Changes in bone turnover markers in adolescents with gastroesophageal reflux disease treated with lansoprazole.

Background: Proton pump inhibitors (PPIs) have been suggested to lead to bone resorption, while the effects of PPIs on the bone mineral metabolism in children has received only limited attention in literature to date. The present study investigates whether lansoprazole alters bone turnover markers in adolescents with gastroesophageal reflux disease (GERD). Patients and methods: Included in the study were adolescents aged 16-18 with GERD and a healthy volunteers group. The GERD patient group was treated with lansoprazole 30 mg once daily for eight weeks. The serum calcium, phosphorus, magnesium, alkaline phosphatase (ALP), parathormone (PTH), 25 (OH) vitamin D, osteocalcin and urinary calcium, creatinine, deoxypyridinoline (DPD), collagen type-1 crosslinked C-telopeptide (CTX) and collagen type-1 crosslinked N-telopeptide (NTX) of both groups were studied before and after the end of the treatment. Results: A comparison of the 30 patients with GERD and the 30 volunteers revealed no significant difference in the serum calcium, phosphorus, magnesium, ALP, urinary calcium/creatinine ratio, 25 (OH) vitamin D and PTH levels measured before and after the lansoprazole treatment, while the osteocalcin, DPD, CTX and NTX values were found to be higher after treatment when compared to those at pre- treatment. Conclusions: The results of this study reveal that eight weeks of treatment with 30 mg lansoprazole daily increased the bone turnover markers of CTX, NTX, DPD and osteocalcin in adolescents aged 16-18.

Do Meteorological Variations and Climate Changes Affect Hyperemesis Gravidarum?

BACKGROUND: To estimate a possible association between the effects of daily meteorological variation and climatological changes (temperature, air pressure, humidity, sunniness level) on pregnant women with hyperemesis gravidarum (HG) according to symptoms grade and hospitalization state. METHODS: A retrospective study was conducted with 118 patients diagnosed and hospitalized with HG. HG patients were graded as mild, moderate, or severe according to the Pregnancy Unique Quantification of Emesis (PUQE-24) scale. Data regarding demographic characteristics, PUQE scale value, gestational week on hospitalization, hospital admission and discharge dates, weather conditions, daily meteorological values during hospitalization ( temperature, air pressure, humidity, sunniness level), seasonal averages, and daily changes were recorded. Weather records were obtained from the Ankara Meteorology General Directorate (Ankara, Turkey). Differences between groups were compared according to HG grade. RESULTS: HG cases were classified as mild (33.1%), moderate (44.9%), or severe (22.0%). The number of hospitalization days significantly differed between these three groups (p<0.05). In contrast, no statistically significant differences were identified between the HG grade level groups in regard to humidity, pressure, temperature, and sunniness level data (p>0.05). In addition, no statistically significant relationship was identified between HG grades and seasonal conditions according to the chi-square test (p>0.05). CONCLUSION: Changes in the meteorological and climate values examined were independent of symptom severity and hospitalization rate for our HG patients. However, it is possible that climate changes occurring around the world may affect the pregnancy period and should be further investigated.

El valor de la gammagrafía paratiroidea en la detección de lesiones en pacientes con hiperparatiroidismo primario normocalcémico / The value of parathyroid scintigraphy on lesion detection in patients with normocalcemic primary hyperparathyroidism

Objetivo: El hiperparatiroidismo primario (HPP) es una de las enfermedades endocrinas más frecuentes. La mayoría de los pacientes con HPP son asintomáticos, y solo el 20% de ellos se vuelven sintomáticos con niveles crecientes de calcio (Ca). Se ha informado que el hiperparatiroidismo primario normocalcémico puede ser el período incipiente de HPP en el que los niveles de Ca están en un rango normal, y puede avanzar a HPP abierto. El diagnóstico temprano de la HPP es importante para prevenir sus complicaciones. En este estudio retrospectivo, nos propusimos evaluar el papel de la gammagrafía paratiroidea 99mTc-MIBI en la detección de lesiones en pacientes con HPP normocalcémico.Material y métodos: La base de datos de gammagrafía paratiroidea fue revisada retrospectivamente en pacientes con HPP. 117 pacientes que se sometieron a la gammagrafía 99mTc-MIBI fueron reclutados para el estudio. El nivel de Ca sérico superior a 10,5mg/dl se consideró como hipercalcemia.Resultados: Los niveles medios de PTH sérica (media±DE) de un total de 117 pacientes (mujeres/mujeres: 98/19) fueron de 149±97pg/ml en el grupo normocalcémico (Ca: 9,6±0,6mg/dl, n=38) y de 189±135pg/ml en el grupo hipercalcémico (Ca: 11,4±0,6mg/dl, n=79) (p=0,072). El sexo y la edad no fueron diferentes entre los grupos de gammagrafía positiva y negativa, pero las tasas de detección de lesiones con gammagrafía paratiroidea fueron del 42% en el grupo normocalcémico y del 81% en el grupo hipercalcémico (p<0,0001).Conclusiones: Varios factores, entre los que se incluyen el Ca sérico, el protocolo de imágenes, la existencia de enfermedad multiglandular, el tamaño y la biocinética MIBI del adenoma pueden influir en la detectabilidad de la lesión en la gammagrafía paratiroidea. Aunque un alto nivel de Ca en suero es un parámetro importante para predecir su éxito, la gammagrafía paratiroidea sigue siendo un método de diagnóstico valioso incluso en pacientes con HPP normocalcémico (AU)

Objective: Primary hyperparathyroidism (PHPT) is one of the most frequent endocrine diseases. Most of the patients with PHPT are asymptomatic, and only 20% of them become symptomatic with increasing levels of calcium. It has been reported that normocalcemic primary hyperparathyroidism (NPHPT) may be the incipient period of PHPT where calcium (Ca) levels are in normal range, and it may advance to overt PHPT. Early diagnosis of PHPT is important in order to prevent its complications. In this retrospective study, we aimed to evaluate the role of 99mTc-MIBI parathyroid scintigraphy on lesion detection in patients with NPHPT.Material and methods: The parathyroid scintigraphy database was reviewed retrospectively in patients with PHPT. 117 patients who underwent 99mTc-MIBI scintigraphy were recruited to the study. Serum calcium level above 10.5mg/dl was considered as hypercalcemia.Results: A total of 117 patients’ (female/male:98/19) mean serum PTH levels (mean±SD) were 149±97 pg/ml in normocalcemic group (Ca:9.6±0.6mg/dL, n:38) and 189±135 pg/ml in hypercalcemic group (Ca:11.4±0.6mg/dL, n:79) (p:0.072). The sex and ages were not different between the scintigraphy positive and negative groups, but the lesion detection rates with parathyroid scintigraphy were 42% in normocalcemic group and 81% in hypercalcemic group (p<0.0001).Conclusions: Several factors including serum Ca, the imaging protocol, existence of multiglandular disease, the size and MIBI biokinetics of the adenoma may influence lesion detectability in parathyroid scintigraphy. Although high serum Ca level is an important parameter in predicting its success, parathyroid scintigraphy remains a valuable diagnostic method even in patients with NPHPT (AU)

Correlation between 25-hydroxy vitamin D levels and COVID-19 severity in pregnant women: a cross-sectional study.

OBJECTIVE: To evaluate the relationship between 25-hydroxy vitamin D (25(OH)D) levels and disease severity in hospitalized COVID-19 positive pregnant women. METHODS: The COVID-19 (+) pregnant women (confirmed by PCR test) were classified as asymptomatic, mild symptomatic, and severe disease according to their symptoms and laboratory results. Severe COVID-19 criteria were respiratory symptoms and/or findings. The following laboratory results were considered as poor prognostic factors: the number of lymphocytes <800/µl and/or CRP value >10 times the upper limit of the normal range and/or ferritin value >500 ng/ml and/or D-Dimer value >1000 µg/l. The patients were divided into two groups; asymptomatic or mild symptomatic group (Group 1), and severe disease and/or poor prognostic factor group (Group 2). The 25(OH)D levels were compared between groups. ROC curve analysis was used to analyze the cutoff value for vitamin D to predict the severity of COVID-19. RESULTS: 25(OH)D levels were found to be statistically significantly lower in group 2 (15.5 (10.25) ng/ml in Group 1, 13 (12) ng/ml in Group 2, p = .010). The 25(OH)D level under 14.5 ng/ml was associated with severe COVID-19 and/or poor prognostic factors (p = .010). The risk of severe COVID-19 and/or having poor prognostic factors was 1.87 times higher among pregnant women who had 25(OH)D levels below 14.5 ng/ml. This value was found to have 54.1% sensitivity and 61.3% specificity in predicting severe COVID-19 and/or poor prognostic laboratory findings in pregnant women. CONCLUSION: There is a relationship between vitamin D status and the severity of COVID-19 in pregnant women. During the pandemic period, vitamin D supplementation for pregnant women should gain more importance.

Newborn Hearing Screening Results of Infants Born To Mothers Who Had COVID-19 Disease During Pregnancy: A Retrospective Cohort Study.

OBJECTIVE: Viral infections are known to be a risk factor for neonatal hearing loss. COVID-19 infection has been reported to affect hearing test results in one small sample sized study. We aimed to investigate the incidence the risk of neonatal hearing loss in infants of mothers who had COVID-19 infection during pregnancy, regarding their trimesters, by evaluating the neonatal hearing screening results. DESIGN: In this retrospective case-control study, neonatal hearing test results of 458 women with a history of COVID-19 infection in pregnancy were compared with 339 women who gave birth before the pandemic. Data of pregnant women who attended the COVID-19 outpatient clinic of the emergency service of a tertiary pandemic hospital and who had confirmed infection with a reverse transcriptase-polymerase chain reaction (RT-PCR) test were determined from the hospital's records and their neonatal hearing screening results were analyzed from the national database. Neonates born before <34 weeks, and with reported risk factors in the database such as congenital anomaly or known TORCH infection during pregnancy were excluded. The screening tests, Automated Auditory Brainstem Response or Transient Evoked Otoacoustic Emission (TEOAE), were used for screening, and patients who failed the first screening were reevaluated at least 2 weeks apart with a second screening. RESULTS: The incidence of failed second screening was 1.3% in the COVID-19 group and 2.9% in controls, and no significant difference was observed between the two groups according to the final screening results on the second test. Among the 458 mothers, 8 were infected in first trimester, 126 in second trimester, 127 in third trimester but did not deliver within 15 days after infection and 197 were positive at birth. Six neonates in the infected group failed the second screening (3 [2.4%] in the second trimester, 1 [0.8%] third trimester, and 2 [1.0%] positive at birth). CONCLUSIONS: COVID-19 infection during pregnancy was not found to be a risk factor for hearing loss, according to the newborn hearing screening results.

Seronegative autoimmune hepatitis in children: a single-center experience.

BACKGROUND: Seronegative autoimmune hepatitis (AIH) is a diagnostic challenge with unclear prognosis. This study describes the features and outcomes of seronegative AIH in children. PATIENTS AND METHODS: Patients under 18 years of age, who had been diagnosed with AIH between April 2014 and April 2020, were retrospectively evaluated. Seronegative AIH was identified by the absence of the three conventional non-organ-specific autoantibodies (anti-nuclear antibody [ANA], anti-smooth muscle antibody [ASMA], and anti-liver kidney microsomal [anti-LKM] type 1 antibody), alongside the characteristic AIH liver histopathology and a positive response to immunosuppressive therapy in the absence of other liver diseases. RESULTS: The study included 54 patients with AIH. 15 (27.77%) were seronegative at the time of diagnosis. 13 of the 15 seronegative patients presented with acute hepatitis or acute liver failure (ALF). Mean follow-up duration was 27.48 months in seronegative patients. Two seronegative patients had lymphocytopenia on admission, and, although the liver disease improved after corticosteroid treatment, they developed aplastic anemia (AA). Other seronegative patients responded well to immunosuppressive therapy. CONCLUSIONS: Patients with seronegative AIH present frequently with acute hepatitis or ALF. AIH diagnosis can be confirmed by observing the effects of corticosteroid therapy in seronegative patients with characteristic AIH liver histopathological features. However, the presence of lymphocytopenia in seronegative patients is a sign of bone marrow failure.

Association between TSH Values and GFR Levels in Euthyroid Cases with Metabolic Syndrome.

BACKGROUND: Metabolic syndrome (MetS) is associated with the risk of developing chronic kidney disease. Although the negative effects of high thyroid-stimulating hormone (TSH) values on glomerular filtration rate (GFR) levels have been known for years, the negative effects of increased TSH on GFR in euthyroid cases have been reported in recent years. This study was aimed at investigating the association between the effect of increased TSH values and estimated-GFR (eGFR) levels in euthyroid cases with MetS. METHODS: For this hospital-based descriptive study, 191 MetS cases (123 females, 68 males) were evaluated. Those whose TSH was not within 0.5-4.5 uIU/mL, eGFR was <40 mL/min/1.73 m2, and/or reported any thyroid/kidney disease were excluded. Partial correlation coefficients were calculated to investigate the relationship between the eGFR values and several other numerical variables while controlling for age and BMI in addition to the adjusted gender effect. Thereafter, the multiple linear regression analysis with a stepwise variable selection approach was used to reveal the independent factors that could affect the logarithmically transformed eGFR. RESULTS: The median age was 52 (19-65) years, the median eGFR was 94.3 (41.3-194) mL/min/1.73 m2, and the median TSH was 1.58 (0.50-4.50) uIU/mL in the whole group. Increased TSH even in the normal range was associated with eGFR after adjusting for age and body mass index (BMI), especially in females. The high age (b = -0.160, p=0.005), high BMI (b = -0.134, p=0.020), high TSH (b = -0.380, p < 0.01), and high uric acid (b = -0.348, p < 0.01) were found as significant predictors of the eGFR in MetS patients. CONCLUSION: Independent of age and BMI, elevated TSH even in the euthyroid range showed an association with the eGFR in female MetS cases who had normal kidney functions. This correlation was stronger than the correlations between the eGFR and the MetS diagnostic parameters. These findings need further studies on the issue..

The value of parathyroid scintigraphy on lesion detection in patients with normocalcemic primary hyperparathyroidism. / El valor de la gammagrafía paratiroidea en la detección de lesiones en pacientes con hiperparatiroidismo primario normocalcémico.

OBJECTIVE: Primary hyperparathyroidism (PHPT) is one of the most frequent endocrine diseases. Most of the patients with PHPT are asymptomatic, and only 20% of them become symptomatic with increasing levels of calcium. It has been reported that normocalcemic primary hyperparathyroidism (NPHPT) may be the incipient period of PHPT where calcium (Ca) levels are in normal range, and it may advance to overt PHPT. Early diagnosis of PHPT is important in order to prevent its complications. In this retrospective study, we aimed to evaluate the role of 99mTc-MIBI parathyroid scintigraphy on lesion detection in patients with NPHPT. MATERIAL AND METHODS: The parathyroid scintigraphy database was reviewed retrospectively in patients with PHPT. 117 patients who underwent 99mTc-MIBI scintigraphy were recruited to the study. Serum calcium level above 10.5mg/dl was considered as hypercalcemia. RESULTS: A total of 117 patients' (female/male:98/19) mean serum PTH levels (mean±SD) were 149±97 pg/ml in normocalcemic group (Ca:9.6±0.6mg/dL, n:38) and 189±135 pg/ml in hypercalcemic group (Ca:11.4±0.6mg/dL, n:79) (p:0.072). The sex and ages were not different between the scintigraphy positive and negative groups, but the lesion detection rates with parathyroid scintigraphy were 42% in normocalcemic group and 81% in hypercalcemic group (p<0.0001). CONCLUSIONS: Several factors including serum Ca, the imaging protocol, existence of multiglandular disease, the size and MIBI biokinetics of the adenoma may influence lesion detectability in parathyroid scintigraphy. Although high serum Ca level is an important parameter in predicting its success, parathyroid scintigraphy remains a valuable diagnostic method even in patients with NPHPT.

Comparison of the maternal and neonatal outcomes of pregnant women whose anemia was not corrected before delivery and pregnant women who were treated with intravenous iron in the third trimester.

AIM: Anemia is one of the most common problems of pregnancy. In this study, we aimed to compare the maternal and fetal outcomes in labor and delivery in women whose anemia was treated with intravenous iron and women who delivered with uncorrected anemia. MATERIALS: METHODS: This retrospective case-control study was carried out in a tertiary obstetric care center. Term (> 37 weeks), singleton, low-risk pregnant women who were admitted for delivery were evaluated. Seventy-two pregnant women who had intravenous ferric carboxymaltose treatment in the third trimester were compared with 72 women who were anemic (Hb < 10 g/dL) at the time Queryof admission for delivery. RESULTS: The groups were similar in terms of age, parity, and gestational age. The mean gestational age of the study group was 38.6 weeks. Their mean Hb of 8.2 ± 0.8 g/dL improved to 11.1 ± 1.3 g/dL prior birth. The mean Hb of the anemic group was 9.1 ± 0.5 g/dL upon admission for birth. The mean APGAR scores, admission to neonatal intensive care unit, and the rates of preterm delivery, small for gestational age, and low-birth weight infant were similar between groups. The primary cesarean section rate was significantly higher in anemic women (4.2% vs. 19.4%; p < 0.001) and the need for postpartum blood transfusion also decreased with iv iron treatment (8.3% vs. 29.2%; p = 0.02). CONCLUSION: Correction of anemia with intravenous ferric carboxymaltose in the third trimester does not significantly change neonatal outcomes but it is effective in reducing maternal morbidity.

The Effect of COVID-19 Pandemic and Social Restrictions on Depression Rates and Maternal Attachment in Immediate Postpartum Women: a Preliminary Study.

We aimed to evaluate the postpartum depression rates and maternal-infant bonding status among immediate postpartum women, whose last trimester overlapped with the lockdowns and who gave birth in a tertiary care center which had strong hospital restrictions due to serving also for COVID-19 patients, in the capital of Turkey. The low-risk term pregnant women who gave birth were given the surveys Edinburgh Postpartum Depression Scale (EPDS) and Maternal Attachment Inventory (MAI) within 48 h after birth. A total of 223 women were recruited. The median score obtained from the EPDS was 7 (7) and 33 (14.7%) of the women were determined to have a risk for postpartum depression. The median scores of the EPDS inventory of depressive women were 15 (3). The median MAI score of 223 women was 100 (26); and the MAI scores of women with depression were significantly lower than the controls [73 (39) vs. 101 (18) respectively, p < 0.001]. Evaluation of the factors that affect the psychological status of pregnant and postpartum women will lead the healthcare system to improve the implementations during the COVID-19 pandemic.

Mean Platelet Volume is Affected in Term Fetuses with Intrauterine Growth Restriction.

OBJECTIVES: The aim of our study was to analyze the mean platelet volume levels as a potential marker of altered placentation in intrauterine growth restriction (IUGR) cases. METHODS: A total of 126 term singleton pregnant women with IUGR fetuses and 345 healthy pregnant controls were recruited and compared. RESULTS: The mean platelet volume was significantly higher in the IUGR group (10.8±0.9 fl) than the control group (9.9±1.1 fl) (p=0.03). The mean hemoglobin was lower in IUGR group (11.3 (8.3-14.5) g/dl) than the control group (11.9 (8.2-13.0) g/dl) (p=0.04). The optimal cut-off MPV for prediction of IUGR was ≥10.55 fl, with a sensitivity of 59% and a specificity of 75%. CONCLUSION: Increased MPV levels in term pregnant women may be particularly helpful for discrimination and prediction of high-risk fetuses when IUGR is suspected.

Subcutaneous tissue stiffness of cesarean incision scar by elastography as a predictor of intra-abdominal adhesions.

AIM: This study aimed to investigate whether subcutaneous tissue stiffness of the previous cesarean section (CS) skin incision could predict the severity of the intra-abdominal adhesions at a repeat CS. METHODS: In this prospective cross-sectional study, pregnant women with at least one prior cesarean delivery were included. The subcutaneous tissue stiffness of the previous CS skin scar was measured by shear wave elastography (SWE) on the day of the repeat CS and the intra-abdominal adhesions were recorded by an adhesion classification scheme specific for CS. Total adhesion score was classified as mild adhesion between 1 and 4, moderate adhesion between 5 and 12, and severe adhesion if ≥13. RESULTS: Of the 102 women, 41 (40.2%) had no adhesions, 18 (17.6%) had mild adhesions, 26 (25.5%) had moderate adhesions and 17 (16.7%) had severe adhesions. The mean SWE measurements were significantly higher in the moderate and severe adhesion group than the non-adhesion and mild adhesion group (51.5 ± 25.3 vs 36.8 ± 22.6, P = 0.003). There was a statistically significant correlation between the preoperative SWE measurements and total adhesion scores (correlation coefficient [r] = 0.397, P < 0.001). In receiver-operator characteristics curve analysis, the cut-off value for moderate or severe adhesions was found to be 36.5 (area under curve = 0.710, %95 confidence interval 0.606-0.815; P < 0.001). With the cut-off point of ≥36.5, the sensitivity and specificity for the prediction of mild and severe adhesions were 74.4% and 40.5%, respectively. CONCLUSION: Elastographic evaluation of the subcutaneous tissue stiffness of the cesarean incision scar might show the degree of intra-abdominal adhesions at a repeat CS.

Parvovirus B19 Infection as a Rare Cause of Fulminant Liver Failure: A Case Report.

Parvovirus B19 infection is common in childhood. The clinical presentations range from benign to life threatening. The literature shows that the clinical presentation is influenced by the patient's age and the presence of chronic disease such as chronic hemolytic disorders and immunosuppressed conditions. As the majority of patients with liver failure are diagnosed as indeterminate, knowledge about parvovirus B19 associated liver disease is limited. We examined 3 children with parvovirus B19-induced fulminant liver failure, 2 of whom underwent liver transplantation. Although the presented patients received standard corticosteroid and tacrolimus therapy as an immunosuppressive regimen, acute rejection, parvovirus B19 persistence, or any other complications due to parvovirus B19 were not observed. Physicians should be aware of the parvovirus B19 infection in association to acute liver diseases.

Effect of high-frequency bio-oxidative ozone therapy for masticatory muscle pain: a double-blind randomised clinical trial.

To evaluate the effect of bio-oxidative ozone application at the points of greatest pain in patients with chronic masticatory muscle pain. A total number of 40 (40 women, with a mean age of 31·7) were selected after the diagnosis of myofacial pain dysfunction syndrome according to the Research Diagnostic Criteria for temporomandibular disorder (RDC/TMD). The patients were randomly divided into two groups: patients received the ozone therapy at the point of greatest pain, ozone group (OG; n = 20); patients received the sham ozone therapy at the point of greatest pain, placebo group (PG; n = 20). Ozone and placebo were applied three times per week, for a total of six sessions. Mandibular movements were examined, masticator muscles tenderness were assessed and pressure pain threshold (PPT) values were obtained. Subjective pain levels were evaluated using visual analogue sale (VAS). These assessments were performed at baseline, 1 month and 3 months. Ozono therapy decreased pain intensity and increased PPT values significantly from baseline to 1 month and 3 months in OG compared with PG. PPTs of the temporal (OG = 24·85 ± 6·65, PG = 20·65 ± 5·43, P = 0.035) and masseter (OG = 19·03 ± 6·42, PG = 14·23 ± 2·95, P = 0.007) muscles at 3 months of control (T2) were significantly higher in the OG group. PPT value of the lateral pole was also significantly higher at T2 in the OG group (OG = 21·25 ± 8·43, PG = 15·35 ± 4·18, P = 0.012). Mandibular movements did not show significant differences between treatment groups except right lateral excursion values at T2 (OG = 8·90 ± 1·77, PG = 6·85 ± 2·41, P = 0.003); however, OG demonstrated significantly better results over time. Overall improvements in VAS scores from baseline to 3 months were OG 67·7%; PG 48·4%. Although ozone therapy can be accepted as an alternative treatment modality in the management of masticatory muscle pain, sham ozone therapy (placebo) showed significant improvements in the tested parameters.

Patients with ultrasound diagnosis of hepatic steatosis are at high metabolic risk.

Background and aims: Hepatic steatosis is the basis of non-alcoholic fatty liver disease (NALFD). Mere fat accumulation within hepatocytes is considered the mild form of NAFLD, but can progress in some patients to advanced steatohepatitis (NASH), which may lead to fibrosis, cirrhosis or hepatocellular carcinoma. However, even hepatic steatosis alone may be a risk factor for cardiovascular disease (CVD). Patients and methods: In the present real life study 106 patients from the outpatient clinic of the Department for Gastroenterology and Hepatology with either NAFLD (n = 60) or other typical diagnoses (n = 46) were included. Ultrasound examination identified 77 patients with hepatic steatosis. Liver enzymes, lipid profile, surrogate cell death markers, and adiponectin were determined. Transient elastography (Fibroscan®) and bioelectrical impedance analysis (BIA) were performed. Results: Mean patient age was 46 years (23 - 62) for non-NAFLD and 53 years (18 - 71) for the NAFLD group. ALT and AST did not differ significantly between the two groups. Adiponectin and HDL were significantly lower in NAFLD (p < 0.05) and BIA profiles showed higher fat and fat free mass. Non-NAFLD patients with steatosis also exhibited an adverse metabolic profile. Overall steatosis was associated with factors of metabolic syndrome (MS) and CVD. Prevalence of CVD and factors of MS hint to steatosis as an early event for these conditions. Conclusion: Patients with steatosis are at higher cardiovascular and metabolic risk without differences in transaminases levels compared to those without steatosis. Steatosis diagnosed by ultrasound needs to rise attention for further metabolic alterations including CVD.

The assessment of maternal and umbilical cord homocysteine levels in obese pregnant women.

PURPOSE: The aim of this study was to compare the maternal plasma and umbilical cord blood homocysteine levels in obese and non-obese pregnant women. MATERIALS AND METHODS: One hundred-ten term pregnant women, who completed their 3711, gestational weeks and were not in active labor, were enrolled in the study. While 41 out of them were obese (BMI ≥ 30 kg/m(2)), 69 were non-obese (BMI < 30 kg/m(2)). The maternal plasma and umbilical cord homocysteine levels and umbilical cord pH values were compared between the groups. The statistical analyses were performed using t-test, Mann Whitney test, and Chi-square test. Ap < 0.05 value was set as statistically significant. RESULTS: The mean of age was higher in obese group in borderline significance (26.8 ± 5.4 vs. 28.8 ± 5. l,p = 0.049). The mean of gestational weeks, birthweight, the mode of delivery, and umbilical cord pH values were similar between the groups (p > 0.05). The maternal plasma homocysteine levels [median (interquartile range); 7.6 (4.1) vs. 7.1 (4.9)] and umbilical cord homocysteine values were not statistically different [8.6 (4.2) vs. 8.8 (4.5)] between the groups (p > 0.05). CONCLUSION: The maternal and umbilical cord blood homocysteine levels are not different in obese and non-obese pregnant women.

Transabdominal Sonographic Study of the Cavum Vergae Detection Rate in Healthy Third-Trimester Fetuses.

OBJECTIVES: We aimed to measure the thickness and volume of the cavum vergae by sonography in fetuses at gestational ages of 25 to 41 weeks to determine the relationship of cavum vergae thickness and volume with gestational age and biparietal diameter and to estimate the rate of cavum vergae closure in relation to gestational age. METHODS: A total of 336 patients in their third trimester of pregnancy had transabdominal sonography. The fetal cavum vergae was scanned in the coronal and axial planes. The thickness of the anteroposterior diameter of the cavum vergae and the largest inner surface were measured after marking the internal borders of the structure, and then longitudinal and vertical sizes were obtained. The values obtained were multiplied by each other and then by 0.52 to obtain the cavum vergae volume. RESULTS: In 55 of 322 cases, the cavum vergae volume and thickness could not be calculated because the cavum vergae was closed. In the remaining cases, the cavum vergae volume and thickness and biparietal diameter were measured. Although the degree of correlation between cavum vergae thickness and volume increased with increasing gestational age, there was no correlation between cavum vergae thickness and volume at 37 to 41 weeks. There was a positive but weak statistically significant correlation between biparietal diameter and cavum vergae volume (P= .05), but there was no statistically significant correlation between biparietal diameter and cavum vergae thickness. The cavum vergae closure rate increased significantly as gestational age increased (P < .001). CONCLUSIONS: Cavum vergae closure increases as gestational age increases. However, we did not find any relationships between cavum vergae thickness and volume, gestational age, and biparietal diameter.

Simultaneous Disruption of the Pubic Symphysis and Sacroiliac Joint during Vaginal Birth.

Background. Puerperal diastasis of the pubic symphysis is a rare intrapartum complication. This report presents the case of a woman who experienced synchronous pubic symphysis and sacroiliac joint separations induced by vaginal delivery. Case. A 32-year-old woman (gravida 2, parity 2) with an uncomplicated prenatal course developed acute-onset anterior pubic pain during vaginal delivery. The pain persisted postpartum and was exacerbated by leg movement. Physical and radiographic examinations showed a pubic symphyseal separation of 2.4 cm, accompanied by a 10 mm disruption of the left sacroiliac joint. The patient was treated conservatively with pain-relief medication; bed rest, mostly in the left lateral decubitus position; closed reduction and application of a pelvic binder; use of a walker; and physical therapy. Conclusion. The patient responded to conservative management. She was essentially pain-free and regained movement and ambulation by 12 weeks postpartum.

Association between asthma self-management knowledge and asthma control in the elderly.

BACKGROUND: Considerable evidence points to the importance of patient education in achieving better asthma control. However, little is known about the effect of older adults' asthma knowledge on asthma control. OBJECTIVE: To identify the relation between asthma self-management knowledge and short-term asthma control in older adults. METHODS: The study included 82 patients with asthma undergoing usual asthma care who were interviewed by the same trained allergist. At the same time, the authors conducted an asthma knowledge questionnaire, an Asthma Control Test, skin prick testing, spirometry, and evaluation of inhaler device technique. The Turkish version of the asthma knowledge questionnaire was administered to all participants in face-to-face interviews. The relation between asthma knowledge and asthma control was tested by regression analysis. RESULTS: The education level was below the secondary level in 79% of patients; 59% of patients were obese; and 44% of patients had mild, 41% had moderate, and 5% had severe persistent asthma. The atopy rate was 21%. The most common sensitization was to Dermatophagoides pteronyssinus. Fifty-two percent of patients had uncontrolled asthma; 22 patients showed proper use of the inhaler device. Forty patients (48%) had limited asthma knowledge. The main source of asthma knowledge was from physicians for 81% of patients. There was no significant association between patients' asthma knowledge and asthma control level (P = .991). CONCLUSION: Knowledge of asthma was very low in elderly patients and usual asthma care was largely insufficient. These findings suggest that asthma education programs should be developed for older adults based on their education level and clinical asthma characteristics.