Navegando por Palavras-chave "interleukins"
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- ItemAcesso aberto (Open Access)Avaliação do efeito da s(+)cetamina associada a remifentanila na dor e hiperalgesia pós-operatória em colecistectomia videolaparoscópica: estudo randomizado, duplo-cego(Universidade Federal de São Paulo (UNIFESP), 2014-11-26) Leal, Plinio da Cunha [UNIFESP]; Sakata, Rioko Kimiko [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The use of remifentanil results in short-term analgesic effect and is related to the phenomenon of opioid induced hyperalgesia. Some mechanisms have been proposed to explain the phenomenon of hyperalgesia, including the activation of N-methyl-Daspartate (NMDA). The association of blocking NMDA receptor, S(+)ketamine, to remifentanil can promote better analgesia and longer duration. The aim of this study was to determine if the association of ketamine to remifentanil promotes better postoperative analgesia and reduces postoperative hyperalgesia, evaluated with algometer, monofilaments and cytokine dosage. Methods: The study was a prospective, randomized, double-blind clinical trial, including 60 patients ≥ 18 years of age submitted to laparoscopic cholecystectomy. Anesthesia was induced with remifentanil (1 μg.Kg-1), propofol and atracurium. Patients in G1 received remifentanil (0.4 μg.Kg-1.min-1) and ketamine (5 μg.Kg-1.min-1); patients in G2 received remifentanil (0.4 μg.Kg-1.min-1) and normal saline. The dose was increased or decreased as needed. The infusion of the solutions was continued until skin closure. Postoperative pain was treated with morphine PCA. The parameters evaluated were: time to first PCA complementation; total morphine consumption in 24 h; intensity of postoperative pain; hyperalgesia using algometer and monofilaments; allodynia using soft brush; extent of hyperalgesia using a 300g monofilament; and inflammatory respose through interleukin 6, 8 and 10 dosage. Adverse effects were noted. Results: There was no difference in demographic characteristics between the groups, as well as the duration of surgery, anesthesia and time to awakening. There was no statistically significant difference in time for the morphine dose requirement between G1 (18 min) and G2 (15 min), or in pain intensity at the evaluation period. There was no statistically significant difference between groups in the dose of remifentanil, as well as the total dose of morphine consumption (27.4 ± 18.3 mg for G1 and 27.7 ± 12.9 mg for G2). There was a statistically significant difference in hyperalgesia evaluated with monofilaments in the thenar eminence of the hand 24 hours after surgery (p = 0.019, student's t test), with a lower sensitivity threshold seen in patients in group 2. No statistically significant difference was observed in hyperalgesia evaluated with algometer, allodynia with soft brush or in the extent of hyperalgesia. There was no statistical difference in interleukin 6, 8 and 10 dosage between the groups at the evaluation times. Regarding adverse effects, there was a statistically significant difference in visual changes, sedation and vomiting, with a higher rate in G1. Conclusions: The association of ketamine (5 μg.kg- 1.min-1) to remifentanil for laparoscopic cholecystectomy did not change postoperative pain intensity, time to first supplementary analgesia or total dose of morphine in 24 hours, although it was promoted a reduction in hyperalgesia evaluated using monifilaments in the thenar eminence of the hand 24 hours after surgery; there was no statistical difference in hyperalgesia seen using a algometer, allodynia using a soft brush and in IL-6, IL-8 e IL-10 dosage
- ItemSomente MetadadadosExhaled nitric oxide for monitoring childhood asthma inflammation compared to sputum analysis, serum interleukins and pulmonary function(Wiley-Blackwell, 2008-02-01) Paro-Heitor, Maria Luisa Z.; Bussamra, Maria Helena C. F.; Saraiva-Romanholo, Beatriz M.; Martins, Milton A.; Okay, Thelma Suely; Rodrigues, Joaquim Carlos; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)The level of fractional exhaled nitric oxide (FENO) is significantly elevated in uncontrolled asthma and decreases after anti-inflammatory therapy the aim of this prospective study was to analyze the behavior of FENO in the follow-up and management of the inflammation in asthmatic pediatric patients treated with inhaled corticosteroids (ICS), compared to sputum cellularity, serum interleukins (IL), and pulmonary function. Twenty-six clinically stable asthmatic children aged from 6 to 18 years, previously treated or not with ICS were included. Following an international consensus (GINA), the patients were submitted to standard treatment with inhaled fluticasone for 3 months according to the severity of the disease. During this period, each patient underwent three assessments at intervals of approximately 6 weeks: Each evaluation consisted of the measurement of FENO, determination of serum interleukins IL-5, IL-10, IL-13, and interferon gamma (INF-gamma), spirometry and cytological analysis of spontaneous or induced sputum. A significant reduction in mean FENO and IL-5, without concomitant changes in FEV1, was observed along the study. There was no significant correlation between FeNO and FEV1 in the three assessments. A significant correlation between FeNO and IL-5 levels was only observed in the third assessment (r = 0.499, P=0.025). in most patients, serum IL-10, IL-13, and INF-gamma concentrations were undetectable throughout the study Sputum samples were obtained spontaneously in 11 occasions and in 56 by induction with 3% hypertonic saline solution (success rate: 50.8%), with 39 (69.9%) of them adequate for analysis. Only two of the 26 patients produced adequate samples in the three consecutive evaluations, which impaired the determination of a potential association between sputum cellularity and FeNO levels throughout the study. in conclusion, among the parameters of this study, it was difficult to perform and to interpret the serial analysis of spontaneous or induced sputum. Serum interleukins, which remained at very low or undetectable levels in most patients, were not found to be useful for therapeutic monitoring, except for IL-5 that seems to present some correlation with levels of FeNO exhaled. Monitoring of the mean FEV1 indicated no significant variations during the treatment, demonstrating that functional stability or the absence of obstruction may not reflect the adequate management of asthma. Serial measurement of FeNO seemed to best reflect the progressive anti-inflammatory action of ICS in asthma.
- ItemAcesso aberto (Open Access)Sepse por Salmonella associada à deficiência do receptor da Interleucina-12 (IL-12Rbeta1)(Sociedade Brasileira de Pediatria, 2003-06-01) Costa-Carvalho, Beatriz Tavares [UNIFESP]; Iazzetti, Antônio V.; Ferrarini, Maria Aparecida G.; Campos, Sandra de Oliveira [UNIFESP]; Iazzetti, Marco Antônio; Carlesse, Fabianne Altruda de Moraes Costa [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); Santa Casa de Misericórdia de São Paulo Faculdade de Ciências Médicas Departamento de PediatriaOBJECTIVE: to present a case report of a child who developed sepsis by Salmonella enteritidis associated with the diagnosis of primary immunodeficiency. DESCRIPTION: a twenty-one months old boy presenting fever and skin lesions, bilateral pneumonia with pleural effusion and septic shock. Salmonella enteritidis was isolated in blood cultures and pleural fluid. The identification of the bacteria suggested the presence of the MIM syndrome. The diagnosis of IL-12Rbeta1 was confirmed after IL-12 and IFN-gamma levels were measured using patient cells in a culture medium. The results showed absence of IL-12 and the IFN-gamma post stimulation using BCG. COMMENTS: a severe infection by Salmonella enteritidis is strongly suggestive of an immune system dysfunction. Laboratory tests for humoral, cellular and innate immunity were performed. Interleukin 12 receptor beta1 (IL-12 Rbeta1) deficiency was confirmed after specific laboratory evaluation. The use of INF-gamma is recommended in severe cases.
- ItemSomente MetadadadosTumour necrosis factor-alpha plus interleukin-10 low producer phenotype predicts acute kidney injury and death in intensive care unit patients(Wiley-Blackwell, 2013-08-01) Dalboni, Maria Aparecida [UNIFESP]; Quinto, B. M. R. [UNIFESP]; Grabulosa, C. C. [UNIFESP]; Narciso, R. [UNIFESP]; Monte, J. C. [UNIFESP]; Durao, M. [UNIFESP]; Rizzo, L. [UNIFESP]; Cendoroglo, M. [UNIFESP]; Santos, O. P. [UNIFESP]; Batista, M. C. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Tufts Univ New England Med CtrGenetic polymorphism studies of cytokines may provide an insight into the understanding of acute kidney injury (AKI) and death in intensive care unit (ICU) patients. the aim of this study was to investigate whether the genetic polymorphisms of -308 G < A tumour necrosis factor (TNF)-alpha, - 174 G > C interleukin (IL)- 6 and - 1082 G > A IL- 10 may predispose ICU patients to the development of AKI and/or death. in a prospective nested case-control study, 303 ICU patients and 244 healthy individuals were evaluated. the study group included ICU patients who developed AKI (n = 139) and 164 ICU patients without AKI. the GG genotype of TNF-alpha (low producer phenotype) was significantly lower in the with AKI than without AKI groups and healthy individuals (55 versus 62 versus 73%, respectively; P = 0.01). When genotypes were stratified into four categories of TNF-alpha/IL-10 combinations, it was observed that low TNF-a plus low IL- 10 producer phenotypes were more prevalent in patients with AKI, renal replacement therapy and death (P < 0.05). in logistic regression analysis, low TNF-alpha producer plus low IL-10 producer phenotypes remained as independent risk factors for AKI and/or death [ odds ratio (OR) = 2.37, 95% confidence interval (CI): 1.16- 4.84; P = 0.02] and for renal replacement therapy (RRT) and/or death (OR = 3.82, 95% CI: 1.19- 12.23; P = 0.02). in this study, the combination of low TNF-alpha plus low IL- 10 producer phenotypes was an independent risk factor to AKI and/or death and RRT and/or death in critically ill patients. Our results should be validated in a larger prospective study with long- term follow- up to emphasize the combination of these genotypes as potential risk factors to AKI in critically ill patients.