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Journal Article 2002; 23(3): 219-225 PubMed PMID: 12080282 Citation  Keywords:  Acute Disease:psychology, Adult, Age Factors, Birth Weight, Cognition, Cross-Sectional Studies, Female, Humans, Male, Models, Psychological, Neuroimmunomodulation, Predictive Value of Tests, Retrospective Studies,.   

BACKGROUND: The Barker Hypothesis suggests that an unfavourable uterine environment can have the effect of programming the body for disease later in life. Research indicates a bidirectional relationship between thought and biochemical reactions, that may be influenced by early programming. Reports suggest that 25% of variance in birthweight is a result of foetal environment and that the health and cognitive deficits do not just affect those with an officially low birthweight.

OBJECTIVE: This study investigates the influence of birthweight on cognition and minor illness in adults.

METHODS: This is a retrospective, cross sectional design with an opportunity sample of 75 adults. Participants whose birthweight ranged from 2.5 kg to 4.88 kg, completed a symptom check list and general self-efficacy scale, reporting on the previous month.

RESULTS: Analysis of variance indicates that those with higher birthweight have fewer minor illness symptom days and higher general self-efficacy. Regression analysis indicates that birthweight is significantly predictive of levels of minor illness and general self-efficacy.

CONCLUSION: From the findings of this and previous studies, it is possible to infer vertical coactions between foetal environment and immuno competence. It is suggested that birthweight is an early predictor of levels of a cognitive mediator and minor illness. Data were applied to an equilibrium model to represent the relationship in terms of Gottlieb's concept of horizontal and vertical coactions....

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Journal Article 2002; 23(3): 199-208 PubMed PMID: 12080279 Citation  Keywords:  Humans, Mental Disorders:complications, Neurodegenerative Diseases:complications, Stress, Physiological:complications,.   

OBJECTIVE: Evidence for a connection between stress and selected neurodegenerative diseases as well as mental disorders is analyzed. Does stress cause or exacerbate related pathophysiological disease processes?

METHOD: The stress phenomenon is illustrated and the impact of stress on the nervous system, neurodegenerative diseases, and mental disorders is examined. The connection between stress and the hippocampus - and its association with memory functions - is described. In particular, the pathophysiological significance of stress in Alzheimer's disease, multiple sclerosis, anxiety, depression, posttraumatic stress disorder, and schizophrenia is investigated.

RESULTS: Stress plays a major role in various (patho)physiological processes associated with neurodegenerative diseases and mental disorders. In principle, stress has the potency to exert either ameliorating or detrimental effects. The specific outcome depends on multiple variables. However, the amount of stress experienced in relation to activated physiological processes that aim at successful coping and positive adjustments (i.e., stress response) most often is overwhelming - and may thus become detrimental in the long-term. Moreover, the hippocampus is sensitive to stress, and its involvement in neurodegeneration - in the course of stress-related disease processes - may account for severe clinical disabilities (e.g., memory loss).

DISCUSSION/CONCLUSION: Stress has a major impact upon neurodegenerative diseases and mental disorders. It plays a significant role in susceptibility, progress, and actual outcome. Also, subjective or individual differences have to be taken into account. However, stress - especially 'adequate' acute stress (stress that is not overwhelming) - may even improve performance/biological functions and be beneficial in certain cases....

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Clinical Trial 2002; 23(Suppl 1): 97-102 PubMed PMID: 12019361 Citation  Keywords:  Adult, Blood Pressure:physiology, Circadian Rhythm:physiology, Creatinine:urine, Disease Progression, Female, Humans, Kidney Failure, Chronic:blood, Male, Melatonin:blood, Middle Aged, Urea:metabolism,.   

OBJECTIVES: In spite of broad interest, intensive studies on function of melatonin have not yielded much information about relationships between this hormone and kidneys in health, and particularity, in disease. Very little is known about the circadian plasma melatonin concentrations in patients with chronic renal failure (CRF). There are only a few studies dealing with melatonin concentrations in renal diseases, mainly performed in hemodialyzed patients with end-stage renal disease (ESRD). Moreover, the most melatonin assays were performed during the daytime, and the results are conflicting. Therefore, the aim of the present study was to determine the circadian melatonin profiles in patients with different stages of CRF.

MATERIAL AND METHODS: Twenty four patients (13 males and 11 females) with CRF aged 35 to 58 years (mean+/-SEM: 47.0+/-1.6 years) were included in the study. Patients were divided into two groups: group 1 -- patients with compensated CRF (serum creatinine: 2.0-5.0 mg/dL), group 2 -- patients with ESRD (serum creatinine: > 8,0 mg/dL). The control group consisted of 20 healthy volunteers (10 males and 10 females) aged 35 to 55 years (mean+/-SEM: 46.0+/-1.5 years) checked not to have renal failure [serum creatinine: 0.8-1.4 mg/dL], and matched according to sex and age. Blood samples were collected at 08:00, 12:00, 16:00, 20:00, 24:00, 02:00, 04:00, and 08:00 h. Melatonin concentration was measured by enzyme immunoassay.

RESULTS: In both groups of patients with chronic renal failure, i.e. in patients with compensated disease and in patients with end-stage renal disease melatonin nocturnal concentrations were significantly lower then those in healthy volunteers. Moreover, in patients with compensated renal failure also day-time melatonin concentrations were significantly depressed. Area under curve was significantly lower in both groups of patients in comparison with the control group.

CONCLUSIONS: The mechanism of depressed melatonin concentrations in CRF observed in our study remains unclear. However, it seems possible that decline in melatonin levels is due to impairment in adrenergic function that occurs in CRF. Because the studies on the melatonin secretion in CRF bring about conflicting results, the relationship between renal diseases and melatonin secretion needs further investigations....

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Journal Article 2002; 23(Suppl 1): 20-23 PubMed PMID: 12019347 Citation  Keywords:  Aged, Alzheimer Disease:complications, Antioxidants:therapeutic use, Circadian Rhythm:drug effects, Clinical Trials as Topic, Humans, Melatonin:therapeutic use, Sleep Wake Disorders:drug therapy,.   

: About 45% of Alzheimer's disease (AD) patients have disruptions in their sleep and sundowning agitation. Since melatonin secretion is greatly inhibited in AD patients we have used melatonin to treat sleep disorders in AD patients since 1995. In a first study [21] we reported, in 7 out of 10 dementia patients treated with melatonin (3 mg p.o. at bed time), a decreased sundowning. In a second study [22] we examined 14 AD patients who received 9 mg melatonin daily for 22 to 35 months, observing a significant improvement of sleep quality with stabilization of behavioral and cognitive parameters. In a third study [23] we reported two monozygotic twins with AD and similar cognitive impairment, one of them receiving 6 mg melatonin at bedtime daily for 3 years. Melatonin treatment improved sleep quality and suppressed sundowning. We now report the effect of melatonin (4-month-long treatment with 6 mg/day) in 45 AD patients with sleep disturbances. Melatonin improved sleep and suppressed sundowning, an effect seen regardless of the concomitant medication employed to treat cognitive or behavioral signs of AD. Melatonin treatment seems to constitute a selection therapy to ameliorate sundowning and to slow evolution of cognitive impairment in AD patients....

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Journal Article 2002; 23(2): 155-160 PubMed PMID: 12011802 Citation  Keywords:  Aged, Aged, 80 and over, Alzheimer Disease:blood, Estradiol:blood, Estrone:blood, Female, Folic Acid:blood, Humans, Logistic Models, Mental Status Schedule, Testosterone:blood,.   

OBJECTIVES: In vitro and in vivo animal studies suggest that sex steroids, such as estrogens and testosterone, could protect the brain. However, estrogen replacement therapy (ERT) for Alzheimer's disease (AD) in women has not been successful. We hypothesised that the lack of effect of ERT might be related to an interaction between estrogens and some other factor(s) associated with AD.

DESIGN, SETTING AND METHODS: We analysed total estrogen (TE) and testosterone (TT) levels in women diagnosed with AD and controls of the Oxford Project To Investigate Memory and Ageing. Because estradiol (TE2) after the menopause is largely derived from estrone (TE1), we computed the ratio TE2/(TE1+TE2) and a total steroid index (TT+TE2+TE1).

RESULTS: Women with AD (n=66) had significantly higher levels of TE2 (27+/-13 vs. 21+/-13) and a higher TE2/(TE1+TE2) ratio. Stepwise logistic regression analyses showed that the TE2/(TE1+TE2) ratio was the main sex steroid predictor for AD (O.R.=1.06, 95% C.I.=1.01-1.11, p<0.01). Multiple regression analyses revealed that dementia severity was associated with an interaction between the TE2/(TE1+TE2) ratio and serum folate (B=4.59 (SE=1.48), beta=1.22, 95% C.I.=1.62-7.56, p<0.005). None of the other potential mediators of this association (body mass index, sex hormone binding globulin, homocysteine levels, ApoE genotype, smoking, diabetes, blood pressure) was significant.

MAIN FINDINGS: A high ratio of estradiol to total estrogens is associated with AD but, in subjects with a high ratio, the dementia severity was lower in those with high serum folate levels.

CONCLUSIONS: If this association is causal, then supplementation with folic acid might be considered in future studies on ERT in AD....

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Journal Article 2002; 23(2): 133-140 PubMed PMID: 12011799 Citation  Keywords:  Biomarkers, Bites and Stings:complications, Child, Creatine Kinase:blood, Creatine Kinase, MB Form, Female, Heart Diseases:etiology, Humans, Interleukin-8:blood, Isoenzymes:blood, L-Lactate Dehydrogenase:blood, Male, Myocardium:metabolism, Scorpion Venoms.   

OBJECTIVES: (1) To investigate the significance of assessment of serum levels of cardiac troponin I (cTnI) and interleukin-8 (IL-8) beside other biomarkers of myocardial injury in scorpion envenomed children. (2) To find the correlation between these biochemical indices with clinical status, prognosis and outcome of these cases.

METHODS: Forty-one children in Upper Egypt were admitted to Pediatric Intensive Care Unit, Assiut University Hospital, for scorpion envenomation. They were compared with fifteen apparently healthy children of matching age as controls. The victims and controls were subjected to complete clinical examination, full blood count and arterial blood gases analysis. According to severity of scorpion envenomation, 17 children had manifestations of severe envenomation and clinical signs of toxic myocarditis (severe cases), 14 children had moderate manifestations of envenomation without clinical evidence of carditis (moderate cases) and 10 cases showing only mild symptoms of envenomation (mild cases). The serum levels of cTnI and IL-8 beside the enzymatic activities of creatine phosphokinase (CPK), CPK-MB isoenzyme (CPK-MB) and lactate dehydrogenase (LDH) were determined once for mild cases and controls on admission and twice for severe and moderate cases on admission and after 24 hrs. The measurements of electrocardiography (ECG), echocardiographic measurement of % fractional shortening of left ventricule (%SF), left ventricular ejection fraction (LVEF) and cardiac chambers dilatation were done for severe and moderate cases.

RESULTS: All the envenomed victims showed significantly higher mean values of CPK, CPK-MB, LDH, and IL-8 on admission in comparison to control group. cTnI was not detectable in the sera of control group as well as patients with mild envenomation. The mean values of CPK, CPK-MB, LDH, and IL-8 were significantly higher in severe cases while only IL-8 and CPK-MB were significantly higher in moderate cases in comparison with mild cases. The mean values of IL-8, cTnI, CPK, CPK-MB and LDH were significantly higher in severe cases both on admission and on follow-up comparing with moderate cases. The case fatality rate was 12.5% and all were from severe cases with toxic myocarditis (5/41=12.5%). The non-survivors victims showed significant higher mean values of only cTnI on admission and both cTnI and IL-8 on follow up in comparison to the survivors. Significant reduction of % SF and LVEF were noticed among the non-survivors in comparison to survivors. The cTnI showed 100% specificity and sensitivity for diagnosis of myocardial injury in relation to Echo finding in the envenomed victims. In severe cases, cTnI was positively correlated with IL-8 while negatively correlated with %SF and LVEF.

CONCLUSION: it may be suggested that cTnI is the most specific marker for diagnosis of myocardial injury in scorpion envenomation, which is almost associated with skeletal muscle injury. Other biochemical markers did not show such specificity. Also, IL-8 may be involved in the pathogenesis of myocardial injury of scorpion envenomation. Both cTnI and IL-8 may be useful to forecast the fatal outcome in scorpion envenomation....

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Journal Article 2002; 23(2): 115-118 PubMed PMID: 12011796 Citation  Keywords:  Adnexal Diseases:complications, Animals, Antioxidants:pharmacology, Female, Guinea Pigs, Lung:chemistry, Malondialdehyde:analysis, Melatonin:pharmacology, Ovariectomy, Pulmonary Edema:drug therapy, Reperfusion Injury:complications, Torsion Abnormality,.   

OBJECTIVES: Pulmonary edema has been shown to occur following ischemia-reperfusion injury in a variety of organs and effects of several pharmacological agents on ischemia-reperfusion-induced damage has been investigated previously. However, there are only a few studies in the literature about pulmonary injury following adnexial ischemia-reperfusion. In this study we aimed at investigating pulmonary changes following adnexial ischemia-reperfusion and the effects of melatonin on noncardiogenic pulmonary edema secondary to adnexial ischemia-reperfusion.

METHODS: A total of 32 Dunkin-Harley guinea pigs were randomly divided into four groups. In group I, oopherectomy was performed following adnexial torsion of three hours (ischemia). Adnexial torsion of three hours followed by a 3 hours detorsion period (reperfusion) and then oopherectomy was performed in remaining three groups. No therapy was given in group one and two while isotonic saline and melatonin was applied intraperitoneally in groups three and four, respectively. Serum malondialdehyde (MDA) levels of operated ovaries and lungs and polimorphonuclear leucocyte infiltration of lungs were determined.

RESULTS: MDA levels in serum, ovary and lungs were higher in detorsion groups (groups II, III) than torsion group (group I) (p<0.01). Melatonin administration significantly decreased the polimorphonuclear leukocytes infiltration of lung parenchime and MDA levels in serum, ovaries and lungs (groups II and IV; groups III and IV; p<0.01, p<0.01). MDA levels and lung tissue PNL infiltration levels of melatonin administered detorsioned group was similar to those levels of only salphingo-oopherectomy performed group (Group I and IV, p>0.05).

CONCLUSION: Pathophysiology of ischemia-reperfusion must be considered in the cases of adnexial torsion where detorsion is thought. As an antioxidant, melatonin administration might be helpful in decreasing post-operative morbidity by decreasing reperfusion injury of lungs....

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Case Reports 2001; 22(4): 263-269 PubMed PMID: 11524634 Citation  Keywords:  Adolescent, Adult, Child, Choristoma:diagnostic imaging, Female, Hormones:therapeutic use, Humans, Hyoid Bone, Mandibular Diseases:drug therapy, Middle Aged, Thyroid Gland, Tomography, X-Ray Computed, Tongue Diseases:diagnostic imaging,.   

OBJECTIVES: The authors describe the classification of heterotopic thyroid tissue. A survey of more than 600 literature cases is provided. Different therapy approaches for these anomalies are discussed. Data from seven subsequent cases have been added to the existing literature data. The authors present an alternative approach to the therapy of heterotopic thyroid tissue.

MATERIALS AND METHODS: The records of seven patients treated for a heterotopy of the thyroid tissue as the Department of ENT and Head and Neck Surgery of First Medical school of the Charles University of Prague since 1.1.1991 to 1.1.2001 have been analyzed.

RESULTS: The first group: No surgery. This approach was used for children. In these patients the heterotopic thyroid tissue is the only thyroid tissue they have, but its function is not damaged and there are no mechanical symptoms (no airway obstruction and dysphagia). TSH substitution-suppression therapy is necessary for this group. Cooperation and follow up by the endocrinology, otolaryngology and pediatric departments is necessary. At a later age these patients can be treated as in the second group. The second group: Surgery. All patients in this group had heterotopic thyroid tissue. The total removal of thyroid tissue has been preferred. Carcinomatous change or the development of mechanical syndrome, dysphagia or airway obstruction is possible. Total removal is the best surgical approach. Various surgical methods are described in the literature (CO2 laser, intraoral, mandibulotomy, middle hyotomy etc.). These patients are treated as after total thyroidectomy and substitution therapy with synthetic thyroid hormones is necessary. The authors describe and add seven cases to the literature data. The authors describe radical removal of aberrant and accessory tissue [corrected]....

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