1. Spa Therapy and Oxidant Antioxidant Systems 03.06.2015 / Prof Dr Nergis ERDOGAN ISTANBUL 1

2. Spa Therapy and Oxidant Antioxidant Systems 03.06.2015 / Prof Dr Nergis ERDOGAN ISTANBUL 2 Aerobe organisms produce Reactive Oxygen Species (ROS) Superoxide, hydro peroxide and hydroxyl ROS reactions: Removing atoms, transferring electrons and adding radicals Inactivation of enzymes, DNA injury and vital injury at cell membrane and decrease cell energy Introduction

3. Spa Therapy and Oxidant Antioxidant Systems 03.06.2015 / Prof Dr Nergis ERDOGAN ISTANBUL 3 ROS play a major role in events like Inflammatory reactions Cataract, arteriosclerosis Intracellular aging, Cell necrosis and apoptosis, Ischemia reperfusion injury Cancer Introduction

4. Spa Therapy and Oxidant Antioxidant Systems 03.06.2015 / Prof Dr Nergis ERDOGAN ISTANBUL 4 ROS promoters Physical and psychological stress, High caloric diet, Alcohol and cigarette use Air pollution, ozone UV light, microwave Ionizing radiation Some chemotherapeutic Hyperthermia treatment also increase ROS production Introduction

5. Spa Therapy and Oxidant Antioxidant Systems 03.06.2015 / Prof Dr Nergis ERDOGAN ISTANBUL 5 Aerobe organisms have antioxidant defence systems Intracellular antioxidant enzyme systems –Super oxide dysmutase (SOD) catalases, glutathione peroxides –In vivo synthesizing substances: Bilirubins, sex hormones, melatonine, lipoic acide, coenzyme Q, and uric acid –Ceruloplasmin, albumin, transferrin, haptoglobin, lactoferrin and hemopexin Introduction

6. Spa Therapy and Oxidant Antioxidant Systems 03.06.2015 / Prof Dr Nergis ERDOGAN ISTANBUL 6 A, C and E vitamins and Plant phenols have antioxidant features Oxidative stress may results with adaptation or cell damage Cells response to mild oxidative stress by antioxidant defence systems Introduction

7. Spa Therapy and Oxidant Antioxidant Systems 03.06.2015 / Prof Dr Nergis ERDOGAN ISTANBUL 7 Oxidative stress Damage DNA and other molecules and cause degenerative diseases, malignity and aging Therapy with hyper thermal baths, drinking cures and peloid packs reduce oxidative stress and induce antioxidant defence Introduction

8. Spa Therapy and Oxidant Antioxidant Systems 03.06.2015 / Prof Dr Nergis ERDOGAN ISTANBUL 8 The effect of spa therapy on plasma malondialdehit and total antioxidant levels

9. Spa Therapy and Oxidant Antioxidant Systems 03.06.2015 / Prof Dr Nergis ERDOGAN ISTANBUL 9 Patients and Method Twenty-eight patients (19 female, 9 male) primary osteoarthritis Bursa Military Hospital (Spa group) Seven patients (5 male, 2 female) İstanbul Medical Faculty Medical Ecology Hydroclimatology department ambulatory policlinic (Control group) The effect of spa therapy on plasma malondialdehit and total antioxidant levels

10. Spa Therapy and Oxidant Antioxidant Systems 03.06.2015 / Prof Dr Nergis ERDOGAN ISTANBUL 10 Spa group patients had 10 –15 minute head out immersion in 39 O -41 O C thermomineral water, physical therapy and regular exercise for 15 days Control patients home exercise and simple analgesics Plasma malondialdehit (MDA) and total antioxidant capacity (TAA) were compared The effect of spa therapy on plasma malondialdehit and total antioxidant levels

11. Spa Therapy and Oxidant Antioxidant Systems 03.06.2015 / Prof Dr Nergis ERDOGAN ISTANBUL 11 Fasting blood at the beginning (first measurement) and thirteenth day (15. Day) Plasma MDA and TAA levels in Department of Clinical Biochemic by TBARS (Thiobarbituric acid) and FRAP (Ferric Reducing Antioxidant Power Assay) methods The effect of spa therapy on plasma malondialdehit and total antioxidant levels

12. Spa Therapy and Oxidant Antioxidant Systems 03.06.2015 / Prof Dr Nergis ERDOGAN ISTANBUL 12 Figure I: Spa group, beginning and 15. Day mean MDA levels (P> 0.05) There was a statistically insignificant decrease Statistically insignificant decrease The effect of spa therapy on plasma malondialdehit and total antioxidant levels

13. Spa Therapy and Oxidant Antioxidant Systems 03.06.2015 / Prof Dr Nergis ERDOGAN ISTANBUL 13 Figure II: Spa group, MDA levels at beginning and 15. Day in patients with beginning MDA levels are above 6 nmol/ml ( P< 0.05) Statistically significant decrease The effect of spa therapy on plasma malondialdehit and total antioxidant levels

14. Spa Therapy and Oxidant Antioxidant Systems 03.06.2015 / Prof Dr Nergis ERDOGAN ISTANBUL 14 Figure III: Spa group, MDA levels at beginning and 15. Day in patients beginning MDA levels are below 6 nmol/ml ( P< 0.05) Statistically significant increase The effect of spa therapy on plasma malondialdehit and total antioxidant levels

15. Spa Therapy and Oxidant Antioxidant Systems 03.06.2015 / Prof Dr Nergis ERDOGAN ISTANBUL 15 Figure IV: Spa group the first and15. Day plasma mean TAA levels ( P> 0.05) No significant difference The effect of spa therapy on plasma malondialdehit and total antioxidant levels

16. Spa Therapy and Oxidant Antioxidant Systems 03.06.2015 / Prof Dr Nergis ERDOGAN ISTANBUL 16 Figure V: In spa group male and female the first and 15. Day plasma mean TAA values. (P< 0.05) Statistically significant increase in men Statistically significant decrease in women The effect of spa therapy on plasma malondialdehit and total antioxidant levels

17. Spa Therapy and Oxidant Antioxidant Systems 03.06.2015 / Prof Dr Nergis ERDOGAN ISTANBUL 17 Figure VII. Control group the first (5.34±0.65) and 15. Day (4.64±0.96) plasma mean MDA values No significant difference The effect of spa therapy on plasma malondialdehit and total antioxidant levels

18. Spa Therapy and Oxidant Antioxidant Systems 03.06.2015 / Prof Dr Nergis ERDOGAN ISTANBUL 18 Figure VIII. Control group the first(1065.42±143.27) - 15. day (1243.86±258.46) mean plasma TAA values ( P>0.05 ) No statistically significant difference The effect of spa therapy on plasma malondialdehit and total antioxidant levels

19. Spa Therapy and Oxidant Antioxidant Systems 03.06.2015 / Prof Dr Nergis ERDOGAN ISTANBUL 19 The effect of spa therapy on plasma malondialdehit and total antioxidant levels

20. Spa Therapy and Oxidant Antioxidant Systems 03.06.2015 / Prof Dr Nergis ERDOGAN ISTANBUL 20 DISCUSSION and CONCLUSION

21. Spa Therapy and Oxidant Antioxidant Systems 03.06.2015 / Prof Dr Nergis ERDOGAN ISTANBUL 21 Spa therapy decreases oxidant stress ?! Increases TAA levels in male and Decreases in females (menopause-estrogens deficiency?) Decrease in oxidant stress is more prominent Increase of antioxidant defence is less manifest DISCUSSION and CONCLUSION

22. Spa Therapy and Oxidant Antioxidant Systems 03.06.2015 / Prof Dr Nergis ERDOGAN ISTANBUL 22 Oxidant effect of hyperthermic baths and antioxidant consumption in defence to oxidative stress Disappearance of inverse proportion between disease duration and MDA level Balneotherapy more effective in early period of disease in decreasing oxidative stress??! DISCUSSION and CONCLUSION

23. Spa Therapy and Oxidant Antioxidant Systems 03.06.2015 / Prof Dr Nergis ERDOGAN ISTANBUL 23 Decreasing of MDA levels in patients with high MDA level Increasing of MDA levels in patients with low beginning MDA levels Regulatory effect of balneotherapy??!! DISCUSSION and CONCLUSION

24. Spa Therapy and Oxidant Antioxidant Systems 03.06.2015 / Prof Dr Nergis ERDOGAN ISTANBUL 24 Elimination of environmental oxidative factors Dietary regime Regular exercise Physical therapy Hyperthermic applications Chemical effects of thermo mineral waters DISCUSSION and CONCLUSION

25. Spa Therapy and Oxidant Antioxidant Systems 03.06.2015 / Prof Dr Nergis ERDOGAN ISTANBUL 25