Valéria Gaál

Relationship between Hyperglycemia and Retinopathy of Prematurity in Very Low Birth Weight Infants

Retinopathy of prematurity (ROP) is a multifactorial vasoproliferative retinal disorder that increases in incidence with decreasing gestational age. Recently, an association between hyperglycemia and severe ROP was found in extremely low birth weight infants (ELBWI). The purpose of this study was to evaluate the possible relation between hyperglycemia and ROP at any stage in very low birth weight infants (VLBWI). We analyzed the data of 201 VLBWI. The incidence of ROP and hyperglycemia was detected and the χ2 test was applied to investigate the association between the two variables. The Clinical Risk Index for Babies (CRIB) score was attributed as a marker of illness severity. The incidence of ROP and hyperglycemia in VLBWI was 35.3 and 19.4%, respectively. ROP developed more frequently in hyperglycemic infants (p < 0.001). The gestational age, birth weight, and Apgar scores were significantly lower, the CRIB score was higher in ROP patients. In hyperglycemic ROP patients the CRIB score was significantly higher compared to euglycemic ROP patients (mean (SD) 8.1 (4.2) vs. 5.5 (3.3); p < 0.01). A logistic regression model revealed that gestational age (OR 0.59; 95% CI 0.46–0.76; p < 0.001) and hyperglycemia (OR 3.15; 95% CI 1.12–8.84; p < 0.05) are independent risk factors in ROP development. When ELBWI were analyzed separately, gestational age (OR 0.38; 95% CI 0.20–0.72; p < 0.01) and CRIB score (OR 1.58; 95% CI 1.02–2.45; p < 0.05) were found as significant contributors. Further studies are needed to elucidate the pathophysiological role of hyperglycemia in the development of vasoproliferative retinal disorder.

Investigation of pituitary adenylate cyclase activating polypeptide in human gynecological and other biological fluids by using MALDI TOF mass spectrometry.

Pituitary adenylate cyclase activating polypeptide (PACAP) is a multifunctional and pleiotropic neuropeptide. PACAP has diverse effects in the endocrine system, among others, it plays important roles in oogenesis, implantation and development of the nervous system. However, it is not known whether PACAP is present in the fluids of the human reproductive organs. The aim of the present study was to determine, by means of mass spectrometry and radioimmunoassay, whether PACAP is present in human amniotic fluid, ovarian follicular fluid and cervico-vaginal fluid. Samples were obtained from healthy adult volunteers. Our MALDI TOF and MALDI TOF/TOF spectrometry results show that PACAP38 is present in all of the follicular fluid samples, and PACAP-like immunoreactivity was also measured by radioimmunoassay. However, we did not find the characteristic peak representing the unmodified 38 amino acid form of the peptide in normal cervico-vaginal smear and amniotic fluid samples. Furthermore, we analyzed other body fluids for comparison, such as human nasal fluid, saliva and aqueous humor. PACAP was not found in these latter samples. In summary, the present study provides evidence for the presence of PACAP in human follicular fluid, suggesting a role in oocyte function, but determination of the exact physiological significance awaits further investigation.

The effect of aspirin on hemorheological parameters of patients with diabetic retinopathy

Hemorheological factors play an important role in the pathogenesis of severe complications of diabetes. The diabetic retinopathy is the leading cause of blindness in patients aged 20-65 years. In our study we investigated the effect of aspirin on the hemorheological parameters in patients with different diabetic retinopathies. Hemorheological parameters (hematocrit, fibrinogen, plasma and whole blood viscosity, red blood cell aggregation) of diabetic patients with non-proliferative (n=14, mean age: 66 years) and proliferative retinopathy (n=8, mean age: 48 years) were measured. The results between the two groups were compared: twelve patients were taking aspirin (group A), while ten patients were not (group B).Hematocrit, fibrinogen, plasma and whole blood viscosity were significantly higher (p < 0.05-0.001) in patients with diabetic retinopathy who did not take aspirin than in those who took. No significant difference was observed in red blood cell aggregation parameters between the two groups. We could not find any significant difference in the measured parameters between patients with non-proliferative and proliferative diabetic retinopathy. According to our results, all the measured hemorheological parameters were in the pathological range, although aspirin treatment could decrease these factors and thus may help to prevent the progression of severe diabetic retinopathy and perhaps blindness.

Susac’s syndrome: clinical characteristics of a Hungarian case

UNLABELLED Encephalopathy, recurrent occlusion of retinal arteries and hearing loss comprise the clinical picture of Susacs syndrome. The correct diagnosis is frequently missed because of incomplete clinical signs or negligence of previous symptoms. Early diagnosis and treatment can halt the progression and prevent permanent disability. METHODS Here, we describe a Hungarian case and review the clinical characteristics, diagnostic procedures and current concepts of therapy. RESULTS A 30-year-old female was admitted to our neurology department because of change in her personality, apathy, and difficulty in concentration. Brain MRI indicated multiple hyperintense T2-weighted lesions including cerebellum and corpus callosum. Protein content of the CSF was markedly elevated. The recurrent bilateral loss of vision and hearing along with migraine in her previous 2,5-year-long medical history suggested Susacs syndrome. Fundoscopy and fluorescein angiography indicated multiple occlusions of the retinal arteries, audiography revealed bilateral hearing loss. Systemic autoimmune and connective tissue diseases and thrombophilia were excluded. The markedly elevated protein in the cerebrospinal fluid supported Susacs syndrome. Chronic treatment with methylprednisolone resulted in remission of clinical signs. DISCUSSION Consideration of multiple clinical signs is an important key to the diagnosis of rare clinical entities like Susacs syndrome.A Susac-szindroma ritka, tobbszoros szervi erintettseggel jaro korkep, melyet encephalopathiabol, a retinat ellato arteria againak okkluziojabol es hallascsokkenesből allo triasz jellemez. Ritka előfordulasa, fluktualo lefolyasa es a hosszabb-rovidebb ideig inkomplett klinikai kep miatt sokszor nem ismerik fel, pedig az időben megkezdett kezeles a prognozist kedvezően befolyasolja. Modszer: Kozlemenyunkben egy beteg esetet ismertetjuk, es osszefoglaljuk a korkep legfontosabb ismerveit, diagnosztikai es terapias lehetősegeit. Eredmenyek: A 30 eves nőbeteg ismeretlen eredetű encephalopathia, napok alatt kialakulo szemelyisegvaltozas, meglassult gondolkodas, inditekhiany miatt kerult a pszichiatriai, majd a neurologiai klinikankra. A koponya MR-vizsgalata multiplex feherallomanyi laesiokat, liquorvizsgalata emelkedett osszfeherjet mutatott. Az anamnezisben szereplő ismetlődő ketoldali lataszavar, hallascsokkenes es migrenes fejfajas az encephalopathiaval egyutt a fiatal nőbeteg eseteben Susac-szindroma lehet...

Fructosamine Levels and Hyperglycemia in Preterm Neonates

Background: Hyperglycemia is a common complication of prematurity, which requires attention because of its high prevalence and multiple consequences. Serum fructosamine used in diabetic patients provides information about the average glucose concentration in the preceding period of 2–3 weeks. Objective: We investigated the physiologic characteristics of a glycemic marker, fructosamine, in preterm and term neonates. We also studied its association with hyperglycemia and related morbidities of preterm infants. Method: Fructosamine levels of 22 extremely premature (gestational age, GA: 25.8 ± 1.0 weeks), 36 moderately premature (GA: 29.8 ± 1.3 weeks) and 26 term infants (GA: 39.1 ± 1.3 weeks) were determined in the 1st week of life. Fructosamine assay was repeated in all preterm neonates in the 4th and 7th postnatal weeks. Hyperglycemic episodes and main morbidities of preterm infants were recorded and analyzed in association with fructosamine levels. Results: Preterm infants had higher fructosamine levels after birth compared to term infants and a postnatal fall was observed. Serum fructosamine did not show association with the occurrence of hyperglycemia or its main morbidities in preterm infants. Conclusion: In the framework of our study, we could not confirm the usefulness of fructosamine determination in the glycemic control of preterm neonates during the perinatal period.

Life expectancy of extremely preterm infants

Extremely preterm infants [gestational age (GA) between 24-28 weeks] should be delivered optimally in an institute where neonatal intensive care unit (NICU) is available and their short- and long-term care is ensured. At the Department of Obstetrics and Gynecology, Medical School, University of Pécs, 7499 infants were born between 1st of January, 2000 and 31st of December, 2004. During this period the rate of preterm deliveries was 20% (1499/7499). Among preterm infants the incidence of extremely preterm babies (GA 28 weeks or less) was 18% (272/1499), the rate of profoundly preterm infants (GA less than 25 weeks) was 3.2% (48/1499). Advancing with gestational age the survival rate is increasing. At the department, the rate of handicapped infants among extremely premature babies was 15.3%. The majority of the handicapped infants were profoundly preterm, meanwhile, more than 50% of infants born at the 26 gestational weeks were free of symptoms influencing social activities. It is important to stress the prognostic value of the screening for hearing loss (otoacoustic emission), visual problems, and intracranial bleeding for the early detection and cure of the possible complications of prematurity.

Contents Vol. 95, 2009

S. Andersson, Helsinki E. Bancalari, Miami, Fla. G. Buonocore, Siena W.A. Carlo, Birmingham, Ala. V.P. Carnielli, Ancona W.J. Cashore, Providence, R.I. I.A. Choonara, Derby T. Curstedt, Stockholm O. Dammann, Boston, Mass. C. Dani, Florence B. Darlow, Christchurch P. Gluckman, Auckland M. Hallman, Oulu B. Jonsson, Stockholm S.E. Juul, Seattle, Wash. A. Llanos, Santiago R.J. Martin, Cleveland, Ohio C.J. Morley, Cambridge J. Neu, Gainesville, Fla. P.C. Ng, Hong Kong M. Obladen, Berlin A.G.S. Philip, Palo Alto, Calif. M. Post, Toronto E. Saliba, Tours O.D. Saugstad, Oslo B. Schmidt, Philadelphia, Pa. E. Shinwell, Rehovot J. Smith, Cape Town B. Sun, Shanghai H. Togari, Nagoya F. van Bel, Utrecht N. Vain, Buenos Aires M. Vento Torres, Valencia M. Weindling, Liverpool J.A. Widness, Iowa City, Iowa Fetal and Neonatal Research