Elif Didem Ozdemir

Sex-hormone-binding globulin early in pregnancy for the prediction of severe gestational diabetes mellitus and related complications.

Aims:  The aim of this study was to evaluate the predictive value of sex‐hormone‐binding globulin (SHBG) for the diagnosis of gestational diabetes mellitus (GDM), and to clarify the association between SHBG levels and GDM complications/medication requirements.

Maternal and umbilical cord ischemia-modified albumin levels in nonreassuring fetal heart rate tracings regarding the mode of delivery

Objective: To evaluate umbilical cord blood ischemia-modified albumin (IMA) levels in cases of fetal distress (FD) and to explore fetal blood IMA levels regarding the route of delivery. Methods: Umbilical cord and maternal serum IMA concentrations were assessed in term 40 cases with cesarean section (CS) due to FD, 76 cases with elective repeat CS and 85 cases with noncomplicated vaginal delivery. Results: The maternal and umbilical cord IMA levels were significantly lower in vaginal deliveries when compared with CS cases either in FD or previous CS groups (p = 0.02). Although no statistically significant difference was found in IMA levels of CS groups (previous CS vs. FD), cord blood IMA levels tend to be higher in FD group. Neither demographic characteristics nor fetal outcome parameters were found to have any correlation with maternal IMA levels. However, umbilical cord IMA levels were found to be negatively correlated with 1th min Apgar scores (r = –0.143, p = 0.043). Conclusions: IMA seems to be responsive to hypoxic FD showing the highest levels in cases with severe fetal hypoxia. Higher levels of IMA in cases with elective repeat CS might indicate acute transient hypoxia and possible myocardial ischemia in these cases.

Maternal and fetal blood levels of S100 and ischaemia modified albumin in term intrauterine growth restricted fetuses with abnormal umbilical artery Doppler values.

Abstract The purpose of this study was to investigate whether levels of fetal hypoxia markers, S100 and ischaemia modified albumin (IMA) change in cases of intrauterine growth restriction (IUGR). This case–control study included 15 intrauterine growth restricted fetuses and 20 age-matched controls. During delivery of the fetuses, cord blood and maternal blood S100 and IMA levels were studied. The fetal weight and umbilical cord pH values of IUGR fetuses were significantly lower than the control group. The mean maternal and umbilical cord blood values of S100 and IMA were similar in the two groups. IMA levels in cord blood of the IUGR group were significantly higher than maternal levels, whereas umbilical and maternal levels of IMA did not differ among control cases. In cases without brain sparing effect in Doppler ultrasonography, umbilical cord S100 and IMA levels do not change significantly in IUGR when compared with appropriate-for-gestational-age (AGA) fetuses.

The Association of Osteocalcin and Adiponectin with Glucose Metabolism in Nondiabetic Postmenopausal Women

Background/Aim: This study was designed to determine if osteocalcin is associated with insulin resistance, metabolic risk factors and adiponectin levels in nondiabetic postmenopausal women. Methods: A total of 87 menopausal nondiabetic subjects were enrolled into the study. Levels of fasting plasma glucose (FPG), insulin and serum lipids were determined. To estimate insulin sensitivity, homeostasis model assessment (HOMA-IR) and the quantitative insulin sensitivity check index (QUICKI) were used. Serum total osteocalcin and adiponectin levels were measured and the features of metabolic syndrome were identified. Results: The mean age of the patients was 54.7 years. Among the participants, 28.7% were obese (body mass index, BMI, ≥30). Insulin resistance was detected by HOMA-IR in 42.5% and by the QUICKI index in 63.2% of the cases. Metabolic syndrome was present in 29.8% of the patients. Neither the baseline characteristics nor the metabolic risk factors were correlated with osteocalcin or adiponectin levels (p > 0.05). When the patients were analyzed regarding BMI, osteocalcin levels were significantly lower in overweight women. Serum adiponectin levels were significantly lower in women with metabolic syndrome. Conclusion: No correlation between total osteocalcin and FPG, fasting insulin and insulin resistance parameters was found in nondiabetic postmenopausal women. Serum levels of adiponectin were associated with metabolic syndrome.

Ischaemia-modified albumin in preeclampsia: A critical view

Abstract The aim of the study was to compare ischaemia-modified albumin (IMA) levels, both original and corrected, in healthy pregnancies and pregnancies complicated with preeclampsia. Maternal and cord blood samples from study (n = 16) and control (n = 17) groups were collected at the time of delivery. IMA levels were given in absorbance units (ABSU). IMA levels, both original and corrected, were compared between study and control groups. No significant difference was found between maternal and cord blood IMA levels between the study and control groups [1.0 (0.3–3.5) vs 1.2 (0.2–1.4) ABSU, p = .053 and 1.0 (0.1–2.2) vs 0.9 (0.4–3.6) ABSU, p = .382, respectively]. The results were similar for maternal IMA levels, after correction of IMA levels [1.1 (0.3–5.1) vs 1.2 (0.2–1.6) ABSU, p = .292]. IMA is a novel marker for ischaemia, without precise conclusions about its value in preeclampsia. An absolute correction formula, considering all possible intervening factors, is required for more accurate results.

The association between prolactin, high-sensitivity C-reactive protein and Framingham risk score in menopause.

Aims: To evaluate the association between serum prolactin, high-sensitivity C-reactive protein (hs-CRP) levels and cardiovascular disease risk in postmenopausal women regarding the Framingham Risk Score (FRS). Methods: Fifty-eight menopausal women were enrolled into the cross-sectional study. All participants had 24-hour ambulatory blood pressure monitoring, echocardiography, electrocardiography, and carotid intima-media thickness measurement. Blood samples were obtained for prolactin, hs-CRP, lipid profile, fasting glucose, and insulin. Results: Among the participants, 67.24% had a FRS <10%, and 32.75% had a FRS ≥10%. Levels of prolactin and hs-CRP did not differ between the FRS groups. In the FRS <10% group, significantly higher levels of prolactin were found. Cases with hypertension have significantly higher levels of hs-CRP. Prolactin and hs-CRP were found to be associated with hypertension in the FRS <10% and ≥10% groups, respectively. Conclusions: Hypertensive postmenopausal women with low risk for cardiovascular diseases have increased levels of prolactin, suggesting a possible role in the pathogenesis of hypertension. The correlation of hs-CRP with systolic blood pressure can be interpreted as a potential effect of hypertensive heart disease reflecting a state of high-risk milieu with elevated inflammatory markers.

Atherogenic dyslipidemia, subclinical atherosclerosis, non-alcoholic fatty liver disease and insulin resistance in polycystic ovarian syndrome / [Polikistik over sendromunda insülin direnci, aterojenik dislipidemi, subklinik aterosklerozis ve non-alkolik yağlı karaciğer hastalığı]

Abstract Objective: We aimed to explore the relationship between insulin resistance (IR) and small dense lipoprotein (sd-LDL) particles, carotid intima-media thickness (CIMT) and non-alcoholic fatty liver disease (NAFLD) in young normal weight PCOS cases. Methods: This prospective, case-control study was designed in a University Hospital and 34 women with PCOS and 21 healthy controls were enrolled. Fasting plasma glucose, insulin, lipid (including sd-LDL particles) and hormone profiles, abdominal ultrasound and CIMT were evaluated. Results: IR was present in 68% of PCOS group while in none of controls. High density lipoprotein (HDL), very low density lipoprotein (VLDL), triglycerides (TG), and sd-LDL were higher in patients with IR (p<0.05). A positive correlation of sd-LDL with IR, VLDL and TG was found. A significantly higher rate of NAFLD and CIMT was found in PCOS. Totaltestosterone levels were weakly and positively correlated with CIMT (r=0.277, p=0.041). Conclusion: Insulin resistance and NAFLD are highly prevalent among young normal weight PCOS patients. When compared to controls levels of sd-LDL and CIMT are increased in PCOS. Insulin resistance is the key parameter for NAFLD and atherogenic dyslipidemia in PCOS. Hence, screening for NAFLD may be valuable for detection and prevention of liver disease. Higher levels of sd-LDL in insülin resistant PCOS cases necessiates treating PCOS for IR. Özet Amaç: Bu çalışmada, genç, normal kilolu PKOS hastalarında insülin direncinin ve küçük dansiteli lipoprotein (sd-LDL) partiküllerinin, karotis intima-media kalınlığı ve non-alkolik yağlı karaciğer hastalığı ile ilişkisinin araştırılmasını hedefledik. Metod: Otuzdört PKOS’lu hasta ile 21 sağlıklı kontrol hastasını içeren bu prospektif vakakontrollü çalışma bir üniversite hastanesinde yürütüldü. Hastaların açlık plazma glukoz, insülin düzeyleri, lipid (sd-LDL partiküllerini de içeren) ve hormon profilleri, abdominal ultrasonografi ve karotis intima-media kalınlığı değerlendirildi. Bulgular: İnsülin direnci, PKOS’lu hastaların %68’inde mevcut iken kontrol grubunda hiçbir hastada saptanmadı. Yüksek dansiteli lipoprotein (HDL), çok düşük dansiteli lipoprotein (VLDL), trigliserid (TG) ve sd-LDL insülin direnci olan hastalarda yüksekti (p<0.05). sd-LDL ile insülin direnci, VLDL ve TG arasında pozitif korelasyon saptandı. PKOS’da belirgin daha yüksek oranda non-alkolik yağlı karaciğer hastalığı ve artmış karotis intima-media kalınlığı izlendi. Total testosteron seviyeleri karotis intima-media kalınlığı ile zayıf pozitif korele idi (r=0.277, p=0.041). Sonuç: İnsülin direnci ve non-alkolik yağlı karaciğer hastalığı normal ağırlıklı PKOS hastalarında yaygındır. Kontrollerle kıyaslandığında, sd-LDL ve karotis intima-media kalınlığı PKOS’da artmıştır. İnsülin direnci, non-alkolik yağlı karaciğer hastalığı ve aterojenik dislipidemi için anahtar noktadır. Bu nedenle, karaciğer yönünden tarama karaciğer hastalığının tanınmasında ve önlenmesinde değerlidir. İnsülin dirençli PKOS vakalarında yüksek sd-LDL bu konuda tedaviyi gerekli kılmaktadır.

Importance of HbA1c and Fructosamine As A Marker Of Glycemic Control and Evaluation Of Some Biochemical Parameters During Pregnancy

Objective: Controlling and monitoring the diabetes during pregnancy, because of the malformation, macrosomia and other complications is especially important. Our study is designed to investigate the reliability of the two most commonly used parameter is the hemoglobin A1c (HbA1c) and fructosamine during pregnancy. Also among our study group, serum total protein, albumin, vitamin B12, folic acid, glucose, insulin, ferritin and hemoglobin data were evaluated. Methods: The study groups are pregnant women (n=252; age mean: 27,761± 5/year) and control group (n=28; age mean: 28,61± 5,38/year) who are no additional health problems. Diabetic pregnant women number is 124 (consisted of 10 first trimester, 62 second trimester and 52 third trimester) and nondiabetic pregnant women number is 138 (consisted of 24 first trimester, 32 second trimester and 82 third trimester). All measurement data are obtained from hospital information system. Results: No statistically significant difference in any of the groups for HbA1c. It’s clearly observed that all the significant differences found for fructosamine occur depending on the level of albumin and fructosamine levels decreased progressively during the three trimesters. In our diabetic pregnant women group; although statistically make a difference; mean blood glucose values were below our expectations. Conclusion: Our study is support that fructosamine and HbA1c are unavailable for diagnosis and monitoring the gestational diabetes. However the lack of difference between the groups for levels of fructosamine and HbA1c; and blood glucose levels below our expectations in diabetic pregnant women group can be connected good diabetes control.

Collagen cross-links as a marker for subclinical atherosclerosis in postmenopausal women.

ObjectiveThis study aimed to examine the utility of pyridinoline (Pyd) and deoxypyridinoline (Dpd) cross-links in the detection of subclinical atherosclerosis in postmenopausal women with or without osteoporosis. MethodsWe measured Pyd, Dpd, carotid intima-media thickness (CIMT), fasting total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and blood pressure in 59 healthy postmenopausal women: 30 had normal bone mineral density (group I) and the remaining 29 had osteoporosis or osteopenia (group II) according to World Health Organization criteria. ResultsThere were no statistically significant differences in age, duration of menopause, age at menopause, lipid profile, body mass index, Pyd level, Dpd level, and Pyd-to-Dpd ratio between the groups (P > 0.05). No significant difference in CIMT was found when groups I and II were compared (P = 0.538). No statistically significant differences in Pyd level, Dpd level, and Pyd-to-Dpd ratio were found when women with CIMT higher than 5 mm and women with CIMT of 5 mm or less were compared in groups I and II (P > 0.05). However, significantly declined Dpd level and increased Pyd-to-Dpd ratio were found in women with CIMT higher than 5 mm when compared with women with CIMT of 5 mm or less. CIMT was found to be negatively correlated with Dpd level (r = −0.346, P = 0.007) and to be positively correlated with the Pyd-to-Dpd ratio (r = 0.702, P < 0.001). ConclusionsThe increase in the Pyd-to-Dpd ratio, irrespective of the participants’ bone mineral density, may have predictive value in the determination of subclinical atherosclerosis in postmenopausal women.