[COMPLICATED URINARY TRACT INFECTIONS IN THE ELDERLY].

Urinary tract infections (UTI) are the most common bacterial infections involving lower (cystitis, prostatitis) or upper (pyelonephritis, renal abscess, perinephric abscess) urinary tract. Differentiation of complicated and uncomplicated UTI is usually based on the presence of structural or functional urinary tract abnormalities, which can increase the risk of treatment failure and development of serious complications. Factors that increase the risk are foreign bodies, stones, obstruction, neurogenic bladder, kidney transplantation, immunosuppression, and pregnancy. Complicated UTI includes a spectrum of conditions that increase the risk of treatment failure, as well as of serious complications such as bacteremia and sepsis, perinephric abscess, renal impairment and emphysematous pyelonephritis. To avoid the potentially devastating outcomes, appropriate diagnostic procedures, antibiotic and surgical treatment, and appropriate follow-up are required. The incidence of complicated UTI will grow in the future due to general aging of the population, increasing incidence of diabetes, and ever growing number of immunocompromised and immunosuppressed patients. It is of key importance to recognize complicated UTI on time, and treat it wisely and aggressively to reduce duration of the disease and the risk of antibiotic resistance.

High clinical accuracy of asymmetric dimethylarginine and symmetric dimethylarginine in patients with ischemic heart disease.

Elevated plasma concentrations of asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) were found in various clinical settings including coronary heart disease. To assess ADMA and SDMA diagnostic validity in patients with different stages of ischemic heart disease, we studied these markers in patients having stable angina pectoris (SAP), unstable angina (USAP), and acute myocardial infarction (AMI). The results were compared with the values of healthy individuals. Plasma ADMA and SDMA levels were measured by high-performance liquid chromatography. In all patient groups both markers were significantly elevated in comparison with control ones (p < 0.001). In SAP patients, the median ADMA value was 0.75 (0.31-2.73) µmol/L, and SDMA 1.11 (0.69-0.1.42) µmol/L, in USAP patients, the marker values were 0.94 (0.34-3.13) µmol/L and 1.23 (0.88-4.72) µmol/L, and in AMI patients, 0.98 (0.48-2.01) µmol/L and 1.26 (0.75-2.93) µmol/L, while in healthy subjects they were 0.31 (0.17-0.87) µmol/L and 0.29 (0.20-0.83) µmol/L, respectively. SDMA was found significantly different in SAP and AMI patients (p < 0.05). Diagnostic accuracy was determined by receiver operating characteristic (ROC) curve analysis. The highest area under the ROC (AUC) for ADMA was obtained in AMI patients (0.976), while for SDMA in USAP patients (1.000). There was no significant difference between the AUCs. The greatest sensitivity and specificity were found in the USAP group (95.65 and 96.30 % for ADMA, and 100 % for each characteristic of SDMA). Considering these results, SDMA showed better clinical accuracy in assessing ischemic disease, where it could be used as a valid marker and a therapeutic target.

Oxidative stress intensity in lens and aqueous depending on age-related cataract type and brunescense.

PURPOSE: Cataract formation represents a serious problem in the elderly, and has a large impact on healthcare budget. The oxidative stress form and intensity might determine the cataract type and pigmentation, making efforts in the cataract prevention challenge more complex. METHODS: This is a retrospective cross-sectional review of 80 samples of aqueous humor and lens corticonuclear blocks. Aqueous samples were analyzed by the method of antioxidant activity estimation (%iMDA), while lipid peroxides (LP) and total sulfhydryl groups (TSH) were determined in lenses. RESULTS: Mixed and brunescent cataracts have statistically significant lower values of antioxidative %iMDA and TSH (p<0.001 for both parameters) and higher values of lipid peroxidation (p<0.001). No correlation between LP and TSH with maturity of cortical cataract was found, but there was a significant correlation with the %iMDA (p<0.05). CONCLUSIONS: The role of the oxidative stress in cataractogenesis could not be the same for all cataract types. High level of lipid peroxides in pigmented cataracts may point to the different nature of pigment source than proteins solely, whereas lipid peroxidation and SH groups consumption in cortical cataractogenesis might be of less importance.

Effect of raloxifene on lowering lipid parameters in patients with osteoporosis.

The aim of this study was to show the effect of raloxifene on the lowering of lipid parameters in patients with osteoporosis. New investigations introduced selective estrogen receptor modulators (SERMs), such as raloxifene, as a potent drug in the lowering of lipid parameters. Raloxifene is known as a substance that works well in preventing and treating osteoporosis. We investigated the effect of raloxifene on the lowering of lipid parameters (cholesterol and triglycerides) in 94 women who took 60 mg/day of raloxifene for the treatment of osteoporosis. We performed three measurements of cholesterol and triglycerides, at the beginning of the study and at 3 and 12 months. Bone mineral density (BMD) was measured at the begining and at 12 months; spine BMD increased 2.7%. The mean value of cholesterol was 6.6961 mmol/l at the beginning, 6.060 mmol/l at 3 months and 5.826 mmol/l at 12 months. The difference between mean values was statistically significant at p < 0.01. Mean values of triglycerides were 2.153 mmol/l at the beginning, 1.970 mmol/l at 3 months and 1.680 mmol/l at 12 months. The difference between mean values at 3 months was statistically significant at p < 0.05 and at 12 months at p < 0.01. We concluded that raloxifene had significant effects on lowering cholesterol and triglycerides in postmenopausal women and that raloxifene is the best choice in the treatment of osteoporosis and moderate lipid disorders.

Monotherapy with metformin: does it improve hypoxia in type 2 diabetic patients?

Metformin reduces blood glucose levels predominantly by inhibiting hepatic gluconeogenesis, although it also may enhance insulin receptor number or activity. The full effects of metformin are still poorly understood. In this study the effects of metformin on plasma xanthine oxidase (XO) activity, thiobarbituric acid-reactive substance (TBARS), lactate and fructosamine concentration as well as erythrocyte antioxidant enzyme activities were investigated in 46 patients with type 2 diabetes mellitus. All parameters were measured simultaneously just before metformin therapy (T0), 1 month (T1) and 2 months (T2) later. Results were compared with placebo and control group. We noted significant decrease in XO activity and in TBARS concentration (p<0.001) during monotherapy with metformin vs. placebo and T0 group. A significant correlation was observed between the activity of XO and the concentration of fructosamine (p<0.001). Erythrocyte glutathione peroxidase showed significantly lower activity in T2 group in comparison with T0 group (p<0.01). It is known that diabetic patients produce more TBARS as a result of enhanced free radical generation the source of which may also be the large amounts of XO produced following the conversion of xanthine dehydrogenase in hypoxic diabetic tissues. Thus, our results indirectly suggest that metformin can reduce toxic tissue damage through the inhibition on XO activity.

Method for the measurement of antioxidant activity in human fluids.

AIM: To develop a new, simple, and cheap method for estimating antioxidant activity in human fluids. METHODS: The assay measured the capacity of the biological fluids to inhibit the production of thiobarbituric acid reactive substances (TBARS) from sodium benzoate under the influence of the free oxygen radicals derived from Fenton's reaction. A solution of 1 mmol/litre uric acid was used as standard. RESULTS: The following mean (SD) antioxidative activities were found (as uric acid) in the various biological fluids: serum, 2.04 (0.20) mmol/litre; urine, 176.5 (25.6) micromol/litre; cerebrospinal fluid, 95.0 (26.9) micromol/litre; aqueous humour oculi, 61.25 (9.9) micromol/litre; saliva, 838.5 (48.2) micromol/litre; tears, 247.0 (17.0) micromol/litre; ascites fluid, 270.0 (63.3) micromol/litre; kidney cyst fluid, 387.1 (28.1) micromol/litre. Small samples of the biological material were needed for the analyses: 10 microl of serum and 50-100 microl of other body fluids. In the sera of 48 healthy individuals there was a significant positive correlation between values obtained with the Randox method (as a reference method) and the new method proposed here (correlation coefficient, 0.8728; mean difference between methods, <0.4%). CONCLUSIONS: This method is easy, rapid, reliable, and practical for the routine measurement of total antioxidant activity in serum and other human body fluids. Small samples of biological material are needed for the analyses and the results are comparable with the reference (Randox) method.

Does captopril change oxidative stress in puromycin aminonucleoside nephropathy?

Puromycin aminonucleoside (PAN) nephropathy in rats has been induced by the intraperitoneal injections of PAN. One group of animals which received PAN has been treated simultaneously with captopril (angiotensine converting enzyme-ACE-inhibitor) with the aim to test whether continuing treatment with captopril along with PAN injections would be able to modulate the toxic effects of PAN. The third group of rats was given only captopril. Morphological changes in the kidney were evaluated by scanning electron microscopy that showed the loss of podocyte foot processes in the kidney of PAN treated animals but also in the kidney of captopril treated ones as well as in the animals treated with both drugs simultaneously. Reduced glutathione content, catalase, superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), xanthine oxidase activities as well as lipid peroxides were investigated in rat blood and kidney. Captopril given alone produced a significant decrease of plasma lipid peroxides, but it did not show any significant effect on investigated antioxidative factor levels neither in blood nor in the kidney. PAN given alone produced a significant depletion of plasma lipid peroxides, kidney catalase and erythrocyte GSH-Px activity as well as a significant increase of plasma catalase and erythrocyte SOD activity. Treatment of animals with both drugs simultaneously resulted in a significant increase of erythrocyte SOD activity and a significant decrease of plasma lipid peroxides, erythrocyte GSH-Px and kidney SOD activities. Kidney xanthine oxidase activity showed a significant increase in both PAN and PAN plus captopril treated animals in comparison with the values of captopril treated rats. These data suggest that PAN changes the antioxidative factor pattern in rat blood and kidney. Contrary to our expectations that captopril may protect the toxic effects of PAN it only to a certain extent modifies these effects showing protective effect only on tissue catalase activity.