Disordered Eating in Young Women with Polycystic Ovary Syndrome.

Polycystic ovary syndrome (PCOS) was the most prevalent endocrine disorder among women. Weight issues were commonly observed and found to be associated with comorbidities. This study aimed to compare Eating Disorder Examination Questionnaire (EDE-Q) scores and Night Eating Questionnaire (NEQ) scores in patients with and without PCOS and analyze the factors associated with disordered eating. Women aged 18-25 years with and without PCOS (n = 110 for each group) were included in the study. All patients completed the EDE-Q, NEQ, Beck Anxiety, and Beck Depression inventories. Disordered eating was found more frequently in women with PCOS than in controls (25.5% vs. 2.7%, p < 0.001). There were no significant differences in NEQ scores between the two groups. Anxiety and depression scores were higher in patients with PCOS than in controls (p = 0.002 and p = 0.001, respectively). PCOS diagnosis (OR: 7.4, CI: [1.63-33.7]; p = 0.010) and high BMI (OR: 1.24, CI: [1.10-1.39]; p < 0.001) were found to be independent factors for disordered eating (EDE-Q global score ≥ 4). Disordered eating was more common in young women with PCOS compared to the control group. PCOS diagnosis and having a high BMI (> 25) were found to be independent factors related to disordered eating in young women with PCOS. Young women with a high BMI or PCOS appear to be at a higher risk of disordered eating than women of the same age. Scanning this group may help clinicians in identifying women at high risk for eating disorders and preventing comorbidities associated with them.

The relationship of pain, disability, physical activity, and body awareness with kinesiophobia in pregnant women with low back pain.

PURPOSE/AIM: To investigate the relationship of pain intensity, disability level, physical activity level, and body awareness with kinesiophobia in pregnant women with low back pain (LBP). MATERIALS AND METHODS: This cross-sectional study was conducted in the obstetrics and gynaecologic clinic of a tertiary centre. Eighty-six pregnant women were included in the study. Pain intensity, disability level, physical activity, body awareness, and kinesiophobia were assessed with a Visual Analogue Scale, the Oswestry Disability Index (ODI), the International Physical Activity Questionnaire-Short Form (IPAQ-SF), the Body Awareness Questionnaire (BAQ), and the Tampa Scale for Kinesiophobia (TSK), respectively. RESULTS: Kinesiophobia score was high in pregnant women with LBP (40.01 ± 9.02). In pregnant women with LBP, a weak positive correlation was found between kinesiophobia with mean intensity of LBP (r = 0.339, p = 0.001) and intensity of LBP in activity (r = 0.283, p = 0.008); a moderate positive correlation between kinesiophobia and disability score (r = 0.539, p = 0.001); and a weak negative correlation between kinesiophobia and physical activity level (r = -0.308, p = 0.004) and body awareness (r = -0.324, p = 0.002). There was no relationship between kinesiophobia and intensity of LBP at rest (r = 0.160, p = 0.142) and nocturnal LBP intensity (r = 0.176, p = 0.105). CONCLUSIONS: LBP intensity, disability level, physical activity level, and body awareness were significantly correlated with kinesiophobia in pregnant women with LBP. Therefore, kinesiophobia may be addressed as an important issue in pregnancy education programs.

Evaluation of Women's Sexual Functions After COVID-19 Infection.

Objectives: Sexual health is an essential component of life quality. In this study, we aim to compare the sexual dysfunction of women who had a history of COVID-19 and those who did not have been infected by COVID-19. Methods: This study was conducted in a tertiary center between May 2020 and December 2020. Our study group included 50 women treated for COVID-19 at home, and control group included 51 women with no history of COVID-19. Female Sexual Functioning Index (FSFI) was used to assess of these patients' sexual dysfunctions. Results: Sexual dysfunction in women with a history of COVID-19 was found to be significantly higher than those with no history of COVID-19. Sexual dysfunction development risk in women with a history of COVID-19 (study group) was 3.4 times higher compared to women with no history of COVID-19 (control group) (p=0.008). In addition, high number of children and low economic status were found to be predictive for sexual dysfunction after recovery (p=0.02 and p=0.024, respectively). Arousal, orgasm, satisfaction subscale scores, and total FSFI scores in women with a history of COVID-19 were significantly lower than those with no history of COVID-19 (p=0.011, p=0.002, p=0.028, and p=0.008, respectively). Conclusion: Sexual dysfunction in the patients with a history of COVID-19 seems to be higher than in women with no history of COVID-19. Increased parity and low economic status are predictive for sexual dysfunction after treatment. There is a need for future studies relating to the effect of the COVID-19 infection in women's sexual functions.

Levonorgestrel-Releasing Intrauterine Device Use Can Be a Treatment Option in Symptomatic Patients with Isthmocele.

Levonorgestrel-releasing intrauterine devices have been used for contraception and treatment of heavy menstrual bleeding. There is only limited data about the effect of this on isthmocele. Here, we aimed to evaluate the effect of levonorgestrel-releasing intrauterine devices in a larger study population with a longer follow-up as compared to the literature on symptomatic patients with isthmocele. A total of 29 patients with symptomatic isthmocele and inserted levonorgestrel-releasing device were included in this prospective study. All patients were included at January 2020 and followed for 18 months. Sociodemographic findings, laboratory parameters, premenstrual spotting, postmenstrual spotting, menorrhagia, dysmenorrhea, and pelvic pain related to isthmocele were recorded. In sonography, width, length, area of isthmocele, and residual myometrial thickness were determined. The frequency of symptoms during follow-up was compared between visits and also compared between groups according to residual myometrial thickness. Premenstrual spotting and pelvic pain were significantly reduced at 6th months (48.3 to 10.3%, p = 0.007 and 34.5 to 10.3%, p = 0.039, respectively) and no significant change was detected until the end of follow-up period. Postmenstrual spotting reduced at 6th months (96.6 to 34.5%, p < 0.001) and also significant change was detected between 6 and 12th months (34.5% vs 13.8%, p = 0.031). Menorrhagia and dysmenorrhea disappeared at 12th months. No association was found between residual myometrial thickness and the frequency of symptoms for each follow-up. Levonorgestrel-releasing intrauterine devices are useful and reliable therapeutic tools for symptomatic isthmocele patients who do not desire fertility, regardless of residual myometrial thickness.

Serum kisspeptin, to discriminate between ectopic pregnancy, miscarriage and first trimester pregnancy.

The present study aimed to determine serum kisspeptin levels which is an emergent marker regarding trophoblastic invasion, in patients with different types of early pregnancy. We also aimed to investigate whether kisspeptin can be used for differential diagnosis of ectopic pregnancy or miscarriage from early pregnancy. This was a prospective case-control study that was conducted at a tertiary centre of obstetrics and gynaecology. Four groups of women (81 patients) enrolled in the study: group 1, women with ectopic pregnancy (n = 17); group 2, women with miscarriage (n = 23); group 3, women with healthy pregnancy at first trimester (n = 21); and group 4, healthy non-pregnant women (n = 18). Serum kisspeptin levels were found as 0.30 (0.22-0.40), 0.11 (0.08-0.16), 1.48 (1.29-1.80), and 0.03 (0.01-0.04) ng/mL in ectopic, miscarriage, healthy pregnancy and non-pregnant groups, respectively (p< .001). A moderate correlation was seen between serum kisspeptin levels and human chorionic gonadotropin (ß-hCG) (r= 0.51, p< .001). Our data showed that for the first time that a single serum kisspeptin level may be used to discriminate ectopic pregnancy or miscarriage from healthy pregnancy at early weeks' gestation. In addition, serum kisspeptin levels of the patients with ectopic pregnancy were found higher significantly than the patients with miscarriage.Impact StatementWhat is already known on this subject? Definite diagnosis of abnormal or abnormal pregnancies at first trimester is based on hCG levels and ultrasonography. Kisspeptin, a neuropeptide was investigated in normal pregnancies and found to be increased in trophoblastic invasion.What do the results of this study add? Serum kisspeptin levels in patients with normal pregnancy were found more higher than patients with ectopic or miscarriage at early weeks of gestation (p < .001). The women with ectopic pregnancy have higher kisspeptin levels than the women with miscarriage (p < .001).What are the implications of these findings for clinical practice and/or further research? These findings can be used to make differential diagnosis between abnormal and normal early pregnancies. In future studies with more sample size, serum or plasma kisspeptin levels in early weeks of gestation can be investigated.

Predicting previable preterm premature rupture of membranes (pPPROM) before 24 weeks: maternal and fetal/neonatal risk factors for survival.

We sought to compare maternal and neonatal risk factors in cases with previable premature rupture of membranes (pPPROM, between 14-24 weeks) for optimal counselling. Therefore, 192 pregnancies of 485 cases which met selection criteria and agreed to follow-up were retrospectively analysed. Mean gestational age at pPPROM was 20.45 weeks. Live births occurred in 171 cases, but 67 (39.2%) of them died in the neonatal period (neonatal death group) and 104 cases (60.8%) constituted surviving neonate group. Of the surviving neonates, 37 (33.7%) experienced at least one complication. Most seen maternal complications were chorioamnionitis (24.48%) and placental abruption (8.33%). Although amniotic fluid volume, length of pPPROM period, completing antibiotherapy and CRP values were significant, amniotic fluid volume and length of pPPROM showed also significance for multivariate regression analysis for maternal risk factors. Risk factors for birth were gestational age at pPPROM, gestational age at birth, new-born weight at birth, 1st and 5th minute Apgar scores, umbilical cord pH value and need for neonatal resuscitation. Furthermore, development of respiratory distress syndrome, necrotising enterocolitis, intraventricular haemorrhage and retinopathy of premature were additional risk factors for neonate. Of them, gestational age at birth, new-born weight at birth, respiratory distress syndrome and retinopathy of prematurity were also significant in multivariate regression analysis.Impact StatementWhat is already known on this subject? Management of previable premature rupture of membranes is controversial and there is no definite consensus on the approach. The factor that best predicts neonatal survival is the gestational age at birth (Deutsch et al. 2010).What do the results of this study add? Appropriate counselling for pPPROM cases is important especially during antenatal period (maternal factors) and postpartum period (neonatal factors). Maternal infection risk is increased with an increased latency period of PPROM. As the gestational age at birth increases, the survival rate increases and neonatal complication rates decrease. Other important determinants of neonatal survival and well-being are the presence of oligo-anhydramnios and latency period of previable PPROM to delivery.What are the implications of these findings for clinical practice and/or further research? Counselling the patient with previable PPROM about pregnancy complications and paediatric outcome is challenging because of the small size, different gestational age ranges, and retrospective nature of the multiple studies on this subject. The most important feature of our study was the relatively high number of patients compared to other series. Thus, we can counsel pregnant women with PPROM prior to 24 weeks of gestation about the maternal antenatal factors and neonatal postnatal factors with related outcomes and help make an informed decision regarding termination or conservative follow-up. Nevertheless, there is a need for larger multicentric prospective studies to validate our data and to establish the prognosis of previable PPROM for both mother and foetus.

Do serum hepassocin levels change in women with polycystic ovary syndrome?

BACKGROUND: Insulin resistance is common in polycystic ovary syndrome (PCOS), especially in obese patients. Hepassocin is a peptid marker which increases in obesity and insulin resistance. OBJECTIVE: We aimed to investigate hepassocin levels in patients with PCOS in this study. METHODS: This prospective case-control study was conducted with a total of 60 patients with PCOS and age-matched 30 healthy women with body mass index < 30. Patients with PCOS were classified as obese PCOS and non-obese PCOS according to their BMI. Hepassocin levels were measured by using a commercially available enzyme-linked immunosorbent assay (ELISA) kit. A multivariate linear regression analysis was used to determine independent factors related to hepassocin levels. RESULTS: Hepassocin levels of the obese-PCOS group were found significantly higher than non-obese PCOS and control group (6.95 ± 3.59, 2.69 ± 2.51, 2.66 ± 2.22, respectively, p < 0.001). There was no significant difference in hepassocin levels between control and non-obese PCOS group (p = 0.99). Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) was independently associated with hepassocin concentrations after adjusting for age, low density lipoprotein C (LDL-C), high density lipoprotein C (HDL-C), triglyceride (TG), total testosterone, dehydroepiandrosterone sulfate (DHEA-S), and C reactive protein (CRP). CONCLUSION: Obese patients with PCOS exhibited high serum levels of hepassocin. HOMA-IR index was found as the independent variable associated with high levels of hepassocin. Hepassocin can be used as a simple and easy way of detecting insulin resistance in obese patients with PCOS.

Endometrial polyps: Is the prediction of spontaneous regression possible?

OBJECTIVE: Endometrial polyps have been considered as a hyperplastic growth of endometrial stromal and glandular tissues. Even asymptomatic polyps in premenopausal women are usually removed as soon as they are diagnosed, although it is still unknown how often endometrial polyps disappear spontaneously. The aim of this study was to investigate the regression rate of endometrial polyps and the possible factors related to their spontaneous regression. METHODS: A total of 197 women with endometrial polyps were treated with operative hysteroscopy between January 2017 and April 2019 at our tertiary center. Of these, 123 patients who preferred conservative follow-up were enrolled in the study. Clinical and pathological data were obtained from electronic medical records. RESULTS: Patients with endometrial polyps were followed up for a median period of 62 days (range 30-360 days). Most women with endometrial polyps (84%) were reported to have gynecologic symptoms. Spontaneous polyp regression was observed in 28 (23%) patients who underwent surgery reevaluation. Patient age (<45 years), premenopausal period, and polyp size (<2 cm) were found to be associated with spontaneous endometrial polyp regression (P<0.05). We also observed more polyp regression in women with abnormal uterine bleeding (P=0.05). Second-look hysteroscopy showed that all postmenopausal women had persistent endometrial polyps. CONCLUSION: Patient age (<45 years), premenopausal period, polyp size (<2 cm), and abnormal uterine bleeding may be associated with spontaneous endometrial polyp regression.

Use of video-based multimedia information to reduce anxiety before office hysteroscopy.

INTRODUCTION: Use of multimedia tools has been shown to improve patient comprehension, reduce pre-procedural anxiety, and increase patient satisfaction in various surgical settings. AIM: To investigate the impact of video-based multimedia information (MMI) on the anxiety levels of patients undergoing office hysteroscopy (OH). MATERIAL AND METHODS: All consecutive women aged 18-65 years and scheduled for diagnostic OH were enrolled in this prospective randomized study. Subjects were assigned to receive video-based MMI or conventional written information (controls). The trait and state anxiety were assessed using the State and Trait Anxiety Inventory (STAI) before the MMI or written information. STAI-state (STAI-S) was repeated after application of the MMI or written information. All patients underwent a standardized transvaginal hysteroscopy procedure by the same gynecologist. Following the hysteroscopy, patient satisfaction and procedural pain were ranked using a Likert scale and visual analogue scale. RESULTS: Fifty-two patients were randomized to receive a video-based MMI, and 52 patients were randomized to receive written information. Post-information STAI-S score was significantly lower in the MMI group than that of the written information group (45.0 ±8.0 vs. 49.4 ±8.4, p < 0.001, 95% CI for the difference: 1.36-7.79). Moreover, the satisfaction rate of the video group was significantly higher than the satisfaction rate of the controls (92.3% vs. 63.5%, p < 0.001). VAS score of procedural pain was similar for the two groups. CONCLUSIONS: A video-based MMI before OH might be preferred to conventional information methods in order to reduce the pre-procedural anxiety and to increase patients' satisfaction.

Comparison of Unilateral and Bilateral Sacrospinous Ligament Fixation Using Minimally Invasive Anchorage.

Objective The aim of this study was to determine the effectiveness of a newly developed anchoring system for unilateral sacrospinous ligament fixation (USSLF) and bilateral sacrospinous ligament fixation (BSSLF) procedures. Material and Methods Ninety-three patients with pelvic prolapse who were treated surgically with the Anchorsure System ® between 2013 and 2018 were included in the study. USSLF was performed in 52 patients (group 1), and BSSLF was performed in 41 patients (group 2). Pelvic organ prolapse was assessed preoperatively and 6 months postoperatively. Results There were no significant differences between groups 1 and 2 with regard to age, parity, and demographic characteristics. Anatomical improvement rates were similar, irrespective of the type of SSLF used. No bleeding requiring blood transfusion or organ injuries occurred in any patient. Three patients in the group that received BSSLF developed small asymptomatic cystoceles (grade 1 to 2); there was no recurrence of rectoceles or enteroceles. Mild cystocele was found in 1 patient from the USSLF group. There was no significant difference between the groups with respect to the recurrence of cystocele. Recurrence of vaginal vault prolapse was found in 2 patients from the USSLF group (3.84%). There was no significant difference between the groups with regard to recurrence. Febrile morbidity, clinical outcomes, blood loss, duration of operation, intraoperative complications, and length of hospital stay were similar for the two groups. Conclusions Unilateral and bilateral SSLF techniques produce similar clinical outcomes. USSLF and BSSLF performed using the new anchoring system are safe and effective methods to treat pelvic organ prolapse.

Adenoid basal carcinoma combined with invasive squamous cell carcinoma of uterine cervix: A case report of a 37-year-old woman and literature review.

Adenoid basal carcinoma (ABC) is uncommon malignancy of the uterine cervix and it can be pure or combined with cervical intraepithelial lesions. There were less than 20 cases of ABC combined with invasive squamous carcinoma (mixed type) in English literature. These cases had similar properties as seen at postmenopausal women and diagnosed with abnormal cervical smear findings. Here we present a case of 37-year-old woman who suffered from spotting and received endocervical curettage. The pathological report revealed squamous cell carcinoma (SCC) of the cervix. The patient underwent type 3 radical hysterectomy and bilateral pelvic and para-aortic lymph node dissection. The final pathological report revealed SCC coexisting with ABC. Human papillomavirus (HPV) 16,18 and others (11 types) were negative in both components of the mixed tumor by in situ hybridization detection. Our case was cytokeratin 7 negative, cytokeratin 8 positive and p63 positive which supports the hypothesis that mixed type cervical carcinoma originates from endocervical reserve cells.

Urinary neutrophil gelatinase-associated lipocalin is associated with preeclampsia in a cohort of Turkish women.

Purpose: We investigated the optimal cut-off level for urinary neutrophil gelatinase-associated lipocalin (NGAL) in preeclamptic patients to confirm the diagnosis. Methods: Urinary NGAL concentrations were measured by specific enzyme-linked immunosorbent assay (ELISA). Results: Patients with preeclampsia had significantly higher urinary NGAL concentrations than controls (mean: 387 ng/ml vs. 188 ng/ml, respectively; P< 0.001). Using a cutoff value 252 ng/ml for urinary NGAL to confirm diagnosis of preeclampsia, sensitivity, and specificity were 92% and 91%, respectively. Conclusion: Urinary NGAL concentrations were significantly elevated in women with preeclampsia versus normotensive controls.