Prediction of gestational diabetes mellitus in the first trimester: comparison of maternal fetuin-A, N-terminal proatrial natriuretic peptide, high-sensitivity C-reactive protein, and fasting glucose levels

ABSTRACT Objective We investigated the utility of maternal fetuin-A, N-terminal proatrial natriuretic peptide (pro-ANP), high-sensitivity C-reactive protein (hs-CRP), and fasting glucose levels at 11-14 gestation weeks for predicting pregnancies complicated by gestational diabetes mellitus (GDM). Subjects and methods This prospective cohort study included 327 low-risk pregnant women who completed antenatal follow-up at a tertiary research hospital between January and April 2014. Maternal blood samples were collected between 11-14 gestational weeks in the first trimester of pregnancy and then stored at -80 °C until further analyses. During follow-up, 29 (8.8%) women developed GDM. The study population was compared 1:2 with age- and body mass index-matched pregnant women who did not develop GDM (n = 59). Fasting plasma glucose (FPG) levels and serum fetuin-A, pro-ANP, and hs-CRP levels were measured using automated immunoassay systems. Results There was a significant negative correlation between fetuin-A and hs-CRP (CC = -0.21, p = 0.047) and a positive correlation between FPG and hs-CRP (CC = 0.251, p = 0.018). The areas under the receiver operating characteristic curve for diagnosing GDM were 0.337 (p = 0.013), 0.702 (p = 0.002), and 0.738 (p < 0.001) for fetuin-A, hs-CRP, and FPG, respectively. The optimal cut-off values were > 4.65, < 166, and > 88.5 mg/dL for maternal hs-CRP, fetuin-A, and FPG, respectively. Conclusion Reduced fetuin-A, elevated hs-CRP, and FPG levels in women in the first trimester can be used for the early detection of GDM. Further research is needed before accepting these biomarkers as valid screening tests for GDM.

Relationship between cigarette smoking and the carbon monoxide concentration in the exhaled breath with perioperative respiratory complications / Relação entre consumo de tabaco e concentração de monóxido de carbono na expiração com complicações respiratórias perioperatórias

Abstract Background The purpose of the current study was to determine the effects of preoperative cigarette smoking and the carbon monoxide level in the exhaled breath on perioperative respiratory complications in patients undergoing elective laparoscopic cholecystectomies. Methods One hundred and fifty two patients (smokers, Group S and non-smokers, Group NS), who underwent laparoscopic cholecystectomies under general anesthesia, were studied. Patients completed the Fagerstrom Test for Nicotine Dependence. The preoperative carbon monoxide level in the exhaled breath levels were determined using the piCO+ Smokerlyzer 12 h before surgery. Respiratory complications were recorded during induction of anesthesia, intraoperatively, during extubation, and in the recovery room. Results Statistically significant increases were noted in group S with respect to the incidence of hypoxia during induction of anesthesia, intraoperative bronchospasm, bronchodilator treatment intraoperatively, and bronchospasm during extubation. The carbon monoxide level in the exhaled breath and the Fagerstrom Test for Nicotine Dependence, and number of cigarettes smoked 12 h preoperatively were designated as covariates in the regression model. Logistic regression analysis of anesthetic induction showed that a 1 unit increase in the carbon monoxide level in the exhaled breath level was associated with a 1.16 fold increase in the risk of hypoxia (OR = 1.16; 95% CI 1.01-1.34; p = 0.038). Logistic regression analysis of the intraoperative course showed that a 1 unit increase in the number of cigarettes smoked 12 h preoperatively was associated with a 1.16 fold increase in the risk of bronchospasm (OR = 1.16; 95% CI 1.04-1.30; p = 0.007). While in the recovery room, a 1 unit increase in the Fagerstrom Test for Nicotine Dependence score resulted in a 1.73 fold increase in the risk of bronchospasm (OR = 1.73; 95% CI 1.04-2.88; p = 0.036). Conclusions Cigarette smoking was shown to increase the incidence of intraoperative respiratory complications while under general anesthesia. Moreover, the estimated preoperative carbon monoxide level in the exhaled breath level may serve as an indicator of the potential risk of perioperative respiratory complications.

Resumo Justificativa O objetivo deste estudo foi determinar os efeitos do tabagismo pré-operatório e o nível de monóxido de carbono no ar expirado sobre complicações respiratórias perioperatórias em pacientes submetidos a colecistectomias laparoscópicas eletivas. Métodos No total, 152 pacientes (Grupo F: fumantes; Grupo NF: não fumantes) submetidos a colecistectomias laparoscópicas sob anestesia geral foram avaliados. Os pacientes completaram o Teste para Dependência de Nicotina de Fagerstrom. Os níveis pré-operatórios de monóxido de carbono no ar expirado foram determinados usando o piCO + Smokerlyzer 12 h antes da cirurgia. As complicações respiratórias foram registradas durante a indução da anestesia, no intraoperatório, durante a extubação e na sala de recuperação. Resultados Aumentos estatisticamente significativos foram observados no Grupo F em relação à incidência de hipóxia durante a indução da anestesia, broncoespasmo intraoperatório, tratamento broncodilatador intraoperatório e broncoespasmo durante a extubação. O nível de monóxido de carbono no ar expirado, o Teste para Dependência de Nicotina de Fagerstrom e o número de cigarros fumados em 12 h no pré-operatório foram designados como covariáveis no modelo de regressão. A análise de regressão logística da indução anestésica mostrou que um aumento de uma unidade no nível de monóxido de carbono no ar expirado foi associado a um aumento de 1,16 vez do risco de hipóxia (OR = 1,16; IC de 95% 1,01-1,34; p = 0,038). A análise de regressão logística do período intraoperatório mostrou que um aumento de uma unidade no número de cigarros fumados em 12 h no pré-operatório foi associado a um aumento de 1,16 vez no risco de broncoespasmo (OR = 1,16; IC de 95% 1,04-1,30, p = 0,007). Enquanto na sala de recuperação, um aumento de uma unidade no escore do Teste para Dependência de Nicotina de Fagerstrom resultou em um aumento de 1,73 vez no risco de broncoespasmo (OR = 1,73; IC de 95% 1,04-2,88; p = 0,036). Conclusões O tabagismo mostrou aumentar a incidência de complicações respiratórias intraoperatórias sob anestesia geral. Além disso, o nível estimado de monóxido de carbono no ar expirado no pré-operatório pode servir como um indicador do risco em potencial de complicações respiratórias perioperatórias.