RESUMEN

INTRODUCTION: The most risk group with high rate of infection of viral hepatitis C represents the former drug abusers (IDUs). OBJECTIVES: The objectives of the clinical study were to assess the sustained virological response (SVR) in the group of former IDUs with chronic hepatitis C (CHC) treated with pegylated interferon-α and ribavirin. PATIENTS AND METHODS: Of 293 previously untreated (naive) former IDUs with CHC who have started treatment, we assessed 239 (69 women, 170 men) with an average age of 27 years who completed treatment and received a follow-up examination after 24 weeks. Prior to therapy abstinence to drug abuse 6 and more months has been required. The CHC has been diagnostics by the standard virological diagnostic tests, increased activity of aminotranferases (ALT) and histology of liver biopsy. Patients were treated with combined immunomodulatory therapy in the standard duration and standard regimen. SVR was considered if qualitative test HCV RNA was negative 24 weeks after the completion of the treatment. RESULTS: End-of-treatment virological response was in 224/94 % patients. Overall SVR rate was 95 %, 227 subjects had negative HCV RNA and only 12 patients no response. During treatment there was a statistically significant decrease in ALT. Treatment was accompanied by the expected side effects. CONCLUSION: Young age, short duration of HCV infection, high prevalence of genotype 3 and low grade of liver fibrosis in majority of patients and good adherence of patients to treatment were crucial predictive factors resulting in high SVR.

Asunto(s)

Antivirales/administración & dosificación , Hepacivirus/aislamiento & purificación , Hepatitis C Crónica/tratamiento farmacológico , Factores Inmunológicos/uso terapéutico , Interferón-alfa/administración & dosificación , Polietilenglicoles/administración & dosificación , Ribavirina/administración & dosificación , Abuso de Sustancias por Vía Intravenosa/complicaciones , Adolescente , Adulto , Anticuerpos Antivirales/sangre , Quimioterapia Combinada , Femenino , Hepatitis C Crónica/complicaciones , Hepatitis C Crónica/virología , Humanos , Masculino , Persona de Mediana Edad , ARN Viral/análisis , Proteínas Recombinantes/administración & dosificación , Adulto Joven

RESUMEN

INTRODUCTION: Virus of hepatitis C (HCV) is the leading cause of chronic liver disease, including cirrhosis and cancer, and the most common indication for liver transplantation. In industrialised countries, injecting drug use is currently the most important risk factor for infection with hepatitis C, resulting in high prevalence of hepatitis C among injecting drug users (IDUs). The aim of the study was to assess the seroprevalence of HCV infection and distribution of genotypes among IDUs in the years 2004-2008. PROBANDS AND METHODS: A total number of 846 probands, both sexes (590 males and 256 females) with mean age from 24 to 29 years were investigated in the years 2004-2008. Standard virological tests were performed. RESULTS: The seroprevalence of anti-HCV positivity during the years 2004-2008 were in range 34-78% and positivity of HCV RNA assessed by PCR method were in range 17-71%. The genotypes distribution was in favour of genotype 3. CONCLUSIONS: In Slovakia IDUs represent risk group with high prevalence of hepatitis C. These results are comparable to those published in other European countries.

Asunto(s)

Hepatitis C/epidemiología , Abuso de Sustancias por Vía Intravenosa/complicaciones , Adulto , Anticuerpos Antivirales/sangre , Femenino , Hepacivirus/aislamiento & purificación , Hepatitis C/transmisión , Humanos , Masculino , Prevalencia , ARN Viral/sangre , Estudios Seroepidemiológicos , Eslovaquia/epidemiología , Adulto Joven

RESUMEN

AIMS: The aim of this clinical study was to assess virological response at end-of -treatment (ETR), sustained virological (SVR) and biochemical response in former drug users with chronic hepatitis C treated with PEG-IFN-alpha and R. PATIENTS: Ninety two former drug users (21 F, 71 M) average age 27 years (18 to 41 years) and previously not treated with IFN-alpha and R (naive patients, pts) were evaluated for their virological and biochemical response. Standard treatment regimen of either 24 or 48 weeks was applied in patients with genotype 3 or genotype 1, respectively. SVR was considered if viral tests (HCV RNA) were negative 24 weeks after the end of treatment. RESULTS: Overall SVR was attained in 87 (95%) of 92 treated patients, and therapy failed in 5 pts with genotype 1. In genotype 1 patients ETR and SVR were 81% and 86%, respectively (p < 0.001). In genotype 3 patients ETR and SVR were 98% and 100%, respectively (p < 0.001). ALT levels decreased significantly after 12 weeks of therapy (ALT 1.61 vs 0.64 micro/kat/l, p < 0.001) and were at normal levels during follow-up. CONCLUSIONS: Crucial predictive factors resulting in high SVR were the younger age in combination with low stage of liver fibrosis, relatively short duration of viral infection, high proportion of genotype 3 and excellent adherence of patients to treatment regimen than previously not treated with IFN-alpha and R (naive patients). High proportion of SVR in former drug users has been achieved in patients with genotype 3 (100%) and genotype 1 (86%). The most decisive prognostic factor which favors high therapeutic efficacy appears to be young age and early onset of anti-HCV treatment (Tab. 3, Fig. 1, Ref. 33). Full Text (Free, PDF) www.bmj.sk.

Asunto(s)

Antivirales/administración & dosificación , Hepatitis C Crónica/tratamiento farmacológico , Interferón-alfa/administración & dosificación , Polietilenglicoles/administración & dosificación , Ribavirina/administración & dosificación , Abuso de Sustancias por Vía Intravenosa/virología , Adolescente , Adulto , Quimioterapia Combinada , Femenino , Hepacivirus/aislamiento & purificación , Hepatitis C Crónica/complicaciones , Hepatitis C Crónica/patología , Hepatitis C Crónica/virología , Humanos , Interferón alfa-2 , Hígado/patología , Masculino , ARN Viral/sangre , Proteínas Recombinantes , Adulto Joven

RESUMEN

The authors outline current practice regarding the pre-hospital use of adrenaline. They conclude that intramuscular adrenaline recommended in the current European guidelines may not be the only correct route of administration. Both intradermal and intravenous routes may be more appropriate in certain situations. The decision as to which route is the most appropriate in a particular situation will depend on several factors discussed in the article. Nevertheless, the early use of intramuscular adrenaline, particularly in pre-hospital or in the unmonitored setting, still warrants direct comparison with intravenous adrenaline to examine their relative efficacies compared with complication rates. Similarly, the benefits and risks of subcutaneous adrenaline in patients with milder reactions or increased cardiovascular risk warrant further investigation (Tab. 3, Ref. 24).

Asunto(s)

Anafilaxia/tratamiento farmacológico , Epinefrina/administración & dosificación , Epinefrina/efectos adversos , Humanos , Inyecciones Intramusculares , Inyecciones Subcutáneas , Guías de Práctica Clínica como Asunto

RESUMEN

Hypokalemia is associated with some renal diseases manifested by renal tubular acidosis (type I and II) or by renal tubular syndrome (Bartter's, Gitelman's and Liddle's syndrome). Bartter's syndrome, originally described by Batter and colleagues in 1962, is a set of closely related renal tubular disorders characterized by hypokalemia, hypochloremia, metabolic alkalosis and hyperreninemia with normal blood pressure. The underlying renal abnormality results in excessive urinary losses of sodium, chloride, potassium and calcium. Muscle weakness, polydipsia, polyuria and mental retardation can be also present. Affected children have poor growth rates and they appear malnourished. The article is focused on ethiopathogenesis, laboratory and clinical characteristics and on the treatment of Bartter's syndrome.

Asunto(s)

Síndrome de Bartter , Síndrome de Bartter/diagnóstico , Síndrome de Bartter/genética , Síndrome de Bartter/fisiopatología , Síndrome de Bartter/terapia , Humanos

RESUMEN

Coenzyme Q10, a vitamin-like substance, represents a components of the complex antioxidant system of the human organism. The paper presents its structure, physiological function and the role in the disease pathogenesis with the accent on the supplementation therapy during human immune system disturbances, including infectious and oncological diseases.

Asunto(s)

Inmunidad , Ubiquinona/análogos & derivados , Ubiquinona/fisiología , Adyuvantes Inmunológicos/uso terapéutico , Animales , Antioxidantes/metabolismo , Coenzimas , Humanos , Ubiquinona/inmunología , Ubiquinona/uso terapéutico

RESUMEN

Accumulating data indicate that bronchial asthma is a chronic inflammatory disease. Airway inflammation and it's control became a principal focus in asthma treatment. Nedocromil sodium is chemically nonsteroidal anti-inflammatory agent for the treatment of mild to moderate asthma. The aim of the study was to determine the effects of NS on bronchial hyperresponsivness and eosinophil activation markers isolated from peripheral blood of asthmatics with mild intermittent asthma. Twenty nine patients of both sexes (17 women, 12 men) with average age of 34 years were recruited into the clinical open study. Bronchial responsivness was assessed by metacholine challenge test prior to starting therapy with NS (preparation Tilade mint aer) and 3rd week and 9th week of follow up. Baseline lung function tests were performed at intervals before treatment and at 3rd and 9th week, respectively. Eosinophil activation markers were determined before and after 3rd and 6th week. Assessement was done by flow cytometry using standard monoclonal antibodies. Bronchial responsivness decreased significantly at 3rd and 9th week of follow up (provocation dose--PD20 increased significantly, p < 0.05, p < 0.02, respectively). Improvements of baseline lung function tests were observed in majority of parameters: FVC (p < 0.01), FEV1 (p < 0.01), FEV1/FVC (p < 0.01), MEF 25 (p < 0.03), MEF 50 (p < 0.01), MEF 25-75 (p < 0.01), PEF (p < 0.01) after 3rd week, however the enhancement of improvement was seen in majority of parameters after 9th week of the study. Significant reduction of eosinophil activation markers expression was noticed: CD69 (p < 0.05, p < 0.01) and HLA DR (p < 0.05, p < 0.05) after 3rd and 6th week, respectively and CD66 (p < 0.05) after 3rd week and CD81 (p < 0.05) after 6th week of follow up. NS possessed complex antiasthmatic effects resulting in decrease of bronchial responsivness and reduction of eosinophil activation markers in mild asthmatics. The tolerance of the drug was good and no adverse effects have been reported. NS is effective prophylactic drug recommended for use in both adults and children in long-term management of mild asthma. (Tab. 2, Fig. 1, Ref. 27).

Asunto(s)

Antiasmáticos/uso terapéutico , Asma/tratamiento farmacológico , Nedocromil/uso terapéutico , Adulto , Asma/inmunología , Asma/fisiopatología , Hiperreactividad Bronquial , Pruebas de Provocación Bronquial , Eosinófilos/inmunología , Femenino , Volumen Espiratorio Forzado , Humanos , Masculino , Persona de Mediana Edad , Capacidad Vital

RESUMEN

Hemodialysis as a therapeutic procedure in patients being in the end-stage of renal failure has been used since the sixties of the 20th century. Generally speaking, the conservative drug therapy in patients treated by hemodialysis is complex, and economically it consummes as great proportion of financial expenses. The aim of the study was to perform an economic analysis of 101 patients, both sexes (37 females and 64 males, aged from 22 to 81 years) treated by hemodialysis, in respect of drug treatment costs. The total average cost of treatment medication represented 161,589 SKK/patient/year. Eighty one percent of total expenses were linked with the consumption on antianemic drugs (102,298.40 SKK/patient/year). The second most expensive drug group (9% of the total cost) were medications used in coincidence with hemodialysis complications (14,981 SKK/patient/year). Diuretic--furosemid was the most frequently used drug out of the category of antihypertensive medications (68% of patients), followed by beta-blockers (preparation Concor), calcium channel blockers (preparations Norvasc and Plendil) and angiotensin converting enzyme tritace inhibitors (ACEI, preparations Trirace, Enap, Prestarium), respectively. Only 27% of patients were treated by hypolipidemic drugs mostly by the preparations of Gevilon and Innogen. In the majority of patients (93%) preparations for the correction of calcium and phosphorus metabolisms such as Vitacalcin and Rocaltrol were administered, the latter being most expensive. Antianemic drugs have been used in all patients. In this category of preparations, those composing acid folate and erythropoetin were used most frequently. Alkaline supplementation of NaHCO, (bicarbonate) was used in 88% of patients. In order to prevent the development of thrombosis and other vascular complications, the drugs with antiaggregative effects were used (Ibustrin, Curantyl, Anopyrin). To prevent the manifestation of gastrointestinal adverse reactions, the administration of H2-antagonists have been preferred (Famosan, Quamtel). The group of "Other drugs" was represented by vitamins and drugs with anti-uratic effects (ascorbic acid--preparation Celaskon, tocopherol--preparation E-vitamin and Milurit). When summed together, the costs of therapy in patients treated by hemodialysis are three times higher compared with those in the pre-dialysis phase. In addition to the latter hemodialysis is associated with a large number of medical, psychic and social complications. In the presented pilot study the authors analysed the financial expenses coinciding with drug costs (direct loads) which are significant, but represent only a part of the pharmacoeconomic complexity. In the future it is necessary to perform a more complex pharmacoeconomic analysis in order to evaluate also other factors, such as the costs of hospitalization, dialysate solutions, technologys, salaries of the staff, etc. (Tab. 6, Ref. 37.).

Asunto(s)

Costos de los Medicamentos , Honorarios Farmacéuticos , Diálisis Renal , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Eslovaquia

RESUMEN

Treatment by dialyzing represents an important contribution to the therapy of nephropathic patients. On the other hand, besides high financial costs it is not possible to forger significant social and psychic consequences of this therapy. The present paper aimed at a pharmacoeconomic evaluation of the costs of conservative treatment of nephropathic patients. The secondary aim was to compare the costs of conservative treatment in patients with markedly limited renal functions, creatinine clearance (Ccr < 0.4 ml/s), with those in patients with only slightly and medium-reduced renal functions (Ccr 0.4-1 ml/s). Health documentation from three nephrological out-patient surgeries was used to evaluate the results, the criterion for the selection of patients being a nephrological diagnosis with Ccr below 1 ml/s. The group comprised 102 patients aged 21-84 years (average age being 63.99 years), including 56 females (54.9%) and 46 males (45.1%). According to the stage of renal disease, they were divided into two groups. The patients with slightly and medium-reduced renal functions (Ccr 0.4-1.0 ml/s) represented nearly three quarters, whereas the patients with markedly reduced renal functions (Ccr < 0.4 ml/s) only slightly more than one quarter. In the group under study, the pharmacotherapeutic costs represented 2,889,778.0 SK/year (28,331.16 SK/1 patient/1 day), in patients with renal insufficiency the costs being markedly higher (47,427.3 SK/1 patient/1 day in comparison with 21,456.7 SK/1 patient/1 day). Of total pharmacotherapeutic costs, 29.38% was represented by antihypertensive agents, 24.47% by preparations supplementing essential amino acids, 14.83% by hypolipidemic agents, 14.37% by preparations supplementing calcium, 6.19% by antianaemic agents, and 7.76% by other drugs. The results demonstrate that pharmacotherapy of renal diseases is costly but in comparison with elimination methods (dialysis) it is incomparably less expensive. The spectrum of employed agents is in agreement with the present-day trends in conservative treatment which decelerates the progress of nephropathies.

Asunto(s)

Costos de los Medicamentos , Enfermedades Renales/tratamiento farmacológico , Enfermedades Renales/economía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Eslovaquia

RESUMEN

UNLABELLED: The prevalence of patients with chronic nephropathies leading to the end stage of renal failure (ESRF) is increased. The conservative therapy of patients in the phase of ESRF as well as the performance of hemodialysis represent an extensive burden on health care budgets. AIM: The aim of the study was to evaluate the financial expenses for medications in group of conservatively treated patients with nephropathies. PATIENTS AND METHOD: One hundred and two patients (56 females, 46 males) aged 21-84 years with nephropathies collected from three out-patient departments of nephrology in the regions of Bratislava and Nitra (Western Slovakia) were enrolled into the study. RESULTS: The total financial expenses represented 2,889,778 Sk The average expense per 1 patient/1 year was 28,331 Sk and that of 1 patient/1 day was 77.6 Sk, respectively. Antihypertensive therapy represented 1st position (29.4%) of the total financial cost followed by keto-analogs (27.5%), hypolipideamics (14.8%), drugs for disorders of calcium metabolism (14.4%) and antianaemics (6.2%), respectively. The group of "other" drugs represented 7.7% of total costs. CONCLUSIONS: Results show that the financial expenses for pharmacotherapy in conservatively treated patients with nephropathies are high, but significantly less expensive in comparison with hemodialysis (700,000-1,000,000 Sk/year/patient). The prevention and the slowing down of the progression of renal disease seem to be crucial in the management of nephropathies. The therapeutic approach in conservatively treated patients with renal diseases was rational and up to date. (Tab. 1 Fig. 5, Ref. 12. )

Asunto(s)

Costos de los Medicamentos , Enfermedades Renales/economía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Costos de la Atención en Salud , Humanos , Enfermedades Renales/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Eslovaquia

RESUMEN

BACKGROUND: The contribution of free oxygen radicals in the pathogenesis of bronchial asthma is generally accepted. The modulation of antioxidative defence by supplementation with antioxidants represents additive therapy in complex management of disease. The aim of the study was to assess the levels of coenzyme Q10, alpha-tocopherol, and beta-carotene both in plasma and whole blood, and malondialdehyde (MDA) and eosinophil cationic protein (ECP) in plasma of asthmatics (As). METHODS: Fifty-six As (15 males and 41 females) aged from 19 to 72 years (mean age 46 years) suffering from allergic asthma were enrolled into the study. The control group comprised 25 healthy volunteers (16 males, 9 females) aged 25-50 years. RESULTS: The concentrations of CoQ10 decreased significantly both in plasma and whole blood, compared with healthy volunteers (0.34 +/- 0.15 micromol/l vs. 0.52 +/- 0.15 micromol/l, 0.33 +/- 0.14 micromol/l vs. 0.50 +/- 0.13 micromol/l, P < 0.001, P< 0.001, respectively). The levels of alpha-tocopherol were decreased both in plasma and whole blood in comparison with controls [24.10 micromol/l (19.8; 30.5), vs. 33.20 micromol/l (28.25; 38.05), 17.22 +/- 6.45 micromol/l vs. 21.58 +/- 7.92 micromol/l, P= 0.006, P = 0.01, respectively]. The levels of MDA were elevated over the reference range in both groups (reference range < 4.5 micromol/l). No changes were seen in beta-carotene concentrations. Positive correlation was found between whole blood CoQ10 and alpha-tocopherol concentrations. CONCLUSION: Results of the study suggest a possible contribution of suboptimal concentrations of CoQ10 on antioxidative dysbalance in As and provide a rationale for its supplementation.

Asunto(s)

Antioxidantes/análisis , Asma/sangre , Ribonucleasas , Ubiquinona/análogos & derivados , Ubiquinona/sangre , Adulto , Anciano , Proteínas Sanguíneas/análisis , Coenzimas , Proteínas en los Gránulos del Eosinófilo , Femenino , Humanos , Mediadores de Inflamación/sangre , Peroxidación de Lípido , Masculino , Malondialdehído/sangre , Persona de Mediana Edad , alfa-Tocoferol/sangre , beta Caroteno/sangre

RESUMEN

The present paper aims to analyze therapeutic trends in allergic rhinitis and their relationships to selected pharmacoeconomic parameters. Health and Disease out-patient records from three out-patient allergologic-immunologic surgeries in the towns of Trencín, Nové Zámky, and Bratislava were surveyed. The analysis is based on the recorded prescription of drugs prescribed to the patients in the period of his or her "most recent season" in the years 1999-2000. Altogether 279 records (164 females, 115 males) were evaluated. The highest percentage of pollinotics was dispensed in Bratislava (73%) followed by Nové Zámky (55%) and Trencín (31%). In all three out-patient surgeries, the dominant therapy was a combination of specific immunotherapy (SIT) and antihistanime treatment (AH, 70-75%). Average costs for one day of treatment of allergic rhinitis in the out-patient surgeries under study did not significantly differ (22.20-24.50 Sk, the average value of the daily defined dose being 23.20 Sk). Due to confused kept records, the economic analysis did not take into account the financial costs connected with SIT. The present analysis shows a positive state in the field of diagnostics, connected with improved identification of the inducing allergen and application of causal therapy based on SIT (72%). Approximately one third of patients (27%) received only solo medicamentous therapy without application of SIT, and the SIT therapy alone was received by less than 2% of patients (1.4%).

Asunto(s)

Antialérgicos/economía , Rinitis Alérgica Perenne/economía , Rinitis Alérgica Estacional/economía , Costos de los Medicamentos , Femenino , Humanos , Masculino , Rinitis Alérgica Perenne/tratamiento farmacológico , Rinitis Alérgica Estacional/tratamiento farmacológico , Eslovaquia

RESUMEN

Selenium (Se) deficiency attenuates the host immune response, thereby increasing the risk of bacterial and viral infections. We have examined the effects of selenium supplementation (SeS) in corticoid-dependent asthmatics (CDAs) with lowered circulatory Se status. Twenty CDAs (10 males and 10 females, average age 54.5 yrs) were enrolled into the study. The average duration of the disease was 10 yrs. The asthmatics were receiving 200 micrograms of Se per day for a period of 6 months, in addition to regular treatment with inhaled corticosteroids and beta-agonists. The expression of adhesion molecules (CD11a, CD11b, CD18, CD49d, CD54, CD62L) on peripheral blood mononuclear cells (PBMCs) of asthmatics and the expression of E- and P-selectins, ICAM-1, VCAM-1 on cultured human umbilical vein endothelial cells (HUVEC) after stimulation with PBMCs from CDAs before and after 3 and 6 months of SeS were assessed by standard monoclonal antibodies and analyzed by flow cytometry. The concentrations of soluble adhesion molecules P-selectin, E-selectin, ICAM-1 and VCAM-1 were determined by ELISA method. The expression of adhesion molecules on PBMCs: After 3- and 6-months of SeS, a decreased expression of molecules CD11a, CD11b and CD62L was observed (p < 0.02, p < 0.005, p < 0.003). No changes were seen in the expression of CD18, CD49d except for the increased expression of CD54 (p < 0.005). Modulation of adhesion molecules expression on HUVEC: We observed a significant increase in VCAM-1, P- and E-selectins expressions in the group of asthmatics without SeS in comparison with the control group (p < 0.05, p < 0.01, p < 0.05). During SeS a significant decrease in molecules VCAM-1, E-selectin (after 3 months) (p < 0.05, p < 0.05) and P-selectins and ICAM-1 (after 6 months) (p < 0.05, p < 0.01) were observed. Soluble adhesion molecules: After 3 months of SeS we noticed a significant decrease in VCAM-1 and P-selectin expressions (p < 0.05, p < 0.05) and after 6 months the level of VCAM-1 decreased (p < 0.01). The effect of Se on the adhesion molecules expression in endothelial cells in vitro experiments: Se blocks the expression of adhesion molecules stimulated by IFN-gamma in a dose-dependent way after addition of Se into a culture of endothelial cells. Concentration of 10 micrograms/ml inhibits the increase in expression of ICAM-1 (p < 0.05) but not that of VCAM-1, E- or P-selectins. The inhibition of expression in Se concentration of 10 micrograms/ml is over 80% (p < 0.01). Our data demonstrate that Se is able to affect the adhesion molecules expressions that are crucial in the inflammatory process. (Fig. 5, Ref. 22.)

Asunto(s)

Antioxidantes/administración & dosificación , Asma/metabolismo , Moléculas de Adhesión Celular/metabolismo , Glucocorticoides/uso terapéutico , Selenio/administración & dosificación , Antioxidantes/farmacología , Asma/tratamiento farmacológico , Células Cultivadas , Endotelio Vascular/metabolismo , Femenino , Humanos , Leucocitos Mononucleares/metabolismo , Masculino , Persona de Mediana Edad , Selectinas/metabolismo , Selenio/farmacología

RESUMEN

UNLABELLED: Selenium (Se) is a trace element that is essential for immune functions, and protects the immune system from oxidative damage. AIM: The aim of the pilot clinical study was to assess the influence of selenium supplementation (SeS) on the selected immune parameters analyzed from peripheral blood of corticoid-dependent asthmatics (CDAs). MATERIAL AND METHODS: Seventeen CDAs aged from 30 to 74 years (7 females, 10 males) with suboptimal levels of Se in plasma were enrolled into the study. The follow up of SeS lasted 96 weeks. It is daily dose was 200 micrograms (2 x 2 tbl daily, 1 tbl contained 50 micrograms of Se). Before (-4 weeks) and after the 12th, 48th, 72nd and 96th weeks of SeS, the following parameters were observed: Epitopes EG1, EG2 expressed on intracellular eosinophil (Eo) cationic protein and eosinophil peroxidase, the numbers of CD3, CD4, CD8, CD19 and CD3 HLADR positive T lymphocytes (Ly), lymphocyte blastogenesis test (LTT) with mitogens concanavalin A, (Conc A) phytohemaglutin (PHA), the levels of C3, C4 complement components, activation of complement by classic and alternative pathways (CP50, AP50), the levels of immunoglobulins (Ig) G, A, M and total IgE, circulating immune complexes (CIC). RESULTS: Epitopes EG1 and EG2 in cytoplasma of Eo decreased significantly after 12 weeks of SeS, (p < 0.01) and 96 weeks of follow up. In parameters of T cell mediated immunity the relative number of CD3 HLADR+ T Ly increased after 24, 48 and 96 weeks of SeS (p < 0.0008, p < 0.009, p < 0.07). Proliferative activity of T Ly to mitogenes PHA and ConcA in LTT decreased significantly after 12, 48, 72 and 96 weeks of SeS (p < 0.0005, p < 0.009, p < 0.04, p < 0.02, respectively). In humoral parameters activation of CP50 decreased after 24, 72 and 96 weeks of SeS to the reference range (p < 0.001, p < 0.03, p < 0.02) and AP50 after 96 weeks, respectively (p < 0.02). The levels of IgG elevated after 24 weeks (p < 0.02), IgA after 24, 48 weeks (p < 0.0007, p < 0.02, respectively). The level of total IgE significantly decreased after 96 weeks of SeS (p < 0.003). CONCLUSION: Our pilot clinical study with the CDAs demonstrates the significant changes particularly in functional parameters of both cellular and humoral types of immunity. These results support the immunomodulating effects of SeS. (Tab. 5, Ref. 15.)

Asunto(s)

Antiasmáticos/uso terapéutico , Antiinflamatorios/uso terapéutico , Antioxidantes/administración & dosificación , Asma/inmunología , Glucocorticoides/uso terapéutico , Selenio/administración & dosificación , Adulto , Anciano , Antiinflamatorios/administración & dosificación , Formación de Anticuerpos/efectos de los fármacos , Antioxidantes/farmacología , Asma/tratamiento farmacológico , Epítopos/análisis , Femenino , Humanos , Inmunidad Celular/efectos de los fármacos , Recuento de Leucocitos , Activación de Linfocitos , Masculino , Persona de Mediana Edad , Selenio/farmacología , Esteroides

RESUMEN

Selenium represents a trace element comprised in enzyme glutathion-peroxidase. It is anti-inflammatory activity is based on the elimination of hydroperoxides produced in the site of inflammation (scavenger of free oxygen radicals). The authors report the results of a pilot study with 17 corticodependent asthmatics (7 females, 10 males) aged 30-74 years, supplemented with the preparation of selenium (Se), in a daily dose of 200 micrograms during the follow-up lasting 96 weeks. We demonstrate the reduced consumption of both inhaled corticosteroids, manifested after 24 to 96 weeks of Se supplementation (SeS) (21.74 mg vs 15.81 mg, p < 0.009, 21.74 mg vs 15.32 mg, p < 0.007, respectively) and systemic corticosteroids after 48 weeks (294 mg vs 78 mg, p < 0.04) and 96 weeks of SeS (294 mg vs 104 mg, p < 0.04). These results correlated with the elevation of Se levels both in plasma and erythrocytes (p < 0.0003, p < 0.0003, respectively). No adverse effects were seen during the study and the tolerance of preparation was good. (Tab. 3, Ref. 17.)

Asunto(s)

Antiasmáticos/administración & dosificación , Antiinflamatorios/administración & dosificación , Antioxidantes/administración & dosificación , Asma/tratamiento farmacológico , Glucocorticoides/administración & dosificación , Selenio/administración & dosificación , Administración por Inhalación , Administración Oral , Adulto , Anciano , Asma/fisiopatología , Pruebas de Provocación Bronquial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mecánica Respiratoria/efectos de los fármacos , Esteroides

RESUMEN

BACKGROUND: Piroxicam-beta-cyclodextrin (PBC) is the first nonsteroidal anti-inflammatory drug (NSAID), in which the active substance is complexed with the cyclic oligosaccharide cyclodextrin, which acts as an artificial receptor. This complex allows single molecules of the NSAID to be released adjacent to the gastrointestinal mucosa, instead of crystals. Since the piroxicam is immediately bioavailable in this formulation, the onset of action is similar to that of a parenteral drug. Since the time contact with gastric mucosa is reduced, the risk of direct-contact gastric irritation is also reduced. There is good evidence that PBC is beneficial in managing acute non-specific back pain (BP) but sufficient evidence on chronic BP is lacking. METHODS: Thirty-one eligible patients aged 18-85 years, resistant to previous therapy with different NSAIDs, were treated with PBC 20 mg once daily in a 40-day open-label noncomparative study. The patients experienced chronic BP defined as pain between the occipital region and gluteal fold, lasting for at least 6 weeks but not more than 6 months. Efficacy was assessed by changes in pain intensity, paravertebral tonus, functional impairment and morning stiffness using a 4-point numerical rating scale. Patients also self-assessed nocturnal and diurnal pain using the visual analogue scale. Tolerability was assessed by adverse events and routine laboratory evaluations. Global assessment of efficacy and tolerability by physician and patients was performed at the last visit. RESULTS: Using intention-to-treat analysis, all efficacy assessments demonstrated statistically significant improvements over baseline at each follow-up. 90.3% of the patients evaluated the efficacy of PBC as improved or greatly improved, and investigators rated the treatment as improved or greatly improved in 87.1% of patients. Remission was achieved in 19.3% of the patients. Tolerability was also rated highly, with 83.9% of the patients characterizing PBC treatment as good or very good, and the investigators rated the treatment as good or excellent in 87.1% of the patients. Drug related adverse events were reported in 9.7% of patients and prompted discontinuation of the study medication in 3.2% of patients. No serious adverse events were reported. CONCLUSION: These results suggest that the newly developed dosage form of piroxicam is effective and well tolerated in the treatment of patients with chronic BP. Thus, PBC, may be an important new treatment option in this condition. (Tab. 3, Fig. 3, Ref. 36.).

Asunto(s)

Antiinflamatorios no Esteroideos/uso terapéutico , Dolor de Espalda/tratamiento farmacológico , Ciclodextrinas/uso terapéutico , Piroxicam/uso terapéutico , beta-Ciclodextrinas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antiinflamatorios no Esteroideos/efectos adversos , Enfermedad Crónica , Ciclodextrinas/efectos adversos , Combinación de Medicamentos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Piroxicam/efectos adversos

RESUMEN

BACKGROUND: The contribution of free oxygen radicals in the pathogenesis of bronchial asthma is generally accepted. The modulation of antioxidative defence by supplementation with antioxidants represents additive approach in complex management of the disease. The aim of the study was to assess the levels of coenzyme Q10, alpha-tocopherol, beta-carotene and malondialdehyde (end-stage parameter of lipid peroxidation) in asthmatics (As). METHODS: Fifty six As (15 males and 41 females) aged from 19 to 72 yrs (mean age 46 yrs) were enrolled into the study. The control group comprised of 25 healthy volunteers (16 males, 9 females) aged 25-50 years. RESULTS: Concentrations of CoQ10 and alpha-tocopherol, decresed significantly both in plasma and whole blood, compared with healthy volunteers (p < 0.009, p < 0.004; p < 0.035, p < 0.001, respectively). The level of MDA was elevated, but not statisticaly significantly. No changes were seen in beta-carotene levels. Positive correlation was found between concentrations of CoQ10 and alpha-tocopherol. CONCLUSION: Our results suggest possible contribution of suboptimal concentrations of CoQ10 on antioxidative dysbalance in As and provide rationale for its supplementation with clinical evaluation. (Tab. 2, Fig. 1, Ref. 39.).

Asunto(s)

Asma/sangre , Ubiquinona/sangre , Adulto , Anciano , Antioxidantes/análisis , Femenino , Humanos , Masculino , Malondialdehído/sangre , Persona de Mediana Edad , alfa-Tocoferol/sangre , beta Caroteno/sangre

RESUMEN

In this study, we report on the interferon-gamma (IFN-gamma) and interleukin-4 (IL-4) cytokine responses to phorbol myristate acetate (PMA) + ionomycin-stimulated CD3+ lymphocytes in asthmatic subjects when compared with normal donors. There was a significantly lower production of intracellular IFN-gamma in asthmatic patients. No difference was found for IL-4 production between these two groups. After administration of a multivitamin-mineral supplement containing selenium, zinc, vitamin A, vitamin B6, vitamin C, and vitamin E for 6 mo, a significant increase in the percentage of CD3+/IL-4 positive cells (p < 0.05) was found. The induction of endothelial cell adhesion molecule (CAM) expression in cultured human umbilical vein endothelial cells (HUVEC) and whole-blood mixture was studied using flow cytometry. The ICAM-1 and VCAM-1 expressions were higher in the patients than in control donors (p < 0.05). There is a correlation between the increased percentage of CD3+/IFN-gamma positive cells and reduced endothelial ICAM-1 and VCAM-1 expression after 6 mo of intervention period. No apparent effect of supplementation on CAM expression was found, suggesting that these changes do not arise from an antioxidant mechanism. This newly developed whole-blood technique for the assessment of CAM expression can be of use for monitoring therapy in inflammatory diseases.

Asunto(s)

Antioxidantes/farmacología , Asma/tratamiento farmacológico , Asma/metabolismo , Interferón gamma/biosíntesis , Interleucina-4/biosíntesis , Corticoesteroides/uso terapéutico , Adulto , Anciano , Asma/inmunología , Complejo CD3/metabolismo , Estudios de Casos y Controles , Células Cultivadas , Endotelio Vascular/efectos de los fármacos , Endotelio Vascular/metabolismo , Femenino , Humanos , Técnicas In Vitro , Molécula 1 de Adhesión Intercelular/metabolismo , Ionomicina/farmacología , Linfocitos/efectos de los fármacos , Linfocitos/inmunología , Linfocitos/metabolismo , Masculino , Persona de Mediana Edad , Minerales/farmacología , Acetato de Tetradecanoilforbol/farmacología , Molécula 1 de Adhesión Celular Vascular/metabolismo , Vitaminas/farmacología

RESUMEN

UNLABELLED: Asthma bronchiale represents serious social and economic problems in all over the world. Financial expenses are elevated every year. THE AIM: Of the presented study was to analyze the current therapeutic approach in the management of bronchial asthma and to evaluate pharmacoeconomic aspects of treatment in selected outdoor asthmatic patients in region of Kosice (Eastern Slovakia). PATIENTS: The data of the total number 297 patients (183 females--61.6%, 114 males 38.4%), aged from 18 to 78 (average age 38) were analyzed. RESULTS: The total expenses per day for all asthmatics represented 19,465 Sk (65.54 Sk/day/patient). Short-acting beta 2-agonists (beta-A) (55.2%) were administered most frequently, followed by inhaled corticosteroids (CS) (43.1%), theophyllins (T) with slow released formulas (36.4%), cromoglycates (C) (33%), long-acting beta-A (19.9%), combined preparations beta-A with anticholinergics (ATCH) (Berodual, Combivent) (12.12%), depot CS (10.44%), antileucotriens (ALT) (10.10%), combined preparation beta-A with C (Ditec, 8.75%), short-acting T (6.73%), systemic CS (5.72%), ATCH (4.71%). Additive therapy represented antihistamines (AH) (69.36%), topic AH, nasal and eyes drops (38.8%), specific immunotherapy (36.03%), immunomodulatory therapy (23.23%), expectorans and antitusive drugs (15.49%), respectively. C (20.33%) represented the highest financial cost from the total financial budget followed by inhaled CS (16.34%), long-acting beta-A (13.20%) and ALT (8.9%), short-acting T (0.39%) and short-acting beta-A (3.41%), respectively. In the group of additive drugs AH dominated (15.85%). CONCLUSION: The optimal selection of antiasthmatic drugs should be kept in mind by physicians. Our study shows some reserves in respect of optimal selection of antiasthmatic (generic drugs should be preferred), therapeutic efficacy and compliance of patients. (Tab. 11, Ref. 15.)

Asunto(s)

Antiasmáticos/economía , Asma/tratamiento farmacológico , Adolescente , Adulto , Anciano , Asma/economía , Costos de los Medicamentos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Eslovaquia

RESUMEN

Adult Still's disease is characterized by diverse clinical and laboratory findings, which may lead to errors in the differential diagnosis, and possible injury of the patient's health due to wrong therapeutic management. In the following case report, we describe a case of a 32-year old patient with fever of unknown etiology. The final diagnosis of Morbus Still adultorum was determined five months after his first check-up. The course of the disease was complicated by acute hepatitis caused by drug toxic damage. We have applied immunosuppressive therapy with very good clinical and laboratory responses. (Ref. 9.)

Asunto(s)

Enfermedad de Still del Adulto/diagnóstico , Adulto , Diagnóstico Diferencial , Fiebre de Origen Desconocido/etiología , Humanos , Masculino , Enfermedad de Still del Adulto/tratamiento farmacológico