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Abstract Introduction: Pregnancy rhinitis is a common sex hormone-related otorhinolaryngological disorder. There are some epidemiological and physiological studies on pregnancy rhinitis, but histopathological and biomolecular changes have not been studied thoroughly. Objectives: The receptors VPAC1 and VPAC2 are known for their roles in allergic rhinitis. On the other hand, activation of subclinical allergy has been suggested in the pathophysiology of pregnancy rhinitis. Therefore, we aimed to compare the physiological and gestational pattern of VPAC1 and VPAC2 expression in rat nasal mucosa. Methods: Twenty adult Wister albino female rats were enrolled into the study. Two groups constituted as 10 control (group A) and 10 pregnant (group B) rats. They were fed ad libitum and sheltered at room temperature (22°±2°C). The rats were sacrificed at the 20th day of gestation by intraperitoneal injection of 400mg/kg Na-pentobarbitone. Then, 10 - 15 mL of blood was taken, and samples were reserved for the detection of serum estradiol and progesterone levels by ELISA test. The nasal septum was resected and divided in half for immunohistochemical analyses and real time polymerase chain reaction testing of VPAC1 and VPAC2. Results: VPAC1 and VPAC2 were found to be in all layers of septal specimens, but the immunostaining of surface epithelium was more distinct in specimens of both groups. We demonstrated higher overall staining intensity in the pregnant group. PCR revealed significant increase in expression of VPAC1 (p = 0.023) and VPAC2 (p = 0.021) in pregnant group when compared with control group. In addition, we demonstrated upregulatory effect of estradiol and progesterone on the vasoactive intestinal peptide receptor expression. Conclusions: Gestational up-regulation of nasal VPAC1 and VPAC2 was shown both by PCR and immunohistochemical analysis. These findings support the hypothesis that PR is caused by the activation of subclinical allergy that is present before pregnancy.
Resumo Introdução: A rinite gestacional é um distúrbio comum da otorrinolaringologia relacionado a hormônios sexuais. Existem alguns estudos epidemiológicos e fisiológicos sobre rinite gestacional, mas as alterações histopatológicas e biomoleculares ainda não foram estudadas completamente. Objetivo: Os receptores VPAC1 e VPAC2 são conhecidos por seu papel na rinite alérgica. Por outro lado, a ativação da alergia subclínica tem sido sugerida na fisiopatologia da rinite gestacional. Portanto, objetivamos comparar o padrão fisiológico e gestacional da expressão de VPAC1 e VPAC2 na mucosa nasal de ratos. Método: Vinte ratas fêmeas Wistar albinas adultas foram incluídas no estudo. Os dois grupos foram divididos em 10 ratas; controle (grupo A) e 10 ratas prenhes (grupo B). Elas foram alimentadas ad libitum e abrigadas em temperatura ambiente (22° ±2° C). Sacrificamos as ratas no 20° dia de gestação por injeção intraperitoneal de 400 mg/kg de sódio-pentobarbital. Em seguida, foram coletados 10 a 15 mL de sangue e as amostras foram reservadas para a detecção dos níveis séricos de estradiol e progesterona pelo método Elisa. O septo nasal foi ressecado e dividido em 2 para análises imuno-histoquímicas e testes de reação em cadeia da polimerase em tempo real, RT-PCR, de VPAC1 e VPAC2. Resultados: VPAC1 e VPAC2 foram encontrados em todas as camadas da amostra septal, mas a imunocoloração do epitélio de superfície foi mais distinta nas amostras de ambos os grupos. Demonstramos maior intensidade geral de coloração no grupo gestante. A reação de polimerase em cadeia revelou aumento significante na expressão de VPAC1 (p = 0,023) e VPAC2 (p = 0,021) no grupo gestante quando comparado ao grupo controle. Além disso, demonstramos um efeito up-regulador do estradiol e progesterona na expressão do receptor peptídeo intestinal vasoativo. Conclusão: A up-regulação gestacional dos receptores VPAC1 e VPAC2 nasais foi demonstrada tanto por reação de polimerase em cadeia quanto por análise imuno-histoquímica. Esses achados corroboram a hipótese de que a rinite gestacional é causada pela ativação de alergia subclínica presente antes da gestação.
ABSTRACT
Objective: To determine the cumulative incidence of pregnancy rhinitis along with prevalence in different trimesters and to find out whether gestational age, BMI and parity have any effect on pregnancy related nasal congestion
Methods: In the prospective protocol at the obstetrics outpatient clinic, 167 pregnant women were enrolled consecutively. According to exclusion criteria, 67 of them were excluded. Visual-Analogue-Scale [VAS], Nasal-Obstructive-Symptom-Evaluation [NOSE] scale and Discharge-lnflammation-Polyps/Oedema [DIP] scoring were utilized for diagnosis of pregnancy rhinitis. Besides, weight, length, age, parity and week of pregnancy were recorded
Results: Total prevalence of pregnancy rhinitis was 17.17% and cumulative incidence was 38.89%. Our study revealed significant relation of NOSE score with both gestational week [r=0.474, p=0.001] and BMI [r=0.301, p=0.003]. VAS score was significantly related with gestational week [r=0.409, p=0.001] and BMI [r=0.270, p=0.007]. DIP score was found to be correlated only with gestational week [r=0.375, p=0.001]
Conclusion: Cumulative incidence of pregnancy rhinitis was 38.89%. Nasal congestion was significantly associated with BMI and gestational week. Patients should be informed about unfavorable fetal and maternal outcomes of pregnancy related nasal congestion which is triggered by obesity and excessive weight gain in pregnancy
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Objective: The goal of this study was to investigate whether gestational trophoblastic disease [GTD] and healthy pregnancy differ with respect to complete blood count parameters and these parameters can be used both to explain the pathophysiologic mechanisms and differentiate the two conditions from each other. Methods: The data obtained from 37 women with GTD and 61 healthy pregnancies [control group] regarding platelet [PLT], mean PLT volume [MPV] and PLT distribution width [PDW], and white blood cell [WBC] levels were evaluated. Patients with GTD were further subdivided into two groups composed of 20 partial mole [PM] and 17 complete mole [CM] cases. Results: PDW and WBC were lower in the GTD than the control. There were no differences for PLT and MPV. WBC was lower in PM and both WBC and PDW were lower in CM compared with control. ROC curve analysis revealed an area under curve [AUC] 75.5% for WBC and AUC 69.3% for PDW. A cut-off value was determined 8.19 for WBC with 81.0% sensitivity and 54.1% specificity. While, 15.85 were accepted for PDW, with 87.9% sensitivity and 44.4% specificity. Conclusion: Lower WBC in GTD may suggest that molar pregnancy requires a lower inflammatory reaction facilitating trophoblastic invasion. Lower PDW as an indicator of platelet activation in CM may suggest that CM requires less PLT activation than healthy pregnancy that needs stronger trophoblast invasion for normal placental development. Decreased PDW levels especially < 15.85 and WBC levels < 8.19 may alert clinicians for risk of GTD
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We aimed to evaluate the alterations in serum levels of platelet indices such as mean platelet volume [MPV] and platelet distribution width [PDW] in ectopic pregnancy [EP] and discuss the mechanism of the alterations in MPV and PDW. This retrospective evaluation of 153 tubal EP patients [39 ruptured and 114 non-ruptured] admitted to our clinic between 2009 and 2013 and 67 healthy pregnancies was conducted. The data regarding the maternal age, hemoglobin level, platelet level, MPV, PDW was analyzed. MPV was lower in the EP, especially in ruptured EP, compared to control group. However, no significant difference could be found between the groups [p=0.616]. PDW was higher in the EP, especially in ruptured EP, compared to control group, however there was no statistical difference between the three groups [p=0.451]. Platelet counts were significantly lower in ruptured EP compared to non-ruptured ectopic pregnancies and control groups [p=0.005]. MPV seems to be lower in ruptured EP suggesting the possible high grade inflammation in pathology. Platelet counts tend to be lower in ruptured EP suggesting the consumption of the platelets at the inflammation site. However, further studies are needed to describe the usefulness of the platelet indices in the diagnosis and clinical follow-up of EP. Our preliminary results show that MPV levels may decrease in the ruptured EP cases. At the same time, PDW levels may increase
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To determine the alterations of mean platelet volume [MPV], platelet distribution width [PDW], platelet level and hemoglobin level in pregnancies with threatened preterm labor [TPL]. The retrospective analysis of 201 pregnant women with threatened preterm labour admitted to our clinic between 2009 and 2013 and 192 healthy pregnancies was conducted. The data regarding the maternal age, hemoglobin level, platelet count, mean platelet volume [MPV], platelet distribution width [PDW] was evaluated. The mean MPV and hemoglobin levels were significantly lower in TPL group [p=0.001 and p=0.01, respectively]. PDW levels were significantly higher in TPL group [p=0.05]. [p=0.01]. Regarding the platelet count, there was no statistically significant difference between the TPL and control groups. ROC curve analysis for PDW revealed an area under curve [AUC] 66.8%. By using a cut-off value 16.15 for PDW, sensitivity was 76.1% and specificity was 43.5% for TPL. MPV seems to be lower in threatened preterm deliveries, whereas PDW levels were increased suggesting the possible high grade inflammation and platelet activation in the pathology. Anemia occurs more frequently in threatened preterm delivery. Increased PDW levels especially > 16.15 may alert the obstetrician for the risk of the preterm delivery. However, further studies are needed to state the usefulness of the platelet indices in the diagnosis and clinical follow-up of preterm labor
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Fusion of the labia majora is generally an acquired defect because of local inflamation, trauma and vaginal lacerations. In postmenauposal period, it is associated with lichen sclerosis. It is typically found in young neonates or prepubertal girls when the labia and vagina are not adequately estrogenized. In this study, a 14-year adolescent with labial fusion as a cause of acute urinary retention is presented