Prunus mume extract and choline treatment in patients with non-alcoholic fatty liver disease estimated by b-mode ultrasonography and hepatorenal index.

Background: The aim of this study was to find the difference between the liver function test (LFT) and hepatorenal index (HRI), before and after the administration of Prunus mume (PM) and choline i.e., to find the predictors of the non-alcoholic fatty liver disease (NAFLD) severity according its HRI, during the three-month follow-up period. Methods: LFT, glucose, and lipid tests were determined in 168 NAFLD patients, at baseline and after three-month drug treatment. HRI was calculated by Image J software analyzing the ultrasound images, and according its value, 3 groups of NAFLD were formed. Results: The HRI at baseline (1.3598±0.1744) and after 3 months therapy (1.3061±0.1923) differs significantly (p<0.0001). Plasma glucose (FPG) (p<0.0001), glycated hemoglobin (HbA1c) (P=0.002), alanine aminotransferase (ALT) (p<0.0001), aspartate aminotransferase (AST) (P=0.0006), gamma-glutamil transferase (γ-GT) (P=0.0053), high density lipoprotein cholesterol (HDL-Ch) (p<0.0001) and triglycerides (P=0.041) differ significantly, too. HRI is positively correlated with: HbA1c (P=0.035), ALT (P=0.002), AST (P=0.003), γ-GT (P=0.043), and triglycerides (P=0.002) and inversely correlated with HDL-Ch (P=0.011). In multiple regression results (standard coefficient and p-value), the independent predictors for HRI in NAFLD patients were: HbA1c (0.1443, 0.0004), ALT (0.001142, 0.0081), triglycerides (0.0431, 0.0235) and γ-GT (0.001376, 0.0329). Conclusion: Three-month administration of PM and choline have beneficial effects on the regulation of glucose and lipid metabolism (HDL-Ch), and on LFT. This plant extract significantly reduces the levels of FPG, HbA1c, ALT, AST, γ-GT, triglycerides and increases HDL-Ch. The triglycerides, ALT, γ-GT and HbA1c are positive independent predictors for the severity of NAFLD.

ISOLATED MATERNAL HYPOTHYROXINEMIA AND ITS PERINATAL OUTCOME IN NORTH MACEDONIA.

Isolated maternal hypothyroxinemia (IMH) is defined as the presence of low maternal total thyroxine (TT4) level in conjunction with normal maternal thyroid-stimulating hormone (TSH) level. The aim was to investigate whether IMH is associated with adverse pregnancy outcome in North Macedonia. Dried blood spot samples were obtained from 359 pregnant women meeting the inclusion criteria and analyzed for TT4 and TSH. Postpartum data were entered from their medical histories. Out of 359 women, 131 (37.42%) belonged to IMH group. There were statistically significant differences in birth weight (p=0.043), intrauterine growth restriction (IUGR) (p=0.028), Apgar score at 1 min <7 (p=0.018) and cesarean section for dystocia/disproportion (p=0.024) between the IMH and normal thyroid function (NTF) groups. In regression analysis, TSH was a significant variable predicting Apgar score (ßst=0.05597, p=0.047), body mass index predicting birth weight (ßst=0.02338, p=0.045) and TT4 predicting small for gestational age/IUGR (ßst=-0.089834, p=0.029) in IMH group. TT4 was a strong predictor of birth weight (ßst=-0.004778, p=0.003) and premature delivery (ßst=0.028112, p=0.004) in NTF group. The impact of IMH in pregnancy remains controversial. IMH was associated with an increased maternal BMI and higher birth weight of neonates. Overweight could be a potential risk factor for thyroid dysfunction in pregnant women, and specifically IMH. The worst fetal outcome was seen in IMH mothers examined in second trimester. We found TSH, TT4 and BMI to be strong predictors of perinatal outcomes.

Thyroid Function of Pregnant Women and Perinatal Outcomes in North Macedonia.

OBJECTIVE: Thyroid diseases are the second most common endocrine disorders in the reproductive period of women. They can be associated with intrauterine growth restriction (IUGR), preterm delivery, low Apgar score, low birthweight (LBW) or fetal death. The aim of the present study is to explore thyroid dysfunction and its relationship with some poor perinatal outcomes (Apgar Score, low birthweight, and preterm delivery). METHODS: Dried blood spot samples from 358 healthy pregnant women were analyzed for thyroid stimulating hormone (TSH), total thyroxine (TT4), and thyroglobulin (Tg). Neonatal data were collected upon delivery. Four groups were formed based on thyroid function tests (TFTs). RESULTS: Of the 358 tested women, 218 (60.72%) were euthyroid. Isolated hypothyroxinemia was present in 132 women (36.76%), subclinical hyperthyroidism in 7 women (1.94%), and overt hypothyroidism in 1 (0.28%). The perinatal outcomes IUGR (p = 0.028) and Apgar score 1 minute (p = 0.015) were significantly different between thyroid function test [TFT]-distinct groups. In the multiple regression analysis, TT4 showed a statistically significant inverse predictive impact on LBW (p < 0.0001), but a positive impact of Tg on LBW (p = 0.0351). CONCLUSION: Thyroid hormones alone do not have a direct impact on neonatal outcomes, but the percentage of their participation in the total process cannot be neglected. Based on the regression analysis, we can conclude that TT4 and Tg can be used as predictors of neonatal outcome, expressed through birthweight and Apgar score. The present study aims to contribute to determine whether a test for thyroid status should become routine screening during pregnancy.

OBJETIVO: As doenças da tireoide são as segundas doenças endócrinas mais comuns no período reprodutivo das mulheres. Elas podem estar associadas à restrição de crescimento intrauterino (RCIU), parto prematuro, baixo índice de Apgar, baixo peso ao nascer (BPN) ou morte fetal. O objetivo do presente estudo é explorar a disfunção tireoidiana e sua relação com alguns resultados perinatais insatisfatórios (índice de Apgar, baixo peso ao nascer e parto prematuro). MéTODOS: Amostras secas de sangue em 358 gestantes saudáveis foram analisadas para hormônio estimulador da tireoide (TSH), tiroxina total (TT4) e tireoglobulina (Tg). Os dados neonatais foram coletados no momento do parto. Quatro grupos foram formados com base em testes de função tireoidiana (TFT). RESULTADOS: Das 358 mulheres testadas, 218 (60,72%) eram eutireoidianas. Hipotiroxinemia isolada estava presente em 132 mulheres (36,76%), hipertireoidismo subclínico em 7 mulheres (1,94%) e hipotireoidismo evidente em 1 (0,28%). Os resultados perinatais RCIU (p = 0,028) e índice de Apgar de 1 minuto (p = 0,015) foram significativamente diferentes entre os grupos distintos de TFT. Na análise de regressão múltipla, TT4 mostrou impacto preditivo inverso estatisticamente significativo no BPN (p < 0,0001), mas impacto positivo da Tg no BPN (p = 0,0351). CONCLUSãO: Isoladamente, os hormônios tireoidianos não têm impacto direto no desfecho neonatal, mas o percentual de sua participação no processo total não pode ser desprezado. Com base na análise de regressão, podemos concluir que TT4 e Tg podem ser usados como preditores do resultado neonatal, expressos por meio do peso ao nascer e do índice de Apgar. O presente estudo tem como objetivo contribuir para que um teste para verificar o estado da tireoide deva se tornar um rastreamento de rotina durante a gravidez.

Thyroid Function of Pregnant Women and Perinatal Outcomes in North Macedonia / Função tireoidiana de mulheres grávidas e resultados perinatais na Macedônia do Norte

Abstract Objective Thyroid diseases are the second most common endocrine disorders in the reproductive period of women. They can be associated with intrauterine growth restriction (IUGR), preterm delivery, low Apgar score, low birthweight (LBW) or fetal death. The aim of the present study is to explore thyroid dysfunction and its relationship with some poor perinatal outcomes (Apgar Score, low birthweight, and preterm delivery). Methods Dried blood spot samples from 358 healthy pregnant women were analyzed for thyroid stimulating hormone (TSH), total thyroxine (TT4), and thyroglobulin (Tg). Neonatal data were collected upon delivery. Four groups were formed based on thyroid function tests (TFTs). Results Of the 358 tested women, 218 (60.72%) were euthyroid. Isolated hypo thyroxinemia was present in 132 women (36.76%), subclinical hyperthyroidism in 7 women (1.94%), and overt hypothyroidism in 1 (0.28%). The perinatal outcomes IUGR (p = 0.028) and Apgar score 1 minute (p = 0.015) were significantly different between thyroid function test [TFT]-distinct groups. In the multiple regression analysis, TT4 showed a statistically significant inverse predictive impact on LBW (p < 0.0001), but a positive impact of Tg on LBW (p = 0.0351). Conclusion Thyroid hormones alone do not have a direct impact on neonatal outcomes, but the percentage of their participation in the total process cannot be neglected. Based on the regression analysis, we can conclude that TT4 and Tg can be used as predictors of neonatal outcome, expressed through birthweight and Apgar score. The present study aims to contribute to determine whether a test for thyroid status should become routine screening during pregnancy.

Resumo Objetivo As doenças da tireoide são as segundas doenças endócrinas mais comuns no período reprodutivo das mulheres. Elas podem estar associadas à restrição de crescimento intrauterino (RCIU), parto prematuro, baixo índice de Apgar, baixo peso ao nascer (BPN) ou morte fetal. O objetivo do presente estudo é explorar a disfunção tireoidiana e sua relação com alguns resultados perinatais insatisfatórios (índice de Apgar, baixo peso ao nascer e parto prematuro). Métodos Amostras secas de sangue em 358 gestantes saudáveis foram analisadas para hormônio estimulador da tireoide (TSH), tiroxina total (TT4) e tireoglobulina (Tg). Os dados neonatais foram coletados no momento do parto. Quatro grupos foram formados com base em testes de função tireoidiana (TFT). Resultados Das 358 mulheres testadas, 218 (60,72%) eram eutireoidianas. Hipotiroxinemia isolada estava presente em 132 mulheres (36,76%), hipertireoidismo subclínico em 7 mulheres (1,94%) e hipotireoidismo evidente em 1 (0,28%). Os resultados perinatais RCIU (p = 0,028) e índice de Apgar de 1 minuto (p = 0,015) foram significativamente diferentes entre os grupos distintos de TFT. Na análise de regressão múltipla, TT4 mostrou impacto preditivo inverso estatisticamente significativo no BPN (p < 0,0001), mas impacto positivo da Tg no BPN (p = 0,0351). Conclusão Isoladamente, os hormônios tireoidianos não têm impacto direto no desfecho neonatal, mas o percentual de sua participação no processo total não pode ser desprezado. Com base na análise de regressão, podemos concluir que TT4 e Tg podem ser usados como preditores do resultado neonatal, expressos por meio do peso ao nascer e do índice de Apgar. O presente estudo tem como objetivo contribuir para que um teste para verificar o estado da tireoide deva se tornar um rastreamento de rotina durante a gravidez.

The Gamma Gap Predicts All-Cause Mortality in Chronic Dialysis Patients.

INTRODUCTION: The gamma gap (γ-gap) represents the total serum protein concentration minus the albumin concentration. The main aim of this study was to test whether the gamma gap is a predictor of mortality and whether it is associated with other predictors of mortality in chronic hemodialysis patients (CHPs). MATERIALS AND METHODS: We studied a cohort of 100 CHPs with a mean age of 59 ± 12.3 years with duration of dialysis 6.5 ± 4.7 years. Serum proteins were determined by electrophoresis. The association of the gamma gap with serum C-reactive protein (CRP), fibrinogen and albumin concentration was evaluated for correlation. Cox regression analysis was used to identify the predictors of mortality. RESULTS: The γ-gap correlates positively with CRP (r = 0.247, P = 0.013) and fibrinogen (r = 0.239, P = 0.016), and inversely with albumin (r = -0.430, P < 0.0001). The regression coefficients (b) and Exp (b) hazard ratio coefficients of covariates in Cox-regression survival analysis in all-cause outcomes were: b = 0.1486, Exp (b) = 1.1602 (P < 0.0001); b = 0.0655, Exp (b) = 1.0677 (P < 0.0015) and b = -0.118, Exp (b) = 0.8887 (P < 0.0009), for γ-gap, CRP and albumin, respectively. CONCLUSIONS: In patients on chronic hemodialysis, the gamma gap, along with serum albumin and CRP levels, is an independent predictor of mortality. Gamma gap levels correlate directly with serum CRP and fibrinogen levels and inversely with serum albumin levels.

Which Better Determines the Renal Function and Glomerular Filtration Rate: Renal Parenchymal Thickness or Renal Resistive Index?

Resistive index (RI) could provide more useful diagnostic and prognostic information for kidney disease than parenchymal thickness (PT) only. The aims of this study were to find the association between PT, glomerular filtration rate (GFR), and RI and their determination of renal function. B-mode and Doppler ultrasonography and standard biochemical laboratory testing (urea and creatinine) were performed among 75 participants (57.1 ± 10.6 years). We measured PT and RI and calculated GFR. The mean and standard deviation were 0.671 ± 0.041, 12.24 ± 1.98 mm, and 86.38 ± 15.96 mL/min/1.73 m2 for RI, PT, and GFR, respectively. The mean RI in two subgroups with PT smaller or greater than 12.5 mm was RI1 = 0.692 ± 0.038 or RI2 = 0.648 ± 0.03 (P <0.0001). Strong inverse correlation between RI (y) and PT (x) presented by the linear regression equation: y = 0.744 + (-0.005932 x). By multiple regression, we show GFR and PT as predictors for increasing of RI (R2 = 0.2063, ßst = -0.0009176, P = 0.0012 and ßst = -0.006003, P = 0.0078), respectively. Renal RI inversely strongly correlates with the PT and GFR. Renal PT and GFR are independent predictors for increasing of RI in general population.

The predictive value of the hepatorenal index for detection of impaired glucose metabolism in patients with non-alcoholic fatty liver disease.

BACKGROUND/PURPOSE: Non-alcoholic fatty liver disease (NAFLD) patients are at increased risk of liver-related as well as cardiovascular mortality, including diabetes, coronary heart disease, and stroke, independently of traditional cardiovascular risk factors and metabolic syndrome. The aim of this study was to find out the predictive impact of hepatorenal index (HRI) in the detection of impaired glucose metabolism in asymptomatic NAFLD patients. METHODS: B-mode ultrasound examinations were performed and ultrasound images from all 89 NAFLD patients aged 50.8 ± 10.1 years were analyzed by echogenicity analyzing software and HRI was acquired, and appropriate laboratory tests for liver, glucose, and lipid metabolism were undertaken. RESULTS: The mean HRI was 1.345 ± 0.189. 23.59% of patients had mild NAFLD (HRI = 1.167 ± 0.041), 64.04% moderate (HRI = 1.401 ± 0.102), and 12.36% patients severe NAFLD (HRI = 1.802 ± 0.098). Impaired glucose metabolism was present in 48.31% of patients. A positive correlation was present between HRI and impaired glucose metabolism (r = 0.335, p = 0.001). The coefficients of determinations R2 for linear regression for HRI and glycated hemoglobin (HbA1c) and oral glucose tolerance test (GTT) were 0.05841 and 0.07498, respectively. The cutoff values for HRI in the detection of diabetes and prediabetes, and prediabetes only, were 1.4 and 1.38, respectively. In logistic regression, the ß coefficients for oral GTT, HbA1c, or HRI were 0.62042 (p = 0.0002), 2.18036 (p = 0.0033), and 2.36986 (p = 0.012). The hazard ratio (HR) coefficients (exp [b]) for HRI, HbA1c, and oral GTT sorted according to their HR strength were 10.6958, 8.8494, and 1.8597, respectively. CONCLUSION: Ultrasonographically acquired HRI has a significant predictive impact on the detection of prediabetes and diabetes in patients with NAFLD.

Acute-phase proteins as promoters of abdominal aortic calcification in chronic dialysis patients.

The aim of this study was to find a correlation between acute-phase proteins (APPs) and abdominal aortic calcification (AAC) as well as the impact APPs on AAC in chronic dialysis patients (CDPs). Native lateral lumbar radiography and biochemical analysis were performed in 112 CDPs (aged 60.0 ± 5.43 years) to estimate and score AAC and biochemical values of APPs. The mean AAC score was 8.39 ± 5.43. We detected 16 (14.28%) CDPs without AAC and 96 (85.71%) CDPs with AAC (10 ± 5.43). The number of CDPs with AAC ≤4 was 34 (30.36%) with mean AAC score of 1.85 ± 1.94. By multiple regression analysis, we found positive correlation between AAC and ferritin (ß = 0.004398, P = 0.0085) and AAC and C-reactive protein [(CRP), ß = 0.1972, P = 0.0178]. Sensitivity/specificity pairs and criterion variables (CrVs) were as follows: for CRP: 44.21%, 100%, and CrV ≥6 and for ferritin: 83.16%, 56.25%, and CrV ≥196.32. The area under curve (AUC) for CRP and ferritin was 0.721 (P <0.0001) and 0.730 (P <0.0026), respectively. Fibrinogen and serum iron AUC in the prediction of AAC were 0.533 (P = 0.5749) and 0.618 (P = 0.0795), respectively. CRP and ferritin were the most powerful APPs involved in the promotion of AAC; serum iron and fibrinogen were shown as lower activity promoters in CDPs. Serum albumin showed inverse activity on AAC.

B - Flow assessment of femoral artery as predictor of coronary artery disease in patients evaluated for chest pain by radionuclide myocardial perfusion scintigraphy.

In the evaluation of patients with suspected coronary artery disease (CAD), the presence of the superficial femoral artery (SFA) plaque is more informative than a carotid plaque and at least as informative as coronary plaque in the identification of coronary death individuals. In 60 patients with chest pain with a normal electrocardiogram, B-flow ultrasound estimation of SFA plaque and radionuclide myocardial perfusion scintigraphy (MPS) estimation for CAD was performed. We found significant positive correlations between age and SFA plaque score (PS) (P = 0.0084), myocardial ischemia in rest and SFA PS (P < 0.0001), and between transient ischemic dilation (TID) and SFA PS (P = 0.0069), too. The TID correlates only with myocardial ischemia in rest (P = 0.0022) and SFA PS (P = 0.0069). The results we got by the receiver operating characteristics (ROC) curve analysis with TID/without TID were the area under curve (0.704, P = 0.0038). The multiple regression analysis showed standardized coefficient ß coefficients for SFA PS and TID (3.4577 and 1.9903, P < 0.001 and P = 0.0021), respectively. By proven correlative relationship of SFA atherosclerotic plaques and CAD, we can use B-flow as a screening method for triage of patients with chest pain before being sent to the assessment of coronary circulation with radionuclide MPS.

B-flow imaging estimation of carotid and femoral atherosclerotic plaques: vessel walls rheological damage or strong predictor of cardiovascular mortality in chronic dialysis patients.

BACKGROUND: The aim of this study was to investigate the cardiovascular mortality in chronic hemodialysis patients (CHPs) and to discover the importance of carotid and femoral artery plaques as cardiovascular (CV) mortality predictor. METHODS: In this study with 4 years of follow-up period, we studied a cohort of 101 CHPs. Mean age at entry was 58.1 ± 11.9 years, and mean duration of dialysis was 5.8 ± 5.3 years. We performed B-flow imaging of both carotid and femoral arteries to estimate and score the plaque thickness. RESULTS: The mean carotid and femoral plaque scores (PSs) at entry were 5.02 ± 4.20 and 4.04 ± 3.30 (p = 0.0002). The carotid cutoff point and femoral cutoff point (by ROC curves) were 5.4 and 5.9. The regression coefficients (b) and Exp (b) hazard ratio coefficients of carotid and femoral PS in Cox regression survival analysis in CV outcomes were: b = 0.142, Exp (b) = 1.153, p = 0.0035 versus b = 0.457, Exp (b) = 1.578, p < 0.0001. Relative hazard ratio (HR) risk of exposed group according to CV events was HR 2.812 (CI 1.301-6.081) for carotid PS and HR 2926 (CI 1.424-6.013) for femoral PS. CONCLUSION: Carotid and femoral plaques are strong independent predictors of CV mortality in CHPs. The HR risk of femoral artery plaques is more predictable than HR risk of carotid artery plaques.

Bone Strength and Arterial Stiffness Impact on Cardiovascular Mortality in a General Population.

Osteoporosis and increased arterial stiffness independently have been found to be associated with higher cardiovascular events rates in the general population (GP). We examined 558 patients from GP by dual-energy X-ray absorptiometry (DXA) and pulse wave velocity (PWV) measurements at baseline, with 36-month follow-up period. DXA assessed bone mineral density of femoral neck (BMD FN) and lumbar spine (BMD LS). Carotid-femoral PWV was assessed by pulsed-Doppler. The aim of our study is to find correlation between bone strength and arterial stiffness and their impact on cardiovascular mortality in GP. The mean ± SD of BMD FN, BMD LS, and PWV was 0.852 ± 0.1432 g/cm(2), 0.934 ± 0.1546 g/cm(2), and 9.209 ± 1.9815 m/s. In multiple regression analysis we found BMD FN (ßst = -6.0094, p < 0.0001), hypertension (ßst = 1.7340, p < 0.0091), and diabetes (ßst = 0.4595, p < 0.0046). With Cox-regression analysis, after 17 cardiovascular events, the significant covariates retained by the backward model were BMD FN (b = -2.4129, p = 0.015) and PWV (b = 0.2606, p = 0.0318). The cut-off values were PWV = 9.4 m/s, BMD FN = 0.783 g/cm(2), and BMD LS = 0.992 g/cm(2). The results for BMD FN and PWV hazard ratio risk were 1.116 and 1.297, respectively. BMD FN as a measure of bone strength and PWV as a measure of arterial stiffness are strong independent predictors of cardiovascular mortality in GP.

Femoral neck and spine bone mineral density-Surrogate marker of aortic calcification in postmenopausal women.

OBJECTIVE: Osteoporosis and abdominal aortic calcification (AAC) are associated with increased morbidity and mortality in postmenopausal women. The aim of this study was to determine the accuracy of anterior-posterior (AP) dual-energy X-ray absorptiometry (DXA) compared with that of X-ray lateral lumbar radiography (LLR) in detecting and scoring AAC. METHODS: In this cross-sectional study conducted in 56 postmenopausal asymptomatic females aged 59.0 ± 9.3 years and who never used medications to treat osteoporosis before, we determined femoral neck and lumbar spine bone mineral density (BMD) by AP DXA and AAC by X-ray LLR. We hypothesized that the subtracted femoral neck BMD (BMDFN) from lumbar spine BMD (BMDLS) presented as ΔBMD=BMDLS-BMDFN would have a diagnostic value in detecting abdominal vascular calcification. RESULTS: The mean BMDFN was 0.744 ± 0.184 g/cm(2), and the mean BMDLS was 0.833 ± 0.157 g/cm(2) (p<0.0001); the mean ΔBMD was 0.089 ± 0.077 g/cm(2), and the mean AAC score was 2.182 ± 1.982. Bivariate Pearson's correlation analysis revealed a significant positive correlation between AAC and ΔBMD (r=0.449, p=0.0006); by linear regression analysis, R(2)=0.2019, and by multiple regression analysis, ßst=13.5244 (p<0.0001). We found a sensitivity of 64.3% and specificity of 82.9% by receiver operating characteristic [ROC; area under the ROC curve (AUC=0.759)] in the prediction of AAC by ΔBMD. CONCLUSION: This AP subtracting BMD DXA method provides a useful tool for detecting and scoring subclinical and extensive AAC in postmenopausal women using a simple, semiquantitative, and accurate scoring system with minimal radiation exposure and low cost.