[Biological properties of coenzyme Q10 and its effects on immunity]. / Biologické vlastnosti koenzýmu Q10 a jeho vplyv na imunitu.

Coenzyme Q10, a vitamin-like substance, represents a components of the complex antioxidant system of the human organism. The paper presents its structure, physiological function and the role in the disease pathogenesis with the accent on the supplementation therapy during human immune system disturbances, including infectious and oncological diseases.

Pharmacoeconomic aspects of patients treated by hemodialysis.

Hemodialysis as a therapeutic procedure in patients being in the end-stage of renal failure has been used since the sixties of the 20th century. Generally speaking, the conservative drug therapy in patients treated by hemodialysis is complex, and economically it consummes as great proportion of financial expenses. The aim of the study was to perform an economic analysis of 101 patients, both sexes (37 females and 64 males, aged from 22 to 81 years) treated by hemodialysis, in respect of drug treatment costs. The total average cost of treatment medication represented 161,589 SKK/patient/year. Eighty one percent of total expenses were linked with the consumption on antianemic drugs (102,298.40 SKK/patient/year). The second most expensive drug group (9% of the total cost) were medications used in coincidence with hemodialysis complications (14,981 SKK/patient/year). Diuretic--furosemid was the most frequently used drug out of the category of antihypertensive medications (68% of patients), followed by beta-blockers (preparation Concor), calcium channel blockers (preparations Norvasc and Plendil) and angiotensin converting enzyme tritace inhibitors (ACEI, preparations Trirace, Enap, Prestarium), respectively. Only 27% of patients were treated by hypolipidemic drugs mostly by the preparations of Gevilon and Innogen. In the majority of patients (93%) preparations for the correction of calcium and phosphorus metabolisms such as Vitacalcin and Rocaltrol were administered, the latter being most expensive. Antianemic drugs have been used in all patients. In this category of preparations, those composing acid folate and erythropoetin were used most frequently. Alkaline supplementation of NaHCO, (bicarbonate) was used in 88% of patients. In order to prevent the development of thrombosis and other vascular complications, the drugs with antiaggregative effects were used (Ibustrin, Curantyl, Anopyrin). To prevent the manifestation of gastrointestinal adverse reactions, the administration of H2-antagonists have been preferred (Famosan, Quamtel). The group of "Other drugs" was represented by vitamins and drugs with anti-uratic effects (ascorbic acid--preparation Celaskon, tocopherol--preparation E-vitamin and Milurit). When summed together, the costs of therapy in patients treated by hemodialysis are three times higher compared with those in the pre-dialysis phase. In addition to the latter hemodialysis is associated with a large number of medical, psychic and social complications. In the presented pilot study the authors analysed the financial expenses coinciding with drug costs (direct loads) which are significant, but represent only a part of the pharmacoeconomic complexity. In the future it is necessary to perform a more complex pharmacoeconomic analysis in order to evaluate also other factors, such as the costs of hospitalization, dialysate solutions, technologys, salaries of the staff, etc. (Tab. 6, Ref. 37.).

[Analysis of the present status of conservative therapy of nephropathies]. / Analýza súcasného stavu konzervatívnej liecby nefropatií.

Treatment by dialyzing represents an important contribution to the therapy of nephropathic patients. On the other hand, besides high financial costs it is not possible to forger significant social and psychic consequences of this therapy. The present paper aimed at a pharmacoeconomic evaluation of the costs of conservative treatment of nephropathic patients. The secondary aim was to compare the costs of conservative treatment in patients with markedly limited renal functions, creatinine clearance (Ccr < 0.4 ml/s), with those in patients with only slightly and medium-reduced renal functions (Ccr 0.4-1 ml/s). Health documentation from three nephrological out-patient surgeries was used to evaluate the results, the criterion for the selection of patients being a nephrological diagnosis with Ccr below 1 ml/s. The group comprised 102 patients aged 21-84 years (average age being 63.99 years), including 56 females (54.9%) and 46 males (45.1%). According to the stage of renal disease, they were divided into two groups. The patients with slightly and medium-reduced renal functions (Ccr 0.4-1.0 ml/s) represented nearly three quarters, whereas the patients with markedly reduced renal functions (Ccr < 0.4 ml/s) only slightly more than one quarter. In the group under study, the pharmacotherapeutic costs represented 2,889,778.0 SK/year (28,331.16 SK/1 patient/1 day), in patients with renal insufficiency the costs being markedly higher (47,427.3 SK/1 patient/1 day in comparison with 21,456.7 SK/1 patient/1 day). Of total pharmacotherapeutic costs, 29.38% was represented by antihypertensive agents, 24.47% by preparations supplementing essential amino acids, 14.83% by hypolipidemic agents, 14.37% by preparations supplementing calcium, 6.19% by antianaemic agents, and 7.76% by other drugs. The results demonstrate that pharmacotherapy of renal diseases is costly but in comparison with elimination methods (dialysis) it is incomparably less expensive. The spectrum of employed agents is in agreement with the present-day trends in conservative treatment which decelerates the progress of nephropathies.

Decreased levels of coenzyme Q(10) in patients with bronchial asthma.

BACKGROUND: The contribution of free oxygen radicals in the pathogenesis of bronchial asthma is generally accepted. The modulation of antioxidative defence by supplementation with antioxidants represents additive therapy in complex management of disease. The aim of the study was to assess the levels of coenzyme Q10, alpha-tocopherol, and beta-carotene both in plasma and whole blood, and malondialdehyde (MDA) and eosinophil cationic protein (ECP) in plasma of asthmatics (As). METHODS: Fifty-six As (15 males and 41 females) aged from 19 to 72 years (mean age 46 years) suffering from allergic asthma were enrolled into the study. The control group comprised 25 healthy volunteers (16 males, 9 females) aged 25-50 years. RESULTS: The concentrations of CoQ10 decreased significantly both in plasma and whole blood, compared with healthy volunteers (0.34 +/- 0.15 micromol/l vs. 0.52 +/- 0.15 micromol/l, 0.33 +/- 0.14 micromol/l vs. 0.50 +/- 0.13 micromol/l, P < 0.001, P< 0.001, respectively). The levels of alpha-tocopherol were decreased both in plasma and whole blood in comparison with controls [24.10 micromol/l (19.8; 30.5), vs. 33.20 micromol/l (28.25; 38.05), 17.22 +/- 6.45 micromol/l vs. 21.58 +/- 7.92 micromol/l, P= 0.006, P = 0.01, respectively]. The levels of MDA were elevated over the reference range in both groups (reference range < 4.5 micromol/l). No changes were seen in beta-carotene concentrations. Positive correlation was found between whole blood CoQ10 and alpha-tocopherol concentrations. CONCLUSION: Results of the study suggest a possible contribution of suboptimal concentrations of CoQ10 on antioxidative dysbalance in As and provide a rationale for its supplementation.

The influence of selenium supplementation on the immunity of corticoid-dependent asthmatics.

UNLABELLED: Selenium (Se) is a trace element that is essential for immune functions, and protects the immune system from oxidative damage. AIM: The aim of the pilot clinical study was to assess the influence of selenium supplementation (SeS) on the selected immune parameters analyzed from peripheral blood of corticoid-dependent asthmatics (CDAs). MATERIAL AND METHODS: Seventeen CDAs aged from 30 to 74 years (7 females, 10 males) with suboptimal levels of Se in plasma were enrolled into the study. The follow up of SeS lasted 96 weeks. It is daily dose was 200 micrograms (2 x 2 tbl daily, 1 tbl contained 50 micrograms of Se). Before (-4 weeks) and after the 12th, 48th, 72nd and 96th weeks of SeS, the following parameters were observed: Epitopes EG1, EG2 expressed on intracellular eosinophil (Eo) cationic protein and eosinophil peroxidase, the numbers of CD3, CD4, CD8, CD19 and CD3 HLADR positive T lymphocytes (Ly), lymphocyte blastogenesis test (LTT) with mitogens concanavalin A, (Conc A) phytohemaglutin (PHA), the levels of C3, C4 complement components, activation of complement by classic and alternative pathways (CP50, AP50), the levels of immunoglobulins (Ig) G, A, M and total IgE, circulating immune complexes (CIC). RESULTS: Epitopes EG1 and EG2 in cytoplasma of Eo decreased significantly after 12 weeks of SeS, (p < 0.01) and 96 weeks of follow up. In parameters of T cell mediated immunity the relative number of CD3 HLADR+ T Ly increased after 24, 48 and 96 weeks of SeS (p < 0.0008, p < 0.009, p < 0.07). Proliferative activity of T Ly to mitogenes PHA and ConcA in LTT decreased significantly after 12, 48, 72 and 96 weeks of SeS (p < 0.0005, p < 0.009, p < 0.04, p < 0.02, respectively). In humoral parameters activation of CP50 decreased after 24, 72 and 96 weeks of SeS to the reference range (p < 0.001, p < 0.03, p < 0.02) and AP50 after 96 weeks, respectively (p < 0.02). The levels of IgG elevated after 24 weeks (p < 0.02), IgA after 24, 48 weeks (p < 0.0007, p < 0.02, respectively). The level of total IgE significantly decreased after 96 weeks of SeS (p < 0.003). CONCLUSION: Our pilot clinical study with the CDAs demonstrates the significant changes particularly in functional parameters of both cellular and humoral types of immunity. These results support the immunomodulating effects of SeS. (Tab. 5, Ref. 15.)

Decreased consumption of corticosteroids after selenium supplementation in corticoid-dependent asthmatics.

Selenium represents a trace element comprised in enzyme glutathion-peroxidase. It is anti-inflammatory activity is based on the elimination of hydroperoxides produced in the site of inflammation (scavenger of free oxygen radicals). The authors report the results of a pilot study with 17 corticodependent asthmatics (7 females, 10 males) aged 30-74 years, supplemented with the preparation of selenium (Se), in a daily dose of 200 micrograms during the follow-up lasting 96 weeks. We demonstrate the reduced consumption of both inhaled corticosteroids, manifested after 24 to 96 weeks of Se supplementation (SeS) (21.74 mg vs 15.81 mg, p < 0.009, 21.74 mg vs 15.32 mg, p < 0.007, respectively) and systemic corticosteroids after 48 weeks (294 mg vs 78 mg, p < 0.04) and 96 weeks of SeS (294 mg vs 104 mg, p < 0.04). These results correlated with the elevation of Se levels both in plasma and erythrocytes (p < 0.0003, p < 0.0003, respectively). No adverse effects were seen during the study and the tolerance of preparation was good. (Tab. 3, Ref. 17.)

Levels of coenzyme Q10 in asthmatics.

BACKGROUND: The contribution of free oxygen radicals in the pathogenesis of bronchial asthma is generally accepted. The modulation of antioxidative defence by supplementation with antioxidants represents additive approach in complex management of the disease. The aim of the study was to assess the levels of coenzyme Q10, alpha-tocopherol, beta-carotene and malondialdehyde (end-stage parameter of lipid peroxidation) in asthmatics (As). METHODS: Fifty six As (15 males and 41 females) aged from 19 to 72 yrs (mean age 46 yrs) were enrolled into the study. The control group comprised of 25 healthy volunteers (16 males, 9 females) aged 25-50 years. RESULTS: Concentrations of CoQ10 and alpha-tocopherol, decresed significantly both in plasma and whole blood, compared with healthy volunteers (p < 0.009, p < 0.004; p < 0.035, p < 0.001, respectively). The level of MDA was elevated, but not statisticaly significantly. No changes were seen in beta-carotene levels. Positive correlation was found between concentrations of CoQ10 and alpha-tocopherol. CONCLUSION: Our results suggest possible contribution of suboptimal concentrations of CoQ10 on antioxidative dysbalance in As and provide rationale for its supplementation with clinical evaluation. (Tab. 2, Fig. 1, Ref. 39.).

[Effect of coenzyme Q10 in patients with kidney diseases]. / Ucinok koenzýmu Q10 u pacientov s ochoreniami obliciek.

BACKGROUND: Coenzyme Q10 belongs to important antioxidants and it has a key role in the synthesis of adenosinetriphosphate. Its beneficial effect was proved in several diseases, e.g. in mitochondrial encephalopathy, mitochondrial myopathy, mitochondrial cardiomyopathy. MATERIAL AND METHODS: All 15 patients of the studied group (5 with tubulopathy and 10 with chronic tubulointersticial nephritis) received antioxidative therapy for three months (E vitamin, C vitamin, riboflavin) and for the last two months coenzyme Q10 was added. Renal functions, spectrum of lipids, parameters of lipid peroxidation (malondialdehyde), levels of alpha-tocopherol, beta-carotene, coenzyme Q10. RESULTS: Before the substitutive antioxidative treatment, coenzyme Q10 levels reached in blood 0.11 +/- 0.03 mumol/l and 0.15 +/- 0.04 mumol/l in plasma. These values were well below the reference range (rr) is 0.4 +/- 1.0 mumol/l). After the substitution coenzyme Q10 levels significantly increased (p < 0.001) to the values of 1.66 +/- 0.16 mumol/l in blood and to 1.78 +/- 0.27 mumol/l in plasma. Plasma levels of beta-carotene increased from the markedly subnormal values 0.25 +/- 0.07 mumol/l (rr > 0.8 mumol/l) to 0.56 +/- 0.02 mumol/l (no statistical difference). Plasma levels of alpha-tocopherol remained within the reference range 32.15 +/- 4.73 mumol/l (rr 15-30 mumol/l) and they increased up to the plasma level of 44.83 +/- 5.82 mumol/l during the period of testing. Malondialdehyde levels did not significantly change within the testing period. No changes in renal functions and parameters of lipid metabolism were described. Patients well tolerated the treatment and no adverse effects were seen during the period of observation. CONCLUSIONS: Our results ascertained that levels of antioxidant CoQ10 were lower in patients with nephropathy who underwent conservative treatment with peroral substation. Such deficit can be amended by CoQ10 administration, which could be therefore taken as complementary treatment of nephrology.

[Prophylactic treatment of vasospasm with nimodipine in subarachnoid hemorrhage]. / Profylaktická liecba vazospazmu nimodipinom u subarachnoideálneho krvácania.

Nimodipine, a calcium antagonist, was administered to 33 patients with subarachnoidal haemorrhage as prophylaxis of late ischaemic neurological deficiency. Despite the relatively high frequency of vasospasm during repeated angiographic examinations (27%), the general therapeutic effect in the group of treated patients was favourable. 52% patients improved and had no or only a minimal neurological deficit. Possible mechanisms of the favourable effect of nimodipine in subarachnoidal haemorrhage are mentioned in the discussion.