Zinc and homocysteine levels in polycystic ovarian syndrome patients with insulin resistance.

In this study, our objective was to evaluating the value of serum zinc levels as an etiologic and prognostic marker in patients with polycystic ovarian syndrome. We conducted a prospective study, including 53 women with polycystic ovarian syndrome and 33 healthy controls. We compared serum zinc levels, as well as clinical and metabolic features, of the cases. We also compared serum zinc levels between patients with polycystic ovarian syndrome with insulin resistance. Mean zinc levels were found to be significantly lower in patients with polycystic ovarian syndrome than healthy controls. Multiple logistic regression analysis of significant metabolic variables between polycystic ovarian syndrome and control groups (serum zinc level, body mass index, the ratio of triglyceride/high-density lipoprotein cholesterol, and homocysteine) revealed that zinc level was the most significant variable to predict polycystic ovarian syndrome. Mean serum zinc levels tended to be lower in patients with polycystic ovarian syndrome with impaired glucose tolerance than patients with normal glucose tolerance, but the difference was not statistically significant. In conclusion, zinc deficiency may play a role in the pathogenesis of polycystic ovarian syndrome and may be related with its long-term metabolic complications.

The risk assessment study for hemolytic disease of the fetus and newborn in a University Hospital in Turkey.

Maternal red-cell alloimmunization occurs when a woman's immune system is sensitized to foreign red-blood cell surface antigens, leading to the production of alloantibodies. The resulting antibodies often cross the placenta during pregnancies in sensitized women and, if the fetus is positive for red-blood-cell surface antigens, this will lead to hemolysis of fetal red-blood cells and anemia. The most severe cases of hemolytic disease in the fetus and newborn baby are caused by anti-D, anti-c, anti-E and anti-K antibodies. There are limited data available on immunization rates in pregnant women from Turkey. The aim of the present study was to provide data on the frequency and nature of maternal RBC alloimmunization in pregnant women in a tertiary care hospital. In this study, we retrospectively evaluated the indirect antiglobulin test results of Rh-negative pregnant women performed in our Blood Bank between 2006 and 2012. Indirect antiglobulin test positive women also underwent confirmatory antibody screening and identification. During the study period, 4840 women admitted to our antenatal clinics. With regards to the major blood group systems (ABO and Rh), the most common phenotype was O positive (38.67%). There were 4097 D-antigen-positive women (84.65%) and 743 women with D-antigen-negative phenotype (15.35%). The prevalence of alloimmunization was found to be 8.74% in D-antigen negative group. Despite prophylactic use of Rh immunglobulins, anti-D is still a common antibody identified as the major cause of alloimmunization in our study (anti-D antibody 68.57%, non-D antibody 31.42%). While alloimmunization rate to D antigen was 6.46%, non-D alloimmunization rate was 2.69% among Rh-negative pregnant women. Moreover, detailed identification facilities for antibodies other than anti-D are not available in most of centers across Turkey. However, large-scale studies on pregnant women need to be done in order to collect sufficient evidence to formulate guidelines and to define indications for alloantibody screening and identification.

Early prenatal diagnosis of conjoined twins at 7 weeks and 6 days' gestation with two-dimensional Doppler ultrasound: a case report.

This case report presents the prenatal diagnosis of conjoined twins at 7 weeks and 6 days' gestation according to the last menstrual period and 6 weeks and 4 days' gestation according to crown-rump length in a 32-year-old Turkish woman, using two-dimensional Doppler ultrasound. The twins were fused to each other at the thoracic region (thoracopagus). In the light of previous reports of conjoined twins this appears to be one of the earliest prenatally diagnosed cases in the medical literature.

Effect of different degrees of glucose intolerance on maternal and perinatal outcomes.

OBJECTIVE: To evaluate the effect of markedly elevated 50-g glucose loading test (GLT) (>or=200 mg/dL) and equivocal 100-g GLT (one abnormal value) results on maternal and perinatal outcomes. METHODS: Retrospective analysis of 2029 singleton pregnancies screened for gestational diabetes mellitus (GDM). Maternal and perinatal outcomes in five different groups with different degrees of glucose intolerance were compared. First group consisted of patients with normal 50-g test, second group was formed by patients with abnormal 50-g glucose test but a normal 100-g test. Third group included patients with one abnormal value after 100-g test. Patients in the fourth group were diagnosed to have GDM after an abnormal 100-g test. Patients in the fifth group had a value >or=200 mg/dL after 50-g test and were diagnosed to have GDM. RESULTS: Macrosomia and large for gestational age incidence were highest in the group with one elevated glucose tolerance test (GTT) value. Hospitalisation rates, hypoglycemia, hyperbilirubinemia and polycythemia were more common in neonates born to mothers with one elevated GTT value and to mothers with a GLT > 200 mg/dL. CONCLUSION: Adverse maternal and perinatal outcomes in patients with one elevated GTT value and in patients with a GLT value > 200 mg/dL warrant close glucose monitoring and treatment in these groups even in the absence of a diagnostic abnormal GTT.

Prenatal diagnosis of achondrogenesis type I: a case report.

INTRODUCTION: Achondrogenesis is a lethal osteochondrodysplasia characterized by hypoplasia of the bones and is associated with various anomalies varying in severity. Based on clinical, radiologic, and histopathologic features, two types are distinguished. CASE PRESENTATION: The prenatal ultrasound examination of a 32-year-old Turkish woman who was referred to our clinic at 33 weeks and 6 days of gestation revealed fetal micromelia together with several other anomalies. The female baby died shortly after birth and was diagnosed with achondrogenesis type I based on the clinical and radiographic findings. CONCLUSION: Ultrasonography is important in prenatal diagnosis and for distinguishing lethal skeletal dysplasias in order to counsel the parents about future recurrent risks. As it is a uniformly lethal disease, a definitive prenatal diagnosis of achondrogenesis may be an indication for pregnancy termination.

Role of oxidative stress in intrauterine growth restriction.

AIMS: The objectives of this study were to determine the role of oxidative stress in intrauterine growth restriction (IUGR) and to investigate the possible molecular mechanism(s) leading to oxidant stress in IUGR. METHODS: Parameters of the oxidative and antioxidant system were evaluated in maternal plasma, umbilical cord blood, and placental tissue of pregnant women with IUGR fetuses. The same samples were obtained from women with normal pregnancies and were evaluated. RESULTS: The results of this study indicate that while the levels of malondialdehyde (MDA) and xanthine oxidase (XO) were higher in maternal plasma, umbilical cord plasma, and placental tissues of the patients with IUGR when compared to the control group [MDA: 142.8 +/- 18.0 vs. 86.4 +/- 22.5 nmol/ml, 151.6 +/- 25.8 vs. 93.3 +/- 7.4 nmol/ml, and 0.72 +/- 0.19 vs. 0.42 +/- 0.09 nmol/mg protein, respectively (for all p < 0.0005); XO: 1.251 +/- 0.674 vs. 0.20 +/- 0.019 mIU/ml (p < 0.0005), 1.97 +/- 0.73 vs. 0.237 +/- 0.143 mIU/ml (p < 0.0005), and 0.023 +/- 0.0012 vs. 0.012 +/- 0.004 mIU/ml (p < 0.025), respectively], the levels of antioxidant potential were identified to be lower in maternal plasma, umbilical cord plasma, and placental tissues of the patients with IUGR: 63.3 +/- 11.9 vs. 198.0 +/- 31.9 U/ml (p < 0.0005), 32.6 +/- 3.7 vs. 206.5 +/- 27.1 U/ml (p < 0.0005), and 0.56 +/- 0.23 vs. 1.16 +/- 0.29 U/ml (p < 0.0005), respectively. On the other hand, the activities of adenosine deaminase of the IUGR patients were higher than those of the control group in maternal plasma (204.8 +/- 103.5 vs. 115.6 +/- 31.8 U/l, p < 0.01) and umbilical cord blood samples (584.2 +/- 285.2 vs. 147.9 +/- 44.8 U/l, p < 0.0005) which may suggest that oxidative stress has a role in IUGR. Moreover, an increased superoxide dismutase activity in maternal plasma (128.2 +/- 37.4 vs. 88.8 +/- 16.6 U/ml, p < 0.005) and cord blood (162.1 +/- 37.0 vs. 116.6 +/- 20.7 U/ml, p < 0.005) and an increased glutathione peroxidase activity in maternal plasma (1.83 +/- 0.26 vs. 1.47 +/- 0.31 IU/ml, p < 0.01) and placental tissue (0.007 +/- 0.0015 vs. 0.003 +/- 0.0012 IU/ml, p < 0.0005) were detected, while decreased catalase activities in cord blood (23,717 +/- 3,538 vs. 16,397 +/- 2,771 IU/ml, p < 0.0005) and placental tissue (47.2 +/- 17.2 vs. 70.7 +/- 11.3 IU/ml, p < 0.005) were identified in IUGR groups. CONCLUSIONS: In the light of the results of this study, it can be stated that the oxidative stress increases in patients with IUGR. Providing high-risk patients with an antioxidant may be useful in the prevention or treatment of IUGR, although it is a condition with no certain treatment outcome.

Therapeutic value of trichloroacetic acid in the treatment of isolated genital warts on the external female genitalia.

OBJECTIVE: To evaluate the value of 85% trichloroacetic acid (TCA) in the treatment of human papillomavirus (HPV)-associated genital warts of the external genitalia and to detect the recurrence rate and side effects of this therapeutic regimen. STUDY DESIGN: All patients with a suspected HPV-related papillary vulvar lesion after initial examination underwent vulvoscopic evaluation with a magnification of 8-20x using acetic acid and toluidine blue. Under local anesthesia, biopsies were taken from acuminate or papillary warts for histopathologic confirmation and from suspicious areas to exclude preinvasive or invasive diseases. Following histopathologic diagnosis, patients were treated with 85% TCA. RESULTS: Overall, 51 patients with isolated vulvar and/or perianal genital warts were included. Of those patients, 11 (21.5%) had acuminate and 40 (78.5%) had papular genital warts. All the women had lesions of the labia minora. The other localizations were as follows: labia majora, 18 (35.3%); lateral vulva, 5 (9.8%); clitoris, 9 (17.6%); fourchette, 16 (31.3%); and perianal area, 7 (13.7%). All lesions were successfully treated by the end of the treatment period (median, 4; range 2-5). None of the patients had recurrence or new lesions during the 6-month follow-up period. In the second 6 months, 9 patients (17.6%) were diagnosed with recurrent lesions. Although all the patients experienced transient burning pain during therapy, none of them discontinued the therapy. Ulceration was observed in 8 patients (15.6%). Of those patients only 3 had permanent scarring (5.8%). CONCLUSION: We recommend the use of TCA in patients with external genital warts, especially for mild to moderate cases. It is associated with a high success rate and low morbidity if sufficient care is taken during application.

Maternal and umbilical venous adrenomedullin and nitric oxide levels in intrauterine growth restriction.

OBJECTIVE: To verify whether adrenomedullin (AM) and nitric oxide (NO) concentrations are changed in the maternal and fetal circulation in pregnancies complicated by intrauterine growth restriction (IUGR) compared to normal pregnancies, and to determine any relationship between them. METHODS: Forty-six small for gestational age (SGA) and 34 appropriate for gestational age (AGA) infants were included in the study. Umbilical and maternal venous AM and NO concentrations were determined. RESULTS: Umbilical NO concentrations in SGA infants (mean +/- SD; 176.2 +/- 75.8 micromol/L) were significantly greater than in AGA infants (143.4 +/- 39.2 micromol/L) (p = 0.015). However, umbilical AM concentrations were similar in SGA and AGA infants with 14.2 +/- 4.4 pmol/mL and 14.5 +/- 6.2 pmol/mL, respectively (p > 0.05). There was no relationship between NO and AM levels in umbilical blood (r = 0.09, p = 0.40). No difference was found between either AM or NO levels in the maternal plasma of the two groups. CONCLUSIONS: We suggest that NO is increased in the fetoplacental circulation in SGA infants probably as a response to decreased blood flow, whereas AM is not. Additionally, increased NO in the fetoplacental circulation was found to be independent from AM secretion.

Distribution of contraceptive use in a Turkish population.

OBJECTIVE: This study is designed to estimate the distribution of contraceptive use among reproductive age women in a Turkish population (Turkey). STUDY DESIGN: We included 2365 women of reproductive age in this study. Women were given a questionnaire via a face-to-face interview. RESULTS: During the time period just after marriage, 1914 women (80.9%) declared that they did not use any type of contraception. Among 451 women who had used a contraceptive method just after marriage, the most commonly used method was condoms (34.2%), followed by oral contraceptives (31.2%) and coitus interruptus (25.9%). When their history of contraceptive use was asked, 1903 women (80.2%) stated that they used a method of contraception while 462 women (19.5%) had never used any type of contraceptive. Distribution of contraceptive methods among women was analyzed and intrauterine devices were detected to be the most commonly used method (n=1046, 55%). CONCLUSION: A point that should be emphasized is that there is a marked increase in contraceptive prevalence, and expansion of family planning activities in Turkey. This change, we believe, is due to improvements in health services of Turkey, realized in recent years.

Urogenital symptoms of postmenopausal women in Turkey.

OBJECTIVE: The objective of this study was to collect data on the prevalence and risk factors of urogenital symptoms in postmenopausal women in Turkey. DESIGN: The study was performed with the participation of 510 postmenopausal women who presented to previously defined clinics for reasons other than urogenital complaints. Women completed a questionnaire including questions about their demographic properties and their urogenital symptoms. Data were analyzed by SPSS 10.0. The chi-square test was the statistical test of choice. RESULTS: The mean age of participants was 58.64 +/- 8.14 years. The mean age of menopause was 47.21 +/- 4.36 years. Urinary frequency was found to be the most common postmenopausal urogenital symptom (16.5%), followed by stress incontinence (10.4%), dyspareunia (10%), and vaginal dryness (9.6%). Risk factors investigated were found not to affect the prevalence of the vaginal symptoms in postmenopausal women. Dysuria was found to be more common in women with diabetes mellitus (P = 0.022) and in women who had given birth to more children (P = 0.018). Stress incontinence was more common in those 60 years of age or older (P = 0.03), in those who had been in the postmenopausal period for more than 20 years (P = 0.01), and in those who had more than three pregnancies (P = 0.047) or who had given birth to more than three children (P = 0.011). Diabetes mellitus (P = 0.001) and use of hormone therapy (P = 0.001) significantly increased the prevalence of urinary frequency. CONCLUSIONS: Urogenital symptoms observed in our population were found to be fewer than reported previously. Symptoms that appear in the postmenopausal period may be related to several factors such as age, number of births, time elapsed since menopause, presence of diabetes mellitus, and use of hormone therapy, but this topic requires further study.

The mean platelet volume in gestational diabetes.

OBJECTIVE: To compare the platelet count and mean platelet volume (MPV) values of pregnancies diagnosed with gestational diabetes with those of healthy pregnancies. MATERIAL-METHOD: Between June 2003 and September 2004, 100 healthy pregnancies and 100 pregnancies with gestational diabetes were studied at Gazi University, Department of Obstetrics and Gynecology. RESULTS: While no statistically significant difference was observed in the platelet count between the two groups, the MPV of the gestational diabetes group (9.4 +/- 1.6 fl) was evaluated to be significantly higher than the MPV of the healthy pregnancy group (8.3 +/- 1.1 fl). Additionally, when linear regression analysis was performed an inverse relationship was observed between platelet number and MPV. CONCLUSION: There is a need for further research focusing on the platelet function in the observation and treatment of gestational diabetes, which can pose the risk of developing Type 2 diabetes for the mother and has negative consequences for the fetus.

Effects of four different regimens of hormone replacement therapy on hemostatic parameters: a prospective randomized study.

OBJECTIVE: To compare the effects of four different regimens including oral and transdermal formulations with or without progestins on the hemostatic system in a prospective randomized fashion. METHODS: Eighty-eight women were randomized to four groups receiving continuous transdermal estradiol 50 microg/day (tE2), oral conjugated equine estrogen 0.625 mg/day (CEE 0.625 mg), oral conjugated equine estrogen 0.625 mg/day plus medroxyprogesterone acetate 2.5 mg/day (CEE 0.625 mg/MPA 2.5 mg), or oral 2 mg 17-beta estradiol combined with 1 mg norethistrone acetate (E2/norethistrone). The hysterectomized patients received only estrogen, and the remaining women received the estrogen plus progesterone combination regimens. As a marker of hemostatic system fibrinogen, tissue plasminogen activator (tPA), and plasminogen activator inhibitor-1 (PAI-1) levels were measured initially, and after 1 and 6 months of therapy. RESULTS: The treatment groups were well matched for baseline characteristics including age, height, weight, body mass index, and systolic and diastolic blood pressures. During the study period fibrinogen levels were below the baseline values in all groups. However, the decrease was only statistically significant in patients treated with oral 0.625 mg/day CEE. tPA levels were decreased significantly by tE2, CEE 0.625 mg, and CEE 0.625 mg/MPA 2.5 mg. PAI-1 levels were decreased significantly by CEE 0.625 mg, and CEE 0.625 mg/MPA 2.5 mg. When the effects of the four different regimens were compared using percentage changes from the baseline, no significant difference was found among the treatment groups. CONCLUSION: One of the treatment regimens resulted in a more coagulable state. Oral therapy with CEE decreased the levels of all parameters, and MPA did not impair this beneficial effect, except for in fibrinogen. Transdermal therapy had a minimal effect. No significant difference was noted among the four regimens.

Immunohistochemical localization of endothelin-1 in human placenta from normal and growth-restricted pregnancies.

The purpose of this study was to investigate whether the localization of endothelin-1 (ET-1) immunoreactivity differs in human placental tissues from third-trimester normal and intrauterine growth restricted (IUGR) pregnancies. Immunohistochemistry for ET-1 was performed on human placentas from 30 IUGR and 30 uncomplicated pregnancies matched for gestational age. The distribution and intensity of ET-1 immunoreactivity was assessed by a semiquantitative scoring system. Doppler flow velocity waveform analysis of the umbilical artery was performed in each patient before delivery. ET-1 was localized diffusely in placental specimens from normal and IUGR pregnancies. The localization of ET-1 immunoreactivity was significantly higher in the capillary endothelial cells of villi as well as in the endothelial, decidual, and trophoblastic cells of the basal plate in placentas from normal pregnancies than from IUGR pregnancies. There was no significant difference in placental ET-1 immunoreactivity between IUGR pregnancies with normal and abnormal umbilical artery Doppler flow velocity waveforms. Placental ET-1 immunoreactivity was significantly higher in the decidual and trophoblastic cells of the basal plate and the capillary endothelial cells of villi in normal pregnancies than in IUGR pregnancies with normal umbilical artery Doppler flow velocity waveforms. However, only the decidual and trophoblastic cells of the basal plate demonstrated significantly higher abundant localization of ET-1 immunoreactivity in normal pregnancies than in IUGR pregnancies with abnormal umbilical artery Doppler flow velocity waveforms. In conclusion, our findings suggest that the lower expression of ET-1 in placental tissues from IUGR pregnancies might be secondary to an adaptive mechanism to reduce the vasoconstrictor effect of ET-1.

Maternal and fetal plasma endothelin levels in intrauterine growth restriction: relation to umbilical artery Doppler flow velocimetry.

The objective of this study was to examine maternal and fetal endothelin-1 (ET-1) in pregnancies complicated with intrauterine growth restriction (IUGR) and to correlate these data with umbilical artery Doppler flow velocity waveforms (FVW). Higher mean maternal (13.8 +/- 6.4 vs 9.2 +/- 3.4 pmol/L, p < 0.05) and fetal (18.5 +/- 9.6 vs 11.7 +/- 6.9 pmol/L, p < 0.05) ET-1 levels were found in pregnancies complicated with IUGR than in controls. Fetal ET-1 level was related to birth weight percentile for gestational week. Maternal and fetal ET-1 concentrations were not related to umbilical artery Doppler flow S/D ratio, PI and RI. Maternal or fetal ET-1 concentrations were also not related to umbilical artery pH, PO2 and PCO2. Pregnancy-induced hypertension was significantly associated with an elevated fetal and maternal ET-1 concentration. In conclusion, increased production and secretion of ET-1 may play a role in the pathophysiology of idiopathic IUGR. Over-production of ET-1 in IUGR is not associated with increased placental resistance as reflected in abnormal umbilical artery Doppler FVW.

Detection of Helicobacter pylori seropositivity in hyperemesis gravidarum and correlation with symptoms.

The aim of this study was to investigate whether there was a relationship between H. pylori (Helicobacter pylori) infection positivity and characteristics (time and duration) of hyperemesis gravidarum (HG) symptoms. Forty-seven pregnant women with HG and 39 pregnant controls at the same gestational weeks without any gastrointestinal symptoms were included in this prospective study. H. pylori serum Immunoglobulin (Ig) G concentrations were determined by enzyme-linked immunoadsorbent assay (ELISA) in patients with HG and controls. Positive serology for H. pylori was correlated with the duration of symptoms in patients with HG. The prevalence of H. pylori infection was 85.1% (40 of 47) and 64.1% (25 of 39) in patients with HG and controls, respectively (p <0.05, chi (2) test). Mean values of H. pylori IgG (+/- standard deviation) were significantly higher in patients with HG than in controls (22.66 aIU/mL +/- 22.34 vs. 11.54 aIU/mL +/- 13.89, p <0.01, Student's t-test). In HG group, time (gestational weeks) and the duration (weeks) of HG symptoms for patients serologically positive and negative for H. pylori were 6.95 +/- 1.55 versus 6.58 +/- 1.78 weeks, (p >0.05, Student's t-test) and 8.35 +/- 5.28 versus 11.40 +/- 7.17 weeks (p >0.05, Mann-Whitney U-test), respectively. There was no correlation between duration of HG symptoms and serum H. pylori IgG concentrations. Although a majority of pregnant women with HG were serologically positive for H. pylori infection, there was no correlation between positive serology and duration of symptoms, which is not suggestive of a direct causal relationship between H. pylori infection and HG.