The relationship between primary ovarian insufficiency and gene variations: a prospective case-control study.

Around 70 percent of cases of Primary Ovarian Insufficiency (POI) etiology remain unexplained. The aim of our study is to contribute to the etiology and genetic background of POI. A total of 37 POI patients and 30 women in the reproductive period were included in this prospective, case-control study between August 2020 and December 2021. The women were examined for 36 genes with next-generation sequencing (NGS) panel. Gene variations were detected in 59.5 percent of the patients in the case group. FSHR p.S680N (rs6166, c.2039 G>A) and FSHR p.A307T (rs6165, c.919 G>A) gene variants, which are most frequently located in exon 10 of the FSHR gene, were detected in both groups. Although it was not found that these gene variants were significantly different between the groups, it was also found that they were significantly different in POI patients under 30 years of age and in those with a family history of POI. Variations were detected in 12 genes in POI patients. Two gene variants (FGFR1 [c.386A>C, rs765615419] and KISS1 [c.58 G>A, rs12998]) were detected in both groups, and the remaining gene variants were detected only in POI patients. No differences were detected between the groups in terms of gene variations. However, the gene variations detected only in POI patients may play a role in the etiology of POI.

Evaluation of definitive histopathological results of patients diagnosed with endometrial polyps: a tertiary care center experience.

Background: Although endometrial polyps are generally benign, there are also risks of malignancy. Objectives: To determine the premalignancy and malignancy prevalence in patients diagnosed with endometrial polyps and to investigate factors affecting premalignancy and malignancy. Methods: In our retrospective study, patients who were diagnosed with endometrial polyp with endometrial samples and who underwent polypectomy by hysteroscopy or hysterectomy within one year were included. Results: Premalignant / malignant histopathological results were detected in 7 (2.8%) patients. There were no statistically significant differences in histopathological results and endometrial sampling indications between premenopausal and postmenopausal patients. Hysterectomy in patients with premalignant/ malignant results and hysteroscopy in patients with benign results were found to be significantly different. There was not a statistically significant difference between patients with benign results and those with premalignant/malignant results in menopausal status, symptoms, status of hormone replacement therapy and endometrial polyp size. Conclusion: The possibility of premalignant/ malignant results in patients diagnosed with endometrial polyps should be kept in mind. The menopausal status, symptoms, sizes of endometrial polyps and whether or not the patient is on hormone replacement therapy should be considered while making the management plan. However, these should not be the decisive factors on their own.

Could Moesin Be a New Marker for Indicating Progression in Endometrial Cancer?

Aim: This study aims to determine an important parameter in progression from pre-invasive lesions of endometrium to endometrial cancer and also evaluate the effect of this parameter on the progression of endometrial cancer. Material and Method: In our study,30 patients with normal endometrial tissue (group 1), 56 patients who had endometrial hyperplasia without atypia (group 2), 36 patients who had endometrial hyperplasia with atypia (group 3), and 63 patients with endometrial cancer (group 4) were included. Age, parity, body-mass index, systemic diseases, and tumor markers of patients were evaluated. Expression levels of Ezrin, Radixin, and Moesin proteins were immunohistochemically evaluated in terms of frequency, intensity, and score value. Results: When we compared hyperplasia cases with or without atypia; frequency, and score value of ezrin expression and frequency, intensity, and score value of moesin expression was significantly higher in patients who had hyperplasia with atypia (p:0.000 p:0.001 p:0.003, p:0.032 p: 0.035 p:0.015 p:0.005, respectively). It was observed that the frequency and score value of moesin expression were significantly higher in patients with endometrial cancer when compared with patients who had hyperplasia with atypia (p:0.003 p:0.045). The frequency of moesin expression was significantly higher in patients who had postoperative mortality (p:0.030 p:0.039). Conclusion: Increased frequency of moesin expression in the preoperative period in patients with atypical hyperplasia should alert the surgeon in terms of malignancy. If the frequency of moesin expression increases in cases with endometrial cancer, the patient should be followed closely in terms of progression in the postoperative period.

OHVIRA syndrome presenting with acute abdomen findings treated with minimally invasive method: three case reports.

BACKGROUND: One of the least common forms of Müllerian anomalies is Herlyn-Werner-Wunderlich syndrome (HWWS), characterized by uterus didelphys, obstructed hemi-vagina, and ipsilateral renal agenesis (OHVIRA). HWWS is also known as OHVIRA syndrome. Patients with OHVIRA syndrome generally present with increasing pelvic pain, dysmenorrhoea, and pelvic mass during puberty, shortly after menarche. These patients may be treated successfully with a minimally invasive method. CASE REPORT: We present three previously asymptomatic patients with OHVIRA syndrome who presented with acute abdomen shortly after menarche. These patients were treated with a minimally invasive method. CONCLUSION: Patients with OHVIRA syndrome may be treated with minimally invasive method after definitive diagnosis and, laparoscopy and laparotomy should be avoided as much as possible. Minimally invasive treatment modality is not only cost-effective, but also provides symptomatic relief and preserves fertility.

Hysterosalpingography: a potential alternative to laparoscopy in the evaluation of tubal obstruction in infertile patients?

BACKGROUND: Evaluation of the fallopian tubes are important for infertile patients. The two most important diagnostic procedures used to evaluate tubal patency are hysterosalpingography and laparoscopy. OBJECTIVES: To asses the hysterosalpingography and laparoscopy results of patients diagnosed with infertility and investigate the diagnostic value of hysterosalpingography in patients with tubal factor infertility. METHODS: The hysterosalpingography and laparoscopy results of 208 patients who presented to the Obstetrics and Gynecology Clinic at Dicle University, Faculty of Medicine between January 2014- January 2018 were retrospectively evaluated. Hysterosalpingography and laparoscopy results were compared with regard to the investigation of the presence of tubal obstruction and of the pelvic structures that could cause tubal obstruction. The specificity, sensitivity, positive, and negative predictive values of hysterosalpingography were computed. RESULTS: The number of patients evaluated was 208. The ratio of primary infertile patients was 57.2% and 42.8% was secondary infertile. Hysterosalpingography was found to have a specificity of 64.6%, the sensitivity of 81.3%, the positive predictive value of 56.4%, and a negative predictive value of 86% in the determination of tubal obstruction. CONCLUSION: Patients with suspected tubal infertility can primarily be examined using hysterosalpingography in consideration of the invasive nature and the higher complication rate of laparoscopy.

Maternal and perinatal outcomes in high compared to low risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection (phase 2): the World Association of Perinatal Medicine working group on coronavirus disease 2019.

BACKGROUND: It has still to be ascertained whether severe acute respiratory syndrome coronavirus 2 infection in pregnancy is associated with worse maternal and fetal outcomes compared to low risk gestations. OBJECTIVE: This study aimed to evaluate maternal and perinatal outcomes in high- and low-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection. STUDY DESIGN: This was a multinational retrospective cohort study involving women with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection from 76 centers from 25 countries in Europe, the United States, South America, Asia, and Australia from April 4, 2020, to October 28, 2020. The primary outcome was a composite measure of maternal mortality and morbidity, including admission to the intensive care unit, use of mechanical ventilation, or death. The secondary outcome was a composite measure of adverse perinatal outcome, including miscarriage, fetal loss, neonatal and perinatal death, and admission to the neonatal intensive care unit. All outcomes were assessed in high- and low-risk pregnancies. Pregnancies were considered high risk in case of either preexisting chronic medical conditions in pregnancy or obstetrical disorders occurring in pregnancy. The Fisher exact test and logistic regression analysis were used to analyze the data. RESULTS: A total of 887 singleton pregnancies who tested positive for severe acute respiratory syndrome coronavirus 2 infection using reverse transcription-polymerase chain reaction of nasal and pharyngeal swab specimens were included in the study. The risk of composite adverse maternal outcomes was higher in high-risk pregnancies than in low-risk pregnancies (odds ratio, 1.52; 95% confidence interval, 1.03-2.24; P=.035). In addition, women carrying high-risk pregnancies were at higher risk of hospital admission (odds ratio, 1.48; 95% confidence interval, 1.07-2.04; P=.002), presence of severe respiratory symptoms (odds ratio, 2.13; 95% confidence interval, 0.41-3.21; P=.001), admission to the intensive care unit (odds ratio, 2.63; 95% confidence interval, 1.42-4.88), and invasive mechanical ventilation (odds ratio, 2.65; 95% confidence interval, 1.19-5.94; P=.002). When exploring perinatal outcomes, high-risk pregnancies were at high risk of adverse perinatal outcomes (odds ratio, 1.78; 95% confidence interval, 0.15-2.72; P=.009). However, such association was mainly because of the higher incidence of miscarriage in high-risk pregnancies compared with that in low-risk pregnancies (5.3% vs 1.6%, P=.008); furthermore, there was no difference in other explored outcomes between the 2 study groups. At logistic regression analysis, maternal age (odds ratio, 1.12; 95% confidence interval, 1.02-1.22; P=.023) and high-risk pregnancy (odds ratio, 4.21; 95% confidence interval, 3.90-5.11; P<.001) were independently associated with adverse maternal outcomes. CONCLUSION: High-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection were at higher risk of adverse maternal outcomes than low-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection.

Assessment of total sialic acid levels in patients with hyperemesis gravidarum: a preliminary study.

To determine the levels of serum total sialic acid (TSA) in patients with hyperemesis gravidarum (HG) and their gestational age-matched controls. Thirty pregnant women with HG, and 30 healthy pregnant women at up to 14 weeks of gestation were enrolled in this preliminary study. Total sialic acid levels in maternal serum were measured using the quantitative sandwich ELISA method. We observed statistically significant difference in TSA levels between HG and the control groups (p = .003). The identification of the role of SA in the prediction, diagnosis and follow-up of HG warrants more comprehensive studies in the future. Impact Statement What is already known on this subject? The derivatives of neuraminic acid are collectively referred to as sialic acid (SA). Changes in SA levels are known to trigger various conditions and disorders, including inflammatory, cardiovascular, neurological and endocrine diseases. Although a sensitive test capable of identifying hyperemesis gravidarum (HG) would be useful for diagnosis purposes, such a test is currently not available. Studies focussing on identifying new potential indicators and biomarkers for HG - as well as identifying their relevance in establishing diagnosis and assessing disease severity - would not only assist in elucidating the underlying causes of this condition but would also contribute to the development of new diagnostic tests for HG. What the results of this study add? Total sialic acid levels are significantly higher in sera of the patients with HG. The present study is the first in the literature to assess total sialic acid levels in patients with HG and healthy pregnant women before 14 weeks of gestation. What the implications are of these findings for clinical practice and/or further research? Total sialic acid levels could give an idea to clinicians in the etiopathogenesis of HG. The identification of the role of sialic acid in the prediction, diagnosis and follow-up of HG warrants more comprehensive studies in the future.

Fetal kidney length as a useful adjunct parameter for better determination of gestational age.

OBJECTIVES: To determine the validity of fetal kidney length and amniotic fluid index (AFI) in labor dating.  METHODS: This prospective study included 180 pregnant women followed up in the outpatient clinic at the Department of Obstetrics and Gynecology, Gaziantep University, Turkey, between January 2014 and January 2015. The gestational age (GA) was estimated by early fetal ultrasound measures and last menstrual period. Routine fetal biometric parameters, fetal kidney length, and amniotic fluid index were measured. We studied the correlation between fetal kidney length, amniotic fluid index, and gestational age.  RESULT: The mean gestational age depending on last menstrual period and early ultrasound was 31.98±4.29 (24-39 weeks). The mean kidney length was 35.66±6.61 (19-49 mm). There was a significant correlation between gestational age and fetal kidney length (r=0.947, p=0.001). However, there was a moderate negative correlation between GA and AFI. Adding fetal kidney length to the routine biometrics improved the effectiveness of the model used to estimate GA (R2=0.965 to R2=0.987).  CONCLUSION: Gestational age can be better predicted by adding fetal kidney length to other routine parameters.

Parasitic omental ovarian dermoid tumour mimicking an adnexal mass: A report of two very unusual cases.

The differential diagnosis of cystic adnexal masses includes various pathologies, some placed extragonadally. Herein, we present two different cases of omental ovarian dermoid tumours that were diagnosed using ultrasonography and removed with surgery. The greater part of the omental teratomas appear to have developed from self-amputation of cysts in the ovary, followed by their re-implantation into the omentum. Omental teratomas can be located in the pelvis, where they might be mistaken for an adnexal mass, an upper abdominal mass, or a periumbilical mass. The location of omental teratomas might slightly change from one examination to another. In such cases, preoperative diagnostic imaging methods may not provide adequate information to physicians. Gynecologists should always keep in mind the possibility of intraabdominal ovarian parasitic cystic teratomas in the differential diagnosis of suspicious adnexal masses during surgery. Awareness among gynecologic surgeons of such masses may help prevent misdiagnosis, delayed surgery, or the use of wrong surgical approaches.