Connection between Telomerase Activity in PBMC and Markers of Inflammation and Endothelial Dysfunction in Patients with Metabolic Syndrome

Metabolic syndrome (MS) is a constellation of metabolic derangements associated with vascular endothelial dysfunction and oxidative stress and is widely regarded as an inflammatory condition, accompanied by an increased risk for cardiovascular disease. The present study tried to investigate the implications of telomerase activity with inflammation and impaired endothelial function in patients with metabolic syndrome. Telomerase activity in circulating peripheral blood mononuclear cells (PBMC), TNF-α, IL-6 and ADMA were monitored in 39 patients with MS and 20 age and sex-matched healthy volunteers. Telomerase activity in PBMC, TNF-α, IL-6 and ADMA were all significantly elevated in patients with MS compared to healthy volunteers. PBMC telomerase was negatively correlated with HDL and positively correlated with ADMA, while no association between TNF-α and IL-6 was observed. IL-6 was increasing with increasing systolic pressure both in the patients with MS and in the healthy volunteers, while smoking and diabetes were positively correlated with IL-6 only in the patients' group. In conclusion, in patients with MS characterised by a strong dyslipidemic profile and low diabetes prevalence, significant telomerase activity was detected in circulating PBMC, along with elevated markers of inflammation and endothelial dysfunction. These findings suggest a prolonged activity of inflammatory cells in the studied state of this metabolic disorder that could represent a contributory pathway in the pathogenesis of atherosclerosis

Effect of exercise therapy on lipid profile and oxidative stress indicators in patients with type 2 diabetes

<p>Abstract</p> <p>Background</p> <p>Yoga has been shown to be a simple and economical therapeutic modality that may be considered as a beneficial adjuvant for type 2 diabetes mellitus. This study investigated the impact of Hatha yoga and conventional physical training (PT) exercise regimens on biochemical, oxidative stress indicators and oxidant status in patients with type 2 diabetes.</p> <p>Methods</p> <p>This prospective randomized study consisted of 77 type 2 diabetic patients in the Hatha yoga exercise group that were matched with a similar number of type 2 diabetic patients in the conventional PT exercise and control groups. Biochemical parameters such as fasting blood glucose (FBG), serum total cholesterol (TC), triglycerides, low-density lipoprotein (LDL), very low-density lipoproteins (VLDL) and high-density lipoprotein (HDL) were determined at baseline and at two consecutive three monthly intervals. The oxidative stress indicators (malondialdehyde – MDA, protein oxidation – POX, phospholipase A2 – PLA2 activity) and oxidative status [superoxide dismutase (SOD) and catalase activities] were measured.</p> <p>Results</p> <p>The concentrations of FBG in the Hatha yoga and conventional PT exercise groups after six months decreased by 29.48% and 27.43% respectively (P < 0.0001) and there was a significant reduction in serum TC in both groups (P < 0.0001). The concentrations of VLDL in the managed groups after six months differed significantly from baseline values (P = 0.036). Lipid peroxidation as indicated by MDA significantly decreased by 19.9% and 18.1% in the Hatha yoga and conventional PT exercise groups respectively (P < 0.0001); whilst the activity of SOD significantly increased by 24.08% and 20.18% respectively (P = 0.031). There was no significant difference in the baseline and 6 months activities of PLA2 and catalase after six months although the latter increased by 13.68% and 13.19% in the Hatha yoga and conventional PT exercise groups respectively (P = 0.144).</p> <p>Conclusion</p> <p>The study demonstrate the efficacy of Hatha yoga exercise on fasting blood glucose, lipid profile, oxidative stress markers and antioxidant status in patients with type 2 diabetes and suggest that Hatha yoga exercise and conventional PT exercise may have therapeutic preventative and protective effects on diabetes mellitus by decreasing oxidative stress and improving antioxidant status.</p> <p>Trial Registration</p> <p>Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12608000217303</p

The Predictive Value of Urinary Vanillylmandelic Acid Testing in the Diagnosis of Phaeochromocytoma at The University Hospital of the West Indies

Objective: To investigate the positive predictive value (PPV) of urinary vanillylmandelic acid (VMA) testing in the diagnosis of phaeochromocytoma and to describe the features associated with phaeo-chromocytoma at the University Hospital of the West Indies (UHWI). Subjects and Methods: There were 551 VMA tests performed from January 2003 to June 2009 and 122 tests in 85 patients were elevated (ie ³ 35 μmol/24 hr). The study patients were categorized as: (i) ‘surgical’ (5 patients who underwent surgery) or (ii) ‘non-surgical’ (remaining 80 patients). Forty medical charts (out of 85) were reviewed using a standardized data extraction form. Results: The median age for patients in the non-surgical group (with charts reviewed, n = 35) was 36 years (range 9–70) and the median VMA was 43 μmol/24 hr (IQR 38–51). Of these patients, 83% had one or no symptom typical of phaeochromocytoma. In the surgical group the median VMA was 58 μmol/24 hr (IQR 44-101); phaeochromocytoma was confirmed histologically in 3 patients, all of whom had several symptoms typical of catecholamine excess. VMA testing had a PPV of 8%, specificity of 79% and sensitivity of 100%. Conclusions: VMA testing at UHWI has poor specificity and high sensitivity. These results contrast with international data showing that VMA testing is poorly sensitive but highly specific. The use of assays with higher specificity (eg plasma or urinary metanephrines) may represent a more cost-effective approach to biochemical screening at UHWI. Keywords: Blood pressure, diagnosis, metanephrines, phaeochromocytoma, vanillylmandelic acid. "El valor predictivo de la prueba del ácido vanilmandélico en orina para el diagnóstico de la feocromositoma en el Hospital Universitario de West Indies" RESUMEN Objetivo: Investigar el valor predictivo positivo (VPP) de las pruebas del ácido vanilmandélico urinario (VMA) en el diagnóstico de la feocromositoma y describir las características asociadas con la feocromositoma en el Hospital de la Universidad de West Indies (HUWI). Sujetos y Métodos: Se realizaron unas 551 pruebas de VMA de enero de 2003 a junio de 2009, y 122 de las pruebas en 85 pacientes tuvieron resultados elevados (ie ³ 35 μmol/24 hr). Los pacientes del estudio fueron clasificados como: (i) “quirúrgicos” (5 pacientes que se sometieron a cirugía) ó (ii) “no quirúrgicos” (los 80 pacientes restantes). Se revisaron cuarenta historias clínicas (de 85) mediante un formulario estandarizado de extracción de datos. Resultados: El promedio de edad de los pacientes en el grupo no quirúrgico (con historias clínicas, n = 35) fue de 36 años (rango 9–70) y la mediana VMA fue 43 μmol/24 h (IQR 38-51). De estos pacientes, 83% tenían uno o ningún síntoma típico de la feocromositoma. En el grupo quirúrgico la mediana VMA fue 58 μmol/24 h (IQR 44-101). La feocromositoma fue confirmada histológicamente en 3 pacientes, cada uno de los cuales presentó síntomas típicos de exceso de catecolaminas. Las pruebas de VMA tuvieron un VPP de 8%, una especificidad de 79%, y una sensibilidad de 100%. Conclusiones: Las pruebas de VMA en HUWI poseen pobre especificidad y alta sensibilidad. Estos resultados contrastan con los datos internacionales que muestran que la prueba de VMA es pobremente sensible pero altamente específica. El uso de ensayos con mayor especificidad (por ejemplo, metane-frinas plasmáticas o urinarias) puede representar un método costo-efectivo a la hora de realizar el pesquisaje bioquímico en HUWI. Palabras claves: Presión arterial, diagnosis, metanefrinas, feocromositoma, ácido vanilmandélic

The Importance of Bone Biomarkers in the Diagnosis of Renal Osteodystrophy

Objective: To evaluate the association of serum biochemical markers in patients with chronic kidney disease (CKD) in Jamaica for early detection of renal osteodystrophy (ROD). Methods: The study contained two groups: CKD group (221) which consisted of adult patients, from dialysis units and renal clinics, with stage III to V CKD. The control group (237) had adult individuals, from the medical outpatient clinics, with mild and controlled chronic diseases and absence of renal failure. The patients in the study were between 18–80 years of age and gave informed consent to participate in the study. The differences in distribution of demographic, clinical and pathologic variables between the two groups were evaluated. Pearson’s chi-squared test and Spearman’ rho correlation coefficient test was used, with p < 0.01 considered statistically significant. Data analysis was conducted using the statistical package for the social sciences (SPSS) version 17.0. Results: Among the 221 CKD patients in the study, 174 (78.7%) had ROD based on serum intact parathyroid hormone (iPTH) levels. The majority of patients in the control group did not have bone disease ie 95–96%. The majority of CKD patients (70.0%) had high-turnover (HTO) bone disease compared to 29.3% of patients with low-turnover (LTO) bone disease. Dialysis patients who had HTO bone disease compared with those with LTO had significantly higher levels of iPTH and total serum alkaline phosphatase (ALP). A similar relationship was observed among CKD patients not on dialysis. There was a significant individual variation in bone turnover biochemical markers. A total of 237 patients were recruited in the control group. Based on the levels of iPTH and tALP, six of them were found to have bone disease. The majority of these patients with bone disease were diabetic (83.3%) while the other patient had cancer (16.7%). The six patients in the control group with bone disease were within the age cohort of 64–80 years, most of whom were 78 years old. Conclusion: A combination of serum biochemical markers might predict underlying renal osteodystrophy better that would individual biochemical markers. A predictive model using bone histology and biochemical markers can be developed in the future. Keywords: Biomarkers, chronic kidney disease, parathyroid hormone, renal osteodystrophy "Importancia de los Biomarcadores Óseos en el Diagnóstico de la Osteodistrofia Renal" RESUMEN Objetivo: Evaluar la asociación de marcadores bioquímicos séricos en pacientes con la enfermedad renal crónica (ERC) en Jamaica, para la detección precoz de la osteodistrofia renal (ODR). Métodos: El estudio comprendió dos grupos: un grupo ERC (221) formados por pacientes adultos, provenientes de las unidades de diálisis y las clínicas renales, y en las fases III a V de la ERC. El grupo control (237) estaba constituido por individuos adultos, provenientes de las clínicas ambulatorias médicas, con enfermedades crónicas moderadas y controladas, y sin insuficiencia renal. Los pacientes del estudio tenían edad que fluctuaban de 18 a 80 años de edad y dieron consentimiento informado para participar en el estudio. Se evaluaron las diferencias en la distribución de las variables demográficas, clínicas y patológicas entre los dos grupos. SE usaron la prueba de chi-cuadrado de Pearson y la prueba de coeficiente de correlación rho de Spearman, considerándose p < 0.01 estadísticamente significativa. El análisis de los datos se llevó a cabo usando paquete que usó el paquete estadístico para las ciencias sociales (SPSS) versión 17.0. Resultados: De los 221 pacientes de ERC en el estudio, 174 (78.7%) tenían ODR, basado en los niveles de hormona paratiroidea intacta (PTHi) sérica. La mayor parte de los pacientes en el grupo de control, ie. 95–96%, no tenían enfermedades óseas. La mayoría de los pacientes con ERC (70.0%) presentaban la enfermedad de alto recambio óseo (ARO) en comparación con 29.3% de pacientes con la enfermedad de bajo recambio óseo (BRO). Los pacientes de diálisis con alto recambio óseo – comparados con los de bajo recambio óseo – tuvieron niveles significativamente más altos PTHi y fosfatasa alcalina sérica total (FASt). Una relación similar se observó entre pacientes de ERC sin tratamiento de diálisis. Hubo una variación individual significativa en los marcadores bioquímicos de recambio óseo. Un total de 237 pacientes fueron reclutados para el grupo de control. Sobre la base de los niveles de PTHi y FASt, se hallaron seis con la enfermedad ósea. La mayoría de estos pacientes con enfermedad ósea eran diabéticos (83.3%) mientras que el otro paciente tenía cáncer (16.7%). Los seis pacientes en el grupo de control con enfermedad ósea estaban dentro de la cohorte de 64–80 años de edad, en la que la mayoría tenía 78 años. Conclusión: Una combinación de marcadores bioquímicos séricos podrían predecir una osteodistrofia renal subyacente mejor que los marcadores bioquímicos individuales. En el futuro puede desarrollarse un modelo de predicción que use marcadores tanto bioquímicos como histológicos del tejido óseo. Palabras claves: Insuficciencia renal crónica, biomarcadores óseos, enfermedad ósea, osteodistrofia rena

The Importance of Bone Biomarkers in the Diagnosis of Renal Osteodystrophy

Objective: To evaluate the association of serum biochemical markers in patients with chronic kidney disease (CKD) in Jamaica for early detection of renal osteodystrophy (ROD). Methods: The study contained two groups: CKD group (221) which consisted of adult patients, from dialysis units and renal clinics, with stage III to V CKD. The control group (237) had adult individuals, from the medical outpatient clinics, with mild and controlled chronic diseases and absence of renal failure. The patients in the study were between 18-80 years of age and gave informed consent to participate in the study The differences in distribution of demographic, clinical and pathologic variables between the two groups were evaluated. Pearson's chi-squared test and Spearman' rho correlation coefficient test was used, with p < 0.01 considered statistically significant. Data analysis was conducted using the statistical package for the social sciences (SPSS) version 17.0. Results: Among the 221 CKD patients in the study, 174 (78.7%) had ROD based on serum intact parathyroid hormone (iPTH) levels. The majority of patients in the control group did not have bone disease ie 95-96%. The majority of CKD patients (70.0%) had high-turnover (HTO) bone disease compared to 29.3% of patients with low-turnover (LTO) bone disease. Dialysis patients who had HTO bone disease compared with those with LTO had significantly higher levels of iPTH and total serum alkaline phosphatase (ALP). A similar relationship was observed among CKD patients not on dialysis. There was a significant individual variation in bone turnover biochemical markers. A total of 237 patients were recruited in the control group. Based on the levels of iPTH and tALP, six of them were found to have bone disease. The majority of these patients with bone disease were diabetic (83.3%) while the other patient had cancer (16.7%). The six patients in the control group with bone disease were within the age cohort of 64-80 years, most of whom were 78 years old. Conclusion: A combination of serum biochemical markers might predict underlying renal osteodystrophy better that would individual biochemical markers. A predictive model using bone histology and biochemical markers can be developed in the future

The Impact of Cannabis Use on the Dosage of Antipsychotic Drugs in Patients Admitted on the Psychiatric Ward at the University Hospital of the West Indies

Objective: To assess the impact of cannabis use on the efficacy of antipsychotic drugs in male subjects presenting to the University Hospital of the West Indies (UHWI) with psychotic episodes. Methods: Male subjects, 18–40 years old, admitted to the psychiatric ward of the UHWI between February 2013 and May 2013, diagnosed with schizophrenia, schizophreniform disorder and who tested positive for ∆9-tetrahydrocannabinol were recruited for the study. On day one, consenting subjects were assessed using the Brief Psychiatric Rating Scale (BPRS). Patients were prescribed seven days of an oral antipsychotic medication (haloperidol, chlorpromazine, risperidone, quetiapine, olanzapine). Medicated subjects were then reassessed using the BPRS on days three and seven. Statistical analysis involved the use of Student’s t-test and repeated measure analysis of variance. Results: In total, 20 subjects were recruited (mean age = 26.00 ± 5.96 years). Subjects were grouped based on the daily chlorpromazine equivalent (CPZE) dose given on day one into CPZE1 (CPZE dose of 100–300mg; n = 8) and CPZE2 (CPZE dose of 400–1250 mg; n = 12). There was no significant difference in the total BPRS score between the groups on day one (CPZE1 = 41.38 ± 16.47 versus CPZE2 = 49.42 ± 25.58; p = 0.44); similar findings were obtained for the positive (26.75 ± 9.27 versus 31.83 ± 17.30; p = 0.46) and negative (14.63 ± 7.73 versus 17.58 ± 9.74; p = 0.48) symptom component on the BPRS. For subjects in CPZE1, there was no significant decrease in total BPRS score [F(2,21) = 0.07, p = 0.93] over the study period. For CPZE2, significant reduction in total BPRS scores was achieved [F(2,33) =7.12, p = 0.01], contributed by significant decrease in the positive [F(2,33) = 5.64, p = 0.02) and negative [F(2,33) = 7.53, p = 0.01) symptom components of the BPRS. Conclusion: The findings of this study purport that male cannabis users presenting with psychotic disorders may not achieve optimal therapeutic benefit within seven days with CPZE doses ≤ 300 mg. As such, it appears that initiating treatment with CPZE doses of > 300 mg will provide better therapeutic outcomes for this patient population