Diagnostic value of glycemic markers HbA1c, 1,5-anhydroglucitol and glycated albumin in evaluating gestational diabetes mellitus.

BACKGROUND: The oral glucose tolerance test (OGTT) is the current established method performed worldwide to diagnose gestational diabetes mellitus (GDM). The purpose of this study was to assess the utility of the use of long- and short-term markers of glycemic status. METHODS: The study group was composed of 80 pregnant women, 40 with GDM and 40 with normal glucose tolerance. GDM was diagnosed with the American Diabetes Association criteria. Glycemic markers were measured in the OGTT blood samples of women at 24-28 weeks of gestation. RESULTS: HbA1c was significantly higher in the GDM group when compared with the controls, whereas 1,5-anhydroglucitol (1,5-AG) levels were significantly lower. There was not a significant difference between the groups for glycated albumin. Whereas HbA1c levels were correlated with fasting and 1 h glucose and negatively correlated with mean corpuscular volume, 1,5-AG was only negatively correlated with the first hour glucose. No difference was found for the diagnostic performances of HbA1c and 1,5-AG (receiver operating characteristic of the area under the concentration curve values were 0.756 and 0.722, respectively). CONCLUSION: HbA1c and 1,5-AG alone does not have sufficient diagnostic accuracy to diagnose GDM. 1,5-AG values were correlated with post-load glucose values in pregnant women so will improve the GDM management and be useful to predict complications.

Fetal gender affects maternal serum total and placental alkaline phosphatase levels during pregnancy.

OBJECTIVE: To analyze whether fetal gender affects total alkaline phosphatase (ALP) and placental ALP levels in normal pregnancy, and to determine the gestational age at which the difference occurs. METHODS: In this longitudinal study, serum total and placental ALP measurements were carried out in 30 normal pregnant women during different ranges of gestational weeks. Infant sex was recorded at the delivery for all women included in the study. Total and placental ALP levels were compared between pregnant women bearing female and male fetuses. RESULTS: At all gestational weeks studied, both total and placental ALP levels were higher in pregnant women carrying female fetuses than in male bearing pregnant women. Particularly, both total (260.9+/-110.2 versus 239.9+/-102.3; p=0.03) and placental (73.1+/-22.4 versus 61+/-18.2; p=0.04) ALP levels were significantly higher in the female group than in the male between 24 and 28 weeks, and the significant difference persisted between 32 and 36 weeks (p=0.02). CONCLUSIONS: Fetal gender seems to affect total and placental ALP levels in healthy pregnant women, particularly during the second and third trimester of pregnancy. Higher ALP levels in pregnant women with female fetuses than in those with male fetuses may suggest that knowledge of the fetal gender may be in particular importance for the studies using ALP as a marker for the prediction of variety of diseases and complications seen during pregnancy.

Effects of transdermal estrogen replacement therapy on plasma levels of nitric oxide and plasma lipids in postmenopausal women.

OBJECTIVE: Our purpose was to assess the effects of transdermal estrogen replacement therapy (TERT) on plasma levels of nitric oxide (NO) and plasma lipids in postmenopausal women. MATERIALS AND METHODS: The study designed as a randomized, double-blind, placebo-controlled trial, involved 43 postmenopausal healthy women who had previously undergone hysterectomy. Women received either transdermal 100 microg 17beta-estradiol (Climara forte TTS) or placebo once a week for 3 months. Plasma levels of NO metabolites, estradiol (E2), total cholesterol (TC), triglicerides (TG), low-density lipoproteins (LDL), high-density lipoproteins (HDL), HDL2 and HDL3 were measured in blood samples of all women which were collected before, after 24 h and after 3 months of therapy. RESULTS: We found significantly increased NO levels 24 h after therapy in TERT group. Moreover significantly higher NO levels were determined at 3rd month of therapy. Serum HDL and HDL2 levels of ERT group were significantly increased at 3rd month of therapy. Alteration of serum levels of HDL3, LDL and TC were not significantly different in groups. TG levels were significantly decreased in TERT group. DISCUSSION: NO-related mechanism may help to explain the cardio-protective effect of TERT in the postmenopausal period. TERT seems to have favorable effects on plasma lipids in surgical menopausal women.

The relationship between trace elements and cardiac markers in acute coronary syndromes.

Previous studies have demonstrated increased serum copper and iron levels and decreased selenium and zinc levels in patients with myocardial infarction. Furthermore, the prognostic value of the levels of trace elements in myocardial infarction has been stressed. We examined serum levels of Cu, Fe, Zn and Se, as well as glutathione peroxidase (GPx), a selenoenzyme with antioxidant properties, and C-reactive protein (CRP), a marker of inflammation, in acute coronary syndromes (ACS) regarding their relationship to cardiac troponins and creatine kinase-MB mass (CK-MBm), important prognostic markers. Serum trace elements, GPx activity and CRP were determined in 70 patients with ACS who were admitted within 12 h after the onset. Differences in these parameters were evaluated in three groups of patients divided according to the levels of cardiac markers: group III consisted of patients with high increases in cTnT, cTnI and CK-MBm (> or =0.9 ng/mL, > or =1.0 ng/mL, > or =30 ng/mL, respectively), patients with milder increases in these markers were included in groups II and I consisted of patients with values just above the upper reference limits. Serum Fe levels increased significantly in group II and even more prominently in group III compared to group I (p = 0.04, 0.002, respectively). There was no significant difference between groups II and III. The increase in serum Cu was significant in group III compared to both groups II and I (p = 0.04, 0.001, respectively). There was no significant difference between groups I and II regarding Cu and Zn. The decrease in serum Se and GPx levels was significant only between groups III and I (p = 0.004 for Se and p = 0.0001 for GPx). CRP levels showed a significant increase in group III compared to groups II and I (p = 0.03 and 0.001). CRP showed a significant positive and GPx a significant negative correlation to the cardiac markers cTnT, cTnI and CK-MBm. Cu was positively correlated to all cardiac markers, while the positive correlation between Fe and cardiac markers was significant only for cTnI. Both Zn and Se were negatively correlated to cTnT, and Se was also to cTnI. In conclusion, the increase in serum levels of Cu and Fe and the decrease in serum levels of Zn and Se in patients with higher levels of troponins and CK-MBm imply that trace element levels are related to the degree of myocardial damage and thus may play a role in the pathogenesis of ischemic heart disease. The strong correlations between cardiac markers and both CRP and GPx suggest that these parameters are promising prognostic factors in acute coronary syndromes.

The values of urinary NTx in postmenopausal women undergoing HRT; the role of additional alendronate therapy.

OBJECTIVE: To determine the changes in levels of urinary NTx at the end of the 6th month of oral and transdermal hormone replacement therapy (HRT) and the effects of additional alendronate therapy for osteoporotic women. METHOD: Of 66 postmenopausal women 23 were treated with oral estradiol+norethisterone acetate (E+P), and 22 were treated with transdermal estradiol+norethisterone acetate. The third group consisted of 21 women with osteoporosis (bone mineral density < 100 mg/cm(3)) and treated with oral E+P plus alendronate 10 mg/day. RESULT: Significant decreases of urinary NTx levels were seen after HRT in all study groups (P < 0.05). But the decline of NTx levels was not different between the oral and transdermal HRT groups (P > 0.05). There was no additional decrease in the levels of NTx with alendronate therapy (P > 0.05) but NTx excretion diminished more in patients with high baseline levels. CONCLUSION: The decline of NTx at the end of the 6th month of HRT reflects the decrease of bone resorption and it is not related to the route of administration.

Cadmium exposure in tobacco workers: possible renal effects.

Cadmium is a nephrotoxic metal widely used in industry and the main source of Cd in general population is smoking. Considering that the source of Cd in cigarettes is the tobacco leaf, the exposure to Cd was evaluated in workers employed at a tobacco leaf processing factory. Blood and urinary Cd levels were measured by flameless atomic absorption spectrometry in 87 workers and 35 controls. Urinary enzymes, total protein, albumin and uric acid were also determined to investigate the possible nephrotoxic effects of Cd. Blood Cd levels were significantly higher in workers (1.63 +/- 1.95 microg/L) than in controls (0.91 +/- 1.15 microg/L) (p = 0.044). The increase observed in urinary Cd levels of workers was non significant (0.56 +/- 0.5 microg/g creatinine in workers and 0.46 +/- 0.5 microg/g creatinine in controls). Both in workers and in controls, subjects smoking >10 cigarettes/day showed significantly increased blood Cd levels compared to non-smokers (p = 0.000 and p = 0.011, respectively). In workers, urinary alkaline phosphatase (ALP), gamma glutamyl transferase (GGT), total protein, and uric acid were observed to be significantly increased (p = 0.013, p = 0.000, p = 0.000, p = 0.025, respectively), ALP, GGT and total protein being positively correlated with Cd in urine. In conclusion, the workers in the tobacco leaf processing factory were found to be exposed to Cd compared to the general population. The increase in the urinary enzymes and proteins suggests that an exposure to Cd affects kidney functions even below the toxic limits generally accepted.

Alanine aminotransferase deficiency in a hepatitis B surface antigen positive patient presenting with acute hepatitis.

This report presents a hepatitis B surface antigen positive case presenting with acute hepatitis and with findings of low serum alanine aminotransferase in contrast to very high levels of aspartate aminotransferase. A 64 year-old female patient was admitted to our hospital with fatigue and jaundice. Hepatitis B surface antigen was positive. During follow up, aspartate aminotransferase levels remained very high, while alanine aminotransferase levels continued to be extremely low. Additionally, all of the patients five daughters had low alanine aminotransferase levels. The clinical importance of alanine aminotransferase deficiency is still unclear.

The effect of malnutrition on protein glycosylation in children.

OBJECTIVE: The goal of this study was to evaluate the effect of protein energy malnutrition on protein glycosylation by investigating transferrin isoform pattern and its relationship to the degree of malnutrition and the biochemical markers of nutritional status in children. METHODS: Forty one children with mild (n=23) and severely/moderately (n=18) acute malnutrition and 29 controls were enrolled in the study. Serum transferrin isoforms were determined by isoelectric focusing electrophoresis. Transferrin, prealbumin, zinc, iron and insulin-like growth factor-1 (IGF-1) were measured using automated analyzers. Findings : Asialotransferrin and disialotransferrin were significantly higher in severely/moderately malnourished patients compared to controls (P=0.04 and P=0.04, respectively). Other transferrin isoform patterns were not different among three groups. Serum IGF-1, transferrin and iron levels of severely/ moderately malnourished group were significantly lower than tose of controls (P=0.001, 0.02 and 0.03, respectively). Serum prealbumin and zinc levels were similar in all three groups. Serum IGF-1, transferrin and iron levels, and all transferrin isoform patterns were not significantly different in mildly malnutrition group from other two groups. CONCLUSION: The changes in transferrin isoform pattern observed in malnourished patients may indicate that malnutrition is a catabolic state which has effects on glycosylation.

Comparative evaluation of serum levels of main minerals and postmenopausal osteoporosis.

OBJECTIVE: The purpose of this study was to determine the relationship between serum main minerals and postmenopausal osteoporosis. STUDY DESIGN: A total of 728 postmenopausal women were included in this study. Women were separated into two groups according to presence or absence of osteoporosis (OP). BMD was measured in total femur (TF), femoral neck (FN) and lumbar spine (L1-L4) by dual-energy X-ray absorptiometry. Risk factors for OP were recorded by using a structured questionnaire. MAIN OUTCOME MEASURES: Women's blood were collected and serum concentrations of iron, copper, zinc, sodium, potassium, magnesium, calcium, ionized calcium, inorganic phosphorus were measured. RESULTS: Low serum copper levels were significantly associated with OP according to BMD values for TF, FN and L1-L4. There was a significant relationship between low serum zinc levels and OP for L1-L4 spines. Low iron serum levels were also significantly associated with OP in BMD measurements of TF. Low serum magnesium levels had significant association with OP of L1-L4 spines and TF. Serum levels of calcium, ionized calcium, potassium, sodium and inorganic phosphorus were not associated with OP. CONCLUSIONS: In postmenopausal women, the low serum levels of copper, zinc, iron and magnesium appear to be an important risk factor for OP.

Electrolytes and trace elements in human breast cyst fluid.

Gross cystic breast disease (GCBD) is one of the most common breast diseases, and women with apocrine (type I) cysts are at higher risk of developing breast cancer than women with flattened (type II) cysts. Type I cysts contain fluid with an electrolyte composition similar to that of intracellular fluid (Na/K ratio <3), whereas type II cysts fluid's content resembles that of plasma (Na/K ratio >3). The electrolyte composition of breast cyst fluid (BCF) has been investigated intensively; however, there have been only a few studies in literature reporting the content of trace elements in BCF. The aim of this study was to compare the concentrations of Na, K, Ca, P, Zn, Cu, Fe, and Na/K and trace element ratios in breast cyst fluid in two subgroups of breast cysts. Sixty-three BCF were obtained by needle aspiration from premenopausal women with GCBD diagnosed by clinical, xheromammographic, and cytological studies. After separation of cells for cytological evaluation, the cyst fluid was centrifuged and supernatant stored at -80 degrees C until the analysis. Sodium, potassium, calcium, phosphorus, and iron were measured using Roche Diagnostics commercial kits on Hitachi 747-200 autoanalyzer. Measurements of copper and zinc were performed by flame atomic absorption spectrophotometer on Shimadzu AAS 680. We found statistically significant higher K, lower Na, higher phosphorus concentrations, and lower Na/K ratios in type I cysts when compared with type II cysts' values. Median values of Na/K ratio in type I and in type II were 0.32 and 6.2, respectively. Higher Zn, Cu, and Fe concentrations with respect to median values were noted in type I cysts; higher [Na.Cu/K.Zn], [Na.Cu/K.Fe], and [Na.Zn/K.Fe] ratios were found in type II cysts. A significant negative correlation existed between Na/K and Cu, and a significant positive correlation between Na/K and Fe in type II cysts (r = -0.660, p = 0.007; r = 0.615, p = 0.014, respectively). We can conclude that the trace elements content of BCF, in addition to electrolytes, could be useful in classifying the breast cyst. Future studies in larger series are needed to confirm these data.

Fate of abstracts presented at the 2002 IFCC meeting.

BACKGROUND: Poster presentations at major meetings serve to rapidly present and share study results with the scientific community. On the other hand, full-text publication of abstracts in peer-reviewed journals provides dissemination of knowledge. The purpose of this study was to evaluate the publication rate of abstracts presented at the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Meeting, to assess the factors influencing publication and determine the impact factor of these journals. METHODS: All poster abstracts presented at the 2002 IFCC Meeting were included in the study. A Medline search was performed to identify a matching journal article. Topics, country of origin, study type, study center and publication year were tabulated. Journals and impact factors of publication were noted. RESULTS: Out of 900 presented abstracts, 125 (13.9%) were published as full-text articles. Publication rates according to topics of the meeting, country of origin and university affiliation demonstrated significant differences. Abstracts from multi-centered studies had higher publication rates, and the journals they were published in had higher impact factors than single center studies. The median impact factor of the journals was 2.093. According to regression analysis, the major predictors for publication were interventional research and university affiliation (odds ratios 2.916 and 1.782, respectively; p < 0.05). CONCLUSIONS: The publication rate for abstracts of this clinical chemistry meeting was lower than rates from other fields of medicine. Factors leading to failure require elucidation. Encouraging authors to submit their presentations for full-text publication might improve the rate of publication.

Suppression of angioplasty-related inflammation by pre-procedural treatment with trimetazidine.

Percutaneous transluminal coronary angioplasty (PTCA) has been recognized as a reliable treatment procedure for acute reversible ischemia and reperfusion. Ischemic reperfusion cycle in PTCA leads to the systemic inflammation and extensive tissue injury by the production of reactive oxygen species including nitric oxide (NO) radicals. In patients with coronary artery disease, undergoing PTCA, the effects of trimetazidine (TMZ), a piperazine-derivative anti-anginal drug, were studied on several indirect markers of systemic inflammatory response: tumor necrosis factor-alpha (TNF-alpha), C-reactive protein (CRP) and NO products (nitrite and nitrate). Patients (n = 11 each group) were untreated or pre-treated with TMZ (20 mg per orally three times a day), begun three days prior to PTCA, and marker levels were measured before the start of TMZ therapy (baseline), just before PTCA (0 hr), and 4, 24, and 48 hrs after PTCA. The baseline levels of markers were not significantly different between the untreated and pre-treated patients. In contrast, all parameters were lower in the TMZ-treated group than those in the matched control group in the pre- and post-angioplasty periods. Interestingly, in the TMZ group, CRP and nitrite levels were significantly lower than in the control group at each time point of the pre- and post-angioplasty periods, but the TNF-alpha levels were significantly decreased only in the post-angioplasty period. Pre-procedural treatment with oral TMZ for three days significantly suppressed the elevation of inflammatory markers before and shortly after PTCA. We suggest the usefulness of TMZ in preventing inflammatory cardiovascular events after PTCA.

The effects of intravenous iron treatment on oxidant stress and erythrocyte deformability in hemodialysis patients.

BACKGROUND: It is well known that free iron causes oxidant stress to increase. However data concerning whether intravenously (I.V) administered iron in maintenance doses (10-20 mg) gives rise to increased oxidant stress and disturbed erythrocyte deformability (EDEF) in hemodialysis (HD) patients is lacking. In the present study, we aimed to evaluate and compare the effects of I.V iron on oxidant stress and EDEF. PATIENTS AND METHODS: Thirteen HD patients (10 males, 3 females, mean age: 49.9 +/- 13.4 years), given I.V iron were included in the study. All patients were undergone three consecutive HD session. The first HD session was performed without iron administration (Group 1), whereas in the following sessions the same patients were given 20 mg (Group 2) and 100 mg (Group 3) iron III hydroxide sucrose (Venofer--Abdi Ibrahim) I.V at the end of the dialysis session. In study periods, 7 blood samples were drawn from each patient: before dialysis, at the end of the dialysis (just after the session), 15, 30, 60, 90 and 120 minutes after each dialysis session. However 15 minute samples were not drawn in the third group, since I.V iron was given by infusion in 30 minutes. EDEF and plasma malondialdehyde (MDA) were studied in all samples. RESULTS: When the results of the session without iron were considered, bivariate correlation analysis did not reveal any correlation between MDA and EDEF. When the course of each parameter were considered separately, MDA levels 90 and 120 minutes after HD session were significantly higher than that of the before and just after the HD session (p < 0.05). Whereas EDEF in 60, 90 and 120 minutes after HD session was found to be worsened when compared to before and just after HD sessions' values (p < 0.05). When results of the session with 20 mg iron were considered, EDEF and MDA values were not found to be correlated and throughout the course. Although EDEF did not present any significant change, MDA levels 60, 90 and 120 minutes after HD session were found to be significantly higher than that of the 15 and 30 minutes after HD session (p < 0,05). When results of the session with 100 mg iron were considered, MDA levels 30, 60, 90 and 120 minutes after HD session were found to be significantly higher than that of the before and just after the HD sessions' (p < 0,05). EDEF in 90 and 120 minutes after HD session was improved and no correlation between MDA and EDEF was observed. When groups were compared with each other, plasma MDA levels in session with 100 mg iron at the beginning, at the end and 30 minutes after HD were significantly lower than that of the without iron group (p < 0.05). Similarly MDA levels in session with 100 mg iron at the beginning, at the end, 30 minutes and 120 minutes after HD were significantly lower than that of the 20 mg iron (p < 0.05). When EDEF values in sessions with 20 mg iron and without iron were considered, only values 60 and 90 minutes after dialysis were significantly improved in 20 mg iron group. The others were statistically similar. CONCLUSION: In the present study, it was observed that I.V administered iron in 20 and 100 mg doses did not cause additional deteriorating effect on oxidant stress and EDEF was even improved by I.V iron.