Wernicke''s encephalopathy due to hyperemesis gravidarum: an under-recognised condition

We present a case of a 25-year-old woman with drowsiness, nystagmus, severe ataxia and areflexia, which developed six weeks after admission to an obstetric clinic for hyperemesis gravidarum. She had been treated with intravenous dextrose and electrolyte solutions and antiemetics. Magnetic resonance imaging (MRI) performed on the fifth day of her neurologic symptoms showed increased intensity in both thalami, periaqueductal grey matter, the floor of the fourth ventricle and superior cerebellar vermis in T2 weighted and FLAIR images. Clinical signs and MRI findings were consistent with the diagnosis of Wernicke's encephalopathy. On the third day of thiamine replacement, neurologic signs improved dramatically In addition to our case, we review 29 previously reported cases of Wernicke's encephalopathy associated with hyperemesis gravidarum, and emphasize the importance of thiamine supplementation to women with prolonged vomiting in pregnancy especially if they are given intravenous or parenteral nutrition.     

The alterations of whole saliva constituents in patients with diabetes mellitus

The present study was undertaken in order to determine the possible alterations in whole saliva and the periodontal status in patients with diabetes mellitus (DM), and was conducted on 17 patients with DM and 17 systemically and periodontally healthy subjects. When the subjects were evaluated clinically, significantly increased probing depths were noticed in the DM group when compared with the healthy subjects. In whole saliva samples, sodium, potassium, total protein, amylase, thiocyanate, and secretory IgA levels were determined in both groups. Difference between the two groups regarding the mean salivary potassium levels were found to be statistically significant since the mean salivary potassium levels in the DM and the control groups were 2.470±9.04 mmol/L and 14.30±3.88 mmol/L, respectively. The mean salivary total protein, amylase and secretory IgA levels in the DM group were 2.41±1.0 mg/mL, 124.2±79.7 U/mL and 6.86±3.50 mg/L, all being significantly higher than the control group. However, no significant differences could be shown for the salivary sodium and thiocyanate levels. Nor was there any difference between non-insulin dependent diabetes mellitus (NIDDM) and insulin-dependent diabetes mellitus (IDDM). The findings of the present study suggest that, besides the clinical examinations, the determination of the possible alterations in the composition of whole saliva might also be helpful in understanding the increased severity of periodontal disease in diabetic patients.     

900 MHz radiofrequency-induced histopathologic changes and oxidative stress in rat endometrium: protection by vitamins E and C

There are numerous reports on the effects of electromagnetic radiation (EMR) in various cellular systems. Mechanisms of adverse effects of EMR indicate that reactive oxygen species (ROS) may play a role in the biological effects of this radiation. The aims of this study were to examine 900 MHz mobile phone-induced oxidative stress that promotes production of ROS and to investigate the role of vitamins E and C, which have antioxidant properties, on endometrial tissue against possible 900 MHz mobile phone-induced endometrial impairment in rats. The animals were randomly grouped (eight each) as follows: 1) Control group (without stress and EMR, Group I), 2) sham-operated rats stayed without exposure to EMR (exposure device off, Group II), 3) rats exposed to 900 MHz EMR (EMR group, Group III) and 4) a 900 MHz EMR exposed + vitamin-treated group (EMR + Vit group, Group IV). A 900 MHz EMR was applied to EMR and EMR + Vit group 30 min/day, for 30 days using an experimental exposure device. Endometrial levels of nitric oxide (NO, an oxidant product) and malondialdehyde (MDA, an index of lipid peroxidation), increased in EMR exposed rats while the combined vitamins E and C caused a significant reduction in the levels of NO and MDA. Likewise, endometrial superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GSH-Px) activities decreased in EMR exposed animals while vitamins E and C caused a significant increase in the activities of these antioxidant enzymes. In the EMR group histopathologic changes in endometrium, diffuse and severe apoptosis was present in the endometrial surface epithelial and glandular cells and the stromal cells. Diffuse eosinophilic leucocyte and lymphocyte infiltration were observed in the endometrial stroma whereas the combination of vitamins E and C caused a significant decrease in these effects of EMR. It is concluded that oxidative endometrial damage plays an important role in the 900 MHz mobile phone-induced endometrial impairment and the modulation of oxidative stress with vitamins E and C reduces the 900 MHz mobile phone-induced endometrial damage both at biochemical and histological levels.     

Reinfarction in Patients with Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): Coronary Findings and Prognosis

Background

Myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA) is common. There are limited data on the mechanisms and prognosis for reinfarction in MINOCA patients.

Serum,salivary, and tissue levels of plasminogen in familial Mediterranean fever,amyloidosis, and chronic periodontitis

1 Background

There are no published studies regarding the role of the plasminogen (PLG) system in familial Mediterranean fever (FMF), FMF‐associated secondary amyloidosis, or chronic periodontitis (CP), although recent limited data have focused on the association between FMF and chronic periodontitis. Therefore, the aim of this study was to evaluate the serum, salivary, and gingival tissue levels of PLG in patients with CP, FMF, and amyloidosis.

2 Methods

The study population included 122 patients with FMF (only FMF, and FMF and amyloidosis and 128 individuals who were systemically healthy controls. Blood and salivary samples were obtained from the cases and controls, and clinical periodontal parameters were recorded. Serum and salivary PLG levels were assessed. The gingival tissue samples of the case and control groups were analyzed histopathologically and immunohistochemically for amyloid deposition and PLG.

3 Results

The amyloidosis group had significantly more severe clinical periodontal parameters than those of the FMF and systemically healthy groups (P < 0.05). Salivary levels of PLG were significantly higher in the FMF and amyloidosis groups compared with those in the control group (P < 0.001). The FMF with periodontitis and amyloidosis with periodontitis groups had higher salivary PLG levels compared with those in the CP group. Serum and salivary PLG levels were significantly associated with the clinical periodontal parameters in the FMF group. The amyloidosis cases had hyperplasia, severe inflammation, and activation of the gingiva.

4 Conclusion

The PLG system could play an important role in inflammatory diseases, such as chronic periodontitis, FMF, and FMF‐associated secondary amyloidosis.     

Portal Vein Embolization: What Do We Know?

Portal vein embolization (PVE) has been developed to increase the size of the future remnant liver (FRL) left in place after major hepatectomy, thus reducing the risk of postoperative liver insufficiency. PVE consist in embolizing preoperatively portal branches of the segments that will be resected. Indication is based on preoperative measurements of the FRL by computed tomography and its ratio with either the theoretical liver volume or by direct measurement of the functional liver volume. After PVE, the volume and function of the FRL increases in 3 to 6?weeks, permitting extensive resections in patients otherwise contraindicated for liver resection. The PVE technique is variable from one center to another; however n-butyl-cyano-acrylate provides an interesting compromise between hypertrophy rate and procedure risk.     

Paraoxonase (PON1) activity in patients with subclinical thoracic aortic atherosclerosis

High density lipoprotein (HDL), a powerful antioxidant, protects low density lipoprotein (LDL) particles against oxidative stress. By limiting LDL oxidation, HDL plays an important role in preventing atherosclerosis (AS). The antioxidant effect of HDL is mostly associated with the paraoxonase (PON1) activity. It has been known that increased aortic intima-media thickness (IMT) is an earlier marker AS than carotid IMT. We aimed to investigate the association between thoracic aortic IMT and serum PON1 activity. We studied 133 patients (mean age: 46.3 ± 8 years) who underwent transesophageal echocardiography (TEE) for various indications. The measurements of thoracic aortic IMT by TEE are classified into four grades (1, 2, 3 and 4). Serum PON1 activity was measured spectrophotometrically. Oxidative and anti-oxidative status was evaluated by measuring serum lipid hydroperoxide (LOOH), total anti-oxidant status (TAS). Serum PON1 activity was progressively decreasing from grade 1 IMT to grade 4 IMT (p < 0.001). However, serum LOOH was significantly lower and TAS was significantly higher in patients with grade 1 when compared with other grades. In multiple linear regression analysis, IMT was independently correlated with PON1 activity (β = ?0.495, p < 0.001), TAS level (β = ?196, p < 0.009), age (β = 0.145, p = 0.029) and LDL cholesterol level (β = 0.169, p = 0.009). Decreased PON1 activity was independently associated with the extent of thoracic AS. PON1 activity may play a role in pathogenesis of thoracic AS besides age, TAS and LDL cholesterol levels.