Analysis of thrombophilic genetic mutations in patients with Sheehan`s syndrome: is thrombophilia responsible for the pathogenesis of Sheehan`s syndrome?

The gene mutations of Factor V R506Q (FV-Leiden), prothrombin (FII G20210A), methylene tetrahydrofolate reductase (MTHFR) C677T and A1298C and PAI-1 4G/5G are well-established risk factors for thrombosis. We aimed to investigate the prevalence of these gene mutations and their possible impact on the development of pathogenesis in patients with Sheehan’s syndrome (SS). 40 female patients with SS compared to a control group of 45 healthy women. The presence of FV-Leiden, FII G20210A, MTHFR C677T, MTHFR A1298C and PAI-1 4G/5G gene mutations were assessed by polymerase chain reaction analysis with a light cycler analyzer. An odds ratio of greater than one is considered to increase the risk of SS disease as found in Factor V Leiden, FII G20210A, MTHFR C677T, MTHFR A1298C and PAI-1 4G/5G polymorphism, as follows respectively: 1.13, 1.85, 6.00, 8.14 and 1.45. MTHFR C677T and MTHFR A1298C polymorphism were found significantly higher in SS patients than the control group (P < 0.001), however FV-Leiden, FII G20210A and PAI-1 4G/5G polymorphism showed no significant difference (P > 0.05). The level of plasma total homocysteine (tHcy) was significantly higher in patients with SS than in the control group (P < 0.001). We suggest that the genetic mutations of FV-Leiden, FII G20210A, MTHFR C677T, MTHFR A1298C and PAI-1 4G/5G increase the risk of SS. Also, high plasma tHcy levels may be a risk factor for the development of SS.     

Ischemia-modified albumin levels in carbon monoxide poisoning

Objectives

Ischemia-modified albumin (IMA) is an emerging diagnostic biomarker for many ischemic conditions. This study was conducted to investigate whether there is a change in IMA levels in carbon monoxide (CO) poisoning and, if so, the clinical relevance of IMA levels.

Methods

This cohort study, performed between November 2008 and April 2009, compared the serum IMA levels of 33 CO-poisoned patients taken at the time of presentation at the emergency department and after 3 hours of treatment and 49 healthy controls. In addition, IMA and carboxyhemoglobin levels were analyzed according to CO poisoning patients' poisoning severity scores.

Results

Carbon monoxide patients' IMA levels were higher than those of the control group both at time of admission and at the third hour of the treatment, P < .0001. A significant fall was determined in carboxyhemoglobin (CO-Hb) levels at the end of the third hour of treatment, P < .0001. However, there was no significant difference between the IMA levels measured at admission and at the end of the third hour of treatment (P > .05). There was no significant correlation between IMA and CO-Hb levels in CO-poisoned patients. Also, there was no difference in blood IMA levels in classification according to patients' poisoning severity score and CO-Hb levels.

Conclusion

Results from this pioneering study established a high level of IMA in CO-poisoned patients, suggesting that IMA may also be sensitive to hypoxia. Considering the preliminary nature of this study, the clinical utility of IMA levels in CO poisoning should be further investigated with more comprehensive studies.     

Fatal Pulmonary Oedema Following Oxytocin Administration in a Pregnant Woman with Acute Myocardial Infarction

Acute myocardial infarction is a rare event in pregnant patients. Mechanical valves are naturally thrombogenic and require careful anticoagulation. Pregnancy produces a hypercoagulable situation and necessitates close follow-up in pregnant patients with mechanical heart valves. We present a 34-year-old pregnant woman who had mitral and aortic valve prosthesis. She developed resistant pulmonary oedema in the post-partum period after myocardial infarction. Oxytocin was used in this patient to induce midterm labour and prevent post-partum bleeding. Issues surrounding management of pulmonary oedema and use of oxytocin therapy during pregnancy are discussed. We emphasize the need for awareness of this condition and call attention to the risk of pulmonary oedema during labour.     

Modulation of adult hippocampal neurogenesis during myelin-directed autoimmune neuroinflammation

In chronic autoimmune diseases of the central nervous system (CNS) such as multiple sclerosis (MS) clinical signs of cognitive dysfunction have been associated with structural changes in the hippocampus. Moreover, experimental studies indicate that inflammatory responses within the CNS modulate the homeostasis of newborn cells in the adult dentate gyrus (DG). However, it remained open whether such changes happen regardless of the primary immunological target or whether a CNS antigen-directed T lymphocyte-mediated autoimmune response may exert a specific impact. We therefore induced experimental autoimmune encephalomyelitis (EAE), a common model of MS serving as a paradigm for a CNS-specific immune response, by immunizing C57BL/6 mice with encephalitogenic myelin oligodendrocyte glycoprotein (MOG) p35-55. In EAE animals, we found enhanced de novo generation and survival of doublecortin (DCX)-positive immature neurons when compared with controls immunized with CNS-irrelevant antigen (ovalbumine). However, despite activation of neurogenesis, we observed a reduced capacity of these cells to generate mature neurons. Moreover, the high number of newly born cells retained the expression of the glial marker GFAP. These effects were associated with downregulation of pro-neurogenic factors Neurogenin1 and Neurogenin2 and dysregulation of Notch, β-catenin, Sonic Hedgehog (Shh) signaling as suggested by altered gene expression of effector molecules. Thus, a CNS antigen-specific immune response leads to an aberrant differentiation of neural precursors associated with dysbalance of signaling pathways relevant for adult hippocampal neurogenesis. These results may further extend our understanding of disturbed regeneration in the course of chronic inflammatory CNS diseases such as MS.     

Effect of relocation and parental psychopathology on earthquake survivor-children's mental health

Earthquakes may increase the risk for psychopathology in children because the disaster may disrupt family functioning through causing psychopathology in the parents or disrupting social network through migration, school changes, or socioeconomic status changes caused by the job losses of the parents. This study aimed to investigate the effects of parental psychopathology on the traumatic stress and depression of earthquake survivor-children 4 years after the earthquake. A convenience sample of 104 earthquake survivor-children (43 boys, 61 girls) and their parents were assessed at their homes for earthquake experience and traumatic stress symptoms. The outcome variables were the factor scores of a child/adolescent traumatic stress questionnaire (Traumatic Stress Symptom Checklist for Children and Adolescents). The predictors of child's factor scores were examined using linear regression analyses. The traumatic stress factor score of the children was predicted two variables: the child's reported fear during the earthquake and the father's traumatic stress factor score. The depression factor score, on the other hand, was predicted using the depression factor score of the mother only. Demographic variables or relocation status were not predictive for either of children's factor scores. The results of the present study show that maternal and paternal psychopathologies have differential effects on the psychological status of earthquake survivor-children. Traumatic stress in the child is predicted using the traumatic stress of father, whereas depression in the child is predicted by mother's depression levels. Social network disruption does not seem to have a negative effect on children once parental psychopathology is taken into account.     

Multimode intravascular RF coil for MRI-guided interventions

Purpose:

To demonstrate the feasibility of using a single intravascular radiofrequency (RF) probe connected to the external magnetic resonance imaging (MRI) system via a single coaxial cable to perform active tip tracking and catheter visualization and high signal‐to‐noise ratio (SNR) intravascular imaging.

Materials and Methods:

A multimode intravascular RF coil was constructed on a 6F balloon catheter and interfaced to a 1.5T MRI scanner via a decoupling circuit. Bench measurements of coil impedances were followed by imaging experiments in saline and phantoms.

Results:

The multimode coil behaves as an inductively coupled transmit coil. The forward‐looking capability of 6 mm was measured. A greater than 3‐fold increase in SNR compared to conventional imaging using optimized external coil was demonstrated. Simultaneous active tip tracking and catheter visualization was demonstrated.

Conclusion:

It is feasible to perform 1) active tip tracking, 2) catheter visualization, and 3) high SNR imaging using a single multimode intravascular RF coil that is connected to the external system via a single coaxial cable. J. Magn. Reson. Imaging 2011;33:995–1002. © 2011 Wiley‐Liss, Inc.