4. DISCUSSION
Free radicals stemming mainly from post-traumatic processes leads to damage in lipids, proteins in the cell membrane and DNA resulting in infections, multiple organ failure, acute failure of respiratory, renal and cerebral systems [30, 31]. Therefore, it is extremely important to know the levels of thiol to reduce free oxygen radicals, prevent harmful effects, and perform appropriate interventions to the patient after trauma. Oxidative stress is an indication of tissue damage from increased reactive oxygen species. Thiol inhibits cellular and tissue damage by inhibiting the effects of reactive oxygen species by lipid metabolism of the cell membrane.
It is known that oxidative stress increases after physical injuries in trauma patients. Although many studies have shown that reactive oxygen species in trauma increase and antioxidant levels to be decreased [30, 32, 33], there are two studies in the literature showing the relationship between trauma and dynamic thiol-disulfide balance [34, 35]. With this study, the relationship between trauma and thiol-disulfide and IMA levels in children was also shown.
In our study, total thiol, native thiol, disulfide/total thiol ratio were found to be significantly decreased significantly, as consistent with the literature and dynamic disulfide as increased in the trauma group compared to the control. IMA and albumin levels were also significantly decreased. In trauma group, however, there was not significant difference between surgery and follow-up sub-groups, or multiple and isolated trauma sub-groups, or type of trauma and systems affected or organs. These laboratory findings indicate that trauma results in a shift towards the oxidant side in favor of oxidative stress in children. However, there was no difference in trauma type, or whether there were surgery or not, multiple or isolated, systems or organs effected, and thiol/disulfide balance and IMA levels.
These results point out that thiol/disulfide balance and IMA levels cannot be used as an adjunctive marker in imaging and determining the affected system and organ from trauma during the follow-up period and deciding the surgical intervention. There was also not found statistical difference in total thiol, native thiol, dynamic disulfide, dynamic disulfide / total thiol rate, albümin or IMA levels between 2nd and 5th days of hospitalization of children with trauma. The development of a test that can help to determine the system and organ affected by the trauma more quickly and easily and can help in the decision of surgical intervention will help both early diagnosis and early surgical intervention.