Serum zinc concentrations in the maintenance hemodialysis patients

Zinc is necessary for growth and cells' division. Its deficiency may seriously affect antioxidant defense system and is usually related to renal failure, gastrointestinal diseases and alcoholism. It is very important to know zinc status in dialyzed patients and to prevent hypo- or hyperzincemia. Serum samples from 89 patients with chronic terminal renal failure on regular hemodialysis were withdrawn for the estimation of zinc concentrations immediately before and after dialysis. Serum zinc concentrations showed to be highly dependent on hemodialysis. In 57 (64%) patients, serum zinc concentrations decreased, sometimes from very high to normal values. In remaining 32 (36%) patients serum zinc concentrations tended to increase, but remained within normal range. Zinc supplementation may be recommended only in the patients with proven zinc deficiency, but for all chronic renal failure patients it is questionable.     

Serum copper and zinc concentrations are lower in Iranian patients with angiographically defined coronary artery disease than in subjects with a normal angiogram.

BACKGROUND: An imbalance between zinc and copper metabolism has been reported to predispose to coronary artery disease (CAD) in Western populations, but there are little data for other racial groups. We have therefore investigated the association between serum copper and zinc, and CAD in Iranian subjects undergoing coronary angiography. METHODS: Serum copper, zinc, fasting lipid profile, and blood glucose levels were measured in 114 patients (67 male and 47 female) undergoing routine coronary angiogram. Anthropometric features including blood pressure were determined using standard procedures. Demographic characteristics, including menopausal status and smoking habit, were assessed by questionnaire. RESULTS: Male patients had lower serum copper (p<0.05), lower serum zinc (p<0.05), and higher serum zinc/copper ratio (p<0.05) than females. Serum copper and zinc concentrations were significantly lower in the subjects with angiographically defined CAD than those patients with a normal angiogram, although the zinc/copper ratio was higher in these patients (p<0.001). Serum copper (r=-0.303, p<0.001) and zinc (r=-0.250, p<0.01) concentrations were both inversely related to age, and copper was positively associated with fasting serum triglycerides (r=0.188, p<0.05). CONCLUSION: Serum copper and zinc concentrations were significantly lower in Iranian patients with abnormal versus those with a normal angiogram. However, the zinc/copper ratio was higher in patients with CAD compared to subjects without CAD. Serum zinc and copper concentrations appear to be influenced by several physiological factors including age and gender.     

Endogenous zinc concentrations in cysteamine-induced duodenal ulcers in the rat

Exogenously administered zinc compounds have been shown to possess anti-ulcer activity against a wide variety of ulcerogenic agents, both in laboratory animal models and in human peptic ulcer disease. However, a strong possibility exists that endogenous zinc may also play an important role during noxious events by various mechanisms. Therefore, the aim of this study was to focus on the changes of endogenous zinc serum and tissue concentrations in cysteamine-induced duodenal lesions. We used atomic absorption spectropho-tometry to determine the tissue and serum concentrations of zinc in normal (control) rats and those with cysteamine-induced duodenal ulcers. The results obtained in this study indicated that the onset, development and spontaneous healing of ulcer lesions were associated with certain shifts in zinc serum and tissue concentrations. Prior to ulcer formation, a significant increase was noted in serum zinc values. With the onset of duodenal lesions, zinc serum concentrations significantly decreased, while there was a significant increase in duodenal tissue concentrations when compared to healthy control animals. Zinc tissue concentrations decreased and returned to starting values by the end of the first week of spontaneous healing. This decrease in zinc tissue concentration corresponded to the healing rate of the duodenal ulcers. Serum zinc concentrations also returned to starting values within the first week period. These observations indicate and confirm that zinc could play an important role in duodenal ulcer disease and represent a natural defense system in the body.     

Alterations of Serum Zinc, Copper, Manganese, Iron, Calcium, and Magnesium Concentrations and the Complexity of Interelement Relations in Patients with Obsessive–Compulsive Disorder

The purpose of the present study was to evaluate the status of serum trace elements: zinc, copper, manganese, iron, calcium, and magnesium concentrations in obsessive-compulsive disorder patients. Forty-eight obsessive-compulsive disorder patients and 48 healthy volunteers were included in this study. Patients were recruited from Bangabandhu Sheikh Mujib Medical University by random sampling. Serum trace element concentrations were determined using flame atomic absorption spectroscopy (for zinc, copper, iron, calcium, and magnesium) as well as graphite furnace atomic absorption spectroscopy (for manganese). Data were analyzed using independent t test, Pearson's correlation analysis, regression analysis, and ANOVA. Statistical analysis of these data showed a definite pattern of variation among certain elements in patients with obsessive-compulsive disorder compared to controls. In patients' serum, zinc, iron, and magnesium concentrations decreased significantly (p<0.05) compared to the controls. Serum manganese and calcium concentrations were significantly higher (p<0.05) in patients compared to the controls. These data showed a definite imbalance in the interelement relations in obsessive-compulsive disorder patients compared to controls and therefore suggest a disturbance in the element homeostasis.     

Effects of angiotensin-converting enzyme inhibitors (ACEi) on zinc metabolism in patients with heart failure

The aim of this study is to investigate the effects of angiotensin-converting enzyme (ACE) inhibitors and furosemide on zinc metabolism by assessing serum zinc and urine levels in hospitalized subjects. We recruited 11 patients with heart failure from the Internal Medicine Department; these patients had been hospitalized less than 72 h before. Heart failure was defined using clinical and radiological signs. Serum zinc concentrations were measured using an air/acetylene flame atomic absorption spectrophotometer. Urine zinc levels were analyzed by inductively coupled plasma mass spectrometry (ICP-MS).Data were obtained from the 11 patients and 24 healthy controls matched for age and sex. Results indicate higher urine zinc levels and lower concentrations of zinc in serum in heart failure patients vs matched controls (p<0.05).This study suggests that treating heart failure patients with ACE inhibitors may result in zinc deficiency.     

O-diphenoloxidase concentrations in leprosy.

O-diphenoloxidase activity was studied in 15 patients with lepromatous leprosy, 15 with tuberculois leprosy, and 15 controls. O-diphenoloxidase isolated from skin and serum samples of patients with lepromatous leprosy had the specificity of a bacterially derived enzyme and not that of a mammalian-derived enzyme. Only the patients who had lepromatous leprosy for over two years showed enzyme activity in serum, though all showed it in skin tissue. O-diphenoloxidase activity in serum may be a useful diagnostic marker of lepromatous leprosy.     

Relapses after multibacillary leprosy treatment

Leprosy relapses are mainly due to bacillary persistence and diamino-diphenyl-sulphone (DDS) monotherapy. Case histories were examined for 33 patients with lepromatous leprosy (LL), diagnosed 7-48 years before the relapse and treated only with DDS during 4 to 38 years. Twenty-eight patients received irregular non-supervised polychemotherapy (PCT) since 1983. Five patients received only DDS, and presented relapses 13-20 years after the treatment was stopped. Relapses were diagnosed by clinical methods, including the reappearance of lesions or presence of new anesthetic areas. All cases were confirmed by bacilloscopy, and a subset of 20 cases by skin biopsy. Four patients presented indeterminate leprosy (IL) and one patient borderline tuberculoid leprosy (BT) in the biopsy. The latter 5 demonstrated presence of intraneural bacilli; the remainder were LL. Two patients relapsed even with PCT treatment. The others were cured with supervised PCT. Predisposing factors for relapses were as follows: DDS monotherapy, irregular PCT with inadequate dosage, unsupervised treatment, treatment uncompliance, and inadequate relationship between the patient and the health staff. Inspections for relapse in leprosy is recommended for in all multibacillary patients that were treated with DDS. The clinical appearance of new lesions or new anesthetic zones, the bacilloscopy and skin biopsy, used together, are effective in establishing the presence of relapses.     

Copper and zinc metabolism with solid tumor growth

The variation in copper and zinc metabolism with tumor growth appears to relate directly to progression or regression of the disease. Historically, elevations in serum copper have been used as clinical indicators in hematological neoplasms since the early 1960s. More recently, we have monitored breast, colo-rectal, and lung cancer patients for a six-month period through courses of cytotoxic chemotherapy to determine copper and zinc changes with tumor growth. Groups were divided into responders and nonresponders blind to their serum copper and zinc levels. Trends in elevated serum copper with active disease have shown similar trends in decreasing values with effective therapy, but normalization was at a slower rate. Serum zinc levels in the same patients were markedly below normal and did not increase in the study period. The clinical significance or elevated serum copper and depressed serum zinc is discussed and the potential relationship between the two elements is explored. A solid tumor-bearing rat model, mammary adenocarcinoma R 3230 AC, has detailed more of the changes in copper and zinc metabolism with solid tumor growth. Serum copper and zinc varied with tumor mass, as in clinical studies. Liver values of the two essential metals did not change significantly, but liver-related copper-containing enzymes showed marked variations. Ceruloplasmin in serum increased with increasing tumor mass, as would be expected with the increased serum copper levels. Cytochrome c oxidase activity in liver homogenates from tumor-bearing animals was significantly depressed.     

The Challenge of Producing Skin Test Antigens with Minimal Resources Suitable for Human Application against a Neglected Tropical Disease; Leprosy

True incidence of leprosy and its impact on transmission will not be understood until a tool is available to measure pre-symptomatic infection. Diagnosis of leprosy disease is currently based on clinical symptoms, which on average take 3–10 years to manifest. The fact that incidence, as defined by new case detection, equates with prevalence, i.e., registered cases, suggests that the cycle of transmission has not been fully intercepted by implementation of multiple drug therapy. This is supported by a high incidence of childhood leprosy. Epidemiological screening for pre-symptomatic leprosy in large endemic populations is required to facilitate targeted chemoprophylactic interventions. Such a test must be sensitive, specific, simple to administer, cost-effective, and easy to interpret. The intradermal skin test method that measures cell-mediated immunity was explored as the best option. Prior knowledge on skin testing of healthy subjects and leprosy patients with whole or partially fractionated Mycobacterium leprae bacilli, such as Lepromin or the Rees'' or Convit'' antigens, has established an acceptable safety and potency profile of these antigens. These data, along with immunoreactivity data, laid the foundation for two new leprosy skin test antigens, MLSA-LAM (M. leprae soluble antigen devoid of mycobacterial lipoglycans, primarily lipoarabinomannan) and MLCwA (M. leprae cell wall antigens). In the absence of commercial interest, the challenge was to develop these antigens under current good manufacturing practices in an acceptable local pilot facility and submit an Investigational New Drug to the Food and Drug Administration to allow a first-in-human phase I clinical trial.     

Serum extracellular superoxide dismutase activity as an indicator of zinc status in humans

The present study focused on whether serum extracellular superoxide dimutase (EC-SOD) activity can be used as a functional indicator of marginal zinc deficiency in humans. Subjects in this study were 444 healthy adults over 30 yr of age living a normal rural life in Kyunggi province, Korea. The mean dietary zinc intake of subjects obtained from one 24-h recall was 6.41 ± 4.35 mg and the average serum zinc concentration of the subjects was 11.06 ± 2.44 (μmol/L. Subjects were divided into three groups by serum zinc concentrations: adequate (serum zinc >10.7 (μmol/L), low (serum zinc 9.0–10.7 μmol/L), and very low (serum zinc <9.0 μmol/L) groups. A total of 50 subjects were selected from the three groups for analysis of EC-SOD activities. The EC-SOD activity of subjects increased with increasing serum zinc concentrations, and the activities of the three groups were significantly different as indicated by the Kruskal-Wallis test (p = 0.0239). Also, serum EC-SOD activities were significantly correlated with serum zinc concentrations (r = 0.289,p = 0.04). Serum EC-SOD activities, however, were not significantly correlated to the dietary zinc intakes. In conclusion, these results show that EC-SOD activities are decreased in subjects with low serum zinc concentrations and suggest that EC-SOD activity may be a functional indicator of zinc nutritional status in humans.     

Liver in Leprosy: Histological and Biochemical Findings

The histological findings and their correlation with biochemical functions of the liver in 240 leprosy patients are presented. In 21% with tuberculoid leprosy and in 62% with lepromatous leprosy leprous granulomata were found in the liver. A significant prevalence of granulomatous lesions in the liver among patients with tuberculoid and borderline-tuberculoid leprosy of less than one year''s duration suggests that bacillaemia occurs early in all forms of leprosy.There was a direct correlation between bacterial index and the presence of acid-fast bacilli in the liver. Of 50 patients with negative skin smears seven had acid-fast bacilli at liver biopsy. From none of these liver homogenates were acid-fast bacilli grown on culture in Löwenstein-Jensen medium.The alterations in liver functions were more consistently seen when acid-fast bacilli were associated with the presence of leprous granulomatous lesions. The acid-fast bacilli were found to persist even after one to five years of specific antileprosy therapy and after the bacilli in the skin had cleared up. This may explain the relatively frequent recrudescence or relapse of the bacillated types of leprosy when specific antileprosy therapy is stopped soon after bacterial negativity is attained on skin smears.     

Effect of end-stage renal disease and diabetes on zinc and copper status

The aim of this study was to compare the nutritional status of zinc and copper in patients with and without diabetes submitted to chronic hemodialysis. Thirty-three patients with type 2 diabetes (DM group), 30 nondiabetic patients (NDM group), and 20 healthy individuals (control group) were studied. Plasma, erythrocyte, and urinary zinc and plasma copper were obtained from atomic absorption spectrophotometry and ceruloplasmin by immunonephelometry. The anthropometric parameters were similar among the groups. Plasma zinc was lower and erythrocyte zinc was higher in the DM and NDM groups in relation to the control group. No difference in urinary zinc was observed comparing the groups. Plasma copper was higher in the DM group when compared to the NDM and control groups. Ceruloplasmin was similar in the three groups. Serum urea was a positive independent determinant of plasma zinc concentrations. The determinants of erythrocyte zinc were MAMC midarm nuscle circumference and Kt/V dialysis adequacy. The determinants of plasma copper concentration were serum creatinine and serum glucose. The results of this study demonstrate an alteration in the distribution of zinc of patients with chronic kidney disease (CKD) independently of the presence of DM. Also, the status of copper seems not to be influenced by CKD, but only by the metabolic derangements associated with diabetes.     

Serum concentrations of sIL-2R, IL-6, TGF-beta1, neopterin, and zinc in chronic hepatitis C patients treated with interferon-alpha

T lymphocytes and immunoregulatory cytokines play an important role in the host response to hepatitis C virus (HCV) infection. Zinc is required for a wide spectrum of immune functions, including T-cell activity. To determine the clinical significance of the cytokines sIL-2R, IL-6, TGF-beta1, neopterin, and of zinc in chronic heptatitis C virus (HCV) infection, we investigated their concentrations in the serum of 16 patients with chronic HCV infection before, during and at the end of therapy with interferon (IFN) alpha (Roferon A), and after 6 months follow-up. Elevated concentrations of sIL-2R, IL-6, TGF-beta1, and neopterin were found in the serum of all patients prior to therapy, as compared to healthy controls. sIL-2R patterns differed in responders and non-responders. While the mean concentration of sIL-2R (335.75 pg/ml) before therapy was about 40% higher in complete responders (n=4) than in controls (272.20 pg/ml), the mean concentration in non-responders (n=6) was 4-fold higher than in controls (1153.33 pg/ml). During therapy, sIL-2R levels in responders decreased by about 40%. Mean IL-6 concentrations in both complete and partial responders (n=6) decreased continuously during treatment, while mean concentrations in non-responders decreased for only a short time, and increased again after cessation of therapy. Mean levels of TGF-beta1 behaved similarly to those of IL-6. Only negligible differences in mean neopterin levels were found between responders and non-responders over the entire observation time. The mean serum zinc concentrations slightly decreased in all 3 patient groups, the greatest reduction occurring in 3 of the 4 responders. The present findings underscore the importance of the immune system in the pathogenesis of chronic HCV infection. Serum sIL-2R levels may be used as a serological marker of outcome following IFN-alpha treatment.     

负压封闭引流技术在躯干部皮肤恶性肿瘤切除术中的应用

目的:探讨负压封闭引流技术应用于躯干部皮肤恶性肿瘤切除术的临床效果,并分析其临床应用价值。方法:回顾性分析2012年5月~2015年3月我院收治的11例躯干部皮肤恶性肿瘤患者的临床资料,均予行肿物切除术并同时行自体皮游离移植术,并外用持续负压封闭引流术于植皮术区。结果:所有患者均接受肿物切除+植皮+封闭负压引流技术治疗。9例患者于4~9天后拆除负压材料,皮片全部成活。1例患者治疗后24小时内吸引管堵塞,经术后于24小时内行管路冲洗疏通后再次行负压吸引,于术后5天首次拆除负压材料,见皮片部分成活,部分皮片仍有浮动,血运未明显建立,予以扩大皮片引流孔后再次行负压封闭引流术,术后9天再次拆除负压材料,见皮片成活较好。1例患者治疗4天后出现新鲜渗血经引流管引出,予拆除负压材料,所植皮片下有积血块,有新鲜渗血,予以清创后再次行负压封闭引流术,术后9天再次拆除负压材料,见皮片成活较好。随访半年到3年,所植皮片无破溃,肿瘤无复发。结论:躯干部皮肤恶性肿瘤切除术中,植皮联合封闭式负压引流技术可使所植皮片固定确实,充分引流渗液积血,利于皮片成活,对无法有效包扎固定肢体特殊部位(肩部、臀部、躯干部)等术区植皮提供了有效方法,具有一定的推广应用价值。     

Differences in zinc status between patients with osteoarthritis and osteoporosis

Zinc has been suggested to play an important role in the development of osteoporosis, whereas the influence of zinc on osteoarthritis has attracted much less attention. The aim of the study was to investigate and compare the zinc status and bone turnover, density, and biomechanical properties of osteoarthritic and osteoporotic patients. The study comprised 40 women who underwent hip replacement due to osteoarthritis or osteoporosis. Serum and urine zinc content, and bone resorption markers and serum bone formation markers were determined. The unaffected hip and the exarticulated affected femoral head underwent DEXA scanning. Bone biopsies were obtained from the femoral heads and the biomechanical properties were determined. The biopsies were ashed and the bone zinc content was ascertained. Osteoarthritic patients had significantly higher serum zinc concentrations and lower urine zinc concentrations than osteoporotic patients, whereas the bone zinc content did not differ. The zinc status was not found to be a predictor for the bone strength. In conclusion, the finding that the zinc status of osteoporotic patients is significantly different from that of osteoartritic patients is new and supports the view that osteoporosis and osteoarthritis rarely occur in the same individual.     

Serum zinc and angiotensin-converting enzyme levels in patients with lung cancer

Forty-two patients with lung cancer and 72 healthy subjects were studied in order to determine a possible relationship between serum zinc and angiotensin-converting enzyme (ACE), a peptidyl dipeptide hydrolase. Serum zinc levels were 105 +/- 21 micrograms/dl in control subjects and 50 +/- 19 micrograms/dl in patients, and angiotensin-converting enzyme activity was 296 +/- 28 U/l in the former and 240 +/- 55 U/l in the latter using hippurylglycylglycine as a substrate. The findings obtained show that the decreased levels of angiotensin-converting enzyme may be related to decreased serum zinc levels and that the primary defect may be the zinc deficiency in these patients.     

The possible role of zinc and metallothionein in the liver on the therapeutic effect of IFN-α to hepatitis C patients

We have studied zinc deficiency in hepatitis C patients (complete responder [C,R] 22, nonresponder [NR] 25) with relation to the therapeutic effect of interferon-α (IFN-α). Circadian variations in serum zinc levels were high in the morning (basal level) and then gradually decreased during the day in both chronic hepatitis C patients and healthy controls. Basal zinc levels in serum were significantly lower in chronic hepatitis C patients (73±3 μg/dL,n=12) than in controls (93±5 μg/dL). An injection of 10 MU of IFN-α to hepatitis C patients augmented the serum zinc reductions, up to 40% in 8 h. Serum cortisol levels were significantly elevated 8 h (25.6±2.3 μg/dL) after IFN-α dose. Forty-seven chronic hepatitis C patients were treated with IFN-α for 24 wk, and serum zinc and copper levels were determined 12 and 24 wk during and after the completion of IFN-α therapy. Serum zinc levels and zinc/copper ratio were higher in CRs than in NRs to IFN therapy at each time-point. Hepatic metallothionein staining became prominent after IFN therapy in most of CRs, whereas it diminished NRs. These data suggest that nutritional status of zinc influences the effect of IFN on hepatitis C patients.     

Effects of inflammation and antiinflammatory treatment on serum trace elements concentrations

We investigated the serum concentrations of zinc and copper during the inflammatory process together with the effect of treatment with a nonsteroid anti-inflammatory agent on these trace elements concentrations. In the present study, we used 92 guinea pigs, 12 of which constituted the control group; the remaining 80 were the experimental group. To start with, proquazone (as anti-inflammatory agent) was administered orally to 40 guinea pigs of the experimental group at 20-mg/kg doses 2 h before the surgery. Throughout the experimental period, the above dose was administered to the animals twice a day. We produced inflammation in all animals of the experimental group by using carrageenan (inflammatory agent) dropped into mandibular surgical defects. Serum concentrations of zinc and copper were determined by atomic absorption spectrophotometry in both groups at the 6th, 48th, 120th, 168th, and 240th h. The serum zinc concentrations of the carrageenan-administered group decreased significantly (p<0.01). When comparing the serum zinc concentrations of the carrageenan plus proquazone-administered group with those of control group, the decrease (p<0.05) at the 6th, 48th, and 120th h were statistically significant. When the copper serum concentrations of the carrageenan-administered group were compared with those of the control group, at the 48th, 120th, and 168th h, a statistically significant increase (p<0.01) was observed. However, there was no significant change in the carrageenan plus proquazone-administered group at the 168th and 240th h. As a result during the acute phase of inflammation, serum zinc concentrations decreased, whereas serum copper concentrations increased. The alterations in zinc concentrations were more rapid than those in copper concentrations, but the administration of proquazone slowed the rate of decrease in serum zinc concentrations. This work was presented at the Fourth International Congress of Pathophysiology, June 29–July 5, 2002, Budapest, Hungary.     

Survey to identify Mycobacterium leprae-infected household contacts of patients from prevalent regions of leprosy in Colombia

Leprosy in Colombia is in the post-elimination phase; nevertheless, there are regions of this country where the incidence is still around 3-4/100,000. Early detection of leprosy patients is a priority for achieving control and elimination of leprosy; however, the clinical exam is not very sensitive and thus, the majority of patients are diagnosed only when they demonstrate lesions, and damage to the nerves and skin has already occurred. The goal of the present study was to identify Mycobacterium leprae infection and immune responses in household contacts (HHC) of leprosy patients from three prevalent regions of Colombia. Clinical examination, the Mitsuda test, evaluation of IgM anti-PGL-I in the serum, the bacillar index (BI), and polymerase chain reaction (PCR) from nasal swabs (NS) were performed for 402 HHC of 104 leprosy patients during a cross-sectional survey. Positive titers for IgM anti-PGL1 were found for 54 HHC, and PCR-positive NS for 22. The Mitsuda reaction was negative for 38 HHC, although three were positive for IgM anti-PGL-1 titers. The data document that leprosy transmission among HHC is still occurring in a non-endemic country.