RESUMEN
OBJECTIVE: (1) To determine the prevalence of gastrointestinal (GI) symptoms in patients with and without Helicobacter pylori infection and treated with non-steroidal anti-inflammatory drugs (NSAIDs) and (2) to estimate the impact of H. pylori eradication on these symptoms. METHODS: This was a multicentric, community-based, randomized, case-control study. Patients presenting with a rheumatic disorder motivating the prescription of an NSAID for at least 2 wks were stratified in two groups (H. pylori-positive and H. pylori-negative) by a serological doctor test and H. pylori-positive patients divided further into two subgroups, receiving either an eradication treatment (group 1) or a placebo (group 2). The main outcome measure was the prevalence of GI symptoms estimated in groups 1 and 2 and in noninfected patients (group 3) at weeks 2, 6, and 12. RESULTS: Among H. pylori-negative patients (n=145), GI symptoms were present in 42.6%, 21.4%, and 10.0% at weeks 2, 6, and 12, respectively. In groups 1 and 2, GI symptoms were present in 57.7% and 40.7%, respectively, at week 2 (p= 0.03); 24.7% and 23% at week 6 (p= 0.85); and 9.4% and 17.3% at week 12 (p= 0.13). The prevalence of GI symptoms at week 2 was similar in group 2 and in the H. pylori-negative group (p= 0.77). The highest prevalence of symptoms at week 2 in group 1 was essentially due to diarrhea. The prevalence of GI symptoms was the same for groups 1 and 3 at week 12, and higher in group 2, but the difference did not reach statistical significance. CONCLUSIONS: The short-term (6 wks) GI tolerance of conventional NSAIDs does not differ whether or not the patients are infected by H. pylori. The tendency observed for the medium term (12 wks) deserves to be confirmed.
Asunto(s)
Antibacterianos/administración & dosificación , Antiinflamatorios no Esteroideos/efectos adversos , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori/aislamiento & purificación , Úlcera Péptica/tratamiento farmacológico , 2-Piridinilmetilsulfinilbencimidazoles , Adulto , Anciano , Anciano de 80 o más Años , Amoxicilina/administración & dosificación , Antiinflamatorios no Esteroideos/administración & dosificación , Estudios de Casos y Controles , Claritromicina/administración & dosificación , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Mucosa Gástrica/microbiología , Mucosa Gástrica/patología , Infecciones por Helicobacter/diagnóstico , Helicobacter pylori/efectos de los fármacos , Humanos , Lansoprazol , Masculino , Persona de Mediana Edad , Evaluación de Necesidades , Omeprazol/administración & dosificación , Omeprazol/análogos & derivados , Úlcera Péptica/prevención & control , Probabilidad , Valores de Referencia , Enfermedades Reumáticas/diagnóstico , Enfermedades Reumáticas/tratamiento farmacológico , Medición de Riesgo , Estadísticas no Paramétricas , Resultado del TratamientoRESUMEN
OBJECTIVE: The primary objective of the present study was to evaluate the efficacy of 30 and 60 mg of lansoprazole administered in combination with two antibiotics for 7 or 10 days in eradicating Helicobacter pylori in duodenal ulcer patients. METHODS: This multicenter double-blind study randomized for the lansoprazole dose was carried out by 325 gastroenterologists. The H. pylori-positive diagnosis was based on three antral biopsies (one for a rapid urease test and two for histological examination). Eradication was checked by a (13) C-urea breath test. Patients were given 30 or 60 mg of lansoprazole with 2 g of amoxicillin and 1 g of clarithromycin for 10 days or 7 days, followed by 30 mg of lansoprazole daily for 18 or 21 days, i.e. the total duration of antisecretory therapy was 28 days. RESULTS: Out of the 665 patients included, 620 were analyzed on the intent-to-treat basis and 567 on the per protocol basis. The eradication rates were significantly higher in the group receiving 60 mg of lansoprazole than in the 30 mg group in both the intent-to-treat analysis (P=0.003) and the per protocol analysis (P=0.006). In the intent-to-treat analysis 60 mg group, the rates (95% confidence intervals) in the 7-day and 10-day sub-groups were 82.5 (CI: 75.2 - 89.8) and 86.8% (CI: 82.2 - 91.4), respectively, and in the per protocol analysis 84.2 (CI: 76.9 - 91.5) and 91.5% (CI: 87.6 - 95.4), respectively. With either lansoprazole dose, the eradication rates seemed higher when therapy was administered for 10 days. CONCLUSION: The double dose of lansoprazole optimizes H. pylori eradication rates. The highest eradication rates were obtained after 10 days of therapy. Additional studies should be carried out to determine the optimal duration of triple therapy for eradicating H. pylori.
Asunto(s)
Antibacterianos/uso terapéutico , Antiulcerosos/uso terapéutico , Úlcera Duodenal/microbiología , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori , Omeprazol/análogos & derivados , Omeprazol/uso terapéutico , 2-Piridinilmetilsulfinilbencimidazoles , Adulto , Amoxicilina/administración & dosificación , Amoxicilina/uso terapéutico , Antibacterianos/administración & dosificación , Antiulcerosos/administración & dosificación , Claritromicina/administración & dosificación , Claritromicina/uso terapéutico , Método Doble Ciego , Quimioterapia Combinada , Úlcera Duodenal/tratamiento farmacológico , Femenino , Humanos , Lansoprazol , Masculino , Persona de Mediana Edad , Omeprazol/administración & dosificación , Penicilinas/administración & dosificación , Penicilinas/uso terapéuticoRESUMEN
Two chromatographic forms of laccase c1 and c2 were purified approximately 225-fold from the extracellular culture fluid of ligninolytic cultures of Dichomitus squalens, using DEAE-Sepharose and Mono-Q fast protein liquid chromatography. Each homogeneous laccase (c1 and c2) has a molecular mass of approximately 66 kDa as determined by SDS-PAGE. Both forms are glycoproteins, and each contains four copper atoms per molecule of protein. The first 20 amino acids of the N-terminal sequences of these two laccases are identical and are similar to those of laccases from other lignin-degrading fungi. The electronic absorption spectra of these laccases exhibit bands at 610 and 330 nm, indicative of type I and type III copper. The EPR spectrum of laccase c1 exhibits bands indicative of type I and type II copper. Each laccase oxidizes a variety of phenolic substrates, has a pH optimum of 3.0 for the oxidation of 2,6-dimethoxyphenol, and is inhibited strongly by fluoride and azide.
Asunto(s)
Basidiomycota/enzimología , Isoenzimas/aislamiento & purificación , Oxidorreductasas/aislamiento & purificación , Secuencia de Aminoácidos , Basidiomycota/efectos de los fármacos , Espectroscopía de Resonancia por Spin del Electrón , Inhibidores Enzimáticos/farmacología , Concentración de Iones de Hidrógeno , Isoenzimas/biosíntesis , Isoenzimas/química , Lacasa , Datos de Secuencia Molecular , Oxidorreductasas/biosíntesis , Oxidorreductasas/química , Especificidad por Sustrato , TemperaturaRESUMEN
Two manganese peroxidase isozymes, MnP1 and MnP2, were purified from the extracellular medium of ligninolytic cultures of Dichomitus squalens. The proteins were purified to homogeneity using DEAE-Sepharose chromatography and Mono Q fast protein liquid chromatography. MnP1 and MnP2 have molecular masses of 48000 and 48900 Da, respectively, as determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Both isozymes are glycoproteins and each contains one iron protoporphyrin IX as a prosthetic group. The pl values of MnP1 and MnP2 are 4.15 and 3.90, respectively. N-Terminal amino-acid analysis suggests that these proteins are encoded by distinct genes. The Soret bands of the native ferric enzymes (408 nm and 406 nm, respectively) are shifted to 434 nm in the reduced enzymes and to 422 nm in the reduced-CO complexes. EPR g-values of the native enzymes are essentially identical to those for other MnPs and lignin peroxidases, and they confirm the high-spin state of the iron. The addition of 1 equivalent of H2O2 to either of the native ferric isozymes yields spectra which are characteristic of compound 1. Successive additions of 1 equivalent of ferrocyanide and 1 equivalent of H2O2 to the native enzymes yield spectra which are characteristic of compound II. Both MnP isozymes oxidize Mn2+ to Mn3+ in the presence of organic acid chelators. The MnP isozymes are produced by D. squalens only when the cells are grown in the presence of Mn.
Asunto(s)
Isoenzimas/química , Peroxidasas/química , Basidiomycota , Western Blotting , Quelantes/farmacología , Cromatografía por Intercambio Iónico , Secuencia Conservada/genética , Electroforesis en Gel de Poliacrilamida , Espacio Extracelular/química , Espacio Extracelular/metabolismo , Proteínas Fúngicas/química , Proteínas Fúngicas/aislamiento & purificación , Proteínas Fúngicas/metabolismo , Concentración de Iones de Hidrógeno , Isoenzimas/aislamiento & purificación , Isoenzimas/metabolismo , Cinética , Manganeso/metabolismo , Metales/metabolismo , Peso Molecular , Peroxidasas/aislamiento & purificación , Peroxidasas/metabolismo , Homología de Secuencia de Aminoácido , Espectrofotometría , Especificidad por SustratoRESUMEN
Extracellular manganese peroxidase and laccase activities were detected in cultures of Dichomitus squalens (Polyporus anceps) under conditions favoring lignin degradation. In contrast, neither extracellular lignin peroxidase nor aryl alcohol oxidase activity was detected in cultures grown under a wide variety of conditions. The mineralization of 14C-ring-, -side chain-, and -methoxy-labeled synthetic guaiacyl lignins by D. squalens and the expression of extracellular manganese peroxidase were dependent on the presence of Mn(II), suggesting that manganese peroxidase is an important component of this organism's lignin degradation system. The expression of laccase activity was independent of manganese. In contrast to previous findings with Phanerochaete chrysosporium, lignin degradation by D. squalens proceeded in the cultures containing excess carbon and nitrogen.