Plasma visfatin concentrations in polycystic ovary syndrome: relationships with indices of insulin resistance and hyperandrogenism

Visfatin, a protein secreted by adipose tissue, is suggested play a role in pathogenesis of insulin resistance. In polycystic ovary syndrome [PCOS], insulin resistance might be involved in the development of endocrine and metabolic abnormalities. The aim of the study was to measure plasma visfatin levels in PCOS women and to assess the relationship between plasma visfatin concentration and indices of insulin resistance and markers of hyperandrogenism in PCOS patients. A total of 50 women were studied. Twenty five women had PCOS, and the remaining 25 were healthy women with regular menstrual cycles who served as control subjects. Blood samples were collected between the 3 rd and the 5 th days of a menstrual cycle in the control group and 3-5 days after a spontaneous menses, or independent of cycle phase in the presence of amenorrhea in the PCOS group for estimation of insulin, glucose, lipid parameters, sex-hormone and visfatin levels. Plasma visfatin concentrations were significantly higher in the PCOS group [72.94 +/- 33.3ng/ml] than in the control group [54.69 +/- 3l.5ng/ml] [p= 0.039]. The PCOS group had higher insulin resistance [HOMA-lR] [3.12 +/- 0.98] in comparison to the control group [2.27 +/- 0. 68] [p=0.017]. In the PCOS group, plasma visfatin levels were found to be positively correlated with BMI and waist circumference, HOMA-lR as well as with free androgen index, and negatively correlated with LH, total testosterone and sex hormone-binding globulin[SHBG] levels. In the whole study group, plasma vislatin levels was positively correlated with BMI and waist circumference, FSH and SHBG levels as well as with free androgen index, and negatively correlated with LH, total testosterone values. Visfatin levels are increased in women with PCOS compared to healthy controls. Visfatin is associated with insulin resistance in PCOS patients. Positive correlation found between visfatin and free androgen index in PCOS patients

Serum heat shoch protein 70 levels in pre-eclampsia and adverse pregnancy outcomes

Heat shock protein 70 [Hsp 70], a marker of cellular stress, was suggested to be elevated in pregnancies complicated by pre-eclampsia. Adverse pregnancy outcomes [APOs] are a group of common obstetric diseases and many studies have been conducted in an effort to clarify their risk factors It is well known that these risk factors can induce the synthesis of a group of highly conserved proteins, called heat shock proteins [Hsps]. The aim of the study was to measure serum heat shock protein [Hsp]70 in mothers with pre-eclampsia and adverse pregnancy outcomes [APOs] and to evaluate whether it can be applied as a useful indicator for the development of these conditions. Eighty pregnant women were included in this study [20 pre-eclamptic women, 20 women with threatened preterm labor, 20 women with intrauterine growth restriction and 20 healthy women with non-complicated pregnancy]. After obtaining informed consent, serum samples were collected from all participants to measure Hsp70 levels. The levels of Hsp 70 were measured using enzyme-linked immunosorbent assay. Measurement of serum Hsp 70 levels showed statistically higher values among pre-eclamptic patients compared to preterm, Intrauterine growth restriction [IUGR] and control groups [24.6 +/- 12.7 ng/ml, 15.l +/- 5.4 ng/ml, 14.3 +/- 6.1 ng/ml, 11 .7 +/- 4.9 ng/ml respectively, p

Searching for optimal serum marker for early prediction of gestational diabetes

To examine which serum marker [sex hormone binding globulin [SHBG], C-reactive protein [CRP], insulin. glucose] is accurate in early predicting the occurrence of GDM. One hundred and fifty six pregnant mothers high risk to develop gestational diabetes mellitus [GDM] were included in the study. When GDM was excluded at hooking setting [using OGTT], mothers are candidate for assaying fasting and non fasting sex hormone binding globulin [SHBO], fasting and non fasting quantitative C-reactive protein [CRP] and fasting insulin levels [from the same blood samples withdrawn during performing the OGTT], OGTT was repeated at 28 weeks and 36 weeks of gestation to diagnose GDM. According to the results of follow up OGTT, participant were divided into cases who developed GDM and those who did not develop GDM to assess the accuracy of each of the studied markers in predicting the occurrence of 0DM in high risk mothers. Sex hormone binding globulin levels [fasting and non fasting] were significantly lower among women who subsequently developed GDM compared with the control group [[276.9 +/- 78.7nmol/L vs 322.4 +/- 71.6nmol/L, P=0.001], [261.5 +/- 66.7 nmol/L vs 299 +/- 59.7 nmol/L, P0.00l] respectively]. No difference was detected in C-reactive protein levels [fasting and non lasting] [P=0.33, 0.349], fasting insulin [P0.082], lasting glucose levels [P=0.119], between the study group who subsequently developed GDM and the control group. SHBG can he used as an early marker to identify the group at highest risk for subsequent GDM allowing earlier intervention and possible benefits to the mothers and their offspring

Role of maternal plasma procalcitonin levels in the prediction of subclinical infection in patients with preterm premature rupture of membranes

To compare maternal plasma procalcitonin [PCT] concentrations in cases of preterm premature rupture of membranes [pPROM] and premature rupture of membranes [PROM] at term, and to determine whether these concentrations are of value in the diagnosis of pPROM cases suspected of subclinical intrauterine infection or in the prediction of the pPROM-to-delivery interval. A total of 90 women with singleton pregnancies were enrolled in this study, 25 patients with pPROM, 25 with PROM at term, 20 healthy women at preterm gestation, and 20 healthy women at term were included. In pPROM group, analysis of PCT concentrations with reference to serum leucocytosis, serum C-reactive protein levels, as well as to the presence/absence of neonatal congenital infection or histological chorioamnionitis was carried out. The outcomes of pPROM cases were also recorded with reference to pPROM-to-delivery interval. PCT concentrations in pPROM and PROM at term cases were significantly higher than in healthy controls in approximate gestational age [40.84 +/- 11.64, 9.19 +/- 4.81 [pPROM, PROM at term cases], 3.33 +/- 1.40, 2.41 +/- 0.91 [preterm and term healthy controls], respectively, p<0.001]. In pPROM group, no significant correlation was observed between PCT and leucocytosis [p=0.458] or C-reactive protein [p=0.188]. Also no statistically significant difference was found between PCT concentrations in patients who gave birth to newborns with and without congenital infection, and in patients with and without histological chorioamnionitis [p=0.591, 0.091 respectively]. The accuracy of procalcitonin determinations were poor. The value of maternal plasma PCT determinations in the diagnosis of pPROM cases suspected of intra-amniotic infection, as well as for the prediction of pPROM-to-delivery interval, newborn's infection or histological chorioamnionitis is unsatisfactory. However, PCT concentrations are elevated, both in patients with preterm and term PROMs in comparison to healthy pregnant mothers, and therefore further evaluations are necessary to establish the role and relative contribution of PCT levels in the prediction of subclinical intrauterine infection in pPROM cases

Predicting preterm delivery in asymptomatic pregnant women with prior preterm delivery by measurement of cervical length, fetal fibronectin and phosphorylated insulin-like growth factor-binding protein-1

To evaluate the accuracy of cervical length measurement in combination with assessment of fetal fibronectin [FFN] and phosphorylated insulin-like growth factor-binding protein-1 [phIGFBP-1] in cervico-vaginal secretions as a predictor of preterm delivery in asymptomatic pregnant women with a history of preterm birth. 91 singleton pregnant mothers [between 22-24 weeks of gestation] with previous history of one or more unexplained preterm birth were included in the study. For all participants transvaginal sonographic measurement of cervical length was carried out together with qualitative assay of fetal fibronectin and quantitative measurement of phosphorylated insulin-like growth factor binding protein-1 in cervico-vaginal secretions. The primary outcome of the study was delivery before completed 37 weeks of gestation. There was a significant association between cervical length and the occurrence of preterm delivery [p=0.002], cervical length was 23.12 +/- 8.5mm in 33 cases who experienced preterm delivery compared to 29.34 +/- 9.4mm in 58 cases who delivered at term. Regarding fetal fibronectin assay in cervico-vaginal secretions, no statistically significant difference was found between those who delivered preterm and those who had term delivery [p=0.972]. Measurement of phosphorylated insulin-like growth factor-binding protein-1 [phIGFBP-1] in cervico-vaginal secretions showed statistically significant difference among patients who delivered preterm compared to those who did not [p=0.007]. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated for cervical length, phIGFBP-1, and for their combination, and our results demonstrated high sensitivity, specificity, positive and negative predictive values for the combined method compared with either method alone. Both cervical length and phIGFBP-1 measurement in cervico-vaginal secretions at 22-24 weeks are likely to be useful in predicting preterm delivery in asymptomatic women with a history of preterm birth and their combination increased their sensitivity, specificity, positive and negative predictive values as predictors

Foley's catheter plus prostaglandin E[2] compared to prostaglandin E[2] alone for induction of labor

To compare the effectiveness of Foley catheter plus prostaglandin E[2] tablets with prostaglandin E[2] tablets alone in cervical ripening and induction of labor. Patients admitted for induction of labor were randomized into 2 groups. Group A received PGE[2] tablets and intracervical Foley catheter. Group B received PGE[2] tablets only. PG tablets were given to a maximum of 2 doses 6 hours apart. All patients had Bishop Score of <5 and no contraindication to vaginal delivery. After 12 hours, Bishop Score was assessed. Patients with favorable cervix [Bishop >/= 7] had artificial rupture of membranes. Syntocinon was started if there are no adequate uterine contractions. 300 patients participated in the study; 150 in each group. Bishop Score after 12hrs was significantly higher in group A compared to group B [7.48 +/- 1.72 Vs 6.09 +/- 1.85, p<0.01] as well as the mean change after 12 hours [3.20 +/- 1.59 Vs 2.37 +/- 1.42, p<0.01]. 14.4% of patients in group A had a Bishop Score of <7 after 12 hours compared to 25% in group B [p<0.05]. The induction to delivery time was significantly less in group A compared to group B [16.81 +/- 3.29 Vs 18.04 +/- 3.53,p<0.01]. Syntocinon was used in 68% of patients of group A compared to 81% of patients of group B [p<0.05]. 74% of group A patients delivered vaginally compared to 70.6% in group B, the difference was insignificant. There was no statistically significant difference regarding the number of C.S. and the number of instrumental deliveries as well. There was no significant difference regarding the incidence of fetal distress, puerperal pyrexia, or uterine hyperstimulation between the 2 groups. The combination of prostaglandin and Foley catheter resulted in better Bishop Score, shorter induction to delivery time, and fewer failed inductions. However, there was no significant effect on vaginal delivery or C.S. rates

Serum resistin as a predictor of ovarian response to clomiphene therapy in PCOS infertile patients

To measure serum resistin levels on day 3-6 of the menstrual cycle of infertile women with Polycystic ovary syndrome [PCOS] undergoing induction of ovulation using clomiphene citrate [CC] to ascertain whether these levels could allow us to predict the ovarian response to CC in those patients. 40 women with the diagnosis of infertility due to polycystic ovary syndrome [PCOS], were included in the study. Participants were included after fulfilling the Rotterdam criteria, 2004. All included participants were investigated by measuring body mass index [BMI], serum follicle stimulating hormone [FSH], serum luteinizing hormone [LH], serum fasting glucose, serum fasting insulin, fasting glucose-to-insulin ratio and serum resistin levels. Participants were treated with clomiphene citrate protocol to induce ovulation. Clomiphene was started as 100mg/day [2 tablets of 50mg] at day 2 for 5 consecutive days for 3 cycles. Ovulation was assessed by midluteal serum progesterone measurement combined with transvaginal sonographic monitoring of follicle growth until the appearance of a preo-vulatory follicle [mean diameter, >/= 18mm] and subsequent follicle rupture. According to the final ovarian response [which is the primary outcome], the study participants were divided into proper response group [ovulation has occurred at least once under treatment during the treatment period] and poor response group [ovulation has never occurred during the 3 study cycles]. Serum resistin was compared between the 2 outcome groups to test its relation to ovarian response. No significant correlation was found between the 2 outcome groups [proper and poor responders] regarding body mass index [BMI], 28.76 +/- 4.86, 29.13 +/- 5.09 respectively, p=0.817. Similarly no statistically significant difference was found between the 2 outcome groups regarding serum LH, FSH, total testosterone levels [p=0.437, 0.327, 0.672 respectively]. Serum fasting glucose, fasting insulin, fasting glucose-to-insulin ratio were not statistically significant when compared between the outcome groups [p=0.456, 0.108, 0.191 respectively]. Serum resistin levels in women who succeeded to ovulate and those who failed to ovulate under clomiphene therapy were not statistically significant when compared between both groups [22.16 +/- 21.6, 24.37 +/- 22.9, respectively, p=0.757]. However, serum resistin levels were positively correlated to serum total testosterone, fasting serum glucose and insulin levels [p=0.008, 0.024, 0.011 respectively]. Serum resistin is likely not a predictor for ovarian response in infertile women with PCOS undergoing induction of ovulation using CC

Prediction of pre-eclampsia and neonatal outcome by the combined use of early second trimester maternal serum homocysteine and uterine artery doppler velocimetry

To evaluate the value of combining early second trimester maternal serum homocysteine and uterine artery doppler velocimetry in the prediction of pregnancies that subsequently develop pre-eclampsia as well as neonatal outcome. This prospective observational study was conducted on eighty seven pregnant mothers [in their 16-19 gestational weeks] at risk to develop pre-eclampsia. All enrolled women should have one or more risk factors to develop pre-eclampsia. Mothers with medical disorders during the current pregnancy were excluded. All participants were investigated with maternal serum homocysteine assay and Doppler analysis of both uterine arteries. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated for homocysteine levels, uterine artery resistance index, diastolic notch [unilateral, bilateral], and for the combination of both homocysteine levels and uterine artery Doppler studies. Pre-eclampsia had occurred in 28 out of the 87 participants [32.18%] of whom 17 cases were diagnosed as mild pre-eclampsia [19.54%] and 11 were diagnosed as severe disease [12.64%]. The mean +/- SD of uterine RI for all cases who developed severe pre-eclampsia was 0.62 +/- 0.09 while it was 0.58 +/- 0.06 in those who did not develop the disease all over their pregnancies and the difference was statistically significant [p=0.016]. Early diastolic notch was detected in 11 out of the 28 mothers who developed pre-eclampsia [39.29%; 5 unilateral and 6 bilateral] versus 4 out of the 59 women who passed uncomplicated pregnancies [6.78%; 2 unilateral and 2 bilateral]. This revealed a statistically significant different [p=0.001]. Serum levels of homocysteine was also significantly higher in cases who developed pre-eclampsia than controls. The median [range] of serum homocysteine in mothers who developed pre-eclampsia [mild and severe disease] was 6.24 [1.9 - 23.4] micro mol/l while in women passed uncomplicated pregnancy it was 5.1 [1.6-19.9] micro mol/l [p=0.024]. Out of all delivered neonates of preeclampsia mothers [31 neonates from 28 mothers], 9 neonates were classified to have poor prognosis [29.03%] all of them were from severe preeclamptic mothers. No early neonatal deaths were recorded. This prospective study confirms the value of combining early second trimester maternal serum homocysteine and uterine artery Doppler velocimetry in the prediction of pregnancies that subsequently develop pre-eclampsia as well as neonatal outcome