The Diagnostic Value of Oxidative/Antioxidative Balance Parameters in Venous Thromboembolism.

BACKGROUND: The aim of this study is to observe the association between venous thromboembolism (VTE) and oxidative stress and to see if there is a diagnostic value in the oxidative/antioxidative balance parameters like total oxidant status (TOS), total antioxidant status (TAS), paraoxonase-(PON1), and arylesterase (ARE) enzyme activities in this specific disease. METHODS: Sixty-nine patients with deep vein thrombosis and/or pulmonary embolism and 40 control subjects were included in the study. Oxidative stress index, total oxidant status, and antioxidant status were examined in addition to the PON1 and ARE enzyme activities in both groups. RESULTS: Serum PON1 and ARE activities were significantly lower in the VTE patients, whereas total oxidant status was higher in patients compared to the controls. CONCLUSIONS: This preliminary study showed that oxidative/antioxidative balance shifted towards the oxidative status in venous thromboembolism. ROC analysis results suggested that the parameters used in this study were not good enough to be used in the diagnosis of VTE.

Decreased paraoxonase 1, arylesterase enzyme activity, and enhanced oxidative stress in patients with mitral and aortic valve insufficiency.

BACKGROUND: Oxidative stress is reportedly associated with several cardiovascular diseases. The antioxidant ability of high density lipoprotein (HDL) is, at least in part, attributable to the pleiotropic serum paraoxonase (PON1). The aim of the study was to investigate the body oxidant/antioxidant balance in patients with mitral regurgitation (MR) and aortic regurgitation (AR) to get new points of view for the underlying oxidative mechanisms. METHODS: Oxidative stress index (OSI), total oxidant status (TOS), and total antioxidant status (TAS) were examined in addition to the PON1 and arylesterase (ARE) enzyme activities in fifty-six patients and thirty-seven healthy control subjects. RESULTS: Serum PON1 and ARE enzyme activities were statistically significantly reduced in heart valve disease (HVD) patients (p = 0.0005 and p < 0.0001, respectively), whereas TOS and OSI levels were found to be significantly higher (p = 0.0021 and p < 0.0001, respectively). CONCLUSIONS: Serum PON1 activity is reduced in patients with HVD, caused by elevated oxidative stress and disturbances of heart valve metabolism. The findings from this novel detailed approach, implicate an inflammatory/oxidative stress process in the pathogenesis of the valve's presentation associated with the HVD. The strength of the significance in differences encourage us to propose that the role of oxidative stress in HVD pathogenesis is very prominent, and oxidative stress markers are potential ancillary tests to evaluate the state of the disease.

Serum total homocystein, folate and vitamin B12 levels and their correlation with antipsychotic drug doses in adult male patients with chronic schizophrenia.

BACKGROUND: Elevated blood levels of homocysteine (hCY) have been associated with schizophrenic male patients. However, controversy remains regarding the association between lowered plasma folate and vitamin B12, hyperhomocysteinemia, and schizophrenia. Sixty-six (66) male patients with chronic schizophrenia were investigated to test the hypotheses that alterations in Hcy, folate, and vitamin B12 levels might be related to the antipsychotic drug doses used in treatment. METHODS: Serum total homocysteine, folic acid, and vitamin B12 levels were determined by chemiluminescence methods in both patients and control subjects. The patients were grouped according to the antipsychotic drug doses used in their treatment. RESULTS: Patients had higher homocysteine levels but they did not differ from controls in terms of folate and vitamin B12 levels. On the other hand, only folate levels were negatively correlated in the patient group treated with higher therapeutic doses of chlorpromazine equivalents (> 400 mg/day) compared to the patient group with lower doses (< 400 mg/day). CONCLUSIONS: Our findings show that higher typical antipsychotic drugs may play a role as modifiying factor for folate metabolism in chronic schizoprenic male patients.

The results of a close follow-up of trainees to gain a good blood collection practice.

BACKGROUND: Phlebotomy is one of the most important steps in the preanalytical phase of a clinical laboratory process. In order to decrease phlebotomy errors, this specific procedure should be taught in detail by laboratory organizations. Our study aims to practice the training program on venous blood sampling and observe the close follow-up results. METHODS: In this observational study, 127 students who started their summer internship in Antalya Education and Research Hospital were given a one-day theoretical phlebotomy training in accordance with the Venous Blood Sampling Guidelines. After the theoretical training, phlebotomy applications of 10 students who were working in the field of out-patient blood sampling were observed both with and without their knowledge. A comprehensive checklist related to phlebotomy was created by the trainers in Antalya Education and Research Hospital and the observers answered each question as yes or no. For the statistical analysis, IBM SPSS Statistics 21.0 was used. RESULTS: After the theoretical education, the trainees were observed but no significant difference was found between the first and the second informed observations (p = 0.125). The students were observed three times more in the following week without their knowledge. There was a statistically significant difference between the first and the third unannounced observations (p=0.001). CONCLUSIONS: In order to perform phlebotomy correctly, apart from theoretical education, a close follow-up is necessary too.

A model for managing and monitoring the quality of glucometers used in a high-volume clinical setting.

INTRODUCTION: The aim of this study is to present a model for assuring the quality of a large number of glucometers being used in a high-volume hospital clinical setting. MATERIALS AND METHODS: Internal quality-control samples and blood samples from two patients were used to determine the accuracy of 83 glucometers used at our hospital. On each glucometer three levels of control were used for glucose concentrations determination. In addition, the difference between the results from patient samples obtained with the glucometers and the hexokinase reference method were compared. The differences were assessed based on the International Organization for Standardization (ISO 15197) standards. RESULTS: The glucose concentrations were as follows: 2.51 ± 0.34 mmol/L for the hypo-control samples; 5.12 ± 0.32 mmol/L for the low-control samples; and 16.11 ± 1.03 mmol/L for high-control samples. All results were within the expected ranges. For Patient I, the result with the first group of 52 glucometers was 11.56 ± 0.5 mmol/L, while the result for Patient II with the second group of 31 glucometers was 10.52 ± 0.62 mmol/L. All data points of the study complied with the requirements of the Clarke error grid. CONCLUSION: All quality-control and comparison assay results were appropriate for evaluating glucometers used in a high-volume hospital setting. The method used in this study can be suggested as a model for laboratory managers, especially in similar high-volume hospitals.

Pre-Test and Post-Test Applications to Shape the Education of Phlebotomists in A Quality Management Program: An Experience in a Training Hospital.

BACKGROUND: After the introduction of modern laboratory instruments and information systems, preanalytic phase is the new field of battle. Errors in preanalytical phase account for approximately half of total errors in clinical laboratory. The objective of this study was to share an experience of an education program that was believed to be successful in decreasing the number of rejected samples received from the Emergency Department (ED). METHODS: An education program about laboratory procedures, quality requirements in the laboratory, patient and health-care worker safety was planned by the quality team to be performed on 36 people who were responsible for sample collection in the ED. A questionary which included 11 questions about the preanalytic phase was applied to all the attendees before and after training. The number of rejected samples per million was discovered with right proportion account over the number of accepted and rejected samples to laboratory after and before the training period. RESULTS: Most of the attendees were nurses (n: 22/55%), with over 12 years of experience in general and 2-4 years experience in the ED. Knowledge level of the attendees was calculated before training as 58.9% and after training as 91.8%. While the total rate of sample rejection before training was 2.35% (sigma value 3.37-3.50), the rate after training was 1.56% (sigma value 3.62-3.75). CONCLUSIONS: Increasing the knowledge of staff has a direct positive impact on the preanalytic phase. The application of a pre-test was observed to be a feasible tool to shape group specific education programs.

Effect of pentylenetetrazol-induced epileptic seizure on the antioxidant enzyme activities, glutathione and lipid peroxidation levels in rat erythrocytes and liver tissues.

OBJECTIVES: In order to clarify whether oxidative stress accompanies epilepsy, we examined the effects of pentylenetetrazol (PTZ)-induced epilepsy on the lipid peroxidation and antioxidant enzyme activities in erythrocytes and liver tissues of adult Wistar rats. MATERIALS AND METHODS: The activities of antioxidative enzymes (glucose-6-phosphate dehydrogenase (G-6-PD)), copper, zinc-superoxide dismutase (Cu,Zn-SOD), catalase (CAT), selenium-dependent glutathione peroxidase (Se-GSH-Px) and the levels of reduced glutathione (GSH) and thiobarbituric acid-reactive substances (TBARS) were measured in erythrocytes and liver tissues of pentylenetetrazol (PTZ)-induced epileptic adult Wistar rats. RESULTS: Single PTZ treatment in a convulsive dose of 50 mg/kg significantly reduced the erythrocyte Cu,Zn-SOD, CAT enzyme activities and GSH levels compared to controls (P < 0.001, P < 0.001, P < 0.05, respectively). Erythrocyte and liver tissue TBARS levels in the epileptic group were significantly higher than controls (P < 0.0001). There was a significant decrease in liver tissue Cu,Zn-SOD activity and GSH levels in the epileptic group (P < 0.0001), whereas significantly higher activities of G-6-PD and Se-GSH-Px were found in the epileptic group. CONCLUSIONS: Our results demonstrate a generalized diminished antioxidant activity and increased TBARS level indicating enhanced oxidative stress in the liver and erythrocytes of epileptic rats. Increased oxidative stress in the liver of epileptic rats might be due to the activation of the recently found glutamate receptors in the liver. These findings suggest that the use of antioxidants with antiepileptic drugs and new drugs such as type-5 metabotropic glutamate receptor (mGlu5) antagonist (MPEP) might protect erythrocytes and liver tissue against anoxic damage and oxidative stress.

Increased levels of total oxidant status and decreased activity of arylesterase in migraineurs.

OBJECTIVES: There is strong evidence associating migraine with a variety of comorbid disorders, including cardiovascular disease and stroke, in which oxidative stress seems to be an important underlying mechanism. The aim of the study was to investigate in migraineurs the body oxidant/antioxidant balance and paraoxonase enzyme activities as a measure of HDL functionality. DESIGN AND METHODS: Oxidative stress index, total oxidant status and antioxidant status were examined in addition to the paraoxonase and arylesterase enzyme activities in sixty-two migraineurs and fifty healthy control subjects. RESULTS: Serum arylesterase activities were significantly lower in migraineurs (p=0.0065), whereas total oxidant status was higher in patients compared to the controls (p=0.0035). CONCLUSIONS: This preliminary study showed that oxidative/antioxidative balance shifted towards the oxidative status in migraine. Moreover, the results also suggested that decreased arylesterase activities might be associated with HDL-related disfunction.

Impaired oxidative balance and association of blood glucose, insulin and HOMA-IR index in migraine.

INTRODUCTION: The nature of the relationship between glucose metabolism and occurrence of migraine has not been elucidated precisely. This study investigated the status of oxidative/antioxidative balance and its relationship with the glucose metabolism in migraineurs to get new points of view for the underlying oxidative mechanisms. MATERIALS AND METHODS: Sixty migraineurs and 46 control subjects were included in the study. Oxidative stress index, total oxidant and antioxidant status of both groups were examined in addition to the insulin and HOMA-IR index levels. RESULTS: HOMA-IR index was significantly enhanced in migraineurs (P = 0.038); similarly oxidative stress index and total oxidant status were higher in patients compared to the controls (P < 0.001 for both). CONCLUSION: This preliminary study shows that oxidative/antioxidative balance shifts towards the oxidative status in migraine. Higher total oxidant status and elevated HOMA-IR index might play a role in the potential early pathogenesis for migraine.