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Hypothesis: Hyperhomocysteinemia is an indicator of oxidant stress

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In patients with RF, plasma concentrations of the cytokines TNF, interleukin IL-6, and IL-8 were measured as sharply increasing at 24 hours after penicillin treatment when patients were experiencing a JHR, with a return toward baseline levels 12 hours after therapy (Figure 1 )

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Most patients see initial improvements within 3-4 weeks , with continued progress over months

So, how do we know that heme isnt just some innocent bystander