Ischemia-modified Albumin Levels Research Articles

Dynamic Thiol-Disulfide Homeostasis in Children with Newly Diagnosed Iron Deficiency Anemia

Objective: Iron is an element, which is found in the structure of antioxidant enzymes and has an important role in the inactivation of reactive oxygen species. Disruption of oxidant-antioxidant balance may be playing a role in the pathogenesis of iron deficiency anemia (IDA). Dynamic thiol-disulfide homeostasis (DTDH) and serum ischemia-modified albumin (IMA) levels are important indicators of pro-oxidant/antioxidant status. In this study, we aimed to evaluate DTDH parameters and serum IMA levels in children with newly diagnosed IDA, who did not receive iron therapy. Material and Methods: Fifty patients diagnosed with IDA and 33 healthy age- and sex-matched control patients were included in the study. DTDH parameters and IMA levels of the patients and control groups were measured. The same parameters were also compared in patients with Hb<7 g/dl (profound IDA) (n:14/50, 28%) and Hb≥7 g/dl (mild-moderate IDA) (n: 36/50, 72%) in the IDA group. The relationship between DTDH parameters in these groups were investigated. Results: Native thiol, total thiol, native thiol/total thiol levels, constituting antioxidant capacity indicators, were found to be significantly lower in IDA patients; while oxidant disulfide, disulfide/native thiol, disulfide/total thiol, and IMA levels were found to be statistically higher compared to those in the control group (p<0.050). When DTDH parameters and IMA levels were examined; there was a positive correlation between antioxidant parameters and a negative correlation between oxidative parameters with hemoglobin and ferritin levels (p<0.050). Also, oxidative parameters were found to be much higher in profound IDA group than in the group with Hb>7 g/dl (p<0.050). Conclusion: In this study, increase in serum disulfide and IMA levels with the decrease in serum native thiol and total thiol levels indicated oxidative stress in IDA patients before treatment, compared to the control group. Evaluation of these indicators in children is important in predicting the toxicity due to IDA.

Independent correlation between ischemia modified albumin and parathormone in hemodialysis patients

Introduction. Hemodialysis patients are the group which oxidative stress is found more exacerbated. Ischemia modified albumin (IMA) is a new and sensitive marker for ischemia and oxidative stress. At current study we evaluated relation between IMA and biochemical parameters in hemodialysis patients. Materials and Methods. Thirty-four patients on maintenance hemodialysis were included. Pre-hemodialysis and post-hemodialysis blood samples were taken. Serum IMA and biochemistry parameters were measured. Results. There was a positive correlation between alkaline phosphatase (ALP) and IMA (r=0,268, p<0,05), CRP and IMA (r=0,452, p=0,007), parathormone and IMA (r=0,436, p=0,010), There was a negative correlation between albumin and IMA (r=-0,338, p=0,05). Multiple regression analysis was run to predict IMA levels from parathormone, CRP and creatinine the model statistically significantly predicted relation p<0,05, R=0,506, out of four two variables added statistically significant to the prediction, PTH (p=0,006), CRP (p=0,029). In multiregression analysis, IMA was found to be associated with PTH and CRP independent of creatinine value. Conclusions. We showed for the first time that PTH is associated with IMA in hemodialysis patients, independent of the level of renal function.

Independent correlation between ischemia modified albumin and parathormone in hemodialysis patients

Introduction. Hemodialysis patients are the group which oxidative stress is found more exacerbated. Ischemia modified albumin (IMA) is a new and sensitive marker for ischemia and oxidative stress. At current study we evaluated relation between IMA and biochemical parameters in hemodialysis patients. Materials and Methods. Thirty-four patients on maintenance hemodialysis were included. Pre-hemodialysis and post-hemodialysis blood samples were taken. Serum IMA and biochemistry parameters were measured. Results. There was a positive correlation between alkaline phosphatase (ALP) and IMA (r=0,268, p<0,05), CRP and IMA (r=0,452, p=0,007), parathormone and IMA (r=0,436, p=0,010), There was a negative correlation between albumin and IMA (r=-0,338, p=0,05). Multiple regression analysis was run to predict IMA levels from parathormone, CRP and creatinine the model statistically significantly predicted relation p<0,05, R=0,506, out of four two variables added statistically significant to the prediction, PTH (p=0,006), CRP (p=0,029). In multiregression analysis, IMA was found to be associated with PTH and CRP independent of creatinine value. Conclusions. We showed for the first time that PTH is associated with IMA in hemodialysis patients, independent of the level of renal function.

Ischemia modified albumin can act as an independent predictor of inhospital mortality in patients with acute aortic dissection

Acute aortic dissection (AAD) is a serious disease characterized by high mortality. However, there are no accurate indicators to predict in-hospital mortality. The objective of this study was to identify the potential value of ischemia modified albumin (IMA) in prediction of in-hospital mortality of AAD patients. This was a single-center, prospective study involved 314 patients undergoing AAD, including 197 males and 117 females, aged 26–87 (57.14 ± 21.71) years old, 116 cases of TAAD and 198 cases of TBAD (37 cases of complicated, 114 cases of high risk, and 47 cases of uncomplicated), 228 cases were underwent surgery/intervention treatment (77 cases of TAAD,151 cases of TBAD) and 86 cases were underwent conservative therapy (39 cases of TAAD, 47 cases of TBAD). The basic data, on-admission IMA level, and the all-cause in-hospital mortality was recorded. IMA in the non-survivor group and TAAD group was found to be significantly higher than that in the survivor group and TBAD group (P < 0.001). Multivariate logistic regression analysis results revealed that age (OR = 1.923, 95%CI: 1.102–4.481, P = 0.020), conservative therapy (OR = 17.892, 95%CI: 7.641–24.748, P < 0.001), D-dimer level (OR = 3.517, 95%CI: 1.874–7.667, P = 0.011) and IMA level (OR = 5.406, 95%CI: 2.951–10.395, P = 0.004) served as independent risk factors for in-hospital mortality of TAAD patients. And D-dimer level (OR = 2.241, 95%CI: 1.475–5.663, P = 0.018), IMA level (OR = 3.115, 95%CI: 1.792–6.925, P = 0.009) also served as independent risk factors for in-hospital mortality of TBAD patients, whereas surgery (OR = 0.110, 95%CI: 0.075–0.269, P < 0.001) was the protective factor of in-hospital mortality of TAAD patients. After IMA prediction, the AUC, optimal cut-off value, sensitivity, and the specificity of in-hospital mortality of AAD patients were observed to be 0.801 (95%CI: 0.744–0.858), 86.55 U/mL, 79.1%, and 73.2%, respectively. In addition, it was found that AUC was 0.799 (95%CI: 0.719–0.880) in TAAD and 0.753 (95% CI: 0.641–0.866) in TBAD. Overall, it was concluded that on-admission IMA level acted as an independent prediction index for in-hospital mortality of AAD patients.

Neurocognitive impairment in multiple sclerosis and its association with thiol-disulfide homeostasis and ischemia-modified albumin.

This study aimed to assess the possible association between cognitive impairment and two important biochemical biomarkers of oxidative stress, thiol-disulfide homeostasis (TDH), and ischemia-modified albumin (IMA) in patients with multiple sclerosis (MS). This study included 85 patients with MS (38 treatment-naïve relapsing-remitting MS (RRMS), 31 RRMS on fingolimod therapy, and 16 secondary progressive MS (SPMS)) and 33 healthy controls. Cognitive evaluation was carried out by applying the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) test battery and the scores were adjusted for age and years of education. Plasma TDH was assessed using an automated method and plasma IMA levels were determined using the cobalt-albumin binding assay. Plasma native thiol and total thiol levels were significantly decreased in patients with SPMS when compared with the naïve patients and healthy controls. Cognitive impairment was detected in 47.4% of naïve patients, 64.5% of patients on fingolimod therapy, and 80% of patients with SPMS. Naïve patients or patients on fingolimod therapy who were cognitively impaired had significantly decreased levels of native thiol and total thiol compared to the cognitively normal patients. Logistic regression analysis revealed total thiol and native thiol to be significantly associated with cognitive impairment in naïve patients and patients on fingolimod therapy. Significant correlations were determined between BICAMS scores, TDH, IMA, clinical indices of disease severity (EDSS and MSSS), and magnetic resonance imaging parameters. This study has shown for the first time that plasma TDH parameters are associated with cognitive impairment in MS.

The Relationship with Disease Severity of Ischemia-Modified Albumin Levels in Diabetic Nephropathy

Background: While type 2 diabetes (T2DM) is increasing rapidly, developing diabetic complications are the leading cause of morbidity and mortality. Biochemical markers are important for early diagnosis and treatment of nephropathy, which is a common complication. The aim of this study is to evaluate serum ischemia-modified albumin (IMA) levels in the development of diabetic nephropathy in T2DM patients and to determine the effectiveness of this parameter in predicting the presence and severity of nephropathy. Materials and Methods: 68 adult patients diagnosed with T2DM and 30 healthy controls were included in this study. The T2DM group consisted of 34 patients without microalbuminuria (&lt;30 mg/g) and 34 patients with microalbuminuria (30–300 mg/g) according to albumin/creatinine ratio (UACR). Biochemical data and serum IMA levels of the patient and control groups were measured and compared. Results: In terms of IMA levels, the difference between T2DM patients with microalbuminuria (0.55 ± 0.08 ABSU) and without microalbuminuria (0.42 ± 0.05 ABSU) and control (0.37 ± 0.08 ABSU) groups was significant (p&lt;0.0001). The T2DM group with microalbuminuria had the highest glucose, HbA1c, UACR, and IMA levels. There was a positive correlation between IMA levels and UACR (r = 0.541, p &lt; 0.001). IMA had a weak correlation with HbA1c (r = 0.345, p = 0.002). ROC analysis was performed and the IMA test had a high diagnostic value in the diagnostic differentiation of T2DM patients with microalbuminuria. According to multiple logistic regression analysis, IMA levels were an independent risk factor for DN (p = 0.003). Conclusions: Our data showed that IMA values increased significantly in diabetic patients, especially in those with microalbuminuria, and this increase was correlated with UACR levels. This study has shown that increased IMA levels are an important marker for the presence and severity of microalbuminuria in diabetic patients and therefore may be important in the early detection of renal dysfunction in T2DM. We even think that it can be used as an important marker in the follow-up of diabetic patients, even before the development of microalbuminuria.

Evaluation of ischemia-modified albumin in the diagnosis and the clinical severity of COVID-19 in children

Background. There is no specific biomarker used in the diagnosis of COVID-19 and predicting its clinical severity. This study aimed to investigate the utility of ischemia-modified albumin (IMA) in diagnosing and predicting clinical severity in children with COVID-19. Methods. Between October 2020 and March 2021, 41 cases constituted the COVID-19 group and 41 cases constituted the healthy control group. IMA levels were measured at admission (IMA-1) and 48-72 hours (IMA- 2) in the COVID-19 group. In the control group, it was measured at admission. COVID-19 clinical severity was classified as asymptomatic infection, mild, moderate, severe, or critical disease. Patients were divided into two groups (asymptomatic/mild and moderate/severe) to evaluate IMA levels in terms of clinical severity. Results. In the COVID-19 group, the mean IMA-1 level was 0.901&amp;#xb1;0.099, and the mean IMA-2 level was 0.866&amp;#xb1;0.090. The mean level of IMA-1 in the control group was 0.787&amp;#xb1;0.051. When IMA-1 levels of COVID-19 and control cases were compared, the difference was statistically significant (p &amp;lt; 0.001). When clinical severity and laboratory data are compared, C-reactive protein, ferritin and ischemia-modified albumin ratio (IMAR) were statistically significantly higher in moderate-severe clinical cases (p=0.034, p=0.034, p=0.037 respectively). However, IMA-1 and IMA-2 levels were similar between the groups (p=0.134, p=0.922, respectively). Conclusions. To date, no study has been conducted on IMA levels in children with COVID-19. The IMA level may be a new marker for the diagnosis of COVID-19 in children. Studies with a larger number of cases are needed to predict clinical severity.

Ischaemia-modified Albumin Estimation and Usefulness of Different Albumin Adjustment as a Marker to Predict Kidney Damage in Diabetes Mellitus

Introduction: Urine Albumin Creatinine Ratio (UACR) has been the standard for detecting albuminuria in diabetes mellitus, but the presence of “non albuminuric renal impairment” has encouraged the search for novel markers. Recently, increased serum Ischaemia Modified Albumin (IMA) levels have been implicated in cases of Diabetic Nephropathy (DN). However, its estimation by conventional albumin cobalt assay is confounded by serum albumin levels. Aim: To estimate IMA and albumin-adjusted IMA levels to assess their utility in diagnosing early renal damage in diabetes mellitus. Materials and Methods: This hospital-based cross-sectional study was conducted from March 2014 to January 2015 at Kasturba Medical College, Mangaluru, Karnataka, India. The study included 30 healthy individuals and 60 patients with diabetes mellitus, which were further divided equally into three groups based on UACR. The groups were as follows: normoalbuminuria group (UACR &lt;30 mg/g of creatinine), microalbuminuria group, and macroalbuminuria group (UACR 30-300 and &gt;300 mg/g of creatinine, respectively). Serum IMA levels were estimated using Enzyme-linked Immunosorbent Assay (ELISA), while Glycated Haemoglobin (HbA1c), serum creatinine, urine albumin, and urine creatinine were measured using auto-analysers. Albumin-adjusted IMA values were measured, and correlation assays between IMA and serum albumin concentration were analysed in each group using oneway Analysis of Variance (ANOVA) and Pearson’s correlation. Results: In the present study, out of the 60 diabetes mellitus patients, 27 were females and 33 were males, with a mean age of 53±17 years. Among the 30 controls, 14 were females and 16 were males, with a mean age of 51±17.5 years. Serum albumin had a significant negative correlation with IMA in the microalbuminuria (r=-0.4, p&lt;0.01) and macroalbuminuria (r=- 0.58, p&lt;0.001) groups. A significant mean difference was found in serum IMA, albumin-adjusted IMA, IMA index, and IMA ratio between the normoalbuminuria group and the other groups. Receiver operating characteristic analysis was used to predict the early stage of nephropathy (albuminuria). High sensitivity and specificity were measured for IMA (97.5% and 78%, respectively) and IMA ratio (97.5% and 76%, respectively) at cut-off percentages of 99 and 24.5, respectively. Conclusion: The IMA ratio has greater diagnostic importance compared to other adjusted IMA values in discriminating diabetic patients with micro- and normoalbuminuria.

Serum oxidative stress factors predict myocardial ischemia reperfusion injury after percutaneous coronary intervention in patients with acute myocardial infarction and type 2 diabetes mellitus.

Serum oxidative stress factors may be considered to be essential parameters for indicating cell oxidative damage. We designed this study to investigate the clinical diagnostic value of serum oxidative stress factors (superoxide dismutase (SOD), malondialdehyde (MDA), and myeloperoxidase (MPO)) combined with ischemia-modified albumin (IMA) and heat shock protein 70 (HSP70) for myocardial ischemia-reperfusion injury (MIRI) after percutaneous coronary intervention (PCI) in elderly patients with acute myocardial infarction (AMI) and type 2 diabetes mellitus (T2DM). From November 2020 to August 2021, 94 patients with AMI + T2DM and 86 patients with AMI were enrolled in the study; they were sub-grouped into the MIRI and non-MIRI groups following the occurrence of MIRI within 48 h after PCI. SOD, MDA, MPO, IMA, and HSP70 levels were determined. The clinical values of the combined serum oxidative stress factors, IMA, and HSP70 levels to predict MIRI events were analyzed. There was a higher probability of MIRI events in the AMI + T2DM group than the AMI group (p < 0.05). The ROC curve for the combined prediction of SOD, MDA, MPO, IMA, and HSP70 for the occurrence of MIRI events was higher in both the AMI and the AMI + T2DM groups than for predictive factors alone (all p < 0.05). Combined prediction of SOD, MDA, MPO, IMA, and HSP70 has the highest diagnostic value for predicting MIRI events after PCI in AMI patients, especially in patients with AMI combined with T2DM.

Investigation of Thiol-Disulphide Homeostasis, Total Oxidant-Antioxidant and Ischaemia-Modified Albumin Levels in Dogs with Babesiosis

This study was designed to reveal the diagnostic efficiency of total antioxidant capacity (TAC), total oxidant capacity (TOC), oxidative stress index (OSI), thiol/disulphide homeostasis (TDH), albumin (ALB) and ischaemia-modified albumin (IMA) parameters in the assessment of oxidative stress in dogs with babesiosis. While the babesiosis group consisted of a total of 7 dogs with clinical and parasitological (ELISA) diagnoses of babesiosis, the control group consisted of 7 healthy dogs. Blood samples were taken from both groups. While the levels of TAC, TOC and ALB in the blood serums of the groups were measured using a commercial kit, the levels of total thiol (TT), native thiol (NT) and IMA were measured using the method. The OSI and disulphide (Ds) levels were calculated using the formula. When compared with the control group, TAC and ALB levels significantly decreased, whereas the levels of TOC and OSI elevated in the babesiosis group (p&lt;0.05). No difference was found between the groups in terms of NT, TT, Ds, and IMA levels and the ratios of NT/TT, Ds/TT, and Ds/NT (p˃0.05). A negative significant correlation was found between TAC and OSI and between Ds/NT and NT, TT and NT/TT (p&lt;0.05; p&lt;0.001, respectively). A significant positive correlation was found between NT and TT and NT/TT and between TT and NT/TT (p&lt;0.001). The areas under the ROC curve of the variables TAC, TOC, OSI and ALB were found to be 0.918, 0.796, 0.980 and 1, respectively. The results showed that TAC, TOC, OSI and ALB performed diagnostically in the assessment of elevated oxidative stress in dogs with babesiosis.

Evaluation of Thiol-Disulfide Homeostasis with Electrical Status Epilepticus in Slow Sleep (ESES).

Electrical status epilepticus in sleep (ESES) is an epileptic syndrome specific to childhood and has a broad clinical spectrum that included seizures, behavioral/cognitive impairments, and motor neurological symptoms. Antioxidants are seen as promising neuroprotective strategies for the epileptic state by combating the harmful effects of excessive oxidant formation in mitochondria. This study aims to evaluate the thiol-disulfide balance and to determine whether it can be used in the clinical and electrophysiological follow-up of patients with ESES, especially in addition to the electroencephalography (EEG) examination. The study included 30 patients, aged 2-18 years and diagnosed with ESES in the Pediatric Neurology Clinic of the Training and Research Hospital and a control group of 30 healthy children. Total thiol, native thiol, disulfide, and ischemia-modified albumin (IMA) levels were measured, and disulfide-thiol ratios were calculated for both groups. Native thiol and total thiol levels were significantly lower and IMA level and disulfide-native thiol percentage ratio were significantly higher in the ESES patient group than in the control group. Serum thiol-disulfide homeostasis is an accurate marker of oxidative stress in ESES, and standard and automated measures of thiol-disulfide balance as an indicator of oxidative stress showed a shift toward oxidation in ESES patients in this study. The negative correlation between spike-wave index (SWI) and thiol levels, and serum thiol-disulfide levels suggest that they can be used as biomarkers for follow-up of patients with ESES in addition to EEG. IMA can also be used for long-term response to monitoring purposes at ESES.

Evaluation of adult immunoglobulin A vasculitis with oxidative stress and inflammation biomarkers

IgA vasculitis (IgAV) is a leukocytoclastic vasculitis affecting small vessels and is more common in children than in adults. In this study, we aimed to investigate the effects of oxidative stress in adult IgAV patients by Dynamic Thiol Disulfide Homeostasis (DTDH) and Ischemia Modified Albumin (IMA) levels. We also aimed to correlate the presence of inflammation detected by C-Reactive Protein (CRP) and Highly Sensitive C-Reactive Protein (hsCRP) with these oxidative stress parameters. Forty-one IgAV patients and forty-five controls were included in the study. Patients were classified as "active" or "in remission" according to the British Vasculitis Activity Score (BVAS). Measured parameters were compared between the groups. DTDH, IMA, CRP and hsCRP parameters were analyzed in both patient and control groups. According to our results, disulfide (p=0.047), index 1 (p&lt;0.001), index 2 (p&lt;0.001), IMA (p&lt;0.001), CRP (p=0.005) and hsCRP (p=0.004) levels were significantly increased while native thiol (p&lt;0.001), total thiol (p&lt;0.001) and index 3 (p&lt;0.001) levels were significantly decreased in IgAV patients. The results of this study show that oxidative stress is associated with IgAV disease and also with disease severity. The oxidative stress parameters evaluated were also correlated with markers of inflammation.

Maternal serum ischemia-modified albumin (IMA), total-sulphydryl concentrations, and some subclinic inflammatory markers in hyperemesis gravidarum (HG)

ObjectiveThis study investigates the relationship between Ischemia Modified Albumin and Total-Sulphydryl levels with some subclinical inflammatory markers in patients with hyperemesis gravidarum. Materials and methodsA total of 258 pregnant women, 137 with hyperemesis gravidarum and 121 low-risk pregnancies, were included in this case–control study. The patients were divided into three groups according to the severity of hyperemesis gravidarum as mild (n = 53), moderate (n = 41) and severe (n = 43). ResultsSerum Ischemia Modified Albumin levels were statistically different from the control group (P < 0.001). Among the subgroups, the highest Ischemia Modified Albumin value was observed in the severe hyperemesis gravidarum group, and the highest Total-Sulphydryl level was observed in the mild hyperemesis gravidarum group (P < 0.001). Serum potassium levels were higher in the control group (P < 0.001). While a negative correlation was observed between Ischemia Modified Albumin and Total-Sulphydryl, a positive correlation was observed in Platelet crit, C-reactive protein, and ketonuria. As the severity of the disease increases, Ischemia Modified Albumin, which is an oxidative stress factor, increases, and Total-Sulphydryl levels decrease (p < 0.001). Logistic regression analysis revealed that a one-unit increase in Ischemia Modified Albumin resulted in a statistically significant 1.9-fold increase in the risk of Severe hyperemesis gravidarum (OR 1.92, 95% CI 1.008–1.956; P = 0.01) ConclusionThis study shows that there is a condition in the pathophysiology of hyperemesis gravidarum, with an increase in Ischemia Modified Albumin and a decrease in Total-Sulphydryl levels, and oxidative stress occurs. It was important to detect increased Ischemia Modified Albumin and decreased antioxidant values in relation to the inflammatory factors that were effective in the severe hyperemesis gravidarum group.

Dynamic thiol-disulphide homeostasis and ischemia modified albumin levels in neonatal calf diarrhea

The aim of this study was to determine dynamic thiol-disulphide homeostasis (TDH) parameters and ischemia modified albumin (IMA) levels in calves with neonatal diarrhea and compare with healthy controls. A total of 50 calves were included in the study. There were 25 calves in both diarrhea and healthy groups. Serum native thiol, total thiol, disulfide and IMA levels were measured using new methods. Native thiol (P=0.025) and total thiol (P=0.041) values decreased significantly in calves with neonatal diarrhea compared to the healthy control group. Disulphide (P= 0.133), disulphide/native thiol ratio (P=0.001) and IMA (P=0.0018) parameters were lower in healthy group, and the difference between the two groups was significant for the parameters other than disulphide. This study shows that TDH is impaired in neonatal calf diarrhea and IMA levels are increased due to oxidative stress.

Ischemic-Modified Albumin in Neonates with Congenital Heart Defects.

Ischemia-modified albumin (IMA) is a new biochemical marker of ischemia. We aimed to search blood IMA levels in neonates with congenital heart defects. During the study period, patients diagnosed with congenital heart disease and newborns with a diagnosis of hyperbilirubinemia as a control group were included in the study. IMA level was analyzed using the IMA absorbance unit (ABSU) method. In total, 57 newborns with congenital heart disease requiring cardiac operation for the study group and 38 newborns for the control group were included. There was no difference between the two groups in terms of gender, mode of delivery, and weeks of gestation. The average IMA values in the control group were 0.19 ± 0.09 ABSU. The prepostoperative mean IMA values of the patient group were 0.22 ± 0.07 and 0.23 ± 0.07 ABSU, respectively. Comparison of the postoperative IMA with the mean of the control group was statistically significant. Preoperative and postoperative IMA values of patients who have died due to primary heart disease and surgical complications were 0.21 ± 0.07 (0.08-0.32) ABSU and 0.25 ± 0.06 (0.12-0.36) ABSU, respectively. IMA levels were not statistically different between the two groups. Hypoxia and ischemia in congenital heart disease in the newborn period both preoperatively and postoperatively were important in prognosis. IMA was higher in the postoperative group. Many comprehensive studies are important in terms of preventing complications and decreasing mortality and morbidity by commenting on prognosis. · IMA is a new biochemical marker of ischemia.. · In the literature, there are no reports about the relation between congenital heart defects and IM.. · The exposure of CHD patients to hypoxia/asphyxia in the preintra and postoperative periods cause neurologic deficits.

Impact of mode of anesthesia on ischemia modified albumin, operative conditions, and outcome in emergency craniotomies

ABSTRACT Background In neurosurgical procedures, selection of anesthetic techniques can have a substantial role in neurological outcome. Ischemia modified albumin (IMA) is a promising biomarker in strokes either hemorrhagic or ischemic. This work tried to explore the impact of type of the used anesthetics on operative condition, outcome, and if it can affect the level of IMA after emergency craniotomies. Methodology Fifty-four patients, 18–69 years of either sex, GCS>8, who underwent emergency craniotomies were enrolled into two groups where anesthesia was maintained by either: isoflurane ≤ 1Mac + fentanyl 1 mcg/kg/h. (Group I (inhalational)) or propofol infusion (100–150 mcg/kg/min) + dexmedetomedine 0.3mcg/kg/h. (Group P (TIVA)). Intraoperative hemodynamics, ICP, brain relaxation score, blood loose, and surgeon satisfaction were assessed. Also, recovery conditions, ICU stay, any complication and mortality, pre- and postoperative IMA and GCS were followed and analyzed. Results Group (P) revealed lower but steadier hemodynamics, significantly better brain relaxation score, lower ICP, adequate CPP, fewer patients needed blood transfusion, better surgeon satisfaction, and significantly shorter extubation time with higher sedation. Elevation in postoperative IMA was reported in both groups but the times of increase were significantly lower in group (P) with significant correlation between IMA level and GCS at all times that were detected in both groups. The two groups were comparable regarding postoperative complications, GCS, mortality, and ICU stay. Conclusion In emergency craniotomies, the use of TIVA (propofol + dexometomidine) produced lower ICP, better brain relaxation, and shorter extubation time with lower postoperative IMA level than inhalational anesthetics, which correlate well with GCS.

Kronik Böbrek Hastalığı Olan Hastalarda Dinamik Tiyol-Disülfid Dengesi ve İskemi Modifiye Albümin Düzeylerinin Değerlendirilmes

Objective: In this study, it was aimed to determine the dynamic thiol-disulfide balance and ischemia modified albumin (IMA) levels in patients with chronic kidney disease (CKD). &#x0D; &#x0D; Method: Thirty hemodialysis (HD), 30 CKD patients (stage 3-5) and 30 controls were included in the study. The dynamic thiol-disulfide balance was determined by the colorimetric method developed by Erel et al. IMA levels were determined by using cobalt binding test developed by Bar- Or et al. &#x0D; &#x0D; Results: Native and total thiol levels of CKD and HD patients were significantly lower than that of the control group (p=0.001 for both). However, disulfide levels were significantly higher in the HD group (p=0.001), but there was no significant difference between control and CKD groups(p=0.547). A statistically significant negative correlation was found between the native and total thiol levels and IMA (r=-0.628; -0.631), BUN (r=-0.747; -0.747), and creatinine (r=-0.732; -0.721). There was a significant positive correlation between GFR and the thiol levels (r=0.835;0.824). TrxR levels were significantly higher in the patient groups compared to the controls (p=0.001). CRP levels of the patient groups were significantly higher compared to the controls (p=0.001).&#x0D; &#x0D; Conclusion: We have demonstrated that measurement of dynamic thiol-disulfide levels by using colorimetric method can contribute to the diagnosis and follow-up of the disease as a marker, because it is easily applicable in routine clinical biochemistry laboratories and related with disease severity in CKD patients. Also, we showed that albumin correction due to dialysis process should be consider in studies dealing with plasma thiol values and the final results should be given after the correction process.

The effect of positive pressure ventilation on serum ischemia-modified albumin levels in obese patients with obstructive sleep apnea syndrome.

Respiratory abnormalities in obstructive sleep apnea syndrome (OSAS) are corrected with positive pressure ventilation treatments. We investigated the effect of positive airway pressure (PAP) treatment on the serum level of ischemia-modified albumin (IMA), an oxidative stress product, in OSAS patients with higher body mass index (BMI) and indication for PAP treatment. Seven consecutive female and 23 male patients with a BMI of ≥30 kg/m2 who were diagnosed as having OSAS according to ICSD3 criteria and were planned for PAP, were included. The Epworth Sleepiness Scale and STOP-Bang Questionnaire were performed. Morning arterial blood gas, hemogram, biochemistry, insulin, and IMA were measured after polysomnography and after three months of PAP. There were no significant changes in lactate, CRP, and serum electrolyte levels measured before and after PAP, except for potassium. When 30 patients were compared in terms of serum IMA levels at baseline and after treatment, the mean baseline value was 0.56 absorbance units (ABSU), and the 3rd-month follow-up IMA value was 0.53 ABSU (p= 0.537). The mean serum fasting insulin level was 15.85 µIU/mL and 11.6 (p= 0.002) and the mean HOMA index was 4.4 and 3.0 (p= 0.001), respectively. Serum IMA levels seem not to be an appropriate marker for the evaluation of PAP treatment in OSAS patients with higher BMI. PAP is associated with a decrease in the fasting insulin level, HOMA index, and hematocrit, but not with serum electrolytes except potassium.

Kinetics of d-lactate and ischemia-modified albumin after abdominal aortic surgery and their ability to predict intestinal ischemia

ObjectivesAcute intestinal ischemia is a severe complication of abdominal aortic surgery that is difficult to diagnose early and therefore to treat adequately and timely. In this study the perioperative kinetics of d-lactate and ischemia-modified albumin (IMA) are described and the predictive value of these markers for the early diagnosis of acute intestinal ischemia is assessed. Design & methodsThis non-randomised, single-centre cohort study enrolled 50 patients with abdominal aortic aneurysm (AAA) and 30 patients with aortoiliac occlusive disease (AOID). Serum d-lactate and IMA were assessed pre-, intra-, and postoperatively at eight defined time points. ResultsThe highest serum d-lactate was at 6 h after complete declamping of the vascular graft. The highest predictive power of d-lactate was at 3 h after complete declamping (AUC 0.857). IMA was found to be higher in the AAA group in ischemic patients 10 min after complete declamping than in the AOID group. The highest predictive values of IMA were at 1 h after aortic cross-clamping (AUC 0.758) and 3 and 6 h after complete declamping (0.745 and 0.721, respectively). Moreover, the multivariate model with both markers at 3 h after complete declamping improved the detection of intestinal ischemia (AUC 0.894). ConclusionsSerum levels of IMA and d-lactate seem to be influential predictive markers for postoperative intestinal ischemia, especially after 3 h from complete declamping of vascular reconstruction.

Value of thiol and ischemia modified albumin (IMA) in predicting mortality in serious COVID-19 pneumonia

Background/aimViral infections of the respiratory tract are generally related to many factors such as excessive production of cytokines, inflammation, cellular death, redox imbalance or oxidative stress. The aim of this study was to determine the serum levels of thiol and IMA in patients with severe COVID-19 pneumonia to evaluate oxidative stress. Study designThis was a prospective, sectional cohort study conducted at a pandemics hospital between 01.01.2022 and 01.02.2022. MethodsA total of 153 patients who had been confirmed with severe COVID-19 pneumonia in the emergency unit were prospectively analyzed. The control group was formed by 50 healthy volunteers with similar age and no chronic disease history. Thiol and IMA levels were statistically compared both in the patient and the control groups, and within the patient groups (survived and non-survival). ResultsWhile 96 out of 153 patients had survived, 57 patients had non-survival. There was a statistically significant distinction between the survived and non-survival patients with regard to Thiol and IMA levels (p < 0.001). The thiol levels in the patient group were significantly lower compared to the control group, and the IMA levels were significantly higher (p < 0.001). The sensitivity, specificity and NPV were 70.2%, 86.5% and 83% when thiol cut-off value was ≤345.2 μmol/L (AUC: 0.886, p < 0.001). The sensitivity, specificity and NPV were 70.2%, 85.4% and 82.8% when the IMA cut-off was >302.9 ABSU (AUC: 0.875, p < 0.001). ConclusionsOur results demonstrate that thiol and IMA levels may be used as bioindicators for risk classification and mortality in patients with serious COVID-19 pneumonia.