariate analysis performed, no correlation was found between BMI values (neither BMI ≥ 35 kg/m2 nor BMI < 35 kg/m2) and trough concentrations. Conclusion: Lower apixaban trough concentration was observed in patients with BMI ≥ 35 kg/m2 but remains within the steady-state apixaban exposure range found to be effective according to manufacturer data.

Background Patients with severe coronavirus disease-2019 (COVID-19) are susceptible to superimposed infections. Objectives To describe COVID-19 patients who presented with complications due to Candida bloodstream co-infection (candidemia) and their outcome in a single center in northern Israel (Emek Medical Center) during the second outbreak of COVID-19 in Israel (15 June 2020 to 20 September 2020). Methods A retrospective study of COVID-19 patients presenting with candidemia was conducted, including clinical and laboratory data. The incidence of candidemia among hospitalized COVID-19 patients was compared to a historical cohort of non-COVID-19 controls. Results Three COVID-19 patients complicated with candidemia were documented. All three patients died shortly after the detection of candidemia. Three different Candida sp. were isolated from the blood cultures: C. albicans, C. parapsilosis, and C. glabrata. The incidence of candidemia among COVID-19 patients was 0.679 episodes per 1000 hospital days. Conclusions Our small sample suggests a much higher incidence of candidemia among COVID-19 patients compared to a historical cohort of non-COVID-19 controls. All clinicians treating COVID-19 patients in GICU should be aware of this complication.

Patients with severe coronavirus disease-2019 (COVID-19) are susceptible to superimposed infections.To describe COVID-19 patients who presented with complications due to Candida bloodstream co-infection (candidemia) and their outcome in a single center in northern Israel (Emek Medical Center) during the second outbreak of COVID-19 in Israel (15 June 2020 to 20 September 2020).A retrospective study of COVID-19 patients presenting with candidemia was conducted, including clinical and laboratory data. The incidence of candidemia among hospitalized COVID-19 patients was compared to a historical cohort of non-COVID-19 controls.Three COVID-19 patients complicated with candidemia were documented. All three patients died shortly after the detection of candidemia. Three different Candida sp. were isolated from the blood cultures: C. albicans, C. parapsilosis, and C. glabrata. The incidence of candidemia among COVID-19 patients was 0.679 episodes per 1000 hospital days.Our small sample suggests a much higher incidence of candidemia among COVID-19 patients compared to a historical cohort of non-COVID-19 controls. All clinicians treating COVID-19 patients in GICU should be aware of this complication.

Background Otogenic cerebral sinus vein thrombosis (CSVT) is a rare but severe complication of otitis media in children. To date, the role of prothrombotic evaluation is still controversial. Objectives To report the clinical manifestations, prothrombotic evaluation, and current management of CSVT. Methods We performed a retrospective study of nine pediatric patients with otogenic CSVT who underwent prothrombotic evaluation between 2008 and 2018. Results Prominent clinical features included persistent otorrhea (88.8%), signs of mastoiditis (88.8%), high fever ≥ 38.3°C (100%), a classic spiking fever pattern (55.5%), and neurological signs (55.5%). A subperiosteal abscess (66.6%) was the most common otitis media complication associated with mastoiditis and CSVT. No microorganism was identified in 55.5% of patients. Cultures collected from ear secretions had a low yield (6.25%). However, PCR assays had a high detection rate (100%; n=3). The prothrombotic evaluation demonstrated an abnormal LAC-dRVVT ratio (6/9), elevated Factor VIII (5/8) (and a combination of both in four patients), antiphospholipid antibodies (2/8), and high homocysteine levels (1/5).The surgical intervention of choice included one-sided mastoidectomy with myringotomy and ventilation-tube placement on the affected side (77.7%). There were no mortalities and no long-term sequela except chronic otitis media (22.2%). Conclusions Our findings demonstrate good outcomes for otogenic CSVT treatment with intravenous antibiotics, anticoagulation, and conservative surgical intervention, which supports the current trend in management. The prothrombotic evaluation revealed transient inflammation-related risk factors but did not alter management. Further prospective multicenter studies are needed to determine its relevance.

The identification of SARS-CoV-2 variants across the globe and their implications on the outspread of the pandemic, infection potential and resistance to vaccination, requires modification of the current diagnostic methods to map out viral mutations rapidly and reliably. Here, we demonstrate that integrating DNA barcoding technology, sample pooling and Next Generation Sequencing (NGS) provide an applicable solution for large-population viral screening combined with specific variant analysis. Our solution allows high throughput testing by barcoding each sample, followed by pooling of test samples using a multi-step procedure. First, patient-specific barcodes are added to the primers used in a one-step RT-PCR reaction, amplifying three different viral genes and one human housekeeping gene (as internal control). Then, samples are pooled, purified and finally, the generated sequences are read using an Illumina NGS system to identify the positive samples with a sensitivity of 82.5% and a specificity of 97.3%. Using this solution, we were able to identify six known and one unknown SARS-CoV-2 variants in a screen of 960 samples out of which 258 (27%) were positive for the virus. Thus, our diagnostic solution integrates the benefits of large population and epidemiological screening together with sensitive and specific identification of positive samples including variant analysis at a single nucleotide resolution.

Background Renal injury in transfusion dependent β thalassemia patients (TDT) has been attributed to iron overload, chronic anemia and iron-chelation therapy (ICT) toxicity. We studied renal function in TDT patients treated with two different ICT regimes. Patients and methods We studied 36 TDT patients: 26 received deferasirox (DFX) and 10 were treated with deferoxamine (DFO) +/− deferiprone (DFP). Results Increased uNAG was found in 30% of the DFX group vs. 10% of the DFO+/−DFP group, the mean uNAG level in the DFX group was significantly higher than in the DFO+/−DFP group, ( P < 0.05). A moderate negative correlation was found between uNAG levels and mean serum ferritin for the prior 10 years ( P = 0.03), more pronounced for the DFO+/−DFP group. Twenty nine patients had had their renal function evaluated 10 years earlier; eGFR significantly declined in patients switched to DFX ( P = 0.0093) but not in patients who continued DFO+/−DFP. Conclusions A high prevalence of renal tubular damage was observed in our TDT patients, particularly those treated with DFX; uNAG was negatively associated with mean 10-year serum ferritin, suggesting ICT’s involvement in tubular injury. A significant decline in eGFR compared to a decade earlier was observed only in patients currently treated with DFX. Strict follow-up of renal function in TDT patients is warranted.