Impact of Subtotal Parathyroidectomy on Clinical Parameters and Quality of Life in Hemodialysis Patients with Secondary Hyperparathyroidism

BACKGROUND: Impairment of quality of life (QOL) is a key clinical characteristic of patients with end-stage renal disease (ESRD), and can be especially severe in the presence of secondary hyperparathyroidism (SHPT). Despite the proven success of parathyroidectomy (PTX) in controlling biochemical parameters in patients with severe SHPT, evidence is lacking regarding the effects of PTX on various clinical outcomes, including QOL.METHODS: Twenty ESRD patients on maintenance hemodialysis with SHPT who underwent subtotal PTX were included in an observational longitudinal study. All studied patients underwent history-taking, clinical examinations, and laboratory investigations, including a complete blood count and measurements of serum calcium, phosphorus, magnesium, parathyroid hormone (PTH), and albumin levels preoperatively and at 3 months postoperatively. QOL was assessed before surgery and at 3 months after surgery using the Kidney Disease Quality of Life 36-Item Short-Form instrument.RESULTS: After PTX, significant decreases in serum PTH and phosphorus levels were observed, as well as a significant increase in serum magnesium levels. Significant weight gain and improvements of QOL were also detected postoperatively.CONCLUSION: Subtotal PTX seems to be an efficient alternative to medical management in uncontrolled cases of SHPT, as it is capable of controlling the biochemical derangements that occur in hyperparathyroidism. Furthermore, PTX had a beneficial effect on clinical outcomes, as shown by weight gain and improvements in all QOL scales.

Persistent oxidative stress in patients with chronic active hepatitis-C infection after antiviral therapy Failure

Oxidative stress and hepatocellular pathological changes are common associations with chronic hepatitis C virus [CHC] disease. The aim of this study was to assess serum antioxidant-oxidant [Redox] balance in patients with CHC infection before and after intake of the traditional antiviral therapy [pegylated interferon alpha-2b and oral ribavirin]. Blood samples from 50 biopsy-proven CHC patients, with no prior anti-viral treatment and persistently elevated serum transaminase levels for 6 months, as well as 15 age- and sex-matched healthy subjects were used for determination of the antioxidants: reduced glutathione [GSH], superoxide dismutase [SOD], alpha tocopherol and ascorbic acid as well as lipid peroxidation [LPO] index [malondialdehyde [MDA]]. The measurements were repeated in the diseased group 25 weeks after pegylated interferon alpha-2b and ribavirin combination therapy. Serum levels of bilirubin, aspartate aminotransferase [AST], and alanine aminotransferase [ALT] were significantly higher in CHC patients than in the control group [P < 0.05]. Pretreatment serum MDA values were significantly higher in patients with CHC infection than the control group [P < 0.001], while serum antioxidant levels were significantly lower [P < 0.001]. Responders [10 patients] had lower pretreatment serum levels of MDA than non-responders [35 patients] [P < 0.001]. Both groups were comparable for the antioxidant serum levels. There was significant negative correlation between serum MDA and serum SOD, GSH, alpha tocopherol, and ascorbic acid concentrations in CHC patients. On the other hand, there was no correlation between the studied parameters and serum bilirubin, albumin, ALT, and AST. Redox imbalance was detected in patients with CHC. Responders had significantly lower levels of MDA than non-responders. Serum MDA may be used as a pretreatment predictor of response to antiviral treatment in patients with CHC

Assessment of some antioxidant vitamins in essential hypertension and renal-related hypertension

Background: hypertension [HTN] and chronic renal failure [CRF] are known risk factors for atherosclerosis. Oxidative stress has been implicated as an important etiologic factor in this complication. Antioxidants can alleviate the process of thermogenesis through multifactorial reactions that finally inhibit lipid peroxidation

Objectives: this work aimed to determine concentrations of the main antioxidant vitamins [serum alpha tocopherol, serum Beta-carotene and plasma ascorbic acid] in essential HTN and to assess the possible effect of hypertension due to end-stage renal disease [ESRD] on these antioxidant vitamins

Subjects and Methods: serum alpha-tocopherol, serum B-carotene and plasma ascorbic acid concentrations were determined by spectrophotometric methods in thoroughly diagnosed 20 patients with essential HTN and 20 patients with renal related hypertension [HTN+CRF]. Similar investigations were done for 15 clinically healthy control volunteers

Results: serum concentrations of alpha-tocopherol were subnormal in both essential HTN and renal related hypertension [HTN+CRF] but the decrease was only significant in the latter group. Subsequently, the difference between the essential HTN renal related hypertension groups was significant. With regard to Beta-carotene, its serum concentration was significantly lower than normal in both essential HTN and HTN CAF but the difference between both patient groups was insignificant. With regard to plasma ascorbic acid, its concentration was significantly lower in both essential HTN and HTN + CRF groups than normal mean value but the mean value of plasma ascorbic acid in HTN+ CRF was significantly lower than that in essential HTN alone

Conclusion: HTN is significantly related to the main antioxidant vitamins [a-tocopherol, Beta-carotene and ascorbic acid]. CRF has an additive effect to HTN on both water soluble antioxidant vitamin [ascorbic acid] and lipid soluble forms [alpha tocopherol and Beta-carotene]