The thesis reports on the application of advanced microanalytical techniques to answer a fundamental open question on the homeostasis of Plasmodium falciparum infected red blood cells, namely how infected cells retain their integrity for the duration of the parasite asexual reproduction cycle. The volume and shape changes of infected cells were measured and characterized at femtolitre resolution throughout the intraerythrocytic cycle using confocal microscopy. Fluorescence lifetime imaging and electron probe X-ray microanalysis were applied for the quantification of intracellular haemoglobin and electrolyte concentrations. The cytomechanical properties of uninfected and infected red cells were studied using a novel optical stretcher device, which enabled individual cells to be trapped and manipulated optomechanically in microfluidic channels. Combined, these methods offered a unique insight into the homeostatic and rheological behaviour of malaria-infected red cells. The results were analysed by comparison with predictions from a detailed physiological model of the homeostasis and volume regulation of infected cells, providing broad support to the view that excess haemoglobin consumptions by the parasite was necessary for the integrity of infected cells (the colloidosmotic hypothesis). The dissertation is introduced with an overview of malaria, red blood cells homeostasis and the changes induced by Plasmodium falciparum infection. In the following, this description is extended to an in-depth theoretical analysis of the infected red blood cell homeostasis, from which the need to characterise certain parameters arises. The subsequent chapters address sequentially the assessment of the haemoglobin and electrolyte concentration, cell shape and volume changes and ultimately alterations in cell elasticity. The experimental part is complemented with a comparison of the resulting data to the predictions from the theoretical analysis and an outlook on future work.

La drépanocytose est une hémoglobinopathie essentiellement connue pour ses répercussions hématologiques, hémodynamiques et vasculaires chez les patients homozygotes (SCA). Bien que ces sujets présentent une intolérance à l'effort, la littérature est très pauvre concernant les répercussions musculaires de la maladie. Ce travail doctoral nous a permis de caractériser pour la première fois les répercussions structurales, énergétiques et microvasculaires du muscle d’hommes (étude 1) et de femmes (étude 2) drépanocytaires par rapport à des sujets SCT et contrôles (CON). Nos analyses histologiques et biochimiques ont mis en évidence chez les sujets SCA masculins une amyotrophie qui explique au moins en partie la diminution de l’IMC des SCA au dépend de la masse maigre. Nous avons également observé l’altération de plusieurs indices du métabolisme oxydatif (CS, β-HAD et COx) qui pourrait relever de la restriction d’approvisionnement et d’utilisation tissulaire en O2 et expliquer en partie l’intolérance à l’effort. Enfin, un remodelage microvasculaire caractérisé par une raréfaction, une moindre tortuosité et une fragilisation des microvaisseaux a également été démontré. Ce remodelage microvasculaire pourrait contribuer à limiter le risque d’enclavement des hématies falciformées et ainsi réduire les risques de vaso-occlusions. La recherche de ces différents stigmates dans le muscle de la population féminine homologue a rapporté un remodelage musculaire similaire à celui observé chez les hommes SCA, mais ce dernier semble atténué, suggérant un effet genre / Sickle cell anemia (SCA) is a hemoglobinopathy particularly known for its hematologic, hemodynamics and vascular repercussions. Although SCA patients are exercise intolerant, no studies have looked at muscle repercussions. We assessed repercussions of sickle cell anemia on skeletal muscle and its microvasculature in men (study 1) and women (study 2) for the first time. Our results showed that men with SCA displayed an amyotrophy which can at least partly explain the decrease of BMI at the expense of lean muscle mass. We also pointed out a decrease in muscle oxidative capacities (CS, β-HAD and COx) which could result from O2 supply and utilization disorders and partly explain their exercise intolerance. Finally, a microvascular remodeling characterized by a rarefaction, a decrease in microvessel tortuosity and a microvessel weakening was also highlighted. This remodeling could contribute to maintain local blood flow and reduce risks of entrapment of sickle red blood cells in the microvasculature, hence reducing vaso-occlusive risks. Muscle repercussions on a similar female population testified of the same muscle remodeling as the one observed in men with SCA, but this latter seemed to happen at a lesser extent in women with SCA, suggesting a gender effect

Catecol e catecolaminas foram ensaiados sobre as atividades NADPH e NADH oxidásica dos microssomos. Quantidades catalíticas de adrenalina aumentam de duas a três vezes a velocidade de oxidação do NADPH, após um pequeno período de indução. O efeito da adrenalina é suprimido pela superóxido dismutase, se a enzima é adicionada antes de iniciada a reação. O efeito catalítico é atribuído a dois produtos de oxidação da adrenalina pelo íon superóxido; à quinona, produto de oxidação de dois elétrons e ao adrenocromo, produto de oxidação de quatro elétrons. Provavelmente, o adrenocromo reoxida a NADPH citocromo c redutase, e a quinona formada reage com oxigênio, regenerando adrenocromo. A adrenalina não mostrou qualquer efeito sobre a atividade NADH oxidásica, nem sobre a atividade NADPH oxidásica, estimulada por menadiona. Provavelmente, durante estes processos, dois elétrons são transferidos simultaneamente ao oxigênio. Catecol e catecolaminas duplicam a velocidade de oxidação do NADH em presença de quantidades catalíticas de NADH-citocromo b5 redutase e citocromo b5. Este resultado sugere a formação do íon superóxido, durante a autoxidação do citocromo b5. Catecol e p-hidroquinona promovem, cataliticamente, a oxidação da oxihemoglobina e oximioglobina à forma ferri. A velocidade de oxidação da oxihemoglobina mostra dependência de primeira ordem em relação à concentração de hemeproteína e de meia ordem em relação ao difenol ; contudo a altas concentrações dos catalisadores observa-se saturação, com valores de Vmáx similares para ambos os difenóis. É proposto que uma quinona , inicialmente formada, oxida a oxihemeproteína com liberação de oxigênio; por sua vez, a semiquinona oxida uma segunda molécula de oxihemeproteína, sendo que o oxigênio ligado recebe dois elétrons. Exceto para o caso da oximioglobina, que é mais reativa, a forma reduzida do catalisador deve estar presente para se opor ao desaparecimento da semiquinona por dismutação. Desde que se observa a liberação de oxigênio, esperada para a formação de água, o sistema pode ser considerado modelo de oxidase terminal. Infere-se tentativamente, que a oxihemoglobina tem estrutura HbFe2+ ...O2, e que a velocidade da oxidação catalisada é limitada pela velocidade de produção da verdadeira forma reativa, a estrutura ferri-superóxido, HbFe3+...O-2. / Catechol and catecholamines have been assayed upon the microsomal NADPH and NADH oxidase activities. Adrenaline shows a catalytic effect on the NADPH oxidation characterized by a small lag. The two-to three fold increase in rate can be supressed by dismutase if the enzyme is added before superoxide the reaction begins. The catalytic effect is ascribed to two products of adrenaline oxidation by the superoxide ion; to the quinone, the two electron oxidation product, and to the adrenochrome, the four electron oxidation product. Presumably, the adrenochrome reoxidizes the NADPH-cytochrome c reductase, and the formed quinone reacts with oxygen and regenerates the adrenochrome. Adrenaline neither changed, the NADH oxidase activity nor the menadione-stimulated NADPH oxidase activity. Presumably in these processes, two electrons are simultaneously transferred to the oxygen. Catechol and catecholamines doubled the rate of autoxidation of NADH in the presence of catalytic amounts of NADH-cytochrome b5 reductase and cytochrome b5 This result suggests superoxide ion formation in the autoxidation of the cytochrome. Catechol and p-hydroquinone catalytically promote the oxidation of oxyhemoglobin and oxymyoglobin to the ferri-form. Kinetic data for oxyhemoglobin oxidation indicates a first-order dependence upon the hemoprotein concentration and half-order dependence upon diphenol; however at high catalyst concentration, saturation is observed with similar Vmax values for both diphenols despite the difference in reactivity. It is proposed that initially formed quinone oxidizes the hemoprotein with oxygen release; in turn the semiquinone oxidizes a second molecule of hemoprotein and regenerates the quinone, with the bound oxygen acquiring two electrons. Except for the more reactive oxymyoglobin, the reduced form of the catalyst must be present to oppose semiquinone disappearance by dismutation, Since the expected release of 02 for water formation is observed, the system may be considered a model for terminal oxidase. It is tentatively inferred that oxyhemoglobin has the structure HbFe2+...02 and that the rate of the catalyzed oxidation is limited by the rate of generation of the true reacting form, the superoxide ferri structure, HbFe3+...0-2.

Objetivo: Valorar la asociación entre el control glicémico y la presencia de microalbuminuria en pacientes con diabetes mellitus tipo 2. Métodos: Se realizó un estudio transversal analítico en pacientes con diabetes mellitus tipo 2 de una clínica privada en Lima, Perú. Se incluyeron pacientes adultos mayores de 18 años que pertenecían a un programa de seguimiento durante el 2018 en una clínica privada. El mal control glicémico fue definido con una hemoglobina glicosilada mayor o igual a 7%. La presencia de microalbuminuria fue definida considerando valores de albúmina mayores a 20 mg/L en la primera orina de la mañana. Se realizó un modelo de regresión lineal generalizado de la familia de Poisson con varianza robusta. Calculamos la razón de prevalencias cruda y ajustada con un intervalo de confianza de 95%. Resultados: Se analizaron los datos de 907 participantes, la mediana de edad fue de 58 años (RIC 49 a 66) y 62,8% de los participantes fueron hombres. La prevalencia de mal control glicémico fue de 39,8%, y la prevalencia de microalbuminuria fue de 32,7%. La prevalencia de microalbuminuria en el grupo de mal control glicémico y en el de buen control glicémico fue de 44,1% y 25,3% respectivamente. En el análisis de regresión ajustada, se encontró una asociación estadísticamente significativa entre el mal control glicémico y microalbuminuria. (RPa=1.48; IC 95%: 1.19-1.85). Conclusión: Se encontraron altos niveles de hemoglobina glicosilada y microalbuminuria en la población estudiada. Los adultos con diabetes mellitus tipo 2 con mal control glicémico tuvieron una mayor prevalencia de microalbuminuria en la primera orina del día. / Background and Aims: Microalbuminuria is the first sign for diabetic nephropathy in people with type 2 diabetes mellitus (T2DM). Few studies associate poor glycemic control and higher microalbuminuria prevalence in Latin American populations. We aimed to evaluate the association between glycemic control and microalbuminuria in adults with T2DM. Methods: We conducted a cross-sectional analytical study in adults with T2DM from a private clinic in Lima, Peru. We included adults over 18 years old who belonged to the clinical follow-up program in 2018. We defined poor glycemic control based on the serum value of glycosylated haemoglobin (HbA1C) ≥7%. We defined microalbuminuria considering albumin values > 20 mg/L in the first-morning urine. We carried out generalized linear regression models from the Poisson family with robust variance. We calculated the crude and adjusted prevalence ratio (PR) with their 95% confidence interval (CI). Results: We analyzed 907 participants, the median age was 58 years (IQR 49 to 66), and 62.8% were males. The prevalence of poor glycemic control was 39.8%, and the prevalence of microalbuminuria was 32.7%. The prevalence of microalbuminuria in the group with poor glycemic control and adequate glycemic control was 44.1% and 25.3%, respectively. In the adjusted regression analysis, we found a statistically significant association between poor glycemic control and microalbuminuria (aPR=1.48; 95% CI: 1.19-1.85). Conclusion: Our study population had high levels of glycosylated haemoglobin and microalbuminuria. T2DM adults with poor glycemic control had more likelihood of microalbuminuria in the first-morning urine. / Tesis

No description available.

Cílem diplomové práce je zhodnotit antioxidační účinky pěti různých sloučenin s potenciálním využitím jako antioxidanty v potravinách (propylgalát, kávová kyselina, ferulová kyselina, p-kumarová kyselina a L(+)-askorbová kyselina), a to prostřednictvím čtyř běžně používaných testů antioxidační kapacity (FC, FRAP, DPPH, ABTS) a v modelovém systému liposomů za použití volného železa (Fe2+, Fe3+) a hovězího hemoglobinu jako prooxidantů se zvláštním zaměřením na různé koncentrace testovaných sloučenin v systému. K nepřetržitému monitorování oxidace lipidů při pH 5,5 a teplotě 30 °C je použita spotřeba kyslíku. Výsledky této práce mají přispět k lepšímu pochopení základních pro- a antioxidačních mechanismů a faktorů ovlivňující oxidaci buněčných membrán, liposomálních roztoků a emulzí typu olej-ve-vodě stabilizovaných fosfolipidy.

Sickle cell disease is a disabling chronic autosomal recessive blood disease characterized by abnormal hemoglobin, pain crises, and frequent emergency department visits. Adherence to hydroxyurea therapy has been shown to improve these patient outcomes. Guided by the theory of comfort, the purpose of this project was to determine if an educational intervention would increase adherence to hydroxyurea therapy in pediatric patients between 2 and 17 years of age recruited from an urban university hospital hematology clinic. The RE-AIM model was used to support the translation of evidence and the change process. An educational video produced by AFLAC was viewed by patients' parents 4 weeks after enrollment into this pretest/posttest design project. A total of 22 African-American parent participants completed the 8-item Morisky Medication Adherence Scale at baseline and again at 8 weeks to assess hydroxyurea adherence. The Short Test of Functional Health Literacy in Adults tool was used to assess parents' health learning needs; all parents met the adequate literacy level at baseline. Using t test statistics, no statistically significant differences were found pretest to posttest on the Morisky Medication Adherence Scale scores, mean corpuscular hemoglobin, and fetal hemoglobin percentages. Wilcoxon Signed Rank tests showed no significant differences in emergency room visits nor number of pain crisis. Although no significant changes emerged in short-term hematologic findings, emergency room visits, and pain crises, social change in the health care setting was promoted by confirming parents were able to understand education and a high level of hydroxyurea adherence was maintained; literature indicated that long-term adherence to hydroxyurea limits severe attacks.

The aim of this thesis is to contribute to the clarification of the pathogenesis of chronic complications of diabetes mellitus. The main goal of the research was glycaemic variability, its contribution to the activation of oxidative stress and its possible role in the process of advanced glycation, all beyond the scope of persistent hyperglycaemia itself. Another aim of the work is to contribute to the clarification of a possible relationship between glycaemic variability and vascular complications of diabetes. We were the first to describe the association between the concentrations of reactive aldehydes formed during lipid peroxidation and disorders of skin microvascular reactivity in patients with type 1 diabetes (DM1). Elevated markers of oxidative stress were found in this group, furthermore during the 3 years of follow-up higher plasma antioxidant activity was observed. These findings were not dependent of the method of glucose monitoring and glucose variability, which was lower in a subgroup of patients using real-time continuous glucose monitoring (rt-CGM), compared to a subgroup using conventional glucometers. However, it is clear, that hyperglycaemia alone induces increased oxidative stress in patients with diabetes. Simultaneously we observed the opposite process of oxidative stress...

No description available.

Inom klinisk verksamhet är det av stor betydelse att känna till hållbarheten på olika analyter för att säkerställa att analysen inte genomförs på för gamla prover. Vid litteratursökning framgick att bland de publicerade studier som undersökt hållbarheten på blodprover har de flesta undersökt hållbarheten på venösa men inte kapillära blodprover. En vanligt förekommande analys med både venösa och kapillära prover är blodstatus, som inkluderar bland annat bestämning av hemoglobinkoncentrationen (Hb-), leukocyt- samt trombocytpartikelkoncentrationen (LPK och TPK). Analys av blodets celler kan ge allmän information om hälsotillståndet hos patienter och är därav viktiga och vanligt förekommande analyser. Syftet med examensarbetet var att undersöka hållbarheten för analyserna Hb, LPK och TPK på kapillära blodprover efter fyra och sex timmars förvaring i rumstemperatur. Provmaterialet utgjordes av 100 kapillära prover som analyserades på hematologiinstrumentet Sysmex XN-10. Analysmetoden för Hb var fotometri med natriumlaurylsulfat- (SLS-) metoden. LPK bestämdes med flödescytometri medan TPK bestämdes med impedansmetoden alternativt flödescytometri. Resultatet visade att det för Hb inte förekom någon signifikant statistisk skillnad mellan den initiala analysen och efter fyra respektive sex timmar. Analysresultatet för Hb var därmed stabilt under förhållandena i denna studie. För LPK och TPK förekom statistiskt signifikanta skillnader mellan resultatet vid den initiala analysen jämfört med efter fyra respektive sex timmar. Analysresultaten för LPK och TPK var därmed inte lika stabila som Hb är under förhållandena i studien. Den statistiska skillnaden bedömdes däremot inte ha någon klinisk betydelse, vilket ledde till slutsatsen är att kapillära prover för analys av Hb, LPK och TPK är hållbara i sex timmar vid förvaring i rumstemperatur. / One important factor in clinical practice is understanding the stability of analytes and for how long blood samples can be stored before analysis. Most published studies are based on venous blood samples rather than capillary. The knowledge about storage time for cells in capillary blood is therefore limited. Plenty of information can be obtained by analysing the blood cells and its components, including haemoglobin, white blood cells and platelets. These analyses are therefore some of the most common in clinical practice. The aim of this study was to evaluate the effect of the analysis result for haemoglobin, white blood cells and platelets in capillary blood samples after storage at room temperature for four and six hours, respectively. In the study, 100 capillary samples from anonymous patients were analysed with the haematology analyser Sysmex XN-10. The method for analysing haemoglobin was the sodium lauryl sulphate (SLS) detection method with spectrophotometry. White blood cells were analysed with fluorescens flow cytometry. Platelets were analysed with either impedance or fluorescens flow cytometry. The result of the study showed no statistically significant difference between the initial analysis results in haemoglobin and at four and six hours, concluding that within the conditions of this study, the analysis result for haemoglobin was stable. Significant statical differences were identified for both white blood cells and platelet analysis results at four and six hours. However, the identified statistical significance was not esteemed to have any clinical relevance. In conclusion haemoglobin, white blood cells and platelets in capillary blood can be stored for at least six hours at room temperature.