Trimester-specific reference intervals of thyroid function tests in Turkish pregnants.

Physiological changes in hormone levels occur in thyroid gland during pregnancy. Screening of the thyroid hormone levels and determining trimester-specific reference intervals in pregnancy are important. Guidelines recommend the use of trimester-specific reference ranges for each country. The aim of this study is to determine trimester-specific thyroid function reference intervals for pregnancy in Turkish population. In total, 5000 patients were screened out of which 1258 patients have all of fT3, fT4 and TSH levels measured, were included in the study. Patients were grouped as follows: 482 women were in first trimester, 361 women were in second trimester, and 415 women were in third trimester. All analyses were performed by means of chemiluminescence methods (Liaison®; DiaSorin S.p.A., Saluggia, Italy). The TSH reference intervals were 0.005-3.65, 0.01-3.63, and 0.2-3.46 mIU/L at the first, the second, and the third trimesters of pregnancy, respectively. The fT4 reference intervals were 0.72-1.79, 0.71-1.26, and 0.65-1.12 ng/dL at the first, the second, and the third trimesters, respectively. The fT3 reference intervals were 2.45-4.03, 2.37-3.85, and 2.31-3.77 ng/dL at the first, the second, and the third trimesters, respectively. It is crucial to determine population- and gestational-specific reference intervals for trustworthy treatment of pregnants.

The association of choroidal thickness with rheumatoid factor and anti-cyclic citrullinated peptide in rheumatoid arthritis.

PURPOSE: To measure ocular vascular parameters in rheumatoid arthritis patients and compare with those of controls and to evaluate the association of rheumatoid factor and anti-cyclic citrullinated peptide antibody with the choroidal thickness. METHODS: Superficial foveal vessel density, superficial and deep foveal avascular zone area, and subfoveal choroidal thickness were measured using the swept-source optical coherence tomography angiography. Multivariate linear regression was used to assess the correlation of subfoveal choroidal thickness with serological markers in patients with rheumatoid arthritis. RESULTS: Choroidal thickness in patients was significantly thinner than that in healthy controls (278.87 ± 59.54 µm vs. 323.94 ± 98.02 µm, p = 0.03). Despite the weak positive correlations between rheumatoid factor/anti-cyclic citrullinated peptide and choroidal thickness, these relationships were not statistically significant (p > 0.05). CONCLUSIONS: In patients with rheumatoid arthritis, subfoveal choroid was thinner than controls. There were similar correlations between choroidal thickness and rheumatoid factor and anti-cyclic citrullinated peptide antibody.

Renal function improves with the treatment of hypothyroidism.

BACKGROUND: It has been known that thyroid hormones may affect renal function. In this study, we aimed to investigate the effect of levothyroxine replacement on renal function in hypothyroid patients before and after treatment. METHODS: We retrospectively investigated free T3 (fT3), free T4 (fT4), TSH, creatinine, and eGFR measurements during both hypothyroid and euthyroid states of hypothyroid patients. The eGFR was calculated using the simplified Modification of Diet in Renal Disease formula. RESULTS: fT3, fT4, and eGFR measurements increased, meanwhile creatinine and TSH levels decreased significantly after euthyroidism was achieved with levothyroxine treatment (p < 0.0001 for all). The correlation analyses revealed that ∆creatinine and ∆TSH levels were significantly correlated before and after levothyroxine treatment (r: 0.288, p < 0.0001). ∆eGFR and ∆TSH levels were significantly correlated before and after LT4 treatment (r: -0.272, p < 0.0001). CONCLUSION: In this study, we evaluated creatinine and eGFR levels in patients with hypothyroidism and found out that renal function improved in most patients after euthyroidism was achieved. In some patients, above-normal creatinine levels completely returned to normal once the patients became euthyroid.

The association between the parenchymal neurological involvement and posterior uveitis in Behçet's syndrome.

OBJECTIVES: Behçet's syndrome (BS) is a systemic vasculitis, which may involve multiple organ systems simultaneously. Clinical findings in BS often fit into well-recognized patterns, such as the association between papulo-pustular skin lesions and arthritis. We have recently observed a distinct pattern, in which a subtype of neuro-Behçet's syndrome (NBS) is often preceded by specific ophthalmic manifestations of the disease process. The purpose of this study is to evaluate the association between the parenchymal subtype of NBS and posterior uveitis (PU). METHODS: We have retrospectively reviewed the clinical records of 295 patients with BS, who met the international classification criteria for BS, diagnosed at two major rheumatology clinics from 2010 to 2014. Patient demographics, ophthalmic examinations, clinical and radiologic patterns of neurological involvement were recorded. Manifestations of BS were classified as PU, NBS, vascular involvement, and arthritis. The association between clinical findings was analysed for statistical significance. RESULTS: Of the 295 patients, 100 had PU and 44 had NBS. 30 patients had parenchymal NBS and 14 had vascular NBS. Patients with PU were significantly more likely to have neurological involvement compared to those without PU (p<0.001; Odds Ratio: 3.924; 95% CI: 1.786-8.621). Rate of posterior uveitis was higher in patients with parenchymal NBS when compared to patients with vascular NBS, vascular BS or arthritis (63.3%, 21.4%, 22% and 4.2% respectively, p<0.001). CONCLUSIONS: Our findings suggest a clinically and statistically significant association between posterior uveitis and parenchymal type of neurologic involvement in BS. The development of posterior uveitis in a patient with previously diagnosed BS should be recognized as a "warning sign" for predisposition to neurologic involvement. These patients should be informed about the possible signs and symptoms of neurological involvement, which can cause very rapid and irreversible damage unless recognized and treated immediately.

Retro-orbital granuloma associated with granulomatosis with polyangiitis: a series of nine cases.

Retro-orbital granuloma is a rare and devastating component of granulomatosis with polyangiitis (GPA). Current medical treatment protocols are falling short, and outcomes are poor. The aim of the study was to investigate the frequency, clinical features, and treatment outcomes of retro-orbital granuloma in patients with GPA. This is a retrospective, multi-centre study, which involves GPA cohorts from five different clinics. Data were extracted from patient charts including history, physical examination, radiological-laboratory-histological findings, and treatment protocols. Major clinical outcome measures were changes in the volume of the granuloma on comparative MRI, and visual acuity on repeated ophthalmologic examinations. Among 141 GPA patients, nine (five females and four males) were diagnosed with a retro-orbital granuloma. Median duration of disease was 8 years. Proptosis and diplopia were the dominant presenting symptoms (77%), followed by orbital pain (55%). Three out of nine patients had isolated retro-orbital granulomas, without other organ involvement of GPA. Five patients received conventional pulse steroid and pulse cyclophosphamide (CYC) as the first-line remission induction therapy. Four of these patients had progressive disease, and a regression in granuloma size was observed in one patient using this regimen. Two patients were already receiving immunosuppressants when they were diagnosed with retro-orbital granuloma. Six patients had been treated with RTX as the second-line remission induction therapy. None of these patients had progression following RTX therapy. Three patients underwent orbital decompression surgery. The indication for the decision for surgery was either progressive loss of vision or intractable pain. Standard first-line chemotherapy (CYC and steroids) was ineffective against retro-orbital granuloma associated with GPA. RTX could be an alternative in these cases. Surgical intervention may help to decrease the morbidity. Further prospective studies with greater patient numbers are needed to test the clinical efficiency of RTX as a first-line remission induction chemotherapy.

Hyperthyroidism influences renal function.

PURPOSE: While the effects of hypothyroidism on renal function have been studied extensively, there is less information concerning the effect of hyperthyroidism. We aimed to elucidate the effect of overt and subclinical hyperthyroidism, on estimated glomerular filtration rate (eGFR) with large number of patients treated for hyperthyroidism and after euthyroidism was achieved. METHOD: A total of 433 consecutive overt and subclinical hyperthyroid patients were included in the study. We assessed serum fT3, fT4, TSH, BUN, creatinine, and eGFR measurements during both hyperthyroid and euthyroid states of the same patients. The eGFR was calculated using the simplified modification of diet in renal disease (MDRD) Formula. RESULTS: Among these patients, 367 had overt, and 66 had subclinical hyperthyroidism. fT3, fT4, and eGFR measurements decreased, meanwhile BUN, creatinine and TSH levels increased significantly after euthyroidism was achieved (p < 0.0001 for all). The correlation analyses revealed that eGFR in hyperthyroid state (eGFRh) and fT3 in hyperthyroid state (fT3h) (r = 0,210, p < 0,0001), and fT4 in hyperthyroid state (fT4h) (r = 0,176, p < 0,0001) were significantly correlated. ∆GFR did not differ between overt hyperthyroid group and subclinical hyperthyroid group. CONCLUSIONS: We observed a significant decline in eGFR measurements after the patients became euthyroid. Some of these patients had lower values than 60 mL/min/1.73 m2, which mean that hyperthyroidism may be masking mild renal failure.

Cytotoxic effects of platinum nanoparticles obtained from pomegranate extract by the green synthesis method on the MCF-7 cell line.

The study utilizes monodisperse platinum nanoparticles (Pt NPs) biosynthesized from Punica granatum crusts as anti-tumor agents on the human breast cancer cell line, MCF-7. The obtained Pt NPs were fully characterized using the UV-vis spectrum (UV-vis), transmission electron microscopy (TEM), X-ray diffraction (XRD), field emission scanning electron microscopy (FESEM) and Fourier transformation infrared spectroscopy (FTIR). Effectiveness of the Pt NPs was determined by cell viability, propidium iodide staining test, flow cytometry and comet tests on the MCF-7 cancer cell line. Cell survival percentage was determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The biosynthesized monodisperse platinum nanoparticles inhibited MCF-7 proliferation with an IC50 of 17.84 µg/ml after 48 h of incubation. Propidium iodide staining demonstrated that the monodisperse Pt NPs induced apoptosis by means of molecular DNA fragmentation.