Cognitive functioning of adolescents using Methamphetamine: The impact of inflammatory and oxidative processes

BACKGROUND

Methamphetamine is a substance that causes neurotoxicity and its use is increasing in recent years. Literature highlights cognitive impairment resulting from Methamphetamine use. The aim of the present study is to evaluate the relationship between cognitive impairment and inflammatory processes in adolescents with Methamphetamine use disorder.

METHODS

The study included 69 adolescents aged 15-19 years, comprising 37 participants with Methamphetamine Use Disorder and 32 healthy controls. Central Nervous System Vital Signs was used to detect cognitive impairment. Childhood Trauma Questionnaire-33 and The Children's Depression Inventory scales were used. In addition, venous blood was collected from the volunteers. Biochemical parameters (IL-1beta, IL-6, TNF-a, BDNF, FAM19A5, TAS, TOS) were analyzed.

RESULTS

Our study showed that (I) IL-6 and TNF-a levels of Methamphetamine users were lower than the healthy group; (II) BDNF levels of Methamphetamine users were higher than the healthy group; (III) mean Neurocognitive Index in cognitive tests of Methamphetamine using adolescents was negatively correlated with duration of Methamphetamine use and BDNF levels.

CONCLUSIONS

Our study suggests that Methamphetamine use may have a negative effect on cognitive functions.

Inflammatory markers in exhaled breath condensate in nonasthmatic children with food allergy

Allergy is a systemic inflammation; therefore, although the allergic symptom may be seen in a specific organ system, the effects of this inflammation may be seen in other organs. interleukin (IL) IL4, IL5 and IL13 are the major Th2 cytokines and e-cadherin is an epithelial barrier protein. The objective of this research was to assess indicators of inflammation specific to Th2 responses and proteins related to the protective barrier of the airway's inner lining. These assessments were conducted using exhaled breath condensate (EBC), which provides insights into peripheral airway conditions of children suffering from food allergies. The study had 24 patients with food allergy and 24 control individuals younger than three years of age with no history of food reaction. The diagnosis of food allergy was based on food allergen-specific IgE and skin prick test positivity in our clinic and oral food testing in selected cases. EBC samples were obtained by Ecoscreen (Jaegar, Hoechberg, Germany). IL4, IL5, IL13 and E-cadherin levels were measured in these samples by enzyme linked immunoassay. The group of children with food allergies, consisting mainly of 14 girls, had a median age of 16 months, whereas the control group, which included 11 girls, had a median age of 15 months (p= 0.89). Comparing the two groups, children with food allergies exhibited notably lower levels of IL-13 in the EBC compared to the control group (median values of 59.14 and 76.36, respectively,p= 0.02). Conversely, the concentration of IL-4 in the EBC was significantly higher in children with food allergies (median values of 1.94 and 1.29, respectively,p= 0.003). However, the levels of IL-5 and e-cadherin showed no significant differences between the two groups (withp-values of 0.74 and 0.09, respectively) as shown in table1. High level of IL-4 despite the low level of IL-13 in the EBC of children having food allergy may be indicative of an early inflammatory phase that is not yet in the effector phase. Studies about the evolution of this process later in life are needed to assess the role of airway inflammation in children with food allergy who develop asthma.

An evaluation of both serum Klotho/FGF-23 and apelin-13 for detection of diabetic nephropathy

PURPOSE

The aim of our study is to evaluate whether serum Klotho/FGF-23 and apelin-13 can be used as new biomarkers for detection of development of nephropathy.

METHODS

In this cross-sectional study, 88 type 2 diabetes mellitus (T2DM) patients and 38 healthy controls were included. The mean duration of T2DM was 11.4 ± 9.7 years. T2DM individuals were categorized into two groups as group 1 with e-GFR < 60 mL/min/1.73 m2 and group 2 with e-GFR > 60 mL/min/1.73 m2. They were also divided into two groups according to their 24 h urine albumin levels, classifying them as follows: normoalbuminuria if less than 30 mg/day and albuminuria if more than 30 mg/day.

RESULTS

Mean serum Klotho levels in the T2DM group were observed to be significantly higher than in the control group. Serum apelin-13 levels were observed to be significantly lower in the T2DM group compared to the control group (p < 0.001). In the diabetic group, apelin-13 levels were positively correlated with age, waist circumference, and albuminuria while they were negatively correlated with e-GFR. Apelin-13 levels were seen to be significantly higher in group 1 (p < 0.001).

CONCLUSION

Apelin-13 levels were found to be significantly higher in individuals with diabetic nephropathy than in those without diabetic nephropathy. In the diabetic group, a significant relationship was detected between apelin-13 levels and albumin excretion. Based on these findings, we consider that serum Klotho and apelin-13 levels may have a protective effect on diabetic nephropathy and can additionally be used as a biomarker to predict diabetic nephropathy.

The Relationship of Testicular Sonoelastography with Gonadotropin Hormone Levels and Sperm Parameters

Background: Elastography is a non-invasive medical imaging technique that helps determine the stiffness of organs and other structures in our body. In this study, we investigated the effectiveness of elastography in the diagnosis of infertility. Aim

In this study, we aimed to examine the relationship between testicular elastography and hormonal parameters and sperm parameters.

Patients and Methods

The study included 136 patients, 272 testicles were examined, and the mean age of the study participants was 30.1 years. Testicular tissue stiffness was measured by scrotal ultrasonographic shear wave elastography. Gonadotropin and testosterone hormones were measured from blood samples. Spermiogram parameters were studied manually.

Results

The control group included 66 patients, and the varicocele group consisted of 70 patients. Testicular stiffness degrees of the control group were measured as 4.29 kPa for the right testis and 4.23 kPa for the left testis. The varicocele group was divided into grades 1, 2, and 3 according to physical examination. In group 1 (grade 1), the right testis was 4.07 ± 1.24 kPa and the left testis was 3.77 ± 0.98 kPa. In group 2 (grade 2), the right testis was 4.31 ± 1.40 kPa and the left testis was 3.98 ± 0.93 kPa. In group 3 (grade 3), the right testis was 4.73 ± 1.50 kPa and the left testis was 3.99 ± 1.68 kPa. Hormone and sperm parameters were not statistically significant when comparing the control and varicocele groups. There was no statistical significance between the testicular tissue stiffness degrees of the control and varicocele groups. Hormone and spermiogram findings were also similar in groups.

Conclusion

It is known that varicocele leads to histological tissue changes in the testes. These changes result in tissue softness and loss while affecting sperm parameters and testosterone levels in a negative way. Before varicocele surgery, there is a need for new imaging methods with more sensitivity that can detect tissue changes in the testes.

Effectiveness of nonsurgical antibiotic treatment in the experimental appendicitis model in rats

Background

In this study, we aimed to demonstrate efficacy and laboratory follow-up criteria of nonsurgical antibiotic treatment in uncomplicated acute appendicitis. We established an experimental appendicitis model in rats, and antibiotic treatment was evaluated by biochemical and immunohistochemical changes.

Materials and method

In the study, 28 rats were divided into 4 groups. Group 1 constituted the group of sham; group 2 was the control group that appendicitis model was created and did not receive any treatment. Group 3 was created as an appendicitis model and was given regular antibiotic treatment. In group 4, appendicitis model was created, and appendectomy was performed on the 2nd day. Blood samples were taken from the rats on the 0, 2nd, and 7th days in all groups. Rats in groups 1, 2, and 3 underwent appendectomy with laparotomy under anesthesia on the 7th day. Serum C-reactive protein (CRP), procalcitonin, and leukocyte levels were measured for biochemical analysis. In immunohistochemical evaluation, inflammation severity of the tissue samples taken from appendices was evaluated. Also, tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) levels of tissue samples were evaluated.

Results

A statistically significant difference in CRP values was observed between groups 1 and 2 on the 7th day (p = 0.046), between groups 1 and 4 on 0 and 2nd days (p = 0.004, p = 0.004), between groups 2 and 3 on 0, 2nd, and 7th days (p = 0.018, 0.013, 0.025), between groups 2 and 4 on 0, 2nd, and 7th days (p = 0.002, p = 0.002, p = 0.009), and between groups 3 and 4 on 0 and 2nd days (p = 0.013, p = 0.025). There was a significant difference in procalcitonin values between groups 1 and 3 on the 7th day (p = 0.032) and between groups 1 and 4 on day 0 (p = 0.019). A significant difference was also observed in TNF-α and IL-6 inflammation between groups 2 and 3 (p = 0.031, p = 0.018) and between groups 2 and 4 (p = 0.031, p = 0.01).

Conclusion

Acute uncomplicated and early appendicitis may be treated with antibiotics. According to our results, CRP levels are useful as follow-up criterion in experimental appendicitis model. Clinical studies on the assessment of CRP levels in the course of nonsurgical treatment in the patients with acute appendicitis will reveal out the effectiveness of this marker.

The effect of insulin, leptin, adiponectin, ghrelin levels in cord blood on growth in the first two years

Objective: The main hormones and adipokines that regulate growth, energy metabolism and adipogenesis in the intrauterine period are insulin, leptin, ghrelin, and adiponectin. Changes in these hormones and adipokines may affect weight gain, obesity and metabolic syndrome in advanced ages. In this study, it was aimed to investigate the relationship between insulin, leptin, ghrelin, adiponectin levels in the cord blood of term newborns and growth in the first two years of age. Methods: Term newborns in our hospital between May 2019 and October 2019 were included in the study. Insulin, glucose, ghrelin, leptin and adiponectin levels were studied in the umbilical cord blood of 80 newborns. The growth of 44 of the 80 newborns included in the study was monitored until the age of two years. Results: The relationship between insulin, ghrelin, leptin and adiponectin levels in the cord blood of 44 newborns included in the study with growth up to two years of age was investigated. A positive correlation was found between the insulin level in the cord blood and birth weight, birth head circumference, and the weights at the 12th and 24th months of life. A negative correlation was found between the level of ghrelin in the cord blood and the weights at the 6th and 24th months of life. A positive correlation was found between the level of adiponectin in the cord blood and the weight in the 6th month of life. There was no significant correlation between cord leptin level and anthropometric measurements in the first two years of age. Conclusion: While the levels of insulin and adiponectin in the cord blood were positively correlated with the weight in the first two years of life, they were negatively correlated with the ghrelin level in the cord blood. The level of leptin in cord blood did not correlate significantly with the weight in the first two years of life.

Effect of the presence of polycystic ovary syndrome-related features on anti-Mullerian hormone and androstenedione levels in adolescents with or without menstrual irregularity

PURPOSE

To determine the variation in anti-Mullerian hormone (AMH) and androstenedione (A4) concentrations in adolescent girls, with or without menstrual cycle disorder in relation to phenotypic features of. PCOS.

METHODS

Adolescent girls (n = 129), age range 14-19 years, were recruited in the cohort study. All participants were in the 4th or 5th year after menarche. Sixty-eight had menstrual irregularities, usually oligomenorrhea (OM), and 61 had regular menstruation (RM). AMH and A4 concentrations were measured. Hirsutism was recorded. Polycystic ovarian morphology (PCOM) was evaluated by transabdominal pelvic ultrasonography. Polycystic ovary syndrome (PCOS) features were defined according to Rotterdam consensus criteria.

RESULTS

AMH and A4 were significantly higher in adolescent girls with OM than in girls with RM (p < 0.05). A4 and body mass index (BMI) of adolescents with OM was significantly higher in those with hirsutism than those without hirsutism (p = 0.01 and 0.008, respectively). There was a positive correlation between A4 and BMI (r: 0.327, p < 0.01). Logistic regression showed that the frequency of OM in the presence of PCOM was 10.8 times (95% CI 2.04-12.09) compared to those without PCOM. The highest AMH concentrations were found in girls with OM, hirsutism, and PCOM (p < 0.05).

CONCLUSIONS

AMH and A4 are elevated in adolescents with oligomenorrhoea. High A4 is more prominent in the presence of hirsutism and is associated with increased BMI. PCOM, increases the likelihood of oligomenorrhea by about 10 times. AMH increase as the combination of clinical features of PCOS increases in adolescents with menstrual irregularity.

Systemic inflammatory response during cardiopulmonary bypass: Axial flow versus radial flow oxygenators

BACKGROUND

The objective of this study was to investigate the inflammatory effects of different oxygenator flow pattern types in patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass.

METHODS

We designed this randomized, single-blind, prospective study of patients with coronary artery disease. We compared the systemic inflammatory effects of oxygenators with two types of flow: axial flow and radial flow. Therefore, we divided the patients into two groups: 24 patients in the axial group and 28 patients in the radial group. IL-1, IL-6, IL-10, and TNF-α were examined for cytokine activation leading to a systemic inflammatory reaction. The samples were collected at three different time intervals: T1, T2, and T3 (T1 was taken before cardiopulmonary bypass, T2 just 1 h after CPB onset, and T3 was taken 24 h after the surgery).

RESULTS

There were no significant differences in demographic characteristics between the two groups. We observed that there were notably lower levels of humoral inflammatory response parameters (IL-1, IL-6, and TNF-α) in the radial flow oxygenator group than in the axial flow group at the specific sampling times. For IL-10, there was no significant difference for any time period.

CONCLUSION

It might be advantageous to use a radial-flow-patterned oxygenator to limit the inflammatory response triggered by the oxygenators in cardiopulmonary bypass.

Urinary NGAL is a Potential Biomarker for Early Renal Injury in Insulin Resistant Obese Non-diabetic Children

OBJECTIVE

Neutrophil gelatinase-associated lipocalin (NGAL) is one of the new biomarkers for detecting acute renal injury. There are studies showing the relationship between NGAL and renal injury in obese children. The aim of this study was to investigate whether urinary levels of NGAL, kidney injury molecule-1, and serum cystatin C are increased in insulin resistance (IR) patients before the development of diabetes.

METHODS

Cross-sectional, case-controlled study that included non-diabetic obese children and adolescent patients with IR and a non-diabetic obese control group with no IR, who attended a tertiary center pediatric endocrinology outpatient clinic between 2016-2018. Those with diabetes mellitus and/or known renal disease were excluded. NGAL and creatinine (Cr) levels were evaluated in the morning spot urine from all participants. Serum renal function was evaluated.

RESULTS

Thirty-six control and 63 IR patients were included in the study, of whom 68 (68.7%) were girls. The mean age of all participants was 13.12±2.64 years and no statistically significant difference was found between the two groups in terms of age or gender distribution. Median (range) spot urinary NGAL (u-NGAL) values in the IR group were significantly higher at 26.35 (7.01-108.7) ng/mL than in the control group at 19.5 (3.45-88.14) ng/mL (p=0.018). NGAL/Cr ratio was also significantly higher in the IR group compared to the control group (p=0.018).

CONCLUSION

Obese pediatric patients with IR were shown to have elevated levels of u-NGAL, a marker of renal injury. u-NGAL examination may show early renal injury before development of diabetes.

Thiol/disulfide homeostasis in medication-naive children and adolescents with obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) causes significant psychic distress and affects children's social and academic functioning. Approximately 80% of OCD cases begin in childhood. Earlier onset is associated with more severe OC symptoms, poorer treatment response, and a more unfavorable clinical course. A particular oxidative stress marker, thiol/disulfide homeostasis, using a new, comparatively inexpensive, easily calculated, easily accessible, repeatable, and fully automated method was investigated between pediatric patients diagnosed with OCD and a healthy control group in this study. This study is the first to address this subject in pediatric patients with OCD and aims to contribute to our knowledge of the etiopathogenesis and treatment of pediatric OCD. The study included children with OCD (n = 35, 52.2%) (drug free, comorbidity free) between 11 and 18 years of age and age- and sex-matched healthy controls (n = 32, 47.8%). The total thiol (p = 0.025) and disulfide (p = 0.001) levels and the disulfide/native thiol (p = 0.001) and disulfide/total thiol ratios (p = 0.001) were significantly different between the groups. Also, in the patient group, biochemical analysis revealed that the disulfide level (p = 0.05) and the disulfide/native thiol (p = 0.034) and disulfide/total thiol ratios (p = 0.039) differed significantly according to the presence of a family history of psychiatric disorders. Consequently, the results of our study show that thiol/disulfide homeostasis may affect the etiopathogenesis of pediatric OCD and can be utilized as a new method when evaluating oxidative stress.

Maternal psychiatric status and infant wheezing: The role of maternal hormones and cord blood cytokines

RATIONALE

Maternal psychosocial stress might be associated with development of allergic diseases in the offspring.

OBJECTIVES

To evaluate the association of maternal depression and anxiety with ever wheezing and recurrent wheezing among infants and to assess the role of maternal hypothalamo-pituatary-adrenal axis changes and fetal immune response in this association.

METHODS

This study encompasses two designs; cohort design was developed to evaluate the association of prenatal depression with development of wheezing in infants while nested case-control design was used to assess the role of maternal cortisol and tetranectin and cord blood interleukin 13 and interferon γ.

RESULTS

We enrolled 697 pregnant women. Elementary school graduate mother (odds ratio [OR] = 1.5, p = .06), maternal smoking during pregnancy (OR = 3.4, p = .001), familial history of asthma (OR = 2.7, p < .001) increased the risk of ever wheezing. Elementary school graduate mother (OR = 2.6, p = .002), maternal smoking during pregnancy (OR = 4.8, p < .001) and familial history of asthma (OR = 1.7, p = .01) increased the risk of recurrent wheezing. Maternal previous psychiatric disease, or Edinburgh Postnatal Depression Scale or Spielberger State-Trait Anxiety Inventory scores were not associated with wheezing. Maternal tetranectin levels were significantly higher among never wheezers compared to the ever wheezers (264.3 ± 274.8 vs. 201.6 ± 299.7, p = .04).

CONCLUSIONS

In conclusion, the major risk factors for ever wheezing and recurrent wheezing were maternal smoking, level of education and family history of asthma. However, maternal depression and anxiety were not determined as risk factors for wheezing. Maternal tetranectin carries potential as a biomarker for wheezing in the infant.

The role of the kynurenine pathway and quinolinic acid in adolescent major depressive disorder

BACKGROUND

The biological mechanisms underlying major depressive disorder (MDD) are not yet sufficiently understood. The kynurenine pathway has been proposed to play a key role between peripheral inflammation and alterations in the central nervous system. This is because of reduced usability of tryptophan (TRP) and production of oxygen radicals and highly potent neurotoxic agents in this pathway.

OBJECTIVE

In this study, we aimed to compare the metabolites of the serum kynurenine pathway (tryptophan, kynurenine, quinolinic acid and kynurenic acid) and IFN-γ, IL-6, IL-1β and high-sensitivity C-reactive protein (hsCRP) levels in patients with major depressive disorder and in healthy controls and to evaluate the relationship between cytokine levels and the functioning of the kynurenine pathway.

METHODS

Clinical and biochemical data from the patients were obtained and assessed in a cross-sectional design. Serum samples were analysed for IL-6, IL-1β, interferon (IFN)-γ, tryptophan (TRP), quinolinic acid (QUIN), kynurenic acid (KYNA) and kynurenine (Kyn) levels by the enzyme-linked immunosorbent assay. hsCRP test was analysed by the immunoturbidimetric method.

RESULTS

In total, 48 adolescent patients with major depressive disorder (no drug use) and 31 healthy controls were included in the study. TRP levels were observed to be significantly lower in patients with MDD than in healthy controls (P = .046); the Kyn/TRP ratio was significantly higher in patients with MDD than in healthy controls (P = .032); the levels of QUIN were significantly higher in patients with MDD than in healthy controls (P = .003). No significant difference was found between the groups in terms of other kynurenine metabolites and cytokines levels.

CONCLUSION

These results suggest that the Kyn and related molecular pathways may play a role in the pathophysiology of MDD. The most important finding was the increased level of QUIN, which has a neurotoxic effect, in the kynurenine pathway.

Preanalytical Phase Errors: Experience of a Central Laboratory

Introduction: The study intends to observe the frequency of preanalytical phase errors both inside and outside the clinical laboratory according to certain quality indicators (QIs).

Methods: The one-week observation focused on 73 nurses drawing blood from 337 patients. It was performed in two stages: the observation of blood collection up to the receipt of the samples, and the receipt of the samples up to the analytical phase. The data pertaining to the number of patients, tests, and rejection rates were obtained from the laboratory information system (LIS) for the one-week and the one-year period and compared with the observational data.

Results: The process of blood sample collection from 337 patients taken into 1347 tubes was observed. Although the majority of the nurses (78%) used safety needles, the safety mechanism was properly activated only in 38% of the interventions. Evaluation of biochemistry tubes (n=971) revealed the following: the incorrect fill volume error was 40%; the hemolysis was seen by 17%, and the clotted sample and fibrin were observed by 6%. The incorrect fill volume error was 12% and 20% in ethylenediaminetetraacetic acid (EDTA) and citrated tubes, respectively. Clotted samples and platelet clumps were seen in 1% of EDTA tubes.

Conclusion: The study confirms the relative frequency of preanalytical phase error occurring inside and outside of the laboratory.

Maternal serum perlecan levels in women with preeclampsia

Objective: Perlecan is an extracellular matrix proteoglycan suggested to maintain endothelial functions. We aimed to measure maternal serum perlecan levels in different preeclampsia phenotypes.Methods: This study included 50 women with preeclampsia and 30 healthy pregnant women.Results: Serum perlecan levels were significantly higher (p = 0.016) in preeclamptic women with severe features(n = 23) than preeclampsia patients(n = 27). There were no statistically significant differences in serum perlecan levels between the early-onset preeclampsia(n = 25), late-onset preeclampsia(n = 25), and healthy pregnancies.Conclusion: Our findings suggest that preeclamptic women with severe features have higher serum perlecan levels than women with preeclampsia.

Serum levels of spexin are increased in the third trimester pregnancy with gestational diabetes mellitus

Spexin is a peptide that is involved in energy homeostasis and its expression is influenced by altered glucose metabolism. Gestational diabetes mellitus (GDM) is associated with increased insulin resistance (IR) and pregnancy is a progressive insulin resistant state. We hypothesized that spexin may have an effect on the pathophysiology of GDM which further could help to identify the disease. The aim of this study was to investigate spexin levels in the third trimester pregnancies with GDM and healthy controls. Thirty-nine women with GDM and 39 healthy singleton pregnancies were enrolled in this case-control study. Serum spexin concentrations were measured and correlated to biochemical and clinical parameters. Serum spexin levels were significantly higher in women with GDM (3686.25 ± 348.37 vs. 3472.33 ± 293.93 pg/ml, p=.004). Spexin levels ​​did not differ significantly according to treatment modality. Moreover, spexin levels were significantly positively correlated with homeostasis model assessment of IR (HOMA-IR). Spexin levels were significantly higher in women with GDM and closely related to HOMA-IR in the third trimester pregnancy. This may help to better clarify the pathophysiological role of spexin in GDM.

Can maternal urinary and serum carbohydrate antigen 19-9 concentrations be utilized in the diagnosis of fetal hydronephrosis?

Objective:

Fetal hydronephrosis (FH) is the most common fetal renal pathology encountered in daily obstetric practice. Urinary and serum carbohydrate antigen 19-9 (CA 19-9) concentrations are elevated in obstructive renal pathologies. Our aim was to assess maternal urinary and serum CA 19-9 concentrations in pregnancies with FH and compare results with controls.

Material and Methods:

Twenty pregnancies with severe FH, 20 pregnancies with mild-moderate FH, and 20 healthy singleton pregnancies were included in this descriptive, case-control study. The diagnosis and classification of FH was based on the anterioposterior diameter of fetal renal pelvis. Maternal urinary and serum CA 19-9 concentrations were measured and compared between groups.

Results:

Severe FH cases had significantly higher maternal urinary CA 19-9 concentrations compared to controls (median: 75 vs 24 U/mL; respectively; p=0.014). Concentrations of CA 19-9 did not differ between the mild-moderate FH group and control group. No statistically significant difference was found between the groups with respect to maternal serum CA 19-9 concentrations.

Conclusion:

Our results show that maternal urinary CA 19-9 concentration is significantly higher in pregnancies with severe FH. However, no difference was detected in serum CA 19-9 concentrations between pregnancies with severe FH, mild-moderate FH and controls. If the mechanisms of transplacental passage and maternal urinary excretion are clarified, maternal urinary CA 19-9 may be a potential marker for indicating fetal kidney damage.

Decreased maternal serum cortistatin levels in pregnancies with gestational diabetes mellitus

Objective: To investigate serum cortistatin levels in women with gestational diabetes mellitus (GDM) and women with uncomplicated pregnancies.Material and methods: This case-control study consisted of 40 pregnancies with GDM and 41 healthy singleton pregnancies matched for maternal and gestational age. The maternal serum levels of cortistatin were measured with enzyme-linked immunosorbent assay and compared between groups.Results: Cortistatin levels were significantly lower in GDM group (48.85 ± 20.18 versus 65.84 ± 33.98 ng/ml, p = .008). There was a statistically significant difference in cortistatin levels between different treatment modalities and control group (χ²(2) = 8.828, p = .012). Pairwise comparisons showed that diet group had significantly lower CST levels than control group (p = .012). Serum cortistatin levels were negatively correlated with serum insulin and glucose levels and HOMA-IR (r = -0.358, p = .001; r = -0.303, p = .006; r = -0.444, p < .001, respectively).Conclusion: Cortistatin levels were significantly lower in GDM pregnancies and related to serum insulin and glucose levels and HOMA-IR in pregnancy. This may help to better clarify the mechanism of GDM pathogenesis.

Low Mononuclear Cell IL-18 and IL-27 Response in Children: Susceptibility to Tuberculosis Infection after Contact

Background Identification of the immune response against tuberculosis is vital to develop new diagnostic and therapeutic modalities. The objective of this study was to determine IL (interleukin)-18 and IL-27 responses of peripheral blood mononuclear cells to early secreted antigen (ESAT-6) and culture filtrate protein-10 (CFP-10) stimulation in children with a (+) or (−) tuberculin skin test (TST) with in-house tuberculosis contact.

Methods We enrolled 40 children aged 1 to 5 years who had an in-house contact with a tuberculous adult. Blood samples were obtained from all children for QuantiFERON tuberculosis (TB) gold in tube (QFT-GIT), and peripheral blood mononuclear blood cell culture tests. The subjects were grouped as TST (−) QFT-GIT (−), TST (+) QFT-GIT (−), and TST (+) QFT-GIT (+). Supernatant of peripheral blood mononuclear cell culture was separated with and without stimulation of ESAT-6 and CFP-10, and IL-18 and IL-27 levels were measured with enzyme linked immunoassay (ELISA) test.

Results The study group included 22 boys and 18 girls with mean age 4.25 ± 0.9 years. IL-18 and IL-27 levels were statistically significant in ESAT-6/CFP-10-stimulated supernatants of peripheral blood mononuclear cell (PBMC) samples among the three groups (p = 0.000, p = 0.007, respectively). IL-18 levels between the TST (−) QFT-GIT (−) and TST (+) QFT-GIT (+) groups were significantly different (p = 0.026). Both IL-18 and IL-27 levels were significantly different between ESAT-6/CFP-10 stimulated PBMC supernatants of TST (−) QFT-GIT (−) and TST (+) QFT-GIT (−) groups (p = 0.000, p = 0.003, respectively).

Conclusion Low IL-18 and IL-27 responses of peripheral blood mononuclear cells in children with Bacillus Calmette–Guérin (BCG) vaccine may play a role in Mycobacterium tuberculosis infection after in-house contact.

Assessing the relationship between attachment, parental attitude and plasma oxytocin in schizophrenia patients and their unaffected siblings

BACKGROUND

It is widely acknowledged that schizophrenia patients tend to have insecure attachment styles and improper parenting. However, the biological processes related to these adversities remain unclear and that the disturbance in oxytocin system is considered as one of the strongest predictors of such adversities.

METHODS

Thirty-four patients with schizophrenia and their unaffected thirty-four healthy siblings were recruited for the study and they were compared with thirty-one healthy controls. We examined attachment styles via Experience in Close Relationship-Revised Test and perceived parental attitudes with the My Memories of Upbringing-Short Version Test. In addition, we evaluated plasma oxytocin levels across groups.

RESULTS

The patients with schizophrenia had lower plasma oxytocin levels and obtained higher levels for attachment anxiety and avoidance with more parental rejection and over protection. There was a significantly negative relationship between the levels of plasma oxytocin in blood and parental over protection in the healthy sibling and healthy control groups. In contrast, there was a significantly positive relationship between the levels of plasma oxytocin in blood and parental over protection in the schizophrenia group. Results of the regression analyses revealed that the plasma oxytocin levels and over protection were notable factors in discriminating the groups from each other.

CONCLUSION

Our findings suggested that disturbance in oxytocin is associated with susceptibility to schizophrenia predisposition. In sum, therapeutic interventions that address oxytocin and over protection may influence the outcomes in this severe mental disorder.

Bone mineral density, vitamin D status, and calcium intake in healthy female university students from different socioeconomic groups in Turkey

Peak bone mass is reached in late adolescence. Low peak bone mass is a well recognized risk factor for osteoporosis later in life. Our data do not support a link between vitamin D status, bone mineral density (BMD), and socioeconomic status (SES). However, there was a marked inadequacy of daily calcium intake and a high presence of osteopenia in females with low SES.

PURPOSE

Our aims were to (1) examine the effects of different SES on BMD, vitamin D status, and daily calcium intake and (2) investigate any association between vitamin D status and BMD in female university students.

SUBJECTS AND METHODS

A questionnaire was used to obtain information about SES, daily calcium intake, and physical activity in 138 healthy, female university students (age range 18-22 years). Subjects were stratified into lower, middle, and higher SES according to the educational and occupational levels of their parents. All serum samples were collected in spring for 25-hydroxyvitamin D concentration (25OHD). Lumbar spine and total body BMD was obtained by dual-energy X-ray absorptiometry (DXA) scan (Lunar DPX series). Osteopenia was defined as a BMD between - 1.0 and - 2.5 standard deviations (SDs) below the mean for healthy young adults on lumbar spine DXA.

RESULTS

No significant difference was found between the three socioeconomic groups in terms of serum 25OHD concentration, BMD levels, or BMD Z scores (p > 0.05). Both the daily intake of calcium was significantly lower (p = 0.02), and the frequency of osteopenia was significantly higher in girls with low SES (p = 0.02). There was no correlation between serum 25OHD concentration and calcium intake and BMD values and BMD Z scores (p > 0.05). The most important factor affecting BMD was weight (β = 0.38, p < 0.001).

CONCLUSIONS

Low SES may be associated with sub-optimal bone health and predispose to osteopenia in later life, even in female university students.

Etiologic risk factors and vitamin D receptor gene polymorphisms in under one-year-old infants with urolithiasis

The incidence of urinary tract stones in infancy has been increasing in Turkey. Risk factors and vitamin D receptor (VDR) gene polymorphisms were investigated in infants aged < 1 year who had stones. Forty infants with urinary tract stones and 80 infants without stones, aged < 1 year were enrolled in this study. Detailed surveys were taken of all infants, metabolic parameters and ApaI and FokI VDR gene polymorphisms were investigated. Infants with stones tended to be more commonly fed formula and multivitamins (vitamins A, C, D) (p < 0.05). Positive family history came into prominence in the stony group (p < 0.05). There were no significant differences in ApaI and FokI VDR gene polymorphisms between the groups with stones and the control groups. However, CA genotype of ApaI polymorphism was associated with family history and C allele of ApaI was related with family history and hypercalciuria (p < 0.05). Hypercalciuria emerged as an underlying metabolic abnormality in the etiology of stones, and was observed at a rate of 38%. Infants who are given formula and multivitamins for vitamin D supplementation are at increased risk for the formation of urinary tract stones. VDR gene polymorphisms cause the formation of urinary tract stones and affect calcium (Ca) metabolism.

A nationwide multicentre study in Turkey for establishing reference intervals of haematological parameters with novel use of a panel of whole blood

INTRODUCTION

A nationwide multicentre study was conducted to establish well-defined reference intervals (RIs) of haematological parameters for the Turkish population in consideration of sources of variation in reference values (RVs).

MATERIALS AND METHODS

K2-EDTA whole blood samples (total of 3363) were collected from 12 laboratories. Sera were also collected for measurements of iron, UIBC, TIBC, and ferritin for use in the latent abnormal values exclusion (LAVE) method. The blood samples were analysed within 2 hours in each laboratory using Cell Dyn and Ruby (Abbott), LH780 (Beckman Coulter), or XT-2000i (Sysmex). A panel of freshly prepared blood from 40 healthy volunteers was measured in common to assess any analyser-dependent bias in the measurements. The SD ratio (SDR) based on ANOVA was used to judge the need for partitioning RVs. RIs were computed by the parametric method with/without applying the LAVE method.

RESULTS

Analyser-dependent bias was found for basophils (Bas), MCHC, RDW and MPV from the panel test results and thus those RIs were derived for each manufacturer. RIs were determined from all volunteers' results for WBC, neutrophils, lymphocytes, monocytes, eosinophils, MCV, MCH and platelets. Gender-specific RIs were required for RBC, haemoglobin, haematocrit, iron, UIBC and ferritin. Region-specific RIs were required for RBC, haemoglobin, haematocrit, UIBC, and TIBC.

CONCLUSIONS

With the novel use of a freshly prepared blood panel, manufacturer-specific RIs' were derived for Bas, Bas%, MCHC, RDW and MPV. Regional differences in RIs were observed among the 7 regions of Turkey, which may be attributed to nutritional or environmental factors, including altitude.

Neurological outcome after cardiac arrest: a prospective study of the predictive ability of prognostic biomarkers neuron-specific enolase, glial fibrillary acidic protein, S-100B, and procalcitonin

BACKGROUND/AIM

Factors affecting neurological outcome and the usefulness of neuron-specific enolase (NSE), S-100B, glial fibrillary acidic protein (GFAP), and procalcitonin (PCT) in predicting neurological outcomes were assessed in patients who survived at least 24 h after cardiopulmonary resuscitation (CPR).

MATERIALS AND METHODS

Thirty successfully resuscitated cardiac arrest patients were included in this prospective clinical study. The initial cardiac arrest rhythm, duration of CPR, return of spontaneous circulation time, administered doses of adrenaline, base excess, blood sugar, and hemodynamic parameters were recorded. Patients with Glasgow Outcome Scale (GOS) scores of 1-3 were defined as Group I and patients with GOS scores of 4-5 were defined as Group II. Serum NSE, GFAP, S-100B, and PCT levels were compared between the two groups shortly after CPR (hour 0) and at hours 12 and 24 of the postresuscitation period.

RESULTS

Serum S-100B was significantly higher (P = 0.009) in Group II immediately after CPR. Serum S-100B and NSE after CPR at hours 0, 12, and 24 were significantly lower in patients who survived to hospital discharge. Serum PCT at hours 12 and 24 and serum S-100B after CPR at 0, 12, and 24 h reached 94.7% sensitivity. Serum NSE, GFAP, S-100B, and PCT specificities were lower than 50%.

CONCLUSION

In predicting neurological outcomes, serum S-100B has high sensitivity and low specificity immediately after CPR.

The effect of the MTHFR C677T mutation on athletic performance and the homocysteine level of soccer players and sedentary individuals

This study investigated athletic performance and homocysteine (Hcy) levels in relation to the methylenetetrahydrofolate reductase (MTHFR) C677T mutation and explored the relationship between this mutation and other cardiac risk factors in soccer players and sedentary individuals. The study groups consisted of randomly selected soccer players (n=48) from the Turkish Super and Major League and sedentary male students (n=48) aged 18-27. Anthropometric variables, aerobic and anaerobic thresholds were measured, furthermore, biochemical assays were performed. The level of HDL cholesterol, LDL cholesterol, triglyceride, Hcy, folate, vitamin B12, hemogram and MTHFR C677T was investigated. The results showed that there was a statistical difference between the two groups in terms of body mass, body fat, the BMI, the aerobic threshold heart rate (ATHR), aerobic threshold velocity (ATVL) and anaerobic threshold velocity (ANTVL). The soccer players were found to have lower levels of triglyceride, total cholesterol and LDL cholesterol, and higher levels of folate than the sedentary participants. The analysis of the alleles of the MTHFR C677T polymorphism showed that the participants that carried TT genotypes had a lower level of vitamin B12 and folate, and a higher level of Hcy than the participants carrying CC and CT genotypes. In conclusion, the baseline homocysteine and cardiovascular fitness levels of healthy young males with the TT genotypes of the MTHFR C677T genotype were found to strongly correlate with their levels of Hcy.

Insulin sensitivity indices: fasting versus glucose-stimulated ındices in pediatric non-alcoholic fatty liver disease

OBJECTIVE

We aimed to compare insulin sensitivity indices, fasting vs glucose stimulated, in children and adolescents with non-alcoholic fatty liver disease.

PATIENTS AND METHODS

Two hundred-eleven obese children with median age of 11.24 ± 2.65 years were evaluated. After initial clinical and anthropometric examination, B-mode ultrasonography (USG) was performed and all subjects underwent Oral Glucose Tolerance Test (OGTT). Quantitative insulin sensitivity check index (QUICKI), homeostatic model assessment for insulin resistance (Homa-IR), the insulinogenic index (IGI), the Matsuda index, and the oral glucose insulin sensitivity (OGIS) model were used to determine peripheral insulin sensitivity.

RESULTS

59.24% (68 boys, 57 girls) of obese children had NALFD. The prevalence of FLD in obese adolescents was significantly higher than in prepubertal children (65.8% vs. 51.5%). Fasting glucose, insulin, Homa-IR, QUICKI, and OGIS and Matsuda were significantly different between subjects with and without NALFD. Insulin and glucose indices were not found to be significantly different in the prepubertal group, whereas Homa-IR, QUICKI, Matsuda, and OGIS were significantly different in the pubertal group. Age, waist circumference, and OUICKI were found to be risk factors associated with the presence of NALFD in the logistic-regression analysis.

CONCLUSIONS

Age, waist circumference, and OUICKI were found to be risk factors associated with NALFD. As the value of QUICKI decreases, the probability of having steatosis increases. Although OGTT results gave the information about the glucose tolerance of a subject, indices derived from OGTT were not found to be superior to the traditional surrogates such as Homa-IR or QUICKI.

A multicenter nationwide reference intervals study for common biochemical analytes in Turkey using Abbott analyzers

BACKGROUND

A nationwide multicenter study was organized to establish reference intervals (RIs) in the Turkish population for 25 commonly tested biochemical analytes and to explore sources of variation in reference values, including regionality.

METHODS

Blood samples were collected nationwide in 28 laboratories from the seven regions (≥400 samples/region, 3066 in all). The sera were collectively analyzed in Uludag University in Bursa using Abbott reagents and analyzer. Reference materials were used for standardization of test results. After secondary exclusion using the latent abnormal values exclusion method, RIs were derived by a parametric method employing the modified Box-Cox formula and compared with the RIs by the non-parametric method. Three-level nested ANOVA was used to evaluate variations among sexes, ages and regions. Associations between test results and age, body mass index (BMI) and region were determined by multiple regression analysis (MRA).

RESULTS

By ANOVA, differences of reference values among seven regions were significant in none of the 25 analytes. Significant sex-related and age-related differences were observed for 10 and seven analytes, respectively. MRA revealed BMI-related changes in results for uric acid, glucose, triglycerides, high-density lipoprotein (HDL)-cholesterol, alanine aminotransferase, and γ-glutamyltransferase. Their RIs were thus derived by applying stricter criteria excluding individuals with BMI >28 kg/m2. Ranges of RIs by non-parametric method were wider than those by parametric method especially for those analytes affected by BMI.

CONCLUSIONS

With the lack of regional differences and the well-standardized status of test results, the RIs derived from this nationwide study can be used for the entire Turkish population.

Is "Attenuation of Oxidative Stress" Helpful to Understand the Mechanism of Remote Ischemic Preconditioning in Cardiac Surgery?

OBJECTIVES

The aim of this study was to determine the effect of remote ischemic preconditioning (RIPC) on markers of cardiac ischemia and response to oxidative stress in patients undergoing coronary artery bypass grafting (CABG) surgery.

DESIGN

A prospective, randomized, and blinded study.

SETTING

A single-center university hospital.

PARTICIPANTS

This study included patients who underwent isolated CABG surgery with cardiopulmonary bypass who were selected carefully to prevent confounding with factors known to affect markers of ischemia-reperfusion and response to oxidative stress.

INTERVENTIONS

The authors randomly assigned patients to RIPC to the left lower extremity using a blood pressure cuff (study group) or a cuff that was applied but not inflated or deflated (control group).

MEASUREMENTS AND MAIN RESULTS

At 6 hours after CABG surgery, high-sensitivity cardiac troponin T levels were significantly lower in the study group than in the control group. Levels of superoxide dismutase, an antioxidant enzyme, were significantly greater 15 minutes after release of the cross-clamp in the study group, whereas malondialdehyde levels were lower (not significantly) at 1 and 15 minutes after release of the cross-clamp. Hemodynamic parameters were not significantly different at any time point during the study.

CONCLUSIONS

The authors' method of RIPC before CABG surgery resulted in less myocardial ischemia, as indicated by lower troponin levels. Changes in levels of endogenous antioxidant enzymes supported the hypothesis that this protection from ischemia-reperfusion injury was related to scavenging of free oxygen radicals. Future studies might include a more heterogeneous population and medications that lower the body's response to oxidative stress.

IL-5, IL-8 and MMP -9 levels in exhaled breath condensate of atopic and nonatopic asthmatic children

RATIONALE

Asthma is a heterogeneous disease, and a great majority of pediatric patients with asthma demonstrate atopic characteristics and develop a Th2 type cytokine response. Nonatopic asthma, on the other hand, is seen more rarely.

METHODS

In this study, levels of IL-5, IL-8 and MMP-9 were measured in exhaled breath condensate (EBC) of the subjects to demonstrate the extent of tissue damage as well as eosinophilic and neutrophilic inflammation in children with atopic and nonatopic asthma. A total of 37 children with atopic asthma and 37 children with nonatopic asthma were enrolled in the study. Patients who exhibited protease positive aeroallergen (House dust mite, mould mix, olea, grass mix) sensitivity in allergen skin prick test were included in the atopic asthma group. To evaluate the EBC, the fluid content of the breath was collected by having the patients exhale into an EBC device, after which the IL-5, IL-8 and MMP-9 levels were assayed using the ELISA method.

RESULTS

The atopic asthmatics exhibited significantly higher IL-5 levels in their EBC samples than the nonatopic asthmatics (0.271 [0.198-0.489] pg/ml and 0.198 [0.125-0.344] pg/ml, respectively, p = 0.04), while no significant differences were observed in the levels of IL-8 and MMP-9 in the EBC samples of the atopic and nonatopic asthmatics.

CONCLUSIONS

IL-5 levels, as a marker of eosinophilic inflammation, were demonstrated to be higher in the children with atopic asthma when compared to those with nonatopic asthma in EBC. The fact that no significant difference was apparent in the IL-8 levels between the groups suggests that it is the severity of the disease rather than the atopic state that plays an important role in IL-8 levels. Since no difference was recorded between the groups in terms of MMP-9 levels, lung damage in asthma sufferers seems to develop independent of atopia.

Protective effect of ketamine against hemorrhagic cystitis in rats receiving ifosfamide

Objective:

To investigate the possible protective effect of a single dose of ketamine and the synergistic effect between ketamine and 2-mercaptoethane sulfonate (mesna) against ifosfamide-induced hemorrhagic cystitis.

Materials and Methods:

35 adult female wistar rats were divided into five groups and pretreated with ketamine at 10 mg/kg and/or mesna 400 mg/kg 30 minutes before intraperitoneal injection of IFS (400 mg/kg) or with saline (control group). Hemorrhagic cystitis was evaluated 24 hours after IFS injection according to bladder wet weight (BWW), and microscopic changes, i.e. edema, hemorrhage, cellular infiltration, and urothelial desquamation. The markers of oxidative damage including nitric oxide (NO) and malondialdehyde (MDA) levels and the expressions of tumor necrosis factor alpha (TNF-α), interleukin 1-beta (IL-1β), inducible nitric oxide synthase (i-NOS) and endothelial nitric oxide synthase (e-NOS) were also assayed in the bladder tissues.

Results:

Pretreatment with ketamine alone or ketamine in combination with mesna reduced the IFS-induced increase of BWW (58,47% and 63,33%, respectively, P < 0.05). IFS- induced microscopic alterations were also prevented by ketamine with or without mesna (P < 0.05). In addition, also statistically insignificant, the bladder tissue expressions of IL-1β were lower in ketamine and/or mesna-receiving groups (P > 0,05). The parameters of oxidative stress, the NO and the MDA contents of the bladder tissues of the study groups were not different.

Conclusion:

The results of the present study suggest that a single dose of ketamine pretreatment attenuates experimental IFS-induced bladder damage. It is therefore necessary to investigate ketamine locally and systematically with various dosing schedulesin order to reduce the bladder damage secondary to oxazaphosphorine-alkylating agents and these results may widen the spectrum of ketamine.

E-cadherin as an epithelial barrier protein in exhaled breath condensate

Airway epithelium plays an important role as a physical barrier and a modulator of allergic response. Junctions between cells provide epithelial integrity and barrier function. The aim of this study was to investigate the influence of atopy on airway epithelial integrity in asthma and to measure E-cadherin levels in exhaled breath condensate as an indicator epithelial damage. A total of 74 patients with asthma (35 atopic and 39 non-atopic) and 39 healthy children were enrolled in this case-control study. Sociodemographic characteristics and asthma severity parameters in the last three-month period were recorded and pulmonary function tests were performed. Blood samples were obtained to measure serum immunoglobulin E (IgE) levels and peripheral blood eosinophil count, and exhaled breath condensate (EBC) was obtained to measure E-cadherin.EBC E-cadherin levels were significantly lower in the asthmatics when compared to non-atopic controls (0.109 (0.076) versus 0.191 (0.184) ng mL(-1) respectively, p = 0.01). Atopic and non-atopic asthmatic groups had lower EBC E-cadherin levels compared to the control group. (0.112 (0.060) ng ml(-1), 0.106 (0.089) ng ml(-1) and 0.191 (0.184) ng ml(-1), p = 0.02 and p < 0.01 respectively). However, EBC E-cadherin levels were not different between atopic and non-atopic asthmatics. The results of our study support the role of E-cadherin in the pathogenesis of asthma. However, the absence of difference in E-cadherin levels between atopic and non-atopic asthmatics suggests that allergic sensitization is not the primary factor for development of epithelial barrier dysfunction in asthma.

Metabolic syndrome and carotid intima-media thickness in chronic obstructive pulmonary disease

Background

The aim of this study is to investigate the prevalence of metabolic syndrome (MetS), carotid intima media thickness (IMT), and serum C-reactive protein (CRP) levels in patients with chronic obstructive pulmonary disease (COPD), and the possible relationships among them.

Methods

Fifty stable COPD patients and 40 healthy controls were included in the study. The participants were further divided into four groups according to their smoking status. Pulmonary function tests were performed in COPD patients. Anthropometric measurements and blood chemistry analysis, serum CRP levels and carotid intima-media thickness (IMT) measurements were performed in all the study population.

Results

Prevalence of metabolic syndrome was 43% in COPD patients and 30% in the control group (p = 0.173). FEV₁% and FEV₁/FVC were higher in COPD patients with MetS (p = 0.001 and p = 0.014, respectively) compared to those without MetS. Prevalence of MetS was significantly different among the COPD patients with different stages (p = 0.017) with the highest value in stage 2 (59%). Carotid IMT was significantly higher in COPD patients than in control group (1.07 ± 0.25 mm and 0.86 ± 0.18 mm, respectively; p < 0.001). Serum CRP levels were not different in COPD patients and controls, however they were higher in individuals with MetS compared to those without MetS regardless of COPD presence (p = 0.02).

Conclusions

Early markers of atherogenesis, in terms of carotid IMT, were found to be higher in COPD patients than in healthy controls. MetS prevalence was observed to decrease as the severity of airflow obstruction increased. Therefore, screening COPD patients for these cardiovascular risk factors would be a novel approach even in absence of symptoms.

Metabolic syndrome and carotid intima-media thickness in chronic obstructive pulmonary disease

Background: The aim of this study is to investigate the prevalence of metabolic syndrome (MetS), carotid intima media thickness (IMT), and serum C-reactive protein (CRP) levels in patients with chronic obstructive pulmonary disease (COPD), and the possible relationships among them. Methods: Fifty stable COPD patients and 40 healthy controls were included in the study. The participants were further divided into four groups according to their smoking status. Pulmonary function tests were performed in COPD patients. Anthropometric measurements and blood chemistry analysis, serum CRP levels and carotid intimamedia thickness (IMT) measurements were performed in all the study population. Results: Prevalence of metabolic syndrome was 43% in COPD patients and 30% in the control group (p = 0.173). FEV1% and FEV1/FVC were higher in COPD patients with MetS (p = 0.001 and p = 0.014, respectively) compared to those without MetS. Prevalence of MetS was significantly different among the COPD patients with different stages (p = 0.017) with the highest value in stage 2 (59%). Carotid IMT was significantly higher in COPD patients than in control group (1.07 ± 0.25 mm and 0.86 ± 0.18 mm, respectively; p < 0.001). Serum CRP levels were not different in COPD patients and controls, however they were higher in individuals with MetS compared to those without MetS regardless of COPD presence (p = 0.02). Conclusions: Early markers of atherogenesis, in terms of carotid IMT, were found to be higher in COPD patients than in healthy controls. MetS prevalence was observed to decrease as the severity of airflow obstruction increased. Therefore, screening COPD patients for these cardiovascular risk factors would be a novel approach even in absence of symptoms.

α-Thalassemia frequency and mutations in children with hypochromic microcytic anemias and relation with β-thalassemia, iron deficiency anemia

The majority of the anemias during childhood are hypochromic and microcytic. The aim of the present study was to determine the status of α-thalassemia mutations and its association with other etiologies, such as iron deficiency anemia (IDA) and β-thalassemia trait, that are frequently seen hypochromic microcytic anemias in children. Children with hypochromic microcytic anemias were included in the study. Serum iron (SI), total iron-binding capacity (TIBC), ferritin levels, and hemoglobin electrophoresis with high-performance liquid chromatography (HPLC) method were analyzed. Reverse hybridization of biotinylated polymerase chain reaction (PCR) product method was used for detection of α-globin gene mutations. Of the 46 patients involved in the study, 54.3% (n = 25) were boys, and 45.7% (n = 21) were girls. Iron deficiency anemia and β-thalassemia trait were diagnosed in 67.4% (n = 31) and 19.5% (n = 9), respectively. In 17.4% there were α-thalassemia mutations (in 10.9% 3.7 single-gene heterozygote mutation, in 4.3% 20.5-kb double-gene deletion mutation, and in 2.2% α-2 poly-A-1 heterozygote mutation was detected). In 2 patients (4.3%) no etiology was determined. In 2 patients (4.3%) association between iron deficiency anemia and α-thalassemia, in 1 patient (2.2%) association between β and α-thalassemia was detected. In conclusion, α-thalassemia carrier status and its association with other etiologies are frequently seen in Manisa. So, α-thalassemia should be considered in the differential diagnosis of hypochromic microcytic anemias, especially in cases without iron deficiency (ID) and β-thalassemia carrier state.

Is genetic screening necessary for determining the possibility of venous thromboembolism in cancer patients?

OBJECTIVE

To determine the risk of an association with some genetic polymorphisms involved in venous thromboembolism (VTE) gene variations (FVL, FV H1299R, FII G20210A, MTHFR C677T, MTHFR A1298C, PAI-1 4G/5G, β-fibrinogen -455 G → A, FXIII Val34Leu and GpIIIa HPA-1a) in cancer patients.

SUBJECTS AND METHODS

Among 78 cancer patients, 28 who had proven first episode of VTE were selected as the patient group, with 50 control samples selected from age-, sex- and body mass index-matched healthy volunteers (healthy group). The differences in frequency of genetic polymorphisms were found to be statistically insignificant between these two groups.

RESULTS

Logistic regression analysis after adjustment for age, sex, smoking and hypertension showed no difference. The screened mutations of these genes were not significantly associated with VTE risk.

CONCLUSION

There is no possible benefit from genetic screening tests regarding VTE in cancer patients.

Acute oxidative stress and antioxidant status responses following an American football match

AIM

Intense physical activity is known to induce oxidative stress. Though regular physical training enhances the antioxidant defence system, the effects of diminished training periods are unclear. American football is one of the recently popular sports in Türkiye and is defined as a mixed activity. The aim of the research was to examine some markers of oxidative stress and antioxidant status in occasionally competitive American football players following a match, and relations with aerobic power and playing position.

METHODS

Twenty two male players volunteered for the study. To determine oxidative stress and antioxidant status from blood samples collected before and immediately following a match, plasma malondialdehyde (MDA) and nitric oxide (NO) levels, erythrocyte superoxide dismutase (SOD) and glutathione peroxidase (GPx) activities, and total antioxidant status (TAS) were assessed, using spectrophotometric methods. Wilcoxon's signed rank test was used to determine the match effect, and Mann-Whitney U test was used to compare playing position and VO2max effects.

RESULTS

Plasma MDA (P<0.001) and NO (P<0.05) levels increased significantly following the match. Antioxidant parameters were unchanged following the match when compared with the resting level, except for a VO2max related effect (P<0.05) on TAS.

CONCLUSION

Collected data revealed that an American football match caused excessive production of free radicals and oxidative stress. The training loads players underwent were not high enough to cause positive effects on the antioxidant status. To enhance training-induced antioxidant status adaptation, higher amounts of physical activity may be required.

Serum and pleural fluid N-Terminal-Pro-B-Type natriuretic peptide concentrations in the differential diagnosis of pleural effusions

Currently, new biomarkers like N-Terminal-Pro-B-Type natriuretic peptide (NT-proBNP) have been used in the differential diagnosis of pleural effusions. In our study, we aimed to investigate the diagnostic value of NT-proBNP, especially in cardiac originated pleural effusions. Forty-five patients with pleural effusions were included in the study. NT-proBNP levels and biochemical markers involved in the Light's criteria were analyzed in pleural fluid and serums of the patients. Pleural fluid culture, AFB smear, cytology were performed where they were indicated according to the clinical evaluation. In patients, to whom cardiac pathology was considered to be; cardiological evaluation and echocardiography were also done. Thirty-eight pleural effusions were exudative and, 7 were transudative according to the Light's criteria. Final diagnosis were malignant effusion in 13, infection (tuberculosis/pneumonia) in 10, congestive heart failure in 21, and other conditions related with pleural effusion in 1 of the patients. Median (25th to 75th percentiles) NT-proBNP levels of serum and pleural fluid due to congestive heart failure (CHF) were 4747 pg/mL (931-15754) and 4827 pg/mL (1290-12.430) while median NT-proBNP levels of serum and pleural fluid related with non-cardiac reasons were 183 pg/mL (138-444) and 245 pg/mL (187-556) respectively. NT-proBNP levels of serum and pleural fluid were significantly high in CHF (p< 0.001 for both). When four groups were compared serum and pleural fluid NT-proBNP levels were highest in the CHF group which was followed by malignancy, infection and others (p< 0.001 for both). Fourteen of 21 patients who were accepted to have congestive heart failure as the final diagnosis by a cardiological evaluation had an exudative pleural fluid according to the Light's criteria. Serum and pleural fluid NT-proBNP levels were higher in transudates and this reached statistically significance for pleural fluid (p= 0.009). We suggest that measurement of pleural fluid NT-proBNP is a smart approach and pleural fluid NT-proBNP can reflect cardiac origin of effusions better than serum NT-proBNP and Light's criteria.

Metabolic predictors for early identification of fatty liver using doppler and B-mode ultrasonography in overweight and obese adolescents

(1) to evaluate the frequency of asymptomatic fatty liver disease (FLD) using both Doppler and B-mode ultrasound (US) in overweight and obese adolescents; (2) to compare metabolic findings of fatty liver (FL) assessed by two methods; and (3) to evaluate metabolic predictors of FL shown by these methods. Fifty-nine overweight and obese adolescents aged between 9.0 and 17.0 years and 41 non-obese healthy adolescents were included in this study. B-mode and right hepatic vein Doppler ultrasonography (US) were performed and anthropometric indices, lipid profiles, and adiponectin levels were evaluated in all adolescents. HDL-C levels were significantly lower in patients with FL detected by Doppler US compared to patients without FL (p < 0.05). HDL-C levels were inversely correlated with presence of FL assessed by two methods (r = -0.285, p = 0.004; r = -0.328, p = 0.001, respectively) and adiponectin levels were correlated with presence of FL only detected by B-mode US (r = -0.263, p = 0.008). Adiponectin levels were significantly lower in patients with FL than those without FL assessed by B-Mode US (p = 0.049). Multiple regression analysis revealed that HDL-C levels was the most important predictor of FL assessed by Doppler US (p = 0.027), while body mass index was the determinant of FL assessed by two methods (p < 0.001) in asymptomatic overweight and obese adolescents. It was found that FLD, identified by both B-mode and Doppler US, is seen frequently in asymptomatic overweight and obese adolescents. Elevated BMI is associated with increased risk of FL assessed by two ultrasonographic methods. When using Doppler US, low HDL-C levels can be used as a good predictor for presence of FLD in overweight and obese adolescents.

Correlation of serum BDNF levels with hippocampal volumes in first episode, medication-free depressed patients

The hippocampus seems to be affected in MDD, and brain-derived neurotrophic factor (BDNF) has positive effects on neurogenesis within the hippocampus. Although there are inconsistencies among study results, a smaller hippocampal volume in depressed patients is thought to be related to the pathophysiology of the disease. We looked at the correlation between serum BDNF (sBDNF) levels and hippocampal volumes (HCV) of first-episode MDD patients (18 female, 7 male; mean age = 32.1 ± 9.3) and healthy controls (17 female, 5 male; mean age = 29.7 ± 6.4). Region of interest analysis was conducted on the images acquired via MRI. sBDNF levels and HCV correlated only in the MDD group (right: r = 0.46, P = 0.02; left: r = 0.47, P = 0.02); however, HCV did not differ between MDD patients and healthy controls (right: F = 2.45, df = 1.46, P > 0.05; left: F = 0.05, df = 1.46, P > 0.05). BDNF may be a factor underlying HCV differences between MDD and healthy control subjects, which become apparent as severe and multiple episodes are experienced.

Vitamin A status of healthy children in Manisa, Turkey

BACKGROUND

Vitamin A deficiency is a major public health nutrition problem in the developing world. Even subclinical Vitamin A deficiency is associated with increased childhood mortality. Severe maternal vitamin A deficiency may cause increased mortality in the first months of life. There have been a limited number of studies regarding vitamin A status in Turkey. The aim of this study was to assess vitamin A status of healthy children in Manisa, Turkey.

METHODS

Vitamin A status of 100 healthy children aged 36-48 months is evaluated. The children were seen during routine examination. Serum retinol concentrations were measured by high-performance liquid chromatography. Duration of breast feeding, age solid foods introduced, use of supplementary vitamins, weight and height, and intake of specific groups of nutrients on a daily, weekly and monthly basis were collected from a questionnaire completed by the mothers. Height and weight z-scores were calculated according to national standards. Mothers of 20 of the 100 children were known to have normal serum and breast milk retinol concentrations. Children with normal serum retinol concentration were compared with the children with VAD. Student's t-test and Mann-Whitney test were used to compare independent variables. The Pearson correlation analysis test was used to test relation between numeric variables.

RESULTS

Mean retinol concentration was 0.98 ± 0.32 μmol/L in the whole study group. Serum retinol concentrations were normal (>0.70 μmol/L) in 89% of the children. When children with normal serum retinol concentrations were compared with those with retinol concentrations lower than 0.70 μmol/L, there was no difference in terms of age, gender, weight and height at the time of study, z-scores, birth weight, birth length, duration of breast feeding, time to begin solid food, rate of supplementary vitamin use, and rate of infections (P > 0.05). There was not any relation between vitamin A concentrations and weight and height at the time of study, z-scores, birth weight, birth length, duration of breast feeding, time to begin solid food, vitamin use, and frequency of intake of specific groups of nutrients (P > 0.05).

CONCLUSIONS

This study showed that VAD is a moderate health problem in Manisa.

Relationship Between Cyclic Citrullinated Peptide Antibodies Positivity and HLA-DRB1 Shared Epitope Alleles in Patients with Rheumatoid Arthritis in Turkey

Objective: The most characteristic genetic risk factors for rheumatoid arthritis (RA), the HLA-DRB1 shared epitope (SE) alleles, encode for a common amino acid sequence in the peptide-presenting part of the HLA class II molecule. These SE alleles have been described recently to be a risk factor for the development of antibodies against citrullinated proteins in RA. The current study was performed to investigate the association between the cyclic citrullinated peptide antibodies (anti-CCP) and HLA-DR1 HLA-DRB1 shared epitope alleles in patients with RA in Turkey.

Materials and Methods: Sixty patients with RA who were newly diagnosed or under conventional treatment in our clinic and 60 healthy volunteers as controls were enrolled in the study. In patients with RA anti-CCP levels were investigated with enzyme-linked immunosorbent assay and HLA-DRB1 subtyping and SE was assessed by polymerase chain reaction. Only anti-CCP was measured in healthy volunteers.

Results: SE was positive in 50% of the patients with RA. Amongst the SE carriers, 30% of them were carrying double copy of SE. While anti-CCP was positive in 73,3% of patients with RA, this ratio was 0% in healthy volunteers. We determined that the existence of SE increases the positivity of anti-CCP (OR=4,3, 95% [CI], P=0.04 ), and a significant relationship was found between the anti-CCP positivity and the RF positivity. (OR=5,3, 95% [CI] P<0.05).

Conclusion: The results of the present study revealed that Turkish patients with RA carrying SE with HLA-DRB1 genes is significantly related with the production of anti-CCP. The diagnostic sensitivity and specificity of anti-CCP for RA is determined as 73,3% and 100% respectively. (Turk J Rheumatol 2010; 25: 12-8)