Melatonin treatment prevents carbon-tetrachloride induced rat brain injury

Introduction

Herein the neuroprotective properties of melatonin, a highly effective antioxidant, administered in a single dose 50 mg/kg intraperitoneally, were investigated in the brain tissue of Wistar rats acutely exposed to the toxin carbon-tetrachloride (1 mL/kg, intraperitoneally).

Methods

To assess the degree of whole encephalic mass damage, biochemical parameters related to lipid and protein oxidation, antioxidant enzymes (catalase and superoxide dismutase), glutathione and inducible nitric oxide/arginase pathways were determined.

Results

The results showed that carbon-tetrachloride impaired the function of antioxidant enzymes (reduced catalase and superoxide dismutase activities) and reduced glutathione-metabolizing enzymes (reduced glutathione, glutathione S-transferase and peroxidase activity). Furthermore, carbon-tetrachloride increased lipid peroxidation and protein oxidative damage in the brain tissue, as well as myeloperoxidase and inducible nitric oxide synthase content/activities.

Conclusions

The application of a single dose of melatonin post intoxication has been able to reverse the disturbance in the function of antioxidant enzymes and alleviate the tissue damage caused by oxidative stress, indicating that melatonin could be a potential therapeutic agent in oxidative-damage related neurodegenerative disorders.

Validation of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) in a Large Cohort of Relapsing-Remitting MS Patients

Cognitive impairment is one of the most frequently reported symptoms in persons with multiple sclerosis (MS). The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) has been recommended as a standardized international screening and monitoring tool for brief cognitive assessment. The aim of our study was to assess the reliability and validity of the Serbian version of the BICAMS. A total of 500 relapsing-remitting MS (RRMS) patients and 69 age-, gender- and education-matched healthy control (HC) subjects were examined. All participants performed the BICAMS test battery, which includes the oral version of the Symbol Digit Modalities Test (SDMT), California Verbal Learning Test second edition (CVLT-II), and Brief Visuospatial Memory Test Revised (BVMTR). A randomly selected subset of patients were retested one to three weeks after baseline. Statistically significant differences between patients and HCs were evident on the SDMT and BVMTR (p<0.001). HCs had higher CVLT-II scores but this difference did not reach statistical significance (p=0.063). Cognitive impairment, defined as an abnormal test score on ≥1 subtest, was found in 62.9% of MS patients. There were statistically significant correlations between BICAMS scores and age, education, EDSS and disease duration in patient sample. Test-retest reliability was confirmed with Pearson correlation coefficient of 0.70 in all measures. This study supported the reliability and validity of the Serbian BICAMS, although the CVLT-II version tested here lacked sensitivity to detect MS compared to healthy volunteers.

Current progress in the therapeutic options for mitochondrial disorders

Mitochondrial disorders manifest enormous genetic and clinical heterogeneity - they can appear at any age, present with various phenotypes affecting any organ, and display any mode of inheritance. What mitochondrial diseases do have in common, is impairment of respiratory chain activity, which is responsible for more than 90% of energy production within cells. While diagnostics of mitochondrial disorders has been accelerated by introducing Next-Generation Sequencing techniques in recent years, the treatment options are still very limited. For many patients only a supportive or symptomatic therapy is available at the moment. However, decades of basic and preclinical research have uncovered potential target points and numerous compounds or interventions are now subjects of clinical trials. In this review, we focus on current and emerging therapeutic approaches towards the treatment of mitochondrial disorders. We focus on small compounds, metabolic interference, such as endurance training or ketogenic diet and also on genomic approaches.

[Effects of carbonic anhydrase inhibitors on pseudophakic corneal edema]

INTRODUCTION

Acetazolamide as inhibitor of carbonic anhydrase, in glaucoma therapy, has an effect on lowering intraocular pressure. In addition to this primary effects, we attempted to determine the effect on the cornea after phacoemulsification. In our study, we determined the effects of systemically applied dose of 500 mg of acetazolamide on the edema, thickness, and corneal morphology after phacoemulsification ,with the Anterior Segment Optical Coherence Tomography (AS OCT).

MATERIAL AND METHODS

The study included 53 patients who were divided into two groups. Groups were stratified by type of cataract (nuclear), age (62+/-1.5), preoperative visual acuity (5/60) Snellen table,and preoperative findings on AS-OCT. Phacoemulsification has done the same surgeon, with the same ultrasound probe length using ultrasonic force of the average value of 14 for a period of 72+/-2.5 seconds. Group of 33 patients were administered systemic acetazolamide at a dose of 250 mg per scheme 01 hours +24 hours after phacoemulsification (group I). Another group of 20 patients did not receive acetazolamide(group II). AS OCT recordings were performed before surgery, 6 hours and 24 hours after surgery.

RESULTS

The mean value in both groups was 549+/-9 microm before surgery. Group I had average value of 648+/-6 microm after 6h, and the mean value was 612+/-4 microm after 24h. The group II,had a mean thickness of the cornea after 6 hours of 720+/-5 microm, and after 24 hours 708+/-4 microm. Morphological changes in the tomograms of the group I showed minimal creases Descemet's membrane. Postoperative visual acuity was 0,6,24h after the surgery in the I group of patients,and 0,3 in the II group.

CONCLUSION

In our study the patients who administered systemic acetazolamide had significant reduction of central corneal thickness. The folds of Descemet's membrane and endothelial dysfunction in AS OCT tomograms showed less structural changes in group I. Significant better postoperative visual acuity in these patients is probably because of the smaller corneal edema after 24 h, which improves patients' comfort.

Autoimmune polyglandular syndrome type 2 shows the same HLA class II pattern as type 1 diabetes

Autoimmune polyglandular syndrome (APS) type 2 is defined by the manifestation of at least two autoimmune endocrine diseases. Only few data exist on genetic associations of APS type 2. In this controlled study, 98 patients with APS type 2, 96 patients with type 1 diabetes (T1D), and 92 patients with autoimmune thyroid disease, both as a single autoimmune endocrinopathy, were tested for association with alleles of the human leukocyte antigen (HLA) class II loci DRB1, DQA1, and DQB1. Patients with APS type 2 had significantly more often the alleles DRB1*03 (P(c) < 0.0001), DRB1*04 (P(c) < 0.000005), DQA1*03 (P(c) < 0.0001), and DQB1*02 (P(c) < 0.05), when compared with controls. Less frequent in APS were DRB1*15 (P(c) < 0.05), DQA1*01 (P(c) < 0.0005), and DQB1*05 (P(c) < 0.005). With regard to frequency and linkage of these alleles, the susceptible haplotypes DRB1*0301-DQA1*0501-DQB1*0201 and DRB1*0401/04-DQA1*0301-DQB1*0302 were deduced. Protective haplotypes in this study were DRB1*1501-DQA1*0102-DQB1*0602 and DRB1*0101-DQA1*0101-DQB1*0501. Comparing APS patients with vs without AD, no significant differences regarding HLA class II alleles were noted in our collective. Patients with T1D as a singular disease had the same susceptible and protective HLA alleles and haplotypes. The prevalence of DRB1*03 and DRB1*04 in APS patients was not because of the presence of diabetes, as the APS type 2 patients without diabetes had the same allele distribution. In conclusion, these data suggest a common immunogenetic pathomechanism for T1D and APS type 2, which might be different from the immunogenetic pathomechanism of other autoimmune endocrine disease.

[Effect of certain aspects of female sexual behavior on the development of cervical intraepithelial neoplasia]

The paper presents results of investigation of certain parameters of female sexual activity and their effect on the appearance of squamous intraepithelial cervical lesions (SIL). This correlation was investigated in the context of Human Papilloma Virus (HPV) infection, in view of the role attributed to certain types of these viruses in the appearance and development of cervical SIL. Research was done on 1000 patients suffering from low histological grade (LSIL) or high histological grade (HSIL) intraepithelial cervical neoplasms. It transpired that such lesions were most frequent in women in the second, third and fourth decade of life, and that one third of pathological lesions was a function of age. Human Papilloma Virus infection was detected in 65% of patients. The frequency of HPV negative results or presence of non-oncogenic types of viruses (6 and 11) was significantly higher in LSIL type lesions, while the frequency of detection of oncogenous HPV types (16, 18, 31 and 33) was significantly higher in more severe stadiums of the disease. Of the investigated parameters of sexual activity, early onset of such activity and several sexual partners proved to be significant. The number of parturitions and abortions did not appear to be significant risk factors for the onset and development of these diseases.

[The modern approach to hysterectomy]

Being quite experienced in the field of gynaecologic surgery and hysterectomies especially, being familiar with recent innovations in laparoscopic surgery and also having some own experience in laparoscopic surgery, the authors discuss the advantages and disadvantages of all surgical methods of hysterectomy. Comparing the techniques, the duration, bearing in mind the the risks, overall costs and all other surgical details, the authors concluded that laparoscopically assisted vaginal hysterectomy is the best choice because it is the least invasive, less risky, no scars are left, the postoperative recovery is quick, there are numerous indications for it, the preparation obtained as a whole can be used for further clinical examination. The only disadvantage is it is too costly and sometimes the operation itself lasts too long, so it should not be applied in some cases.

[The ovarian hyperstimulation syndrome]

The use of controlled ovarian hyperstimulation has increased the efficacy of ovulation induction and enhanced the ability to recruit multiple mature oocytes for use in the assisted reproductive technologies. However, the administration of medications is not without risk. Ovarian hyperstimulation syndrome is a serious complication with various manifestations. Two fundamental pathologic changes are characteristic: ovarian enlargement with underlying stromal oedema and multiple haemorrhages of luteinized cysts coupled with a dramatic shift of fluid from the intravascular spaces into the peritoneal, pleural, and pericardial cavities. The most efficacious treatment of hyperstimulation syndrome is its prevention. The correction of hypovolaemia and electrolyte abnormalities is one of the most important procedures in the treatment of this syndrome.

[Antibiotic therapy in the treatment of inflammatory diseases in the minor pelvis]

Pelvic inflammatory diseases are usually caused by sexually transmitted microorganisms, as are Neisseria gonorrhoeae and Chlamydia trachomatis, either alone or associated with endogenous flora of the lower genital tract, as with other gram-positive and gram-negative anaerobic and aerobic bacteria [1, 2].

SUBJECT

The aim of the study was to estimate the effect of three broad-spectrum combinations of antimicrobial therapy in the treatment of pelvic inflammatory diseases in hospitalized patients.

MATERIAL AND METHODS

We analysed the therapeutic success of some antimicrobial therapies in 154 patients with pelvic inflammatory disease, who were treated in the Narodni Front Hospital of Gynaecology and Obstetrics in Belgrade, during 1992 and 1993. Three drug therapies were applied. The combination of Ceftriaxon plus Doxycycline was given to 51 women. Fifty five women were treated by a combination of Gentamycin plus Clidamycin, and 48 women were treated by a combination of Gentamycin and Metronidazole.

RESULTS

The therapeutic success after the application of the three different antibiotic therapies was recorded in 139 of 154 women (90.26%). Of 136 patients with uncomplicated pelvic inflammatory diseases, the therapeutic success was noted in 129 (94.85%) individuals, while of 18 women with tubo-ovarian abscess therapeutic success was recorded in 10 (55.56%) patients. Of 51 women treated by the combination of Ceftriaxon plus Doxycycline, the therapeutic success was observed in 46 (90.19%) patients. Fifty five women treated by the combination of Gentamycin plus Clindamycin, the therapeutic success was noted in 50 (90.19%) subjects. Of 48 women, treated by the combination of Gentamycin plus Metronidazole, the therapeutic success was found in 43 (89.58%) women. No statistically significant difference was found among the applied antibiotic therapies (p > 0.05). Of 18 women with tubo-ovarian abscess 8 were operated on. Of these 8 women in 6 patients hysterectomy with bilateral salpingo-oophorectomy was performed and in two women unilateral salpingo-oophorectomy was carried out.

DISCUSSION

Pelvic inflammatory diseases are often of polymicrobial aetiology. In 43 patients we found two types of bacteria in the cervical culture. The therapeutic success was achieved by these three antibiotic therapies. It was 90.26%, the therapeutic success in the treatment of pelvic inflammatory diseases by Ceftriaxon plus Doxycycline was noted in 90.19% of patients. The therapeutic success of antibiotic therapy with Gentamycin plus Clindamycin was obtained in 90.91% of patients. The success of antibiotic therapy with Gentamycin plus Metronidazole was recorded in 89.59% of patients. Our results are similar to those of other authors [3, 4, 6, 7]. No statistically significant difference was found among the applied antibiotic therapies.

CONCLUSION

An early diagnosis and an aggressive treatment may prevent serious sequelae of this increasingly common sexually transmitted disease. The antibiotics should be of antimicrobial broad spectrum. Good effects can be best reached by a combined antibiotic therapy. Duration of parenteral administration of antibiotics should be several days and for at least 48 hours after the patient's defervescence.

[Diagnostic value of hysterosalpingography and laparoscopy in infertile women]

Tubal pathology with tubal blockage due to the pelvic inflammatory diseases is one of the most frequent causes of infertility in a woman [1]. The two most important diagnostic procedures which are used for evaluation of tubal patency are hysterosalpingography and laparoscopic hydrotubation [4].

SUBJECT

The aim of the study was the comparison of hysterosalpingographic and laparoscopic findings and determination of accuracy of these two procedures in the diagnosis of tubal patency.

MATERIAL AND METHODS

We studied and compared the results of hysterosalpingography and laparoscopy in 102 infertile women who were operated on at the Narodni Front Hospital of Gynaecology and Obstetrics in Belgrade during 1993 and 1994. Of 102 operated women 47 women were with primary infertility and 55 with secondary infertility. The patients were from 20 to 41 years of age, the average 28 +/- 2.4 years.

RESULTS

Of one hundred and two operated women tubal blockage was found in 94 (92.1%) patients. Unilateral hydrosalpinx was found by hysterosalpingography in 16 (15.7%) subjects and bilateral hydrosalpinx in 30 (29.4%) women. Unilateral hydrosalpinx was found by laparoscopy in 17 (16.1%) patients and bilateral hydrosalpinx in 32 (31.4%) subjects. The concordant findings by hysterosalpingography and laparoscopy in the diagnostics of unilateral hydrosalpinx were found in 76.5% of cases, and in bilateral hydrosalpinx in 70.4%. This difference was not statistically significant. Unilateral tubal blockage was identified by laparoscopy in 26 (25.5%) patients and bilateral in 27 (26.5%) subjects. The concordant findings by hysterosalpingography and laparoscopy in unilateral tubal blockage were found in 61.5% of cases, and in bilateral tubal blockage in 70.4% of women. The total concordant findings by hysterosalpingography and laparoscopy in tubal blockage were found in 65.7 of cases, and concordant findings after hysterosalpingography and surgery were noted in 61.7% cases. The findings by laparoscopy and surgery were in harmony in 86.3% patients. Ovarian abnormalities were found by laparoscopy and surgery in 22 (21.6%) women. Pelvic adhesions were found by laparoscopy in 42 women of 49 patients in whom pelvic adhesions were found during the operation. Uterine congenital anomalies were found by laparoscopy in 3 (2.9%), women and by hysterosalpingography in 6 (5.9%) patients.

DISCUSSION

Of 102 operated women tubal blockage was found in 94 (92.2%) women. Unilateral tubal blockage was found in 38 (40.4%) patients, and bilateral tubal blockage in 56 (59.6%) subjects. Hysterosalpingographic and laparoscopic hydrotubation findings in the diagnosis of tubal patency were concordant in 65% of cases, hysterosalpingographic and operative findings in 61.7% of patients, and laparoscopic and operative findings in 86.3% of subjects. Although concordant findings of 65.7% were noted in this study, which were similar to findings of other authors, the percentage of 62.5% [4], and 76% was observed [5]. During the operation pelvic adhesions were found in 49 patients, and laparoscopic in 42 women only. Ovarian abnormalities were found by laparoscopy in 22 (21.6%) patients, while uterine fibroid was found in 10 (9.8%) subjects. Uterine congenital anomalies were found by hysterosalpingography in 6 (5.9%) cases and by laparoscopy only in 3 (2.9%) patients. The advantage of visual hysterosalpingography seems to be in identification of some congenital uterine anomalies. However, the advantage of laparoscopy is identified by the possibility of visualisation of some other pelvic abnormalities which may be the cause of infertility.

CONCLUSION

There are some hysterosalpingographic and laparoscopic advantages and disadvantages in the diagnosis of infertility in women. Only by using both procedures accurate results can be achieved in the tubes, the uterus and the ovary, that can be a cause of infertility in women.

[Importance of daily serum progesterone measurement in ovulation induction]

It is known that the rise of serum progesterone concentration frequently precedes the rise of serum luteinizing hormone in spontaneous menstrual cycles and during induction of ovulation. The aim of this study was to evaluate the role of single serum progesterone measurement in the prediction of spontaneous serum luteinizing hormone rise in patients with ovulation induction. The study concerned 97 infertile women. The induction of ovulation was performed according to individual endocrine profile of a patient. In 59 (61%) patients spontaneous increase of luteinizing hormone was not recorded and in 31 (32%) patients this increase was evident. In 7 (7%) high serum luteinizing hormone concentration was measured at the time of use of human chorionic gonadotropin. The correlation between serum progesterone level and serum luteinizing hormone concentration in patients with spontaneous serum luteinizing hormone rise was statistically significant (r=0.79; p<0.01). The double daily serum progesterone rise is an important method for prediction of serum luteinizing hormone rise (x2=24.08; p<0.001). After the use this method the pregnancy rate was 29 percent in our study group.

[Correlation between ultrasonographic and celioscopic findings during stimulated cycles in women undergoing fertilization in vitro]

The authors emphasize the importance of ultrasonographic follow-up of the growth and development of the follicle in patients prepared for fertilization in vitro. The study concerned 30 patients in whom an appropriate stimulation was carried out. Correlation between ultrasonographic and coelioscopic findings is analysed. On the basis of the obtained results it was concluded that ultrasonographic diagnosis may be useful in the evaluation of the number, size and volume of a follicle. This method was also appropriate for the evaluation of the follicle maturity and determination of the best time for their puncture. In this was follicles that are in the most favourable time for fertilization in vitro, can be obtained.

[Value of the fetal biophysical profile in intensive monitoring of high risk pregnancy]

The fetal biophysical profile (FBP) is a combination of both acute and chronic condition markers of the fetus in the uterus (fetal movements, fetal breathing movements, amniotic fluid volume, maturity of the placenta, intestine distension, cardiotocographic "non stress test", cardiotocographic "oxytocin stress test" cardiotocographic "physical stress test") presented numerically, is an irreplaceable method for monitoring the condition of the fetus in the uterus. In 271 women with high risk pregnancies at the gestational age of 34-44 weeks, depending on the FBP value, the time and mode of pregnancy termination were chosen. There is a significant difference regarding the outcome of pregnancy (general bad outcome--p less than 0.001, mortality--p less than 0.004, low 5 min Apgar score--p less than 0.002, fetal distress during labour--p less than 0.001) depending on the FBP value (normal or pathological) and the connection of the pathological FBP values with the low fetal biochemical profile values (estriol in 24th urine less than 40,000 n mol/day and HPL less than 5 mg). Sensitivity (46.4%), specificity (99.2%), the prognostic value of the pathological test PVP (86.7%), and prognostic value of the normal test - PVN (94.1%) show a high FBP value as a diagnostic test. It is necessary to stick to the protocol while using this test which is very simple, cheap and not at all harmful.

[Cervical maturation using Prepidil gel in pregnancy termination in primigravidas]

The study investigated the possibility of pharmacological servical ripening induced by Dinoprostone (Prepidil Gel--Upjohn Co) prior to therapeutic abortion in primigravida. The study concerned patients-volunteers choosen by random. 73 patients were divided into two groups with the same average age, term of gestation, cervix consistency and passage through the cervical canal before the application of gel. In the first group therapeutic abortion was carried out 6 hours after the application of gle into cervical canal, and in the second group--4 hours after the gel application. Cervical maturation, testified by its consistency and spontaneous cervical ripening, was equal in both groups (average delta Hegar I was 7.32 and delta Hegar II--7.02), and it enabled medical procedure only with the local anaesthesia with 2% hylocein in 82% ob pregnant women. In a fifth of patients ob both groups it was necessary to do additional mechanical dilatation, which was easily performed due to the already soft cervix; these patients were also administered 1 ampulla ob Fortral I.V. In both groups during the action of Dinoprostone there were no significant changes either in blood pressure or in body temperature. More expressed uterine activity, followed by initial and incompleted abortions, were more frequent in patients of the first group (3529%) than in those from the second group (17.95%) in which only contractions occurred (33.33%). The rate of gastrointestinal side effects was 29.41% in the first group and 41.03% in the second group. There was no uterine complication during the activity of Dinoprostone as well as during and after medical procedure.

[Growth of the fetal cerebellum in normal pregnancy]

An ultrasonographic study was carried out in 203 physiological pregnancies whose menstrual gestational age (MGA) was between 20 and 40 weeks. The following biometric parameters were determined: transversal cerebellar diameter (TCD), biparietal diameter (BPD), occipito-frontal diameter (OFD) and head circumference (HC). The data analysis gave the optimal mathematical models with the following relations: 1) TCD/MGA (R2 = 0.904; SD = 2.6 mm); 2) MGA/TCD (R2 = 0.924; SD = 1.7 wks); 3) BPD/TCD (R2 = 0.914; SD = 4.3 mm); 4) HC/TCD (R2 = 0.919; SD = 14.3 mm), which are graphically and tabularly presented. Also the variability in the determination of MGA from TCD is calculated before 26 weeks (2 SD = 2.6 wks) and after 26 weeks (2 SD = 3.5 wks). TCD can be practically applied in cases where it is difficult or impossible to measure BPD, or in cases where it is unsuitable because of the expressed moulding of the head, since the cerebellum is not liable to changes in forms and its size is in correlation with MGA and BPD. The use of TCD is also important in the detection of congenital malformations which are manifested in the posterior cranial fossa. The potential importance of TCD in the diagnosis of the fetal intrauterine growth retardation is based on the assumption that the cerebellum is not liable, or at least not considerably liable, for growth retardation.

[Effect of intensive cardiotocographic monitoring on the time and method of completion of labor]

The authors examined selected groups of pregnant women so as to define the influence of intensive cardiotocographic monitoring of a foetus on the time and procedure of completing a labour. Two groups of pregnant women were selected: with high risk-pregnancy and with normal pregnancy monitored cardiotocographically. The results obtained were evaluated by means of the Hammacher scale. Two control groups were also examined--one group of high-risk pregnancies and the other of normal pregnancies, both monitored in the classical way (auscultation of the heart of a foetus, amnioscopy and obstetric examination). In the group of pregnant women monitored cardiotocographically, the authors found a good tolerance of the labour lasting more than 12 hours. The condition of mothers and foeti, in spite of high-risk pregnancies, was good. This was confirmed by high evaluation of newborns by means of the Apgar scale and the level of pH in the blood in the umbilical artery. In the group monitored by classical methods, from the moment of appearing a condition threatening the foetus, there was a tendency towards a fast completion of the labor. In some cases, this was worse, not better. By comparing a procedure of completing a labour in women monitored cardiotocographically and those monitored by classical methods the authors found that in the group monitored cardiotocographically labour was completed instrumentally in 25% of women, whereas in the group monitored classically--in 39% of women, which is statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)