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Isleyen M, Cina M, Asci H, Ilhan I, Oguz Yuceer R. The Preventive Effect of Preoperative and Postoperative Selenium on the Medication-Related Osteonecrosis of the Jaw: An Animal Study in Rats. J Oral Maxillofac Surg 2024; 82:828-839. [PMID: 38621662 DOI: 10.1016/j.joms.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 03/04/2024] [Accepted: 03/21/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Medication-related osteonecrosis of the jaw (MRONJ) is a condition that can occur primarily in patients undergoing or have previously undergone therapy with bisphosphonates, particularly in the presence of risk factors, such as tooth extraction (TE). PURPOSE This study aimed to evaluate the effect of selenium (SEL) administration on the prevention of osteonecrosis of the jaw in an MRONJ animal model. STUDY DESIGN, SETTING, AND SAMPLE This study was a longitudinal in vivo animal study using a TE model in a sample of 48 Wistar rats. PREDICTOR VARIABLE The predictor variables were SEL exposure, timing of SEL exposure, and zoledronic acid (ZOL) exposure. The animals were randomly assigned to 4 treatment groups (n = 12 per group): 1) saline (negative control), 2) ZOL (positive control), 3) SELpreop + ZOL, and 4) ZOL + SELpostop. The animals were administered saline (negative control) or ZOL (0.06 mg/kg, intraperitoneally) once a week for 5 weeks. All rats underwent TE at the end of the fifth week. SEL (0.3 mg/kg, intraperitoneally) was administered once daily for 15 days to the SELpreop + ZOL group before TE and to the ZOL + SELpostop group after TE. All animals were sacrificed at the end of the ninth week. MAIN OUTCOME VARIABLES The primary outcome variables were new bone area, necrotic bone area, fibrosis, new connective tissue formation, and inflammatory cell infiltration in the histopathological analysis, as well as angiogenesis and percentage of osteoblasts in the immunohistochemical analysis. COVARIATES There was none. ANALYSES Statistical analysis was conducted using the Kruskal-Wallis test, followed by post hoc Bonferroni-corrected Mann-Whitney U tests, with a significance level of P ≤ .05. RESULTS The new bone area was higher in the ZOL + SELpostop group (3.00 score) than in the saline group (0.58 ± 1.08 score, P < .001) and the ZOL group (0.82 ± 1.40 score, P = .001), while the necrotic bone area was lower in the ZOL + SELpostop group (0.08 ± 0.29 score) than in the ZOL group (2.82 ± 0.40 score, P < .001) and the SELpreop + ZOL group (1.67 ± 0.89 score, P = .007). The percentage of osteoblasts was higher in the ZOL + SELpostop group (18.73%) than in the saline group (8.63%, P < .001) and the ZOL group (0.07%, P < .001), and it was also higher in the SELpreop + ZOL group (18.49%) than in the ZOL group (0.07%, P < .001). CONCLUSION AND RELEVANCE In conclusion SEL prevents MRONJ, with postoperative SEL demonstrating greater prevention effects. Given these findings, we hypothesize that SEL exposure may decrease the risk of MRONJ.
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Affiliation(s)
- Mustafa Isleyen
- Assistant Professor, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Mehmet Akif Ersoy University, Burdur, Turkey.
| | - Muge Cina
- Associate Professor, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Suleyman Demirel University, Isparta, Turkey
| | - Halil Asci
- Associate Professor, Faculty of Medicine, Department of Pharmacology, Suleyman Demirel University, Isparta, Turkey
| | - Ilter Ilhan
- Assistant Professor, Faculty of Medicine, Department of Biochemistry, Suleyman Demirel University, Isparta, Turkey
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de Man AME, Amrein K, Casaer MP, Dizdar OS, van Zanten ARH, Gundogan K, Lepp L, Rezzi S, Shenkin A, Berger MM. LLL 44-4 : Micronutrients in acute disease and critical illness. Clin Nutr ESPEN 2024; 61:437-446. [PMID: 38777466 DOI: 10.1016/j.clnesp.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 05/25/2024]
Abstract
Micronutrients (MN), i.e. trace elements and vitamins, are essential components of the diet in relatively small amounts in any form of nutrition, with special needs in critically ill patients. Critical illness is characterised by the presence of inflammation and oxidative stress. MNs are tightly involved in antioxidant and immune defences. In addition, some conditions, and treatments result in large losses of biological fluids containing MNs: therefore, acute renal injury requiring renal replacement therapy, acute intestinal failure, and major burns and trauma are at high risk of acute depletion of body stores, and of deficiency. MN requirements are increased above standard DRI. Blood level interpretation is complicated by inflammation: some biomarkers assist the status determination. Due to the acute challenges of critical illness, it of utmost importance to cover the needs to maintain the organism's endogenous immune and antioxidant defences, and capacity to repair tissues. Practical strategies are proposed.
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Affiliation(s)
- Angélique M E de Man
- Amsterdam UMC, Location Vrije Universiteit, Department of Intensive Care, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
| | - Karin Amrein
- Medical University of Graz, Department of Internal Medicine, Division of Endocrinology and Diabetology, Austria.
| | - Michael P Casaer
- KU Leuven, Department of Cellular and Molecular Medicine, Laboratory of Intensive Care Medicine, Leuven, Belgium.
| | - Oguzhan S Dizdar
- Department of Internal Medicine and Clinical Nutrition Unit, University of Health Sciences Kayseri City Training and Research Hospital, Kayseri, Turkey.
| | - Arthur R H van Zanten
- Gelderse Vallei Hospital, Ede and Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands.
| | - Kursat Gundogan
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey; North Estonia Regional Hospital, Tallinn, Estonia.
| | - Liis Lepp
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey.
| | - Serge Rezzi
- Swiss Nutrition and Health Foundation, Epalinges, Switzerland.
| | - Alan Shenkin
- Institute of Aging and Chronic Disease, University of Liverpool, Liverpool, UK.
| | - Mette M Berger
- Faculty of Biology & Medicine, Lausanne University, Lausanne, Switzerland.
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Takenaka R, Matsumoto S, Nureki S, Wada S, Oyama Y, Sakamoto T, Kitano T, Shigemitsu O. Real-time monitoring of vitamin C levels in trauma patients by electron-spin resonance spectrometry. BMC Emerg Med 2023; 23:85. [PMID: 37542224 PMCID: PMC10403879 DOI: 10.1186/s12873-023-00857-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 07/27/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND In critically ill patients, healthy vitamin C levels are important to avoid an imbalance in reactive oxygen species. To achieve this, oxidative stress levels in emergency patients need to be accurately measured in real-time. However, normally, reactive oxygen/nitrogen species are short-lived, rendering measurement difficult; moreover, measurement of relatively stable antioxidants and other oxidative stress markers in real-time is challenging. Therefore, we used electron-spin resonance spectrometry (ESR) to assess vitamin C levels, clarify their relationship with patients' severity, and establish more effective vitamin C therapy in critically ill patients. METHODS We studied 103 severely ill emergency patients and 15 healthy volunteers. Vitamin C radical (VCR/dimethyl sulfoxide [DMSO]) values were analyzed in arterial blood samples by ESR at admission and once daily thereafter during the acute recovery phase. Severity scores were calculated. The relationship between these scores and VCR/DMSO values and chronological changes in VCR/DMSO values were analyzed. RESULTS Serum VCR/DMSO values were significantly lower in critically ill patients than in healthy volunteers (0.264 ± 0.014 vs. 0.935 ± 0.052, p < 0.05), particularly in the severe trauma group and the cardiopulmonary arrest/post-cardiac arrest syndrome group. VCR/DMSO values and various severity scores did not correlate at admission; however, they correlated with SOFA scores from days 2-6. VCR/DMSO values remained low from the first measurement day through Day 6 of illness. CONCLUSIONS Vitamin C levels were low at admission, remained low with conventional nutritional support, and did not correlate with the initial patient's severity; however, they correlated with patients' severity after admission. Some patients had normal vitamin C levels. Therefore, vitamin C levels should be measured in real-time and supplemented if they are below normal levels. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Ryuichi Takenaka
- Department of Emergency Medicine, Oita University, 1-1 Idaigaoka, Hasama-Machi, Yufu, Oita, 879-5593, Japan.
| | - Shigekiyo Matsumoto
- Department of Anesthesiology and Intensive Care Medicine, Oita University, 1-1 Idaigaoka, Hasama-Machi, Yufu, Oita, 879-5593, Japan
| | - Shinichi Nureki
- Department of Respiratory Medicine and Infectious Disease, Oita University, 1-1 Idaigaoka, Hasama-Machi, Yufu, Oita, 879-5593, Japan
| | - Shinsuke Wada
- Department of Emergency Medicine, Oita University, 1-1 Idaigaoka, Hasama-Machi, Yufu, Oita, 879-5593, Japan
| | - Yoshimasa Oyama
- Department of Anesthesiology and Intensive Care Medicine, Oita University, 1-1 Idaigaoka, Hasama-Machi, Yufu, Oita, 879-5593, Japan
| | - Teruo Sakamoto
- Advanced Trauma, Emergency and Critical Care Center, Oita University Hospital, 1-1 Idaigaoka, Hasama-Machi, Yufu, Oita, 879-5593, Japan
| | - Takaaki Kitano
- Department of Anesthesiology and Intensive Care Medicine, Oita University, 1-1 Idaigaoka, Hasama-Machi, Yufu, Oita, 879-5593, Japan
| | - Osamu Shigemitsu
- Department of Emergency Medicine, Oita University, 1-1 Idaigaoka, Hasama-Machi, Yufu, Oita, 879-5593, Japan
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Polaka S, Katare P, Pawar B, Vasdev N, Gupta T, Rajpoot K, Sengupta P, Tekade RK. Emerging ROS-Modulating Technologies for Augmentation of the Wound Healing Process. ACS OMEGA 2022; 7:30657-30672. [PMID: 36092613 PMCID: PMC9453976 DOI: 10.1021/acsomega.2c02675] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
Reactive oxygen species (ROS) is considered a double-edged sword. The slightly elevated level of ROS helps in wound healing by inhibiting microbial infection. In contrast, excessive ROS levels in the wound site show deleterious effects on wound healing by extending the inflammation phase. Understanding the ROS-mediated molecular and biomolecular mechanisms and their effect on cellular homeostasis and inflammation thus substantially improves the possibility of exogenously augmenting and manipulating wound healing with the emerging antioxidant therapeutics. This review comprehensively delves into the relationship between ROS and critical phases of wound healing and the processes underpinning antioxidant therapies. The manuscript also discusses cutting-edge antioxidant therapeutics that act via ROS scavenging to enhance chronic wound healing.
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Fadeur M, Preiser JC, Verbrugge AM, Misset B, Rousseau AF. Oral Nutrition during and after Critical Illness: SPICES for Quality of Care! Nutrients 2020; 12:nu12113509. [PMID: 33202634 PMCID: PMC7696881 DOI: 10.3390/nu12113509] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 12/12/2022] Open
Abstract
Malnutrition is associated to poor outcomes in critically ill patients. Oral nutrition is the route of feeding in less than half of the patients during the intensive care unit (ICU) stay and in the majority of ICU survivors. There are growing data indicating that insufficient and/or inadequate intakes in macronutrients and micronutrients are prevalent within these populations. The present narrative review focuses on barriers to food intakes and considers the different points that should be addressed in order to optimize oral intakes, both during and after ICU stay. They are gathered in the SPICES concept, which should help ICU teams improve the quality of nutrition care following 5 themes: swallowing disorders screening and management, patient global status overview, involvement of dieticians and nutritionists, clinical evaluation of nutritional intakes and outcomes, and finally, supplementation in macro-or micronutrients.
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Affiliation(s)
- Marjorie Fadeur
- Department of Diabetes, Nutrition and Metabolic Diseases, University Hospital, University of Liège, Sart-Tilman, 4000 Liège, Belgium;
- Multidisciplinary Nutrition Team, University Hospital, University of Liège, Sart-Tilman, 4000 Liège, Belgium;
| | - Jean-Charles Preiser
- Erasme University Hospital, Medical Direction, Université Libre de Bruxelles, 1070 Brussels, Belgium;
| | - Anne-Marie Verbrugge
- Multidisciplinary Nutrition Team, University Hospital, University of Liège, Sart-Tilman, 4000 Liège, Belgium;
| | - Benoit Misset
- Department of Intensive Care and Burn Center, University Hospital, University of Liège, Sart-Tilman, 4000 Liège, Belgium;
| | - Anne-Françoise Rousseau
- Multidisciplinary Nutrition Team, University Hospital, University of Liège, Sart-Tilman, 4000 Liège, Belgium;
- Department of Intensive Care and Burn Center, University Hospital, University of Liège, Sart-Tilman, 4000 Liège, Belgium;
- Correspondence: ; Tel.: +32-4-3667495
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Hariharan S, Dharmaraj S. Selenium and selenoproteins: it's role in regulation of inflammation. Inflammopharmacology 2020; 28:667-695. [PMID: 32144521 PMCID: PMC7222958 DOI: 10.1007/s10787-020-00690-x] [Citation(s) in RCA: 256] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 02/06/2020] [Indexed: 12/22/2022]
Abstract
Abstract Selenium is an essential immunonutrient which holds the human’s metabolic activity with its chemical bonds. The organic forms of selenium naturally present in human body are selenocysteine and selenoproteins. These forms have a unique way of synthesis and translational coding. Selenoproteins act as antioxidant warriors for thyroid regulation, male-fertility enhancement, and anti-inflammatory actions. They also participate indirectly in the mechanism of wound healing as oxidative stress reducers. Glutathione peroxidase (GPX) is the major selenoprotein present in the human body, which assists in the control of excessive production of free radical at the site of inflammation. Other than GPX, other selenoproteins include selenoprotein-S that regulates the inflammatory cytokines and selenoprotein-P that serves as an inducer of homeostasis. Previously, reports were mainly focused on the cellular and molecular mechanism of wound healing with reference to various animal models and cell lines. In this review, the role of selenium and its possible routes in translational decoding of selenocysteine, synthesis of selenoproteins, systemic action of selenoproteins and their indirect assimilation in the process of wound healing are explained in detail. Some of the selenium containing compounds which can acts as cancer preventive and therapeutics are also discussed. These compounds directly or indirectly exhibit antioxidant properties which can sustain the intracellular redox status and these activities protect the healthy cells from reactive oxygen species induced oxidative damage. Although the review covers the importance of selenium/selenoproteins in wound healing process, still some unresolved mystery persists which may be resolved in near future. Graphic abstract ![]()
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Affiliation(s)
- Sneha Hariharan
- Department of Biochemistry, Karpagam Academy of Higher Education, Eachanari Post, Pollachi Main Road, Coimbatore, Tamil Nadu, 641021, India
| | - Selvakumar Dharmaraj
- Department of Biochemistry, Karpagam Academy of Higher Education, Eachanari Post, Pollachi Main Road, Coimbatore, Tamil Nadu, 641021, India.
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Abstract
OBJECTIVES To evaluate the available literature for associations between nutrition and outcomes after operative treatment of long bone and long bone periarticular fractures. DATA SOURCES Systematic review of English-language articles in the MEDLINE, Embase, PubMed, and Cochrane computerized literature databases (through December 2015) using PRISMA guidelines. STUDY SELECTION Randomized controlled trials, quasi-randomized controlled trials, case-control studies, and cohort studies (retrospective and prospective) involving long bone and long bone periarticular fractures that included the effect of nutritional status on fracture union, time to union, and any related soft-tissue complication were eligible for review. DATA EXTRACTION Two authors independently extracted data from the selected studies using a standardized data collection form with predefined data fields for demographics, interventions, study methods, complications, and management outcomes. DATA SYNTHESIS Although one of the original aims of the study was to conduct a meta-analysis, the available literature did not offer sufficient data for meta-analysis. CONCLUSIONS Although our systematic review demonstrates a possible role for oral nutritional supplementation and vitamin supplementation in the orthopaedic trauma patient, there remains a need for well-designed trials to clarify this role. There is likely benefit to multidisciplinary approaches to nutritional optimization in the orthopaedic trauma patient, and this should be explored further in forthcoming work. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Perioperative supplementation with a fruit and vegetable juice powder concentrate and postsurgical morbidity: A double-blind, randomised, placebo-controlled clinical trial. Clin Nutr 2018; 37:1448-1455. [DOI: 10.1016/j.clnu.2017.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 01/13/2023]
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Mkhize BT, Mabaso MHL, Madurai S, Mkhize-Kwitshana ZL. The Investigation of the Use of Prealbumin as a Tool for Nutritional Assessment in Adults Coinfected with HIV and Intestinal Helminth Parasites in KwaZulu-Natal, South Africa. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7805857. [PMID: 30065944 PMCID: PMC6051331 DOI: 10.1155/2018/7805857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/14/2018] [Indexed: 12/17/2022]
Abstract
Serum prealbumin is considered to be as important as albumin in the nutritional status assessment. However, there is relatively little evidence of its advantage over the commonly used albumin. This study investigated the use of prealbumin compared to albumin as a marker of nutritional status in adults singly and dually infected with human immunodeficiency virus (HIV) and intestinal helminths, with or without inflammatory conditions, in different body mass index (BMI) categories. This cross-sectional study was conducted in a periurban setting in KwaZulu-Natal, South Africa. Multivariate multinomial logistic regression models were fitted to investigate the effect of prealbumin and albumin in nutritional assessment among HIV and helminth individuals with or without inflammation, indicated by elevated and normal C-reactive protein (CRP) levels. In normal CRP, albumin was significantly lower in unadjusted BMI [RRR = 0.8, p = 0.001] and in normal weight [RRR = 0.7, p = 0.003] and overweight [RRR = 0.5, p = 0.001] participants. In elevated CRP, albumin was significantly lower [RRR = 0.8, p = 0.050] and prealbumin was significantly higher in unadjusted BMI [RRR = 1.2, p = 0.034] and overweight [RRR = 1.4, p = 0.052] individuals. The current study found that prealbumin can differentiate between inflammation-induced reduction of albumin and true malnutrition in adults singly or coinfected with HIV and intestinal helminths in the presence or absence of inflammation in various BMI categories.
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Affiliation(s)
- B. T. Mkhize
- Department of Biomedical and Clinical Technology, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
- Department of Medical Microbiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - M. H. L. Mabaso
- Epidemiology and Strategic Information Unit, HIV/AIDS, STI and TB (HAST), Human Sciences Research Council, Durban, South Africa
| | - S. Madurai
- Global Clinical and Viral Laboratory, Durban, South Africa
| | - Z. L. Mkhize-Kwitshana
- Department of Medical Microbiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Department of Biomedical Sciences, Faculty of Natural Sciences, Mangosuthu University of Technology, Durban, South Africa
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Protein and micronutrient deficiencies in patients with radiation cystitis and outcome after hyperbaric oxygen therapy. Clin Nutr ESPEN 2018; 23:141-147. [DOI: 10.1016/j.clnesp.2017.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 10/03/2017] [Accepted: 10/26/2017] [Indexed: 11/20/2022]
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Abstract
Vitamin C is essential to prevent scurvy in humans and is implicated in the primary prevention of common and complex diseases such as coronary heart disease, stroke, and cancer. This chapter reviews the latest knowledge about dietary vitamin C in human health with an emphasis on studies of the molecular mechanisms of vitamin C maintenance as well as gene-nutrient interactions modifying these relationships. Epidemiological evidence indicates 5% prevalence for vitamin C deficiency and 13% prevalence for suboptimal status even in industrialized countries. The daily intake (dose) and the corresponding systemic concentrations (response) are related in a saturable relationship, and low systemic vitamin C concentrations in observational studies are associated with negative health outcomes. However, there is no evidence that vitamin C supplementation impacts the risks for all-cause mortality, impaired cognitive performance, reduced quality of life, the development of eye diseases, infections, cardiovascular disease, and cancers. This might be related to the fact that prevention would not be realized by supplementation in populations already adequately supplied through dietary sources. Recent genetic association studies indicate that the dietary intake might not be the sole determinant of systemic concentrations, since variations in genes participating in redox homeostasis and vitamin C transport had been associated with lowered plasma concentrations. However, impact sizes are generally low and these phenomena might only affect individual of suboptimal dietary supply.
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Affiliation(s)
- Matthew Granger
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Peter Eck
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB, Canada.
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Freitas RGBDON, Nogueira RJN, Cozzolino SMF, Vasques ACJ, Hessel G. Influence of selenium supplementation on patients with inflammation: A pilot double blind randomized study. Nutrition 2017; 41:32-36. [PMID: 28760425 DOI: 10.1016/j.nut.2017.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 03/08/2017] [Accepted: 03/10/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of the study was to analyze the effect of selenium supplementation on patients with inflammation receiving PN. METHODS This double-blind randomized study included 20 hospitalized patients experiencing an inflammatory process while being fed by PN, who were monitored in three stages: first 72 h (0), day 7 (1), and day 14 (2) of PN. The supplemented patients group (G+S) received 60 μg/d (0.75 μmol) of selenium as selenious acid which was added to the PN bag. The nonsupplemented group (G-S) did not receive selenium. The concentration range of 84 to 100 μg/L (1.07-1.27 μmol/L) was used as a reference of plasma selenium. RESULTS The study included 20 patients (8 G+S and 12 G-S) mainly diagnosed with cancer and/or sepsis. Most of them were hospitalized in the intensive care unit and were receiving PN for clinical reasons. Plasma selenium was greater in the G+S than in the G-S (P = 0.05) in two stages (0 and 1). Since the start of assessment, C-reactive protein (CRP) levels were elevated; however, there was no statistical difference in CRP values between groups (P > 0.05). There was no significant change of glutathione peroxidase over time or between groups (P > 0.05). CONCLUSION The selenium concentration was greater in the G+S than in the G-S, acting independently from CRP behavior. However, supplementation was not enough to reach the reference values.
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Affiliation(s)
| | | | | | | | - Gabriel Hessel
- College of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
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Ihle C, Freude T, Bahrs C, Zehendner E, Braunsberger J, Biesalski HK, Lambert C, Stöckle U, Wintermeyer E, Grünwald J, Grünwald L, Ochs G, Flesch I, Nüssler A. Malnutrition - An underestimated factor in the inpatient treatment of traumatology and orthopedic patients: A prospective evaluation of 1055 patients. Injury 2017; 48:628-636. [PMID: 28132729 DOI: 10.1016/j.injury.2017.01.036] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 01/19/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Suboptimal nutritional status is often observed among hospitalized patients across all medical specialties. The objective of the present study was to (1) analyze the prevalence of malnutrition in hospitalized orthopedic and trauma patients and (2) to evaluate the relationship between malnutrition and selected clinical outcomes. MATERIALS AND METHODS The prospective field study was conducted between 06/2014 and 06/2015 in a German level I trauma center (Department of Traumatology, Septic Trauma Surgery and Arthroplasty) with a total number of 1055 patients. At hospital admission, patients were checked for malnutrition using the validated Nutritional Risk Screening (NRS). Patients at risk for malnutrition were defined as NRS≥3. Quality of life (SF-36) was assessed to evaluate the physical and mental health status prior to hospitalization. Clinical outcomes under consideration included 1) rate of adverse events, 2) length of hospitalization, and 3) mobilization after operative and conservative treatment. Patients were included independently of surgical intervention or age. RESULTS 22.3% (235) of our patients were at risk for malnutrition (NRS≥3) while a regular nutritional status (NRS<3) was diagnosed in 77.7% (819). The highest prevalence of malnutrition was found in Septic Surgery with 31.0% (106), followed by Traumatology with 19.2% (100) and Arthroplasty with 15.1% (29). Higher prevalence of malnutrition was observed among patients with typical fractures of the elderly, such as lumbar spine and pelvis (47.4%), proximal femur (36.4%) and proximal humeral (26.7%) fractures. Furthermore, patients at risk for malnutrition showed prolonged hospitalization (13.7±11.1 vs. 18.2±11.7days), delayed postoperative mobilization (2.2±2.9 vs. 4.0±4.9days) and delayed mobilization after conservative treatment (1.1±2.7 vs. 1.8±1.9days). A statistically significant correlation of NRS with each parameter (Spearman's rank correlation, p<0.05) was observed. The incidence of adverse events in patients at risk for malnutrition was statistically significantly higher compared to that of patients with a regular nutritional status (37.2% vs. 21.1%, p<0.001). CONCLUSIONS Malnutrition is widespread regarding hospitalized patients in the field of orthopedic and trauma surgery and results in suboptimal clinical outcome. It should be considered as an important factor that significantly contributes to delayed recovery. Especially elderly trauma patients and patients suffering from postoperative infections should be monitored carefully during hospitalization.
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Affiliation(s)
- Christoph Ihle
- Siegfried Weller Institute for Trauma Research, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076 Tübingen, Germany.
| | - Thomas Freude
- Siegfried Weller Institute for Trauma Research, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076 Tübingen, Germany.
| | - Christian Bahrs
- Siegfried Weller Institute for Trauma Research, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076 Tübingen, Germany.
| | - Eva Zehendner
- Siegfried Weller Institute for Trauma Research, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076 Tübingen, Germany.
| | - Janick Braunsberger
- Siegfried Weller Institute for Trauma Research, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076 Tübingen, Germany.
| | - Hans Konrad Biesalski
- Institute of Biological Chemistry and Nutritional Science, University of Hohenheim, Garbenstr. 30, 70593 Stuttgart, Germany.
| | - Christine Lambert
- Institute of Biological Chemistry and Nutritional Science, University of Hohenheim, Garbenstr. 30, 70593 Stuttgart, Germany.
| | - Ulrich Stöckle
- Siegfried Weller Institute for Trauma Research, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076 Tübingen, Germany.
| | - Elke Wintermeyer
- Siegfried Weller Institute for Trauma Research, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076 Tübingen, Germany.
| | - Julia Grünwald
- Siegfried Weller Institute for Trauma Research, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076 Tübingen, Germany.
| | - Leonard Grünwald
- Siegfried Weller Institute for Trauma Research, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076 Tübingen, Germany.
| | - Gunnar Ochs
- Siegfried Weller Institute for Trauma Research, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076 Tübingen, Germany.
| | - Ingo Flesch
- Siegfried Weller Institute for Trauma Research, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076 Tübingen, Germany.
| | - Andreas Nüssler
- Siegfried Weller Institute for Trauma Research, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076 Tübingen, Germany.
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dos Reis AR, El-Ramady H, Santos EF, Gratão PL, Schomburg L. Overview of Selenium Deficiency and Toxicity Worldwide: Affected Areas, Selenium-Related Health Issues, and Case Studies. PLANT ECOPHYSIOLOGY 2017. [DOI: 10.1007/978-3-319-56249-0_13] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Robitaille L, Hoffer LJ. A simple method for plasma total vitamin C analysis suitable for routine clinical laboratory use. Nutr J 2016; 15:40. [PMID: 27102999 PMCID: PMC4839128 DOI: 10.1186/s12937-016-0158-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 04/13/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In-hospital hypovitaminosis C is highly prevalent but almost completely unrecognized. Medical awareness of this potentially important disorder is hindered by the inability of most hospital laboratories to determine plasma vitamin C concentrations. The availability of a simple, reliable method for analyzing plasma vitamin C could increase opportunities for routine plasma vitamin C analysis in clinical medicine. METHODS Plasma vitamin C can be analyzed by high performance liquid chromatography (HPLC) with electrochemical (EC) or ultraviolet (UV) light detection. We modified existing UV-HPLC methods for plasma total vitamin C analysis (the sum of ascorbic and dehydroascorbic acid) to develop a simple, constant-low-pH sample reduction procedure followed by isocratic reverse-phase HPLC separation using a purely aqueous low-pH non-buffered mobile phase. Although EC-HPLC is widely recommended over UV-HPLC for plasma total vitamin C analysis, the two methods have never been directly compared. We formally compared the simplified UV-HPLC method with EC-HPLC in 80 consecutive clinical samples. RESULTS The simplified UV-HPLC method was less expensive, easier to set up, required fewer reagents and no pH adjustments, and demonstrated greater sample stability than many existing methods for plasma vitamin C analysis. When compared with the gold-standard EC-HPLC method in 80 consecutive clinical samples exhibiting a wide range of plasma vitamin C concentrations, it performed equivalently. CONCLUSION The easy set up, simplicity and sensitivity of the plasma vitamin C analysis method described here could make it practical in a normally equipped hospital laboratory. Unlike any prior UV-HPLC method for plasma total vitamin C analysis, it was rigorously compared with the gold-standard EC-HPLC method and performed equivalently. Adoption of this method could increase the availability of plasma vitamin C analysis in clinical medicine.
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Affiliation(s)
- Line Robitaille
- Lady Davis Institute for Medical Research and Department of Medicine, McGill University and Jewish General Hospital, 3755 Cote Sainte Catherine, Montreal, QC H3T 1E2 Canada
| | - L. John Hoffer
- Lady Davis Institute for Medical Research and Department of Medicine, McGill University and Jewish General Hospital, 3755 Cote Sainte Catherine, Montreal, QC H3T 1E2 Canada
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Bedreag OH, Rogobete AF, Sărăndan M, Cradigati AC, Păpurică M, Roşu OM, Luca L, Vernic C, Nartiţă R, Săndesc D. Influence of antioxidant therapy on the clinical status of multiple trauma patients. A retrospective single center study. Rom J Anaesth Intensive Care 2015; 22:89-96. [PMID: 28913463 PMCID: PMC5505380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
INTRODUCTION The biochemical processes of bioproduction of free radicals (FR) are significantly increasing in polytrauma patients. Decreased plasma concentrations of antioxidants, correlated with a disturbance of the redox balance are responsible for the installation of the phenomenon called oxidative stress (OS). OS action is associated with a series of secondary complications with direct implications in reducing the rate of survival, as well as in increasing morbidity The objectives of this study were to reveal possible relations between antioxidant therapy and a number of serum biochemical variables (ALT, AST, APPT, LDH, urea, leukocytes, platelets), the length of mechanical ventilation, the time spent in the ICU, and the mortality rate in major trauma patients. MATERIALS AND METHODS In this retrospective study from a single center, 64 medical files of polytrauma patients admitted to the ICU "Casa Austria" were analysed. The selection criteria were: the Injury Severity Score (ISS) > 16 and a systolic arterial pressure (SAP) < 89 mmHg. The selected patients (n = 34) were divided into two groups: Antiox group, 20 patients who benefited from antioxidant therapy and the Contr group, 14 patients who did not received antioxidant therapy and served as a control group. The antioxidant therapy consisted of the simultaneous administration of vitamin C (i.v.), vitamin B1 (i.v.) and N-acetylcysteine (i.v.). The clinical and the biological evaluation were performed repeatedly until discharge from the ICU or the death of the patient. RESULTS No significant differences were highlighted concerning the demographic data, the magnitude or the trauma mechanism between the two groups. In comparison with patients from the Contr group, the patients submitted to antioxidant therapy showed lower values after the treatment for leukocytes (p = 0.0066), urea (p = 0.0076), LDH (p = 0.0238), AST (p = 0.0070) and ALT (p < 0.0001). No statistically significant differences were evidenced regarding the incidence of sepsis or the development of multiple organ dysfunction syndrome (MODS). The period of mechanical ventilation was longer in patients from the Contr group (p = 0.0498), with no differences concerning the ICU length of stay (p = 0.7313). The mortality rate was lower in the Contr group (p = 0.0475). CONCLUSION In multiple trauma patients a prolonged antioxidant therapy improved the posttraumatic laboratory tests.
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Affiliation(s)
- Ovidiu Horea Bedreag
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brînzeu”, Timişoara, Timiş, Romania
- Faculty of Medicine, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Timiş, Romania
| | - Alexandru Florin Rogobete
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brînzeu”, Timişoara, Timiş, Romania
- Faculty of Medicine, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Timiş, Romania
- Faculty of Chemistry, Biology, Geography, West University of Timişoara, Timişoara, Timiş, Romania
| | - Mirela Sărăndan
- Clinic of Anaesthesia and Intensive Care “Casa Austria”, Emergency County Hospital “Pius Brînzeu”, Timişoara, Timiş, Romania
| | - Alina Carmen Cradigati
- Clinic of Anaesthesia and Intensive Care “Casa Austria”, Emergency County Hospital “Pius Brînzeu”, Timişoara, Timiş, Romania
| | - Marius Păpurică
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brînzeu”, Timişoara, Timiş, Romania
- Faculty of Medicine, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Timiş, Romania
| | - Oana Maria Roşu
- Clinic of Anaesthesia and Intensive Care “Casa Austria”, Emergency County Hospital “Pius Brînzeu”, Timişoara, Timiş, Romania
| | - Loredana Luca
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brînzeu”, Timişoara, Timiş, Romania
| | - Corina Vernic
- Faculty of Medicine, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Timiş, Romania
| | - Radu Nartiţă
- Faculty of Chemistry, Biology, Geography, West University of Timişoara, Timişoara, Timiş, Romania
| | - Dorel Săndesc
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brînzeu”, Timişoara, Timiş, Romania
- Faculty of Medicine, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Timiş, Romania
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Xu G, Hu B, Chen G, Yu X, Luo J, Lv J, Gu J. Analysis of blood trace elements and biochemical indexes levels in severe craniocerebral trauma adults with Glasgow Coma Scale and injury severity score. Biol Trace Elem Res 2015; 164:192-7. [PMID: 25575666 DOI: 10.1007/s12011-014-0225-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 12/29/2014] [Indexed: 02/05/2023]
Abstract
We aimed to investigate the correlation between the Glasgow Coma Scale (GCS), the injury severity score (ISS) and serum levels of trace elements (TE) in severe trauma patients to analyze alteration of the levels of trace elements and serum biochemical indexes in the period of admission from 126 adult cases of severe brain trauma with traffic accidents. Multi-trace elements for patients in the trauma-TE groups were used. The results indicated that all patients presented an acute trace elements deficiency syndrome (ATEDs) after severe trauma, and the correlation between ISS and serum levels of Fe, Zn, and Mg was significant. Compared to the normal control group, levels of the trace elements in serum were significantly decreased after trauma, suggesting that enhancement of immunity to infection and multiple organ failure (MOF) via the monitoring and supplement of trace elements will be a good strategy to severe traumatic patients in clinics.
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Affiliation(s)
- Guangtao Xu
- National Key Disciplines, Department of Forensic and Pathology, Shantou University Medical College, 515041, Shantou, Guangdong Province, People's Republic of China,
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Stoffaneller R, Morse NL. A review of dietary selenium intake and selenium status in Europe and the Middle East. Nutrients 2015; 7:1494-537. [PMID: 25734564 PMCID: PMC4377864 DOI: 10.3390/nu7031494] [Citation(s) in RCA: 224] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 01/23/2015] [Accepted: 02/05/2015] [Indexed: 11/17/2022] Open
Abstract
This is a systematic review of existing data on dietary selenium (Se) intake and status for various population groups in Europe (including the United Kingdom (UK)) and the Middle East. It includes English language systematic reviews, meta-analyses, randomised controlled trials, cohort studies, cross-sectional and case-control studies obtained through PUBMED searches from January, 2002, to November, 2014, for European data and from 1990 to November 2014, for Middle Eastern data. Reports were selected if they included data on Se intake and status. The search identified 19 European/UK studies and 15 investigations in the Middle East that reported Se intake and Se concentration in water and/or food and 48 European/UK studies and 44 investigations in the Middle East reporting Se status. Suboptimal Se status was reported to be widespread throughout Europe, the UK and the Middle East, and these results agreed with previous reports highlighting the problem. Eastern European countries had lower Se intake than Western European countries. Middle Eastern studies provided varying results, possibly due to varying food habits and imports in different regions and within differing socioeconomic groups. In conclusion, Se intake and status is suboptimal in European and Middle Eastern countries, with less consistency in the Middle East.
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Affiliation(s)
- Rita Stoffaneller
- Station Road, Polegate, East Sussex, BN26 6EA, UK.
- Research consultant to Wassen International Ltd. Cedar Court Office Park, Denby Dale Road, Wakefield WF4 3DB, UK.
| | - Nancy L Morse
- Research consultant to Wassen International Ltd. Cedar Court Office Park, Denby Dale Road, Wakefield WF4 3DB, UK.
- Horsburgh Dr., Berwick, N.S., B0P 1E0, Canada.
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P111: Dépistage des carences en vitamines, minéraux et oligoéléments dans la population diabétique sans et avec mal perforant plantaire. NUTR CLIN METAB 2014. [DOI: 10.1016/s0985-0562(14)70753-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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