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      Evaluación hepática y renal en pacientes que recibieron conjuntamente zinc y tratamiento antituberculosis acortado Translated title: Hepatic and renal evaluation in patients that received jointly zinc and antituberculosis shortened treatment

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          Abstract

          La terapia de la tuberculosis con el esquema 2RHZE/4HE comprende la administración durante seis meses de rifampicina, isoniazida, pirazinamida y etambutol, de las cuales las tres primeras son potencialmente hepatotoxicas y excepcionalmente nefrotoxicas. La tuberculosis produce depleción de la concentración de zinc lo que incrementa la susceptibilidad a la cronicidad de la infección. Objetivo: evaluar el efecto de la administración conjunta de zinc y la terapia 2RHZE/4HE sobre la función hepática y renal en pacientes con tuberculosis pulmonar. Métodos: estudio descriptivo de tipo caso control, doble ciego aleatorizado con 22 pacientes con tuberculosis pulmonar en terapia farmacológica y 22 controles sanos reclutados en los centros de salud Sebastián pagador y Alalay. Los pacientes fueron divididos aleatoriamente en dos grupos a los que se les administró zinc (45mg/día) o placebo durante tres meses. En todos los pacientes se tomó muestras de sangre antes y después de la intervención para medir pruebas de función renal y hepática. En los sujetos control la muestra de sangre se tomó al inicio del estudio para realizar las mismas determinaciones. Resultados: no se encontró deferencias en la concentración de marcadores específicos de daño hepático o renal. Conclusiones: la adición de un suplemento diario de 45mgr de zinc a la terapia 2RHZE/4HE no produjo daño renal ni hepático en las personas evaluadas.

          Translated abstract

          Tuberculosis therapy with the 2RHZE/4HE scheme comprises the administration for six months of rifampin, isoniazid, pyrazinamide and ethambutol, of which the first three are potentially hepatotoxic and exceptionally nephrotoxic. Tuberculosis produces depletion of the zinc concentration which increases the susceptibility to chronicity of the infection. Objective: to evaluate the effect of co-administration of zinc and 2RHZE/4HE therapy on hepatic and renal function in patients with pulmonary tuberculosis. Methods: a, descriptive case-control, randomized double-blind study. 22 patients with pulmonary tuberculosis receiving pharmacological therapy and 22 healthy controls recruited in the health centers Sebastián Pagador and Alalay. The patients were randomly divided into two groups. Who were given zinc (45mg/day) or placebo for three months. All patients were blood sampling before and after intervention to measure hepatic and renal functional tests. For the control subjects were blood sampling before the study to do the same test. Results: no deference was found in the concentration of specific markers of hepatic or renal damage. Conclusions: the addition of a daily supplement of 45 mg of zinc to 2RHZE/4HE therapy did not cause hepatic, neither renal damage in the people evaluated.

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          Most cited references12

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          Zinc toxicity

          G Fosmire (1990)
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            Antituberculosis therapy-induced acute liver failure: magnitude, profile, prognosis, and predictors of outcome.

            Antituberculosis therapy (ATT)-associated acute liver failure (ATT-ALF) is the commonest drug-induced ALF in South Asia. Prospective studies on ATT-ALF are lacking. The current study prospectively evaluated the magnitude, clinical course, outcome, and prognostic factors in ATT-ALF. From January 1986 to January 2009, 1223 consecutive ALF patients were evaluated: ATT alone was the cause in 70 (5.7%) patients. Another 15 (1.2%) had ATT and simultaneous hepatitis virus infection. In 44 (62.8%) patients, ATT was prescribed empirically without definitive evidence of tuberculosis. ATT-ALF patients were younger (32.87 [+/-15.8] years), and 49 (70%) of them were women. Most had hyperacute presentation; the median icterus encephalopathy interval was 4.5 (0-30) days. The median duration of ATT before ALF was 30 (7-350) days. At presentation, advanced encephalopathy and cerebral edema were present in 51 (76%) and 29 (41.4%) patients, respectively. Gastrointestinal bleed, seizures, infection, and acute renal failure were documented in seven (10%), five (7.1%), 26 (37.1%), and seven (10%) patients, respectively. Compared with hepatitis E virus (HEV) and non-A non-E-induced ALF, ATT-ALF patients had nearly similar presentations except for older age and less elevation of liver enzymes. The mortality rate among patients with ATT-ALF was high (67.1%, n = 47), and only 23 (32.9%) patients recovered with medical treatment. In multivariate analysis, three factors independently predicted mortality: serum bilirubin (>or=10.8 mg/dL), prothrombin time (PT) prolongation (>or=26 seconds), and grade III/IV encephalopathy at presentation. ATT-ALF constituted 5.7% of ALF at our center and had a high mortality rate. Because the mortality rate is so high, determining which factors are predictors is less important. A high proportion of patients had consumed ATT empirically, which could have been prevented.
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              Requirements and toxicity of essential trace elements, illustrated by zinc and copper.

              Early signs of toxicity of essential trace elements are important. Some trace elements are available over-the-counter (OTC) and/or are present at industrial waste sites. Physicochemically similar trace elements compete for ligands, impairing functions, which is exemplified by the zinc-copper antagonism described long ago by Van Campen, Hill and Matrone, and Klevay. Intestinal absorption of copper is inhibited by zinc. Thus risk of copper deficiency is increased when the molar ratio of zinc to copper (Zn:Cu) is high. As shown by experiments, copper deficiency can occur in humans. Manifestations include decreased erythrocyte copper-zinc superoxide dismutase, increased low-density-lipoprotein cholesterol, decreased high-density-lipoprotein cholesterol, decreased glucose clearance, decreased methionine and leucine enkephalins, and abnormal cardiac function. Calculation of a preliminary reference dose for OTC zinc that assumed high bioavailability and uncertain copper intakes established 9 mg as a safe amount for 60-kg adults.
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                Author and article information

                Journal
                gmb
                Gaceta Médica Boliviana
                Gac Med Bol
                Facultad de Medicina de la Universidad Mayor de San Simón (Cochabamba, , Bolivia )
                1012-2966
                June 2019
                : 42
                : 1
                : 06-10
                Affiliations
                [01] orgnameFacultad de Medicina UMSS orgdiv1Centro Universitario de Medicina Tropical aleidav_15@ 123456hotmail.com
                Article
                S1012-29662019000100002 S1012-2966(19)04200100002
                26087492-c6cd-43a4-9efd-486c0cc52c32

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 04 February 2019
                : 26 November 2018
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 21, Pages: 5
                Product

                SciELO Bolivia

                Categories
                Artículo Original

                tuberculosis pulmonar,hepatic and renal function,zinc,suplemento nutricional,pulmonary tuberculosis,nutritional supplement,función hepática y renal

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