Association between basal proteinuria levels and pregnancy outcomes in familial Mediterranean fever.

We aimed to investigate whether proteinuria in the first trimester of pregnancy in Familial Mediterranean fever (FMF) patients has an impact on pregnancy outcome and perinatal and neonatal outcome of pregnancies. A total of 66 pregnant with FMF were compared with healthy controls at the same gestational weeks. Patients with FMF had a higher antenatal hospitalisation rate (34.8% vs. 6.1%, respectively, p < .01) and higher rate of 2 or more miscarriages. FMF patients with or without obstetric complications also had a similar amount of 24-h urine proteinuria in the first trimester. Patients on colchicine therapy during pregnancy had more frequent attacks in pregnancy (59.3% vs. 18.2%, respectively, p: .012). The rates of preeclampsia, preterm delivery, foetal anomalies, small for gestation age neonates and primary caesarean rate were similar between groups. In conclusion; FMF had no significant impact on pregnancy. Neither attacks in pregnancy nor basal proteinuria were associated with adverse outcomes.Impact statementWhat is already known on this subject? Familial Mediterranean fever (FMF) is an autosomal recessive disease characterised by inflammation of the serosal, synovial and cutaneous tissues with recurrent attacks. One of the most serious complications of FMF is amyloidosis that can cause end-stage renal disease. Outcomes of FMF on pregnancy have been analysed by only few studies. Amyloidosis based on the initial renal function may adversely affect pregnancies. It has been reported that FMF patients with renal amyloidosis may suffer pregnancy complications to a greater extent.What do the results of this study add? There have been few studies on the correlation between FMF, proteinuria and pregnancy outcomes. In our study we found that FMF had no significant impact on pregnancy. Neither attacks in pregnancy nor basal proteinuria were associated with adverse outcomes.What are the implications of these findings for clinical practice and/or further research? Our study suggested that FMF had no relationship between pregnancy outcomes. However, our study population is relatively small. It will contribute to comprehensive studies involving a larger population. Future studies should be performed to investigate the effects of basal proteinuria in pregnancy with FMF.

Is SCUBE1 helpful to predict the arterial thrombotic risk in patients with multi-ple myeloma: a preliminary study.

BACKGROUND: Signal peptide-CUB-EGF-like domain-containing protein 1 (SCUBE1) is expressed in vascular endothelium and human platelets. SCUBE1 levels are increased in acute arterial thrombosis. Multiple myeloma patients are also at increased risk of arterial thrombotic events. This study aimed to measure SCUBE1 levels in newly diagnosed multiple myeloma patients and to define whether SCUBE1 could be a useful marker determining the arterial thrombotic risk. METHODS:   SCUBE1 levels of 32 newly diagnosed multiple myeloma patients and 41 healthy control subjects were measured by enzyme-linked immunosorbent assay. RESULTS: Plasma SCUBE1 levels of multiple myeloma patients and control subjects were 6.22 ± 0.9 and 7.95 ± 1.1 ng/ml, respectively. In the patient group, SCUBE1 levels were significantly lower compared to control subjects (p <0.001). CONCLUSIONS: SCUBE1 level measuring does not help to predict the arterial thrombotic risk in multiple myeloma patients. The significantly lower levels of SCUBE1 in multiple myeloma patients are likely to be due to defective platelets and/or increased TNF-α cytokines and is another proof of platelet dysfunction seen in these patients. HIPPOKRATIA 2019, 23(1): 21-24.

Effect of intrahepatic cholestasis of pregnancy on maternal serum screening tests.

OBJECTIVE: In this study, we aimed to evaluate whether the changes in the first and second trimester maternal serum biochemical markers used for prenatal screening are associated with euploid pregnancies complicated by intrahepatic cholestasis of pregnancy (ICP). METHODS: A total of 94 pregnant women were included in this retrospective comparative study. Thirty-seven women whose pregnancy was complicated with ICP constituted the study group whereas 57 of them constituted the control group. All hospital records were examined in terms of combined first trimester screening test and second trimester triple test parameters. Perinatal outcomes were also recorded. RESULTS: No significant difference was observed between the two groups in term of age, BMI, and obstetric history (all p > 0.05). Mean serum aspartate aminotransferase (AST), alanine aminotransferase (ALT) and serum bile acid concentrations in the study group were significantly higher than in the controls (p < 0.001). There were no significant differences between the two groups in terms of first and second trimester serum biochemical markers. Newborn gender, route of birth, and NICU admission rates were also similar in the two groups. Mean birth weight of the control group was statistically significantly higher than the ICP group (p = 0.012). CONCLUSION: We report no significant differences between pregnancies complicated by ICP and healthy pregnancies in terms of first and second trimester maternal serum screening test results.

Anterior placenta previa is associated with increased umbilical cord blood hematocrit concenrations.

OBJECTIVE: We aimed to evaluate the umbilical cord blood (CB) hematocrit (Hct) levels in women with anterior located placenta previa (PP). METHODS: This is a prospective case-control study performed in a tertiary level maternity hospital. Thirty seven pregnant women diagnosed with anterior PP (study group) and 37 women without PP (control group) included into the study. Groups were matched with regard to age, gestational age, and fetal gender. All women underwent Cesarean section. Umbilical CB Hct levels of the newborns were measured. Demographics, operative features, and neonatal outcomes were recorded. RESULTS: Umbilical CB Hct levels were statistically significantly higher in the PP patients compared with controls (p: 52.6±5.0 vs. 47.5±5.0, p < 0.001). Preoperative maternal hemoglobin (Hgb) and Hct levels were similar in the two groups. However, postoperative Hb and Hct levels were significantly lower in the study group (p: 0.003, p < 0.001, respectively). Intraoperative complication rates were higher in this group. Neonatal Apgar scores were lower and neonatal intensive care unit admission was more common in the PP group when compared with controls. CONCLUSION: We think that anterior PP is associated with increased umbilical CB Hct levels. Neonatologists should consider this condition in the infants born to mothers with anterior PP.

P wave and QT dispersion in familial mediterranean fever.

OBJECTIVE: Familial mediterranean fever (FMF) is the most common auto-inflammatory disease that is characterized by recurrent, self-limited attacks of fever and serous membrane inflammation. Patients with inflammatory rheumatic diseases are considered to have a raised cardiovascular diseases risk. The aim of this study was to investigate; by means of P wave dispersion (Pd) and QT dispersion (QTd) parameters detected by simple standard electrocardiogram (ECG), atrial and ventricular repolarization changes in pregnant women with and without FMF. PATIENTS AND METHODS: In this case-control study including 37 pregnant women with FMF who already put on colchicine treatment and 40 healthy, uncomplicated pregnancy cases, were prospectively assessed using 12-lead ECG and echocardiography. RESULTS: No differences in Pd and corrected QT values were found between the groups. Epicardial fat thickness values were significantly higher in the FMF group compared with the control group (p = 0.015). A positive correlation was found between FMF duration and epicardial fat thickness (r = 0.350, p = 0.042). CONCLUSIONS: Pd, a non-invasive marker of potential atrial arrhythmia and QT-d, a non-invasive marker of potentially lethal ventricular tachyarrhythmia, constitute a recent contribution to the field of noninvasive electrocardiology. Pd and QT-d values were not altered in pregnant women with FMF who already put on colchicine treatment, with no increased risk of atrial or ventricular arrhythmias indicated. Colchicine may have a cardio-protective effect beyond the effect mediated through suppression of inflammation.

The value of complete blood count parameters in predicting preterm delivery.

OBJECTIVE: The association between inflammation and threatened preterm labor (TPL) is well known. The aim of this study was to investigate a possible relation between TPL and new defined systemic inflammatory markers, neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR) and platelet to lymphocyte ratio (PLR). PATIENTS AND METHODS: Fifty-three healthy pregnant women as the control group and 55 pregnant women diagnosed with TPL as the study group were included in this prospective controlled study. The study group was divided into two groups according to the gestational age at delivery: pregnant with TPL who delivered < 37 weeks and pregnant with TPL who delivered ≥ 37 weeks. The clinical and laboratory data were compared among the groups. RESULTS: LMR was found to be significantly higher in patients complicated with TPL who delivered prematurely when compared to the women whose pregnancies continued to term (p = 0.02). Furthermore, a significant negative correlation was also observed between the gestational week at delivery and LMR in women who delivered < 37 weeks. DISCUSSION: We demonstrated that LMR was significantly increased in pregnant women with preterm birth and threatened preterm labor than healthy subjects. CONCLUSIONS: Although increased LMR levels were demonstrated to be associated with preterm birth and threatened preterm labor to be able to extrapolate these findings into clinical daily practice, further studies are needed.

Effects of antioxidant vitamins (A, D, E) and trace elements (Cu, Mn, Se, Zn) on some metabolic and reproductive profiles in dairy cows during transition period.

The objective of this study was to determine the effects of some antioxidant vitamins and trace elements on some metabolic and postpartum reproductive profiles in dairy cows during transition period. In the study, altogether 20 clinically healthy Brown Swiss dairy cows (aged 4-5 years-old) under the same management and feeding conditions in periparturient period were used. The animals were divided into two equal groups: control (C) and treatment (T) group (n=10 for each group). Vitamins (A, D, E) and trace elements (Cu, Mn, Se, Zn) were administered intramuscularly into the cows of the T group, while isotonic saline, as placebo, was injected subcutaneously into those in the C group. Blood samples were collected by venipuncture of the jugular vein at the beginning of transition period, parturition and 3-weeks after the parturition. The metabolic and reproductive parameters were determined. In the C group, statistically significant changes were observed in the levels of non-esterified fatty acids (NEFA), high density lipoprotein (HDL), low density lipoprotein (LDL), total protein (TP) (p<0.05), glucose (GLU), progesterone (P4) (p<0.01), total cholesterol (T.CHOL), triglycerides (TG), UREA, creatinine (CRSC) and total bilirubin (TBIL) (p<0.001). In the T group, significant changes in the levels of NEFA, TBIL (p<0.05), T.CHOL, HDL, LDL (p<0.01), TG, GLU, P4, TAC and TOC (p<0.001) were observed. It was concluded that the administration of various vitamins and trace elements could be effective to improve some metabolic and reproductive profiles in dairy cows during the transition period.

Prevalence and screening for risk factors of type 2 diabetes in Rize, Nourtheast Turkey: findings from a population-based study.

AIMS: We aimed to determine the prevalence of diagnosed and undiagnosed diabetes, risk factors affecting the healthy population, and factors that increase diabetes risk in the adult northeast Turkish population. METHODS: Using population proportional cluster sampling, 930 adults were selected. After excluding people with diabetes, risk screening was conducted in the healthy population (n: 825) using the Information Form and FINDRISK questionnaire. Fasting venous blood and biochemical parameters were measured. RESULTS: Prevalence of diabetes was 13.6% (new % 2.3), translating to approximately 44 thousand adults. Among the healthy population, 37.5% had high risk. Prevalence of not exercising (78.2%), obesity (36.1%), and hypertension (24.5%) were high. Predictors of risk of diabetes were aging (OR 1.09), low education (OR 0.51), familial diabetes history (OR 15.27), not exercising (OR 0.41), obesity (OR 5.17), high waist circumference (OR 1.05), heart disease (OR 4.81), and hypertension (OR 2.60). CONCLUSIONS: This study can stimulate early screening for cardiovascular diseases and hypertension and initiating aggressive treatments in people with high diabetes risk. In primary health services, number of doctors and nurses trained in diabetes should be increased and dieticians should be involved. People with high risk should receive lifestyle regulations training.

Alterations in lipid peroxidation and T-cell function in women with hyperemesis gravidarum.

The objective of this study was to investigate serum adenosine deaminase (ADA) activity as a marker of T lymphocyte activation and parameters of oxidative stress and antioxidant defence in hyperemesis gravidarum (HG). Serum ADA activity, malondialdehyde (MDA), catalase (CAT) and glutathione peroxidase (GPx) levels were investigated in 40 pregnant women with the HG and 40 with healthy pregnancies, in a descriptive study. Although serum ADA and CAT were measured to be higher in HG group, the difference was not significant. Serum MDA and GPx levels were significantly elevated in women with HG when compared with those without HG. The significance of changes in lipid peroxidation and T-cell activation in the pathogenesis of HG and whether this is a cause or a compensatory reaction to HG requires further investigations with larger multicentre trials.

Topiramate has protective effect on renal injury.

BACKGROUND: Topiramate (TPM) decreases tumor necrosis factor-alpha (TNF-α) and oxidative stress. We investigated protective effects of TPM on cell damage in kidney tissue during ischemia-reperfusion (I/R) damage. METHODS: A total of 30 male Wistar albino rats were divided into three groups: control, I/R, and I/R plus TPM (I/R+TPM). Laparotomy without I/R injury was performed in control group. After laparotomy, cross ligation of infrarenal abdominal aorta was applied for two hours in I/R groups which was followed by two hours of reperfusion. TPM (100 mg/kg/day) was orally administrated to animals in the I/R+TPM group for seven consecutive days before I/R. RESULTS: The I/R group's TNF-α and interleukin-1 beta (IL-1ß) levels were significantly higher (1184.2 ± 129.1 pg/mg protein; 413.1 ± 28.8 pg/mg protein, respectively) than those of the control (907.8 ± 113.0 pg/mg protein, p = 0.002; 374.7 ± 23.7 pg/mg protein, p = 0.010, respectively) and I/R+TPM groups (999.5 ± 115.2 pg/mg protein, p < 0.001; 377.9 ± 30.9 pg/mg protein, p = 0.007, respectively). CONCLUSION: TPM may partially prevent renal damage in rats. The opening of new horizons of this kind of knowledge will help understand the complex challenge in the prevention of renal I/R damage (Tab. 1, Fig. 3, Ref. 42).

Serum YKL-40 levels as a novel marker of inflammation and endothelial dysfunction in patients with pseudoexfoliation syndrome.

PURPOSE: To evaluate serum levels of YKL-40 in patients with pseudoexfoliation syndrome (PEX) in comparison with those of age- and sex-matched healthy subjects. METHODS: Forty patients with PEX (PEX group) and 40 age- and sex-matched control subjects (control group) were enrolled in the study. An enzyme immunoassay method using the commercially available test MicroVue YKL-40 was used to measure serum YKL-40 concentration. Systolic and diastolic blood pressures, serum levels of high sensitivity C-reactive protein (hsCRP), total cholesterol, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), and triglycerides were also examined. RESULTS: The mean age was 54.4±7.6 (ranging 41-65) years in each group. The mean serum YKL-40 level of the PEX group was significantly higher than that of the control group (P<0.001). In addition, the mean serum HsCRP, total cholesterol, LDL, and triglycerides levels were significantly higher, and mean serum HDL level was significantly lower in the PEX group than in the control group (all P<0.001, excluding both P=0.002 for triglycerides and HDL levels). Further, the mean systolic and diastolic blood pressures were significantly higher in the PEX group than in the control group (P1=0.001 and P2=0.01, respectively). CONCLUSION: We have shown a relationship between PEX and elevated serum levels of YKL-40. We imply that a better understanding of the role of YKL-40 in the pathogenesis of endothelial dysfunction and atherosclerosis is necessary to develop new therapies for preventing or treating PEX. Further studies are warranted to clarify the clinical relevance of these findings.

Increased serum resistin levels in patients with coronary slow-flow phenomenon.

BACKGROUND: Slow coronary flow (SCF) is an angiographic finding characterized by delayed opacification of the epicardial coronary arteries without obstructive coronary disease. Resistin, an adipocytokine, plays a major role besides low-grade inflammation in atherosclerotic vascular processes and may be of importance in other coronary pathologies such as SCF. METHODS: The present study was cross-sectional and observational, consisting of 70 individuals who underwent coronary angiography and had angiographically normal coronary arteries of varying coronary flow rates. The study included 50 patients with isolated SCF and 20 control participants with normal coronary flow (NCF). RESULTS: There were no statistically significant differences between the SCF and NCF groups with respect to age, gender, presence of hypertension or diabetes mellitus, and smoking habit, except for increased creatinine levels (p = 0.014). The serum resistin level was significantly higher in the SCF group than in the NCF group (8.4 ± 7.2 vs. 5.4 ± 2.6 ng/ml, p = 0.014). Ln-transformed resistin levels correlated positively with left anterior descending (LAD) coronary artery TIMI frame count (TFC) (r = 0.408, p < 0.001) as well as with glucose (r = 0.340, p = 0.004), creatinine (r = 0.248, p = 0.044), and C-reactive protein (CRP; r = 0.283, p = 0.023) levels, and negatively with LAD coronary flow velocity (r = - 0.314, p = 0.009). When multivariate analyses were performed, in linear regression analysis, ln-resistin was associated with a longer TFC [beta (standardized regression coefficient): 0.404, p = 0.001] and lower coronary flow velocity (beta: - 0.280, p = 0.035); in logistic regression analysis, ln-resistin was an independent predictor of the presence of SCF (OR: 6.692, 65 %CI: 1.117-40.1, p = 0.037). CONCLUSION: We demonstrated, for the first time, a significant increase in serum resistin levels in patients with SCF compared to subjects with NCF. We believe that further studies are needed to clarify the role of resistin in patients with SCF.

Elevated serum YKL-40 level predicts myocardial reperfusion and in-hospital MACE in patients with STEMI.

BACKGROUND: Macrophages in atherosclerotic plaques secrete YKL-40, a new biomarker of acute and chronic inflammation in patients with stable CAD. We hypothesized that YKL-40 may be a specific marker reflecting the burden of localized inflammation in myocardium and a predictor in patients with STEMI. In this study, we investigated the relationship of YKL-40 to in-hospital major adverse cardiac events (MACE), reperfusion parameters and its predictors in patients with STEMI. METHODS: In total, 80 patients with STEMI and no history of prior coronary artery disease (CAD), who underwent primary percutaneous coronary intervention (p-PCI), were enrolled consecutively. In addition, 30 patients with normal coronary arteries (NCA) were enrolled as a control group. Cardiac biomarker levels including creatinine kinase-MB fraction (CK-MB), troponin-I, admission glucose and inflammatory markers including leukocytes and YKL-40 levels were measured as admission values. RESULTS: In our study, YKL-40 levels correlated to high-sensitivity CRP levels (r = 0.333, p = 0.003), TIMI risk score (r = 0.445, p < 0.001), age (r = 0.477, p < 0.001), pain to balloon time (r = 0.432, p < 0.001), leukocyte and neutrophil count (r = 0.386, p < 0.001 and r = 0.430, p < 0.001, respectively), hemoglobin (r = - 0.345, p = 0.002), admission and fasting blood glucose (r = 0.388, p < 0.001 and r = 0.427, p < 0.001), creatinine levels (r = 0.395, p < 0.001) and myocardial blush grade (r = - 0.334, p = 0.004). When the patients were divided into two groups determined by presence or absence of MACE, the patients with MACE had significantly higher levels of YKL-40 in comparison to the patients without MACE and the control group (194 ± 104, 114 ± 61 and 110 ± 53 µg/L, p < 0.001, respectively). In multivariate logistic regression analysis in STEMI patients, only YKL-40 level (OR: 1.011, 95%CI: 1.002-1.019, p = 0.011) and leukocyte count (OR: 1.264, 95%CI: 1.037-1.540, p = 0.020) were the independent predictors for MACE. Sensitivity and specificity of YKL-40 to predict MACE, when 125 µg/l was accepted as a cut-off value, were 84% and 70%, respectively. CONCLUSION: We found that serum YKL-40 is related to older age, increased admission glucose levels, leukocyte counts and decreased hemoglobin levels; YKL-40 level and leukocyte count independently predicted MACE.