SummaryBackgroundThe study was undertaken to assess the influence of functional -308G/A TNF-α (rs 1800629) and -174G/C IL-6 (rs1800795) promoter polymorphisms on the therapeutic response to etanercept, a TNF-α blocker, in patients with rheumatoid arthritis (RA).MethodsSeventy-three patients suffering from active RA were studied, at baseline and 6 and 12 months after therapy. The therapeutic response was estimated according to the European League Against Rheumatism response criteria. Patients were genotyped for -308G/A TNF-α and -174G/C IL-6 polymorphisms by the PCR-RFLP method, and the influence of genotype on etanercept response was assessed.ResultsNo difference in the percentage of responders (patients who had DAS28 improvement > 1.2) between patients with the TNF-α-308GG and GA and AA genotype was detected after 6 and 12 months of treatment. After 12 months of treatment the percentage of responders was significantly increased in patients with the IL-6 -174GG genotype compared with those with the GC or CC genotype (p=0.006 by Chi-square test). Evaluation of the patients according to their combined IL-6/TNF-α genotypes showed that patients with the IL-6 -174GG / TNF-α-308GG genotype were more frequent among the responders compared to those with other combined genotypes (p=0.022 by Chi-square test). More precisely, all patients with the combined IL-6 -174GG / TNF-α-308GG genotype were responders after 12 months of etanercept treatment.ConclusionsThe study suggests that patients who are genetically low TNF-α and IL-6 producers are the best responders to etanercept therapy.
Infekcije su čest uzrok morbiditeta i mortaliteta u dečijem uzrastu. Evaluacija i tretman dece sa visokom temperaturom bez poznatog uzroka infekcije veliki su izazov za kliničare. Kliničkim pregledom se ne može isključiti ozbiljna bakterijska infekcija. Rana i brza dijagnoza veoma je značajna za pravovremenu i adekvatnu terapiju (1, 2). STRUČNI RAD SAŽETAK Cilj. Cilj studije bio je da se proceni značaj određivanja C-reaktivnog proteina i prokalcitonina, u dijagnostikovanju sepse kod febrilne dece. Metode. U studiji su korišćeni podaci iz istorija bolesti 82 deteta (uzrast od 30 dana do 16 godina), koja su lečena na Odeljenju intenzivne nege Klinike za pedijatriju Kliničkog centra "Kragujevac" u Kragujevcu. Deca su podeljena u dve grupe prema određenim kriterijumima za definisanje sepse. Odmah posle prijema, praćene su vrednosti sedimentacije eritrocita, ukupnog broja leukocita, C-reaktivnog proteina i prokalcitonina, u određenim vremenskim intervalima i njihove vrednosti su analizirane kao pokazatelji kontrole bolesti i uspeha antibiotske terapije. Rezultati. Sepsa je dijagnostikovana kod 47 (57,32%) dece, kod 31 (37,8%) dijagnostikovane su lokalizovane infekcije respiratornog ili urinarnog trakta, a kod četiri deteta dokazan je serozni meningitis. U grupi sa sepsom vrednosti ispitivanih parametara statistički su značajno više u odnosu na kontrolnu grupu. Najsenzitivniji parametar u dijagnostici sepse jeste prokalcitonin (senzitivnost = 87,2%), dok najmanju senzitivnost pokazuje sedimentacija eritrocita (senzitivnost = 57,4%).
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