Cytomegalovirus and Epstein-Barr virus reactivation in the intensive care unit.

AIM: The purpose of this work was to evaluate the reactivation of cytomegalovirus (CMV) and Epstein-Barr virus (EBV) in immunocompetent patients in the intensive care unit (ICU) and to identify risk factors associated with reactivation. MATERIALS AND METHODS: In this observational prospective study, 60 adult immunocompetent patients who stayed at least 7 days in an ICU were evaluated. During hospitalization, the viral load was monitored at admission and on day 7 with polymerase chain reaction to detect viral reactivation and weekly thereafter on days 14, 21, and 28 if hospitalization continued. RESULTS: The mean age of patients was 63.3 years (±23.4 years) and 34 (56.7 %) of them were male. Mean APACHE II scores for patients was 25 at admission. Of these patients, 28 were hospitalized in the internal ICU and 32 were hospitalized in the anesthesiology ICU. CMV/EBV reactivation was found in 17 individuals (12 for EBV, 3 for CMV, and 2 for both). The median high-sensitive C-reactive protein value in patients with CMV reactivation was significantly higher than in those patients without CMV reactivation (p = 0.037). EBV reactivation was statistically higher in patients with mechanical ventilation compared to patients without mechanical ventilation (p = 0.023). EBV reactivation in patients with fever was found to be statistically higher than in the patients without fever (p = 0.035). CONCLUSION: There is a need for extended studies with a larger number of patients from specific groups to better understand the reactivation frequency and identify risk factors. EBV and CMV reactivation should be taken into consideration in critically ill patients with fever, without specific symptoms and unresponsive to the treatment.

Appreciation of trimetazidine treatment in experimental sepsis rat model.

INTRODUCTION: Our aim was to determine the efficacy of trimetazidine on experimental sepsis rat model. MATERIAL AND METHODS: Sixty rats were randomized into three groups. In Group 1, sepsis was induced. In Group 2, sepsis was induced and as a therapeutic agent trimetazidine was given. In Group 3, rats were sham operated. Serum interleukin-1 beta (IL-1ß), tumor necrosis factor alfa (TNF-α), superoxide dismutase (SOD), glutathion peroxidase (GSH-Px) and malondialdehyde (MDA) levels were determined in all groups. RESULTS: In Group 2, serum GSH-Px and SOD levels were statistically significantly higher than in Group 1 (p< 0.05) and serum MDA levels were statistically significantly lower than in group 1 (p < 0.05). Trimetazidine also significantly decreased the levels of IL-1ß and TNF-a which are the proinflammatory cytokines (p < 0.05). CONCLUSION: Trimetazidine treatment significantly improved inflammation, oxidative stress and membrane destruction in LPS-induced sepsis. As the proinflammatory cytokines are supposed to play a primary role in the pathogenesis of sepsis, we assumed that the trimetazidine treatment would give new insights into the treatment of sepsis (Tab. 1, Fig. 5, Ref. 29).

The effects of glycyrrhizin on experimental acute pancreatitis in rats.

INTRODUCTION: Although physiopathology of acute pancreatitis (AP) is not fully understood, the roles of reactive oxygen species (ROS) and changes of cytokines have been determined. AIM: To investigate anti-inflammatory and anti-oxidant effects of glycyrrhizin (GL) on taurocholate-induced AP in rats. MATERIALS AND METHODS: Thirty six rats were randomly divided into three groups as sham, AP and AP+GL (n=12 per group). AP was induced by 1 ml/kg body weight using 5% taurocholate injection into the biliopancreatic duct in groups II and III after clamping the hepatic duct. In groups III, GL (20 mg/kg) was given by oral gavage twice daily for 4 days. Group I and II did not receive any treatment. After the rats were killed; blood samples were taken to measure amylase, lipase, calcium, albumin, urea, glucose, AST and LDH assays before killing. Pancreatic tissue samples were also taken for biochemical analyses and histopathology. RESULTS: Amylase, lipase, AST and urea levels were significantly lower in the AP+GL group than in the AP group. Cytokines including IL-6, TNF-α and MPO levels were significantly lower in the AP+GL group than in the AP group. Even so there is no statistically difference between in the AP+GL group and the AP group in terms of pancreatic tissue IL-1ß, IL-6 and TNF-α levels. DISCUSSION: GL treatment significantly decreased pancreatic tissue MPO activities and MDA levels in the AP+GL group compared with the other groups (p = 0.001 and p = 0.05, respectively). Acinar cell necrosis, hemorrhage, and edema determined that were significantly lower in the AP+GL group than in the AP group (p < 0.001). CONCLUSIONS: GL treatment for acute necrotizing pancreatitis in rats suppressed the levels of pro-inflammatory cytokines, and caused a clear recovery of histological changes.

Oxidative stress status and plasma trace elements in patients with asthma or allergic rhinitis

Introduction: This study was conducted to evaluate the oxidant/antioxidant balance (oxidative stress status) and plasma essential trace element levels in patients with bronchial asthma or allergic rhinitis. Methods: A total of 94 individuals consisting of 19 allergic asthmatics; 17 non-allergic asthmatics; 22 patients with allergic rhinitis; and 36 healthy control people were enrolled into this study. Superoxide dismutase (CuZnSOD) and glutathione peroxidase (GSH-Px) activity as antioxidant defence mechanism parameters, along with malondialdehyde (MDA) as a marker of lipid peroxidation, were determined in erythrocytes of patient groups and controls. Plasma copperand zinc levels were also determined in all groups. Results: CuZnSOD activity was significantly lower in all groups of patients (p<0.001 for allergic asthmatics, p=0.008 for allergic rhinitis patients, and p<0.001 for non-allergic asthmatics) when compared to those of controls. Erythrocyte GSH-Px enzyme activity was not different when compared to that of the control group. Similarly, the patient groups had no difference from those of the controls with respect to erythrocyte MDA levels. While plasma Cu levels in all asthmatic patients were not different from those of the controls, allergic rhinitis patients had significantly elevated (p<0.001) Cu levels compared to those of the controls. No statistically significant difference was established between patient groups and controls with respect to plasma zinc levels. Conclusion: While defective CuZnSOD activity observed in all patients groups was expected to cause an increase in lipid peroxidation indicated by high MDA levels in these patients groups, the fact that MDA levels were not different from those of controls in all patient groups indicates that other components of anti-oxidant defence system preserve their functions in these patients. On the other hand, statistically significant difference between all patients groups and controls with respect to trace elements was only observed in allergic rhinitis patients who had higher levels of Cu than those of controls (AU)

Oxidative stress status in patients with chronic idiopathic urticaria

Aim: The controversial data related to oxidative stress status in patients with chronic idiopathic urticaria (CIU) have been reported. Therefore, the present study was aimed to contribute to this debate by determining oxidative stress markers along with some trace element levels inpatients with CIU. Methods: Twenty-five patients with CIU (10 males, 15 females) and 36 healthy controls were enrolled into the study. Erythrocyte lipid peroxidation status, scavenger enzyme activities and trace element levels were determined. Results: While erythrocyte MDA levels, erythrocyte GSH- Px activities and erythrocyte Zn levels showed no differences between the patient and control groups, a statistically significant decrease and increase were observed in erythrocyte CuZn-SOD activities and Cu levels, respectively, in the CIU patients when compared to those of the controls (p < 0.001 for both of them). Conclusion: In conclusion, an oxidative burden which can be relieved by some preserved antioxidant mechanisms seems to be present in patients with CIU even if they are clinically stable and it may probably have a role in the pathogenesis (AU)

Oxidative stress status and plasma trace elements in patients with asthma or allergic rhinitis.

INTRODUCTION: This study was conducted to evaluate the oxidant/antioxidant balance (oxidative stress status) and plasma essential trace element levels in patients with bronchial asthma or allergic rhinitis. METHODS: A total of 94 individuals consisting of 19 allergic asthmatics; 17 non-allergic asthmatics; 22 patients with allergic rhinitis; and 36 healthy control people were enrolled into this study. Superoxide dismutase (CuZnSOD) and glutathione peroxidase (GSH-Px) activity as antioxidant defence mechanism parameters, along with malondialdehyde (MDA) as a marker of lipid peroxidation, were determined in erythrocytes of patient groups and controls. Plasma copper and zinc levels were also determined in all groups. RESULTS: CuZnSOD activity was significantly lower in all groups of patients (p<0.001 for allergic asthmatics, p=0.008 for allergic rhinitis patients, and p<0.001 for non-allergic asthmatics) when compared to those of controls. Erythrocyte GSH-Px enzyme activity was not different when compared to that of the control group. Similarly, the patient groups had no difference from those of the controls with respect to erythrocyte MDA levels. While plasma Cu levels in all asthmatic patients were not different from those of the controls, allergic rhinitis patients had significantly elevated (p<0.001) Cu levels compared to those of the controls. No statistically significant difference was established between patient groups and controls with respect to plasma zinc levels. CONCLUSION: While defective CuZnSOD activity observed in all patients groups was expected to cause an increase in lipid peroxidation indicated by high MDA levels in these patients groups, the fact that MDA levels were not different from those of controls in all patient groups indicates that other components of anti-oxidant defence system preserve their functions in these patients. On the other hand, statistically significant difference between all patients groups and controls with respect to trace elements was only observed in allergic rhinitis patients who had higher levels of Cu than those of controls.

Oxidative stress status in patients with chronic idiopathic urticaria.

AIM: The controversial data related to oxidative stress status in patients with chronic idiopathic urticaria (CIU) have been reported. Therefore, the present study was aimed to contribute to this debate by determining oxidative stress markers along with some trace element levels in patients with CIU. METHODS: Twenty-five patients with CIU (10 males, 15 females) and 36 healthy controls were enrolled into the study. Erythrocyte lipid peroxidation status, scavenger enzyme activities and trace element levels were determined. RESULTS: While erythrocyte MDA levels, erythrocyte GSH- Px activities and erythrocyte Zn levels showed no differences between the patient and control groups, a statistically significant decrease and increase were observed in erythrocyte CuZn-SOD activities and Cu levels, respectively, in the CIU patients when compared to those of the controls (p < 0.001 for both of them). CONCLUSION: In conclusion, an oxidative burden which can be relieved by some preserved antioxidant mechanisms seems to be present in patients with CIU even if they are clinically stable and it may probably have a role in the pathogenesis.

Efficacy of deferoxamine, N-acetylcysteine and selenium treatments in rats with Adriamycin-induced nephrotic syndrome.

BACKGROUND: Various experimental models related to Adriamycin (ADR)-induced nephropathy have been reported. The purpose of the present study was to evaluate the efficacy of N-acetylcysteine (NAC), deferoxamine (DFO) and selenium in protection against renal injury in ADR nephropathy. METHODS: The study included 53 Sprague Dawley male rats. Nephrotic syndrome was induced by injection of ADR 5 mg/kg intravenously (n=46). Control rats (n=7) were injected with an equal volume of isotonic saline. After ADR administration, they were divided into a group given only ADR (n=17) and 3 antioxidant treatment groups: (i) NAC (n=10), (ii) DFO (n=10) and (iii) selenium (n=9). In both renal tissue and erythrocytes, oxidative system parameters and trace elements were determined. RESULTS: Nephrotic syndrome was proven in ADR-injected rats 4 weeks after injections, with proteinuria, higher blood lipids and hypoalbuminemia. All of the antioxidant agents used in the present study to prevent the development of nephrotic syndrome provided benefits for the nephrotic state. Of them, selenium seemed to offer relatively lower and statistically insignificant efficacy for preventing proteinuria compared with the others. CONCLUSIONS: Our results showed that concomitant administration of some antioxidants with ADR injections seems to have beneficial effects on clinical parameters even if antioxidants were given in a single dose. NAC and DFO are more effective than selenium to prevent renal injury.

Detrimental effects of N-acetylcysteine plus desferoxamine combination in an experimental nephrotic syndrome model.

The aim of this study was to evaluate the effects of N-acetylcysteine (NAC) and desferoxamine (DFO) administered alone or in combination together in rats with doxorubicin (DOX)-induced nephrotic syndrome, by monitoring oxidative stress parameters and trace elements in renal tissue and erythrocytes. Fifty-four male Sprague-Dawley rats were included the study. Equal volume of isotonic saline was injected to control rats. After DOX administration, the animals were divided into four experimental groups: (a) rats given only DOX; (b) rats treated with NAC; (c) rats treated with DFO; (d) rats treated with NAC plus DFO. The combination of N-acetylcysteine and DFO has no beneficial effect on reducing proteinuria in experimentally nephrotic rats, although both of these agents ameliorate the condition when administered separately. It seems likely that detrimental effects of NAC plus DFO could be secondary to its effects on erythrocyte selenium levels demonstrated here. Consequently, the results may propose caution to the use of antioxidant therapeutic strategies such as NAC plus DFO against nephropathy.

CA-125; a new marker for diagnosis and follow-up of patients with tuberculous peritonitis.

BACKGROUND: Most malignancies with peritoneal infiltration, especially ovarian cancers and chronic liver diseases associated with ascites give rise to high serum CA-125 levels. Tuberculous peritonitis is another cause for high serum CA-125 levels. AIM: To investigate the relation between serum CA-125 level and response to treatment in tuberculous peritonitis patients. PATIENTS: Ten patients with tuberculous peritonitis were enrolled in the study. METHOD: Definite diagnosis of tuberculous peritonitis was made by acid-fast smears, specific culture, and polymerase chain reaction. Serum CA-125 levels were measured before and at the fourth month of treatment. RESULTS: Before antituberculous treatment, serum CA-125 levels of all patients were very high (mean+/-SD: 475. 80+/-106. 19 U/ml) and comparable with those of patients with ovarian cancers. At the end of the fourth month of treatment, serum CA-125 levels in all patients decreased to within normal limits (<35 U/ml)(20.80:+/-5.18 U/ml) in parallel with the clinical improvement. The differences in CA125 levels before and after treatment were statistically significant (p<0.001). CONCLUSIONS: Results of our study suggest that serum CA-125 levels in patients with tuberculous peritonitis are as high as ovarian cancers associated with peritoneal infiltration. By the end of the fourth month of antituberculous therapy, serum CA-125 levels have returned to normal. We, therefore, suggest that serum CA-125 can be used to evaluate the efficacy of therapy in tuberculous peritonitis.