Eren Pek

Elevated circulating nitric oxide levels correlates with enhanced oxidative stress in patients with hyperemesis gravidarum

Abstract Since the biochemical and molecular mechanisms responsible for ongoing oxidative stress in hyperemesis gravidarum (HEG) patients have not yet been fully elucidated, the aim of this study was to evaluate the possible role of nitric oxide (NO), malondialdehyde (MDA) and other oxidative stress markers in the disease pathophysiology. Moreover, the relation between oxidative stress markers and Helicobacter pylori (H. pylori) infection was also investigated. Women with pregnancies complicated by HEG (n = 33) were compared with pregnant women without HEG (n = 30) and with healthy non-pregnant women (n = 31). Serum NO, MDA, total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI) and H. pylori infection status were determined for each subject. Serum NO levels and OSI index were found to be increased (p = .001 and .013, respectively) and TAS levels were decreased (p < .001) in HEG patients compared with both controls regardless of H. pylori infection status. Serum MDA and TOS levels were not different between the study groups. Helicobacter pylori infection rates were similar in each group. The reduced antioxidant activities, as well as the increased OSI and NO levels in HEG patients indicate possible oxidative stress conditions in HEG patients. Moreover, serum NO levels may be used as an adjunctive marker to distinguish HEG patients from other causes of emesis during pregnancy. Impact statement What is already known on this subject? Current evidence suggests that oxidative stress is a significant factor responsible for a number of complications during pregnancy. What do the results of this study add? Hyperemesis gravidarum is an oxidative stress condition, as reflected by increased nitric oxide (NO) and decreased total antioxidant status activity, regardless of H. Pylori infection. What are the implications for clinical practice and/or further research? Full disclosure of the association between circulating NO and hyperemesis gravidarum would shed light on underlying biological mechanisms and could help clinical management of similar pregnancy-associated morbidity states.

Evaluation of the hematologic system as a marker of subclinical inflammation in hyperemesis gravidarum: a case control study

OBJECTIVES Current evidence suggests that subclinical inflammation plays a significant role in the development of hyperemesis gravidarum (HEG). Simple hematological markers, such as mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), have been shown to reflect inflammatory burden and disease activity in several disorders. This study aimed to determine the diagnostic value of these hematological parameters for HEG. MATERIAL AND METHODS A total of 54 HEG patients and 58 age- and gestational-age-matched control subjects were studied. NLR, MPV, PLR, platelet distribution width (PDW), and red cell distribution width (RDW) values in all patients were calculated and recorded from complete blood cell counts. RESULTS For HEG patients, the median NLR was 3.2 (1.6-7.1), and the median PLR was 143.7 (78.1-334.6); for control subjects, the values were 2.1 (1.0-4.7) and 93.1 (47.3-194.7), respectively. Although both the NLR and PLR of HEG patients were found to be significantly higher than in the controls, no significant difference was found between the study groups in terms of MPV, RDW, or PDW. Correlation analysis revealed a significant correlation between NLR and CRP (r = 0.872, p < 0.001). CONCLUSIONS Our results show that peripheral blood NLR and PLR values can reflect inflammatory burden in HEG patients and can be used as markers for HEG.

Effects of vitamin B 12 , folate, uric acid, and serum biomarkers of inflammation on bone mineral density in postmenopausal women

Introduction Despite the accumulating evidence suggesting a possible relationship between femur and lumbar bone mineral density (BMD) and serum uric acid (UA), it is unclear whether alterations in UA levels reflect any underlying subclinical inflammatory conditions in postmenopausal osteoporosis. In addition, the mechanistic link between osteoporosis and dietary factors including vitamin B12 and folate in postmenopausal women is still obscure. The aim of the present study is to investigate the association between serum vitamin B12, folate, UA, and subclinical inflammatory markers and BMD measurements in postmenopausal women. Material and methods One hundred and eighty-four postmenopausal women were recruited for the present study. Clinical data, as well as serum vitamin B12, folate, UA, conventional inflammatory markers, and other related biochemical markers, were assessed for each subject. Bone mineral density measurements of proximal femur and lumbar spine were taken using dual-energy X-ray absorptiometry. Correlation analysis was performed between serum vitamin B12, folate, UA and other biochemical and metabolic parameters. Results Although no association was found between serum inflammatory markers, vitamin B12 and folate levels with femur neck and lumbar spine BMD measurements, elevated UA levels were observed in subjects with normal BMD values. Higher BMD values were obtained in higher UA tertiles. UA (p < 0.001) and BMI (p = 0.003) were found to be correlated with femur neck BMD measurements. Conclusions The femoral and lumbar BMD measurements were associated with serum UA levels. Higher serum UA levels were found to have a protective effect on postmenopausal osteoporosis irrespective of inflammation and dietary factors.

Impact of distinct factors affecting serum homocysteine levels in preeclamptic women

In their article on a recent issue of Archives of Gynecology and Obstetrics, Maged and colleagues [1] briefly address the importance of maternal serum total homocysteine and uterine artery Doppler as predictors of preeclampsia (PE) and intrauterine growth restriction (IUGR). They conclude that the combined use of uterine artery Doppler velocimetry and serum total homocysteine improves the prediction accuracy of poor placentation disorders more than each predictor alone. However, we have some remarks concerning the lack of evaluation of distinct variables that could affect serum homocysteine levels. In the discussion section of the paper, authors mention that vitamins B6, B9, and B12 and folic acid are needed as cofactors for proper homocysteine enzyme functioning but there is no information on the rest of the manuscript regarding the serum status of vitamin B12 and folic acid of their patient population. Both of these vitamins are involved in one carbon metabolism and associated with increases in circulating plasma homocysteine levels and reduction in DNA methylation patterns resulting in genome instability events [2]. Although a majority of epidemiological studies have shown homocysteine levels correlate inversely more closely with plasma folate levels and less so with vitamin B12 and B6 levels, it has been shown that strict vegetarians are often at severe risk for hyperhomocysteinemia due to low plasma B12 levels [3, 4]. In this context, the Hordaland Homocysteine Study can be regarded as one of the biggest community-based studies of homocysteine and its determinants [5]. In this study, older age, male sex, smoking, coffee consumption, high blood pressure, unfavorable lipid profile, high creatinine, and the MTHFR 677C polymorphism are mentioned to be the factors associated with increased homocysteine levels and physical activity, moderate alcohol consumption, and a good folate or vitamin B12 status are associated with lower homocysteine levels. Among these variables age, smoking, sex and folate intake are reported to be the strongest determinants of serum total homocysteine concentration in the general population. For this reason, we think that in a study evaluating the role of homocysteine on preeclampsia and other placental complications, determining the effect of serum folate and vitamin B12 levels on placental functioning could be noteworthy in the context of this close relationship. In conclusion, although this trial provides a promising evidence for combined use of homocysteine and uterine artery Doppler in predicting placental abnormalities in preeclampsia in a setting of reduced uterine perfusion, it must be noted that folate and vitamin B12 deficiencies could also be related to the final outcome.

A rare case of complete penoscrotal transposition with hypospadias in a newborn

Dear Editor, Penoscrotal transposition (PST) is an infrequent congenital external genital malformation in which the scrotum is located superior and anterior to the penis(1). PST can be defined as either complete or incomplete according to the positional exchanges between the penis and scrotum and both forms of PST are generally linked with hypospadias. Incomplete transposition is the common form of this entity and the penis lies in the middle of the scrotum, but in complete transposition, the scrotum almost entirely covers the penis, which emerges from the perineum(2). Both of these conditions are commonly reported to be linked with a wide variety of abnormalities and pathologies that affect distinct organ systems. In this case report, we present a complete PST in a patient with urinary tract abnormalities including hypospadias, polycystic renal disease, and malpositioned right kidney. A gravida 2, para 1 woman aged 35 years was admitted to the emergency department of our institute with premature membrane rupture when she was 36 weeks’ pregnant. The patient had undergone one prior cesarean delivery. The ultrasound examination revealed severe oligohydramnios. No previous histories of genetic abnormalities, illicit drug use, cigarette or alcohol consumption were reported. During her pregnancy, perinatal evaluations with ultrasound were performed at 26+6 weeks of gestation, which demonstrated a single umbilical artery, bilateral pelvic kidney, megacystitis, and penile curvature extending to the anal sphincter. Unfortunately, we were not able to obtain prenatal ultrasound pictures or a genetic analysis report because of the nature of the emergency hospital admission of the patient. A final prenatal diagnosis of PST and severe hypospadias was made based on these perinatal evaluations. The patient underwent a cesarean section and gave birth to a male baby of 3070 grams with 8/9 Apgar score. Physical examination revealed a PST and severe hypospadias (Figure 1). Laboratory examinations were all reported to be normal. Ultrasonographic examination revealed a malpositioned right kidney (low lying) with multiple anechoic cysts of varying sizes. The newborn was transferred to the neonatal intensive care unit for further treatment. PST is a very rare clinical situation in which the scrotum is located anterior and superior to the penis and a severe degree of PST, as in our case, with hypospadias and normal scrotum have been infrequently reported in medical literature(1,3,4). During normal human maturation, scrotal swellings move inferomedially during the 9th-11th week, and fuse in the midline caudal to the penis by the 12th week of gestation(4). The primary cause of this rare clinical disorder is a fusion defect or delay of urethral folds. Embryologically, PST is considered to result from abnormal genital tubercle development around the 6th-7th week of gestation(1). The differential diagnosis for PST should include pseudohermaphroditism, micropenis, penile amputation in the intrauterine period, penoscrotal hypospadias, and agenesis of