Melatonin Acts as Antioxidant and Improves Sleep in MS Patients

This prospective observational study aimed to compare abdominal hysterectomy (AH), vaginal hysterectomy (VH), and total laparoscopic hysterectomy (TLH) in terms of oxidative stress (OS) by measuring serum levels of total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI). Of the 3 groups, namely, AH, VH, and TLH, 22 patients were enrolled in each to investigate the aim of the study mentioned above. Patient demographics, clinical and surgical characteristics, and preoperative and postoperative (0th and 24th hours) serum TAS, TOS, and OSI levels were investigated. The groups differed significantly based on surgical indications (P < .001). While abnormal uterine bleeding was more prevalent in the AH (95.5%) and TLH (77.3%) groups, pelvic organ prolapse (POP) was more prevalent in the VH group (90.1%). The mean age and menopausal patient rates were significantly higher in the VH group than in the AH and TLH groups (P < .001). The groups did not differ significantly in terms of simultaneous bilateral salpingo-oophorectomy rates (P = .10). However, additional POP surgery was performed in 14 patients in the VH group. The mean operative time was significantly shorter in the AH group than in the VH and TLH groups (P = .001). The groups did not differ significantly based on either the preoperative or postoperative serum TAS levels (P > .05). Furthermore, the change in serum TAS levels over time was not significant in any of the groups (P > .05). In contrast, preoperative serum TOS and OSI levels were significantly higher in the VH group than in the AH and TLH groups (P < .05). The groups did not differ significantly in terms of serum TOS and OSI levels at 0th and 24th hours postoperatively (P > .05). Serum TOS and OSI levels increased dramatically over time in the AH and TLH groups (P < .05), but not in the VH group (P > .05). post hoc analysis showed that the changes in serum TOS and OSI values in the AH and TLH groups were between the preoperative and postoperative 0th hour levels (P < .001). Our results indicated that the total antioxidant capacity was preserved in all 3 techniques. However, VH causes less OS than the other hysterectomy techniques.

Purpose: To investigate the relationship between seasonal allergic conjunctivitis (SAC) and oxidative stress by measuring serum total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI). Methods: A total of 95 participants, 49 patients with SAC (18 female, 31 male) and age and gender matched 46 controls (23 female, 23 male) were included during allergy season in this observational casecontrol study. Serum samples were obtained from all participants. The measurements of serum TAS and TOS levels were made by automatic colorimetric method and OSI was calculated. Results: Serum TAS levels of the patient and control group were measured as 1.45 ± 0.19 mmol Trolox Equ/L and 1.46 ± 0.15 mmol Trolox Equ/L, respectively. The median serum TOS values of the patient and control group were 3.60 (1.34-36.27) μmol H2O2 Equ/L and 3.29 (1.00-12.96) μmol H2O2 Equ/L respectively. OSI values of the patient and control group were calculated as 37.67 ± 39.32 and 26.78 ± 15.38, respectively. There was no statistically significant difference between serum TAS, TOS and OSI values of two groups (p: 0.974, 0.544 and 0.372, respectively). Conclusion: We found no significant difference in levels of serum oxidative stress markers in patients with SAC and control group. There may be localized oxidative stress only in the ocular surface, which does not affect serum values in patients with SAC.

Recent data have demonstrated increased lipid peroxidation (LPO) levels and oxidative stress in periodontitis. Malondialdehyde (MDA) and superoxide dismutase (SOD) are both increased during oxidative stress. Furthermore, this study examined SOD concentration, total oxidative status (TOS) and MDA levels in periodontal patients and investigated the longitudinal effect of periodontal therapy on the index levels of chronic periodontitis (CP) patients. Serum, saliva and gingival crevicular fluid (GCF) samples were obtained from 48 CP patients and 35 healthy control subjects prior to, as well as after 16 weeks following non-surgical post-periodontal therapy. MDA, TOS and SOD and clinical parameters were determined pre- and post-therapy. The levels of TOS and SOD values were significantly higher in the CP group than in the control group (p < 0.05), but only MDA in GCF. Post-periodontal therapy, serum, saliva and GCF TOS and SOD levels significantly decreased compared to basal levels (p < 0.05), but only MDA in GCF. LPO was higher in the periodontal region, with TOS and SOD increasing both locally and peripherally. Non-surgical therapy can restore and control the subject antioxidant capacity by locally and systemically modifying the levels of MDA, TOS and SOD.

The aim of our study was to evaluate serum paraoxonase (PON1), total antioxidant status (TAS), total oxidant status (TOS), and ischemia-modified albumin (IMA) levels in patients with prediabetes, diabetes, and in healthy control subjects. The subjects were aged between 20 and 60 years. Forty diabetic subjects (mean age 46.6 ± 9.7 years), 39 prediabetic subjects (mean age 44.0 ± 9.3 years) and 24 healthy control subjects (mean age 43.7 ± 9.7 years). Lipid profile, PON1, TAS, TOS and IMA levels were measured. The serum TOS and IMA levels in diabetes were significantly higher than those of the control subjects (P = 0.024 and P = 0.012, respectively), while the serum PON1 levels of the diabetes patients were significantly lower than those of the control subjects (P = 0.039). The serum TOS levels of the diabetes patients were significantly higher than those of the subjects with prediabetes (P = 0.013). There were no significant differences between the serum IMA and PON1 levels of the prediabetes and diabetes groups (P = 0.075 and P = 0.110, respectively). The serum TAS levels of the three groups were similar. The present study demonstrated that in diabetes there is greater oxidative stress. Patients with type 2 diabetes had higher TOS and IMA levels, but lower PON1 values, than controls. There were no differences in oxidative stress markers between prediabetic patients and healthy subjects.

There are several reports that increased oxidative stress and DNA damage were found in β-thalassemia major (β-TM) patients. In this study, we aimed to evaluate the effects of N-acetylcysteine (NAC) and vitamin E on total oxidative stress and DNA damage in children with β-TM. Seventy-five children with transfusion-dependent β-thalassemia (β-thal) were randomly chosen to receive 10 mg/kg/day of NAC or 10 IU/kg/day of vitamin E or no supplementation; 28 healthy controls were also included in the study. Serum total oxidant status (TOS) and total antioxidant capacity (TAC) were measured, oxidative stress index (OSI) was calculated, and mononuclear DNA damage was assessed by alkaline comet assay; they were determined before treatment and after 3 months of treatment. Total oxydent status, OSI, and DNA damage levels were significantly higher and TAC levels were significantly lower in the thalassemic children than in the healthy controls (p < 0.001). In both supplemented groups, mean TOS and OSI levels were decreased; TAC and pre transfusion hemoglobin (Hb) levels were significantly increased after 3 months (p ≤ 0.002). In the NAC group, DNA damage score decreased (p = 0.001). N-acetylcysteine and vitamin E may be effective in reducing serum oxidative stress and increase pre transfusion Hb levels in children with β-thal. N-acetylcysteine also can reduce DNA damage.

Objective This study compares the nutritional status and physical activity levels of relapsing-remitting multiple sclerosis (RRMS) patients and healthy people. Method The study included 120 participants: 60 multiple sclerosis (MS) patients and 60 controls. RRMS diagnoses were made based on the 2017 McDonald criteria. The food intake frequency questionnaire was administered to the participants, their threeday food intake records were collected, their activity levels were determined, and anthropometric measurements were made. The differences between the groups were analyzed using the Mann–Whitney U test and Pearson's exact chi-squared test. Results The participants with MS (46.7%) had a significantly lower rate of shopping for their own food compared to the control group (68.3%) (p = 0.002). The MS group (3.3%) had a lower rate of intake of green leafy vegetables 5 times weekly or more frequently than the control group (20.0%) (p < 0.05); and the control group (35.0%) had a higher consumption rate of pastry more than 1 to 2 times monthly than the MS group (13.3%) (p < 0.05). The participants with MS had a higher intake of fiber, insoluble fiber, and omega 3 fatty acid than the control group (p < 0.05). Expanded Disability Status Scale (EDSS) scores indicates that a positive correlation was found between daily intake of fiber and insoluble fiber (p < 0.05). The patients with MS in the inactive group had a higher EDSS median [2.00(0.00 –5.00)] than the minimal active group [1.25(0.00 –4.00)] (p = 0.034). Conclusion With the increase in disability in MS patients, their physical activity levels decrease and it becomes difficult for them to shop on their own. In addition, the consumption frequency of green leafy vegetables, which take time to prepare and a source of fiber, is also decreasing. It has been shown that fiber intake decreases when the disability increase. Therefore, preventing the progression of disability in MS patients is very important in ensuring diversity in food consumption.

ABSTRACTBackground: The prevalence of multiple sclerosis (MS) is rapidly changing. Objectives: To determine the prevalence and incidence of MS in Dubai, UAE. Methods: Data for all MS patients fulfilling McDonald criteria and registered in the Neurology Department, Rashid Hospital, Dubai between January 01, 2000 to December 12, 2007 were analyzed. Results: Two hundred and eighty-four MS patients were identified of which 158 (55.6%) were Dubai Natives and 126 (44.4%) Immigrants. In the Dubai Native population, the female to male ratio was 2.85:1. Motor manifestation was the commonest presentation 72.78% followed by sensory symptom 48.41%. The median and mean expanded disability status scale (EDSS) was 1.5 and 2.38 respectively. The mean age of onset was 26.66 ± 6.6 years. The prevalence of MS in 2007 was 54.77/100,000 (95% C.I. 46.99–62.55) with an annual incidence rate of 6.8/100,000 (95% C.I. 3.8–9.87) during 2000–2007. Conclusion: Dubai should be considered as one of the regions with medium to high risk for MS, with prevalence rate higher than what has been previously believed. This high MS incidence and prevalence in Dubai is surprising and it may represent a true increase. Central MS registry and long-term follow-up epidemiological studies are recommended.

Oxidative stress has been shown to play an important role in the pathogenesis of post-traumatic stress disorder (PTSD). Although there are some studies on oxidative stress and PTSD, there is no report available on the serum total oxidant and antioxidant status in earthquake survivors with PTSD. Therefore, this study aimed to investigate the serum total oxidant and antioxidant status in earthquake survivors with chronic PTSD. The study group included 45 earthquake survivors with PTSD and 40 earthquake survivors without PTSD. The oxidative status was determined using the total antioxidant status and total oxidant status (TOS) measurements and by calculating the oxidative stress index (OSI). There were no statistically significant differences in the total antioxidant status, TOS, or OSI when comparing individuals with and without PTSD (all, p>0.05). There were no correlations between Clinician-Administered PTSD Scale scores and oxidant and antioxidant stress markers (all, p>0.05). Our results suggest that the total oxidant and antioxidant status may not affect earthquake survivors with PTSD. This is the first study to evaluate the oxidative status in earthquake survivors with PTSD. Further studies are necessary to confirm these findings.

ABSTRACTThe aim of the present study is to evaluate the relationship of total antioxidant capacity, total oxidant status, oxidative stres and total free sulfydryl groups in patients with diabetic and nondiabetic senil cataract.The study was carried out on venous blood samples from 70 subjects admitted to the ophtalmology clinic of a research hospital. Of these, 25 were senile Type 2 diabetic patients with cataract who were using oral hypoglycemic agents or insülin. Fourty-five patients with nondiabetic senile cataract comprised the control group. Total oxidant status (TOS), total antioxidant capacity (TAC) and total free -SH levels were measured in sera of patients with cataract. Serum TAS and TOS levels were determined using a novel automated measurement method. Oxidative status was determined using TAC and TOS measurement and with the calculation of oxidative stres index.TOS and OSI levels were significantly higher in diabetic cataract than senile cataract (p=0.008, p=0.013), respectively. TAC and total free -SH levels were similiar in the two groups (p = 0.17, p=0.54). Free sulfydryl groups levels are consistent with TAC.The results of present study suggest that TOS and intensity of the oxidative stress in diabetic patients are higher, compared to other age-related cataract patients without diabetes. Since oxidative stress is important in development of diabetic complications, increased TOS and oxidative stress might have a role in the pathophysiology of diabetic cataract.

The aim of this study was to investigate the effects of ischemic preconditioning (IPC) and N-acetylcysteine (NAC) on oxidative stress resulting from tourniquet-induced ischemia-reperfusion (IR) period in arthroscopic knee surgery. Forty-five patients who had arthroscopic knee surgery for meniscal and chondral lesions and for pathologic medial plica were included in this study. They were assigned to the following treatment groups: control (group C; n=15), IPC (group P; n=15), and NAC (group N; n=15). Subjects in the control group underwent routine surgical procedures. Subjects in the preconditioning group were subjected to temporary ischemia, with tourniquet performed by three compression cycles of 5 minutes followed by 5 minutes of reperfusion just before the application of tourniquet inflation. Subjects in the NAC group received 10 mg/kg NAC dissolved in 100 mL 0.9% normal saline intravenously 30 minutes before tourniquet inflation. An hour before the tourniquet was applied (preischemia) and 2 hours after tourniquet was removed (reperfusion), blood samples (to test for metabolites) were obtained. Levels of malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), total antioxidant capacity (TAC), and total oxidant status (TOS) were measured in all serum samples. Results were compared between preischemia and reperfusion in three groups. MDA in the control group was found to be increased significantly compared with preischemia, whereas MDA in IPC and NAC groups did not change insignificantly. SOD and GSH activities in the control group were found to be increased significantly, whereas SOD and GSH activities in IPC and NAC groups did not change significantly after reperfusion. TAC in the control group was found to be decreased and TOS was found to be increased significantly, but TAC and TOS in IPC and NAC groups were not significantly different after reperfusion. Mean serum MDA, TOS, SOD, and GSH-Px levels were lower in group P than group C at reperfusion period (p<0.05). Mean serum SOD levels were lower in group P than group N at reperfusion period (p<0.05). Tourniquet-induced IR period in routine arthroscopic knee surgery resulted in oxidative stress by increasing MDA, SOD, GSH-Px, TOS and decreasing TAC. NAC and IPC had protective effect on occurrence of oxidative stress resulting from IR period by preventing MDA, SOD, GSH-Px, TAC, and TOS changes in routine arthroscopic knee surgery.

We aimed to determine the role of placental A Disintegrin and Metalloproteinase with thrombospondin motifs 5 (ADAMTS5), and maternal serum ADAMTS5, total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI) levels at 24–28th gestational weeks in GDM. This study included 57 patients, who had been diagnosed as having GDM at their 24–28th gestational week, and 29 controls. The maternal blood samples were collected at the 24-28th gestational week and ADAMTS5 was studied with the enzyme-linked immunosorbent assay (ELISA) method, whereas an automated colorimetric method was used to study TAS, TOS, and OSI. The level of ADAMTS5 in maternal serum of patients with GDM were significantly lower than the controls (p = .017); whereas TOS and OSI levels were significantly higher (p = .003 and p = .008). Multivariable logistic regression analysis revealed ADAMTS5 and TOS levels were independently associated with adverse perinatal outcomes (p = .004 and p = .018). We found that serum ADAMTS5 levels decreased and TOS level increased in GDM pregnant at 24–28th gestational weeks. In addition, we found that increased levels of serum ADAMTS5 and decreased TOS levels at 24–28th weeks were associated with adverse perinatal outcomes independent of the mode of treatment in GDM.Impact statementWhat is already known on this subject? Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy. The insulin resistance, which starts at the 24–28th gestational weeks, increases during gestation. GDM increases maternal complications like preeclampsia, cesarean rate, cardiovascular disease, obesity, and diabetes after pregnancy; and neonatal complications like macrosomia, hypoglycemia, hyperbilirubinemia, delivery trauma, shoulder dystocia, and adult-onset obesity, and diabetes.What the results of this study add? A significant relationship between ADAMTS5, TOS levels and adverse perinatal outcome. insulin resistance and was observed.What the implications are of these findings for clinical practice and/or further research? Based on this finding, we concluded that increased levels of oxidative stress and decreased ADAMTS5 levels are associated with GDM and predictive for adverse perinatal outcomes. The results of the present study were consistent with the previous reports and indicated that increased oxidative stress in GDM patients are related to adverse perinatal outcomes.

Purpose/Aim: Our study aims to evaluate corneal subbasal nerve plexus morphology by in vivo corneal confocal microscopy (CCM) in Multiple Sclerosis (MS) patients and to explore its potential ability to distinguish between MS patients and healthy subjects. Materials and methods: Cross-sectional study, including 60 MS patients and 22 healthy subjects. Expanded Disability Status Scale (EDSS) was used to assess neurological disability. All participants underwent full ophthalmology evaluation, CCM and optical coherence tomography (OCT). Corneal nerve fibre density (CNFD), branch density (CNBD), fibre length (CNFL) and fibre tortuosity (CNFT) were analysed. Generalized additive regression models were used to analyse the data. Results: Compared to controls, MS patients had lower CNFD, CNBD and CNFL (p < .001) and higher CNFT (p = .002). The area under the ROC curve to distinguish MS patients from healthy controls with CNFD and CNBD was 0.84 (95%CI: 0.75 to 0.93; 95%CI: 0.75 to 0.92, respectively). A nonlinear association between EDSS and CNFD was found, with an initial density increase followed by a significant decrease until more severe disability status. EDSS was associated with CNFL and CNBD, with values being significantly lower for patients with an EDSS > 2.5 (−2.06 mm/mm2; 95%CI: −3.84 to −0.28; p = .027 and −8.70 branches/mm2; 95%CI: −14.69 to −2.71; p = .006, respectively). An optic neuritis (ON) history did not influence CCM parameters. Conclusions: Our results confirm CCM parameters’ potential to differentiate MS patients from healthy subjects, not being influenced by a previous ON history. A significant relationship between patient’s disability and corneal nerve morphology was also found.

Background: Serum uric acid (UA), a natural scavenger of peroxynitrite, has been found to be of lower levels in patients with multiple sclerosis (MS) in some recent preliminary studies.Objective: To evaluate the correlation between serum UA levels and several clinical parameters of MS reliably.Methods: We surveyed studies on the serum UA levels and MS patients with comprehensive search and review of the references. A meta-analysis was performed to demonstrate the potential association between serum UA levels in MS patients and their clinical characteristics by random effects models.Results The serum UA levels were lower in patients with MS than in healthy controls (standardized mean difference (SMD) = −0·68; 95% confidence interval (CI): −0·82 to −0·55), as well as in other inflammatory neurological diseases (OINDs) (SMD = −0·45; 95% CI: −0·60 to −0·30). Similarly, the serum UA levels decreased in MS patients with clinical activity when compared to MS with clinical inactivity (SMD = −0·29; 95% CI: −0·48 to −0·10), as well as in relapsing–remitting MS (RRMS) patients with relapse in comparison to RRMS patients with remission (SMD = 0·64; 95% CI: 0·39 to 0·89). However, the results suggested that serum UA levels did not correlate with higher (or lower) expanded disability status scale (SMD = −0·09; 95% CI: −0·10 to 0·27) and magnetic resonance imaging (MRI) activity (SMD = −0·14; 95% CI: −0·13 to 0·41). In the subtypes of MS group, there were significant differences in serum UA levels between secondary progressive MS (SPMS) and RRMS (SMD = −0·34; 95% CI: 0·16 to 0·52), or primary progressive MS (PPMS) (SMD = −0·58; 95% CI: −0·89 to −0·27), but no significant difference between RRMS and PPMS (SMD = −0·18; 95% CI: −0·44 to 0·08).Conclusions: Our study suggests that UA is relevant to MS. Future research is needed to determine whether the administration of UA levels by inosine might be considered as a novel treatment strategy for MS.

This study was undertaken to investigate oxidant and antioxidant systems in patients with immune thrombocytopenic purpura (ITP). With this purpose, we measured the levels of serum malondialdehyde (MDA), total antioxidant capacity (TAC), total oxidant status (TOS), and other oxidative stress parameters. Fifty-two pediatric patients with ITP (25 acute, 27 chronic) and 21 healthy children were included in the study. Patients with acute ITP were studied, before and after, methylprednisolone treatment. Hemoglobin, hematocrit, platelet count, and TAC were statistically significantly lower in patients with acute ITP before treatment than those in the control group (P<0.05). In addition, in this group, MDA, TOS levels, and OSI (oxidative stress index) were found to be higher than those in the control group. In chronic ITP group, although hemoglobin hematocrit, platelet counts, and TAC levels were statistically significantly lower than those in the control groups,the mean platelet volume, MDA, TOS, and OSI were found to be statistically significantly higher (P<0.05). Platelet count and mean platelet volume values were statistically significantly lower in patients with acute ITP before treatment than after treatment (P<0.05). We also found a positive correlation between thrombocyte count and TAC, in patients with acute ITP before treatment (r: 0.601, P<0.001) and acute ITP after treatment (r: 0.601, P<0.001) and chronic ITP (r: 0.601, P<0.001). A negative correlation was found between thrombocyte count and serum MDA levels, in patients with acute ITP before treatment (r: -0.356, P<0.001) and acute ITP after treatment (r: -0.356, P<0.001) and chronic ITP (r: -0.356, P<0.001). We also found a negative correlation between thrombocyte count and serum OSI, in patients with acute ITP before treatment (r: -0.494, P<0.001) and acute ITP after treatment (r: -0.494, P<0.001) and chronic ITP (r: -0.494, P<0.001). A negative correlation was found between thrombocyte count and TOS, in patients with acute ITP before treatment (r: -0.470, P<0.001) and acute ITP after treatment (r: -0.470, P<0.001) and chronic ITP (r: -0.470, P<0.001). In conclusion, increased MDA, TOS and OSI, and decreased TAC levels were found in patients with acute and chronic ITP. On the basis of these findings, we suggest that free oxygen radicals may have an effect on the structural and functional damage of platelets, and on the mechanism of thrombocytopenia in both, acute and chronic ITP.

Sexual dysfunction (SD) is prevalent in multiple sclerosis (MS) patients and affects quality of life. Furthermore, lower urinary tract dysfunction (LUTD) is common in MS patients. This study aims to evaluate the relationship between SD, neurological disability, depression, anxiety, and urodynamic alterations in patients with MS and LUTD. From January 2011 to September 2013, 135 consecutive patients with MS in remission phase and LUTD underwent first urodynamic examination, according to the International Continence Society criteria. Depression and anxiety were evaluated with the Hamilton Depression Scale (HAM-D) and the Hamilton Anxiety Scale (HAM-A), neurological impairment was assessed using the Expanded Disability Status Scale (EDSS), and SD was investigated with the Female Sexual Function Index (FSFI) or the International Index of Erectile Function (IIEF-15). Multivariate logistic regression analyses were carried out to identify variables for predicting female sexual dysfunction (FSD) (FSFI < 26.55), male SD (IIEF-15 < 60), or moderate-severe erectile dysfunction (IIEF-EF ≤ 16), after adjusting for confounding factors. Total IIEF-15 and all subdomains (all P < 0.01), total FSFI, FSFI-arousal, FSFI-lubrication, and FSFI-orgasm (all P < 0.05) were lower in subjects with EDSS ≥ 4.5. We found inverse relationship between IIEF-15 and relative subdomains with EDSS (all P < 0.01) and between FSFI and relative subdomains with EDSS (all P < 0.01), HAM-D (all P < 0.01), and HAM-A (all P < 0.01). Continuous EDSS (odds ratio [OR] = 1.54; P = 0.03) and categorical EDSS (≥4.5) (OR = 6.0; P = 0.03), HAM-D (OR = 4.74; P = 0.03), and HAM-A (OR = 4.10; P = 0.02) were significantly associated with FSD (FSFI < 26.55). Detrusor overactivity (DO) was an independent predictor of moderate-severe ED (IIEF-EF ≤ 16) (OR = 2.03; P < 0.01), and of FSD (OR = 9.73; P = 0.04). Neurological disability, depression and DO are significantly predictive of SD in MS patients, irrespective of gender. An EDSS ≥ 4.5 may significantly predict the presence of SD.