Defense Mechanisms In Patients Research Articles

Cu/Zn-superoxide dismutase, paraoxonase and arylesterase activities and malondialdehyde levels in patients with familial mediterranean fever

In this study, alterations in antioxidant enzyme activities and malondialdehyde (MDA) levels in the serum samples of patients with familial Mediterranean fever (FMF), an autosomal recessive disease characterized by recurrent episodes of peritonitis, pleuritis, arthritis and fever, were investigated and compared with those of age- and sex-matched healthy controls. Twenty-five patients with FMF undergoing colchicine therapy at doses of 1-1.5 mg and 25 age- and sex-matched healthy controls were included in the study. In the patients with FMF and control subjects, the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level were measured. Cu/Zn-superoxide dismutase (Cu/Zn-SOD), paraoxonase-1 (PON-1) and arylesterase (ARE) enzyme activities and MDA levels as a production of lipid peroxidation were evaluated using the appropriate methods. No statistically significant differences in the serum levels of ESR, CRP, Cu/Zn-SOD, MDA and PON-1 between the groups were observed (p>0.05). Serum ARE activity was significantly decreased in the patients with FMF compared with the control subjects (p<0.01). In conclusion, some abnormalities in the antioxidant defense system and lipid peroxidation may be observed in FMF patients during attack-free periods. However, further long-term studies on the subject are needed to explore altered lipid peroxidation and antioxidant defense mechanisms in patients with FMF (Tab. 1, Fig. 1, Ref. 35).

P03-319 - Dominant social frustrating factors and mechanisms of psychological adaptation among women with prolonged paranoid schizophrenia

Given the dominance now in medical science biopsychosocial paradigm of mental disorder becomes relevant to study the social and frustrating factors and psychological defense mechanisms in patients with schizophrenia, particularly in patients with a prolonged course of disease. To study this question have been examined 11 patients with paranoid schizophrenia, a female, being hospitalized, aged 33–59 years with disease duration more than 5 years. Used clinical-psychopathological method objectification of clinical self-report scale (SCL - 90 - R), experimental psychology (questionnaireindex of life style). According to the questionnaire SCL - 90 - R obtained rather higher values on the scales: somatization (2.16), obsessive-compulsive (3.70), interpersonal anxiety (2.41), phobias (4,0), psychotism (2.3), which indicates a bright psychopathology in the current status. In these patients revealed the following psychological defense mechanisms: regression, denial, repression, displacement, which largely prevented adequate social and occupational adaptation of patients. The obtained results reflect the syndromic profile of the examined patients, as well as leading mechanisms of their psychological adaptation, which subsequently will provide an opportunity to more adequately use the methods of pharmacotherapy and psihorehabilitation activities in both inpatient and outpatient in this group of patients.

Comparison of Irrational Beliefs and Defence Mechanisms in Patients with Obsessive Compulsive Disorder and Normal Individuals

This study aims at comparing beliefs and defense mechanism in patients with obsessive compulsive disorder and normal individuals. Sample consisted of 50 patients with obsessive compulsive disorder and 100 normal individuals. Defensive Styles Questionnaire DSQ-40, Whimsical-Yale-Brown Obsessive Compulsive Scale and Jones's Irrational Beliefs Test were used as the instruments of the study. To analyze the data descriptive statistics and independent t-tests were used. The results showed that there was a significant difference between two groups in their irrational beliefs and defense mechanisms. The findings of this study generally confirmed the findings of other studies. However, research in the field of defense mechanisms requires more attention.

Defense mechanisms in patients with fibromyalgia and major depressive disorder

Background and objectives: Fibromyalgia (FM) and depression has been suggested to share a common underlying etiology. Few studies have investigated the role of emotional regulation processes in FM compared to depressive disorders. The purpose of the current study was to explore the use of defense mechanisms in FM patients with and without comorbid lifetime depressive disorder (LDD), and to compare their use of defenses to healthy control subjects and patients with Major Depressive Disorder (MDD). Methods: A total of 91 participants were included (17 with FM and LDD, 25 with FM but not LDD, 24 with MDD, and 25 healthy controls). Depressive disorders were identified by using the Structured Clinical Interview for DSM Axis I disorders (SCID-I). All diagnosis of FM were confirmed to meet the American College of Rheumatology’s criteria for FM. The Life Style Index (LSI) was used to measure defense mechanisms. Results and Conclusions: Group comparisons indicated that MDD patients and FM patients with LDD made significantly more use of defenses than healthy controls, whereas FM patients without LDD made significantly less use of defenses than both MDD patients and FM patients with LDD, but did not differ from healthy controls. Follow up analyses indicated significant main effects for the defense mechanisms of regression, compensation and displacement. This study suggests that FM and depression do not share common risk factors in terms of restricted affects or avoidance of conflicted feelings. Received 1 October 2007 Revised 26 June 2008 Accepted 11 July 2008 186 TORMOD LANDMARK ET AL.

Carvedilol modifies antioxidant status of patients with stable angina

The aim of this study was to evaluate the effect of carvedilol on the enzymatic antioxidative defence and plasma antioxidative activity in patients with stable angina. The study comprised 30 patients, aged 37–49 years with stable angina. Patients received carvedilol in escalating doses of 12.5 mg/24 h, 25 mg/24 h, and 50 mg/24 h for 4 weeks each. The control group was matched for age and gender, and consisted of 12 healthy volunteers, aged 39-49 years. Blood samples were collected from the cubital vein before and 4, 8 and 12 weeks after the therapy from the patients and once from the control group. For all the subjects, the superoxide dismutase (SOD-1), glutathione peroxidase (GSH-Px), catalase (CAT) activities in the erythrocytes and the antioxidant activity of the blood plasma were determined. The enzymatic antioxidative defence was significantly decreased in patients with stable angina in comparison to the healthy subjects. During the carvedilol therapy, an increase in the SOD-1, GSH-Px and CAT activities was observed. Moreover, 8 and 12 weeks after carvedilol therapy, the GSH-Px activity did not differ significantly from that observed in the group of healthy subjects. Carvedilol also increased the plasma antioxidative activity in patients with stable angina, but its level remained significantly lower than in the control group. In conclusion, carvedilol enhances antioxidant defense mechanisms in patients with chronic stable angina pectoris.

ASSESSMENT OF LIFE QUALITY IN COMPLEX ESTIMATION CONDITION OF COMPENSATION IN TYPE 1 DIABETES

The attitude of patients with diabetes Type 1 to treatment which essentially affects clinical course, is formed as a result of influence of many psychological and social factors. Achievement and long maintenance of compensation at diabetes is impossible without active participation of the patient in medical process. Detection of psychological features in a complex with definition of metabolic infringements is directed on complete representation about adaptive opportunities and defense mechanisms of patients with the purpose of development more adequate psychosomatic approaches. Quality of life (QOL) - it is satisfaction degree of man with his physical, mental and social condition. QOL on influence of remedial measures and reflecting subjective judgment of condition as a result of treatment or influences of illness.

Defense mechanisms in hemodialysis-dependent patients

Defense mechanisms are automatic psychological processes that protect the individual against anxiety and from the awareness of internal or external dangers or stressors. The influence of defense mechanisms in patients on chronic hemodialysis treatment was studied. There were 53 uremic subjects (37 males and 16 females), aged between 22 and 88 years (mean age 60.11, SD 15.03), on chronic dialysis and 50 healthy subjects as controls have been enrolled in the study. According to the duration of dialysis, uremic patients were divided in two subgroups: 21 patients with less than 5 years and 19 patients with more than 10 years of dialytic treatment. Assessment was conducted using the Defense Mechanisms Inventory DMI. The inventory identifies five defensive styles: turning against the object (TAO), projection (PRO), principalization (PRN), turning against the self (TAS) and reversal (REV). Results showed DMI scores within the normal range both for uremics and controls with significant differences in TAO (t = -3.053, p = 0.003) and REV (t = 5.067, p < 0.0001) between groups. No significant differences in the use of defensive styles related to the duration of dialytic treatment were observed. Besides other psychological features, the assessment of defense mechanisms in patients with chronic and invalidating diseases may contribute to ameliorate the knowledge of the adjustment processes and of the psychological well-being of the patients.

Life events and defense mechanisms of patients with tension-type headache

目的 探讨紧张型头痛(Tension-Type Headache,TTH)住院患者的生活事件、防御方式及其相关关系.方法将35例诊断为TTH的住院军人作为患者组,以35名正常军人作为对照组,分别用生活事件量表及防御方式问卷(DSQ)对他们的生活事件及防御方式进行评定,并对二者进行相关分析.结果 TTH患者所经历的正性生活事件分值为5.73±7.16,对照组为14.66±9.98,二者差别有显著性(P 0.05).在防御方式上,TTH组的不成熟防御分值为4.73±0.86,对照组为3.67±0.88,前者高于后者(P <0.05);TTH组中间型防御分值为4.74±0.71,对照组为4.46±0.68,前者高于后者(P <0.01);TTH组成熟防御方式分值为4.66±0.89,低于对照组5.56±0.93(P <0.05);两组在掩饰维度上差异不显著.不成熟防御机制及中间型防御机制与负性生活事件之间呈正相关关系,不成熟防御机制与正性生活事件之间、成熟防御机制与负性生活事件之间呈负相关关系.结论 TTH住院军人所经历的不良生活事件及对这些生活事件所采取的不适当心理防御机制在TTH的发病过程中起着重要作用。

Positron Emission Tomography of the Human Brain in Relation to Psychological Defense Mechanisms in Patients with Multiple Sclerosis

Neurophysiological correlates of psychological defense mechanisms (PDMs) were studied in patients with multiple sclerosis. PDM scores (the Lifestyle Index test) were compared with the relative glucose metabolic rate (GMR) estimated by positron emission tomography. The results testified that the combined metabolic activity of the limbic system and the frontal and temporal brain areas of the right hemisphere plays a predominant role in the functioning of the PDM system. An increase or decrease in PDM activity was associated with changes in GMR in several brain structures of the parietal and frontal regions.

Differential effects of clindamycin on neutrophils of healthy donors and septic patients

Antibiotics are frequently administered to ICU patients in case of bacterial infections. Little is known, however, about the interference of antibiotics with neutrophil host defence mechanisms in patients with sepsis and multiple organ dysfunction syndrome (MODS). With our study, evidence for differential clindamycin effects on neutrophils in healthy donors and septic patients without or with MODS was sought. Functional parameters (oxidative response and phagocytosis) and fMLP receptor expression were analysed. The study was approved by the local ethical board. Venous blood was drawn from healthy donors and septic patients. Neutrophils in PBS were incubated with 0, 5, 25 or 125 μg/ml clindamycin and analysed flow cytometrically. Neutrophils of patients with sepsis and MODS showed a significantly higher basal activation compared to healthy donors. Clindamycin application led to a dose-dependent significant suppression of the fMLP-induced oxidative response in patients with sepsis and MODS, but not in healthy donors or septic patients in the absence of MODS. In patients with sepsis and MODS, phagocytosis of Escherichia coli and Staphylococcus aureus was significantly suppressed by clindamycin 125 μg/ml. In both other treatment groups, clindamycin did not affect phagocytosis. fMLP receptor expression was not altered by clindamycin. High-dose clindamycin selectively suppresses functional responses of neutrophils in septic patients with MODS. Simultaneously applied drugs, such as general anaesthetics, may potentiate this modulation of antibacterial defence and inflammation.

Free radical activity and antioxidant defense mechanisms in patients with hyperthyroidism due to Graves’ disease during therapy

Free radical-mediated oxidative stress has been implicated in the etiopathogenesis of several autoimmune disorders. We investigated the prooxidant–antioxidant status in order to evaluate the possible deleterious role of oxidative phenomena in patients with Graves’ disease. Thirty patients with hyperthyroidism due to Graves’ disease were investigated. Thirty age-matched healthy subjects were studied as a control group. Free radical activity indices, antioxidant defense systems, and thyroid and pituitary hormone levels were measured in fasting blood samples. Blood samples were taken before initiation of therapy and after attainment of euthyroid state. A significant increase in lipid peroxidation activity indices, i.e., conjugated dienes and thiobarbituric acid-reacting substances, was found in blood serum of the patients with untreated Graves’ disease. These changes were accompanied by a decrease in plasma thiol and erythrocyte lysate thiol groups concentrations. Hyperthyroidism resulted in a marked increase in intracellular antioxidant enzymes, i.e., superoxide dismutase, catalase and glutathione peroxidase activities as compared to the controls. Extracellular anti-free radical scavenging systems potential, measured by glutathione reductase activity and total antioxidant status level, was found to be significantly decreased in untreated Graves’ patients. Treatment with thiamazole resulted in normalization of the free radical and antioxidant activity indices. The obtained results indicate an enhanced generation of reactive oxygen species and impairment of cellular and extracellular antioxidant systems potential in patients with Graves’ disease. The attainment of euthyroid state led to an improvement in oxidative stress indices and antioxidant potential parameters.

URINARY IMMUNOGLOBULINS IN PATIENTS WITH CONTINENT URINARY RESERVOIRS AND ILEAL CONDUITS

Although bowel segments are commonly used for reconstructing the urinary tract, a high incidence of bacteriuria is observed in patients with urinary intestinal diversion. The normal gastrointestinal tract possesses a potent mucosal immune system characterized by secretory immunoglobulin A (sIgA) as the major humoral defense factor. However, the significance of urinary IgA secretion as the mucosal defense mechanism in patients with urinary intestinal diversion has remained obscure. In this study, urinary levels of sIgA as well as serum-type IgA were measured in patients with continent urinary reservoirs (Kock and Indiana pouches) and ileal conduits. Twenty-four-hour urine samples were collected in a total of 80 patients with urinary intestinal diversion (22 Kock pouch patients, 21 Indiana pouch patients and 37 ileal conduit patients). The amount of sIgA and serum-type IgA were measured by enzyme-linked immunosorbent assay (ELISA). Urinary IgA levels showed great inter- and intra patient variability in all three groups. Indiana reservoir urine contained significantly greater amounts of sIgA (mean 32.0 mg/24 hrs) than Kock reservoir urine (11.9 mg) and conduit urine (4.9 mg), whereas Kock reservoir urine contained significantly more sIgA than conduit urine. However, the corresponding difference was not observed in regard to serum-type IgA. In none of the three modes of urinary diversion did 24-hour sIgA excretion show any correlation with the length of time after surgery. Since the amounts of sIgA in these patients were much greater than reported in urinary tract infection as well as in normal subjects, the major portion of urinary sIgA seemed to be secreted by the intestinal segments. Long-term sIgA secretion in urinary intestinal diversion, especially continent urinary reservoirs, may be an important host defense system.

IMPAIRED MICROBICIDAL CAPACTIES OF MONOCYTES AND MACROPHAGES FROM PATIENTS WITH GAUCHER DISEASE (GD)

Because of the primary manifestations of GD are due to involvement of monocyte-derived cells, we studied functional activity of phagocytic cells from Gaucher patients GD type 1 was diagnosed in three patients (7 yr-old male/Pt.1/, 8 yr-old male/Pt.2/, 25 yr-old female /Pt.3/). Killing of S angeus by freshly isolated blood granulocytes (Gr) and monocytes (Mo), and monotyle-derived macrophages (MDM; obtained by culturing Mo for 5 d in Teflon beakeis in DMEM medium) was studied in suspensions of bacteria (5×104/ml) and phagocytic cells (5×104/ml) Incubations of phagncytie suspensions were performed in the presence of 10% human serum for 120 min, under slow rotation (4 rpm), bacterial killing was measured by colony counts after disrupting phagocytic cells in liquid nitrogen. The results shown below indicated a decreased capacity of Mo to kill S aureus, and the lack of any killing of bacteria by MDM, whereas killing of staphylococci by G1 were comparable to that of controls. These in vitro studies provide new data to the pathophysiology of Mo and inactophages whose β-D-glucosidase activity has been reduced. Our results further elucidate host defense mechanism in patients with GD and indicate a decreased resistance to bacterial pathogens in these patients.

Impairment of Specific Host Defense Mechanisms in Patients with Chronic Post-traumatic Osteomyelitis

We studied both in vivo and in vitro specific host defense mechanisms in patients suffering from chronic post-traumatic osteomyelitis (n = 26). The cell-mediated immunity in vivo was impaired as indicated by the reduced reactivity in the delayed type hypersensitivity skin test. The concanavalin A or phytohemagglutinin-induced T-cell proliferation in vitro was markedly decreased in comparison to healthy donors. In contrast, B-cell proliferation stimulated by Staphylococcus aureus Cowan I was not altered. While the absolute lymphocyte counts and the percentage of T, B, and O cells were within the normal range, nine out of the 26 patients showed a significantly diminished ratio of CD4+ and CD8+ T cells. Humoral immunity in the patients was less affected as assessed by the unchanged serum levels of immunoglobulins (Ig). However, the T-cell dependent polyclonal Ig synthesis after in vitro stimulation with pokeweed mitogen was suppressed. Our results provide evidence that cell-mediated immune functions are predominantly impaired in patients with post-traumatic osteomyelitis which may contribute to the persistence of the localized bone infection.

Psychological defence mechanisms in patients with pain

There is a long standing position that pain, and especially chronic pain, may arise from psychological mechanisms of defence. We have compared a group of chronic pain patients with a sample of psychiatric patients attending for reasons other than pain. The pain group had less evidence of poor care in childhood (measured by the Parental Bonding Instrument) and tended to use more mature psychological defence mechanisms (assessed with the Defense Mechanisms Inventory), compared with the other group. The pain group also had fewer current psychiatric diagnoses but more evidence of anxiety and depression on the Hospital Anxiety and Depression Scale. We conclude that in general the patients with chronic pain had more normal childhoods and more mature defences than the psychiatric control group. They showed an increase in the diagnosis of depression, attributable to reactive factors. In the sample of patients with pain the majority of the psychological change cannot be attributed to the operation of primitive psychological defences.

Illness bahaviour and defense mechanisms of patients with psychogenic pain: Rheumatoid arthritis and fibrositis syndrome

Illness bahaviour and defense mechanisms of patients with psychogenic pain: Rheumatoid arthritis and fibrositis syndrome

Overview of the problem of infections in the immunocompromised host

The term immunocompromised is imprecise and, in its broadest usage, could include, among others, the elderly, post-operative patients, and patients with diabetes or cancer. Even when used in a more restrictive manner, it is important to recognize that there are many components incorporated into the system of host defense mechanisms. Deficiencies in different components may make the host susceptible to quite different infectious complications. Table I lists diseases and therapeutic measures that are associated with alterations in host defense mechanisms. Each specific defect predisposes to specific predominant infectious complications. For example, patients who are unable to produce normal immunoglobulins are more susceptible to gram-positive coccal infections, whereas patients with impaired cellular immunity are more susceptible to intracellular pathogens. Therefore, it is important to identify the specific impairment in host defense mechanisms in order to recognize those organisms that are most likely to cause infection. Neutropenia probably is the most common and most important factor predisposing to infection. It is the major defect in host defense mechanisms in patients with acute leukemia and in patients during the early stages after bone marrow transplantation. Moreover, neutropenia is a frequent additional factor predisposing to infection in patients with other deficiencies in host defense mechanisms. For example, patients with chronic lymphocytic leukemia may have hypogammaglobulinemia as their only deficiency during the early stages of their disease, but neutropenia emerges as the predominant deficiency in the advanced stages of this disease. The major factor predisposing patients with acquired immunodeficiency syndrome to infection is impaired lymphocyte function, but

Factors affecting development of peritonitis in continuous ambulatory peritoneal dialysis.

A questionnaire based survey in patients receiving continuous ambulatory peritoneal dialysis showed that there was an increased incidence of upper respiratory tract symptoms (suggestive of viral illness) in the 14 days before the development of peritonitis. No other factors were identified that might distinguish patients who develop peritonitis. The possibility that viral infections predispose to peritonitis by altering host defence mechanisms in patients receiving this form of renal replacement therapy warrants further study.

Sepsis Following Burns, Trauma, and Intra-abdominal Infections

In the last ten years anaerobic organisms have emerged as the major infecting agent in surgical patients. While these groups of organisms including Bacteroides fragilis, clostridia, and anaerobic cocci persist, there has, in addition, developed in the last few years a virulent group of nosocomial infections, and modern management of sepsis is primarily directed at gram-negative and anaerobic infections, which include nosocomial infections, for example, those caused by the Serratia group. Much has been learned about control of infections from the patient who has sustained thermal injury. While topical water-soluble antibiotics have been a remarkable advance in the care of the burn patient, systemic and subeschar antibiotics have proved essential in the management of severe burn injury. There is increasing evidence that there is remarkable interference with host defense mechanisms in patients who have sustained burns or significant trauma or intraabdominal infection. The patient sustaining nonthermal traumatic injury also sustains reduction in host resistance. Because of this and the additional initial contamination, in the traumatized patient antibiotic therapy should be started early and as a therapeutic measure. Newer localization techniques, including sonography and computed axial tomography scanning, have helped localize abdominal infections early. Specific antimicrobial therapy may be begun as an adjunct to the surgical therapy of intra-abdominal infection.

Influence of chemotherapeutic agents on the antibacterial activity of normal and leukemic sera.

The influence of various chemotherapeutic agents on the antibacterial activity of normal and leukemic sera was tested by bacteriolytic and bactericidal assays with use of 2 rough strains of Escherichia coli, one sensitive to the antlbacterlal activity of human serum and another resistant to such action. With a “low” dose of drugs, daunorublcine, mechlorethamine, and methotrexate slightly inhibited early stages of bacteriolytic activity of normal human serum against E. coli Lilly. With a "high" dose of drugs, mechlorethamine, daunorubicine, and cytarabine definitely enhanced early stages of bacteriolytic activity. Enhancement of bactericidal activity of normal human serum against E. coli Lilly was achieved by admixture with 1,3-bis(2-chloroethyl)-l-nitrosourea (SCN.U, carmustine) fluorouracil, methotrexate, vincrisUne, cytarabine, and prednisone. There was no enhancement of antibacterial activity by any drug against E. coli resistant to the action of normal human serum. Preincubation of E. coli Lilly with various drugs indicated that their enhancing activity was not expressed when the bacterial envelope was intact. Sera of patients receiving cyclophosphamid e intravenously did not differ in antibacterial activity from the samples drawn before the injection. Apparently certain chemotherapeutic agents influence antibacterial activity of the serum in vitro against some microorganisms. This fact should be considered when defense mechanismsof patients with leukemia or cancer are investigated.