Tomasz Kornatowski

Melatonin improves oxidative stress parameters measured in the blood of elderly type 2 diabetic patients.

Abstract:  An elevated oxidative status in the aging organism may be involved in the development of non‐insulin dependent diabetes mellitus (NIDDM). Melatonin, a potent antioxidant agent, is essential for glucose homeostasis and regulation. The aim of this study was to determine the influence of melatonin supplementation on the oxidative stress parameters in elderly NIDDM patients. The malondialdehyde (MDA) concentration, Cu‐Zn superoxide dismutase (SOD‐1) activity in erythrocytes, the level of nitrate/nitrite in plasma and morning melatonin concentration and oxidase activity of ceruloplasmin (Cp) in serum in 15 elderly NIDDM patients at baseline and after the 30 days of melatonin supplementation (5 mg daily) in comparison with levels in 15 healthy elderly volunteers were determined. A significant increase of MDA level and decrease of SOD‐1 activity and melatonin concentration were observed in NIDDM patients. Cp oxidase activity and nitrate/nitrite level were similar in both examined groups. Melatonin administration in NIDDM patients resulted in a significant increase in the morning melatonin concentration and SOD‐1 activity, and a reduction in the MDA level and Cp oxidase activity. Statistically significant alterations in nitrate/nitrite levels were not observed. These results indicate an improvement of antioxidative defense after melatonin supplementation in the NIDDM individuals and suggest melatonin supplementation as an additional treatment for the control of diabetic complications.

Functional assessment and health-related quality of life (HRQOL) of elderly patients on the basis of the functional assessment of chronic illness therapy (FACIT)-F questionnaire

Elderly patients represent a significant part of all the patients in various hospital wards. They also suffer from many diseases. Maintenance of their everyday independence, treatment, rehabilitation and improvement of their HRQOL is the main goal of geriatric care in the world, and also in Poland. Performing a comprehensive geriatric assessment for each elderly patient to identify their needs and problems is a standard procedure. The goal of this research was a functional assessment of the influence of social and clinical factors on HRQOL in elderly people. The aim of the study was to assess the influence of social and clinical factors on the functional state and HRQOL in elderly people. The study group was recruited among hospitalized patients in the Department and Clinic of Geriatrics, 64 women and 60 men, for a total of 124 people. The mean age of the study group was 72.1 years. The research was carried out using a diagnostic poll method with the application of FACIT-F questionnaire. The results of FACIT-F for the study group were running at an average level and were dependent on age, marital status, education level and duration of the illness. Correlations were found between the FACIT-F results and the following expectations of the patients: treatment, rehabilitation and information given about treatment, alleviating pain, referral to social care, organizing home care. Results of FACIT-F were dependent on activities of daily living (ADL) scores in the study group.

Evaluation of selected parameters of the antioxidative system in patients with type 2 diabetes in different periods of metabolic compensation

Introduction:The aim of the study was to evaluate some selected parameters of the antioxidative system in patients with type 2 diabetes.Materials and Methods:Eighty-one type 2 diabetes patients took part in the study (39 patients with metabolically balanced and 42 with metabolically unbalanced diabetes). The control group consisted of 30 healthy people. The total antioxidant capacity of plasma was measured fluorometrically using phycoerythrin. To calculate the low-molecular-weight antioxidant concentration in the plasma samples, the duration of Trolox activity as a function of its concentration in the sample was measured. The activity of antioxidative enzymes in red blood cells was determined using the Misra and Fridovich method and Beers and Sizer method.Results:The total plasma antioxidant capacity and the low-molecular-weight antioxidant concentration in the group of patients with metabolically compensated type 2 diabetes were statistically significantly higher than in the group of patients with metabolically uncontrolled diabetes. The activity of antioxidative enzymes was found to be higher in the group of type 2 diabetes patients at the stage of metabolic balance.Conclusions:The obtained results confirm the thesis of glucose toxicity and intensification of oxidative stress in patients with diabetes.

Independence of elderly patients with arterial hypertension in fulfilling their needs, in the aspect of functional assessment and quality of life (QoL)

Functional efficiency is the ability to be independent in fulfilling the basic needs of everyday life. Independence in meeting these needs is important to maintain a good quality of life (QoL). Chronic diseases affecting elderly people may, to some extent, limit fulfilling numerous needs, however, the acquired ability to live with a disease enables such patients to cope well with their needs. The aim of the study was to evaluate in the examined patients the independence in meeting their bio-psycho-social needs in relation to functional efficiency and QoL. The study group was recruited among hospitalized patients in the Department and Clinic of Geriatrics, 91 women and 59 men, for a total of 150 people. The mean age of the study group was 73.4 years. The research was carried out using a diagnostic poll method with the application of The Functional Assessment of Chronic Illness Therapy questionnaire (FACIT-F version 4); Activities of Daily Living questionnaire (ADL) of assessment of daily efficiency on the basis of the Katz Scale; Care Dependency Scale questionnaire (CDS) used to measure the level of the care dependency and human needs. The results of CDS for the study group were running at high level and were dependent on the marital status and age. No impact of gender, place of residence, education, material situation and disease duration was revealed. Similarly, FACIT-F scores were higher for married patients than for widowed ones, and they were age-dependent. Most of CDS scores were at a high level, which means that the investigated patients were, to a limited extent, care-dependent in meeting their needs. In the majority of subjects, the level of daily activities was high, which proves an independent functioning. Results of CDS were dependent on FACIT-F scores in the study group.

Effects of perindopril and hydrochlorothiazide on selected indices of oxidative stress in the blood of elderly patients with essential hypertension.

1 The aim of the present study was to determine the effect of hypotensive therapy with a diuretic (hydrochlorothiazide) and an angiotensin‐converting enzyme inhibitor (perindopril) on selected oxidative stress parameters in the blood of elderly patients with essential hypertension. 2 Studies were performed in 45 elderly patients with essential hypertension at baseline and after the 45th day of perindopril (n = 25) or hydrochlorothiazide (n = 20) therapy, as well as in 25 young and 25 elderly normotensive subjects. The following parameters were measured: systolic and diastolic blood pressure, nitric oxide (NO), carbonyl groups and malondialdehyde (MDA) concentrations, as well as the activity of ceruloplasmin (Cp) oxidase, Cu‐Zn superoxide dismutase (SOD‐1) and catalase (CAT). 3 The activity of SOD‐1 and NO levels were reduced with age. 4 Compared with elderly controls, hypertensive subjects showed increases in baseline MDA, carbonyl group concentrations and Cp oxidase activity and decreases in NO levels and SOD‐1 and CAT activities. 5 Treatment with perindopril, but not hydrochlorothiazide, resulted in significant increases in SOD‐1 and CAT activities and decreases in MDA concentration and Cp oxidase activity. Both therapies decreased the level of carbonyl groups and increased NO levels. 6 Angiotensin‐converting enzyme inhibitor therapy has significant anti‐oxidant effects that may be important in the treatment of elderly patients with essential hypertension.

Care Dependency Scale - psychometric testing of the Polish version

The importance of this study lies in the availability of psychometrically sound assessment instruments, which are of critical importance for the study of patients care dependency and the provision of care to these patients. The aim of this study was to identify the psychometric properties of the Care Dependency Scale (CDS) by analyzing data gathered in Poland. The Polish research instrument was a translation of the original Dutch CDS. Psychometric evaluations were carried out based on a convenience sample of 216 older patients. A high alpha coefficient of 0.98 was obtained. Subsequent inter-rater and test-retest reliability revealed Kappa values between 0.82-0.97 and 0.64-0.86, respectively. Factor analysis (principal component analysis) confirmed the one-factor model reported in earlier studies. The analysis of the scale showed that the instrument is promising to be used in elderly care in Poland. The Polish version of the CDS permits comparison with results from earlier studies using this instrument.

Production of nitric oxide, lipid peroxidation and oxidase activity of ceruloplasmin in blood of elderly patients with primary hypertension. Effects of perindopril treatment

Background and aims: One of the factors playing a role in both the aging process and the etiopathogenesis of primary hypertension is oxidative stress. The purpose of this work was to estimate the production of nitric oxide (NO), oxidase activity of ceruloplasmin (Cp) and level of malondialdehyde (MDA), the end-product of lipid peroxidation in the blood of elderly patients with primary hypertension. The influence of treatment with the angiotensin-con-verting enzyme inhibitor perindopril (P) on the above parameters was also ascertained. Methods: The study was carried out on 37 patients (69–91 yrs) with primary hypertension, treated with perindopril for 6 weeks, and normotensive subjects who constituted the two control groups: 25 (65–96 yrs — K1)and 23 (22–41 yrs — K2). Cp oxidase activity in serum, MDA level expressed as the concentration of substances reacting to thiobarbituric acid in red blood cells, and production of NO (concentration of nitrite/nitrate in plasma) by the Griess reaction were all determined. Results: In the group of patients with hypertension, Cp activity was significantly higher than that in the control groups (K1 and K2). MDA concentrations in the erythrocytes of patients with hypertension were significantly higher than in the control groups and hypertensive patients had a lower NO (nitrite/nitrate) levels in plasma when compared with controls. In patients with hypertension, after only 7 days of therapy a substantial decrease in Cp oxidative activity was found, although the lowest value was observed after 6 weeks of therapy. Nevertheless, significantly lower MDA was observed after 6 weeks of therapy, corresponding to the values obtained in controls (K1 and K2). After 6 weeks of perindopril therapy, NO (nitrite/nitrate) was statistically higher in comparison with the values obtained before therapy. Conclusions: Results confirm intensification of oxidative stress and disorders in the production of NO in elderly patients with primary hypertension, and indicate the beneficial antioxidant effect of P.

Functional assessment of geriatric patients in regard to health-related quality of life (HRQoL)

Purpose The main aim of our research was to evaluate general health, functioning, and performance parameters, as well as care problems of Geriatric Clinic inpatients in relation to deficits in fulfilling needs. The assessment of health-related quality of life was also performed. Patients and methods The research subjects were patients attending the Clinic of Geriatrics: 149 women and 78 men; 227 persons in total. The research was carried out using a diagnostic poll method, with the application of the Activities of Daily Living questionnaire of assessment of daily efficiency on the basis of the Katz index, the Instrumental Activities of Daily Living questionnaire, the Care Dependency Scale used to measure the level of care dependency and human needs, and the Nottingham Health Profile scale. Results The results showed that the majority of respondents achieved high and medium levels of functional capability. The main problems associated with the fulfillment of needs were difficulties with the adoption of appropriate body posture, movement restrictions, and problems related to participating in unassisted leisure activities outside the home. The general deficit in fulfilling the needs of the patients was low. The most significant problems were related to sleep disorders, restrictions in freedom of movement, loss of vital energy, and ailments resulting in the observable presence of pain. Conclusion Good daily functioning of elderly patients significantly depended on their intellectual and mental efficiency. Elderly patients require a comprehensive, holistic approach to a variety of problems that occur with aging.