EVALUATION OF FETUIN-A LEVELS IN THE EARLY STAGE OF AUTOIMMUNE THYROIDITIS.

Context: Fetuin-A is a multifunctional protein and is known to be related to metabolic syndrome, vascular calcification, and inflammation. Objective: The purpose of this study was to determine the effects of serum fetuin-A levels on autoimmune thyroiditis without thyroid dysfunction. Subjects and Methods: This prospective case-control study was performed at the pediatric endocrinology outpatient clinic of a tertiary health institution in Istanbul, Turkey between July 2022 and October 2022. Serum fetuin-A levels were assessed using a human fetuin-A enzyme-linked immunosorbent assay (ELISA) kit (Elabscience Biotechnology, Houston, TX, USA). Results: The study included 86 participants, of which 42 were patients with Hashimoto's thyroiditis (HT) and 44 were controls. Autoimmune thyroiditis without thyroid dysfunction was found to be related to lower plasma fetuin-A levels. There were no statistically significant differences in the neutrophil-to-lymphocyte ratio, fasting blood glucose level, insulin level, or HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) value between the groups. A fetuin-A level of ≤162.22 µg/mL (80.95% sensitivity and 70.45% specificity) was found to support the identification of autoimmune thyroiditis. Conclusions: The findings of our study suggest that autoimmune thyroiditis without thyroid dysfunction is related to lower fetuin-A levels. Low fetuin-A levels are known to be associated with an increased risk of cardiovascular disease, suggesting that careful monitoring is required in patients with low fetuin-A levels.

Pediatric reference intervals for Free Testosterone, 17-OH Progesterone, Androstenedione, and IGF-1 with chemiluminescence immunoassay.

BACKGROUND: The aim of the study was to produce age and sex specific pediatric reference intervals (RIs) on a fully automated chemiluminescent immunoassay (CLIA) system. MATERIAL AND METHOD: A total of 1586 patients' remnant sera were included in the study and free testosterone (FT), 17-OH progesterone (17OHP), androstenodione (A4) and insulin-like growth factor-1 (IGF-1) parameters were measured on MAGLUMI 2000 (Shenzhen New Industries Biomedical Engineering Co., Ltd. (Snibe), Shenzhen, China) CLIA analyser. After appropriate age and gender partitioning, specific intervals were calculated according to Clinical Laboratory Standart Institute's (CLSI) C28-A3 protocol. RESULTS: All analytes showed sex and age dependent concentrations requiring several subgroups with specific reference intervals. 17OHP and A4 were found high with birth, declined thereafter: 17OHP by the end of 12 months and A4 by 6 months. So this period was also partitioned for these two hormones. All showed gradual increases by the end of 18 years. 17OHP, A4 and IGF-1 of girls were higher than boys around puberty as the result of earlier sexual development and maturation. FT values of boys and girls didn't differ from each other upto 10 years of age but boys had significantly higher values than girls afterwards. IGF-1 values gradually increase in both sexes upto the ages of 13, girls with significantly higher values than boys. In 13-18 years no significant gender difference was found. CONCLUSIONS: We present method specific pediatric RIs, which are comparable with medical literature, necessary for interpretation of patient results.

Is Prevention of Hemolysis Possible in Blood Samples Collected from IV catheters in the Emergency Department?

BACKGROUND: The effectiveness of aspiration and vacuum filling method with an adaptor in reducing hemolysis was investigated. METHODS: The study was conducted in the yellow zone of the Emergency department. Two different apparatuses that draw blood with two different techniques from an IV catheter were compared with our routine procedure. The first system drew blood with aspiration technique into 4.9 mL serum gel tube (Sarstedt S-Monovette®). The second was vacuum filling with a specific adaptor attached to the same catheter drawing the blood into vacuumed serum separator tubes (BD Vacutainer® SST™II and Luer-Lok™ Access Device (LLAD). In our routine, we use plastic syringes and deliver it into the same serum separator vacuum tubes. We measured the hemolysis index, AST, CK, potassium, and LDH. RESULTS: Hemolysis rates of aspiration method vs. routine were 0.80% and 38.7% (p < 0.001) and of vacuum filling with adaptor vs. routine were 13.5% and 40.6%, respectively (p = 0.0001). The hemolysis rate of the aspiration method was lower than the vacuum filling adaptor method (p = 0.0004). Both techniques showed better performance when measured parameters were compared; aspiration technique being the superior (all p < 0.0001). CONCLUSIONS: Aspiration method was more successful then vacuum filling methods in reducing hemolysis.

Evaluation of the Analytical Performance Beckman Coulter Access Sensitive Estradiol Assay.

BACKGROUND: The study aimed to assess the analytical performance of the Access Sensitive Estradiol (SNSE2) Assay on a DxI800 (Beckman Coulter, Brea, CA, USA) and compared it with a Cobas E 601 (Roche Diagnostics, Penzberg, Germany). METHODS: SNSE2 was assessed for imprecision, accuracy, limit of blank (LoB), limit of detection (LoD), limit of quantitation (LoQ), linearity, interference, and carryover. Two hundred and fourteen samples were run on both instruments. Bland-Altman plots, Passing-Bablok regression, and concordance correlation coefficient (CCC) graphs were used for comparisons. RESULTS: Access SNSE2 showed appropriate assay performance characteristics in terms of imprecision, LoB, LoD, LoQ, linearity, and interference. The Bland-Altman analysis of DxI 800 yielded negative bias from Cobas E 601 and the deviations for E2 ≤ 150 pmol/L, 150 - 500 pmol/L, and ≥ 500 pmol/L were found as 0.8%, -15%, and -8.9%, respectively. DxI 800 and E170 systems showed poor agreement for E2 levels ≤ 150 pmol/L and 150 - 500 pmol/L with CCC values of 0.7404 and 0.8342. For E2 levels ≤ 150 pmol/L there was a significant amount of both proportional and constant error with the highest slope of 1.518 (1.269 to 1.761) and an intercept of -45.08 (-66.09 to 18.78, respectively, according to the Passing-Bablok regression analysis). CONCLUSIONS: Analytical performance for SNSE2 assay was found appropriate. However, attempts to improve harmonization and standardization across assays do not seem to contribute much for E2 measurements. Results obtained with different systems cannot be used interchangeably and follow up of patients should be done with the same system.

Serum YKL-40 level is correlated with apnea hypopnea index in patients with obstructive sleep apnea sindrome.

OBJECTIVE: Obstructive sleep apnea syndrome (OSAS) has been associated with elevated biochemical markers of inflammation. Although the exact mechanism is unknown, both sleep deprivation and hypoxemia are believed to be important causative factors. YKL-40, also known as chitinase-like protein, has been shown to be related to various inflammatory conditions including atherosclerosis, diabetes, cancer, and asthma. The present study aimed to evaluate the relationship between YKL-40 levels and the Apnea Hypopnea Index (AHI) in patients with obstructive sleep apnea syndrome. PATIENTS AND METHODS: The study was conducted at the Sleep Unit of the Namik Kemal University Research Center. From January 2013 to December 2013, 120 patients diagnosed with OSAS by polysomnography and 40 subjects without OSAS were recruited. Patients in both groups were matched by age, sex, and body mass index (BMI). They were further divided into groups of mild, moderate and severe OSAS based on their AHI value. Serum YKL-40 concentrations were measured by the enzyme-linked immunosorbent assay (ELISA). RESULTS: OSAS patients showed significantly elevated YKL-40 levels compared to the control group; 102,05 (23.14) pg/ml in the control group vs. 144.81 (65.53) pg/ml in the OSAS group. A Spearman correlation analysis showed that serum YKL-40 levels were significantly and positively correlated with AHI (r = 0.434, p < 0.001) and oxygen desaturation index (r = 0.374, p < 0.001). CONCLUSIONS: The study demonstrated that high serum YKL-40 levels correlated with the severity of OSAS and might serve as a nonspecific biomarker for prediction and progression of the disease.

Comparison of colorectal neoplastic polyps and adenocarcinoma with regard to NLR and PLR.

OBJECTIVE: Cancer-related inflammation affects many aspects of malignancy, including proliferation and survival of malignant cells, angiogenesis, and therapeutic response. Some biomarkers representing the degree of systemic inflammation, such as the Glasgow prognostic score, NLR and PLR, have been shown to have prognostic value in many kinds of cancer patients. Aim of this study to investigate to compare neutrophil/leukocyte (NLR) and platelet/lymphocyte (PLR) ratios of the patients with colorectal neoplastic polyps and colorectal cancer (CRC) and tried to determine whether this could be used as a biomarker in follow up of the patients with neoplastic polyps. PATIENTS AND METHODS: A total of 100 colorectal polyps, 113 colorectal cancers and 124 healthy controls were included in the study. Exculusion criteria were endocrinologic or metabolic diseases, acute or chronic diseases, hypertension and atherosclerotic heart diseases, renal diseases. Blood count parameters of the patients were measured. The NLR was calculated as a simple ratio between the absolute neutrophil and the absolute lymphocyte counts. The PLR was defined as the platelet counts to lymphocyte ratio. RESULTS: A statistically significant difference was not detected between Group A and C with regard to NLR and PLR. NLR and PLR were found statistically significantly high in Group B (CRC), Group A (colorectal polyp) and Group C (healthy individuals) (p < 0.001 and p < 0.001). Our study showed that the optimum NLR cut-off point for neoplastic polyps was 2.28 (sensitivity: 68.7%, specificity: 42.3%). When the sensitivity and specificity levels of the PLR were assessed, they were 68.7% and 46.5% for neoplastic polyps, 80% and 68.9% for colorectal cancer. CONCLUSIONS: NLR and PLR may be used for follow up conversion of colonic and rectal neoplastic polyps to invasive tumor.

Spinal cord infarction as a complication of percutaneous coronary intervention.

OBJECTIVES: Acute spinal cord ischemia syndrome (ASCIS) due to coronary invasive intervention is rarely seen. In this case report we wish to highlight the mortality and morbidity of this entity. METHODS: Case report. RESULTS: A 60-year-old woman, diagnosed with acute myocardial infarction, presented with paresthesia and paraparesis of her legs after coronary invasive intervention. Magnetic resonance imaging showed hyperintensity from T6 to T10 consistent with ASCIS. Despite immediately starting rehabilitation program the patient never regained ambulation. CONCLUSION: Spinal cord infarction secondary to coronary intervention is rare, but when it presents the mortality and morbidity are high.

Selection of newly isolated mushroom strains for tolerance and biosorption of zinc in vitro.

Nine newly isolated mushroom strains were tested to assess both their zinc tolerance and potential for zinc removal from an aqueous solution. Four strains of ectomycorrhizal fungi, namely Clavariadelphus truncatus (T 192), Rhizopogon roseolus (T 21), Lepista nuda (T 373), and Tricholoma equestre (T 174), along with five strains of white rot fungi, Lenzites betulina (S 2), Trametes hirsuta (T 587), Ganoderma spp. (T 99), Polyporus arcularius (T 438), and Ganoderma carnosum (M 88), were investigated using zinc-amended solid and liquid media. Their biosorption properties were also determined. The colony diameter and dry weight were used as tolerance indices for fungal growth. C. truncatus and T. equestre were not strongly inhibited at the highest concentrations of (225 mg/l) zinc in solid media. The most tolerant four strains with solid media, C. truncatus, G. carnosum, T. hirsuta, and T. equestre, were then chosen for tolerance tests in liquid media. An ectomycorrhizal strain, C. truncatus, was also detected as the most tolerant strain in liquid media. However, the metal-tolerant strains demonstrated weak activity in the biosorption studies. In contrast, the highest biosorption activity was presented by a more sensitive strain, G. carnosum. In addition, seven different biosorbent types from G. carnosum (M 88) were compared for their Zn (II) biosorption in batch experiments.

Cervicovaginal fetal fibronectin (FFN) for prediction of preterm delivery in symptomatic cases: a prospective study.

OBJECTIVE: To assess the clinical value of cervicovaginal fetal fibronectin (FFN) in the prediction of preterm delivery (PTD) in women with signs and symptoms of preterm labor (PTL). METHOD: This investigation prospectively studied a cohort of a women with symptoms of PTL, between 24 and 37 weeks' gestation with < 3 cm of cervical dilatation and intact membranes. Cases were evaluated in terms of maternal demographic characteristics like age, body mass index, number of parities, previous PTL history, Bishop scores at admission, gestational age at delivery, mode of delivery, use of tocolytic or steroids, presence of histologic chorioamnionitis, neonatal outcomes and delivery before 34 weeks' gestation as well as within seven days of admission. RESULTS: A total number of 68 cases were included in the study. There were no statistically significant differences between positive and negative FFN groups in terms of maternal characteristics, mode of delivery and adverse neonatal outcomes. However, FFN + cases had higher Bishop scores on admission (3.4 +/- 1.2 vs 2.5 +/- 0.3, p = 0.03) and lower gestational age at delivery (33.4 +/- 3.1 weeks vs 36.8 +/- 2.1 weeks, p = 0.002). Likelihood ratio (LR) for positive results was 1.83 (95% CI: 1.61-2.26) for predicting birth before 34 weeks' gestation, with a corresponding negative LR of 0.62 (95% CI: 0.3-1.2). LR for positive results was 4.34 (95% CI: 3.65-5.12) for predicting birth within seven days of testing, with a corresponding negative LR of 0.3 (95% CI: 0.2-0.5). CONCLUSION: Based on the results of cervicovaginal FFN, positive tests represent an increased likelihood of PTD among women with symptoms of threatened preterm labor.

Digital and transvaginal ultrasound cervical assessment for prediction of successful labor induction.

OBJECTIVE: To compare the values of preinduction transvaginal cervical length measurements and Bishop score to predict successful labor induction. METHODS: A prospective, observational trial of nulliparous women undergoing labor induction. Inclusion criteria were gestational age between 36 and 42 weeks, singleton cephalic presentation of the fetus, and intact membranes. Preinduction cervical ripening was performed using 25 microg intravaginal misoprostol (PGE1), repeated every 4 h, up to a maximum of 3 doses. Induction was subsequently continued by oxytocin and amniotomy. RESULTS: A total of 43 women met the inclusion criteria. Mean preinduction cervical length for women with successful or failed labor induction was 26 mm (95% Confidence interval [CI], 27-32) and 34 mm (95% CI, 33-38), respectively (P=0.002). Mean Bishop scores for successful and failed induction groups were 5.4 (95% CI, 5.2-6.2) and 3.1 (95% CI, 2.8-3.5), respectively (P=0.003). CONCLUSION: Digital examination and transvaginal ultrasound of the cervix predict successful labor induction with reasonable accuracy.

Comparison of clinical and laboratory characteristics of cases with polycystic ovarian syndrome based on Rotterdam's criteria and women whose only clinical signs are oligo/anovulation or hirsutism.

This study was an attempt to determine whether the hormonal and clinical profiles of polycystic ovarian syndrome (PCOS) or non-PCOS cases whose only admission signs were oligo/anovulation or hirsutism. This retrospective study comprised a total number of 118, age-matched, young Turkish women with initial admission signs and symptoms of menstrual disorders (MD) like oligo/anovulation or hirsutism. Of these, 66 cases were diagnosed as PCOS, based on 2003 Rotterdam criteria [presence of two of first three criteria such as oligo- and/or anovulation, signs of clinical hyperandrogenism (HA-c) and/or biochemical signs of hyperandrogenism (HA-b) and polycystic ovaries on ultrasonography after exclusion of specific identifiable disorders]. Fifty-two women were diagnosed as cases of oligo/anovulation or hirsutism before the era of PCOS Rotterdam's consensus criteria. These two PCOS and non-PCOS cases were evaluated in terms of body mass index (BMI), waist-to-hip ratio, serum FSH, LH, estradiol (E2), dehydroepiandrosterone sulphate (DHEAS), androstendione (A) 17 hydroxyprogesterone (17-HP), fasting insulin, C-peptide levels, sex hormone-binding globulin (SHBG) and finally, ultrasonographic ovarian morphology. PCOS cases with unilateral and bilateral polycystic ovarian morphology on ultrasound scan were analyzed based on Rotterdam criteria. No statistically significant difference was detected among two groups, in terms of BMI, waist-to-hip ratio, serum FSH, LH, E2, fasting insulin, C-peptide levels (P > 0.05). However, blood levels of DHEAS, A and 17-HP were higher, whilst SHBG levels were remarkably lower (P = 0.008) in PCOS cases. Among PCOS group, hormonal and clinical characteristics did not differ, irrespective or uni- or bilaterality of ovarian morphology on ultrasonographic scan. Percentages of cases with androgenic alopecia, oily skin/acnea and increased ovarian volume were higher in PCOS group; whereas Ferriman-Gallwey score >/= 8 were similar between two groups. Total but not free testosterone remained high in PCOS group (P < 0.01). In both PCOS and non-PCOS cases, a linear correlation was apparent between BMI and insulin levels (r (s )= 0.69 and 0.32, P < 0.05, respectively). Among PCOS group, MD + HA-b + HA-c (n = 40) was present in 60.6% of subjects, MD + HA-b (n = 12) in 18.2%, and MD + HA-c (n = 14) in 21.2%. The three phenotypes did not differ in mean BMI, waist-to-hip ratio and biochemical characteristics. To conclude, non-PCOS women with only sign or symptom of oligo/anovulation or hirsutism had a more favorable endocrine milieu. These cases should be followed in vigilance in an aim to confront the development of short- and long-term adverse effects of impending PCOS in the future. Furthermore, different phenotypes of PCOS cases were clinically or biochemically similar in characteristics.

Client participation and provider communication in family planning counselling and the sample study from Turkey.

BACKGROUND: The family planning program in Turkey was established in 1965 to curb the rapid increase in population growth. The last Demographic and Health Survey showed that about 64 % of married women in Turkey used contraception. OBJECTIVES: This study examines of behaviour of family planning clients and provider in Eskisehir/Turkey, to see whether they can achieve this ideal parnership. METHODS: Consultation between 83 physicians, 222 nurses and 324 clients requesting family planning methods were audiotaped and analysed for physicians and nurses communication style. Data were collected from 3 hospital and 14 small health units that give services in Eskisehir. The audiotaped consultations were coded using an adaptation of the RIAS which has been used extensively in both developed and developing countries and in statistical analysing chi(2) and t test were utilized. RESULTS AND CONCLUSION: The single strongest factor was providers giving biomedical and technical information. The qualitative analysis of audiotapes found that most of clients' questions concern contraceptive side effects and symptoms. The next category social talk, consisted largely of greetings. Most of the providers (87.6 %) are women. The results show that providers dominate most counselling session and clients rarely take on active role.

Report of a rare human variation: the superficial ulnar artery arising from the axillary artery.

A rare variation of the ulnar artery is presented on routine anatomical dissection in one male cadaver. The superficial ulnar artery was found to originate from the axillary artery. The free forearm flap is increasingly popular among plastic surgeons. As a result of this case, and a review of the literature to gain further knowledge of anatomical variations, it is advised that more attention should be paid clinically to this artery to prevent its injury.