Hyperglycemia and insulin resistance are common in many critically ill patients. Hyperglycemia increases the production of reactive oxygen species in cells, stimulates the production of the potent proinflammatory cytokines IL-8 and TNF-alpha, and enhances the expression of haem oxygenase-1, an inducible stress protein. It has been shown that administration of insulin and the semi-essential amino acid glutamine have been beneficial to the septic patient. The aim of our study is to test whether these two molecules, glutamine and insulin used in combination attenuate the proinflammatory responses in endothelial cells which have been triggered by hyperglycaemia. Our results demonstrate that a combination of insulin and glutamine are significantly more effective in reducing the expression of IL-8, TNF-alpha and HO-1 than insulin or glutamine alone.
A case of haemorrhagic fever with renal syndrome that originated in Malaysia is reported. The patient presented with clinical symptoms which were not typical of the disease as seen in endemic regions. Renal involvement, which is characteristic of haemorrhagic fever with renal syndrome, was mild, and the predominant symptom was a persistently marked elevation of serum transaminase levels that was suggestive of hepatitis. Liver involvement has not been described in the Asian form of haemorrhagic fever with renal syndrome. The patient developed a petechial skin rash and had severe thrombocytopenia. Serological confirmation of the diagnosis of haemorrhagic fever with renal syndrome was obtained by the demonstration of significant antibody rises to hantaviruses in the patient's acute- and convalescent-phase sera.
Hantaviruses are primarily rodent-borne and transmission is by inhalation of virus-contaminated aerosols of rodent excreta, especially urine and saliva. The genus Hantavirus, family Bunyaviridae, comprises at least 14 serotypes and the symptoms of clinical illness range from mild fever to severe hemorrhagic manifestations with renal complications. Many countries in Southeast Asia are unaware of the importance of hantavirus infections and give them low priority. Malaysia, like other countries in the region, has conducted very few studies on the epidemiology of hantaviruses - and even these were conducted in the 1980s. Using a more extensive range of hantavirus antigens, we conducted a seroprevalence study of rodents and humans and found further evidence of hantavirus infections. Moreover, the data from the antibody profiles strongly suggest the presence of different hantaviruses at the study sites.