The Role of Total Oxidant and Antioxidant Levels in Follicular Fluid in Unexplained Infertility.

BACKGROUND: Unexplained infertility is defined as the absence of any pathology in the basic evaluation performed in couples who cannot achieve pregnancy after 1 year of unprotected sexual intercourse. The results of tests examining the causes of infertility show no identifiable cause in almost 15% of couples. AIM: The aim of this study was to investigate the effects of reactive oxygen species (ROS) on pregnancy and embryos. METHODS: This study included 200 patients, aged between 20-44 years, with unexplained infertility, who had recurrent intrauterine inseminations failures and hence started in vitro fertilization (IVF)/intracytoplasmic sperm injection treatment. Some amounts of waste follicular fluid samples were collected by embryologists from the oocytes of these patients during the ovum pick-up procedure. Next, total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) values were calculated in the biochemistry laboratory. RESULTS: In terms of pregnancy status, both follicular TOS and OSI values were not significantly different in patients with biochemical and clinical pregnancy, whereas TAS values were significantly higher in patients with pregnancy (P < 0.05). In terms of embryo quality, no significant difference was observed in TAS, TOS, and OSI values between grade 1 and 2 embryos, whereas pregnancy rates were significantly higher in patients who received grade 1 embryo transfer (P < 0.05). However, the follicular fluid TAS levels were significantly lower in smoking patients than in those who did not smoke; TOS and OSI levels were significantly higher. CONCLUSION: This study showed that exposure to oxidative stress might be a causative factor for infertility. In addition, ROS decreased the level of TAS by increasing OSI in the follicular fluid; thus, antioxidant supplementation might be a necessity.

Microbiological properties and volatile compounds of salted-dried goose.

Salted-dried goose is a traditional Turkish product with specific flavor that is produced by dry salting, post-salting, and subsequently air-drying of the goose carcass. In this study, the leg and breast parts of salted-dried goose carcasses were analyzed in terms of microbiological properties and volatile compounds. Lactic acid bacteria and Micrococcus-Staphylococcus bacteria constituted a significant part of microbiota in both leg and breast samples. The Enterobacteriaceae count was below the detectable level (<2 log cfu g-1) in 60% of the leg samples and in 47% of the breast samples. The yeast-mold count was less than 5 log cfu g-1 in 80% of both leg and breast samples. Many volatile compounds belonging to different chemical groups, including aldehydes, aliphatic and aromatic hydrocarbons, esters, alcohols, terpenes, ketones, sulfur compounds, and furans, were identified from samples. The breast samples showed a higher mean amount of hexanal than the leg samples. No significant difference was found between the breast and leg samples in terms of ketones and sulfur compounds. It was also determined that a considerable part of volatile compounds is formed by lipid oxidation.

Comparison of pregnancy rates between patients with and without local endometrial scratching before intrauterine insemination.

OBJECTIVES: To determine the implantation success of local endometrial injury in patients undergoing intrauterine insemination following ovulation induction with gonadotropins as an infertility treatment. MATERIAL AND METHODS: In this prospective randomized controlled trial, ovulation induction was performed with gonadotropins in 80 patients following intrauterine insemination. In 40 patients, local endometrial injury (scratch) was performed in the midluteal phase of the cycle preceding ovarian stimulation with a Novak curette to the posterior side of the endometrial cavity. RESULTS: Fifteen pregnancies (37.5%) and 11 clinical pregnancies (27.5%) occurred in the intervention group, whereas eight pregnancies (20%) and five clinical pregnancies (12.5%) occurred in the control group. Although the pregnancy rates and clinical pregnancy rates were increased in the intervention group, no statistically significant difference was found between the intervention and control groups (pregnancy rates: P=0.084; clinical pregnancy rates: P=0.094). CONCLUSION: Performing local endometrial injury (scratch) in the cycle preceding ovulation induction in patients with a diagnosis of infertility and indication for intrauterine insemination increased the pregnancy and clinical pregnancy rates. This increase was not, however, statistically significant. More randomized, controlled, prospective studies with larger patient numbers are required before the use of iatrogenic induction of local endometrial injury can be recommended in routine clinical practice.

Mitochondrial DNA 4977 bp Deletion in Chronic Cervicitis and Cervix Cancers.

Mitochondrial DNA (mtDNA) mutations have been implied in many diseases including cancer and inflammatory diseases. The aim of this study is to investigate the relationship between the 4977 bp deletion of the mtDNA and chronic cervicitis or cervix cancer in patients. The study included a group of patients with chronic cervicitis or cervix cancer, and a control group consisting of individuals without any cervical tissue disease. A total of 72 subjects in an East Turkish population were included in the study. Of these, 35 had chronic cervicitis, 21 had cervix cancer and 16 served as the control group. Isolation of mtDNA was performed from the tissues of these patients and then mtDNA deletions were studied using polymerase chain reaction (PCR). In the cancer groups, there were 9.5% heteroplasmic and homoplasmic deletions. There were no homoplasmic deletions in the cervicitis and control groups, but the frequencies of heteroplasmic deletions were 80.0 and 31.2%, respectively. Chronic inflammation leading to increased reactive oxygen species (ROS) may be the cause of the high mtDNA 4977 bp deletion frequencies in cancer and cervicitis. The older age of the cancer patient may suggest that ageing in addition to long time exposure to ROS may lead to deletions and subsequently cancer. This is the first study to investigate the relationship of the mtDNA 4977 bp deletion to chronic cervicitis and cervix cancer.

Albumin/creatinine ratio for prediction of 24-hour albumin excretion of > or =2 g in manifest preeclampsia.

PURPOSE OF INVESTIGATION: To compare whether albumin/creatinine ratios obtained from random or 8-hour urine collected in different periods of day differ in prediction of albumin excretion > or =2 g in 24-hour urine collection in preeclampsia. METHODS: From a total of 70 women, 24-hour urine collected by three consecutive periods of eight hours and three random urine samples were taken before each period. The variation of albumin-creatinine ratios in samples across the day was analyzed by the Friedman and inter-assay coefficient variation. For each sample, receiver operator characteristic (ROC) curves were constructed to determine an optimal albumin/creatinine ratio value in the prediction of albuminuria > or =2 g. RESULTS: The albumin/creatinine ratio did not vary significantly over time when all samples pooled. However, there was considerable intra-individual variation in both random and timed urine samples. On ROC analysis, the albumin/creatinine ratio in both random and timed urine samples predicted the 24-hour urine results and there was no difference between samples in prediction of albuminuria > or =2 g. A single optimal cut-off point was not available between samples. The positive and negative predictive values for optimal cut-offs ranged from 48%-88% and 94%-100%, respectively. CONCLUSIONS: The random urine albumin/creatinine ratio was a poor predictor for proteinuria a 2 g in patients with preeclampsia.

Spinal anesthesia with sequential administration of plain and hyperbaric bupivacaine provides satisfactory analgesia with hemodynamic stability in cesarean section.

BACKGROUND: Hypotension during spinal anesthesia is one of the major concerns in cesarean section. To achieve adequate spinal anesthesia with less hypotension, we evaluated the viability of sequential subarachnoid injection of two different baricities of bupivacaine. We used plain bupivacaine 5mg to obtain dense anesthesia of the surgical site, followed by hyperbaric bupivacaine 5mg to achieve spread to T5 anesthesia to address visceral pain. METHODS: In this double-blind prospective study, 72 parturients undergoing cesarean section were randomized to receive either hyperbaric bupivacaine 10mg or 5mg each of plain and hyperbaric bupivacaine sequentially for spinal anesthesia. Loss of pinprick sensation to T6 was regarded as sufficient for cesarean section to proceed. Characteristics of anesthesia, episodes of hypotension, bradycardia and ephedrine use were assessed by blinded observers. RESULTS: Demographic data, characteristics of anesthesia, quality of intraoperative anesthesia and Apgar scores were similar in the two groups. Compared to hyperbaric bupivacaine, the combination of plain and hyperbaric bupivacaine provided a marked decrease in the incidence of hypotension (13.9% vs. 66.7%, P<0.001) and side effects related hypotension such as nausea and vomiting (13.9% vs.52.8%, P<0.001). The amount of ephedrine administered was significantly lower in the plain and hyperbaric bupivacaine group (2.2+/-1.0mg vs. 20.5+/-8.7 mg (P<0.001). CONCLUSIONS: Sequential subarachnoid injection of plain and hyperbaric bupivacaine for cesarean section can provide reliable spinal anesthesia with a lower incidence of hypotension and vomiting.

Placental tissue iodine level and blood magnesium concentration in pre-eclamptic and normal pregnancy.

OBJECTIVE: To assess iodine concentration in the placental tissue and magnesium concentration in the blood of women with severe pre-eclampsia in northeast Anatolia and compare these values with those of healthy pregnant women from the same region. METHODS: Placental tissue and blood specimens were obtained from 20 severely pre-eclamptic and 15 healthy pregnant women. Iodine levels in placental tissue were determined by the Foss method based on the Sandell-Kolthoff reaction. RESULTS: Placental tissue iodine levels were lower in women with severe pre-eclampsia than in healthy pregnant women (4.30+/-1.36 ng of iodine/mg protein vs. 7.71+/-2.84 ng of iodine/mg tissue protein; P<0.001), as were blood magnesium levels (1.63+/-0.05 mg/dL vs. 1.87+/-0.05 mg/dL; P<0.001). There was a positive correlation between placental tissue iodine levels and blood magnesium levels in women with severe pre-eclampsia (r=0.55, P<0.05), but no such correlation was observed in healthy pregnant women (r=0.23, P=0.41). CONCLUSION: Magnesium assimilation is known to be defective when iodine levels are insufficient. In northeast Anatolia, where iodine deficiency is common, clinical trials of iodine supplementation should be considered for pre-eclamptic therapy.

Placental tissue cyclo-oxygenase 1 and 2 in pre-eclamptic and normal pregnancy.

OBJECTIVE: To investigate the activities of the 2 isoforms of prostaglandin synthetic enzyme cyclo-oxygenase (COX), COX-1 and COX-2, in the placental tissue of women with pre-eclampsia and healthy pregnant women. The relationship between placental lipid peroxidation and the activities of COX-1 and COX-2 was also investigated. METHODS: Tissue specimens were obtained from pre-eclamptic women (20 had severe pre-eclampsia and 38 had mild pre-eclampsia) and 27 healthy pregnant women who underwent cesarean section before the onset of labor. Malondialdehyde (MDA) levels and COX-1 and COX-2 activities were measured in placental tissue homogenates. RESULTS: Mean activities for COX-1 and COX-2 were significantly lower in women with severe pre-eclampsia than in healthy controls (P<0.05 and P<0.01, respectively). COX-1 and COX-2 activities were also lower in women with mild pre-eclampsia than in healthy controls, but the difference was of borderline significance (P=0.049 and P=0.059, respectively). The mean placental MDA level was significantly higher in pregnant women with severe and mild pre-eclampsia than in healthy pregnant women (P<0.01 for both). The correlation analysis showed significant negative correlations between MDA and COX-1 (r=-0.44, P<0.001) and MDA and COX-2 (r=-0.45, P<0.001) in the placental tissue of women with pre-eclampsia. CONCLUSION: These results suggest that COX-1 and COX-2 activities are decreased in the placental tissue of women with pre-eclampsia, probably by oxidative stress.

Measurement of plasma glutathione S-transferase in hepatocellular damage in pre-eclampsia.

Glutathione S-transferase (GST) is a cytosolic enzyme found in high concentrations in the liver. We investigated the value of plasma GST measurements in pre-eclamptic patients. A total of 80 patients (40 in the pre-eclampsia group and 40 in the control group) were recruited. All patients were evaluated for GST, alanine aminotransferase (ALT), aspartate aminotransferase and lactate dehydrogenase. Pre-eclampsia was defined as the occurrence, after 20 weeks' gestation, of a diastolic blood pressure greater than 90 mmHg on two or more occasions at least 4 h apart, and concomitant proteinuria greater than 0.3 g/l over a 24-h urine collection period. There was no statistical difference between the pre-eclampsia and control groups in terms of ALT, gestational age, maternal age or number of previous pregnancies; a significant difference was found between the pre-eclampsia and control groups in terms of GST. Preeclampsia represents a significant cause of maternal and perinatal morbidity and mortality. Accurate assessment of hepatocellular damage is essential in the clinical management of these patients. GST levels in pre-eclamptic patients were found to be much higher (131.98 IU/l) than in control patients (68.67 IU/l), and this high level suggests hepatocellular damage. We concluded that measurement of plasma GST might provide an earlier and much more sensitive indicator of hepatocellular damage than other liver-function tests.

Changes in leukocyte, granulocyte and lymphocyte counts following antenatal betamethasone administration to pregnant women.

OBJECTIVE: Preterm labor and premature rupture of membranes are associated with a mild leukocytosis. However, we have observed a higher maternal leukocyte count after antenatal betamethasone therapy. We planned this study to evaluate the effects of antenatal betamethasone treatment on maternal leukocyte, granulocyte and lymphocyte count. METHODS: Forty-six pregnant women with the diagnosis of preterm labor between 28 and 33 weeks of gestation age received 12 mg betamethasone at a 12-h interval. The control group consisted of 50 pregnant women between 28 and 33 weeks of gestational age with no medical or obstetrics problems. After a baseline venous sampling, serial leukocyte, granulocyte and lymphocyte counts were obtained every 6 h until it returned to baseline value. RESULTS: There were no statistically significant differences in the control group with respect to the total leukocyte, lymphocyte, and neutrophil count. Total leukocyte and granulocyte counts were increased by 29.8% and 17.8% within 24 and 12 h after betamethasone injection, respectively (P < 0.01). A significant reduction in lymphocyte count was observed within 12 h (45.4%) after betamethasone injection (P < 0.01). All changes in leukocyte, granulocyte and lymphocyte counts returned to baseline values within 3 days. CONCLUSION: Antenatal betamethasone therapy leads to an increase in maternal leukocyte count and a decrease in lymphocyte count. This effect is transient and any leukocytosis persisting for more than 3 days is not due to betamethasone administration.