Demographic, clinical and laboratory characteristics of adult-onset minimal change disease in Turkey: Turkish Society of Nephrology-Glomerular Diseases (TSN-GOLD) Working Group.

PURPOSE: In our study, diagnostic and demographic characteristics of patients diagnosed with minimal change disease (MCD) by biopsy, clinical and laboratory findings in our country were investigated. METHODS: Data were obtained from the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD) Working Group database. Demographic characteristics, indications for biopsy, diagnosis of the glomerular diseases, comorbidities, laboratory and biopsy findings of all patients were recorded. The data presented are cross-sectional and includes application data for the biopsy period. RESULTS: Of 3875 patients, 233 patients with MCD (median age 35.0 years) were included in the study, which constitutes 6.0% of the total glomerulonephritis database. Renal biopsy was performed in 196 (84.1%) patients due to nephrotic syndrome. Median serum creatinine was 0.7 (0.6-1.0) mg/dl, mean eGFR was 104 ± 33 ml/min/1.73 m2 and median proteinuria 6000 mg/day. The number of patients under the age of 40 years was 139 (59.7%) (Group A), and the number of patients aged 40 years and over was 94 (40.3%) (Group B). Compared to Group A, global sclerotic glomeruli (24 vs. 43, p < 0.001) interstitial inflammation (15 vs. 34, p < 0.001), interstitial fibrosis (20 vs. 31, p = 0.001, vascular changes (10 vs. 25, p < 0.001) and tubular atrophy (18 vs. 30, p < 0.001) were found to be significantly higher in Group B. There was no difference in immunofluorescent staining properties between the two groups. CONCLUSION: Our data are generally compatible with the literature. Chronic histopathological changes were more common in patients aged 40 years and older than younger patients. Studies investigating the effects of these different features on renal survival are needed.

Post-COVID-19 outcomes of non-dialysis dependent chronic kidney disease patients: a national, multicenter, controlled study.

PURPOSE: Coronavirus disease 2019 (COVID-19) has a higher mortality in the presence of chronic kidney disease (CKD). However, there has not been much research in the literature concerning the outcomes of CKD patients in the post-COVID-19 period. We aimed to investigate the outcomes of CKD patients not receiving renal replacement therapy. METHODS: In this multicenter observational study, we included CKD patients with a GFR < 60 ml/min/1.73 m2 who survived after confirmed COVID-19. Patients with CKD whose kidney disease was due to diabetic nephropathy, polycystic kidney disease and glomerulonephritis were not included in this study. CKD patients with similar characteristics, who did not have COVID-19 were included as the control group. RESULTS: There were 173 patients in the COVID-19 group and 207 patients in the control group. Most patients (72.8%) were treated as inpatient in the COVID-19 group (intensive care unit hospitalization: 16.7%, acute kidney injury: 54.8%, needing dialysis: 7.9%). While there was no significant difference between the baseline creatinine values of the COVID-19 group and the control group (1.86 and 1.9, p = 0.978, respectively), on the 1st month, creatinine values were significantly higher in the COVID-19 group (2.09 and 1.8, respectively, p = 0.028). Respiratory system symptoms were more common in COVID-19 patients compared to the control group in the 1st month and 3rd month follow-ups (p < 0.001). Mortality at 3 months after the diagnosis of COVID-19 was significantly higher in the COVID-19 group than in the control group (respectively; 5.2% and 1.4%, p:0.037). Similarly, the rate of patients requiring dialysis for COVID-19 was significantly higher than the control group (respectively; 8.1% and 3.4%, p: 0.045). CONCLUSIONS: In CKD patients, COVID-19 was associated with increased mortality, as well as more deterioration in kidney function and higher need for dialysis in the post-COVID-19 period. These patients also had higher rate of ongoing respiratory symptoms after COVID-19.

Could systemic immune inflammation index be a new parameter for diagnosis and disease activity assessment in systemic lupus erythematosus?

PURPOSE: Systemic immune inflammation index (SII) has been used as a marker of inflammatory status in various diseases, but its role in systemic lupus erythematosus (SLE) is unknown. We aimed to investigate the role of SII in SLE and its association with disease activity and renal involvement. METHODS: In this retrospective study, 76 patients with SLE were compared with 76 age- and gender-matched healthy control group in terms of SII, neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR). SLE Disease Activity Index 2000 system (SLEDAI-2 K) was used to divide the SLE patients into an inactive group (SLEDAI-2 K < 9) and an active group (SLEDAI-2 K ≥ 9). Correlations between the ratios and both disease activity and renal involvement were analyzed. RESULTS: SLE patients had a higher level of SII compared with controls. The ability of SII in predicting SLE (AUC = 0.626) was lower than NLR (AUC = 0.723) and PLR (AUC = 0.666). SII was positively correlated with C-reactive protein (r = 0.288. p = 0.01), but no association between SII and SLEDAI-2 K scores was found. Significantly higher values of NLR, but not SII, were detected in patients with nephritis (p = 0.04). The best NLR cut-off value to predict SLE patients with nephritis was 2.32, with 78.5% sensitivity and 56.2% specificity. CONCLUSION: For the first, we demonstrated that SII level was elevated in patients with SLE. However, NLR is a better marker than SII in predicting SLE and could serve as an indicator of nephritis. Larger-scale studies should be carried out to confirm our results.

Can systemic immune inflammation index at admission predict in-hospital mortality in chronic kidney disease patients with SARS-CoV-2 infection? / ¿Puede el índice de inflamación inmunitaria sistémica al ingreso predecir la mortalidad hospitalaria al ingreso de pacientes con enfermedad renal crónica e infección por SARS-CoV-2?

Background and aim: Patients with chronic kidney disease (CKD) are susceptible to SARS-CoV-2 infection and more prone to develop severe disease. It is important to know predictors of poor outcomes to optimize the strategies of care.Methods: 93 patients with CKD and 93 age-sex matched patients without CKD were included in the study. Data on demographic, clinical features, hematological indices and outcomes were noted and compared between the groups. Neutrophile to lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune inflammation index (SII) (platelet counts×neutrophil counts/lymphocyte counts) and lymphocyte-to-CRP ratio (LCR) were calculated on admission and the association of these markers with disease mortality in CKD patients was identified. (AU)

Antecedentes y objetivo: Los pacientes con enfermedad renal crónica (ERC) son susceptibles a la infección por SARS-CoV-2 y más propensos a desarrollar una enfermedad grave. Es importante conocer los predictores de los malos resultados para optimizar las estrategias de atención. Métodos: Se incluyeron en el estudio 93 pacientes con ERC y 93 pacientes sin ERC, emparejados por edad y sexo. Los datos sobre las características demográficas, clínicas, índices hematológicos y resultados, se anotaron y compararon entre los grupos. La proporción de neutrófilos a linfocitos (NLR), la proporción de plaquetas a linfocitos (PLR), el índice de inflamación inmunitaria sistémica (SII) (recuentos de plaquetas×recuentos de neutrófilos/recuentos de linfocitos) y la proporción de linfocitos a PCR (LCR) se calcularon en el momento de la admisión y se identificó la asociación de estos marcadores con la mortalidad por enfermedad en pacientes con ERC. (AU)

Comparison of bone mineral density and biochemical factors in hemodialysis and peritoneal dialysis patients.

AIM: The aim of the study is to assess and compare the level of bone mineral density (BMD) in the patients undergoing hemodialysis (HD) and peritoneal dialysis (PD) and to identify risk factors related to low BMD. MATERIALS AND METHODS: Dual-energy X-ray absorptiometry (DEXA) scans were performed in 34 HD patients and 47 PD patients. Serum levels of albumin, calcium, phosphorus, alkaline phosphatase (ALP), intact parathyroid hormone (I-PTH), and 25-hydroxy (OH) vitamin D were recorded for the prediction of BMD loss. RESULTS: Among the biochemical parameters compared, only calcium levels differed between the group in such that HD patients had lower calcium compared with patients on PD (p = 0.001). The overall prevalence of osteoporosis (OP) among all participants was 27%. There was a negative correlation between femur neck BMD and age (r = -554, p = 0.007), and BMI (r = -555, p = 0.007). Diabetic nephropathy was the only etiology associated with decreased BMD at the femoral site (p = 0.027). There was a positive correlation between the serum albumin and BMD of lumbar spine (LS) (r = 585, p = 0.004). Bone mass of any site did not correlate with the dialysis type, duration of dialysis, and other biochemical markers like serum calcium, phosphorus, I-PTH, ALP, and 25 (OH) vitamin D. CONCLUSION: Prevalence of OP and osteopenia are high in dialysis patients, with no difference between patients on regular HD and PD. Bone mass loss is related to older age, higher BMI, and lower serum albumin level. DEXA measurement is necessary to monitor bone loss and timely treatment of OP in dialysis patients.

Prognostic value of histopathological scoring and grading in patients with renal AA amyloidosis.

OBJECTIVE: The amount and distribution pattern of amyloid deposits may contribute to renal function and outcome, given the great diversity of renal involvement in amyloidosis. The aim of this study was to analyze the impact of histological characteristics of patients with biopsy-proven renal AA amyloidosis (AAA) on renal outcome. METHODS: Renal biopsies of 37 patients with AAA were re-evaluated. The distribution pattern of glomerular amyloid (GA) deposits was classified, the extent of amyloid deposits in glomeruli, vessel, and interstitium and other histopathologic lesions were scored, and renal amyloid prognostic score (RAPS) was determined by summing all scores. Their potential prognostic relevance on renal outcome was investigated. RESULTS: GA and vascular amyloid (VA) deposits were noted in all cases, interstitial amyloid (IA) was detected in 70.2%. GA deposits were predominantly seen in diffuse mesengiocapillary fashions (class IV) (51.4%). GA class, the extent of GA, VA, IA deposit, and RAPS, as well as interstitial fibrosis (IF) and interstitial inflammation were correlated to renal function at diagnosis. During the median follow-up of 52 months, 13 patients developed doubling of serum creatinine or end stage renal disease and they had a higher degree of GA and VA load (p = 0.03 and p = 0.042, respectively) as compared to the remaining patients. VA load, but not GA and RAPS grade, was associated with poor renal outcome (HR 3.016, 95% CI 1.45-6.25, p = 0.003). CONCLUSIONS: Baseline renal function is closely linked to the extent of AA amyloid deposit in renal parenchyma but only VA load was a predictor of renal outcome in AAA patients.

Daily variability of acid-base status and determinants of serum bicarbonate in hemodialysis patients.

AIM: We aimed to evaluate daily variability of bicarbonate in hemodialysis (HD) patients and identify the factors which affect that issue. MATERIALS AND METHODS: Blood samples of 41 patients for bicarbonate (total carbon dioxide (CO2)) and blood gas analysis (pH, bicarbonate (HCO3-)) were obtained, pre-dialysis and post-dialysis, on the first, second, and third session of the week. Those with pre-dialysis HCO3- < 22 mmol/L in all sessions were classified as acidotic. Demographic and laboratory data of acidotic and non-acidotic groups were compared, and the factors related to HCO3- level were identified. RESULTS: pH, tCO2, HCO3- of the first HD session were significantly lower than those of short inter-dialytic intervals (p < 0.001, respectively). Using Blant Altman analysis, pre- and post-dialysis tCO2 did not show good agreement with HCO3-. Acidotic patients had higher levels of serum albumin and phosphorus (p < 0.01 and p = 0.02, respectively) and were more likely to use sevelamer (p = 0.04). Also, the value of HCO3- was inversely correlated with dialysis vintage (r = -0.432, p = 0.005) and serum albumin (r = -0.427, p = 0.005). CONCLUSION: Since tCO2 did not show good agreement with HCO3-, relying solely on the pre-dialysis tCO2 values to define metabolic acidosis may increase misclassification rate. More work is needed for optimal assessment of acid-base status. Also, understanding the determinants of HCO3- may guide physicians for individualized HCO3- prescription.

Spectrum of biopsy-based renal disease in an elderly Turkish population.

AIM: The prevalence of kidney disease and the number of renal biopsies performed in the elderly are increasing with aging of the population. We aimed to analyze the clinicopathological findings of kidney diseases in the elderly (≥ 65 years), in comparison with their younger counterparts (aged 16 - 64 years). MATERIALS AND METHODS: The data at the time of renal biopsy were obtained by reviewing medical records and the biopsy reports of the patients retrospectively. The data at the time of renal biopsy were obtained by reviewing medical records and the biopsy reports of the patients who underwent renal biopsy at Bakirkoy Dr. Sadi Konuk Education and Research Hospital. Demographic characteristics, clinical syndrome at presentation, and histopathological diagnosis of all patients were recorded. RESULTS: Among the 750 renal biopsies, 93 were performed in elderly patients, which constitutes 12.4% of the biopsies. The mean age of the patients was 71.7 ± 5.4 years, and 62.4% were male. The most common indication for renal biopsy was nephrotic syndrome (NS) in elderly and younger age groups (45.2% vs. 40%). The most frequent histopathological diagnosis was membranous glomerulonephritis (MGN). According to the clinical presentation, MGN (42.8%) was the leading cause of NS, and almost 1/3 of the patients with acute or rapidly progressive renal failure were found to have pauci-immune glomerulonephritis (GN). In comparison with renal biopsy results of younger patients, MGN and pauci-immune GN were more prevalent, but IgA nephropathy, lupus nephritis, and acute tubular necrosis were less common in elderly patients. CONCLUSION: Clinical presentation and the frequency of certain renal pathologies differ with age. The relatively high prevalence of potentially curative kidney diseases in the elderly indicates the importance of renal biopsy in these patients.

Can systemic immune inflammation index at admission predict in-hospital mortality in chronic kidney disease patients with SARS-CoV-2 infection?

BACKGROUND AND AIM: Patients with chronic kidney disease (CKD) are susceptible to SARS-CoV-2 infection and more prone to develop severe disease. It is important to know predictors of poor outcomes to optimize the strategies of care. METHODS: 93 patients with CKD and 93 age-sex matched patients without CKD were included in the study. Data on demographic, clinical features, hematological indices and outcomes were noted and compared between the groups. Neutrophile to lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune inflammation index (SII) (platelet counts×neutrophil counts/lymphocyte counts) and lymphocyte-to-CRP ratio (LCR) were calculated on admission and the association of these markers with disease mortality in CKD patients was identified. RESULTS: CKD patients had higher risk of severe disease, and mortality compared to non-CKD patients (72% vs 50.5%, p=0.003, 36.6% vs 10.8%, p<0.001, respectively) and were more likely to have higher values of immuno-inflammatory indices (leukocyte count, neutrophil, NLR, SII and C-reactive protein, etc.) and lower level of lymphocyte and LCR. Also, higher levels of NLR, SII, PLR and lower level of LCR were seen in CKD patients who died compared to those recovered. In a receiver operating characteristic curve analysis, NLR, SII, PLR and LCR area under the curve for in-hospital mortality of CKD patients were 0.830, 0.811, 0.664 and 0.712, respectively. Among all parameters, NLR and SII gave us the best ability to distinguish patients with higher risk of death. Based on the cut-off value of 1180.5, the sensitivity and specificity of the SII for predicting in-hospital mortality were found to be 67.5% and 79.6%, respectively. The corresponding sensitivity and specificity of the NLR were 85.2% and 66.1%, respectively, at the cut-off value of 5.1. Forward stepwise logistic regression analysis showed that NLR (≥5.1), SII (≥1180.5) and LCR (≤9) were predictors for in-hospital mortality. CONCLUSION: We report for the first time that SII is able to distinguish COVID-19 infected CKD patients of worse survival and it is as powerful as NLR in this regard. As SII is easily quantified from blood sample data, it may assist for early identification and timely management of CKD patients with worse survival.

Can systemic immune inflammation index at admission predict in-hospital mortality in chronic kidney disease patients with SARS-CoV-2 infection?

Background and aim: Patients with chronic kidney disease (CKD) are susceptible to SARS-CoV-2 infection and more prone to develop severe disease. It is important to know predictors of poor outcomes to optimize the strategies of care. Methods: 93 patients with CKD and 93 age-sex matched patients without CKD were included in the study. Data on demographic, clinical features, hematological indices and outcomes were noted and compared between the groups. Neutrophile to lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune inflammation index (SII) (platelet counts × neutrophil counts/lymphocyte counts) and lymphocyte-to-CRP ratio (LCR) were calculated on admission and the association of these markers with disease mortality in CKD patients was identified. Results: CKD patients had higher risk of severe disease, and mortality compared to non-CKD patients (72% vs 50.5%, p = 0.003, 36.6% vs 10.8%, p < 0.001, respectively) and were more likely to have higher values of immuno-inflammatory indices (leukocyte count, neutrophil, NLR, SII and C-reactive protein, etc.) and lower level of lymphocyte and LCR. Also, higher levels of NLR, SII, PLR and lower level of LCR were seen in CKD patients who died compared to those recovered. In a receiver operating characteristic curve analysis, NLR, SII, PLR and LCR area under the curve for in-hospital mortality of CKD patients were 0.830, 0.811, 0.664 and 0.712, respectively. Among all parameters, NLR and SII gave us the best ability to distinguish patients with higher risk of death. Based on the cut-off value of 1180.5, the sensitivity and specificity of the SII for predicting in-hospital mortality were found to be 67.5% and 79.6%, respectively. The corresponding sensitivity and specificity of the NLR were 85.2% and 66.1%, respectively, at the cut-off value of 5.1. Forward stepwise logistic regression analysis showed that NLR (≥5.1), SII (≥1180.5) and LCR (≤9) were predictors for in-hospital mortality. Conclusion: We report for the first time that SII is able to distinguish COVID-19 infected CKD patients of worse survival and it is as powerful as NLR in this regard. As SII is easily quantified from blood sample data, it may assist for early identification and timely management of CKD patients with worse survival.

Antecedentes y objetivo: Los pacientes con enfermedad renal crónica (ERC) son susceptibles a la infección por SARS-CoV-2 y más propensos a desarrollar una enfermedad grave. Es importante conocer los predictores de los malos resultados para optimizar las estrategias de atención. Métodos: Se incluyeron en el estudio 93 pacientes con ERC y 93 pacientes sin ERC, emparejados por edad y sexo. Los datos sobre las características demográficas, clínicas, índices hematológicos y resultados, se anotaron y compararon entre los grupos. La proporción de neutrófilos a linfocitos (NLR), la proporción de plaquetas a linfocitos (PLR), el índice de inflamación inmunitaria sistémica (SII) (recuentos de plaquetas × recuentos de neutrófilos/recuentos de linfocitos) y la proporción de linfocitos a PCR (LCR) se calcularon en el momento de la admisión y se identificó la asociación de estos marcadores con la mortalidad por enfermedad en pacientes con ERC. Resultados: Los pacientes con ERC tuvieron un mayor riesgo de enfermedad grave y mortalidad en comparación con los pacientes sin ERC (72% vs 50,5%, p = 0,003, 36,6% vs 10,8%, p < 0,001, respectivamente) y tuvieron más probabilidades de tener valores más altos de índices inmuno inflamatorios (recuento de leucocitos, neutrófilos, NLR, SII y proteína C reactiva, etc.) y niveles más bajos de linfocitos y LCR. Además, se observaron niveles más altos de NLR, SII, PLR y un nivel más bajo de LCR en pacientes con ERC que murieron en comparación con los recuperados. En un análisis de la curva de características operativas del receptor, el área NLR, SII, PLR y LCR bajo la curva de mortalidad hospitalaria de pacientes con ERC fueron de 0,830, 0,811, 0,664 y 0,712, respectivamente. Entre todos los parámetros, NLR y SII se dió a conocer la mejor manera de distinguir a los pacientes con mayor riesgo de muerte. Con base en el valor de corte de 1180,5, se encontró que la sensibilidad y especificidad del SII, para predecir la mortalidad hospitalaria, fue del 67,5% y 79,6%, respectivamente. La sensibilidad y especificidad correspondientes del NLR fueron del 85,2% y 66,1%, respectivamente, en el valor de corte de 5,1.El análisis de regresión logística escalonada hacia adelante mostró que el NLR (≥5,1), SII (≥1180,5) y LCR (≤9) fueron predictores de mortalidad hospitalaria. Conclusión: Informamos, por primera vez, que el SII es capaz de distinguir pacientes con ERC infectados por COVID-19 de peor supervivencia y, en este sentido, es tan poderoso como el NLR. Como el SII se cuantifica fácilmente a partir de los datos de las muestras de sangre, puede ayudar a la identificación temprana y el manejo oportuno de los pacientes con ERC con peor supervivencia.

Blastocyst transfer does not improve cycle outcome as compared to D3 transfer in antagonist cycles with an elevated progesterone level on the day of hCG.

OBJECTIVE: To evaluate the association between progesterone elevation on the day of human chorionic gonadotropin (hCG) administration and clinical pregnancy rates of gonadotropin-releasing hormone (GnRH) antagonist in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles with the transfer of embryos at different developmental stages (day-3 versus day-5 ETs). MATERIAL AND METHODS: This is a retrospective analysis of fresh IVF/ICSI; 194 cycles out of 2676 conducted in a single center. RESULTS: A total of 2676 cycles were analyzed, of which 386 had no progesterone measurements available. Two hundred eighteen cycles had progesterone elevation (p>1.5 ng/mL) giving an overall incidence of 9.5%. Twenty-four cycles were excluded from further analysis. Of the remaining 194 cycles, 151 had day-3 transfers and 43 had blastocyst transfers. There was no statistically significant difference in pregnancy and clinical pregnancy rates per transfer between the D3-ET and D5-ET groups (46% vs. 49%, and 39% vs. 35%, respectively). CONCLUSION: The results of this study suggest that blastocyst transfer does not improve cycle outcomes compared with D3 transfer in GnRH antagonist cycles with an elevated progesterone level on the day of hCG.

Labial fusion: A rare cause of urinary retention in reproductive age woman and review of literature.

Labial fusion usually affects prepubertal girls and postmenopausal women, it may rarely occurs in reproductive years in the absence of predisposing factors such as vulvar infections, dermatitis, trauma, female circumcision and lichen sclerosis. Should be considered in differential diagnosis in the differential diagnosis of urinary retention even if the patient doesn't have history of sexual intercourse.

Endovascular treatment of postpartum deep venous thrombosis: report of three cases.

Pregnancy and the postpartum period are generally considered as contraindications for thrombolysis. We evaluate in this report the safety and effectiveness of using ultrasound-accelerated catheter-directed thrombolysis (UACDT) in treating three symptomatic postpartum deep vein thrombosis (DVT). UACDT was performed using a recombinant human tissue plasminogen activator (alteplase) which was delivered using the EKOS EkoSonic® system. Postprocedure venography was repeated after treatment which include stenting if stenosis was present. The treatment was successful in all three cases of iliofemoral DVT and symptom relief was achieved in all cases. Minor bleeding at the catheter insertion site in one patient was observed but none of the patients suffered from major bleeding or symptomatic pulmonary embolism. UACDT is a safe and effective treatment for restoration of the venous flow in patients with postpartum iliofemoral DVT. Residual venous obstruction should be treated by angioplasty and stent insertion to avoid early re-thrombosis.

Gastroesophageal reflux disease in our asthma patients: the presence of dysphagia can influence pulmonary function.

BACKGROUND: The prevalence of Gastroesophageal Reflux Disease (GERD) in Turkey is reported as 11.6%. Studies of pulmonary function in asthmatics have demonstrated a correlation between lung resistance and the occurrence of spontaneous gastroesophageal reflux. Few studies have included measures of lung diffusing capacity for carbon monoxide. The aim of this study is to assess whether asthma patients had worse lung function and gas diffusion according to diversity of GERD symptoms they concurrently experienced. The secondary aim of the study is to determine the frequency and different faces of GERD in our asthma patients compared to healthy controls. METHODS: Sixty consecutive asthma patients evaluatd at the pulmonary specialty outpatient clinic were included in the study. The control group included 60 healthy volunteers who had normal pulmonary function and routine laboratory tests. A modified version of a self-reported questionnaire developed by Locke and associates at the Mayo Clinic was conducted face-to-face with consecutive asthma patients and control subjects. Pulmonary function measurements were taken using spirometry. DLCO (mL/dk/mmHg) and DLCO/VA (DLCO adjusted according to alveolar volume) were measured using a single-breath technique. Statistical analyses were performed using the SPSS 17.0 statistical software. RESULTS: DLCO and DLCO/VA were significantly lower in asthma patients who had dysphagia symptoms. Frequent and significant acid regurgitations were seen in 28.33% (n = 17) of patients in the study group and 6.7% (n = 4) of patients in the control group. Severe, troublesome heartburn symptoms were reported by 28.2% (n = 17) of patients in the study group and 16.7% (n = 10) of subjects in the control group. Dysphagia was detected in 38.3% (n = 23) of all asthma cases and in 1.7% (n = 1) of the subjects in the control group. CONCLUSIONS: There were many faces of gastroesophageal reflux disease in our asthmatic patients. Dysphagia was the only GERD symptom influencing on pulmonary function tests, while gastroesophageal reflux symptoms and nocturnal awakening attacks were common in this study.

Umbilical cord thickness in the first and early second trimesters and perinatal outcome.

OBJECTIVES: To study the association between thickness of the umbilical cord at 11+0 to 14+6 gestational weeks and perinatal outcome. METHODS: We studied 216 pregnant women between 11+0 and 14+6 weeks' gestation with singletons, intact membranes, normal volumes of amniotic fluid and a regular menstrual period. Patients with umbilical cord measurements below the 5(th) centile were defined as thin umbilical cord group and those between the 5(th) and 95(th) or above 95(th) centile were defined as non-lean umbilical cord group. Abortion or fetal demise, preeclampsia, mode of delivery, gestational age at delivery, birth weight, and 5-min Apgar scores were noted. RESULTS: A statistically significant difference existed between the mean gestational age, mode of delivery, birth weight and adverse perinatal outcome of the two groups. The relative risk of the adverse perinatal outcome in lean umbilical cords was 6.92 (2.71-17.67; 95% CI). The umbilical cord thickness correlated with birth weight (P<0.05). CONCLUSIONS: Sonographic finding of a lean umbilical cord at 11+0 to 14+6 weeks' gestation should prompt the physician to strict monitoring of pregnancy.