Oxidative stress in perinatal asphyxia in relation to outcome.

OBJECTIVE: To study the serum levels of oxidative stress markers - malondialdehyde (MDA) and protein carbonyl in babies with perinatal asphyxia and to correlate their levels with the outcome in terms of mortality and neurodevelopmental sequelae. METHODS: A group of 40 term AGA (appropriate for gestational age) infants with perinatal asphyxia were selected as cases and same number of healthy babies as controls. Serum levels of oxidative stress markers - malondialdehyde and protein carbonyl were determined in cord blood and at 48 hours of life. Their levels were correlated with the outcome of perinatal asphyxia in terms of mortality and the long term neurological outcome. RESULTS: MDA and protein carbonyl, in cord blood were significantly higher among cases (5.88+/-1.40 micromol/L and 1.50+/-0.48 nmol/mg of protein respectively) than controls (3.11+/-0.82 micromol/L and 0.83+/-0.19 nmol/mg of protein respectively). Among the cases, MDA and protein carbonyl values at 48 hours of life (7.52 +/- 1.06 micrommol/L and 2.91 +/- 0.62 nmol/mg of protein respectively) were significantly higher than those at birth. MDA at birth and 48 hours was significantly higher among babies who had seizures than those who remained seizure free. These values were also significantly higher in babies who expired as compared to those who survived. Protein carbonyl values though higher in those who had seizures and in those who expired, were not statistically significant from controls. MDA and protein carbonyl at birth and 48 hours were higher in babies with developmental delay but the association was not statistically significant. CONCLUSIONS: In hypoxic ischemic encephalopathy (HIE), oxidative stress markers MDA and protein carbonyl are high at birth and rise further at 48 hours and the values correlate with the morbidity and mortality. Therefore, determining the serum levels of oxidative stress markers MDA and protein carbonyl will be of benefit in predicting the outcome in perinatal asphyxia.

Evaluation of anxiety, depression and urinary protein excretion among the family caregivers of advanced cancer patients.

Caregiving to a family member with advanced cancer can be stressful. Stress leads to psychological changes, oxidative stress and increased glomerular permeability to proteins. To find out their association with stress, we assessed anxiety and depression by the hospital anxiety and depression scale (HADS), urinary malondialdehyde:creatinine ratio (UMDA:Cr), urinary protein:creatinine ratio (UP:Cr) and SDS-polyacrylamide gel electrophoresis (SDS-PAGE) profile of urinary proteins in 31 family caregivers of advanced cancer patients and 31 matched controls. HADS, UMDA:Cr and UP:Cr were significantly higher in the caregivers as compared to the controls. These parameters were significantly correlated. Besides an increase in albumin excretion, a few higher and lower molecular weight proteins were detected in the urine of caregivers. These results indicate that the family caregivers of advanced cancer patients undergo anxiety and depression associated with stress leading to increased oxidative stress and glomerular permeability to proteins. These changes might have health implications, warranting appropriate stress management counseling for them.

Can urinary excretion rate of malondialdehyde, uric acid and protein predict the severity and impending death in perinatal asphyxia?

BACKGROUND: Perinatal asphyxia (PA) associated with multi-organ damage is a leading cause of neonatal mortality and morbidity. We evaluated if urinary malondialdehyde:creatinine (UMDA:Cr), uric acid:creatinine (UUA:Cr) and protein:creatinine (UP:Cr) vary with the severity of PA and if these parameters can predict the impending death in PA. METHODS: Study included 20 asphyxiated and 20 healthy newborn males. Hypoxic-ischemic encephalopathy (HIE) staging, APGAR (activity, pulse, grimace, appearance and respiration) score and urinary protein, uric acid, creatinine and MDA were evaluated. RESULTS: UMDA:Cr, UUA:Cr and UP:Cr were significantly higher and correlated with APGAR and HIE in PA. By regression analysis also, urinary parameters were found to have significant association with HIE stage and APGAR in PA. Receiver operating characteristics (ROC) curve of UP:Cr, UUA:Cr and UMDA:Cr showed area under curve of 0.896 (p=0.003), 0.859 (p=0.008) and 0.849 (p=0.010) with cut-off value of 9.04 mg, 2.34 mg and 3.49 microg/mg of creatinine respectively that can optimally predict the impending death in PA. SDS-PAGE of unconcentrated urine detected both high (73 kDa and 68 kDa) and low molecular weight proteins (52 kDa, 47 kDa, 25 kDa and 20 kDa) in PA but not in controls. CONCLUSION: Urinary excretion rate of uric acid, MDA and proteins is higher and has potential to act as biochemical markers for severity evaluation and death prediction in PA.