RESUMO
BACKGROUND AND AIM: The commonly accepted treatment for hepatitis C virus (HCV) infection, pegylated interferon alpha (PEG INF-alpha) and ribavirin, leads to 50-60% of sustained virological response (SVR). On the other hand, pentoxifylline (PTX) possesses antiviral and hepatoprotector properties. AIM: To investigate whether the addition of PTX to conventional hepatitis C treatment increases SVR. MATERIAL AND METHODS: Seventy two patients of both genders were studied in a randomized fashion; the diagnosis of chronic HCV infection was made according to clinical and laboratory criteria and histopathologically classified according to METAVIR scoring system criteria. HCV viral load was tested by PCR, baseline, and after 6 months of treatment, as well as anti-HCV, anti-hepatitis B virus , and anti-human immunodeficiency virus antibodies by enzyme-linked immunosorbent assay. During 48 weeks, control group patients were treated with PEG INF-alpha- 2a plus ribavirin. PTX was administered to Experimental Group patients prior to the treatment. RESULTS: Demographic data were similar in both groups. Experimental- and control-group subjects were at F2 and F3 states according to the METAVIR classification. The most common HCV genotypes were 1a and 1b (39% in the control group in each case, and 42% in the experimental group in each case). At the end of the study, hepatic enzymes and viral load decreased in both groups to similar values. SVR in the experimental group increased significantly (p < 0.05) when compared with standard therapy alone. CONCLUSION: Addition of PTX to conventional chronic hepatitis C treatment may increase the percentage of patients with SVR.
Assuntos
Antivirais/uso terapêutico , Hepatite C Crônica/tratamento farmacológico , Interferon-alfa/uso terapêutico , Pentoxifilina/uso terapêutico , Polietilenoglicóis/uso terapêutico , Ribavirina/uso terapêutico , Adulto , Idoso , Antivirais/efeitos adversos , Biomarcadores/sangue , Distribuição de Qui-Quadrado , Quimioterapia Combinada , Ensaio de Imunoadsorção Enzimática , Feminino , Hepacivirus/genética , Hepacivirus/imunologia , Anticorpos Anti-Hepatite C/sangue , Hepatite C Crônica/sangue , Hepatite C Crônica/diagnóstico , Humanos , Interferon-alfa/efeitos adversos , Masculino , México , Pessoa de Meia-Idade , Pentoxifilina/efeitos adversos , Projetos Piloto , Polietilenoglicóis/efeitos adversos , Reação em Cadeia da Polimerase , Valor Preditivo dos Testes , Estudos Prospectivos , Proteínas Recombinantes/efeitos adversos , Proteínas Recombinantes/uso terapêutico , Ribavirina/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Carga ViralRESUMO
BACKGROUND: The aim of this work was to determine and compare plasma levels of proinflammatory cytokines (IL-1beta, IL-6 and TNF-alpha), C-reactive protein (CRP) and lipoperoxides in patients submitted to laparoscopic cholecystectomy under general anesthesia or regional anesthesia. METHODS: Two groups of 15 patients of both sexes were submitted to laparoscopic cholecystectomy either with general or regional anesthesia. In all cases we obtained three samples of plasma. The first sample was collected immediately before surgery, whereas the other samples were collected 60 min and 24 h after the cholecystectomy. Using commercial kits, plasma levels of IL-1beta, IL-6 and TNF-alpha were quantified by ELISA, whereas lipoperoxides were determined by a colorimetric method. The ultrasensitive CRP was determined in the hospital by the Prestige 24I automated method. RESULTS: In all determinations, proinflammatory cytokines increased 24 h after surgery except plasma levels of IL-1beta in the regional anesthesia group. Comparison of the two different groups showed that the general anesthesia group had a similar or higher quantity of proinflammatory cytokines and oxidative stress when compared to the regional anesthesia group (p <0.05). In contrast, plasma levels of CRP were lower in the general anesthesia group (p <0.005). CONCLUSIONS: The type of anesthesia influences in a different manner the secretion of soluble mediators of inflammation. These observations may have important clinical repercussions.
Assuntos
Anestesia Geral , Raquianestesia , Colecistectomia Laparoscópica/efeitos adversos , Inflamação/sangue , Adulto , Anestesia Geral/estatística & dados numéricos , Raquianestesia/estatística & dados numéricos , Biomarcadores , Proteína C-Reativa/análise , Sedação Consciente , Feminino , Humanos , Inflamação/etiologia , Interleucina-1beta/sangue , Interleucina-6/sangue , Peróxidos Lipídicos/sangue , Masculino , Período Pós-Operatório , Método Simples-Cego , Espaço Subaracnóideo , Fator de Necrose Tumoral alfa/análiseRESUMO
The in vivo and in vitro development of apoptosis induced by gamma-irradiation was studied in mouse peritoneal macrophages. The apoptosis index was measured by fluorescence microscopy and DNA electrophoresis. In vivo apoptosis was greatest eight days after 8 Gy total body gamma-irradiation. A DNA ladder electrophoretic pattern was only observed in the gamma-irradiated group. The participation of reactive oxygen species in apoptosis induction was investigated by pretreating mice with the antioxidants superoxide dismutase, catalase, vitamin E or lipopolysaccharide before gamma-irradiation. Measurement of serum lipoperoxides showed oxidative stress in the gamma-irradiated mice and the protection given by the antioxidants. These results were confirmed using in vitro cultures of peritoneal macrophages: gamma-irradiated groups and antioxidant-pretreated gamma-irradiation groups showed results similar to those observed with in vivo irradiation. A loss of mitochondrial membrane potential (delta psi(m)) was also observed by microscopy in the gamma-irradiated cell cultures. Experiments with caspase inhibitors confirmed the participation of caspase 3 and caspase 9.