Ebru 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.

Serum resistin and adiponectin levels in young non-obese women with polycystic ovary syndrome

Introduction. Although polycystic ovary syndrome (PCOS) was described more than half a century ago, the underlying cause of PCOS is still unknown. The aim of our study was to evaluate whether serum resistin and adipocytokine levels alter and its changes relate with low grade inflammation in non-obese young women with PCOS. Subjects and methods. Newly diagnosed 31 young non-obese women with PCOS (mean age 21.8 ± 5.4 years; body mass index (BMI): 23.8 ± 6.6 kg/m2) and 25 BMI- and age-matched, regular-cycling, healthy women (mean age 24.9 ± 5.7 years; BMI: 23.1 ± 5.8 kg/m2) were included the study Anthropometric measurements were evaluated. Resistin, adiponectin, glucose, insulin, hormone profiles, Lipoprotein (Lp)(a), high sensitive C reactive protein (hs-CRP), and homocysteine levels were measured in the beginning of oral glucose tolerance test. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Results. Non-obese young women with PCOS had high adiponectin levels (28.01 ± 6.47 ng/ml in PCOS vs. 23.89 ± 7.70 ng/ml in control subjects, p = 0.034), whereas serum resistin levels were not significantly different compared with healthy controls (14.14 ± 6.6 ng/ml in PCOS vs. 13.78 ± 4.26 ng/ml in control subjects). There were no significant differences between two groups in terms of fasting insulin, Lp(a), homocysteine, and hs-CRP levels. Mean HOMA-IR value of patients with PCOS was similar with control subjects (1.93 ± 0.73 in PCOS; 1.15 ± 0.54 in control group). Conclusions. Resistin levels did not change in non-obese young women with PCOS whereas adiponectin level in non-obese young women with PCOS was significantly higher than control subjects, perhaps, because of no insulin resistance. Circulating resistin levels may not be candidate to play a role in pathogenesis of PCOS without insulin resistance or obesity.

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.

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.

Amniotic fluid amino acid levels in non-immune hydrops fetalis: a case-control study

In a prospective case-control study, we compared the amniotic fluid amino acid levels in non-immune hydrops fetalis (NIHF) and normal fetuses. Eighty fetuses underwent amniocentesis for different reasons at the prenatal diagnosis unit of the Department of Obstetrics and Gynecology, Faculty of Medicine, Dicle University. Forty of these fetuses were diagnosed with NIHF. The study included 40 women each in the NIHF (mean age: 27.69 ± 4.56 years) and control (27.52 ± 5.49 years) groups, who had abnormal double- or triple-screening test values with normal fetuses with gestational ages of 23.26 ± 1.98 and 23.68 ± 1.49 weeks at the time of sample collection, respectively. Amniotic fluid amino acid concentrations (intra-assay variation: 2.26-7.85%; interassay variation: 3.45-8.22%) were measured using EZ:faast kits (EZ:faast GC/FID free (physiological) amino acid kit; Phenomenex, USA) by gas chromatography. The standard for quantitation was a mixture of free amino acids from Phenomenex. The levels of 21 amino acids were measured. The mean phosphoserine and serine levels were significantly lower in the NIHF group, while the taurine, α-aminoadipic acid (aaa), glycine, cysteine, NH(4), and arginine (Arg) levels were significantly higher compared to control. Significant risk variables for the NIHF group and odds coefficients were obtained using a binary logistic regression method. The respective odds ratios and 95% confidence intervals for the risk variables phosphoserine, taurine, aaa, Arg, and NH(4) were 3.31 (1.84-5.97), 2.45 (1.56-3.86), 1.78 (1.18-2.68), 2.18 (1.56-3.04), and 2.41 (1.66-3.49), respectively. The significant difference between NIHF and control fetuses suggests that the amniotic fluid levels of some amino acids may be useful for the diagnosis of NIHF.

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.

[Effect of multiparity on bone mineral density, evaluated with bone turnover markers].

OBJECTIVE Our aim was to investigate the effect of parity on osteoporosis by evaluating bone mineral density, markers of bone turn-over and other factors that are effective in osteoporosis in multiparous (five deliveries or more) and nulliparous women in the post-menopausal period. METHODS A total of 91 multiparous (five deliveries or more) and 31 nulliparous postmenopausal women were included in this study. All patients were interviewed on sociodemographic characteristics, gynecologic history, personal habits, levels of physical activity, and life-long intake of calcium. Bone mineral density was measured at lumbar (L1-4) and femoral neck regions with Dexa. RESULTS The mean age of multiparous women was 58.79±7.85 years, and the mean age of nulliparous women was 55.84±7.51. The femoral BMD was 0.94±0.16 and lumbar BMD 1.01±0.16 in multiparous women, femoral BMD was 0.99±0.16 and lumbar BMD 1.07±0.14 in nulliparous women. There were no statistical differences between the femoral and lumbar T scores and BMD values of the two groups. Lumbar T scores and lumbar BMD showed a decrease with increasing total duration of breast-feeding in multiparous women. The independent risk factors for osteoporosis in the regression analysis of multiparous women were found to be the duration of menopause and body weight of 65kg and less. CONCLUSION There is no difference between the bone mineral densities of multiparous and nulliparous women. Females with lower body-weight and longer duration of menopause should be followed-up more carefully for development of osteoporosis.

Efeito da multiparidade sobre a densidade mineral óssea, avaliada por marcadores de remodelação óssea

OBJECTIVE Our aim was to investigate the effect of parity on osteoporosis by evaluating bone mineral density, markers of bone turn-over and other factors that are effective in osteoporosis in multiparous (5 deliveries or more) and nulliparous women in the post-menopausal period. METHODS A total of 91 multiparous (5 deliveries or more) and 31 nulliparous postmenopausal women were included in this study. All patients were interviewed on sociodemographic characteristics, gynecologic history, personal habits, levels of physical activity, and life-long intake of calcium. Bone mineral density was measured at lumbar (L1-4) and femoral neck regions with Dexa. RESULTS The mean age of multiparous women was 58.79±7.85 years, and the mean age of nulliparous women was 55,84±7,51. The femoral BMD was 0,94±0,16 and lumbar BMD 1,01±0,16 in multiparous women, femoral BMD was 0,99±0,16 and lumbar BMD 1,07±0,14 in nulliparous women. There were no statistical differences between the femoral and lumbar T scores and BMD values of the two groups. Lumbar T scores and lumbar BMD showed a decrease with increasing total duration of breast-feeding in multiparous women. The independent risk factors for osteoporosis in the regression analysis of multiparous women were found to be the duration of menopause and body weight of 65kg and less. CONCLUSION There is no difference between the bone mineral densities of multiparous and nulliparous women. Females with lower body-weight and longer duration of menopause should be followed-up more carefully for development of osteoporosis.

Karaciğer hastalıklarında (siroz veya hepatit) homosistein ve selenyum düzeyleri

Background/aim: The liver has a crucial role in homocysteine synthesis and metabolism. Important changes in homocysteine metabolism occur when hepatic deficiency exists. Selenium levels have also been reported as being decreased in liver damage. Furthermore, many changes take place in the liver when selenium deficiency occurs, and the role in pathogenesis is being investigated. We aimed to search the changes in homocysteine and selenium levels in liver damage and determine the probable influencing factors. Materials and methods: Twenty-two chronic hepatitis (m:11, f:11, average age: 43.90±15.02), 28 cirrhotic patients (m:25, f:3, average age: 42.50±16.00) and 20 healthy subjects (m:12, f:8, average age: 36.65±8.29) were included in the study. Etiology was hepatitis B in 36, hepatitis C in 7, hepatitis B + D in 3 and Wilson disease in 1 patient. Three patients had cryptogenic cirrhosis. Homocysteine level was measured by fluorescent detector using high performance liquid chromatography (HPLC); selenium level in graphite mode by atomic absorption; AST, ALT, GGT and albumin by Abotte Aeroset autoanalyzer with photometric method; and vitamin B12 and folate levels by ELECYSIS E170 using chemiluminescence method; methylene tetrahydrofolate reductase (MTHFR) gene analysis in DNA of whole blood samples was done. Results: There was no significant difference between the three groups with respect to age. Both chronic hepatitis and cirrhotic groups had higher homocysteine levels than those of the control group (p=0.001). There was no difference in homocysteine levels between chronic hepatitis and cirrhotic groups. On the other hand, there was no difference between chronic hepatitis and control groups with respect to vitamin B12 levels. Vitamin B12 level was higher in the cirrhotic group than in controls and the difference was statistically significant. There was no difference between any of the groups in respect to folate levels. MTHFR gene mutation was similar in both patient and control groups. Selenium level was found to be lower in both patient groups than in the control group (p=0.001). Conclusion: Our results showed that hyperhomocysteinemia in chronic hepatitis and cirrhosis is not related to deficiency in folate and vitamin B12 and MTHFR gene mutation. It is seen that other enzymes involved in homocysteine metabolism might play a part in this process. It is noteworthy that selenium deficiency exists in both chronic hepatitis and liver cirrhosis.