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İç Kalite Kontrol (İKK), hasta numunelerini çalıştırmadan önce bir laboratuvar testinin güvenilirliğini değerlendirme ve kontrol etme sürecidir. Mevcut İKK süreci, kural tabanlı yaklaşımlar kullanarak Toplam Analitik Hatanın (TAE) yönetimine odaklanmaktadır. Toplam İzin Verilebilir Hata (TEa) ihlallerinin zamanlamasını tam olarak tahmin edemez. Çalışmada, Tahmine Dayalı Kalite Kontrol Algoritması (PQCA) için Gaussian Process for Machine Learning (GPML) yöntemini kullanarak İKK sürecini değerlendirmede tahmine dayalı bir hesaplama yaklaşımı önerildi. Python ve Scikit-learn kütüphanesinde yürütülen yazılım uygulaması, Windows tabanlı standart bir PC üzerinde çalıştırıldı. PQCA'ya dayalı bir dijital kontrol tablosu oluşturuldu. Gözlemlerin, PQCA tarafından üretilen karşılık gelen tahminlerinin %95 güven aralığı içinde kaldığı gösterildi. Ayrıca, klasik formül kullanılarak hesaplanan TAE'nin tüm TEa ihlallerini yakalayamadığı da ortaya konuldu. PQCA, ham kontrol verilerini doğrudan kalite hedefleriyle ilişkilendirebilen basit bir prosedür olup, yüksek derecede doğrulukla tahmine dayalı bir yaklaşım sağlamıştır. Klasik TAE hesaplama modeli, tek değişkenli bir Gauss modeline dayanır. PQCA'nın temel aldığı GPML, çok değişkenli bir Gaussian modeldir. Bu nedenle PQCA, klasik IQC modelinin bir genellemesi olarak görülebilir. Laboratuvarlar, PQCA'yı kullanarak analitik kalitenin kontrolüne proaktif bir yaklaşım getirebilir, düzenleyici kurumların gereksinimlerini karşılayabilir ve dolayısıyla daha doğru ve güvenilir hasta sonuçları sağlayabilir. PQCA tabanlı İKK, geleneksel yöntemlerin eksikliklerinin üstesinden gelen tek bir algoritma kullanarak analitik değişkenliğin kontrolünü sağlayabilir. Gelecekte, yeni kullanılabilir hesaplama modelleri, İKK için daha karmaşık, tahmine dayalı matematiksel çerçeveleri mümkün kılacaktır.

Objective Previous studies have reported a link between metabolic parameters and disease activity in rheumatoid arthritis (RA), although the evidence is limited in early RA. We aimed to investigate the relationship between disease activity and adipocytokine levels in subjects with early RA. Methods Forty-seven patients with early RA (symptom duration ≤12 months) were enrolled. Disease activity was determined by DAS28-CRP. Patients were treated with DMARDs according to the EULAR recommendations. Subjects were tested before and five months after treatment. Results Early RA patients with high disease activity (DAS28-CRP > 4.9) had greater BMI (31.2 ± 6.8 kg/m2 vs. 26.7 ± 4.1 kg/m2; p = 0.006) and higher leptin levels (14.62 ± 15.60 ng/mL vs. 7.82 ± 8.00 ng/mL; p = 0.048). Levels of other adipocytokines were not significantly different. Leptin levels were similar in subjects with mild/moderate disease activity and controls. DAS28-CRP was correlated with leptin (r = 0.303, p = 0.039). Leptin levels decreased significantly after treatment (from 10.86 ± 12.34 ng/mL to 9.22 ± 9.29 ng/mL; p = 0.047) along with insulin levels (from 13.68 ± 21.90 mU/L to 7.09 ± 4.72 mU/L; p = 0.010) and HOMA-IR (from 4.39 ± 9.53 to 1.70 ± 1.38; p = 0.012). HDL cholesterol levels increased (from 41 ± 10 mg/dL48 ± 10 mg/dL; p Conclusion Leptin levels were associated with disease activity in patients with early RA and these levels decreased after treatment with DMARDs. Further research is needed to elicit leptin's role to regulate disease activity in early RA.

PURPOSE The syndromes of myocardial infarction/myocardial ischemia with No Obstructive Coronary Artery Disease (MINOCA/INOCA) are seen more and more often. Endothelial dysfunction (ED) leading to ischemic events has been reported in many of these patients. We aimed to compare patients with MINOCA and INOCA regarding brachial artery flow-mediated endothelium-dependent vasodilation (flow-mediated dilation [FMD]) and plasma concentration of cardiotrophin-1 (CT-1). METHODS We included 42 patients with MINOCA and 38 patients with INOCA. Endothelial function was assessed by measuring FMD% and nitroglycerin-mediated dilatation (NMD%) in the brachial artery. The plasma level of CT-1 was determined by solid-phase enzyme-linked immunosorbent assay. RESULTS FMD% was significantly lower in MINOCA than in INOCA patients (6.45 ± 2.65 vs 8.94 ± 3.32, P

Calcific aortic stenosis (AS) is the most common form of calcific aortic valve disease. Many matrix metalloproteinase (MMP) have been shown to be expressed in aortic sclerosis and contribute to valve fibrosis and calcification. We investigated the relationship between Pregnancy-Associated Plasma Protein-A (PAPP-A) and AS.Sixty-one patients who referred to our cardiology clinic having AS diagnosed with transthoracic echocardiography and thirty control subjects were included in this study. The patient group was divided into two groups as mild and moderate-severe AS in terms of echocardiography results. Levels of C-reactive protein (CRP), insulin-like growth factor-1 (IGF-1) and PAPP-A were measured.There was statistically significant difference between the patient and control group for PAPP-A (The level of PAPP-A may be a marker used in diagnosis rather than a marker used to determine the severity of AS. Studies with larger patient populations may further explain the role of PAPP-A in the diagnosis and treatment of AS.

Introduction:Acromegaly is a rare disease caused by overproduction of growth hormone (GH) secreted from a benign pituitary adenoma. It has been shown in many studies that the incidence of cancer is increased in patients with acromegaly with increased GH and insulin-like growth factor-1 (IGF-1). Especially, colon cancer is more common. Thrombospondin-1 (TSP-1) is a glycoprotein that is thought to play an important role in cancer formation. This study aimed to evaluate circulating TSP-1 levels in patients with acromegaly.Methods:This study was a case-control study. Fifty-two patients with active acromegaly with GH

Objectives: We aimed to investigate serum neudesin levels that has neural, metabolic functions in patients with polycystic ovary syndrome (PCOS). Material and methods: The study included 180 women (age range, 18–44 years) with a diagnosis of PCOS and a control group that included 100 healthy females (age range, 18–46 years). Body mass index (BMI), waist circumference, Ferriman-Gallwey score, was evaluated and plasma glucose, lipid profile, estradiol, progesterone, total testosterone, prolactin, insulin, dehydroepiandrosterone sulfate (DHEA-S), FSH, LH, free T3, free T4, thyroid stymulating hormone (TSH), anti-thyroperoxidase (anti-TPO) antibody and neudesin levels were evaluated in all participants. Results: BMI and waist circumference were similar between two groups. Ferriman-Gallwey score was significantly higher in the patient group. Fasting blood glucose, HbA1C, lipid parameters except triglyceride levels, free T3, free T4, TSH, anti-TPO were similar between the two groups. Triglyceride, insulin and HOMA values were significantly higher in PCOS patients. While follicle-stimulating hormone (FSH), estradiol, progesterone, prolactin and DHEAS levels were similar, LH was significantly higher in patients with PCOS. Serum neudesin level was significantly lower in PCOS patients with respect to controls (p = 0.015). Neudesin was positively correlated with insulin (r = 0.224, p = 0.037), and progesterone (r = 0.716, p = 0.001). Multiple regression analysis revealed that neudesin correlated with only progesterone (beta = 0.308, p = 0.001). Conclusions: Due to the association of decreased levels of neudesin with PCOS and correlation of neudesin with progesterone, neudesin may be related with one of patophysiologic pathways of PCOS. Still, it is not certain that decreased neudesin is involved in the pathogenesis of PCOS or is the result of the disorder.

BACKGROUND: We aimed to evaluate the value of ischemia modified albumin (IMA) as a prognostic marker in acute pancreatitis (AP) patients, determine whether it is efficient in assessing the disease severity or not, and to estimate the correlation between IMA and the inflammatory markers, prognostic markers and scoring systems routinely used in clinical practice. METHODS: 100 adult patients (18 years and older) who have been hospitalized and evaluated with AP diagnosis in Tepecik Training and Research Hospital,, Department of Gastroenterology, between April 1, 2017 and April 1, 2018 have been enrolled in the study. Patients have been stratified disease etiology (biliary or non-biliary). The non-biliary group has been divided into subgroups as alcoholic, lipemic, or idiopathic. Disease severity has been categorized as mild, moderate, or severe pancreatitis according to the Atlanta classification. Ranson, Harmless Acute Pancreatitis Score (HAPS), Bedside Severity Index for Acute Pancreatitis (BISAP) scores have been determined for each patient. Patients have been grouped as necrotizing or edematous according to the Atlanta classification. RESULTS: According to our findings, IMA has been found to be correlated with disease severity, Ranson and BISAP scores, and procalcitonin levels. We have observed that some laboratory parameters including blood urea nitrogen and hematocrit levels and HAPS scoring system are not correlated to IMA. CONCLUSION: Our study is the first study to compare multiple prognostic factors with IMA in AP patients. In our study, the association between IMA and AP has been evaluated in the context of prognostic scoring and disease severity.

Objective The aim of this study is to investigate the diagnostic accuracy of complete blood count (CBC), C-reactive protein (CRP), and procalcitonin (PCT) levels, which can be used as a cultural alternative for the diagnosis of infection faster. Methods The patients were divided into two groups as bacteremia (n = 220) and nonbacteremia group (n = 812). The bacteremia group was divided into two subgroups as Gram-positive bacteria (n = 167) and Gram-negative bacteria (n = 53). Results PCT, CRP, red blood cell distribution width (RDW), platelet distribution width (PDW), neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), and mean platelet volume (MPV) levels were significantly higher in patients with positive blood culture than non-patients. The serum PCT levels were 3.80 (0.83–37.68) and 0.43 (0.16–2.61) ng/mL, respectively (p Conclusions It is important that RDW, PDW, NLR, PLR, MPV values can be measured quickly, easily and cheaply by automatic hematological analysis. However, among the markers tested, PCT has the best diagnostic performance for Gram-negative bacteremia.

INTRODUCTION[|]Diabetic nephropathy (DN) is the major cause of chronic renal failure, and proteinuria is an independent risk factor for the end stage renal disease. The random urine protein: creatinine ratio (P: C ratio) can accurately predict the amount of 24-hour urinary protein excretion. Apelin is thought to be associated with endothelial dysfunction, angiogenesis, and inflammation. This study investigated the apelin concentration and its association with the urine P: C ratio, and metabolic parameters in subjects with and without type 2 diabetes mellitus (T2D).[¤]METHODS[|]This study involved 86 subjects: 56 with newly diagnosed and untreated T2D and 30 non-diabetic controls. All subjects underwent a complete clinical examination that included anthropometric and laboratory measurements.[¤]RESULTS[|]Twenty-four males and sixty-two females participated in this study, and their mean age was 52.27+-11.34 years. There were no differences in age, thyrotropin-stimulating hormone (TSH), creatinine clearance, and apelin levels between groups. As expected, fasting plasma glucose, weight, body mass index, and HbA1C were higher in T2D subjects (p=0.001, p=0.02, p=0.03, and p=0.001, respectively). Although apelin levels were higher in the control group, the differences were not statistically significant (p=0.93). The P: C ratio levels were lower in the control group, and the differences were statistically significant (p=0.006). A Spearman correlation analysis revealed that serum apelin levels were not correlated with the urine P: C ratio.[¤]DISCUSSION AND CONCLUSION[|]Our study demonstrates that T2D is associated with decreased serum apelin levels and increased urine P: C ratios compared to those in non-diabetic subjects. This association may depend on impaired glucose homeostasis. Our results show that the serum apelin levels were not correlated with the urine protein: creatinine ratio and provide further evidence regarding the relationship between apelin and DN.[¤]

Objectives Biological variation is defined as the variation in analytical concentration between and within individuals, and being aware of this biological variation is important for understanding disease dynamics. The aim of our study is to calculate the within-subject (CVI) and between-subject (CVG) biological variations of serum creatinine, cystatin C and beta trace protein (BTP), as well as the reference change value (RCV) and individuality indexes (II), which are used to calculate the glomerular filtration rate while evaluating kidney damage. Methods Blood samples were collected from 22 healthy volunteers for 10 consecutive weeks and stored at −80 °C until the day of analysis. While the analysis for serum creatinine was performed colorimetrically with the kinetic jaffe method, the nephelometric method was employed for cystatin C and BTP measurements. All analyses were carried out in a single session for each test. Results Analytical coefficient of variation (CVA) for serum creatinine, cystatin C and beta trace protein was 5.56, 3.48 and 5.37%, respectively. CVI and CVG: for serum creatinine: 3.31, 14.50%, respectively, for cystatin C: 3.15, 12.24%, respectively, for BTP: 9.91, 14.36%, respectively. RCV and II were calculated as 17.94%, 0.23 for serum creatinine, 13.01%, 0.26 for cystatin C, 31.24%, 0.69 for BTP, respectively. Conclusions According to the data obtained in our study, serum creatinine and cystatin C show high individuality, therefore we think that the use of RCV instead of reference ranges would be appropriate. Although II is found to be low for BTP, more studies are needed to support this finding.

Centrifugation separates particles within the specimen according to their shape, dimensions, and density and basically can be defined as a separation method. The centrifuge is an essential device in medical laboratories to prepare the serum, plasma, and urine samples for analysis. It is basically an electric device composed of the stationary (motor) and the motile (rotor) part. The centrifugation depends on two main variables: relative centrifugal force (RCF) and centrifugation time. The physical impact separating the specimen into its components in the centrifuge known as RCF is expressed as the multiples of gravitational acceleration (×g). RPM, defined as the number of rotations of the centrifuge per minute, shows the speed of the centrifuge. RCF value can be calculated by using RPM, and the centrifuge radius. Because models and sizes of centrifuges vary considerably, the use of gravity (g) forces instead of RPM is suggested. The centrifuges can be classified according to their usage, speed, technical specifications, and rotor type. An accurate and precise centrifugation process is essential to prevent errors in the preanalytical phase. The purpose of this document is to ensure the standardization of a good, precise protocol for the centrifugation process among the medical laboratories.

Amaç: Bu çalışmada, otoimmün karaciğer hastalığında (AILD) belirteç olarak total antioksidan durum (TAS), oksidatif stres indeksi (OSI), total oksidan durum (TOS), iskemi modifiye albumin (IMA) ve iskemi modifiye albumin oranının (IMAR) yararı değerlendirildi.Gereç ve Yöntem: Çalışma, 22'si otoimmün hepatit (AIH), 32'si primer biliyer kolanjit (PBC) ve 12'si AIH/PBC örtüşme sendromu olan toplam 66 AILD hastası ve 49 sağlıklı kontrol içermekteydi. Serum TAS, TOS, IMA, albumin (Alb), laktat dehidrojenaz (LDH), alkalen fosfataz (ALP), aspartat aminotransferaz (AST), alanin aminotransferaz (ALT), total bilirubin (TBil), direkt bilirubin (DBil) ve 25-hidroksivitamin D (25 [OH] D) analiz edildi. OSI, TOS/TAS olarak hesaplandı ve IMAR, IMA ve Alb'den türetildi.Bulgular: Serum TAS, TOS, OSI, IMA ve IMAR değerleri AILD grubunda kontrollere göre anlamlı olarak daha yüksekti (sırasıyla p=0.004, Objective: Current study evaluated the utility of total antioxidant status (TAS), oxidative stress index (OSI), total oxidant status (TOS), ischemia-modified albumin (IMA), and ischemia-modified albumin ratio (IMAR) as markers in autoimmune liver disease (AILD).Material and Methods: The study included a total of 66 AILD patients, 22 with autoimmune hepatitis (AIH), 32 with primary biliary cholangitis (PBC), and 12 with AIH/PBC overlap syndrome, and 49 healthy controls. Serum TAS, TOS, IMA, albumin (Alb), lactate dehydrogenase (LDH), alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TBil), direct bilirubin (DBil), and 25-hydroxyvitamin D (25[OH]D) were analyzed. OSI was calculated as TOS/TAS and IMAR was derived from IMA and Alb.Results: Serum TAS, OSI, TOS, IMA, and IMAR values were found to be significantly higher in the AILD group compared to controls (p=0.004

INTRODUCTION: Measurement of blood zinc levels is frequently used in the diagnosis of a few conditions such as growth retardation, immunodeficiency, infertility, neurological disorder, and acrodermatitis enteropathica. The serum matrix is the most preferred one to determine zinc levels due to the ease of analysis with other tests and cost-effectiveness of blood collection tubes used to obtain serum samples. In our study, we aimed to compare serum and plasma zinc test results for accurate and reliable zinc measurement in plain tubes with clot activator and gel and in heparin-free tubes, which specifically produced for trace element analysis. METHODS: Twenty-seven randomly selected patients were included in the study. Blood samples drawn simultaneously from patients were pipetted into tubes with clot activator and gel (SST) (SST II Advance, Vacutainer, Becton Dickinson and Company, USA) as well as into trace element tubes with sodium heparin (NH) (NH Trace Elements Sodium Heparin, Vacuette, Greiner Bio-One GmbH, Austria). After the centrifugation process, zinc levels in serum and plasma samples were analyzed by colorimetric method using an autoanalyzer. Bias between serum and plasma zinc levels was evaluated according to the allowable bias criterion based on biological variation and regression analysis performed. RESULTS: The mean and standard deviation of serum and plasma zinc levels were 49.0±11.5 μg/dL and 46.4±12.0 μg/dL, respectively, and a statistically significant difference was determined (p=0.012) in between. Besides, the bias between serum and plasma was 6.8%, which was above the allowable bias (3.3%) and considered as clinically significant. No systematic or random errors detected. DISCUSSION AND CONCLUSION: When selecting a blood collection tube for trace element analysis, the structural differences between tubes and the matrix effect should be considered carefully.

Objective: The aim of this study was to investigate the levels of ischemia-modified albumin (IMA) in people with essential thrombocytosis (ET).Methods: A total of 30 patients with ET patient group and 30 volunteers with no known disease control group (C group) were included in this study after the approval of ethics committee and written informed consent was obtained. Patients with a history of major thrombosis were excluded. IMA levels and independent variables were investigated and effects on thrombosis susceptibility were also studied. In addition to that; comorbid disease state, drug use and used drugs group were questioned in patient group and effects of them on IMA levels were studied.Results: In our study, when ET patient group and C group were compared, the mean serum IMA levels in ET patient group and C group was detected as 0,6726 (0,527-0,776) Absorbans Unite (ABSU) and 0,4342 (0,346-0,612) ABSU respectively and in ET patient group was significantly higher than C group (p

Background In this study it was aimed to evaluate the effect of pegylated interferon alfa-2a/2b and ribavirin, which are used for treatment of chronic hepatitis C (CHC), on insulin resistance and metabolic factors. Materials and methods A total of 104 CHC patients aged 20–75 years with available serum insulin data at 0 and 48 weeks, and hepatitis C virus (HCV)-RNA data at 0, 12, 24, 48 and 72 weeks were included in the study. All clinical para-meters were assessed according to the therapy response. Results Among 104 patients, sustained virologic response (SVR) was achieved in 55 cases. A statistically significant difference was noted between SVR and non-SVR groups regarding γ-glutamyltranspeptidase (GGT), insulin level plus homeostasis model assessment (HOMA) score and insulin resistance at week 48, log HCV-RNA and stage of fibrosis. Conclusion Insulin resistance is accepted to have a negative effect on SVR. Insulin resistance may improve once SVR is achieved. Presence of IR at week 48 has been found associated with SVR. In this context, it can be advocated that insulin resistance at week 48 may be a predictive factor for prediction of SVR at week 72.

Background and aim: Vitamin D deficiency and oxidative stress were suggested to be related to prostate cancer risk. We aimed to investigate the association of serum PSA concentration with vitamin D...

Acromegaly is a rare disorder existed in the result of overproduction of growth hormone (GH). The disorder is associated with increased cardiovascular risk factors and metabolic abnormalities. Urotensin II (UII), a secreted vasoactive peptide hormone, belonging somatostatin superfamily, plays an essential role in atherosclerosis and glucose metabolism. The aim of this study was to ascertain whether circulating UII levels are altered in subjects with acromegaly, and to describe the relationship between UII and hormonal or cardiometabolic parameters. This cross-sectional study included 41 subjects with active acromegaly, 28 subjects with controlled acromegaly, and 37 age- and BMI-matched controls without acromegaly. Hormonal and metabolic features of the subjects as well as carotid intima media thickness (cIMT) and epicardial fat thickness (EFT) were defined. Circulation of UII levels was determined via ELISA. Both active and controlled acromegalic subjects showed a significant elevation of circulating levels of UII with respect to controls. There was no remarkable difference in circulating levels of UII between active and controlled acromegalic groups. Both cIMT and EFT were remarkably increased in acromegaly subjects comparing to controls. UII positively correlated with cIMT, EFT, BMI, and HOMA-IR. There was no correlation between UII and GH, insulin-like growth factor-1. According to the results obtained from regression models, UII levels independently predicted cIMT and EFT. Elevated UII levels are associated with severity of cardiovascular risk factors including cIMT and EFT in acromegalic subjects.

Serum procalcitonin (PCT) and C-reactive protein (CRP) are markers of systemic inflammation and bacterial infection. We aimed to compare the usefulness of procalcitonin and CRP in patients with community-acquired pneumonia and exacerbations of chronic obstructive pulmonary disease (COPD).A total of 116 consecutive patients were included in the study: 76 with chronic obstructive pulmonary disease in group 1, and 40 with pneumonia in group 2.Median serum CRP level was 44 mg/L in the COPD group and 132 mg/L in the pneumonia group. Median value of serum PCT was found to be 0.07 in the COPD group and 0.14 ng/mL in the pneumonia group. Serum PCT and CRP levels were significantly higher in the pneumonia group compared to the COPD group (p0.001). The area under the ROC curve was 0.788 (CI: 0.704-0.872) for CRP and 0.699 (CI: 0.599-0.800) for procalcitonin to identify pneumonia.Procalcitonin and CRP levels were significantly higher in patients with community-acquired pneumonia presenting to the emergency department with indications for hospitalization than in patients with exacerbations of chronic obstructive pulmonary disease. Serum CRP and procalcitonin concentrations were strongly correlated. CRP might be a more valuable marker in these patients with lower respiratory tract infections.Serumski prokalcitonin (PCT) i C-reaktivni protein (CRP) markeri su sistemske inflamacije i bakterijske infekcije. Naš cilj bio je da se uporedi korisnost prokalcitonina i CRP-a kod pacijenata sa vanbolničkom pneumonijom i pogoršanjima hronične opstruktivne bolesti pluća (HOBP).Ukupno 116 uzastopnih pacijenata je uključeno u ovu studiju: 76 sa hroničnom opstruktivnom bolešću pluća u grupi 1 i 40 sa pneumonijom u grupi 2.Srednji nivo CRP-a u serumu bio je 44 mg/L u grupi sa HOBP i 132 mg/L u grupi sa pneumonijom. Srednja vrednost PCT-a u serumu bila je 0,07 u grupi HOBP i 0,14 ng/mL u grupi sa pneumonijom. Nivo PCT-a i CRP-a u serumu bio je značajno viši u grupi sa pneumonijom u poređenju s grupom sa HOBP (p0,001). Oblast ispod ROC krive bila je 0,788 (CI: 0,704–0,872) za CRP i 0,699 (CI: 0,599–0,800) za prokalcitonin za identifikovanje pneumonije.Nivoi prokalcitonina i CRP-a bili su značajno povišeni kod pacijenata sa vanbolničkom pneumonijom koji su se javili odeljenju hitne sluzbe i imali indikacije za hospitalizaciju nego kod pacijenata sa pogoršanjem hronične opstruktivne bolesti pluća. Koncentracije CRP-a i prokalcitonina u serumu bile su u jakoj korelaciji. CRP bi mogao imati veću vrednost kao marker kod ovih pacijenata sa infekcijama nižeg respiratornog trakta.

Background Cardiovascular events such as myocardial infarction and stroke are frequent comorbidities in rheumatic diseases [1]. In relation, components of the metabolic syndrome (MS) including insulin resistance (IR), central obesity, high blood pressure, high triglycerides, and low high-density lipoprotein (HDL) are related to a high rate of endothelial dysfunction and atherosclerosis in patients with RA [2]. Objectives We aimed to investigate the relationship between disease activity and insulin resistance (IR) and the levels of adipocytokines in non-diabetic patients with newly diagnosed rheumatoid arthritis (RA) who are naive to disease modifying anti-rheumatic drugs (DMARDs). Methods Forty-seven DMARD-naive patients with RA and 25 age-, gender-, and BMI-matched controls were included. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), 28-joint-count disease activity score (DAS28), serum lipids, glucose, HbA1c, insulin, leptin, resistin, visfatin, and RBP4 levels were measured. Homeostasis model assessment for insulin resistance (HOMA-IR) was calculated. Patients were studied before and 3 months after treatment with DMARDs. Results Levels of adipokines were similar in patients with RA and controls (p > 0.05 for all). However, RA patients with active disease (DAS28 > 3.2) had numerically higher levels of leptin (9.3 (3.7-17.4) vs. 7.6 (3.7-11.0), p = 0.289), insulin (8.0 (5.2-12.7) vs. 5.9 (4.2-8.7), p = 0.285), and HOMA-IR (1.9 (1.1-3.0) vs. 1.3 (1.0-1.9), p = 0.209). DAS28 was correlated with HOMA-IR (r = 0.356, p = 0.016), insulin (r = 0.323, p = 0.02), and leptin (r = 0.399, p = 0.005) in the study group (Figure-1). Regardless of the type of treatment modality, leptin levels (7.4 (4.4-13.4) vs. 6.4 (3.3-11.6, p = 0.047) decreased significantly after treatment, as did insulin levels (6.9 (4.9-12.5) vs. 5.9 (4.1- 8.8), p =0.01) and HOMA-IR score (1.7 (1.1-2.7) vs. 1.3 (1.0-2.0), p= 0.012). The reduction in leptin was more prominent in patients with active disease (9.3 (3.7-17.4) vs. 6.9 (3.1-11.4), p = 0.028). The reduction in ESR was correlated with ΔHOMA-IR (r = 0.308, p = 0.039), and CRP reduction was correlated with Δresistin (r = 0.288, p = 0.049) and ΔRBP4 (r = 0.456, p = 0.001). Conclusion Disease activity is associated with IR and correlates with circulating levels of adipokines in patients with RA. Treatment with DMARDs reduces leptin and improves IR. References [1] Maradit-Kremers H, Crowson CS, Nicola PJ, Ballman KV, Roger VL, Jacobsen SJ et al. Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis: a population-based cohort study. Arthritis Rheum.2005; 52:402–11. [2] Burggraaf B, van Breukelen-van der Stoep DF, de Vries MA, Klop B, van Zeben J, van de Geijn GM et al. Progression of subclinical atherosclerosis in subjects with rheumatoid arthritis and the metabolic syndrome Atherosclerosis. 2018; 271:84-91. Disclosure of Interests None declared

Highlights • COVID-19 is more severe in older patients. • Hypertension is the most frequent comorbidity in severe and non-severe COVID-19 cases. • Cough is the prominent clinical symptom in severe and non-severe COVID-19 cases. • Detection of severe and critical COVID-19 cases at an earlier stage is crucial. • CAR is a useful marker in early differentiation of severity in COVID-19 patients., C-reactive protein-to-albumin ratio (CAR) has been used as an indicator of prognosis in various diseases. Here, we intended to assess the CAR’s diagnostic power in early differentiation of hospitalized severe COVID-19 cases. In this retrospectively designed study, we evaluated 197 patients in total. They were divided into two groups based on their severity of COVID-19 as non-severe (n = 113) and severe (n = 84). The comparison of groups’ demographic data, comorbidities, clinical symptoms, and laboratory test results were done. Laboratory data of the patients within the first 24 h after admission to the hospital were evaluated. The calculation of receiver operating characteristic (ROC) curve was used to determine the diagnostic power of CAR in differentiating severity of COVID-19. Independent risk factors predictive of COVID-19 severity were determined by using logistic regression analysis. Although lymphocyte count levels were lower, severe COVID-19 patients had higher mean age, higher levels of neutrophil count, CRP, aspartate aminotransferase (AST), ferritin, and prothrombin time (P

Introduction: Irisin, a recently identified myokine, is associated with increased energy expenditure and has a potential role in obesity. Therefore, we investigated circulating irisin levels in morbidly obese patients undergoing sleeve gastrectomy (SG). Material and methods: Thirty morbidly obese patients undergoing SG and 30 healthy subjects were included. All participants were evaluated at baseline and again at three months post-SG. Body weight and height, the lipid profile, and plasma glucose, HbA1c, insulin, and irisin levels were measured at each visit. Results: The two groups had similar mean age and sex distribution. Serum irisin was significantly lower in the morbidly obese subjects compared with the controls (p = 0.003) and negatively correlated with BMI, body weight, insulin levels, and HOMA-IR (p = 0.006, p = 0.011, p = 0.046, p = 0.048, respectively). When the morbidly obese patients were re-evaluated three months post-SG, their weight and BMI had significantly decreased (both p = 0.001). Similarly, the insulin, HbA1c, HDL-cholesterol, and HOMA-IR values significantly decreased (p = 0.001, p = 0.028, p = 0.006, and p = 0.001, respectively). However, irisin levels remained unchanged (p = 0,267). Conclusion: Although the irisin levels were significantly lower in the morbidly obese subjects, they did not change after SG-induced weight loss. (Endokrynol Pol 2016; 67 (5): 481–486)

Aim: Inducing beta cell replication is a potential therapeutic approach for the treatment of diabetes mellitus. Recently betatrophin was suggested as a novel stimulator of beta cell proliferation in mice but its role in humans remains to be established. We aimed to investigate betatrophin concentration and its association with metabolic parameters in a group of individuals with normal glucose tolerance, pre-diabetes and diabetes mellitus who had not been previously treated. Methods: A total of 72 subjects were recruited for this cross sectional study: 23 subjects with normal glucose tolerance (NGT), 22 subjects with prediabetes, and 27 subjects with diabetes mellitus (DM). Circulating betatrophin concentration, 75 g oral glucose tolerance test, fasting insulin, glycosylated hemoglobin, 25hydroxy vitamin D and HOMA IR were measured. Results: The difference in betatrophin values did not reach statistical significance between the 3 groups [NGT:206 (176–297)pg/mL, Prediabetes:232 (181–254)pg/mL, DM:245 (205–526)pg/mL, p=0.078]. Betatrophin was negatively significantly correlated with BMI and positively significantly correlated with 25(OH)vitD (p=0.043 and p=0.001 respectively). Multivariate linear regression showed that 25(OH) vitD (β=0.440 p=0.001) and fasting glucose (β=0.003 p=0.038) were variables associated with betatrophin concentration (R2=0.251). Conclusions: In a group of subjects ranging from those with normal glucose tolerance to newly diagnosed diabetes, we found that 25(OH)D and fasting glucose were factors associated with serum betatrophin concentration.

Objective Mean platelet volume (MPV) and platelet function analysis have been studied before in acromegaly, but the effect of treatment on both parameters has not been evaluated. We aimed to investigate MPV and platelet function analysis in acromegalic patients after six-months of treatment. Methods Forty patients with active acromegaly and 36 healthy subjects were included in the study. Plasma glucose and lipids, fibrinogen, GH, IGF-1 levels, MPV and platelet function analysis were measured. All patients with acromegaly were re-evaluated six months after treatment. Results Fasting blood glucose (FBG), GH, IGF-1, fibrinogen levels and MPV values were significantly higher in acromegalic group compared with the control. Platelet function was enhanced significantly (pcol-ADP: 0.002, pcolepinephrine: 0.002). After 6 months of treatment FBG, serum GH, IGF-1, fibrinogen and MPV decreased and collagen/ADP- and collagen/epinephrine-closure times (CT) were increased. Acromegalic patients that were in remission with long-acting SSA after surgery had significantly higher fibrinogen levels and MPV and decreased collagen/epinephrine-CT with respect to the controls (pfibrinogen: 0.001, pMPV: 0.026, pcol-epinephrine: 0.037). Conclusion Acromegaly was associated with increased MPV and enhanced platelet activity. Although growth hormone hypersecretion was controlled by surgery and medical treatment, these parameters did not improve - indicating a still increased risk for cardiovascular events.

Objective: In this study, we aimed to evaluate serum irisin and apelin levels in patients with subclinical hypothyroidism (SCH) when they were subclinical hypothyroid and become euthyroid after levothyroxine therapy and association of these adipokines with markers of atherosclerosis such as serum homocysteine levels and carotid intima-media thickness (IMT). Subjects and methods: The study included 160 patients with newly diagnosed subclinical hypothyroidism due to Hashimoto's thyroiditis and 86 euthyroid healty subjects. Serum glucose and lipid profile, insulin, HOMA, TSH, free T3, free T4, anti-thyroperoxidase and anti-thyroglobulin antibodies, homocysteine, apelin and irisin levels were measured in all study subjects. Thyroid and carotid ultrasound examinations were performed. The subclinical hypothyroid group was reevaluated after 12-weeks of levothyroxine therapy when they became euthyroid. Results: Clinical characteristics of the patient and control group were similar. Glucose, insulin and HOMA levels, lipid parameters and free T3 were similar between the two groups.. Serum homocystein was higher and apelin was lower in patients with SCH, but irisin levels were similar between the two groups. While thyroid volume was lower, carotid IMT was significantly greater in patients with SCH (pCarotidIMT:0,01). After 12-weeks of levothyroxine therapy, all the studied parameters remained unchanged except, serum freeT4, TSH, homocystein and apelin. While homocystein decreased (p: 0,001), apelin increased significantly (p = 0,049). In multivariate analysis, low apelin levels significantly contributed to carotid IMT (p = 0,041). Conclusions: Apelin-APJ system may play a role in vascular and cardiac dysfunction in patients with SCH and treatment of this condition may improve the risk of cardiovascular disease.

Objective: Non-alcoholic fatty liver disease (NAFLD) is affecting people worldwide with increasing prevalence. Non-invasive tests are required for both diagnosis and staging of the disease. We aimed to evaluate diagnostic accuracy of routine liver enzymes and cytokines in NAFLD. Methods: A total of 88 cases, aged between 20 and 62 years, were included in the study. Serum ALT, AST, GGT, triglyceride, TNF-alpha, IL-6 and IL-8 were measured in 40 patients with NAFLD and in 48 healthy control patients with similar BMI and demographic characteristics. Diagnostic performances of serum biomarkers for diagnosis of NAFLD were evaluated with ROC analysis. Results: ALT and AST showed good diagnostic performance in predicting patients with NAFLD in the overall group (AUC=0.817; 95% CI[0.721-0.913], AUC=0.815; 95% CI[0.718-0.911] respectively) but in obese subjects ALT and AST showed poor performance (AUC=0.659; 95% CI[0.478-0.841], AUC=0.680; 95% CI[0.498-0.861] respectively). Among cytokines TNF-alpha showed best performance in the diagnosis of NAFLD in both overall group and obese subjects (AUC=0.892; 95% CI[0.824- 0.959], AUC=0.858; 95% CI[0.739-0.977] respectively). The optimal cut off value for TNF-alpha was 10.65pg/ml with a sensitivity of 75% and a specificity of 93% in the overall group. IL-6 and IL-8 showed poor performance. Conclusion: TNF-alpha may be a good parameter for predicting patients with NAFLD. J Clin Exp Invest 2015; 6 (1): 16-20 Key words: TNF-alpha, IL-8, IL 6, non-alcoholic fatty liver disease

Background As plasma is the recommended sample type for Roche adrenocorticotropic hormone (ACTH) assay, we evaluated the effect of EDTA concentration on Cobas ACTH assay. Methods Samples containing twofold and fourfold higher concentrations of EDTA were prepared by adding plasma to empty K2EDTA tubes and by making under-filled EDTA tubes. All measurements were performed with four replicates. Results Increased EDTA concentration resulted in a significant decrease in ACTH concentration. Fifty-per cent-filled EDTA tube showed 19% decrease in ACTH concentration and 25% filled EDTA tube showed 50% decrease in ACTH concentration. Conclusion We recommend that inadequately filled EDTA specimens should be rejected when using Cobas ACTH assay.

The incidence of heart failure (HF) has reached epidemic levels in western populations, and the majority of these patients are admitted to hospitals through the emergency department (ED). We aimed to aid clinicians assessing natriuretic peptide (NP) levels in cases with suspected HF. In this study, we investigated the effect of anemia on amino-terminal pro-BNP (NT-proBNP) and on B-type natriuretic peptide (BNP) levels.This retrospective study examined patients who were admitted to the ED with suspected HF. After admission, the treating physician requested complete blood count and creatinine tests with NT-proBNP (n=2.637) or BNP (n=11.159). The exclusion criteria were used to minimize the factors that could affect the NT-proBNP and BNP results. We examined the data using the Mann-Whitney U test, Chi-square test, Spearman correlation test, and multivariate linear regression analyses.The NT-proBNP and BNP levels were statistically higher in the groups with anemia (p=0.016 and p=0.009, respectively). There was a statistically significant negative correlation between hemoglobin and NP levels (r=-0.272, p0.001 for NT-proBNP and r=-0.179, p0.001 for BNP). The results indicated that advanced age and low hemoglobin levels were significantly associated with the increase in NT-proBNP (p=0.024 and p=0.004, respectively). Advanced age, low hemoglobin and low GFR-MDRD levels were significantly associated with the increase in BNP (p0.001, p=0.002 and p=0.013, respectively).The data suggest that clinicians examining patients admitted to the ED with suspected HF should consider that anemia could lead to increases in NT-proBNP and BNP levels.

Introduction:Determining the factors affecting hemoglobin AMethods:We retrospectively analyzed serum fasting glucose, fasting insulin, 2 h glucose and HbAResults:Insulin resistant subjects with normal glucose tolerance had significantly higher HbAConclusion:Our data showed that HOMA-IR is associated with glycated hemoglobin values independent of glycemic status and the effect of age on HbA

OBJECTIVE Preexisting renal failure diminishes the excretion of N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP), therefore limits the diagnostic value of this peptide for concomitant heart failure. The aim of this study was to evaluate the association between NT-proBNP and the stages of renal dysfunction in a typical population attended to emergency department with acute dyspnea. METHODS In this cross-sectional study, all consecutive patients with acute dyspnea underwent clinical evaluation, laboratory assessment of NT-proBNP, and echocardiographic examinations. Among subjects, 54.5% were diagnosed as heart failure. Grouping variables according to renal function capacity and ejection fraction, independent variables were compared with Kruskal-Wallis or ANOVA with posthoc tests. Correlation and linear regression analysis were done to analyze the variables associated with NT-proBNP. The diagnostic performance of NT-proBNP was evaluated by receiver-operating characteristic (ROC) curve. RESULTS Serum median NT-proBNP level in patients with severe renal impairment was significantly higher than moderate and mildly decreased renal functions (p=0.001). In patients with moderate and severe left ventricular failure, NT-proBNP was significantly higher compared with normal subjects (LVEF>50%) (p=0.040, and 0.017, respectively). Renal dysfunction was associated in 56% of patients with heart failure. The area under the ROC curve of NT-proBNP for identifying left ventricular failure in patients with renal failure (eGFR

Objective: In our study we aimed to examine serum homocysteinelevels of patients without thyroid dysfunctionswho have high serum anti thyroid peroxidase (anti-TPO)levels and patients with subclinical hypothyroidism whohave high serum thyroid stimulating hormone (TSH) andanti-TPO levels.Methods: One hundred and seven premenopause femaleoutpatients who referred to endocrine clinic of our hospitalwere included in our study. We generated 3 groups. Firstgroup (Control) consists of 53 (50%) patients between theages of 30-40 years. Second group (Euthyroid) consistsof 31 (29%) patients between the ages of 26-49. Thirdgroup (Subclinical Hypothyroidism) consists of 23 (21%)patients between the ages of 33-53 years. Serum totalcholesterol, triglycerides, high density lipoprotein (HDL)levels were measured by Olympus 2700 autoanalyzer.Serum TSH, free T4, anti-TPO and homocysteine levelswere measured by Siemens Immulite 2000 autoanalyzer.Results: In our study, total cholesterol, triglycerides, lowdensity lipoprotein (LDL) and very low density lipoprotein(VLDL) levels were not statistically significantly differentamong the groups. Although serum homocysteine levelsof the third group were higher than the other groups it wasnot statistically significantly different among the groups.Conclusion: Serum homocysteine and lipid levels of patientswith euthyroidism and subclinical hypothyroidismwho have positive anti-TPO levels may be inadequate inassessing the risk of cardiovascular diseases. J Clin ExpInvest 2013; 4 (3): 293-297Key words: Hypothyroidsm, homocysteine, premenopause

Objective The main objective of this study was to determine a cutoff level of plasma N-terminal pro–B-type natriuretic peptide (NT-proBNP) that could successfully predict the short- and long-term prognosis of patients with acute heart failure at the time of admission to the emergency department. The results of our study are presented in context with previously published literature. We believe that the present study will be useful and salutary for the progress of literature. Methods N-terminal pro–B-type natriuretic peptide plasma levels were obtained from 100 patients with shortness of breath and left ventricular dysfunction upon admission to the emergency department. All patients underwent follow-up evaluations 30 days and 1 year after admission. The end point was defined as all-cause mortality. Results The mean age of the patients in this study was 70.8 ± 11.6 years, and 51% were female. All-cause mortality at the 30-day and 1-year follow-up evaluations was 21.2% and 53.5%, respectively. We determined that the optimal NT-proBNP cutoff point for predicting 30-day mortality at the time of admission was 9152.4 pg/mL, with a 71.4% sensitivity and an 81.3% specificity (95% confidence interval, area under the curve: 0.726; P = .002). The optimal NT-proBNP cutoff point for predicting 1-year mortality at the time of admission was 3630.5 pg/mL, with an 83.0% sensitivity and a 52.2% specificity (95% confidence interval, area under the curve: 0.644; P = .014). Conclusion Elevated NT-proBNP levels at the time of admission are a strong and independent predictor of all-cause mortality in patients with acute heart failure at 30 days and 1 year after admission. Furthermore, the optimal cutoff level of NT-proBNP used to predict 30-day and 1-year mortality had high sensitivity.

To investigate the relation between serum homocysteine levels and intraventricular hemorrhage (IVH) in preterm infants born to preeclamptic mothers.This study included 84 preterm infants (42 born to preeclamptic mothers and 42 born to normotensive healthy mothers) who were admitted to Izmir Tepecik Training and Research Hospital Neonatology Clinic on the postnatal first day. The measurement of homocysteine levels in all samples were performed with an Immulite 2000 analyzer, using the chemiluminescence method. Cranial ultrasounds were performed on the fourth day and in the 1 month of age.The mean plasma levels of homocysteine in infants born to preeclamptic mothers and in the control group were 8.2 ± 5.9 μmol/L and 5.3 ± 2.7 μmol/L, respectively. The plasma levels of homocysteine were significantly higher in the study group (p = 0.006). There was no association between the plasma homocysteine levels and IVH or other neonatal complications including necrotizing enterocolitis, retinopathy of prematurity, bronchopulmonary dysplasia and mortality.Our data suggest that plasma levels of homocysteine are higher among infants born to preeclamptic mothers, but these high levels are not associated with IVH and other neonatal complications in preterm infants.

Objective: To investigate the effect of temperature and protease inhibitor on adrenocorticotrophin (ACTH) stability. Methods: We collected blood specimens from 10 donors into K3 EDTA (ethylenediaminetetraacetic acid) and K3 EDTA + aprotinin tubes. Plasma specimens were held at room temperature and at 2 °C to 8 ° C for 0, 2, 4, 8, 24, and 72 hours. ACTH concentrations in 4 storage conditions were compared with repeated-measures analysis of variance (ANOVA) at each time point. Results : ACTH concentrations substantially decreased after a 72-hour time period. At the 72nd hour, standard EDTA tubes and EDTA + aprotinin tubes stored at 4 ° C showed the optimal stability. EDTA + aprotinin tubes stored at room temperature performed more strongly than standard EDTA tubes stored at room temperature. Conclusion: Our results show that refrigerated storage is more effective than protease inhibitor addition to maintain ACTH stability. We recommend using aprotinin tubes, especially for specimens standing at room temperature. * Abbreviations : ACTH : adrenocorticotrophin EDTA : ethylenediaminetetraacetic acid CV : coefficient of variance ANOVA : analysis of variance

To investigate the frequencies of vitamin B12 and folate deficiencies in pregnant women in low socioeconomic group, the relation between the animal-source foods consumption and maternal vitamin B12-folate statuses, and their impacts on anthropometric measurements of the infants.A total of 208 pregnant women in the last trimester were included in the study. A questionnaire about socio-demographic status, consumption of meat, egg, milk-dairy products, multivitamin supplementation was used. Vitamin B(12) and folate concentrations were studied by chemiluminescence method. The babies of Vitamin B(12) deficient mothers were evaluated after birth.The rate of vitamin B(12) deficiency was 47.6% and folate deficiency was 17.3% of pregnant women. Animal food consumption was inadequate about half of pregnant women and vitamin B(12) levels in these women were significantly low. There were no statistically significant relationships between the birth weight, birth length and head circumference measurements, and maternal vitamin B(12) and folate concentrations.The rate of vitamin B12 deficiency in pregnant women in low socioeconomic population is high. Although there were no significant effects of the vitamin B12 and folate deficiencies on birth size, additional studies are required to elucidate the subsequent effects.

Objective: Insulin- like growth factor-1 (IGF-1) regulates a number of cellular functions such as prolifera - tion and differentiation. On the other hand, insulin-like growth factor binding protein-3 (IGFBP-3) is a putative tumor suppressor and inhibits the proliferative activity of IGF-I. Therefore most studies report that IGF-I and IGFBP-3 may promote and inhibit tumor growth, respectively. In this study we aimed to evaluate the importance of IGF-1 and IGFBP- 3 in advanced stage non-small cell lung cancer (NSCLC) and to find out whether they contribute to clinical evaluations. Material and Methods: We measured the pretreatment serum levels of IGF-1 and IGFBP-3 in 80 men between July 2007 and June 2008 by chemiluminescent immunometric assay. Serum samples were obtained from 50 patients with in - operable advanced stage NSCLC at Dr. Suat Seren Pulmonary Diseases Hospital and 30 healthy controls at Izmir Tepecik Research Hospital. All 80 men had a smoking history of minimum 20 pack/years. Results: Contrary to the results of many reports, the serum IGF-1 levels were lower in the patients and the difference between the groups reached a sta - tistical significance (p=0.025). IGF-1/IGFBP-3 ratio was also significantly lower in lung cancer patients (p=0.016). The histological subtype of tumor was correlated with IGF-1 level (p=0.005). Conclusion: Our result showed that serum level of IGF-I/IGFBPs may be useful markers for diagnosing and identifying tumor subtypes in NSCLC. In addition, IGF- 1 and IGFBP-3 levels in serum might serve a clinical significance in patients with advanced stage NSCLC. However, fur - ther studies comprising more cases are needed to investigate the clinical significance of IGF-1 and IGFBP-3 in NSCLC.

Objective: In our study, we intended to examine the effects of vitamin D levels of pregnant women on the baby during winter months. Materials and Methods: Study population consisted of 250 healthy pregnant women who have completed 37 weeks of gestation. Venous blood samples were drawn from pregnant women prenatally in the labor room and from babies on the umbilical cord during the delivery. 25(OH)D levels of samples were measured by chemiluminescent immunoassay on Diasorin Liaison autoanalyzer. Results: While the mean of vitamin D levels in mothers was 11.5±5.9 ng/mL, this value was found as 10.9±5.9 in cord blood. Vitamin D levels of mothers and umbilical cords were found to be correlated (r=0.548, p

Although Turkey is located in a sunny region, vitamin D deficiency is still a serious health problem in pregnant women and their infants, especially among the low socio-economic status Turkish population. This study was carried out in order to measure serum 25-hydroxyvitamin D3 [25(OH)D] concentrations of the pregnant women in the last trimester and in their neonates at delivery and to determine the factors associated with maternal serum 25(OH)D concentrations. Among the patients visiting the Ege Obstetrics and Gynecology Hospital in the period March to May 2008, 258 healthy pregnant women ≥37 weeks of gestation were included in this study. The information on different characteristics such as the number of pregnancies and births, nutritional status, vitamin and mineral support during gestation, educational status, clothing style and the economic level of the family was collected from women. Blood samples from the mothers and umbilical cord of the newborns were taken to measure 25(OH)D. The mean 25(OH)D concentrations of the mothers and their infants were 11.5 ± 5.4 ng/mL and 11.5 ± 6.8 ng/mL, respectively. We found a strong positive correlation between maternal serum and umbilical cord blood 25(OH)D concentrations (r = 0.651, P < 0.001). The concentration of 25(OH)D was ≤20 ng/mL in 233 mothers (90.3%) and ≤10 ng/mL in 130 mothers (50.4%). Maternal serum 25(OH)D concentrations related strongly to factors such as uncovered dressing style, sufficient consumption of dairy products and multivitamin use during gestation (P < 0.05). About half (52.7%) of these women had a covered dressing style. 25(OH)D concentrations of these covered dressing mothers and their infants were 9.7 ± 5.1 ng/mL and 9.7 ± 5.6 ng/mL, respectively, which were significantly lower compared with those of uncovered mothers and their babies (P < 0.001). This study showed that, despite a sunny environment, vitamin D deficiency and insufficiency are highly prevalent among the mothers and their neonates. This is generally due to the life style and nutritional status of the mothers. These findings suggest that much more effective vitamin D prophylaxis programmes should be implemented for pregnant women as well as for their babies.

Das familiare Mittelmeerfieber („familial mediterranean fever“, FMF) ist eine autosomal-rezessive autoinflammatorische Erkrankung, bei der es zu rezidivierenden, selbstlimitierenden Phasen mit Fieber und Serositis kommt und die in Mittelmeerregionen haufig vorkommt. Wir untersuchten retrospektiv die Verteilung der MEFV-Genmutation bei 833 Einwohnern der Agaisregion mit der vorlaufigen Diagnose FMF, die in den Jahren 2006 bis 2009 an das Labor fur Typisierung und Molekulardiagnostik am Tepecik Research and Education Hospital (Izmir, Turkei) uberwiesen worden waren. Um die 12 haufigsten MEFV-Mutationen bei FMF-Patienten zu bestimmen, wurde der FMF-Strip-Assay® (ViennaLab Diagnostics, Wien, Osterreich) verwendet. Die Allelfrequenzen der Hauptmutationen in den mutationspositiven Gruppen, einschlieslich M694V, E148Q, M680I(G>C) und V726A, waren 48,4, 16,5, 13,5 bzw. 9,7%. Die M694V-Mutation erwies sich als die am haufigsten auftretende Mutation bei FMF-Patienten aus der Agaisregion. Dies stimmt uberein mit Mutationsstudien aus anderen Regionen in der Turkei und an unterschiedlichen ethnischen Kollektiven.