Marcadores lipídicos en suero y síndrome coronario agudo en pacientes egresados del servicio de cardiología. Hospital Faustino Pérez / Lipid markers in serum and acute coronary syndrome in patients discharged from service of cardiology. Hospital Faustino Pérez

RESUMEN Introducción: las enfermedades cardiovasculares actualmente son la principal causa de muerte en los países industrializados y se espera que también lo sean en los países en vías de desarrollo en el año 2020. Entre ellas la enfermedad arterial coronaria es la manifestación más prevalente, y se asocia a alta morbimortalidad. La ateroesclerosis es su principal génesis y por tanto los trastornos del metabolismo de los lípidos. Objetivo: determinar el perfil lipídico en pacientes egresados por síndrome coronario agudo. Materiales y métodos: se realizó una investigación descriptiva, transversal, correlacional en los pacientes egresados del servicio de cardiología del hospital Faustino Pérez en el período comprendido entre enero y diciembre del 2015. Resultados: se observó un aumento de los lípidos colesterol, triglicéridos, LDL-c, VLDL y Lp (a) en más del 50% de los pacientes estudiados. Los índices de Apo B/Apo A y Col/HDL-c marcaron como indicador de alto riesgo en un 67,5 y 58,75 % respectivamente. La HDL-c considerada como factor protector, resultó disminuida en más del 50% de los pacientes. Conclusiones: se detectó correlación entre el síndrome coronario agudo y trastornos en el metabolismo de los lípidos. Se recomienda realizar estudios observacionales epidemiológicos para determinar la verdadera influencia de estos factores como agente causal de síndrome coronario agudo (AU).

ABSTRACT Introduction: Currently, cardiovascular diseases are the main cause of death in developed countries, and it is believed that they also will be the same in developing countries in 2020 year. Among them, coronary arterial disease is the most prevalent manifestation, and is associated to high morbi-mortality. Atherosclerosis is its most important cause and consequently the disorders of the lipids metabolism. Objective: determining the lipid profile in patients discharged for acute coronary syndrome. Materials and methods: a descriptive, cross-sectional, correlational research was carried out in patients discharged from the service of Cardiology of the hospital Faustino Perez in the period from January to December 2015. Results: it was found an increase of the lipids cholesterol, triglycerides, LDL-c, VLDL and Lp(a) in more than 50 % of the studied patients. The indexes of Apo B/Apo A and Col/HDL-c were high risk indicators in 67.5 and 58.75 % respectively. HDL-c, considered as a protecting factor, was diminished in more than 50 % of the patients. Conclusions: a correlation was found between the acute coronary syndrome and disturbances in the lipids metabolism. We recommend performing epidemiologic, observational studies to determine the real influence of these factors as causal agent of the acute coronary syndrome (AU).

Estresse oxidativo no plasma sanguíneo de indivíduos submetidos ao esforço físico agudo seguido de crioimersão corporal / Oxidative stress in blood plasma in persons who are submitted to cold water immersion after acute physical exercise

O objetivo deste estudo foi analisar a influência da crioimersão corporal (CIC) imediata ao esforço físico agudo no estresse oxidativo (EOx) no plasma sanguíneo. Participaram do presente estudo 12 homens, com idade média de 22±1 anos, submetidos ao teste de esforço físico intenso em esteira, seguido de CIC em um tanque com água a 10ºC durante 10 minutos contínuos. Do repouso ao final da CIC, os indivíduos foram monitorados através de alguns parâmetros como: o índice de percepção subjetiva do esforço (IPE) expresso conforme escala de Borg, frequência cardíaca (FC), pressão arterial (PA) e temperatura corporal (TC) através da temperatura timpânica. A análise morfológica do EOx plasmático foi realizada de acordo com o método denominado Morfologia Óptica do Estresse Oxidativo no Plasma (MEOP), utilizando-se gotas de sangue capilar. Observou-se uma significativa elevação (p<0,01) no grau do estresse oxidativo plasmático após a realização do esforço físico, em relação ao respectivo grau em repouso. Porém, esta elevação no grau do EOx foi significativamente reduzida (p<0,001) em função da CIC. Embora sejam necessários mais estudos científicos com o MEOP, concluiu-se que, para o presente estudo, este teste mostrou-se viável. Os dados encontrados no presente estudo sugerem que a CIC em água a 10ºC por 10 minutos imediatos ao esforço físico agudo com intensidade alta, apresenta-se como uma importante conduta fisioterapêutica para a normalização do EOx pós-esforço.

The purpose of this study was to analyze the influence of cold water immersion (CWI) following acute physical exercise on the oxidative stress in the blood plasma. Twelve men with average age of 22±1 years old, participated this study. All of them underwent the treadmill stress test followed by CWI in tank with water at 10ºC for 10 minutes. During this process, they were monitored and a set of parameters were analyzed: physical effort perception (Borg Scale), Heart Rate (HR), Blood Pressure (BP) and body heat, by measuring tympanic temperature. The morphological analysis of oxidative stress in blood plasma was done in accordance with a method known as Optical Morphology of the Oxidative Stress on Blood Plasma, which uses drops of capillary blood. A significant increase (p<0.01) in the rate of oxidative stress in plasma was noted after intense physical effort when compared with the rate of stress while at rest. However, the stress rate was significantly decreased (p<0.001) after CWI. Although further scientific studies should be carried out on the above mentioned test, may be concluded that, in the present study, the test has proven itself viable. The data found in the present study suggest that cold water immersion at 10ºC for 10 minutes following high intensity physical effort appears to be an important physical therapeutic measure towards the normalization of oxidative stress.

Implications of free radicals and antioxidant levels in carcinoma of the breast: a never-ending battle for survival.

BACKGROUND: Under normal circumstances, there is a steady balance between the production of oxygen derived free radicals and their destruction by the cellular antioxidant system inside the human body. However, any imbalance between the levels of these oxidants and antioxidants might cause DNA damage and may lead to cancer development. The aim of this study was to evaluate the level of antioxidants and free radicals in blood and tissue of cancer patients and compare these levels at different TNM stages to derive the possible role of free radicals and antioxidant enzymes in the etiology of breast cancer. MATERIALS AND METHODS: This study includes 30 patients suffering from cancer breast and 20 patients as controls who had benign breast diseases. Circulating lipid peroxide (Malonyldialdehyde [MDA]) levels and activities of the defensive enzymes (Superoxide Dismutase [SOD] and Catalase [CAT]) were estimated in the blood and breast tissue of these patients. RESULTS: Increased levels of free radicals and low levels of antioxidants were observed in malignant tissue. An elevated lipid peroxide concentration was found in the tissue of all the cancer breast patients as evidenced by an increase in the mean MDA level seen with increasing TNM stage of carcinoma breast. Levels of antioxidants SOD and CAT were decreased in cancer patients. CONCLUSION: The results of our study suggest that free radical activity is enhanced in cancer breast patients while the antioxidant defense mechanism is weakened. This activity is enhanced with the increasing severity of cancer as depicted in different TNM stages of breast cancer.

Impact of oral vitamin E supplementation on oxidative stress & lipid peroxidation in patients with polymorphous light eruption.

BACKGROUND & OBJECTIVES: Polymorphous light eruption (PMLE) is a photo-induced disease which clinically manifests in the form of pruritic eruptions on sun/light exposed parts. Little is known about lipid peroxidation and free radical scavengers in patients during PMLE. The present study was therefore undertaken to evaluate oxidative stress and levels of antioxidant enzymes in patients of PMLE. METHODS: The PMLE was diagnosed clinically by a consultant dermatologist and validated independently by another and through histopathologic findings. Blood samples were collected on day 1 and patients were given oral vitamin E supplementation (400 mg OD) along with topical sunscreen and advice for photo-protection. Samples were collected again after one week. The blood samples were evaluated for lipid peroxidation, oxygen free radical (OFR) scavenging enzymes, glutathione (GSH) and related enzymes such as glutathione reductase (GR), glutathione peroxidase (GPx), gamma glutamyl transpeptidase (GGT) and glutathione- S-transferase (GST) in erythrocytes and compared with healthy controls. RESULTS: The serum malondialdehyde (MDA) level was higher and GSH level was lower in PMLE cases as compared to controls. There was a significant decrease in superoxide dismutase (SOD) activity while activities of catalase (CAT) and glutathione related enzymes were increased in PMLE cases. Administration of oral vitamin E for one week, along with photoprotection resulted in a significant decrease in MDA levels and activities of all others enzymes except SOD. The GSH was replenished and returned to normal. INTERPRETATION & CONCLUSION: Oxidative stress and differential modulation of antioxidant enzymes in PMLE might play a pathogenic role in humans, which supports the incorporation of antioxidant drugs in the treatment protocol of the disease.

Estresse oxidativo e atuacao do sistema antioxidante como removedor de radicais livres no sangue periferico de pacientes hansenianos / Oxidativo Estresse and performance of the antirust system as remover of free radicals in the peripheral blood of hansenianos patients

A hanseniase e uma doença infecciosa cronica causada pelo mycobacterium leprae com um amplo espectro clinico e imunopatologico. Entre os mecanismos de defesa devenvolvidos pelo hospedeiro esta a geração de radicais livres, os quais promovem a destruição do bacilo. Os radicais livres são produzidos dentro das celulas por reaçoes endogeneas, geralmente oxidativas, que ocorrem em processos metabolicos normais, e temabem em condições anormais, como na inflamação causada por doença infecciosas. Este trabalho visa estudar a atividade de substâncias antioxidantes e sua relação com o estresse oxidativo gerado na resposta à hanseniase. Foram realizados experimentos com as enzimas superoxido dismutase(SOD) e catalase(CAT), além do antioxidantes glutationa(GSH) e a participação de óxido nitrico(NO) como indicador da presença de radicais livres. Os resultados foram comparados com um grupo controle e aqueles de pacientes sem tratamento e em tratamento com PQT. Os resultados obtidos indicam um aumento de até 280 por cento dos niveis dos antioxidantes, bem como dos metabolitos do oxido nitrico (596 por cento) em relação ao controle, sugerindo estresse oxidativo severo nos pacientes hansenianos. Os pacientes em tratamento mostram um aumento de até 87 por cento nos niveis de antioxidantes comparados ao controle, reduzindo a geração de radicais livres em relação aos individuos sem tratamento. Portanto, a medida do balanço entre defesas antioxidantes e a presença de radicais livres pode ser uma excelente ferramenta de estudo dos niveis de estresse oxidativo e sua contribuição na evolução da hanseniase.

Evaluation of vitamin E against deltamethrin toxicity in broiler chicks.

Deltamethrin toxicity was studied in broilers and vitamin E was evaluated for therapeutic management. Day old male broiler chicks were randomly divided into 3 groups consisting of 6 chicks in each. Group 1 was maintained as control for 6 wks, group 2 was fed on deltamethrin (100 mg/kg feed) for 6 wks and group 3 was fed on deltamethrin for the first 4 wks and during the subsequent 2 wks with vitamin E (300 mg/kg feed) with out deltamethrin. Weekly body weights, feed conversion ratio, glutathione (GSH) concentration and high density lipoproteins (HDL) were significantly (P < 0.05) reduced, while the activities of glutathione peroxidase (GSH-Px), glutathione reductase (GSH-R), catalase, aspartate aminotransferase (AST) and lactate dehydrogenase (LDH), and the lipid profile and renal biomarkers were increased significantly (P < 0.05) in group 2 and 3 at the end of 4th wk as compared to group 1. Following treatment with vitamin E during the last 2 wks in group 3, all the parameters in study revealed improvement. From this study, it is concluded that deltamethrin induces toxicity by oxidative damage in biological system and supplementing vitamin E in feed is useful in treating accidental toxicity.

Effect of esmolol on oxidant status and antioxidant activity in acute myocardial infarction.

AIMS AND OBJECTIVES: The role of oxygen free radicals in reperfusion injury to the heart in myocardial infarction (MI) has been postulated. In this study, the clinical and antioxidant effects of esmolol, an ultra-short acting beta blocker in patients of acute MI was studied. MATERIAL AND METHODS: This was a randomized, double-blind, controlled, prospective study. Total 30 patients with acute MI were included. All patients were thrombolysed with streptokinase. Fifteen of these patients were randomly selected to receive esmolol while other 15 patients served as controls. The parameters compared at 0, 2 and 24 hours between the esmolol group and the controls were--malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GPX). RESULTS: Patients with MI had 5.16 times higher MDA level at 0 hours (20.34 +/- 6.12 nmol/ml vs. 3.94 +/- 0.70 nmol/ml, p < 0.0001) than MDA level in normal healthy population. At 2 hours, patients with MI had 5.71 times higher MDA level compared to normal healthy population (22.51 +/- 5.51 nmol/ml vs. 3.94 +/- 0.70 nmol/ml, p < 0.0001). A statistically significant difference in MDA levels at 2 and 24 hours was observed in MI patients given esmolol (mean change 2.06 +/- 5.39 nmol/ml vs. -4.47 +/- 6.93 nmol/ml, p = 0.009). Esmolol infusion also caused significant difference in GPX level at 2 hours compared to controls (23.79 + 14.68 U/gm Hb vs 38.3 +/- 8.95 U/gm Hb, p = 0.003). CONCLUSION: Free radical levels are raised in patients with MI which may contribute to reperfusion injury. The antioxidant action of esmolol was clearly observed by significant difference in MDA level and GPX sparing effect. Large scale clinical trials may establish conclusively role of beta blockers as antioxidants as adjuvant to thrombolytic therapy in MI.

Free radical toxicity and antioxidants in Parkinson's disease.

Erythrocyte lipid peroxidation, oxidative hemolysis, erythrocyte antioxidant enzymes, viz. superoxide dismutase, glutathione reductase, glutathione peroxidase, catalase and plasma antioxidants, viz. vitamin A, vitamin E, vitamin C and ceruloplasmin have been determined by spectrophotometric methods in 15 patients with Parkinson's disease (PD) and in 50 controls. Lipid peroxidation, oxidative hemolysis and plasma ceruloplasmin were significantly higher in PD patients as compared to normals. Erythrocyte antioxidants in PD patients were not significantly different from the controls. However, plasma vitamin C in PD patients was significantly lower than the controls. It is concluded that these patients are under oxidative stress which points to a possible involvement of free radicals in PD.

Increased free radical activity in burns.

In burn trauma there is excessive activity of FR at the site of injury that result in oxidative stressful state. This is reflected as elevated blood levels of LPP, UA and CLP. The fall of AA in serum appears to counteract the oxidative stress. Increased eCAT activity occurs as a metabolic response to compensate the oxidative stress. These alterations in the biochemical parameters occur parallel to the degree of burn injury. It is suggested that therapeutic use of antioxidants may be beneficial in the clinical management of burn patients.

Effect of different dialysis membranes on endogenous antioxidant enzyme activity and lipid peroxidation in haemodialysis patients

This work aimed to clarify the most suitable type of the haemodialysis membranes in order to minimize the disequilibrium between the levels of oxidant and antioxidant factors in haemodialysis patients. This study was conducted on 79 subjects who were classified into 5 groups: The 1st group included 14 apparently healthy volunteers, the 2nd group included 13 patients with end stage renal disease [ESRD] just before the beginning of haemodialysis treatment [predialysis], the 3rd group included 18 patients with ESRD on maintenance haemodialysis using dialyzers equipped with cuprophane membrane, the 4th group included 14 patients using polysulphone membrane and the 5th group included 20 patients using hemophane membrane. All participants were subjected to thorough clinical examination and laboratory investigations [estimation of superoxide dismutase [SOD], glutathione peroxidase [GPx], catalase and lipids peroxides [MDA + 4-HNE], serum urea, creatinine, uric acid, fasting and postprandial blood sugar, haemoglobin, haematocrit, creatinine clearance and protein 24 hours urine]. The results revealed that serum lipid peroxides [MDA and 4-HNE] were significantly increased in all patients groups compared to the control group and more significantly elevated in the 3 dialyzed groups compared to the predialysis and alsosignificantly higher in the cuprophane group when compared to the other 2 membranes [polysulphone and haemophane]; while no significant change was detected between the haemophane and the polysulphone groups. There were significantly decreased levels of endogenous antioxidant enzymes [SOD, GPx and plasma catalase] in all patients when compared to the control group. SOD and catalase were significantly lower in the dialyzing groups when compared to the predialysis one; while GPx showed significant decrease only on using cuprophane membrane but not with polysulphone and haemophane. Significant negative correlation between serum lipid peroxides and each of the three antioxidant enzymes was found. Positive correlation existed between haemoglobin concentration, haematocrit and antioxidant enzyme activities. This study confirmed the presence of disequilibrium between the oxidative stress and the antioxidant protective enzymes in uraemic patients; this permanent oxidative stress could act as important mediator to the progression of renal failure and to associated complications such as anaemia and atherosclerosis. This disequilibrium is maximally enhanced by the use of incompatible membranes [cuprophane], while it is significantly reduced on using biocompatible ones [polysulphone and haemophane]. Consequently, in view of the results, the universal use of biocompatible membranes for haemodialysis in a trial to decrease the hazardous effects of haemodialysis is recommended

Improvement in oxidative status with yogic breathing in young healthy males.

The modern living lifestyle is known to produce various physical and psychological stresses and subject the individual to produce oxidative stresses as well. The aim of this study has been to assess the effect of yogic breathing exercises (pranayama) on the oxidatives stress. The study group consisted of 30 young male volunteers, trained for the purpose of this study and an equal number of controls were used. The free radicals and Super oxide dismutase levels were measured before the study and at the end of the study. The free radicals were decreased significantly in the study group but the SOD was increased insignificantly as compared to the control group. Yogic breathing exercises not only help in relieving the stresses of life but also improve the antioxidant status of the individual. An improvement in the antioxidant status is helpful in preventing many pathological processes that are known with impaired antioxidant system of body.

Free oxygen radicals in acute renal failure.

OBJECTIVE: To assess the levels of free oxygen radicals in acute renal failure and their predictive value in clinical outcome. DESIGN: Prospective. SETTING: Intensive care unit. METHODS: Study was conducted in 50 children (25 with acute renal failure and 25 age and sex matched controls). Blood urea, serum creatinine, serum protein, uric acid and free oxygen radical markers were estimated in both groups. Superoxide dismutase (SOD), glutathione peroxidase(GPx) and lipid peroxide (LPO) were estimated in blood by standard techniques. RESULTS: Hemolytic uremic syndrome (HUS) was a major cause of acute renal failure (52%), rest were due to acute glomerulonephritis (AGN), septicemia and renal venous thrombosis. In the renal failure group 56% of the patients were dialyzed (peritoneal) and the mortality was 28% (7/25). The levels of SOD, GPx and LPO were significantly raised in renal failure group. Higher values of LPO, SOD and GPx were documented in subjects who expired. The most important independent variable for predicting clinical outcome was LPO with a sensitivity of 89.4%, specificity of 93%, positive predictive value of 95%. CONCLUSION: Levels of free oxygen radicals (SOD, LPO and GPx) are raised in acute renal failure and these enzymes can be used as marker of renal injury. LPO levels are highly sensitivity and specific for predicting the clinical outcome

Release of iron from haemoglobin--a possible source of free radicals in diabetes mellitus.

Increased blood glucose in diabetes mellitus stimulates nonenzymatic glycosylation of several proteins, including haemoglobin. Although iron is tightly bound to haemoglobin, it is liberated under specific circumstances yielding free reactive iron. Studies with purified haemoglobin from normal individuals and diabetic patients revealed that concentration of free iron was significantly higher in the latter cases and increased progressively with extent of the disease. In vitro glycosylation of haemoglobin also led to increase in release of iron from protein. This increase in free iron, acting as a Fenton reagent, might produce free radicals, which, in turn might be causing oxidative stress in diabetes.

Effect of alpha-tocopherol pretreatment on infarct size following 90 minutes of ischemia and 4 hours of reperfusion in dogs.

The present study was designed to evaluate the effects of pretreatment with antioxidants on free radical mediated reprefusion injury. Five dogs were fed with alpha-tocopherol (1000 IU/kg, bw) for ten days prior to 90 min of left anterior descending coronary artery occlusion followed by 4 hours of reperfusion. Infarct size, serum and myocardial lipid peroxidation were measured in pretreated and in untreated animals. Infarct size, as percentage of myocardial tissue at risk in alpha-tocopherol pretreated animals was 5.86+/-0.83 and was 39.35+/-7.58 in the untreated animals. Following reprefusion in untreated group, the values of serum and myocardial tissue lipid peroxidation were significantly higher than observed values in alpha-tocopherol treated animals. alpha-tocopherol pretreatment significantly reduced the myocardial infarct size and percent necrosis in the left ventricular mass in comparison to the untreated animals. These results suggest that alpha-tocopherol pretreatment possibly helps in reducing infarct size.

Plasma reactive nitrogen intermediate levels in patients with clinically active rheumatoid arthritis.

We studied reactive nitrogen intermediate levels in 31 patients with active rheumatoid arthritis (RA) taking indomethacin and 20 healthy controls using nitrite and citrulline levels, measured by spectrophotometry, as markers. Twenty patients with RA were followed up after 4 and 8 wk of treatment with additional therapy in the form of methotrexate. Mean nitrite levels in 31 patients were 0.94 +/- 0.41 mumol/ml and 20 controls it was 1.18 +/- 0.99. After treatment with methotrexate for 4 and 8 wk the levels were 0.9 +/- 0.45 and 1.25 +/- 1.15 mumol/ml, respectively. Mean citrulline levels in all patients was 1.68 +/- 0.11 and controls was 1.39 +/- 0.6 mumol/ml. Following therapy with methotrexate for 4 and 8 wk the levels were 1.40 +/- 0.49 and 1.40 +/- 0.51 mumol/ml, respectively. It is possible that serum levels of these products may not reflect alterations in the synovial fluid levels. Alternatively, whatever lowering may have been achieved by the anti-inflammatory effect of the therapy may have been countered by drug derived free radicals.

Status of nitric oxide free radicals in diabetic neutrophils: effect of diabetic serum factor on the generation of these species in normal neutrophils and their relation to lysosomal degranulation.

Normal polymorphonuclear leukocytes (PMNL) in contrast to diabetic PMNL, generated significant amounts of .NO and NO2 when challenged with opsonised zymosan. Diabetic neutrophils, on the other hand, responded either weakly or insignificantly to the same stimulants. However, in resting state the levels of .NO and NO2 were higher in diabetic as compared to normal PMNL. Diabetic serum factor (DSF) provoked a significant generation of .NO and NO2 in normal PMNL, a phenomenon found parallel to the enhancement in cytosolic cathepsin D activity in normal cells on insult with DSF.