Increased serum ghrelin in preeclampsia: is ghrelin a friend or a foe?

OBJECTIVES: To investigate maternal serum ghrelin levels in pregnancies complicated by preeclampsia and to explore the relationship between ghrelin level and disease severity. MATERIALS AND METHODS: This case-control study included 40 healthy pregnant women, 42 women with mild preeclampsia, and 40 women with severe preeclampsia. The groups were matched in terms of maternal and gestational age and body mass index. Serum ghrelin levels were measured via enzyme immunoassay. RESULTS: Serum ghrelin levels were significantly higher in women with mild and severe preeclampsia than in healthy controls (p < 0.001). Although serum ghrelin levels were somewhat higher in the severe compared to the mild preeclampsia group, the difference was not statistically significant (p > 0.05). In the control group, no significant correlation was observed between ghrelin level and any other parameter, but in the preeclampsia group, serum ghrelin levels were negatively correlated with uterine artery Doppler index values and both systolic and diastolic blood pressure (all p-values < 0.05). Multivariate stepwise linear regression analysis revealed that systolic blood pressure (ß = 0.493, p = 0.023) was independently associated with serum ghrelin level. CONCLUSION: Elevated blood ghrelin levels were correlated with disease severity in pregnancies complicated by preeclampsia.

Open Radial Artery Study.

Radial artery occlusion (RAO) has been the most common postprocedural complication of transradial artery access. The optimal method of prevention of RAO is still lacking. In our study, we aimed to evaluate the effect of patent hemostasis on early (24 hours) and late (2 weeks) RAO prevention. The Open Radial Artery Study was a single-arm, prospective, and multicenter study. The primary end points were early and late RAO at the vascular access site after transradial coronary procedures. Secondary end points were access site hematoma, pseudoaneurysm formation, arteriovenous fistula, and nerve injury. A total of 2,181 patients were analyzed (67% male, mean age 68 years). The mean interventional duration and hemostatic times were 75.6 ± 55.6 and 60 ± 5.6 minutes, respectively. Radial artery spasm occurred in 10% of patients (n = 218). Catheter kinking, radial artery rupture, or dissection were not observed during the procedure. RAO, hematoma, pseudoaneurysm, arteriovenous fistula, or nerve damage was not observed in any of the patients in the early or late period. In patients who undergo coronary diagnostic or interventional procedures through transradial artery access, the patent hemostasis method seems a critical step in the prevention of early and late RAO.

Effects of methylphenidate on height, weight and blood biochemistry parameters in prepubertal boys with attention deficit hyperactivity disorder: an open label prospective study.

Background: Adverse effects of stimulants on growth in children have long been studied, but the results remain to be clarified, because metabolic changes or predictors accompanying the growth deviations were not sufficiently studied. Objective: This open label-prospective study investigated the effects of methylphenidate (MPH) on weight, height, blood biochemistry in children with attention deficit hyperactivity disorder (ADHD). Method: Prepubertal boys treated with MPH in Child and Adolescent Psychiatry Clinic at Antalya Training and Research Hospital in Health Sciences University, Turkey were recruited. Height and weight z-scores and fasting blood samples were taken at baseline and 6th month. Changes were compared by paired-samples t-test or Wilcoxon signed-rank test. Any association between the changes in growth and biochemical values was analyzed by Spearman's Rank-Order Correlation. The statistical significance threshold was p<0.01. Results: 31 boys aged 74 to 104 months were enrolled in the study sample (mean=87.6, Standard Deviation (SD)=9.2). Osmotic release oral system-MPH (18 mg/day) was used in 77.4% (N=24) and immediate release-MPH (5 mg three times a day) in 22.5% (N=7). Average daily drug dose was 0.66 mg/kg (SD=0.12). Baseline weight z-score was 0.63 (SD=1.12), decreased significantly at 6 months (0.24 [SD=1.04]) (Z=-4.44, p=0.000, r=0.5) (median z-score was 0.53 at baseline, -0.11 at 6 months). Baseline height z-score (0.23[SD=0.87]) was not suppressed significantly at 6 months (0.28[SD=0.85])(t(30) = ‒1.50, p=0.14). Glucose (t(30) = -4.33, p=0.000, r=0.6), creatinine (t(30)=-3.28, p=0.003, r=0.5) and 25OH-VitD (N=29, Z=-3.98, p=0.000, r=0.5) increased but alkaline phosphatase (ALP) decreased (t(28)=3.63, p=0.001, r=0.5). The differences in W-SDS and ALP were positively correlated (r=0.47, p=0.009). Conclusions: Our results indicate the importance of monitoring blood variables that may accompany growth changes early in MPH treatment and should be further assessed in larger samples.

Transcatheter Coil Embolization in 17 Patients with 22 Coronary Artery Fistulas.

Coronary artery fistulas are rare anomalies that often become symptomatic with age. They are typically diagnosed incidentally during coronary angiography. The chief nonsurgical treatment is transcatheter coil embolization. We evaluated the outcomes of this procedure in 17 symptomatic patients who had 22 fistulas in total. The 9 men and 8 women (mean age, 52 ± 16.5 yr; range, 27-74 yr) presented at 4 Turkish hospitals from October 2008 through March 2015. Three patients had multiple fistulas. Twelve fistulas originated from the right coronary artery and 10 from the left coronary artery, draining into the pulmonary artery in 18 instances. We evaluated results postprocedurally and after 2 to 5 months, defining angiographic success as a flow better than Thrombolysis in Myocardial Infarction grade 2 in the treated artery. Twenty-one of the 22 procedures immediately produced the targeted flow. We observed 2 minor and no major complications. On follow-up, 3 symptomatic patients underwent successful repeat treatment of one fistula each. We found that transcatheter coil embolization afforded good success rates with few complications in closing coronary artery fistulas. We share our experience to add to the data on treating patients with coronary artery fistulas, and to raise awareness among clinicians.

Initial Results of Using Blood Beta 2 Transferrin as a Marker of the Functional Status of a Shunt.

OBJECTIVE: Ventriculoperitoneal shunt is the most common cerebrospinal fluid diversion procedure to treat hydrocephalus. With the change of physiologic cerebrospinal fluid absorption site from arachnoid granulations to the peritoneum, beta 2 transferrin enters the systemic circulation. Therefore, the detection of beta 2 transferrin in the blood can possibly be used as a noninvasive method to assess the functional status of the shunt. The objective of this study was to study the presence of beta 2 transferrin in patients with functional shunts and in shunts suspected of being malfunctional. METHODS: Blood samples were obtained from a group of 20 patients with functional ventriculoperitoneal shunts, from a control group of 10 age-matched healthy volunteers, and from 8 patients with suspected shunt malfunction (6 ventriculoperitoneal, 2 lumboperitoneal). Blood serum beta 2 transferrin levels were measured by enzyme-linked immunosorbent assay with specific anti-beta 2 transferrin antibodies. RESULTS: The mean age in the ventriculoperitoneal shunt group was 36.5 years (range, 24-50 years). The mean age in the control group was 39.5 years (range, 32-48). There was no statistical difference in age between the groups. Beta 2 transferrin levels were 1.99 ± 1.02 ng/mL in the ventriculoperitoneal shunt group and 0.05 ± 0.02 ng/mL in the control group; the statistical difference was strongly significant (P < 0.001). Patients presenting with suspected shunt malfunction had preoperative low beta 2 transferrin levels (0.10 ± 0.12). Postoperatively, their beta 2 transferrin levels increased to 1.75 ± 0.46 ng/mL, and the difference was statistically significant (P = 0.012). CONCLUSION: Blood beta 2 transferrin can be used as a noninvasive test to assess the functional status of a shunt.

Endovascular Therapy for Acute Ischemic Stroke: A Comprehensive Review of Current Status.

Stroke remains among the leading causes of disability and death worldwide. Fibrinolytic therapy is associated with poor patency and functional outcomes. Recently, multiple randomized trials have been published that have consolidated the role of endovascular therapy for ischemic stroke due to large vessel occlusion in the anterior cerebral circulation. This manuscript reviews the current understanding of the endovascular management of acute stroke including technical aspects and current evidence base.

Relationship between neutrophil/lymphocyte ratio with oxidative stress and psychopathology in patients with schizophrenia.

INTRODUCTION: The aim of our study was to evaluate the relationship between neutrophil/lymphocyte ratio (NLR) and total antioxidant status (TAS), total oxidative status (TOS), oxidative stress index (OSI), paraoxonase, and total thiol (T.thl) in schizophrenic patients compared to healthy control group and investigate the relationship between these parameters and psychopathological symptoms. METHODS: The study population consisted of 61 healthy control subjects and 64 volunteer patients monitored in the outpatient clinics of psychiatry of Antalya Education and Research Hospital. Hemograms were determined by using a fully automated hematology analyzer (Beckman Coulter LH780). Serum TOS, TAS, paraoxonase, and T.thl were measured using a novel automated colorimetric measurement method developed by Erel. Sociodemographic data forms were completed by the participants. The Positive and Negative Syndrome Scale (PANSS) was used to assess the patients. RESULTS: Neutrophils, NLR, TAS, and TOS significantly increased, whereas lymphocytes, T.thl, and T.thl/OSI ratio were significantly lower in the schizophrenia patient group compared to the control group. A statistically significant positive relationship was found between PANSS positive subscale with leukocytes and significantly negative relationships were found between PANSS positive subscale with lymphocytes and T.thl/OSI ratio. Significant positive relationships were found between PANSS total subscale with leukocytes and NLR. Statistically significant negative relationships were found between PANSS total subscale with lymphocytes and T.thl/OSI ratio. In the group of patients with schizophrenia, a significant negative correlation was found between NLR with T.thl/OSI. In the group of patients with schizophrenia, a significant positive correlation was found between NLR with TOS and OSI. CONCLUSION: By measuring NLR, which is simple, inexpensive, and suitable for routine use, we can obtain information about oxidative stress and psychopathological symptoms in patients with schizophrenia. Inflammation and oxidative stress are important in the pathogenesis of schizophrenia and are closely related with the patients' clinical symptoms.