Mehmet Emin Demir

Comment on: infusion of lin-/sca-1+ and endothelial progenitor cells improves proinflammatory and oxidative stress markers in atherosclerotic mice.

proinflammatory and oxidative stress markers in atherosclerotic mice Turgay Ulas ⁎, Irfan Tursun , Mehmet Emin Demir , Mehmet Sinan Dal , Hakan Buyukhatipoglu d a Harran University, Faculty of Medicine, Department of Internal Medicine, Sanlıurfa, Turkey b Igdır Training and Research Hospital, Department of Internal Medicine, Igdir, Turkey c Dicle University, Faculty of Medicine, Department of Internal Medicine, Diyarbakir, Turkey d Gaziantep University, Faculty of Medicine, Department of Internal Medicine, Division of Medical Oncology, Gaziantep, Turkey

Crohnic kidney disease: Recurrent acute kidney failure in a patient with Crohn's disease

Context: Short bowel syndrome is a rare and devastating complication in chronic inflammatory bowel disease following functional or anatomic loss of extensive segments of the intestine. Case Report: A 60-year-old male patient with Crohns disease had undergone multiple resections of the intestine and developed short bowel syndrome. Despite up to 4-5 liters of orally fluid, sufficient calcium and magnesium intake, he suffered from recurrent acute kidney injury due to profound volume depletion and those electrolyte deficiencies. Administration of intravenous fluid and electrolyte repleacement treatment at regular intervals prevented further kidney injuries. Conclusion: We present a case of recurrent acute kidney failure in a patient with Crohns disease, and aimed to remark importance of receiving sufficient parenteral fluid and electrolyte support in those with short bowel syndrome.

Comment on: Oxidative stress in erythrocytes from patients with rheumatoid arthritis

We read with great interest the article by Staron et al. [1] dealing with an association between oxidative stress parameters in erythrocytes and rheumatoid arthritis (RA) patients. The authors have analyzed thiobarbituric acid, total ATPase, NaKATPase, -SH, catalase, superoxide dismutase, glutathione peroxidase and glutathione levels in erythrocytes both in patients with RA (n = 25) and healthy subjects (n = 35). In our opinion, some points of this work are not sufficiently clear. Firstly, measuring different oxidant and antioxidant molecules is impractical, and their oxidant and antioxidant effects are additive. Since there are numerous oxidants and antioxidants in the body, measuring total oxidant–antioxidant status is more valid and reliable. When only a few parameters are measured, their levels may be unchanged or decreased, even when the actual oxidant status is increased, or vice versa [2]. The authors analyzed some antioxidant and oxidant parameters in their study, and these levels cannot demonstrate the total oxidative status which has been analyzed using erythrocytes in the study population. Indeed, compared to healthy subjects, the authors have found higher thiobarbituric acid levels, lower total ATPase, NaKATPase, -SH, superoxide dismutase and glutathione levels, neither higher nor lower catalase and glutathione peroxidase levels in patients with RA. Namely, it may be difficult to interpret these results in relation to RA. Secondly, the authors have selected 25 RA patients (21 women and 4 men); however, the number of the male and female subjects in the control group has not been stated. Additionally, the demographical, anthropometric characteristics of the study groups have not been stated. Age, duration of the disease, whether the disease was active or in remission, medications for RA are the confounding factors that affect the assays. If any, these should be clearly stated in the article. Further, demographical, anthropometric characteristics of the study groups shown either in the results part or in a table could have been better, too. Finally, the hypothesis and the discussion parts could have been more clear in terms of showing the purpose and the results of the study. We hope that the above-mentioned items might add to the value of the article by Staron et al. [1].

Comment on: acute and chronic fluctuations in blood glucose levels can increase oxidative stress in type 2 diabetes mellitus

Dear Editor, We read with great interest the recent article by Chang et al. [1] dealing with the effects of shortor long-term glycemic fluctuations on oxidative stress and chronic inflammation. In the present study, 32 patients with type 2 diabetes mellitus and age–gender matched 12 healthy subjects were enrolled, and the authors have analyzed the short-term glycemic variability including mean amplitude of glycemic excursions, the long-term glycemic variability including the standard deviation of hemoglobin A1c levels that have been measured over a 2-year period. Also the authors have analyzed oxidative stress markers including: 8-isoprostaglandin F2a, thiobarbituric acid reactive substance, 8-hydroxydeoxyguanosine, and hs-CRP levels as a chronic inflammation marker. Authors have very clearly performed their study and discussed the results. In addition to their fluent discussion on the association of oxidative stress and acute-chronic fluctuations in blood glucose levels, we aimed to emphasize in choosing which oxidative stress markers would be more valid and reliable to demonstrate the correct results. Firstly, measuring different oxidant and antioxidant molecules is impractical, and their oxidant and antioxidant effects are additive. Since there are numerous oxidants and antioxidants in the body, measuring total oxidant–antioxidant status is more valid and reliable. When only a few parameters are measured, their levels may be unchanged or decreased, even when the actual oxidant status is increased, or vice versa [2–4]. The authors have analyzed only 8-isoprostaglandin F2a, thiobarbituric acid reactive substance, and 8-hydroxydeoxyguanosine levels in their study and have found both acute and chronic blood glucose variability increased oxidative stress. However, these levels cannot demonstrate the total oxidative status. Also, it may be difficult to interpret these results in relation to the effect of the blood glucose variability on oxidative stress. Finally, analyzing the total antioxidant and total oxidant status levels in type 2 diabetic patients and enrollment of the similar numbers of the control subjects might have given the best results to assert the blood glucose fluctuations on increased oxidative stress development and pathogenesis. We hope that the above-mentioned items would add to the value of the well-written manuscript of Chang et al. [1]. Communicated by Guido Pozza.

Comment on: Study of Oxidative Stress in Vitiligo

We read with great interest the article by Jain et al. dealing with the association between vitilogo and oxidative stress [1]. The authors have reported an association between vitiligo and increased oxidative stress. In our opinion, some points of this work are not sufficiently clear. Firstly, measuring different oxidant and antioxidant molecules is impractical, and their oxidant and antioxidant effects are additive. Since there are numerous oxidants and antioxidants in the body, measuring total oxidant-antioxidant status is more valid and reliable [2, 3]. When only a few parameters are measured, their levels may be unchanged or decreased, even when the actual oxidant status is increased, or vice versa. The authors have analyzed only superoxide dismutase and glutathione peroxidase levels in their study, these levels can not demonstrate the oxidative status in the study population. Further, levels of antioxidants have not been analyzed and compared. Secondly, the authors have revealed that the design of the study is prospective case–control study. We did not see comparisons between a baseline and after a certain period levels. Therefore, design of the study should be cross-sectional. The statistical analysis is not sufficient to show the whole analysis as has been stated in the results. The comparisons of the oxidative stress parameters among the study and healthy subjects should be performed using Independent Sample T test or Mann–Whitney U tests, and these should be stated in the statistical analysis part. Finally, analyzing and comparison of the total antioxidant and total oxidant status levels among groups might have give the best results to assert the oxidative stress involvement in the pathogenesis of the vitiligo. We hope that the above-mentioned items might add to the value of the article by Jain et al. [1].