ABSTRACT
Abstract: Introduction. Minimal hepatic encephalopathy (MHE) can reverse after short-term treatment. However, relapse rate of MHE after stopping treatment has not been studied so far. We aimed to evaluate long-term (9 months) efficacy of a short-term (3 months) treatment of MHE with lactulose/rifaximin, for maintenance of remission from MHE. Material and methods. In this prospective study, consecutive patients with cirrhosis and MHE were treated with lactulose/rifaximin for 3 months. After treatment, they were followed up for 6 months. Psychometric testing for diagnosis of MHE was performed at baseline, 3 months and 9 months. Results. Of the 527 patients screened, 351 were found eligible and tested for MHE. Out of these, 112 (31.9%) patients had MHE (mean age 55.3 years; 75% males). They were randomized to receive Rifaximin (n = 57; 1,200 mg/day) or Lactulose (n = 55; 30-120 mL/day) for three months. At 3 months, 73.7% (42/57) patients in Rifaximin group experienced MHE reversal compared to 69.1% (38/55) in Lactulose group (p = 0.677). Six months after stopping treatment, 47.6% (20/42) in rifaximin group and 42.1% (16/38) patients in lactulose group experienced MHE relapse (p = 0.274). The overt hepatic encephalopathy development rate (7.1% vs. 7.9%) and mortality rate (0.23% vs. 0%) were similar in both groups. The Child-Turcotte-Pugh score and model for end stage liver disease (MELD) scores of patients who had MHE relapse were higher compared to those who didn’t. On multivariate regression analysis, MELD score was an independent predictor of MHE relapse. Conclusion. Of the patients who became MHE negative after short-term (3 months) treatment with rifaximin/lactulose, almost 50% had a relapse of MHE at 6 months follow-up.
Subject(s)
Humans , Middle Aged , Rifamycins/administration & dosage , Hepatic Encephalopathy/drug therapy , Lactulose/administration & dosage , Liver Cirrhosis/complications , Psychometrics , Recurrence , Rifamycins/adverse effects , Time Factors , Remission Induction , Drug Administration Schedule , Hepatic Encephalopathy/diagnosis , Hepatic Encephalopathy/etiology , Multivariate Analysis , Prospective Studies , Risk Factors , Treatment Outcome , Rifaximin , India , Lactulose/adverse effects , Liver Cirrhosis/diagnosis , Neuropsychological TestsABSTRACT
Administration of Isoniazid [INH] and Rifampicin [RIF] the most common medication prescribed against tuberculosis, produces many metabolic and morphological aberrations in liver due to the fact thai liver is the main detoxifying site for these antitubercular drugs. This work was done to study the hepatoprotective effect of garlic and vitamin [vit] E aginst hepatotoxic effect of INH, and RIF. The expriemental work was done in Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Minia University in a period of April to June 2011. One hundred and sixty adult male albino rats weighting 150-200 grams were divided into seven groups, one control and the other six for the drugs. Control group is subdivided into four subgroups [la, Ib, Ic, Id]. Group II ingested Garlic oil, group III ingested vitamine E, group IV ingested INH+ RIF, group V ingested INH+ RIF+ Garlic oil, group VI ingested INH+ RIF+ vit E, and finally group VII ingested INH+ RIF+ Garlic oiH vit E. The ingestion was done through orogastric tube. After four weeks biochemical studies [ALT, AST, and Total Bilirubin] were done for all rats in all groups, then the rats were sacrified and histopathological studies were done for their livers. Biochemical analysis revealed significant increased in AST, ALT, and Total Bilirubin in the group IV, V, VI and VII in comparison with control groups, and revealed significant decrease in the group V, VI, and VII in comparison with group IV. Histopathological examination of the group IV revealed necro-inflammatory foci with infilteration of the hepatic lobules with inflammatory cells and inflammation in the portal tract. Histopathological examination of the liver section of group V, VI, and VII showed mild necrosis and inflammation in hepatic lobules, and showed mild inflammation in the portal tract. We concluded that the liver is highly affected by ingestion of INH and RIF. But ingestion of garlic and /or vit E which is naturally occurring antioxidants can decrease this harmful effect of these two drugs on the liver
Subject(s)
Male , Animals, Laboratory , Rifamycins/adverse effects , Liver/pathology , Histology , Protective Agents , Garlic/adverse effects , Vitamin E , Treatment OutcomeABSTRACT
O uso da rifamicina sv intraperitoneal e a sua influência na formação de aderências peritoneais pós-operatórias (APs), foram analisados num estudo experimental em 90 ratos, machos, da linhagem Wistar-UNIG, distribuídos em dois grupos iguais. O grupo A (n = 45) foi submetido à laparotomia e instilação de 2 mL de solução salina de cloreto de sódio a 0,9 por cento, realizando-se movimento digital rítmico, nos quatro quadrantes da cavidade peritoneal, totalizando um tempo de manuseio de dois minutos. Após este procedimento, a solução remanescente foi aspirada com seringa, seguida de laparorrafia imediata. O grupo B (n = 45), foi submetido a procedimento semelhante com a instilação de uma solução de rifamicina sv 500mg diluída em 500mL de solução salina de cloreto de sódio a 0,9 por cento, utilizando manobra idêntica àquela utilizada no grupo A. Os animais do grupo A e os do grupo B foram separados em três subgrupos com igual número (n = 15) de acordo com o período de eutanásia, que foi de 7, 14 e 21 dias pós-operatório. As aderências peritoneais foram quantificadas nos seus respectivos períodos de eutanásia, utilizando um método descrito por MORENO-EGEA, AGUAYO, ZAMBUDIO e PARRILLA (1993). O grupo B apresentou aderências significantemente mais intensas que o grupo A em todos os subgrupos. Esta diferença foi mais marcante nos animais submetidos à eutanásia após 21 dias.