A study of association of serum ferritin as a prognostic marker in acute cerebrovascular accident

Cerebrovascular disease (CVD) is the third leading cause of death in developed countries and is now emerging as the commonest preventable life-threatening neurological problem worldwide. It makes an important contribution to morbidity and mortality in developed as well as developing countries. The prognosis of acute stroke is determined by a series of factors some of which may be used in the early stages of stroke to predict prognosis and mortality. However, the role of inflammatory markers in predicting functional outcome in stroke remains controversial, Iron and ferritin are known to have an important role in stroke as well as in other disorders. Serum ferritin which is considered as an acute phase reactant has also been used for assessing the severity and prognosis of stroke. Therefore, testing of serum ferritin is useful in identifying high risk patients.1: To study the effect of level of serum ferritin with early neurological deterioration and the outcome in patients of acute stroke. 2: Association of serum ferritin in ischemic and haemorrhagic stroke.50 patients with acute stroke were selected based on inclusion and exclusion criteria. Appropriate questionnaire was used to collect the data of patients. Diagnosis of stroke was confirmed by CT or MRI scan of brain and examination was done by Canadian stroke scale at the time of admission. About 5ml of venous blood Sample from cubital vein was collected for measuring serum ferritin levels, it was performed within 48hrs of onset of symptoms by using CLIA method. Neurological assessment was repeated on the day of discharge to assess the clinical improvement and prognosis of the stroke patients.Totally 50 patients of acute stroke were included in our study, majority of the patients are males 35 (70%), and females are 15(30%). Approximately 36% were in the age group of 51-60 years. In this study ischemic stroke was seen in 45 (90%) of the patients and 5 (10%) had hemorrhagic stroke. The serum ferritin levels are normal in 41(82%) and high in 9(18%) of the patients. Canadian stroke scale interpretation on the day of discharge showed 20% of the patient are deteriorated, 66% are in the same status and 14% of the patients are improved clinically. The patients with haemorrhagic stroke had high serum ferritin level 60.0% and ischemic stroke are 13.3%. Those patients with high serum ferritin levels had higher deterioration in Canadian stroke scale (p<0.001). The mean serum ferritin levels are higher in deteriorated patients 199.29% when compared to other status group in Canadian stroke scale.High levels of serum ferritin correlates well with early neurological deterioration of stroke patients. Based on this study finding, that high serum ferritin level within 48 hours after the onset of symptoms of stroke helps to predict the early prognosis. Therefore, testing of serum ferritin is useful in identifying high risk patients.

Dietary Intake and Status of Vitamin B12 in Slovenian Population

Vitamin B12 deficiency poses a health concern, especially in vulnerable populations. Dietary vitamin B12 intake was obtained by two 24 h dietary recalls and food propensity questionnaires in a representative Slovenian cross-sectional food consumption survey, SI.Menu (n = 1248 subjects; 10–74 years). For a subgroup of 280 participants, data on serum vitamin B12 were available through the Nutrihealth study. The estimated usual population-weighted mean daily vitamin B12 intakes were 6.2 µg (adults), 5.4. µg (adolescents), and 5.0 µg (elderly). Lower intakes were observed in females. Inadequate daily vitamin B12 intake (<4 µg) was detected in 37.3% of adolescents, 31.7% of adults, and 58.3% elderlies. The significant predictors for inadequate daily vitamin B12 intake were physical activity score in all age groups, sex in adolescents and adults, financial status and smoking in elderly, and employment in adults. Meat (products), followed by milk (products), made the highest vitamin B12 contribution in all age groups. In adolescents, another important vitamin B12 contributor was cereals. The mean population-weighted serum vitamin B12 levels were 322.1 pmol/L (adults) and 287.3 pmol/L (elderly). Low serum vitamin B12 concentration (<148 nmol/L) and high serum homocysteine (>15 µmol/L) were used as criteria for vitamin B12 deficiency. The highest deficiency prevalence was found in elderlies (7.0%), particularly in males (7.9%). Factors associated with high serum homocysteine were also investigated. In conclusion, although vitamin B12 status was generally not critical, additional attention should be focused particularly to the elderly.

High serum levels of CML are associated with poor coronary collateralization in type 2 diabetic patients with chronic total occlusion of coronary artery

Background: The formation of advanced glycation end-products (AGEs) is a crucial risk factor for the pathogenesis of cardiovascular diseases. We investigated whether N-e-carboxy-methyl-lysine (CML), a major form of AGEs in vivo, was associated with poor coronary collateral vessel (CCV) formation in patients with type 2 diabetes mellitus (T2DM) and chronic total occlusion (CTO) of coronary artery.Methods: This study consisted of 242 T2DM patients with angiographically documented CTO. Blood samples were obtained and demographic/clinical characteristics were documented. The collateralization of these patients was defined according to Rentrop score. Receiver operating characteristic (ROC) curve and multivariable regression analysis were performed.Results: 242 patients were categorized into poor CCV group (Rentrop score 0 and 1)(n = 107) and good CCV group (Rentrop score 2 and 3)(n = 135). Serum CML levels were significantly higher in poor CCV group (110.0 ± 83.35 ng/ml) than in good CCV group (62.95 ± 58.83 ng/ml, P<0.001). Moreover, these CML levels were also significantly different across the Rentrop score 0, 1, 2 and 3 groups (P <0.001). In ROC curve for ascertaining poor CCV, AUCs were 0.70 (95% CI 0.64-0.77) for CML. In multivariable logistic regression, CML levels (P<0.001) remained independent determinants of poor CCV after adjustment of traditional risk factors. Conclusions: This study suggests that higher CML levels are associated to poor CCV in T2DM patients with CTO. Inhibition of AGEs including CML is a strategy in antagonizing poor CCV in diabetic patients.

Association of High Serum Adiponectin Level With Adverse Cardiovascular Outcomes and Progression of Coronary Artery Calcification in Patients With Pre-dialysis Chronic Kidney Disease

Background: Serum adiponectin level predicts cardiovascular (CV) outcomes and progression of coronary artery calcification (CAC) in the general population, although the association has not been validated in patients with chronic kidney disease (CKD). In this study, we investigated the association of high serum adiponectin level with the risk of adverse CV outcomes and progression of CAC in patients with pre-dialysis CKD.Methods: A total of 1,127 patients with pre-dialysis CKD from a nationwide prospective cohort of patients with pre-dialysis CKD in Korea were divided into the tertile by serum adiponectin level at the baseline. CV outcome of interest was fatal and non-fatal CV events and all-cause mortality. Progression of CAC was defined as coronary artery calcium score (CACS) change more than 200 during a 4-year follow-up.Results: Cox regression analysis revealed that high serum adiponectin is associated with increased risk of fatal and non-fatal CV events (adjusted hazard ratio 2.799, 95% CI 1.348–5.811). In contrast, high serum adiponectin level was not significantly associated with all-cause mortality (adjusted hazard ratio 0.655, 95% CI 0.203–2.113). Binary logistic regression analysis revealed that high serum adiponectin level is also associated with increased risk of progression of CAC (adjusted odds ratio [OR] 2.078, 95% CI 1.014–4.260). Subgroup analyses demonstrated that the association of high serum adiponectin with increased risk of fatal and non-fatal CV events is not modified by age, gender, history of diabetes, estimated glomerular filtration rate (eGFR), or spot urine albumin-to-creatinine ratio (ACR).Conclusions: High serum adiponectin level is associated with adverse CV outcomes and progression of CAC in patients with pre-dialysis CKD.

Tumor-induced osteomalacia: a case report

Background Tumor-induced osteomalacia is a rare, acquired paraneoplastic syndrome, including hypophosphatemia, high serum alkaline phosphatase, reduced active vitamin D, suboptimal bone mineral density, bone pain, fragility fractures, and muscle weakness. Case presentation We report a case of 74–year–old male of mixed ancestry with hypophosphatemia resistant to treatment despite optimal compliance, associated with profound reduction of bone mineral density and multiple nontraumatic fractures, including bilateral rib fractures, lower-thoracic (T11, T12) vertebrae, and two fractures involving the surgical and anatomical neck of the right humerus. We discuss an approach to identifying the underlying cause of hypophosphatemia associated with fragility fractures, and options for management of this rare condition. Conclusion Although rare, tumor-induced osteomalacia can be diagnosed if a logical stepwise approach is implemented. Surgery could be curative if the tumor is properly located and is resectable.

Assessment of serum hormone levels in female patients with acne vulgaris

Introduction: Acne is a chronic inflammatory disorder of the pilosebaceous unit with differential pathogenesis. To elucidate the roles of hormones in acne pathogenesis, we conducted a study to evaluate the serum testosterone, estradiol, progesterone levels in women with acne vulgaris. Methods: We conducted a cross-sectional descriptive study, and 175 women with acne vulgaris were examined; their serum estradiol, progesterone, testosterone were analyzed by chemiluminescence technique and compared with the healthy control group. Results: Increased serum hormone levels in women with acne vulgaris were accounted for 29.7%, and hyperandrogenism was accounted for 16.0% of cases. We found significant differences in testosterone levels (mean value, 55.67±25.56 versus 38.37±10.16 ng/dL, p<0.05) respectively in the acne group and the control group. However, the estradiol level of the acne group (323.15±93.31 pmol/L) was lower than the control group (370.94±58.88 pmol/L) with p<0.05). No statistically significant differences were found for progesterone (0.60±0.38 versus 0.50±0.15 ng/mL, p>0.05) levels. Moreover, we did not find the relationship between serum hormone levels and the severity of acne vulgaris. Conclusion: This study showed that the female acne vulgaris patients may have high serum testosterone levels and low serum estradiol levels compared with those of female controls. However, hormone alterations had no correlation with the acne grades.

β-hCG levels in second trimester as a predictor of gestational hypertension and preeclampsia

Background: Hypertensive disorders of pregnancy complicate up to 10% of pregnancies worldwide, and remain amongst the most significant and intriguing unsolved problems in obstetrics. The goal of this study is to test the hypothesis that women with high serum β-hCG levels in early pregnancy are at higher risk of developing gestational hypertension and preeclampsia.Methods: This is a prospective study done in 200 women between 13 and 20 weeks of gestation, selected randomly for this study. Serum β-hCG estimation was done by Sandwich chemiluminescence immunoassay method and calculated in multiple of median (MOM). They were followed till delivery for development of gestational hypertension and preeclampsia. Results were analysed statistically.Results: Out of 200 cases, 43 (21.5%) cases developed PIH. β-hCG levels were considered raised if the levels were >2 MOM. Out of 39 cases with beta HCG levels >2 MOM, 32 (82.1%) developed PIH whereas 7 (17.9%) remain normotensives against. Also, higher levels of beta HCG are associated with increased severity of PIH (p<0.000). The sensitivity was 82%, specificity was 93.2% and positive predictive value was 74.3%.Conclusions: The study conclude that elevated serum β-hCG levels in women with second trimester pregnancy indicates increased risk of gestational hypertension and preeclampsia and raised β-hCG levels are associated with severity of disease

A Retrospective Cohort Study of the Association between Serum Osteopontin Levels and Aortic Stiffness in Hypertensive Patients

By suppressing mineralization and preventing ectopic calcium deposits, osteopontin (OPN) has an inhibitory effect on vascular calcification. Also, there is an association between OPN and aortic stiffness (AS). We aimed to investigate the association between serum OPN levels and AS measured by carotid–femoral pulse wave velocity (cfPWV) in hypertensive patients. Baseline characteristics and fasting blood sampling of 120 participants with hypertension and 120 participants without hypertension were acquired. Serum OPN concentrations were determined by enzyme-linked immunosorbent assay. In total, 43 (35.9%) participants were assigned to the AS group with cfPWV of >10 m/s in hypertensive patients. There were more patients with diabetes mellitus, old age, high systolic blood pressure, high serum intact parathyroid hormone (iPTH), elevated C-reactive protein, and high OPN levels in the AS group compared with the control group in hypertensive participants. A multivariate logistic regression analysis discloses that age, SBP, serum OPN, and iPTH levels were independently associated with AS in hypertensive patients. Moreover, according to a multivariate forward stepwise linear regression analysis, OPN level is positively associated with cfPWV. In conclusion, serum OPN level is assumed to be a potential biomarker to predict AS and is positively associated with cfPWV in patients with hypertension.

Correlation Between β2-Microglobulin, Grobulin Levels & The Number of Plasmatic Cells in Patients with Multiple Myeloma

Introduction: Multiple myeloma is multifocal neoplasia of plasmatic cells that affects the bone marrow. It is associated with the production of a urinary or serum protein. It represents approximately 1 percent of cancer cases worldwide and between 10 to 15 percent of all cases of hematological malignancy. Furthermore, it has been proposed that the β2-microglobulin levels are correlated with other factors that can predict multiple myelomas such as the number of plasmatic cells and the creatine levels. Goals: To determine the correlation between β2-microglobulin, globulin levels, and the number of plasmatic cells in patients with multiple myeloma. Methods and techniques: We conducted an observational, retrospective, transversal, and analytical study in the Hospital of the Mexican Institute of Social Security at the Veracruz port. Our population analyzed comprehended 45 patients between the ages 30 and 80 with a confirmed diagnosis of multiple myeloma. We measured the β2-microglobulin levels and globulin levels, and the number of plasmatic cells during the diagnosis of patients. Furthermore, we conducted a statistical analysis using a Pearson correlation. Results: The average age was 61 years with a margin of error of 11.48 years. The myeloma of IgG type was the one of major prevalence and represent 82.2 percent. It was followed by the IgA type and the IgM type, which represented 15.5 and 2.2 percent respectively. The Pearson correlation coefficient (Pearson's r) between the β2-microglobulin levels and globulin levels was 0.92. The Pearson's r between the number of plasmatic cells and β2-microglobulin, excluding patients with high serum creatine levels (i.e. larger than 1.2 mg/dl), was 0.371. Conclusions: The predominant type of myeloma in the analyzed population was the IgG type. Furthermore, this myeloma affected mainly men in our study. The average age was 61 years with a margin of error of 11.48 years when compared to other populations in our study.

Identification of Pre-Diabetic Biomarkers in the Progression of Diabetes Mellitus

Type 2 diabetes mellitus (T2DM) is a major global health issue. The development of T2DM is gradual and preceded by the pre-diabetes mellitus (pre-DM) stage, which often remains undiagnosed. This study aimed to identify novel pre-DM biomarkers in a high-fat diet (HFD)-induced pre-DM mouse model. Male C57BL/6J mice were fed either a chow diet or HFD for 12 weeks. Serum and liver samples were isolated in a time-dependent manner. Semi-quantitative assessment of secretory cytokines was performed by cytokine array analysis, and 13 cytokines were selected for further analysis based on the changes in expression levels in the pre-DM and T2DM stages. HFD-fed mice gained body weight and exhibited high serum lipid, liver enzyme, glucose, and insulin levels during the progression of pre-DM to T2DM. The mRNA expression of inflammatory and lipogenic genes was elevated in HFD-fed mice The mRNA expression of Fc receptor, IgG, low affinity Iib, lectin, galactose binding, soluble 1, vascular cell adhesion molecule 1, insulin-like growth factor binding protein 5, and growth arrest specific 6 was elevated in the pre-DM, which was confirmed by measuring protein levels. Our study identified novel pre-DM biomarkers that may help to delay or prevent the progression of T2DM.