Circulating s-Endoglin concentrations in non-obese patients with gestational diabetes mellitus.

The aim of this study was to compare maternal concentrations of soluble Endodlin (s-Endoglin) in women with gestational diabetes (GDM) and women with normal glucose tolerance (NGT) in pregnancy. Also, the association of insulin resistance markers and s-Endoglin was investigated. Forty patients complicated by GDM and forty gestational age-matched healthy pregnant women with NGT were included in the present study. s-Endoglin level was higher in patients with GDM compared with the control group (p .01). Besides a positive correlation was found between s-Endoglin and fasting glucose (r = 0.206, p = .057), insulin (r = 0.302, p = .005), HbA1c (r = 0.376, p < .01), HOMA-IR values (r = 0.283, p = .008) in pregnant women included in the study. s-Endoglin, as an anti-angiogenic marker seemed to have a role in pathogenesis and significantly associated with insulin resistance markers in non-obese GDM, thus may play important roles in the regulation of glucose hemostasis.Impact StatementWhat is already known on this subject? In women with GDM, hyperglycaemia induced glycosylation products might cause oxidative stress that may be subsequently involved in the release of inflammatory mediators, inducing angiogenesisWhat the results of this study add? s-Endoglin has an anti-angiogenic effect and is a useful marker of endothelial injury, activation of inflammation, senescence and oxidative stress, we speculate that it may be involved in the pathogenesis of GDM.What the implications are of these findings for clinical practice and/or further research? s-Endoglin seemed to have a role in the regulation of glucose hemostasis. Further exploration of novel factors like s-endoglin in the pathogenesis of GDM, is essential and valuable to develop new therapeutic strategies for this complex disease and its complications.

Correlation between maternal serum-amniotic fluid anti-angiogenic factors and uterine artery Doppler indices.

PURPOSE: Elevated sFlt-1 and sEng is usually a clue for impending preeclampsia and intrauterine growth restriction. Likewise, uterine artery Doppler ultrasound is being investigated for prediction of similar conditions. In this study, we aimed to explore the possible relations of these two proteins in different body compartments with uterine artery Doppler indices (UtAD) in a healthy second trimester obstetric population. METHODS: Levels of sFlt-1 and sEng were measured in serum and amniotic fluid samples of 43 patients. UtAD were measured on the days of sample collections. Findings were then analyzed for possible correlation. RESULTS: There was a positive correlation between the levels of maternal serum sFlt-1 (MSsFlt-1) and sEng levels (MSsEng) (r= 0.516, p< 0.001). The negative correlation between MSsFlt-1 and UtAD was disappeared after elimination of poor obstetric outcome pregnancies (r= -0.371, p= 0.016). No correlation was found between UtAD and studied protein levels in amniotic fluid. Mean MSsFlt-1 level was 305.2 ± 220.1 pg/ml and mean AFsFlt-1 was 48.9 ± 11.8 ng/ml. Mean MSsEng level was 4.5 ± 1.3 ng/ml, mean AFsEng level was found 0.7 ± 0.3 ng/ml. Mean values for UtAD were 1.3 ± 0.4, 0.6 ± 0.1 and 3.5 ± 1.3 for PI, RI, and S/D, respectively. CONCLUSION: In normal second trimester pregnancies, there is a positive correlation between serum levels of sFlt-1 and sEng levels. Amniotic fluid levels of sEng and sFlt-1 are not correlated with UtAD in uncomplicated pregnancies.

Maternal serum concentrations of s-Endoglin and IL-6 in pregnancy complicated by preterm premature membrane rupture.

OBJECTIVE: This study aimed to investigate maternal serum concentrations of s-Endoglin and compare s-Endoglin with other inflammatory markers in prediction of time to delivery, in pregnancies complicated by preterm premature rupture of membranes (PPROM). MATERIALS AND METHODS: Fifty five patients complicated by PPROM whose gestational age were between 2433 weeks and 44 matched healthy pregnant women were included in present study. Maternal concentrations of s-Endoglin concentrations were measured by an enzyme-linked immunosorbent assay (ELISA) and compared with maternal inflammatory markers including interleukin-6 (IL-6), white blood cell (WBC) count and serum C-reactive protein (CRP). The best variable for prediction of preterm birth was computed. RESULTS: Mean s-Endoglin levels in PPROM were lower than control groups (0.24 ± 0.12 pg/ml and 0.69 ± 0.25 pg/ml, respectively, p < 0.01). Besides IL-6 (p < 0.01), WBC (p = 0.016) and CRP (p = 0.010) levels were higher in PPROM group. In PPROM group, ROC analysis results of s-Endoglin for prediction of preterm delivery <48 h, <7 days, <32 weeks were not different (p > 0.05). For predicting preterm birth before 48 h and 7 days, only IL-6 at cut off value >0.70 (pg/ml) and >0.55 (pg/ml) had area under curve (AUC); 0.871 (0.7750.965), p < 0.01, AUC; 0.925 (0.8560.993), p < 0.001, respectively. CONCLUSION: s-Endoglin as an anti-angiogenic marker seemed to have a role in pathogenesis but results of present study showed that, unlike IL-6, it was unsatisfactory for estimating time to delivery in PPROM.

Circulating adropin levels in patients with endometrium cancer.

AIM: Adropin is a recently identified protein in liver, brain and many peripheral tissues, which is important in energy homeostasis. The purpose of this study is to determine adropin levels in patients with endometrium cancer (EC). MATERIAL AND METHODS: A total of 74 patients (47 EC patients and 27 healthy controls) were included in the study. Fasting venous blood samples were collected from all patients. Serum adropin levels were measured by an enzyme-linked immunosorbent assay (ELISA). The correlations between serum adropin levels and clinicopathologic variables were determined. RESULTS: In body mass index and age-matched groups of patients, adropin levels were determined lower in patients with EC than control group (p < 0.01). Adropin levels were negatively correlated with age (r = -0.265, p = 0.023), homeostasis model-resistance index (HOMA-IR) (r = -0.294, p = 0.005) and fasting insulin levels (r = -0.292, p = 0.001). It was shown that in receiver operator characteristic (ROC) analysis, at cut-off value ≤ 1.055 (ng/ml), adropin had 92.7% sensitivity, 91.5% specificity and had AUC = 0.948, CI; 0.894-1.000 for diagnosis of EC (p < 0.001). CONCLUSION: Adropin seems to be an important protein in pathogenesis of EC. Clearly, there are largely unknown aspects of adropin in EC pathophysiology and require further multi-centered, molecular and genetic studies including high number of cases.

Comparison of maternal and umbilical cord blood HIF-1α and nitric oxide levels in early and late onset preeclamptic pregnancies.

OBJECTIVE: Despite the absence of a complete physiologic-pathologic understanding, common accepted theory for development of preeclampsia is incomplete trophoblastic invasion leading to failed uterine and spiral arteriolar remodeling, causing maternal vascular endothelial dysfunction by secreted molecules in response to decreased placental perfusion, placental hypoxia, and ischemia. Placental angiogenesis is especially ineffective in early onset preeclampsia and fetal morbidity/mortality rates are higher because of further decreased blood flow. In this study, we aim to compare the maternal and umbilical cord blood levels of hypoxia-inducible transcription factor-1α (HIF-1α), which is believed to regulate hypoxia-related transcriptional responses, to play role in activating genes for initial phases of placental development and angiogenesis and a physiologic vasodilator molecule nitric oxide (NO) in normal, early and late onset preeclamptic pregnant women. METHODS: Pregnant women who were diagnosed with preeclampsia (early onset ≤34 weeks; late onset >34 weeks) and delivered in our clinic were enrolled for this prospective case-controlled study. Pregnant women without preeclampsia were recruited as control group. HIF-1α and NO levels in maternal and umbilical cord blood measured and compared among groups. FINDINGS: A total of 46 cases were enrolled for this study, including 25 preeclamptic (13 in the early onset group and 12 in the late onset group) and 21 normal pregnant women in the control group. Comparison of preeclampsia group to controls revealed higher maternal blood HIF-1α levels in the control group, however higher umbilical cord NO levels in the preeclampsia group (p < 0.05 and p < 0.001, respectively). In a second analysis, when compared to control group, both early and late onset preeclampsia subgroups were found to have higher umbilical cord blood NO levels (p < 0.001). RESULTS: In this study, we observed lower maternal blood HIF-1α levels and higher umbilical cord NO levels in preeclampsia group than controls. These findings suggest that umbilical cord blood NO levels in pregnant women with preeclampsia increase in response to hypoxia. However, lower HIF-1α levels in preeclampsia group can be due to our limited number of cases and we think that there is a need for further studies with larger sample size.

Elevated thrombin activatable fibrinolysis inhibitor levels in women with polycystic ovary syndrome.

OBJECTIVE: The aim of the present study was to evaluate plasma concentrations of thrombin activatable fibrinolysis inhibitor (TAFI) in relation with hormonal, metabolic, and hemostatic profile in patients with and without polycystic ovary syndrome (PCOS). STUDY DESIGN: A total of 38 women with PCOS and 37 age and body mass index (BMI) matched controls were eligible for the study. Hirsutism scores, hormonal, metabolic, and hemostatic profile as well as TAFI levels were evaluated in each subject. RESULTS: Women with PCOS exhibited higher plasma concentrations of TAFI levels than controls (107.42 ± 34.77% versus 91.86 ± 23.88%, p = 0.027). TAFI levels were significantly correlated positively with BMI, fasting insulin levels, modified Ferriman Gallwey scores and Homeostasis Model Assessment (HOMA) index, systolic blood pressure, and waist and hip circumferences, whereas negatively correlated with activated partial thromboplastin time (p < 0.05). However, after adjustment for all possible confounding factors, none of the parameters was significantly deterministic on TAFI levels. CONCLUSION: The data of the present study suggested that plasma TAFI levels were higher in women with PCOS as compared with healthy age and BMI-matched controls, indicating impaired fibrinolysis. This hypofibrinolytic state may be responsible for the increased cardiovascular disease risk in women with PCOS.

Wilson's disease presenting with HELLP syndrome; A case report.

Wilson's disease (WD) is an autosomal recessive disorder. It is characterized by toxic accumulation of copper mainly in the liver and brain but also in cornea and kidney due to a defect in biliary excretion of copper. The hepatic manifestation of WD is diverse and may include asymptomatic elevation of aminotransferase, chronic hepatitis, cirrhosis, or acute/fulminant hepatic failure. Characteristic of acute hepatic failure in WD is concomitance of acute intravascular hemolytic anemia. Acute intravascular hemolytic anemia and thrombocytopenia in WD may be interpreted as a feature of Hemolysis, Elevated Liver Enzymes, Low Platelet Count (HELLP) syndrome besides acute liver failure. The differential diagnosis may be very difficult. Here, WD in pregnancy presenting with clinical symptoms of HELLP syndrome and developing acute liver failure in postpartum period is discussed.

Can platelet indices be new biomarkers for severe endometriosis?

Objective. The aim of this study was to investigate whether platelet indices-mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) would be useful as noninvasive biomarkers for determining the severity of endometriosis. Methods. A retrospective review of the medical charts of 164 patients diagnosed with endometriosis and who were operated on between 2001 and 2013 was performed. The stage of endometriosis was determined according to revised American Society for Reproductive Medicine criteria. Results. In patients with advanced endometriosis (Stages 3-4), PLT, PCT levels were found to be significantly higher and MPV, PDW values to be significantly lower when compared to initial endometriosis (Stages 1-2). In addition, there was a significant positive correlation between PLT (r: 0.800, P: 0.001) and PCT (r: 0.727, P: 0.002) and the inflammatory marker white blood cell count (WBC). Conclusion. Our finding may not sufficient for employing platelet indices solely in this differential diagnosis, but our finding could provide a suggestion for clinical physicians so that attention is paid to the value of platelet indices and that these may be taken into account when making decisions about the initial or advanced stages of endometriosis.

Vaginal repair of vaginal vault dehiscence after postpartum hysterectomy.

Vaginal vault dehiscence (VVD) may occur rarely after hysterectomy. Although mostly, a vaginal cuff dehiscence is seen after robotic or laparoscopic hysterectomy, it may also be observed as a complication of abdominal or vaginal hysterectomy. Vaginal repair is one of the techniques used for VVD. Here, we will describe a case of vaginally repaired VVD, associated with intra-abdominal hematoma after postpartum hysterectomy.

Predictors of success of different treatment modalities for management of ectopic pregnancy.

Aim. The purpose of this study was to investigate factors affecting the success of different treatment modalities for the management of ectopic pregnancy (EP). Methods. One hundred and ninety-seven patients with EP, were included in the study. Patients were treated with either intramuscular methotrexate (Mtx) or surgical treatment. Results. Mtx was applied in 97 (49.2%) patients. In 67 patients (69.1%), a single dose of Mtx and in 30 patients (30.9%) a multiple dose of Mtx was applied. Forty-seven (70.14%) patients were successfully treated with a single-dose Mtx. In the multiple-dose group, the success rate was 70% (21/30 patients). The difference between the success rates was not statistically significant. When the initial serum ßhCG value was <1000 mIU/mL, the overall success rate of Mtx treatment was determined to be 86.11%; however, the rate decreased to 42.3% when the ßhCG value was >3000 mIU/mL. On the other hand, if the EP mass diameter was <25 mm, the success rate was 89.28% and decreased to 52.63% when it was ≥25 mm. Conclusion. The results of the study showed that single-dose treatment with Mtx could be as successful as multiple doses. Overall success of Mtx treatment depended on initial ßhCG value and EP mass diameter.

[Investigation of Coxiella burnetii prevalence in women who had miscarriage and their spouses by serological and molecular methods]. / Düsük yapmis kadinlarda ve eslerinde Coxiella burnetii prevalansinin serolojik ve moleküler yöntemlerle arastirilmasi

Coxiella burnetii is the causative agent of the common zoonotic disease known as Q fever. Human infection is mostly maintained by inhalation of contaminated aerosols that originate from infected birth products, milk and urine. Sexual transmission has also been reported. In pregnant women the disease causes abortion during the first trimester, while at later stages it tends to become chronic causing low birth weight babies and premature birth. The aim of this study was to investigate the prevalence of C.burnetii in women who had miscarriages, their spouses and in a control group composed of women with normal delivery by using serological and molecular methods. A total of 89 cases (58 female, 31 male; age range: 21-64 years, mean age: 33.1 ± 7.6 years) were included in the study. Women who had abortion (n= 36) were recruited along with their husbands (n= 31), and 22 women who had normal pregnancy were accepted as controls. Blood and placental tissue samples (after abortion or normal delivery) were collected from all of the female subjects, while blood samples were collected from the males. C.burnetii IgG and IgM antibodies in the sera of patients and controls were analysed by ELISA and indirect fluorescein antibody (IFA) methods, and the presence of C.burnetii DNA was searched in whole blood and placenta samples by using polymerase chain reaction (PCR). In our study, C.burnetii Phase II IgG antibody positivity rates in women who had miscarriages, their spouses and in women with normal delivery were found as 27.8% (10/36), 38.7% (12/31) and 4.5% (1/22), respectively by ELISA, while those rates were detected as 27.8% (10/36), 41.9% (13/31) and 9.1% (2/22), respectively by IFA which was accepted as the reference method. However C.burnetii Phase I IgM, Phase I IgG and Phase II IgM antibodies were not detected in none of the subjects by both methods. The relatively high seropositivity rate in our study group (25/89; 28.1%) was thought to be associated with high rates of livestock breeding in our region. Although C.burnetii IgG seropositivity rate in in women who had miscarriages was higher than women with normal delivery, the difference was not found to be statistically significant (x2= 2.906, p= 0.088). When the results of the women with miscarriages and their spouses were evaluated together, it was detected that C.burnetii IgG antibodies were not determined in the spouses of four seropositive women (two positive with 1/64, two with 1/128 titer); titer was 1/64 in four women and their spouses and two women with 1/128 titer had spouses with 1/64 titer. The determination of high titer phase II IgG positivity in 13% (4/31) of the spouses of women who had miscarriages was of notice. All of the blood (n= 89) and placenta samples (n= 51, 29 were from aborted and 22 from normal delivered women) were negative for C.burnetii DNA by PCR. In conclusion, since livestock breeding is common in our region, in cases with recurrent abortion and premature births, women and their husbands should be screened for C.burnetii.

Vulvar and perianal condyloma superimposed inflammatory linear verrucous epidermal nevus: a case report and review of the literature.

Inflammatory linear verrucous epidermal nevus (ILVEN) is a benign cutaneous hamartoma characterized by intensely erythematous, pruritic, and inflammatory papules that occur as linear bands along the lines of Blaschko. There is a considerable clinical and histological resemblance between ILVEN and linear psoriasis, lichen striatus, linear lichen planus, and invasion of epidermal nevus by psoriasis. The pathogenesis of ILVEN is unknown. It is regarded as a genetic dyskeratotic disease reflecting genetic mosaicism. Here, a case of vulvar and perianal condyloma superimposed ILVEN is presented.