Treatment of a major depression episode suppresses markers of bone turnover in premenopausal women.

UNLABELLED: Both decrease in bone mineral density and increase in bone turnover had been reported in patients with major depression compared to healthy controls. But the effect of antidepressant treatment on markers of bone turnover is not studied. The aim of this study was to investigate the effect of treatment of a major depressive episode with an SSRI antidepressant on bone turnover in premenopausal women. METHODS: Fifty premenopausal female patients with newly diagnosed major depression according to DSM IV-R criteria were included into the study. Before starting antidepressant therapy (escitalopram 10 mg/day) and three months later, blood samples were collected for the measurement of serum calcium, phosphorus, osteocalcin, ß-CTX and iPTH. Depressive status was determined with Hamilton Depression Scale. RESULTS: Treatment of depression did not create any change in laboratory levels of either calcium or phosphorus. Basal iPTH level was significantly decreased with the treatment. Treatment resulted in an increase in serum osteocalcin and decrease in ß-CTX levels. HAMD score was significantly correlated with both osteocalcin and ß-CTX. The decrease in ß-CTX and increase in osteocalcin levels were more prominent in patients with a HAMD score that remained below 15 than above 15 at the end of the study period. In conclusion, this study shows that with the treatment of depression bone formation increases and bone resorption decreases in premenopausal women with major depression.

The effect of Helicobacter pylori and economic status on growth parameters and leptin, ghrelin, and insulin-like growth factor (IGF)-I concentrations in children.

BACKGROUND: It was suggested that gastric colonization with Helicobacter pylori (H. pylori) was associated with suboptimal nutrition and growth in childhood. Furthermore, several studies indicated a relationship between H. pylori colonization and alterations in the circulating levels of growth-related molecules (GRM). Accordingly, in this study, we investigate the effect of H. pylori infection on GRMs and on the growth of healthy school children, taking into consideration the effect of their economic status (ES) and anthropometric indices of their parents. METHODS: To acquire sociodemographic and anthropometric nutritional parameters and to detect H. pylori-specific serum IgG antibodies and growth-related molecules, we evaluated a total of 473 children attending four different primary and secondary schools in Istanbul. Subsequently, we assessed the effect of H. pylori on growth-related parameters (weight for age SDS, height for age SDS, BMI SDS, TSF, and waist-to-hip ratio) and on GRMs (leptin, ghrelin, and insulin-like growth factor-1 (IGF-1)), controlling for age, gender, family income, household crowding (HC), breastfeeding, maternal and paternal BMI SDS, and midparental height SDS with complex statistical models. RESULTS: Of the 473 children (275 F/198 M, age 6-15 years; mean: 10.3 ± 0.1 years), 161 (34%) were H. pylori-positive. The prevalence of H. pylori was significantly higher in lower economic status (ES) groups, in children living in crowded houses, and in older age groups. Using simple statistical models, we did not find any significant associations between H. pylori infection and the growth parameters. However, in complex models for height for age SDS and for weight for age SDS, there was a significant interaction between H. pylori infection status and ES. Whereas in H. pylori-positive subjects, mid-income family children were both taller and heavier than the low-income group, there was no such an association in H. pylori-negative subjects. Among biochemical parameters, only ghrelin levels were associated with H. pylori infection in all models. Leptin levels were associated with HC in girls, whereas none of the parameters was significantly associated with leptin levels in boys. For IGF-1 levels, for boys, age and maternal BMI, and for girls, age and HC were significantly associated with IGF-1 levels. CONCLUSION: We suggest that H. pylori may impair growth significantly only in susceptible children where unfavorable socioeconomic conditions facilitate its action, probably through mechanisms, at least in part, involving growth-related molecules.

[Relationship between migraine-type headache in childhood with cow's milk allergy and egg-white allergy]. / Çocukluk çaginda migren tipi basagrisi ile inek sütü ve yumurta aki allerjisi arasindaki iliski.

OBJECTIVES: Migraine is a very common headache disorder. Due to the co-occurrence of migraine and allergic disorders, allergic mechanisms have been thought to play a role in migraine pathophysiology. This study aimed to investigate the association between cow's milk allergy and egg-white allergy and migraine-type headache of childhood. METHODS: We included 39 children with migraine-type headache and 167 children with no headache who had been evaluated previously in a school screening study program. Egg-white and cow's milk-specific IgE levels were measured for all involved subjects. RESULTS: Specific IgE levels were positive for cow's milk in 4 children and for egg-white in 2 children, respectively. No meaningful relationship was detected between food allergies and migraine. However, specific IgE levels for egg-white were significantly higher in migraineurs (p=0.008). CONCLUSION: Childhood migraine does not appear to be associated with cow's milk or egg-white allergy. However, the elevation of egg-white-specific IgE levels in migraine-type headache may signify the possible presence of shared pathogenetic pathways in the development of migraine and food allergies.

Relationship between bone mineral density, bone turnover markers and homocysteine, folate and vitamin B12 levels in postmenopausal women.

PURPOSE: We aimed to investigate whether levels of homocysteine (Hcy), folate, and vitamin B12 are related to bone turnover markers and bone mineral density (BMD) in postmenopausal women. METHODS: One hundred and twenty postmenopausal women were divided into three groups: osteoporotic, osteopenic and normal, according to the BMD measurements. The age, weight, body mass index (BMI), years since menopause (YSM), gravidity, parity, bone turnover markers [type I collagen C-telopeptides (CTx) and bone-specific alkaline phosphatase (BAP)], serum Hcy, parathyroid hormone (PTH), vitamin B12, folate, calcium and magnesium levels were compared with each other. RESULTS: Twenty-five women had osteoporotic, 42 women had osteopenic, and 53 had normal BMD values. After adjusting for confounding factors, serum Hcy levels were significantly higher in osteoporotic women [adj OR = 38.95 (1.474-1029.88) p = 0.02]. The age, YSM, PTH, CTx and BAP levels were related to serum Hcy in all women (beta = 0.523, p = 0.0001; beta = 0.446, p = 0.001; beta = 0.295, p = 0.005; beta = 0.239, p = 0.026; beta = 0.451, p = 0.001, respectively). CONCLUSIONS: Our data showed that vitamin B12, folate and Hcy levels were not related with BMD in postmenopausal women. We think that one of the underlying mechanisms of increased Hcy levels and osteoporosis may be a mechanistic link which cannot detected by BMD or biochemical markers.

Post-procedure elevated amylase and lipase levels after double-balloon enteroscopy: relations with the double-balloon technique.

BACKGROUND: Small elevations of pancreatic enzymes are recently recognized complications of double-balloon enteroscopy (DBE). AIMS: The aim of this study was to check the post-procedure pancreatic enzyme (p-amylase, lipase) levels and to disclose their relationships with technical features of DBE. METHODS: Peroral (48) and peranal (8) DBEs were performed in 56 patients, and the p-amylase and lipase levels were measured just before and after the procedure. Patients were also evaluated for abdominal pain after DBE using a visual analog scale (VAS). The route-total duration of the procedure, the total insertion length of the scope, the insertion length where the overtube balloon was inflated for the first time, and the duration between the first and second inflations were also noted. RESULTS: Pancreatitis was observed in 6 of 48 (12.5%) peroral DBE patients. A VAS score above 5 at 4 h had a sensitivity of 100% and specificity of 96% for developing post-DBE pancreatitis. Significant correlations were noted between the levels of pancreatic enzymes after DBE and the total insertion length, duration, and duration between the first and second inflations of the balloon, and an inverse correlation was observed between the levels of these enzymes and insertion length at the first inflation, but an age-sex-adjusted regression analysis only disclosed the duration between the first and second inflations as an independent predictor of post-DBE pancreatitis (P = 0.012). CONCLUSIONS: Hyperamylasemia and hyperlipasemia after DBE seems to be a complication of peroral DBE, which might be prevented by reducing the time between the first and second inflations of the overtube balloon.

Ethylene glycol induced hyperoxaluria increases plasma and renal tissue asymmetrical dimethylarginine in rats: a new pathogenetic link in hyperoxaluria induced disorders.

PURPOSE: The pathogenesis of kidney stones remains elusive. There is some evidence that hyperoxaluria may effect vascular endothelium and many studies link renal stones to atherosclerosis. Also, renal vascular endothelial cells regulate proximal tubular epithelial cell function. We determined the effect of hyperoxaluria on plasma and tissue levels of asymmetrical dimethylarginine. The secondary aim was to determine the effect of verapamil on asymmetrical dimethylarginine. MATERIALS AND METHODS: A total of 42 Sprague-Dawley rats were included in the study. In groups 1A, 1B and 1C hyperoxaluria was induced with ethylene glycol for 2 weeks. Groups 2A, 2B and 2C received ethylene glycol for 14 days and verapamil for 28 days. Control group 3 received no specific medication but distilled water. Blood samples were obtained at 24 hours and at study end, and kidney samples were obtained at 24 hours, and 7 and 28 days for histopathological evaluation. RESULTS: Plasma asymmetrical dimethylarginine increased early in the hyperoxaluric group (p = 0.0002). The effect was retained at the end of the study period (p = 0.01). There was no increase in asymmetrical dimethylarginine in the verapamil group on short-term and long-term followup. Hyperoxaluria induced a significantly dense staining pattern in renal tissue asymmetrical dimethylarginine vs controls (p = 0.01). Asymmetrical dimethylarginine staining did not differ in the control and verapamil groups. CONCLUSIONS: Increased systemic and local tissue asymmetrical dimethylarginine may help explain the pathogenetic mechanisms of hyperoxaluria induced disorders such as nephrolithiasis and atherosclerosis.

Short-term oral magnesium supplementation suppresses bone turnover in postmenopausal osteoporotic women.

Magnesium has been shown to increase bone mineral density when used in the treatment of osteoporosis, yet its mechanism of action is obscure. In this study, the effects of daily oral magnesium supplementation on biochemical markers of bone turnover were investigated. Twenty postmenopausal women have been divided into two groups. Ten patients were given magnesium citrate (1,830 mg/day) orally for 30 days. Ten postmenopausal women of matching age, menopause duration, and BMI were recruited as the control group and followed without any medication. Fasting blood and first-void urine samples were collected on days 0, 1, 5, 10, 20, and 30, respectively. Total magnesium, calcium, phosphorus, iPTH and osteocalcin were determined in blood samples. Deoxypyridinoline levels adjusted for creatinine were measured in urine samples. Thirty consecutive days of oral magnesium supplementation caused significantly decrease in serum iPTH levels in the Mg-supplemented group (p < 0.05). Serum osteocalcin levels were significantly increased (p < 0.001) and urinary deoxypyridinoline levels were decreased (p < 0.001) in the Mg-supplemented group. This study has demonstrated that oral magnesium supplementation in postmenopausal osteoporotic women suppresses bone turnover.

Complexed prostate specific antigen: better test in the diagnosis of prostate cancer for the clinically relevant 2.5-4 ng/ml total PSA range.

BACKGROUND: Data on utilizing complexed prostate specific antigen (cPSA) offering increased diagnostic performance over other available clinical parameters in diagnosis of prostate cancer is still controversial. Our objective was to determine diagnostic performance of cPSA compared to total prostate specific antigen (tPSA) and corresponding ratios for possible routine application. METHODS: In a prospective study including overall 315 consecutive men, 177 patients with suspicious digital rectal examination, and/or tPSA value > 2.5 ng/ml underwent prostate biopsy. Serum samples for tPSA, cPSA and free PSA were analyzed using automated chemiluminometric technology. RESULTS: Area under the curve (AUC) for cPSA, although greater, was not statistically different compared to that of tPSA (p = 0.253). AUCs of f/c, f/t and c/t ratios were all found significantly inferior. At clinically relevant 2.37 ng/ml threshold, cPSA performed with 85% sensitivity and significantly higher specificity of 63.1%, compared to same sensitivity and specificity of 57.2% at a 3.00 ng/ml cut off for tPSA. CONCLUSIONS: Utilizing automated assay systems at predetermined cut off value for cPSA we would be able to save 27.1% of the biopsies while missing 13.4% of the cancers. Therefore, results of this study indicate higher discriminatory power of cPSA in diagnosis of prostate cancer for clinically relevant 2.5-4 ng/ml tPSA range.

Comparative performance analysis of 4 different anti-citrullinated protein assays in the diagnosis of rheumatoid arthritis.

OBJECTIVE: To evaluate the diagnostic performances of 2 recently developed assays, third-generation anti-cyclic citrullinated peptide (anti-CCP3) and anti-mutated citrullinated vimentin (anti-MCV), in comparison to conventional second-generation anti-cyclic citrullinated peptide (anti-CCP2) assay; and to assess a novel fully automated, random-access AxSYM anti-CCP assay for early diagnosis of rheumatoid arthritis (RA). METHODS: A cohort of 176 patients was enrolled in our study; 93 were diagnosed as having RA. The non-RA group consisted of 83 patients including 38 with systemic lupus erythematosus, 17 with primary Sjögren's syndrome, 11 with osteoarthritis, and 17 healthy controls. All were tested for presence of anti-CCP2, anti-CCP3, AxSYM anti-CCP, anti-MCV, and rheumatoid factor (RF)-IgM according to the manufacturers' instructions. RESULTS: Diagnostic performance of the assays revealed the highest area under the curve for the novel AxSYM anti-CCP [89.1; 95% confidence interval (CI) 84.3-93.8], followed by anti-CCP3 (86.7; 95% CI 81.6-91.9), anti-CCP2 (82; 95% CI 75.8-88.3), and anti-MCV (71.9; 95% CI 64.4-79.5). The sensitivities and specificities were 60.2% and 98.8% for anti-CCP2, 61.3% and 97.6% for anti-CCP3, 80.6% and 84.3% for AxSYM anti-CCP, 49.8% and 91.6% for anti-MCV, and 67.8% and 91.6% for RF-IgM, respectively. CONCLUSION: At cutoff of 5 U/ml, AxSYM anti-CCP emerged as a highly sensitive first-line early diagnostic tool for RA, with the greatest discrimination power, above 16 U/ml, in case of positive result. Using a single easily performed automated assay at 2 determined decision limits we were able to diagnose 81% of cases of RA and missing only 1.2%.

The effect of vitamin C on ischemia reperfusion injury because of prolonged tourniquet application with reperfusion intervals.

We examined the effect of vitamin C on muscle injury distal to the tourniquet which was applied for 4 hours with 10- and 20-minute reperfusion intervals after 2 hours of tourniquet. Sixty-four Sprague-Dawley rats were allocated to 4 randomized groups. After 2 hours tourniquet, 10- and 20-minutes of reperfusion were allowed to half of each group respectively. Afterward an additional 2 hours compression was applied. Except the control group the animals received vitamin C intravenously, before the first tourniquet in Group I, at the reperfusion interval in Group II, and at both times in Group III. Malondialdehyde levels were measured in blood and the tibialis anterior muscle. The muscle was histopathologically examined. The data was evaluated statistically. The effects of timing and the dose of vitamin C on ischemia reperfusion injury remain controversial and there was no statistical difference between 10- and 20-minute reperfusion intervals. But the blood malondialdehyde levels showed that vitamin C has a positive effect on the muscle injury caused by ischemia-reperfusion.

Serotonin dilemma in postmenopausal women: is it low or high?

OBJECTIVE: In this study, we have studied with premenopausal (PM), naturally menopausal (NM) and surgically induced menopausal (SM) women in order to investigate the differences in serum cortisol, dehydroepiandrosterone sulfate (DHEA-S), follicle stimulating hormone (FSH) and estradiol (E2) levels on serum serotonin levels. METHODS: Forty premenopausal (36.7+/-3.5 years), 40 naturally menopausal (54.2+/-8.4 years) and 38 surgically induced menopausal (55.4+/-11.2 years) women were included in the study. None of the subjects were using antidepressants or hormone replacement therapy. In NM and SM, years since menopause (YSM) were 3.16+/-1.58 and 3.36+/-1.89, respectively. Cortisol, DHEA-S, FSH and E2 levels were determined by immunochemiluminisence while serotonin levels were determined by HPLC. RESULTS: Serum serotonin levels in NM women were higher than the other two groups [144.23+/-45.29 microg/L vs 61.35+/-37.72 microg/L in SM women and 98.74+/-50.29 microg/L in PM women]. E2 and DHEA-S were positively correlated, while FSH and cortisol were negatively correlated with serotonin in NM and SM. There was no significant correlation between serotonin and age or YSM. In the PM group, there was no significant correlation between serotonin and the hormones. CONCLUSION: In conclusion, increased serotonin levels in naturally menopausal women may be a compensatory mechanism to decreased E2 levels as it is postulated that there is strong interaction between E2 and the serotoninergic system.

Analytical and clinical evaluation of a new urinary tumor marker: bladder tumor fibronectin in diagnosis and follow-up of bladder cancer.

Bladder cancer is the fourth most common malignant neoplasm in men and the tenth most common in women. Cystoscopy presents the gold standard for detection and monitoring of bladder cancer. However, it is an invasive and expensive procedure. Therefore, development of biomarkers for the purposes of screening, diagnosis and prediction of the prognosis in bladder cancer is required. Bladder tumor fibronectin is one of the new urinary tumor markers. The aim of this study is to evaluate the diagnostic performance of urinary bladder tumor fibronectin in detecting and monitoring bladder cancer. A total of 75 patients with the diagnosis of bladder cancer, 20 patients with the diagnosis of benign prostatic hyperplasia, 7 patients with the diagnosis of prostate cancer between the years 1996-2000, and 28 age-matched healthy individuals, were enrolled in the study. The patients were diagnosed by cystoscopy, with histopathological evaluation of the tumor, as having superficial or invasive bladder cancer. Patients were followed-up clinically with data pertinent to disease recurrence and progression. Bladder tumor fibronectin (BTF; ng/ml) was determined by solid phase, two-site chemiluminescent immunometric commercial diagnostic assay developed for the Immulite automated immunoassay system (Diagnostic Products Corporation, Los Angeles, CA, USA). All measured values were normalized by urinary creatinine, and the obtained data were evaluated by receiver-operating characteristics (ROC) curve analysis. Optimal cut-off was established at 43.4 ng/mg. This cut-off rendered overall sensitivities of 72% and specificity of 82.1%. The analytical evaluation of the BTF test displayed promising results in terms of a non-invasive in vitro test in the diagnosis of bladder cancer. Although it was not satisfactory in prediction of recurrence or progression of the disease, it correlated well with the stage, one of the most reliable prognostic factors. In conclusion, the urinary bladder tumor fibronectin test warrants further clinical evaluation.

Protective role of cyclooxygenase (COX) inhibitors in burn-induced intestinal and liver damage.

The aim of this study was to investigate the role of cyclooxygenase (COX) inhibition in intestinal motility and in the extent of tissue injury of the small intestine and liver with the use of various COX inhibitors. Wistar albino rats were exposed to 90 degrees C water bath for 10s. The intestinal transit index decreased compared to control group and treatment with nimesulide (NIM; 10mg/kg, subcutaneously) or piroxicam (Pir; 5mg/kg, orogastrically) reversed this effect significantly. The intestinal and liver glutathione levels showed a significant decrease in the burn group compared to sham (P<0.001 and P<0.05, respectively). Decrease in intestinal glutathione level was reversed by NIM or Pir treatment (P<0.01 and P<0.01, respectively), whereas all drugs tested were effective in reversing low liver glutathione level. The MPO activity in intestinal segments were significantly high in burned animals compared to sham. All test drugs reversed this effect but ketorolac (Ket; 3mg/kg, orogastrically) was the most effective one. The liver samples characterized by sinusoidal dilatation and pericentral atrophy in burn group were protected by treatment with Ket or Pir (P<0.05). Plasma ALT and AST activities were markedly high in this burn group compared to sham (P<0.0001 and P<0.001, respectively). None of the agents reversed these high enzyme activities. These data suggest that not only COX-2 but also COX-1 inhibition is required for protection against inflammatory changes in liver and small intestine following burn injury.