Different clinical effect of several types of airborne allergens on the severity of bronchial hyperreactivity.

BACKGROUND: Atopic sensitization belongs to the most common risk factors for bronchial asthma. However, in clinical practice, it is not clear whether sensitization against pollen and perennial allergens is differently associated with the severity of bronchial hyperresponsiveness (BHR). AIM: To find out whether patients sensitized to perennial allergens differ in severity of bronchial hyperresponsiveness from patients sensitized to pollen allergens. METHODS: The study includes 109 patients. Based on the results of skin prick tests, patients were divided into three groups: sensitivity to pollen allergens - group A; sensitivity to perennial allergens - group B; sensitivity to both pollen and perennial allergens - group C. Based on the histamine bronchoprovocation test, we compared the values of histamine provocative concentration causing a 20% drop in FEV1 (PC20) among particular groups of patients. Mild bronchial hyperresponsiveness was determined if the value of PC20 was >4 mg/ml, while if the value of PC20 was <4 mg/ml, the bronchial hyperresponsiveness was considered as moderate/severe. RESULTS: A statistically significant difference was found in the degrees of bronchial hyperresponsiveness between the three groups of patients, namely, group A with the patients sensitized only to the pollen allergens, group B comprising patients sensitized to the perennial allergens only, and group C, involving patients sensitized to the combination of both pollen and perennial allergens. The PC20 values were higher among the patients from the group A (7.46 mg/ml) compared to group B (4.25 mg/ml) and C (4.52 mg/ml). The odds ratio for moderate/severe BHR was 5.21 and 5.04 in group B and group C, respectively. CONCLUSION: Severity of bronchial hyperresponsiveness shows differences according to sensitization to particular allergens. Perennial allergens are more often associated with serious forms of bronchial hyperresponsiveness which also have an impact on the severity and prognosis of bronchial asthma.

Determination of immunological stress and oxygen free radical formation in white blood cells during allergen immunotherapy.

BACKGROUND: Airway inflammation represents the basis of respiratory allergic disease and is generally associated with increased oxidative stress. As a consequence of successful treatment leading to hyposenzibilization and remission of symptoms, decrease of reactive oxygen formation is expected. MATERIAL/METHODS: This preliminary study evaluates the production of oxygen free radicals in white blood cells and changes in basic immunological parameters in a cohort of 50 patients (27 females and 23 males, age 14-48 years) with upper airway allergic inflammation caused by pollens, before and during specific immunotherapy. RESULTS: We found an unexpected significant increase in the free radical concentration during and after treatment in comparison to values before the treatment and to the control group. Statistical analysis also found significant increase of IgG3 after initial treatment and also 1 year after allergen immunotherapy. Although there were similar trends in the elevated ROS and elevated IgG3, these were not statistically significant. CONCLUSIONS: We observed changes in oxidative mechanisms in white blood cells of patients treated with AIT. Allergen immunotherapy works at a multilayer level and influences airway inflammation as well as the protective antimicrobial defense in treated patients. Further studies for understanding the mechanisms involved in oxidative stress as well as for laboratory monitoring of therapeutic approaches in allergic diseases are needed.

Potential association between Coxiella burnetii seroprevalence and selected risk factors among veterinary students in Slovakia.

The present study investigated the prevalence of antibodies to Coxiella burnetii and the possible factors predisposing students of veterinary medicine to C. burnetii infections. IgG antibodies to phase I and phase II C. burnetii antigens were determined by ELISA. Out of 77 students examined, 13 were positive for phase I and 45 were positive for phase II antibodies. The titres determined were in the range of 1 : 100-1 : 3200. Some risk factors may have contributed to the high seroprevalence found in these subjects. For example, there were positive associations with rural life and exposure to the breeding of farm animals, and in addition, work in a dusty environment, such as on fields, gardens, stables and construction sites were also connected to high seroprevalence.

Relationship between type 2 diabetes mellitus and hypothalamic-pituitary-adrenal axis.

INTRODUCTION: Hypercortisolism often leads to impaired glucose tolerance or type 2 diabetes mellitus. On the other hand, changes in the regulation of hypothalamic-pituitary-adrenal axis become a matter of debate in patients with type 2 diabetes mellitus/metabolic syndrome. PATIENTS, MATERIALS, AND METHODS: Authors assessed the hypothalamic-pituitary-adrenal axis activity and subclinical Cushing's syndrome occurrence in 50 patients with type 2 diabetes mellitus in comparison to 25 sex-, age-, and BMI-matched control nondiabetic subjects. 1 mg dexamethasone suppression test with NIH recommended cut-off level for adrenal incidentaloma (serum cortisol after suppression > 138 nmol/l) was used to postulate the diagnosis of subclinical hypercortisolism. RESULTS: There were no significant differences in serum ACTH, DHEA-S, baseline serum cortisol as well as serum cortisol after suppression of 1 mg dexamethasone/subclinical Cushing's syndrome prevalence in both diabetic and control groups (18 vs. 24% respectively, p = 0.54) and there was no relation to the type of treatment (OAD vs. insulin) in group of diabetics. When divided according to age, diabetics older than 60 years suppressed their serum cortisol significantly worse than their age-related controls (99.3 vs. 85.5 nmol/l, p = 0.0001). Furthermore, diabetics did not show an age-related decrease in DHEA-S levels, whereas controls did (r = -0.302, p = 0.033; r = -0.596, p = 0.0017 respectively). Within the group of diabetics, a positive correlation between C-peptide levels and baseline serum cortisol/DHEA-S levels was detected as well (r = 0.445, p = 0.001 and r = 0.339, p = 0.017 respectively). CONCLUSION: Our data show relatively high but comparable lack of cortisol suppression in both diabetic and control groups; however, we consider the subclinical Cushing's syndrome diagnose to be criteria dependent. There is no dependence of type of diabetes treatment (OAD vs. insulin) on HPA axis activity. Our results might indicate the possible role of cortisol in pathogenesis of type 2 diabetes mellitus in patients with metabolic syndrome as well as possible protective role of DHEA-S within the frame of secondary contraregulatory mechanisms aimed to improve insulin sensitivity and reduce the hyperinsulinemia.

Pathological findings in cornea tissue of patients with penetrating keratoplasty.

The aim of this clinical study was to examine corneas extracted from the patients during penetrating keratoplasty for the presence of immunoglobulins and inflammatory cells that can be warning for the graft failure. Individual clinical diagnoses were correlated to the presence of the inflammatory signs in corneal tissue. The signs of inflammation in corneal layers were detected especially in group of patients classified as viral keratitis but were also found in corneas of patients with degenerative diseases of the cornea. Depending on the number of keratoplasties no statistical difference in analysed parameters was found. Inflammatory process represented by slight positive presence cellular infiltration and/or immunoglobulins could be present in corneal tissue also in absence of acute manifestation. Histological and immunohistochemical evaluation of corneal tissue from patients undergoing penetrating keratoplasty could improve estimation of correct diagnosis. Subsequently prompt adequate therapy could improve worse prognosis of corneal graft with evident immune process.

Adiponectin as a biomarker of clinical manifestation of metabolic syndrome.

OBJECTIVES: To search whether there are differences in serum levels of adiponectin in subjects with metabolic syndrome (MS) as compared to the healthy controls. METHODS: Serum levels of adiponectin were measured by ELISA in 22 subjects with MS (MS group: 9 males and 13 females, average age +/- SD 43.19 +/- 6.16) and in 17 healthy controls of about the same age (CONT group: 8 males and 9 females, average age +/- SD 45.88 +/- 11.6). All subjects of MS group had BMI >30 and also other criteria of MS (e.g. obesity, insulin resistance, possible disorders of glucose metabolism, dyslipidemia and hypertension) were manifested in all of them. Adiponectin levels in serum were compared between the groups and also within the pooled MS plus CONT group the interrelations between serum levels of adiponectin and BMI, serum fasting insulin (estimated by RIA method) and smoking were examined. For statistical processing one way ANOVA or its non-parametric parallel (Kruskal-Wallis one-way analysis) as well as regression and correlation analysis were used. RESULTS: Subjects with MS syndrome had significantly higher BMI, systolic and diastolic BP, fasting glycemia and insulin level. Significantly higher were also the values of both indexes of insulin resistance such as IR(HOMA) and IR(QUlCKI). In contrast, however, MS group had significantly lower adiponectin level than CONT group. There was no difference between the average age of both groups. In pooled MS plus CONT group inverse correlations were found between serum levels of adiponectin on one side and BMI and fasting insulin level on the other, while the level of adiponectin between smokers (which was declared by 18/39 subjects) and non-smokers did not show any influence on serum levels of adiponectin. CONCLUSIONS: Low level of adiponectin in obese individuals may be considered as a marker predicting a possibility of the development of metabolic syndrome. It is suggested that early regulation of serum adiponectin levels in obese subjects by treatment of obesity, especially in young ones, could result in a lowering the risk of mainly cardiovascular diseases associated with MS.

Vitamin E-coated dialyzer and antioxidant defense parameters: three-month study.

Atherosclerotic cardiovascular disease is the most frequent cause of death in patients with end-stage renal disease who have undergone dialysis treatment. Oxidative stress, increased lipid peroxidation, and impaired function of antioxidant systems may contribute to the accelerated development of atherosclerosis in chronic renal failure patients during renal replacement therapy. The aim of this study was to investigate the influence of a vitamin E-coated dialyzer on antioxidant defense parameters in hemodialysis (HD) patients. In 14 HD patients, hemodialysis was performed using a vitamin E-coated dialyzer (Terumo CL-E15NL; Terumo Corporation, Tokyo, Japan) during a 3-month study. In these patients, erythrocyte (ER) antioxidant enzymes, superoxide dismutase (SOD), glutathione peroxidase (GPX), glutathione reductase (GR) and catalase (CAT), plasma total antioxidant capacity (TAC), RBC glutathione (GSH), plasma malondialdehyde (MDA), plasma, and RBC vitamin E were investigated. Each parameter was measured at the beginning of the study, after the 1st, 2nd, and 3rd month of the study, and 10 weeks after the interruption of the use of vitamin E-coated dialyzer. All HD patients were treated by erythropoietin (EPO) and received vitamin C 50 mg/d, pyridoxine 20 mg/d, and folic acid 5 mg/wk during the entire study. The 3-month treatment with the vitamin E-coated dialyzer led to a significant decrease of plasma MDA level (from 2.85 +/- 0.44 to 2.25 +/- 0.37 micromol/L) and to an increase of plasma TAC, RBC, GSH, and the vitamin E levels both in plasma (from 25.9 +/- 2.8 to 33.6 +/- 3.8 micromol/L) and in the RBCs (from 6.7 +/- 0.8 to 7.4 +/- 0.7 micromol/L) by 30% and 10.5%, respectively. Ten-week interruption of the use of the vitamin E-coated dialyzer led to near initial values of MDA (2.90 +/- 0.28 micromol/L), plasma (28.6 +/- 3.5 micromol/L), and RBC (6.9 +/- 0.7 micromol/L) vitamin E and of other investigated parameters. Statistical analysis of results was performed by conventional methods and analysis of variance. The findings of the current study confirm the beneficial effect of the vitamin E-coated dialyzer against oxidative stress in HD patients.

Oral use of iron with vitamin C in hemodialyzed patients.

OBJECTIVE: To investigate if oral use of Sorbifer Durules (EGIS Pharmaceutical Ltd, Budapest, Hungary) (1 tablet/d) is adequate for the maintenance of serum iron and vitamin C in normal range during recombinant human erythropoietin treatment in hemodialyzed patients. One tablet of Sorbifer Durules contains 100 mg of Fe(2+) and 60 mg of vitamin C. DESIGN: Short-term, open-label clinical trial. SETTING: Hemodialysis units. PATIENTS: Twenty-four adult patients with end-stage renal disease on hemodialysis. INTERVENTION: Four-week treatment period of Sorbifer Durules, preceded and followed by iron and vitamin C washout periods. MAIN OUTCOME MEASURE: Fasting predialysis serum samples were collected on days 0, 28, 56, and 84 to determine hematocrit, blood hemoglobin, serum iron, total iron-binding capacity, transferrin saturation, ferritin, vitamin C, and plasma oxalate. RESULTS: Four-week treatment in hemodialyzed patients by Sorbifer Durules led to significant increase of hematocrit, blood hemoglobin, serum iron and vitamin C. This treatment did not influence the level of plasma oxalate. CONCLUSION: Oral dose of one tablet of Sorbifer Durules per day is adequate for the maintenance of serum iron in normal range during recombinant human erythropoietin treatment in hemodialyzed patients. This treatment simultaneously prevented the development of serum vitamin C deficiency and did not lead to further increase of plasma oxalate in these patients.