Ahmet Kale

The comparison of amino-terminal probrain natriuretic peptide levels in preeclampsia and normotensive pregnancy.

Abstract Objective: The purpose of this study was to evaluate the levels of amino-terminal probrain natriuretic peptide (Nt pro-BNP) in preeclampsia in comparison with normotensive pregnancy. Materials and methods: Women with preeclampsia (proteinuria ≥300 mg/24 h and at least two readings of systolic blood pressure ≥140 mm Hg and diastolic blood pressure ≥90 mm Hg) (n=32 mild preeclampsia and n=8 severe preeclampsia) were compared with normotensive women (n=40). Serum Nt pro-BNP was measured using an electrochemiluminescence immunoassay (ECLIA) method (Nt pro-BNP, Roche) with a Roche modular analytics E170 immunoassay analyzer. Statistical analysis was carried out by the Student t-test, and a P value of <0.05 was accepted as statistically significant. Results: The median serum Nt pro-BNP was 430±28.91 pg/mL in preeclampsia. The levels of serum Nt pro-BNP were 74±16.82 pg/mL in normotensive pregnant women (P<0.001) and significantly higher in women with preeclampsia (P<0.001). Conclusion: The higher levels of serum Nt pro-BNP in preeclamptic women may be an indicator of high left-ventricular filling pressure, and indicate left-ventricular diastolic dysfunction.

Risk factors for postmenopausal osteoporosis: anthropometric measurements, age, age at menopause and the time elapsed after menopause onset

Objectives. The aim of this study was to determine, how much the anthropometric measurements and age affect the femur and vertebra T-scores by using correlation and regression analysis in postmenopausal women. Methods. Data of 540 healthy postmenopausal women were included in this analysis. Bone mineral density was determined by dual energy X-ray absorptiometry (DXA). The data of the patients related to height, weight, age, age at menopause were obtained from records, and body mass index (BMI) was calculated (BMI = W (kg)/H(m2)). Statistical analyses were performed with SPSS 15.0 for Windows (SPSS, Chicago, IL). Results. Mean age and standard deviation of 540 postmenopausal women was 59.3 ± 8.4 years. The correlation coefficients among femur, vertebra T-scores, weight, the time elapsed after the menopause onset, age, BMI and height were found as follows, from higher to lower values with 0.465, 0.453, 0.411, 0.382, 0.232, respectively, and were statistically significant (p < 0.001). Conclusions. We determined the effects of the anthropometric measurements on osteoporosis from higher to lower influence as follows: weight, menopause age, age, BMI and height. Weight and menopause age of the patients were the major determinants for osteoporosis.

The relationship between thrombophilic mutations and preeclampsia: a prospective case-control study

BACKGROUND Preeclampsia and its association with thrombophilia remain controversial, due to inconsistent results in different studies, which include different ethnic groups, selection criteria, and patient numbers. The aim of this study was to determine the relationship between thrombophilia and preeclamptic patients in our region. METHODS In a prospective case-control study, we compared 100 consecutive women with preeclampsia and eclampsia (group 1) with 100 normal pregnant women (group 2). All women were tested two months after delivery for mutations of factor V Leiden, methylenetetrahydrofolate reductase (MTHFR), and prothrombin gene mutation as well as for deficiencies of protein C, protein S, and antithrombin III. RESULTS A thrombophilic mutation was found in 42 (42%) and 28 (28%) women in group 1 and group 2, respectively (P=0.27, OR 1.5, 95%CI 1.0–2.2). The incidence of Factor V Leiden mutation (heterozygous), prothrombin mutation (heterozygous), prothrombin mutation (homozygous), MTHFR mutation (homozygous) was not statistically significant in group 1 compared with group 2 (P>0.05). Also, deficiencies of protein S, protein C, and antithrombin III were not statistically significant in group 1 compared with group 2 (P >0.05). CONCLUSION There was no difference in thrombophilic mutations between preeclamptic patients and normal pregnant women in our region. Therefore, we suggest that preeclamptic patients should not be tested for thrombophilia.

Elevated amniotic fluid amino acid levels in fetuses with gastroschisis

Our objective was to measure maternal plasma and amniotic fluid amino acid concentrations in pregnant women diagnosed as having fetuses with gastroschisis in the second trimester of pregnancy. Twenty-one pregnant women who had fetuses with gastroschisis detected by ultrasonography (gastroschisis group) in the second trimester and 32 women who had abnormal triple screenings indicating an increased risk for Down syndrome but had healthy fetuses (control group) were enrolled in the study. Amniotic fluid was obtained by amniocentesis, and maternal plasma samples were taken simultaneously. The chromosomal analysis of the study and control groups was normal. Levels of free amino acids and non-essential amino acids were measured in plasma and amniotic fluid samples using EZ:fast kits (EZ:fast GC/FID free (physiological) amino acid kit) by gas chromatography (Focus GC AI 3000 Thermo Finnigan analyzer). The mean levels of essential amino acids (histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine) and non-essential amino acids (alanine, glycine, proline, and tyrosine) in amniotic fluid were found to be significantly higher in fetuses with gastroschisis than in the control group (P < 0.05). A significant positive correlation between maternal plasma and amniotic fluid concentrations of essential and nonessential amino acids was found only in the gastroschisis group (P < 0.05). The detection of significantly higher amino acid concentrations in the amniotic fluid of fetuses with a gastroschisis defect than in healthy fetuses suggests the occurrence of amino acid malabsorption or of amino acid leakage from the fetus into amniotic fluid.

Analysis of Sensitivity, Specificity, and Positive and Negative Predictive Values of Smear and Colposcopy in Diagnosis of Premalignant and Malignant Cervical Lesions.

Background This study aimed to examine the positive and negative predictive value in the diagnosis of premalignant and malignant lesions of cervical colposcopy, the sensitivity and specificity of smear, and to evaluate the correlation with histopathology of abnormal cytology and colposcopy. Material/Methods The criteria for inclusion of patients with unhealthy cervix in the study were: Erosion, Chronic cervicitis, and Healed lacerations, Hypertrophied cervix, bleeding on touch, suspicious growth/ulcer/polyp on the cervix, and abnormal discharges from the cervix. Women with frank carcinoma cervix, pregnant females, patients with bleeding per vaginum at the time of examination, and those who had used vaginal medications, vaginal contraceptives or douches in the last 48 h of examination were excluded from the study. Demographic analysis was performed for 450 patients who were admitted to the clinic. Sensitivity, specificity, positive predictive value and negative predictive values of patients to identify cervical pathologies of smear and colposcopy were histopathologically calculated. The statistical software package SPSS 15.0 (SPSS Inc., Chicago, IL, USA) and Spearman‘s and Chi-Square tests were used for statistical analysis. Results Sensitivity, specificity, PPD and NDP of smear were 0.57%, 0.76%, 0.26%, 0.92% respectively. Sensitivity, specificity, PPD and NDP of colposcopy were 0.92%, 0.67%, 0.52%, 0.96% respectively. A statistically significant correlation was found between abnormal cytology and histopathology, and abnormal colposcopy finding and histopathology. Conclusions Women with clinical diagnosis of unhealthy cervix should be evaluated by cytology to detect any premalignant or malignant lesions. It was concluded that Pap smear, colposcopy and histopathology should be collectively evaluated to evaluate cervical findings in low socio-economic regions.

Homologous type of malignant mixed Mullerian tumor of the uterus presenting as a cervical mass.

Malignant mixed Mullerian tumors are composed of a mixture of sarcoma and carcinoma. The carcinomatous element is usually glandular, whereas the sarcomatous element may resemble normal endometrial stroma (homologous or so-called carcinosarcoma). Here, we present a homologous type of malignant mixed Mullerian tumor of the uterus that presented as a cervical mass. We describe a 55-year-old patient who had a cervical mass arising from the uterus. We performed total abdominal hysterectomy and bilateral salpingo-oophorectomy and surgical staging (including (peritoneal washings, suspicious areas or peritoneal surfaces sampled, infracolic omental sampling, pelvic and paraaortic lymph node sampling, and appendectomy). Carcinosarcomas of the uterine cervix are extremely rare, and when a postmenopausal woman with a cervical mass is admitted to the gynecology clinic, the physician should keep in mind that the mass might be a carcinosarcoma.

Is Preeclampsia a New Risk Factor for Cochlear Damage and Hearing Loss

Objective: We investigated whether preeclampsia is a risk factor for cochlear damage and permanent hearing loss. Study Design: Prospective case-control study design. Setting: Academic tertiary medical center. Patients: Subjects included 40 patients with preeclampsia and 30 healthy pregnant women. Interventions: Otoscopic examinations and pure-tone audiometry, tympanometry, otoacoustic emissions (OAEs), and stapedial reflex tests were conducted for all subjects. Negative audiologic tests were reevaluated after the postpartum period. Statistical analyses were performed using &khgr;2 and binary logistic regression testing. Main Outcome Measures: We searched for signs of middle ear ventilation, damage of cochlea, and sensorineural hearing loss. Results: Eight patients from the preeclampsia group had 1 or more otological problems. Two patients from the control group were determined as having otological problems. Otoacoustic emissions of the right and left ears (p = 0.029, p = 0.044), hearing levels of right and left ear bone conduction (BC) at the 500-Hz frequency (right and left-BC 500), and left ear at the 2,000-Hz frequency (left-BC 2000) differed significantly between the preeclampsia and control groups (p = 0.040, p = 0.003, and p = 0.003). There was no significant difference in the OAEs between the right and left ears in the preeclampsia group (p < 0.05). The variables BC 500-left, BC 500-right, OAE-right, and OAE-left differed significantly between groups based on binary logistic testing. The odds ratio and 95% confidence intervals (95% CI) for these 4 risk variables were as follows: BC 500-left, 1.167 (1.044-1.306); BC 500-right, 1.117 (1.002-1.244); OAE-right, 0.642 (0.505-0.815); and OAE-left, 0.576 (0.475-0.698), respectively. Conclusion: Preeclampsia is a risk factor for cochlear damage and permanent hearing loss. Even if preeclampsia resolves after delivery, cochlear damage and permanent hearing loss remain unchanged in patients with preeclampsia.

Proposal of a Diagnostic Test for the Detection of Preterm Premature Rupture of Membranes Based on the Determination of Thyroid Hormones in Vaginal Washing Fluid

Objectives: To determine whether measurement of total T3 (triiodothyronine) , total T4 (thyroxine), free T3 (free triiodothyronine) and free T4 (free thyroxine) levels in vaginal fluid is useful for the diagnosis of preterm premature rupture of membranes (PPROM). Study Design: The PPROM group and normal pregnancy group consisted of 30 and 30 pregnant patients between 26 and 36 weeks’ gestation, respectively. Vaginal fluid total T4, free T4, total T3 and free T3 levels were measured in both groups. Results: Vaginal fluid total T3 and free T3 levels were not statistically significant in the PPROM group as compared with the control group (p = 0.087, p = 0.123, respectively). Vaginal fluid total T4 and free T4 levels were significantly higher in the PPROM group as compared with the control group (p = 0.002, p < 0.000, respectively). The optimal cut-off value for total T4 (0.866 µg/dl) gave a sensitivity level of 83.3% (65.3–94.3, 95% CI) at a specificity of 60.0% (40.6–77.3, 95% CI) with positive and negative predictive values of 67.6 and 78.3%, respectively. The optimal cut-off value for free T4 (0.079 ng/dl) gave a sensitivity level of 90% (73.4–97.8, 95% CI) at a specificity of 70.0% (50.6–85.2, 95% CI) with positive and negative predictive values of 75.0 and 87.5%, respectively. Conclusions: Total and free T4 measurements from vaginal fluids appears to be a useful marker of PPROM.

The relationship between fibromyalgia and pressure pain threshold in patients with dyspareunia

Research has suggested that there may be a relationship between dyspareunia (pain during sexual intercourse) and fibromyalgia. Accordingly, the authors of this article aimed to evaluate the presence of fibromyalgia and associated symptoms in a group of patients with dyspareunia compared with a healthy control group. Variables assessed included the tender point pressure pain threshold and depression scores, as measured on the Beck Depression Index.

A New and Practical Aspartate Aminotransferase Test in Vaginal Washing Fluid for the Detection of Preterm Premature Rupture of Membranes

Objectives: To determine whether measurement of aspartate aminotransferase (Ast) and alanine aminotransferase (Alt) levels in vaginal fluid is useful for the diagnosis of preterm premature rupture of membranes (PPROM). Study Design: The PPROM group and normal pregnancy group consisted of 36 and 48 pregnant patients between 26 and 36 weeks’ gestation, respectively. Vaginal fluid Ast and Alt levels were measured in both groups. Results: Vaginal fluid Alt level was not statistically significant in the PPROM group as compared with the control group (p = 0.064). Vaginal Ast level was statistically significant in the PPROM (14.4 ± 17.46 U/l) group as compared with the control group (3.08 ± 7.8 U/l; p = 0.001). The optimal cutoff value of 3 IU/l for Ast gave a sensitivity level of 91% at a specificity of 83%, with positive and negative predictive values of 80 and 93%, respectively. Conclusion: Ast measurement from vaginal washing fluid appears to be a useful marker for the detection of PPROM.