Evaluation of the hematologic system as a marker of subclinical inflammation in hyperemesis gravidarum: a case control study

Objectives: Current evidence suggests that subclinical inflammation plays a significant role in the development of hyperemesis gravidarum (HEG). Simple hematological markers, such as mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), have been shown to reflect inflammatory burden and disease activity in several disorders. This study aimed to determine the diagnostic value of these hematological parameters for HEG. Material and methods: A total of 54 HEG patients and 58 age- and gestational-age-matched control subjects were studied. NLR, MPV, PLR, platelet distribution width (PDW), and red cell distribution width (RDW) values in all patients were calculated and recorded from complete blood cell counts. Results: For HEG patients, the median NLR was 3.2 (1.6–7.1), and the median PLR was 143.7 (78.1–334.6); for control subjects, the values were 2.1 (1.0–4.7) and 93.1 (47.3–194.7), respectively. Although both the NLR and PLR of HEG patients were found to be significantly higher than in the controls, no significant difference was found between the study groups in terms of MPV, RDW, or PDW. Correlation analysis revealed a significant correlation between NLR and CRP (r = 0.872, p < 0.001). Conclusions: Our results show that peripheral blood NLR and PLR values can reflect inflammatory burden in HEG patients and can be used as markers for HEG

The role of serum podocalyxin levels in recurrent pregnancy loss

Objective: To measure serum levels of podocalyxin (PODXL) in recurrent miscarriages as a marker of vascular endothelial dysfunction. Study design: In this case-control study, women who were hospitalized for singleton first-trimester pregnancy terminations due to missed abortion, anembryonic pregnancy, and inevitable abortion were included. There were 24 patients who were admitted for the first pregnancy termination, 39 patients who were admitted for recurrent pregnancy loss (RPL), and 25 fetal cardiac activity positive patients as the control group. Demographic features, medical and obstetric histories were recorded. The measurements of serum PODXL were done by a human enzyme-linked immunosorbent assay kit. Results: Serum PODXL levels were found to be significantly higher in the RPL group than the control group and the first time miscarriage group (13.82 [10.09 113.54] vs. 11.78 [9.25 48.80], p = 0.016 and 13.82 [10.09–113.54] vs. 11.99 [8.20–20.47], p = 0.003; respectively). Serum PODXL levels were not statistically significantly different between the first miscarriage and the control group (p = 0.62). There were positive correlation between serum PODXL levels and the number of gravida and the number of miscarriages (r = 0.217, p = 0.042, and r = 0.291, p = 0.006; respectively). Conclusion: Recurrent miscarriage patients had higher serum levels of PODXL than both normal pregnancies and first-time miscarriages. Our results suggest that maternal endothelial dysfunction might have a role in recurrent pregnancy losses

Evaluation of mean platelet volume / platelet count ratio in hyperemesis gravidarum

Objectives: To investigate whether serum levels of inflammatory markers including high sensitive C-reactive protein (hs-CRP) and mean platelet volume (MPV) to platelet count ratio (MPR) were altered in patients with hyperemesis gravidarum (HEG) compared to asymptomatic pregnant women. Methods: Ninety pregnant women, 46 with HEG and the other 44 with healthy uncomplicated pregnancies were included the study. MPR was calculated as the MPV value to the platelet count obtained from the same blood sample. The clinical information and the laboratory results of the hematologic and biochemical parameters and hs-CRP levels of each participant were recorded. Results: Platelet counts were didnt differ between the groups. MPV, MPR and hs-CRP values were significantly higher in HEG group than in the control (p=0.01, p=0.05 and p=0.03, respectively). Conclusions: The etiopathogenesis of HEG is still obscure and its likely multi-factorial. Although we didnt demonstrate the statistically significant differences in terms of platelet counts between the groups we find elevated levels of MPV, MPR and hs-CRP which conclude inflammatory basis of the disease. [Med-Science 2019; 8(4.000): 866-9

Elevated circulating nitric oxide levels correlates with enhanced oxidative stress in patients with hyperemesis gravidarum

Since the biochemical and molecular mechanisms responsible for ongoing oxidative stress in hyperemesis gravidarum (HEG) patients have not yet been fully elucidated, the aim of this study was to evaluate the possible role of nitric oxide (NO), malondialdehyde (MDA) and other oxidative stress markers in the disease pathophysiology. Moreover, the relation between oxidative stress markers and Helicobacter pylori (H. pylori) infection was also investigated. Women with pregnancies complicated by HEG (n = 33) were compared with pregnant women without HEG (n = 30) and with healthy non-pregnant women (n = 31). Serum NO, MDA, total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI) and H. pylori infection status were determined for each subject. Serum NO levels and OSI index were found to be increased (p = .001 and .013, respectively) and TAS levels were decreased (p < .001) in HEG patients compared with both controls regardless of H. pylori infection status. Serum MDA and TOS levels were not different between the study groups. Helicobacter pylori infection rates were similar in each group. The reduced antioxidant activities, as well as the increased OSI and NO levels in HEG patients indicate possible oxidative stress conditions in HEG patients. Moreover, serum NO levels may be used as an adjunctive marker to distinguish HEG patients from other causes of emesis during pregnancy.Impact statement What is already known on this subject? Current evidence suggests that oxidative stress is a significant factor responsible for a number of complications during pregnancy. What do the results of this study add? Hyperemesis gravidarum is an oxidative stress condition, as reflected by increased nitric oxide (NO) and decreased total antioxidant status activity, regardless of H. Pylori infection. What are the implications for clinical practice and/or further research? Full disclosure of the association between circulating NO and hyperemesis gravidarum would shed light on underlying biological mechanisms and could help clinical management of similar pregnancy-associated morbidity states

Mid term results of the elastic intramedullary nailing in the paediatric long bone shaft fractures a prospective study of 102 cases

The aim of this study was to evaluate the mid-term results of a large series of paediatric patients with long bone shaft fractures who were treated with elastic intramedullary nailing. Between November 2009 and November 2010, 108 long bone shaft fractures in 102 patients were treated with elastic intramedullary nails. The number of nails used, admission time, nail diameter/medullary canal diameter ratio of the nontraumatized extremity, weeks until radiological consolidation, weeks until full weight bearing for the femur and tibia shaft fractures, weeks until the nails were removed, number of radiographs from the diagnosis time to the removal time of nail(s), clinical complications and radiological results were recorded; the union rate, time to union, nonunion, delayed union, malrotation, malalignment, follow-up time and functional outcomes (Flynn outcome scoring) were also recorded. The mean follow-up time was 22.2 (14-30) months. The mean age of the patients was 9.6 (6-15) years for all cases. The mean nail removal time for all cases was 19.2 (17-29) weeks. Eighteen patients developed complications: six had insufficient reductions; two had refractures; four developed a deep infection; one had delayed union that needed revision; two had lower extremity length discrepancies of more than 15 mm; and three had skin impingements. The mean admission time was 19 (6-32) h; the mean number of radiographs from the diagnosis time to the removal time of nail(s) was 14 (8-20) for each fracture. All patients showed excellent or satisfactory results according to Flynn's criteria. The mean time to full weight bearing for the femur and tibia shaft fractures was 62.4 (52-88) days. A nail diameter/medullary canal diameter ratio of over 0.4 showed good results; short union time, less lower extremity length discrepancy and less malalignment were recorded. When patients were informed about possible complications as well as the advantages, almost all chose the operative approach. According to our experience and opinion, elastic intramedullary nailing is the best choice for diaphyseal fractures in children with skeletal immaturity compared with other surgical choices such as osteosynthesis with a plate

The impact of anemia on sleep quality in 15-49 years old women 15-49 Yaş kadınlarda aneminin uyku kalitesi üzerine etkisi

© 2018 by Türkiye Klinikleri.Objective: Sleep disorders which is approaching 40% of frequency in the general population, are closely related not only to physical and mental health, but also to work and social life. The lack of iron in children has been shown to cause sleep disturbances due to psychological disturbances and possible restlesslegs syndrome by affecting neurotransmitters. In adults, the number of studies showing an association between anemia and sleep disturbances is limited. This study aimed to investigate the effect of anemia on sleep quality in 15-49 years old women. Material and Methods: Our study was conducted with a total of 278 female patients aged 15-49 years who had total blood analyses within the last 1 month and had enough socio-cultural level to understand the questions asked. The hemoglobin level under 12 mg/dL was considered as anemia. The socio-demographic characteristics of the patients were analyzed. The general mood of the patients was rated with 10 point likerts cale (1 depressive, 10 very happy). Sleep characteristics were assessed by the Pittsburgh Sleep Quality Index (PSQI). The scores above 5 was considered good sleep quality. Results: Anemia was present in 37.8% of the patients. Total PSQI scores were similar in patients with and without anemia (6.5±3.1 vs 6.8±3.8, p=0.758). Anemia frequency was similar among patients with poor sleep and good sleep quality (36.4% vs 39.8%, p=0.559). However, body mass index in patients with poor sleep quality was higher than patients with good sleep quality (p<0.001). Smoking was more prevelant in patients with poor sleep quality (30.5% vs18.6%, p=0.026). Conclusion: Sleep quality is not affected by the presence of anemia. However, higher body mass index, poor general mood and smoking were found to be effective on sleep quality

Longer anogenital distance in female fetus of diabetic and obese pregnant women

Objective: Previous studies revealed that prenatal exposure to androgen excess such as polycystic ovary syndrome (PCOS) is associated with offspring's anogenital distance (AGD) length, and AGD is a biomarker of intrauterine androgen exposure. This study aims to investigate a possible relationship of fetal AGD with maternal diabetes and obesity, and to evaluate whether AGD predicts the fetal androgen exposure related to diabetes and obesity in female fetus. This study is the first to focus on the relationship between offspring's AGD and maternal diabetes and obesity. Materials and methods: This is a prospective study investigating 218 pregnant women (125 in control group and 93 in study group). Fetal AGD was measured from the center of anus to the posterior convergence of the fourchette by ultrasound. Multivariate linear regression analysis was applied to assess the association of the fetal AGD length with maternal diabetes and obesity. Results: The control patients had significantly shorter fetal AGD (mean:10.7 mm, P < 0.001) compared to diabetic, obese and diabetic obese patients (mean: 12.6 mm, 12.8 mm and 12.9 mm, respectively). The results of regression analysis showed that both maternal diabetes and obesity were significantly correlated with longer AGD in female fetus. The results confirmed also that offspring's AGD measurement in utero by ultrasound is feasible and reliable. Conclusion: The study findings suggest that both maternal diabetes and obesity are associated with intrauterine androgenic milieu during pregnancy, and fetal AGD may be used as a biomarker to predict this effect. This may provide important advantages in terms of early detection of reproductive system abnormalities related to prenatal androgen exposure