Influence of single hemodialysis session on serum paraoxonase-1, arylesterase activity, total oxidant status and total antioxidant status.

AIM: Chronic kidney disease(CKD) and hemodialysis (HD) are associated with increased oxidative stress. Cardiovascular diseases (CVD) are the most important cause of mortality in these patients. Increased cardiovascular risk is associated with oxidative stress. The aim of this study was to evaluate whether the duration of single session hemodialysis may affect oxidative stress parameters on the patients with end-stage renal disease (ESRD). METHODS: Total oxidant status (TOS) and oxidative stress index (OSI) as oxidative markers and total antioxidant status (TAOS), paraoxonase1 (PON1) and arylesterase (ARES) as antioxidant markers were compared hemodialysis therapy before and after the treatment. RESULTS: TOS levels before hemodialysis were found as 4.4±2.4 µmol H2O2 Equiv/L, TAOS 2.1±0.3 µmol trolox Equiv./L, OSI 0.2±0.1%, PON1 levels 58.5±35.6 U/L and ARES levels 22±0.2 U/L while after the HD the respective values were 1.4±1.2 µmol H2O2 Equiv/L, 1.4±0.5 µmol trolox Equiv./L, 0.1±0.1%, 54.3±31.3 U/L, 21.8±0.1 U/L. A significant decreasing was observed in TOS TAOS OSI and ARES values before the HD compared to after the HD (P=0.0001, P=0.0001, P=0.0001, P=0.031, respectively). CONCLUSION: This study shows oxidant (TOS, OSI) and antioxidant (TAOS, ARES) markers were found to be significantly decrease after the HD compared to pre-hemodialysis. Although reverse is expected it is found that oxidants (indirectly ROS) did not increase and antioxidant reserve decreased in HD.

Glomerular filtration rate: which method should we measure in daily clinical practice?

AIM: In this study, we compared estimated glomerular filtration rate (eGFR) calculated with the formulas of Cockcroft-Gault (C&G), Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Mayo Clinic Quadratic (Mayo Q) and, GFR (mGFR) that was scintigraphically measured with creatinine clearance (CrCl) and technetium-99m diethylene triamine penta-acetic acid (99mTc-DTPA). Objective of this study was to define the correlations between the formulas, provide a reliable method for measurement and estimation of GFR in daily clinical practice and demonstrate the potential errors. METHODS: C&G, CKD-EPI, Mayo Q and MDRD eGFR of 84(37 males, 47 females) patients diagnosed with chronic kidney disease were calculated. Values of 99mTc-DTPA based on mGFR were compared with eGFR values of the formulas. RESULTS: Significant correlations were found with the values of 99mTc-DTPA mGFR, CrCl, MDRD, CKD-EPI, Mayo Q and C&G eGFR. The highest correlation was found between LBM(lean body mass) corrected C&G, MDRD-6, Mayo Q and CKD-EPI eGFR. The best estimate was made with MDRD-6 in the cases with 99mTc-DTPA mGFR<30 mL/min/1.73 m(2) and with MDRD-4 in the cases with 99mTc-DTPA mGFR≥30 mL/min/1.73 m(2), while the worst estimate was made with uncorrected C&G formula in both groups. CONCLUSION: All eGFR formulas can be used in daily clinical practice. However, using MDRD-6 in the cases with GFR<30 mL/min/1.73 m(2) and MDRD-4 in the cases with GFR≥30 mL/min/1.73m(2) as well as using LBM for C&G eGFR or correction according to LBM when AW (actual weight) is used, might provide a more accurate estimation.

The association of insulin resistance and metabolic syndrome in early androgenetic alopecia.

INTRODUCTION: Insulin resistance (IR), hyperinsulinaemia and concomitant metabolic syndrome (MS) are known to be independent risk factors for coronary arterial disease (CAD). The aim of this study was to examine the frequency of IR, hyperinsulinaemia and MS in individuals with early androgenetic alopecia (AGA). METHODS: The Hamilton-Norwood scale was used to grade AGA. The homeostasis model assessment of insulin resistance formula was used to detect IR, and a value above 2.7 was considered to show IR. According to the National Cholesterol Education Programme Adult Treatment Panel III-2001 diagnosis criteria, patients with three or more positive criteria were considered to have MS. RESULTS: In this study, we evaluated 80 patients with early AGA and 48 healthy participants. The serum level of insulin was higher in patients with early AGA compared to the healthy participants, although not significantly. IR was detected in 25 patients with early AGA and in six healthy participants. The difference between the groups was statistically significant. Although 20 patients with AGA were diagnosed with MS, it was only diagnosed in five healthy participants. The occurrence of MS was significantly higher in the AGA group than in the control group. CONCLUSION: The prevalence of IR and MS was observed to have increased in early AGA patients. Hence, patients with early AGA should be followed up for CAD in the long term. Our results should be confirmed with prospective studies.

Simultaneous bilateral trochanteric fractures during squatting in a patient with multiple myeloma.

Pathologic bone fractures are usually confined to the trunk in multiple myeloma (MM). But bilateral trochanteric fractures have not been reported in patients with MM before. Radiographic, histological and immunoelectrophoresis revealed typical features of MM. This report points out the importance of physical rehabilitation of patients in addition to chemotherapy in adaptation to the activities of daily living.

Prevalence of hepatitis B and C virus infection in barbers in the Sivas region of Turkey.

Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are among the most devastating health problems in the world, including Turkey. The route of transmission of HBV and HCV is mainly parenteral, a small number of epidemiological studies demonstrating that perinatal, sexual, household and occupational transmission occurs. Contact of a patient's blood or bodily fluids with non-intact skin is another mode of HBV and HCV transmission. Barbers in Turkey may often be exposed accidentally to the blood and bodily fluids of their customers. The aim of this study was to determine the prevalence of HBV and HCV infection in barbers. We conducted a study to determine the prevalence of antibodies against HBV and HCV among 176 barbers and 180 control subjects in the Sivas region of Turkey. The prevalence of HBV and HCV was found to be higher in barbers (39.8 and 2.8%, respectively) than in a comparison group (28.3 and 1.1%, respectively). No significant relationship was found with the duration of occupation. Among the seropositive subjects, it was found that most had been exposed to needle pricks or scissor cuts. Our data suggest that both HBV and HCV infections may constitute occupational hazards for barbers. The sources of infection could be not only such personal risk factors as 'sharps' injuries and scissor cuts, but may also include other unknown factors.

Captopril inhibits the pulmonary toxicity of paraquat in rats.

Paraquat (PQ) is a herbicide that is very toxic to all living organisms. It generates free radicals and leads to acute or chronic lung injury. Free radicals are often associated with fibrogenesis, which occurs in various disease states. The purpose of this study was to determine whether captopril prevents paraquat toxicity in lung tissue. Paraquat alone increased the level of lipid peroxidation (LPO) and the activity of superoxide dismutase (SOD) after 4, 12, 24 and 72 h of administration. Also, the level of hydroxyproline showed an increase after 24 h of paraquat administration. However, paraquat also decreased the level of glutathione (GSH) and the activity of glutathione peroxidase (GSH-Px). Captopril (50 mg/kg i.p.) and paraquat were simultaneously injected (40 mg/kg i.p.), and the captopril injection 1 h after paraquat ameliorated the biochemical toxicity induced by paraquat. This was evidenced by a significant reduction in LPO and balancing the endogenous antioxidant capacity by normalizing the activities of SOD and GSH-Px and the GSH content in the lung tissue. Moreover, captopril injection prevented the increase of hydroxyproline content as an index of lung fibrosis. From these results, the beneficial effects of captopril on paraquat toxicity appear to be through enhancement of the endogenous antioxidant system preventing the lung fibrosis.

Lipid and lipoprotein patterns in type 2 non-obese diabetic patients. Do Lp(a) levels decrease with improved glycemic control in these patients?

BACKGROUND AND AIM: In this study, we investigated the levels of apolipopotein-AI (apo-AI), apolipoprotein (apo-B), triglyceride (TG), high-density-lipoprotein-cholesterol (HDL-C), low-density-lipoprotein-cholesterol (LDL-C), total cholesterol, lipoprotein(a) in a group of non-obese, type 2 diabetes mellitus patients with different types of treatment and a control group of non-obese, non-diabetic subjects. METHODS AND RESULTS: Patients were divided into three groups according to their treatment types: insulin, sulphonylurea and untreated groups. All groups were similar in sex, weights, known duration of diabetes and habits. Each group consisted of 30 subjects. There were no differences in apo-AI, apo-B and TG levels (p > 0.05), whereas HDL-C levels in the untreated group were significantly lower than those of the other groups (p < 0.05). Lp(a) levels in the untreated group were higher than in the other (p < 0.05). CONCLUSIONS: Gaining metabolic control in diabetes mellitus is crucial in pulling back lipid, lipoprotein and apolipoprotein levels to a desired level and in attenuating CAD (coronary artery disease) risk factors, and also in preventing CAD. Lp(a) levels in particular are decreased by insulin or sulfonylurea in non-obese patients with type 2 diabetes mellitus.

Comparison of body composition analysis methods in clinical routine.

BACKGROUND: Skinfold thickness (SFT) and bioelectrical impedance (BIA) are readily available and commonly used techniques in patient monitoring for body composition analysis (BCA) in clinical practise. Another one, dual-energy X-ray absorptiometry (DEXA) method became popular in body composition analysis (BCA) in recent years. Its results have been reported to be quite accurate and precise, in comparison with in vivo or in vitro multiple component reference methods. The aim of the present study was to assess the degree of agreement between SFT and DEXA, and BIA and DEXA methods, in obese and nonobese patients. METHODS: Body fat mass (FM) was measured in 16 nonobese (mean body mass index; BMI = 22.2 +/- 2.2 kg/m(2)) and in 21 obese (BMI = 34.5 +/- 6.1 kg/m(2)) women with DEXA, SFT, and BIA in the same morning. RESULTS: Mean (+/- SD) FM (kg) was 16.3 +/- 5.5, 15.0 +/- 5.1, 14.7 +/- 4.9 in nonobese subjects and 38.8 +/- 10.1, 36.3 +/- 10.0, 37.1 +/- 12.0 in obese patients, by DEXA, SFT and BIA, respectively. Comparison of the DEXA-BIA and DEXA-STF methods showed high correlation in regression line analysis in nonobese subjects as, r(2) = 0.93 and 0.89, respectively. Regression coefficients were 0.84 and 0.75 in obese patients. However, reanalysis of the data by the Bland and Altman method revealed an obvious lack of agreement between the DEXA-BIA and DEXA-SFT methods in obese patients. In addition, FM was underestimated by BIA and SFT as compared to DEXA in both of the study groups. Besides, better precision was obtained by DEXA method among the others. CONCLUSION: The SFT or BIA method would be preferred to monitor BCA in non-obese subjects in clinical routine. However, DEXA should be considered as the method of choice in obese patient monitoring, since reproducibility gains special importance, other than the accuracy in the context.

The effects of hemodialysis on duodenal and gastric mucosal changes in uremic patients.

From March 1992 to July 1992, 30 uremic patients (15 dialysed, 15 non-dialysed) and 15 non-uremic patients who had dyspeptic complaints were compared in terms of gastric and duodenal diseases. Gastritis and duodenitis graded as I, II and III were not found different in three groups (p > 0.05). Although the incidence of peptic ulcer disease is very high in both groups of uremic patients in comparison with the controls, there was no significant difference between two uremic groups (p > 0.05). Also the prevalence of gastritis determined histologically was not different in dialysed and non-dialysed uremic patients (p > 0.05). The incidence of the histologically proven gastritis was found higher in uremic patients than in non-uremic patients (p < 0.05). But, there were no significant differences among the three groups with regard to the rate of histologically proved duodenitis (p > 0.05). Gastrin levels, urea positivity, the incidence of gastritis and duodenitis and peptic ulcers did not differ in both uremic groups. However, these values were found significantly high in the uremic patients when compared to non-uremics. These findings showed serum gastrin levels, H.-pylori-infection, gastritis and duodenal disease in the uremic patients to be higher than those of the control group. Moreover, no effect of hemodialysis treatment on these results was observed.