Impacts of albumin synergized with hydroxyethyl starch on early microvascular albumin leakage after major abdominal surgery in rabbits

Abstract Purpose: To investigate the impacts of albumin synergized with hydroxyethyl starch (HES) on early microvascular albumin leakage after major abdominal surgery in rabbits. Methods: Forty male Japanese rabbits were randomly divided into four groups: the control group, the saline group, the albumin group, and the Syn group (hydroxyethyl starch+albumin). The latter three groups were performed gastrectomy plus resection of pancreatic body and tail and splenectomy. The serum albumin concentration was detected before and 48h after surgery, and the conditions of mesenteric microvascular leakage in these 4 groups were observed under microscope 48 h after surgery to calculate the leakage rate. Results: Compared with the saline group, the albumin group and the Syn group exhibited significantly increased serum albumin concentrations 48h after surgery (P<0.05). The albumin leakage rate was the most obvious in the albumin group, followed by the saline group, while that in the Syn group was the minimal, and there existed significant differences among these groups (P<0.05) . Conclusion: Simple administration of albumin in the early stage after major abdominal surgery could increase the albumin leakage, while the synergization of albumin and hydroxyethyl starch could reduce the albumin leakage.

Factors related to outcomes in lupus-related protein-losing enteropathy

BACKGROUND/AIMS: Protein-losing enteropathy (PLE), characterized by severe hypoalbuminemia and peripheral edema, is a rare manifestation of systemic lupus erythematosus. This present study aimed to identify the distinctive features of lupus-related PLE and evaluate the factors related to the treatment response. METHODS: From March 1998 to March 2014, the clinical data of 14 patients with lupus PLE and seven patients with idiopathic PLE from a tertiary center were reviewed. PLE was defined as a demonstration of protein leakage from the gastrointestinal tract by either technetium 99m-labelled human albumin scanning or fecal alpha1-antitrypsin clearance. A positive steroid response was defined as a return of serum albumin to > or = 3.0 g/dL within 4 weeks after initial steroid monotherapy, and remission as maintenance of serum albumin > or = 3.0 g/dL for at least 3 months. A high serum total cholesterol level was defined as a level of > or = 240 mg/dL. RESULTS: The mean age of the lupus-related PLE patients was 37.0 years, and the mean follow-up duration was 55.8 months. Significantly higher erythrocyte sedimentation rate and serum total cholesterol levels were found for lupus PLE than for idiopathic PLE. Among the 14 patients with lupus PLE, eight experienced a positive steroid response, and the serum total cholesterol level was significantly higher in the positive steroid response group. A positive steroid response was associated with an initial high serum total cholesterol level and achievement of remission within 6 months. CONCLUSIONS: In lupus-related PLE, a high serum total cholesterol level could be a predictive factor for the initial steroid response, indicating a good response to steroid therapy alone.

Self-rated health in Brazilian adults and elderly: Data from the National Household Sample Survey 2008 / Percepción de la salud en adultos y ancianos brasileños: datos de la Encuesta Nacional de Hogares 2008

Objective. To investigate prevalence of poor self-rated health and its association with individual and household-level characteristics among adults and elderly in Brazil. Materials and methods. Cross-sectional study with Brazilian National Household Sample Survey 2008 (n=257 816). Crude and multilevel-adjusted Poisson regression models were fitted. Results. After adjusted analysis, poor self-rated health was significantly associated with higher household income, living alone, not having piped water nor garbage collection, lower education, not having health insurance, female sex, higher age, being a current or previous smoker, physical inactivity, having chronic diseases, having physical impairment. Subjects living in rural areas also had higher prevalence of poor self-rated health. The factors most strongly associated with the outcome were physical impairment and reporting three or more chronic diseases. Conclusions. Socioeconomic, health related behaviors, and physical health were associated with poor self-rated health.

Objetivo. Investigar la prevalencia de la percepción negativa de salud y su asociación con características individuales a nivel de los hogares en adultos y adultos mayores de Brasil. Material y métodos. Estudio transversal con datos de la Encuesta Nacional de Hogares de 2008 (n=257 816). Se estimaron modelos de regresión de Poisson multinivel crudos y ajustados. Resultados. Después del análisis ajustado, la autopercepción negativa de salud se asoció significativamente con mayor ingreso, vivir solo, no tener agua corriente ni recolección de basura, baja educación, carecer de seguro de salud, sexo femenino, mayor edad, tabaquismo, inactividad física, enfermedades crónicas y deterioro físico. Los habitantes de zonas rurales también tuvieron mayor prevalencia de percepción negativa. Los factores más fuertemente asociados fueron impedimento físico y presentación de tres o más enfermedades crónicas. Conclusiones. Factores socioeconómicos, comportamientos relacionados con la salud y salud física se asociaron con la percepción negativa.

Leptin replacement therapy for the treatment of non-HAART associated lipodystrophy syndromes: a meta-analysis into the effects of leptin on metabolic and hepatic endpoints / Terapia de reposição de leptina para o tratamento de síndromes lipodistróficas não associadas ao uso de antirretrovirais: uma metanálise dos efeitos da leptina em parâmetros metabólicos e hepáticos

The clinical manifestations of lipodystrophy syndromes (LS) are hypoleptinemia, hyperglycemia, insulin resistance, dyslipidemia and hepatic steatosis. Leptin replacement therapy (LRT) is effective at improving these pathologies. Currently, there are no data compiling the evidence from the literature, and demonstrating the effect of LRT in LS patients. A systematic review of the MEDLINE and Cochrane Library databases was conducted to identify studies assessing the effect of LRT on metabolic and hepatic endpoints in patients with LS not associated with highly active antiretroviral therapy (HAART) use. Standardized mean differences (SMD) and 95% confidence intervals of pooled results were calculated for overall changes in glucose homeostasis, lipid profile, and hepatic physiology, using an inverse-variance random-effects model. After screening, 12 studies were included for review. Meta-analysis of results from 226 patients showed that LRT decreased fasting glucose [0.75 SMD units (range 0.36‐1.13), p=0.0001], HbA1c [0.49 (0.17‐0.81), p=0.003], triglycerides [1.00 (0.69‐1.31), p<0.00001], total cholesterol [0.62 (0.21‐1.02), p=0.003], liver volume [1.06 (0.51‐1.61), p=0.0002] and AST [0.41 (0.10‐0.73) p=0.01]. In patients with non-HAART LS, LRT improves the outcome of several metabolic and hepatic parameters. Studies were limited by small populations and therefore large prospective trials are needed to validate these findings.

As manifestações clínicas das síndromes lipodistróficas (SL) incluem hipoleptinemia, hiperglicemia, resistência insulínica, dislipidemia e esteatose hepática. A terapia de reposição de leptina (TRL) melhora tais parâmetros, mas atualmente não há dados compilados demonstrando tal efeito. Uma revisão sistemática dos bancos de dados MEDLINE e Cochrane Library identificou estudos avaliando os efeitos da TRL sobre parâmetros metabólicos e hepáticos em pacientes com SL não associadas ao uso de antirretrovirais. Diferenças médias padronizadas (DMP) e intervalos de confiança de 95% foram calculados a partir dos resultados, para os efeitos da TRL sobre a homeostase da glicose, perfil lipídico, e morfologia/função hepática, usando um modelo de variação inversa e efeitos randômicos. Após a triagem, 12 estudos foram incluídos para revisão. A metanálise dos resultados de 226 pacientes mostrou que a TRL reduziu a glicemia de jejum [0,75 DMP (amplitude 0,36‐1,13), p=0,0001], HbA1c [0,49 (0,17‐0,81), p=0,003], triglicerídeos [1,00 (0,69‐1,31), p<0,00001], colesterol total [0,62 (0,21‐1,02), p=0,003], volume hepático [1,06 (0,51‐1,61), p=0,0002] e AST [0,41 (0,10‐0,73), p=0,001]. Em pacientes com SL não associada ao uso de antirretrovirais, a TRL melhora vários parâmetros metabólicos e hepáticos. Os estudos avaliados foram limitados pelo pequeno número de pacientes. Maiores estudos clínicos prospectivos são necessários para validar tais achados.

The Modified Glasgow Prognostic Scores as a Predictor in Diffuse Large B Cell Lymphoma Treated with R-CHOP Regimen

PURPOSE: The modified Glasgow Prognostic Score (mGPS) consisting of serum C-reactive protein and albumin levels, shows significant prognostic value in several types of tumors. We evaluated the prognostic significance of mGPS in 285 patients with diffuse large B cell lymphoma (DLBCL), retrospectively. MATERIALS AND METHODS: According to mGPS classification, 204 patients (71.5%) had an mGPS of 0, 57 (20%) had an mGPS of 1, and 24 (8.5%) had an mGPS of 2. RESULTS: Our study found that high mGPS were associated with poor prognostic factors including older age, extranodal involvement, advanced disease stage, unfavorable International Prognostic Index scores, and the presence of B symptoms. The complete response (CR) rate after 3 cycles of R-CHOP chemotherapy was higher in patients with mGPS of 0 (53.8%) compared to those with mGPS of 1 (33.3%) or 2 (25.0%) (p=0.001). Patients with mGPS of 0 had significantly better overall survival (OS) than those with mGPS=1 and those with mGPS=2 (p=0.036). Multivariate analyses revealed that the GPS score was a prognostic factor for the CR rate of 3 cycle R-CHOP therapy (p=0.044) as well as OS (p=0.037). CONCLUSION: mGPS can be considered a potential prognostic factor that may predict early responses to R-CHOP therapy in DLBCL patients.

Factors predictive of the failure of medical treatment in patients with pleural infection

BACKGROUND/AIMS: The clinical outcomes of some patients with pleural infection may be favorable with medical treatment alone, but in others, the disease progresses and requires additional surgical treatment. However, little is known about the factors affecting this difference. The aim of this study was to investigate the factors predictive of failure of medical treatment in patients with pleural infection. METHODS: A cohort of 127 consecutive patients who were admitted to the hospital with pleural infection was studied. Clinical manifestations and laboratory findings in patients in whom medical treatment succeeded or failed were reviewed. RESULTS: In univariate analysis, the significant factors associated with medical treatment outcome were age, smoking history, duration of chief complaint, serum albumin level, and pleural fluid glucose and lactate dehydrogenase levels (p < 0.05). Multivariate logistic regression analysis identified age and duration of chief complaint as independent predictive factors for failure of medical treatment, with odds ratios of 0.871 (p = 0.013) and 0.797 (p = 0.026), respectively. Receiver operating characteristic curve analysis determined cutoff values of 50.5 years for age and 4.5 days for duration of chief complaint. CONCLUSIONS: We demonstrated that a younger age < 50.5 years and shorter duration of chief complaint < 4.5 days were independent predictive factors for the failure of medical treatment in patients with pleural infection. This suggests their role as evaluative criteria in setting indications for the optimal treatment in patients with pleural infection. A larger, prospective study is required to confirm these findings.

Evaluation of risk factors in patients with vitamin K-dependent coagulopathy presumed to be caused by exposure to brodifacoum

BACKGROUND/AIMS: Recently, many cases of vitamin K-dependent coagulopathy of unknown origin have been reported. Such patients lack any relevant family history and have no systemic disease, raising suspicion of superwarfarin intoxication. We evaluated individual risk factors causing coagulopathy and hemorrhagic symptoms in patients with suspected superwarfarin intoxication. In addition, we determined how to effectively treat vitamin K-dependent coagulopathy caused by suspected superwarfarin intoxication. METHODS: Seven patients with suspected superwarfarin intoxication who lacked any definitive history of rodenticide ingestion were included. Thirty-one patients initially diagnosed with rodenticide poisoning were also included. We performed a retrospective chart review of all subjects and examined clinical data including patient demographics and medical histories. RESULTS: Patients initially diagnosed with rodenticide poisoning were divided into two groups, one of which had a laboratory abnormality (prothrombin time [PT] > 13 seconds) and another group with PTs in the normal range. There was no significant difference between the two groups in any of age, gender, the extent of chronic alcohol consumption, the causative rodenticide, psychiatric problems, ingestion of drugs interacting with warfarin, the extent of intoxication, or the type of ingestion attempt. The albumin level of the former group was significantly lower than that of the latter group (p = 0.014). Furthermore, a significant difference between the two groups was evident in terms of simultaneous ingestion of rodenticide and alcohol (p = 0.023). CONCLUSIONS: Most patients with superwarfarin poisoning did not exhibit any complication. When such complications were evident, they were associated with serum albumin level and coingestion of rodenticide and alcohol.

Ischemia-Modified Albumin: Could It Be a New Oxidative Stress Biomarker for Colorectal Carcinoma?

BACKGROUND/AIMS: An impaired oxidative/antioxidative status plays an important role in the pathogenesis of many diseases, including cancer. The aim of this study was to evaluate the levels of the novel marker ischemia-modified albumin (IMA) and albumin-adjusted IMA (Adj-IMA) in patients with colorectal cancer (CRC) and look for the associations of these with the total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI). METHODS: Forty patients with CRC (19 females and 21 males; mean age, 56.5+/-2.1 years) and 39 age- and sex-matched healthy people (22 females and 17 males; mean age, 56.0+/-1.7 years) were included in this study. Serum levels of IMA, TAS, and TOS were analyzed, and the OSI was calculated. RESULTS: Serum IMA, TOS, and OSI levels were significantly higher in patients with CRC than in controls (p<0.0001), whereas TAS levels were significantly lower in CRC patients (p=0.03). There was no significant difference in serum Adj-IMA levels between groups (p=0.32). CONCLUSIONS: In this study, the oxidative/antioxidant status was impaired in favor of oxidative stress in CRC patients. This observation was not confirmed by IMA measurement. Further studies are needed to establish the relationship between IMA and oxidative stress parameters in CRC and other cancers.

Estimating Average Glucose Levels from Glycated Albumin in Patients with End-Stage Renal Disease

PURPOSE: In patients with diabetic end stage renal disease (ESRD), glycated albumin (GA) reflects recent glycemic control more accurately than glycated hemoglobin (HbA1c). We evaluated the relationship between GA and average blood glucose (AG) level and developed an estimating equation for translating GA values into easier-to-understand AG levels. MATERIALS AND METHODS: A total of 185 ESRD patients, including 154 diabetic and 31 non-diabetic participants, were enrolled (108 hemodialysis, 77 peritoneal dialysis). Patients were asked to perform four-point daily self-monitoring of capillary blood glucose (SMBG) at least three consecutive days each week for four weeks. Serum levels of GA, HbA1c and other biochemical parameters were checked at baseline, as well as at 4 and 8 weeks. RESULTS: Approximately 74.3+/-7.0 SMBG readings were obtained from each participant and mean AG was 169.1+/-48.2 mg/dL. The correlation coefficient between serum GA and AG levels (r=0.70, p<0.001) was higher than that of HbA1c and AG (r=0.54, p<0.001). Linear regression analysis yielded the following equation: estimated AG (eAG) (mg/dL)=4.71xGA%+73.35, and with this formula, serum GA levels could be easily translated to eAG levels. Multivariate analysis revealed significant contributions of postprandial hyperglycemia (beta=0.25, p=0.03) and serum albumin (beta=0.17, p=0.04) in determining serum GA level, independent to other clinical parameters. CONCLUSION: Compared to HbA1c, serum GA levels were better correlated with AG levels. Using the estimating equation, an average blood glucose level of 155-160 mg/dL could be matched to a GA value of 18-19% in patients with ESRD.

Analysis of some biochemical and haematological parameters for Mucuna pruriens [DC] seed powder in male rats

The biochemical and haematological effects of the seed powder of Mucuna pruriens in male rats were evaluated to establish some biological properties of this potential biopesticide currently undergoing investigation. The result showed that Mucuna pruriens seed extract produced a significant [P<0.05] increase in white blood cell [WBC] count, as well as in bilirubin concentrations, alkaline phosphatase [ALP], protein and creatinine levels measured. Alanine aminotransferase [ALT] and aspartate aminotransferase [AST] were significantly reduced [P<0.05] in comparison with the experimental control. PCV, Hb, albumin level and WBC differential counts gave no significant difference between treated and control groups. The results revealed metabolic imbalance in the rats which suggests a mild cholestasis effect of the extract

A Case of Chlamydia trachomatis Peritonitis Mimicking Tuberculous Peritonitis / 대한소화기학회지

Lymphocytic ascites with low serum-ascites albumin gradient (SAAG) are observed mainly in tuberculous peritonitis, peritoneal carcinomatosis, and pancreatic disease. However, pelvic inflammatory disease (PID) induced generalized peritonitis causing diffuse ascites has been rarely described. We report a 26-year old female patient, who was diagnosed as generalized peritonitis with diffuse ascites due to Chlamydia trachomatis infection. Gynecologic examination did not show the clue of PID and in the analysis of ascites, low SAAG, predominant lymphocyte count and high level of adenosine deaminase were noted. Although the best impression was tuberculous peritonitis on the base of these findings, the laparoscopic finding was consistent with PID and the PCR for C. trachomatis infection in cervical swab was positive. This case suggests that C. trachomatis peritonitis should be considered as a rare cause of low SAAG and lymphocytic ascites in sexually active women and should be intensively evaluated including laparoscopic examination.

Clinical factors influencing liver stiffness as measured by transient elastography (Fibroscan(R)) in patients with chronic liver disease / 대한간학회지

BACKGROUND/AIMS: Transient elastography as performed using the Fibroscan(R) is a useful noninvasive method for evaluating hepatic fibrosis. However, recent studies have found that liver stiffness measurement (LSM) values are inappropriately elevated in acute hepatitis or in the acute flare state of chronic hepatitis, suggesting that the LSM value obtained by the Fibroscan(R) is not a reliable marker for fibrosis. We retrospectively evaluated the clinical factors influencing the LSM value obtained using transient elastography as performed using the Fibroscan(R) in patients with chronic liver disease. METHODS: A total of 298 patients who were followed in Kungpook National University Hospital from November 2007 to May 2008 due to previously established liver cirrhosis or chronic liver disease were investigated using the Fibroscan(R), laboratory test, ultrasound, and/or abdominal computed tomography. RESULTS: The 298 patients were aged 47.8+/-12.9 years (mean+/-SD). The cut-off value for a diagnosis of liver cirrhosis was 12.5 kPa (as used in previous studies). Thirty-six patients (15%) and 202 patients (85%) with chronic liver disease without clinical manifestation of cirrhosis had LSMs of >12.5 kPa and <12.5 kPa, respectively. Multivariate analysis revealed that LSM values were unusually increased in patients with chronic liver disease who were older (P=0.007) or who had increased gamma gultamyltranspetidase (GGT) (P=0.022), decreased albumin (P=0.015), or increased total bilirubin (P=0.009). CONCLUSIONS: This study reveals that age, GGT, and albumin are clinical factors influencing LSM values. This reinforces the need to interpret LSM values in the context of a defined diagnosis, biochemical data, radiologic examination, and other clinical findings.

Oxidation of the albumin thiol to sulfenic acid and its implications in the intravascular compartment: [review]

Human serum albumin (HSA) is the most abundant protein in the intravascular compartment. It possesses a single thiol, Cys34, which constitutes ~80 percent of the total thiols in plasma. This thiol is able to scavenge plasma oxidants. A central intermediate in this potential antioxidant activity of human serum albumin is sulfenic acid (HSA-SOH). Work from our laboratories has demonstrated the formation of a relatively stable sulfenic acid in albumin through complementary spectrophotometric and mass spectrometric approaches. Recently, we have been able to obtain quantitative data that allowed us to measure the rate constants of sulfenic acid reactions with molecules of analytical and biological interest. Kinetic considerations led us to conclude that the most likely fate for sulfenic acid formed in the plasma environment is the reaction with low molecular weight thiols to form mixed disulfides, a reversible modification that is actually observed in ~25 percent of circulating albumin. Another possible fate for sulfenic acid is further oxidation to sulfinic and sulfonic acids. These irreversible modifications are also detected in the circulation. Oxidized forms of albumin are increased in different pathophysiological conditions and sulfenic acid lies in a mechanistic junction, relating oxidizing species to final thiol oxidation products.

[In vitro effect of chamomile, clove and garlic extract on non-enzymatic glycosylation of albumin]

Diabetes mellitus is a common disease in human societies. Proteins non-enzymatic glycation has deleterious effects on the structure and function of proteins. Non-enzymatic glycosylation of proteins can be involved in the pathogenesis of diabetic complications such as retinopathy and nephropathy. One was of preventing this reaction is the use of medicinal plants. Chamomile, clove and garlic are herbs which their alkaloid compounds have antioxidant property. The aim of this study was to evaluate the effect of chamomile, clove and garlic extract on non- enzymatic glycosylation of albumin. In this experimental study, hydroalcoholic extract of chamomile, clove and garlic was prepared. In vitro albumin glycosylation reaction was carried out in presence of different concentrations [0.01, 0.05 and 0.1 g/L] of chamomile, clove and garlic extracts and level of glycosylated albumin was measure. Non-enzymatic glycosylation of albumin was determined by nitrobluetetrazuliom method. Absorbance changes were measured in 530 nm by Eppendorf spectrophotometer. In this study, chamomile extract in 0.01, 0.05 and 0.1 g/L of its concentrations had respectively 9%, 17% and 26%, inhibitory effect on albumin glycosylation. Albumin glycosylation reaction was inhibited 23% by 0.01 g/L concentration of clove and garlic extracts and the level of inhibition of albumin glycosylation decreased by increasing of extracts concentration. Chamomile extract with 0.1 g/L concentration has the most effect among the studied extracts. In this study, chamomile extract inhibited the in vitro albumin glycosylation reaction. Clove and garlic extracts showed inhibitory effect in low concentration but this effect decreased with increasing of the extract concentration

Correlation of post-operative hypoalbuminemia with outcome of pediatric cardiac surgery

Hypoalbuminemia may be caused by liver disease, nephrotic syndrome, burns, protein-losing entropathy, malnutrition, and metabolic stress. Alterations in albumin in metabolic stress such as cardiac surgery have been previously investigated. We studied serum albumin concentration in children with congenital heart disease and also the association of hypoalbuminemia with mortality and morbidity after pediatric cardiac surgery. We measured serum albumin concentration prospectively in 300 children with congenital heart disease who underwent surgery between July and September 2008 in Shaheed Rajaee hospital. Serum albumin concentration was measured before and 48 hours after cardiac surgery and was subsequently compared between 2 groups: cyanotic and acyanotic and also with normal values. Serum albumin concentration decreased on the second post-operative day in 70 [23.3%] patients. There was a positive correlation between the post-surgical hypoalbuminemia and cyanotic heart disease. The cyanotic children had lower serum albumin concentration Thant the acyanotic ones [P value < 0.001]. There was a significant association between post-operative serum albumin concentration and acute renal failure [P value < 0.001] and death [P value < 0.001]. Drop in serum albumin concentration was more prominent in the males than in the females [P value= 0.038] and in the cyanotic patients than in the acyanotic ones [P value < 0.001] as well as in those with acute renal failure [P value < 0.001], pericardial effusion [P value= 0.050], seizure [P value < 0.001], and death [P value < 0.001]. Hypoalbuminemia was not associated with longer hospital [P value = 0.142] or intensive care unit stay [P value = 0.199]. Post-operative serum albumin concentration was lower in the cyanotic children and male patients in our study. In addition, the post-operative decrease in albumin was associated with an increased risk of pericardial effusion, renal failure, seizure, and death.

Effects of tobacco smoking on alpha-2-macroglobulin and some biochemical parameters in Thai males.

This cross-sectional study was carried out among smokers and nonsmokers from suburban and urban residential areas in Bangkok, Thailand. One hundred eighty-six smokers and 102 nonsmokers, who voluntarily participated in the study, were investigated. The levels of alpha-2-macroglobulin (A2M), albumin, total protein, and other biochemical and hematological parameters as well as body mass index (BMI) measurements were taken. The levels of A2M, BUN and WBC counts were significantly higher in smokers than nonsmokers. Total protein and albumin concentrations were significantly lower in smokers than nonsmokers, but the levels of other biochemical parameters did not differ between the two groups. The relationship between BMI and median A2M levels in the smoker and nonsmoker groups showed the higher the BMI, the lower the serum A2M levels. Smokers had a higher percentage of hyperalpha-2-macroglobulinemia than nonsmokers. A2M concentrations correlated inversely with BMI, BUN, albumin, total cholesterol, triglycerides, and the quantity of cigarettes smoked for the total period of smoking (cigarette pack-years). Multiple regression analysis revealed that albumin and cigarette pack-years were the most closely related variables to A2M concentrations among smokers. These findings suggest cigarette smoking affects inflammation markers, increasing A2M and WBC and decreasing albumin. This effect may be the mechanism responsible for the development of chronic disease states associated with smoking since cigarette smoke contains many toxic compounds harmful to health.

Albumin cobalt binding (ACB) test: its role as a novel marker of acute coronary syndrome.

The biochemical marker of myocardial ischemia is detected prior to the development of myocardial necrosis, i.e. a novel biochemical evaluation based on human serum albumin binding to cobalt, a transitional metal. The evaluation is known as Albumin Cobalt Binding (ACB) Test. ACB Test is applied to detect the presence of Ischemia Modified Albumin (IMA), an albumin which has altered binding capacity to bind metal ion such as cobalt (Co), copper (Cu) and nickel (Ni) in N-terminus region. It is produced when the serum albumin convenes with ischemic heart tissues. ACB Test detecting the presence of myocardial ischemia that occurs prior to myocardial necrosis has been studied by some researchers and they found an ACB increase prior to troponin increase. The cut off point of ACB evaluation was 85 U/ml. Provided that the value was greater than 85 U/ml then there was positive myocardial ischemia. But it should be noticed that IMA increase in the plasma may be due to other tissues such as gastrointestinal tissues or skeletal muscles tissues. We should also consider other factors which may affect the evaluation result such as severe hypoalbuminemia that will cause a false-high result. ACB Test may be used as an early marker of myocardial ischemia that occurs prior to myocardial necrosis.

Clinical Investigation of Cavitary Tuberculosis and Tuberculous Pneumonia

BACKGROUND: The radiographic characteristics of tuberculous pneumonia in adults are similar to primary tuberculosis that occurs in childhood, and upper lobe cavitary tuberculosis is the hallmark of postprimary tuberculosis. The purpose of this study was to investigate the factors associated with tuberculous pneumonia by making comparison with cavitary tuberculosis. METHODS: The medical records and radiographic findings of patients with cavitary tuberculosis and tuberculous pneumonia, and who were diagnosed between March 2003 and February 2006, were analyzed retrospectively. RESULTS: Forty patients had cavitary tuberculosis and sixteen patients had tuberculous pneumonia. Fever was more frequent for tuberculous pneumonia, whereas hemoptysis was more frequent for cavitary tuberculosis. The duration of symptoms before visiting the hospital was shorter, but the diagnosis after admission was more delayed for tuberculous pneumonia patients than for cavitary tuberculosis patients. The prevalence of underlying comorbidities such cancer, diabetes, alcoholism and long-term steroid use was not different between the two groups. The patients with tuberculous pneumonia were older and they had lower levels of serum albumin and hemoglobin than those with cavitary tuberculosis. The patients with tuberculous pneumonia showed a tendency to have more frequent endobronchial lesion. Tuberculous pneumonia occurred in any lobe, whereas the majority of cavitary tuberculosis patients had upper lung lesion, but the prevalence of lymphadenopathy, pleural effusion and previous tuberculosis scar was not different between the two groups. CONCLUSIONS: Older age, a lower level of serum albumin and hemoglobin and a random distribution of lesion were associated with tuberculosis pneumonia as compared with cavitary tuberculosis. These findings suggest that the pathogenesis of tuberculous pneumonia might be different from that of cavitary tuberculosis.

Serum zinc and hormonal profile in male dialysis patients receiving human recombinant erythropoietin

INTRODUÇAO: Em pacientes submetidos à hemodiálise crônica (HD), o tratamento com eritropoetina humana recombinante (rHuEpo) está associado a melhora no bem-estar geral e na qualidade de vida. OBJETIVOS: O objetivo do presente trabalho foi avaliar os níveis dos hormônios sexuais e do zinco em pacientes sob HD e em uso de rHuEpo em comparacão com pacientes sem tratamento com essa droga. MATERIAL E MÉTODOS: Dois grupos de doze pacientes do sexo masculino cada um, submetidos à HD, sendo um deles sem uso de rHuEpo (grupo 1) e o outro utilizando a droga (grupo 2), foram selecionados para um estudo transversal, comparando-se os níveis séricos do zinco, da albumina, dos hormônios FSH, LH, prolactina, testosterona e do hematócrito. RESULTADOS: No grupo 2, os valores de testosterona (4,65 vs. 3,5ng/ml), hematócrito (30,5 vs. 22 por cento), albumina (3,9 vs. 3,7g/dl) e zinco (62,5 vs. 50,5microg/dl) foram significativamente maiores do que no grupo 1 (p < 0,05). DISCUSSAO: Sugere-se que, em pacientes recipientes da rHuEpo, os níveis mais altos de hematócrito, zinco, albumina e testosterona possam ser fatores que contribuam para melhorar a disfuncão sexual e a qualidade de vida dos pacientes hemodialisados. CONCLUSAO: Os pacientes em HD em uso da rHuEpo apresentaram níveis mais elevados de testosterona, zinco e hematócrito quando comparados com os pacientes sem a terapia hormonal.

The Relation Between Hypoalbuminemia and Compliance and Intima-media Thickness of Carotid Artery in Continuous Ambulatory Peritoneal Dialysis Patients

The aim of this study was to identify the main factor affecting compliance and intima-media thickness of the elastic common carotid artery in continuous ambulatory peritoneal dialysis patients. Increased intima-media thickness and decreased arterial compliance are associated with elevated risk of cardiovascular disease. This study included 20 patients and 20 age- and sex- matched healthy control subjects. The compliance and intima-media thickness of the right common carotid artery within 1 cm to the bifurcation were measured three times using high-resolution B-mode echocardiography. Blood samples were obtained to measure levels of hemoglobin, phosphorus, total calcium, total CO2, serum albumin, C-reactive protein, serum total cholesterol, LDL- and HDL-cholesterol and triglycerides. We found that the compliance of common carotid artery was lower in the patient group than in the control group. In the patient group, the compliance of common carotid artery was positively correlated with serum albumin concentration, and intima-media thickness of common carotid artery was negatively correlated with serum albumin levels. Stepwise regression analysis showed that serum albumin concentration was independently related to the compliance of common carotid artery, suggesting hypoalbuminemia can independently give deleterious effects on the arterial wall in continuous ambulatory peritoneal dialysis patients.