Role of Vitamin B12 and Vitamin D levels in intrahepatic cholestasis of pregnancy and correlation with total bile acid.

This study aimed to evaluate the relationship between intrahepatic cholestasis of pregnancy (ICP) and Vitamin D and B12 levels. The study was a retrospective, cross-sectional, case-control study that evaluated 92 ICP cases and 102 pregnant women without any additional disease. ICP cases were grouped as mild and severe according to their total bile acid (TBA) levels, and their relationship with Vitamin D and B12 levels and perinatal outcomes was evaluated. Vitamin D and B12 levels of the ICP group were significantly lower than those of the control group. There was a moderate negative correlation between TBA and Vitamin D levels and a low negative correlation between TBA and Vitamin B12 levels. Adverse neonatal outcomes were significantly higher in the severe ICP group than in the mild ICP group. IMPACT STATEMENTWhat is already known on this subject? The pathophysiology of ICP, which can lead to adverse perinatal outcomes, is not yet fully understood, and there is no preventive treatment.What do the results of this study add? This study showed that Vitamins B12 and D levels were low in women with ICP and that TBA levels were negatively correlated with Vitamin D and B12 levels.What are the implications of these findings for clinical practice and/or further research? This study may guide future studies in terms of explaining the etiopathogenesis of ICP and developing treatment options.

Morbidly adherent placenta and cesarean section methods. A retrospective comparative multicentric study on two different skin and uterine incision.

OBJECTIVES: Morbidly adherent placenta (MAP) is one of leading causes of maternal mortality, with an increasing rate because of repeated cesarean sections (CS). The primary objective of this study is to compare two techniques of skin and uterine incisions in patients with MAP, evaluating the maternal fetal impact of the two methods. Retrospective multicentric cohort study. MATERIAL AND METHODS: A total of 116 women with MAP diagnosis were enrolled and divided in two groups. Group one, comprised of 81 patients, abdominal entry was performed by Pfannenstiel skin incision plus an upper transverse lower uterine segment (LUS) incision (transverse-transverse), which was 2-3 cm above the MAP border, with the uterus in the abdomen. In group two, comprised of 35 patients, abdominal entry was performed by an infra-umbilical midline abdominal incision, by vertical-vertical technique, and the pregnant uterus was incised by a midline incision (vertical) from the fundus till the border of the MAP. Total surgery time, blood loss, blood product consumption, total hospital stay, cosmetic outcomes, and postoperative complications were investigated. RESULTS: Total time of surgery was significantly shorter in group 1 (p < 0.05). Intraoperative blood loss was higher in group 2. Difference between preoperative and postoperative Hb and Htc levels were 3.30 ± 1.04 and 12.99 ± 5.07 respectively (p = 0.012; p = 0.033). The use of erythrocyte suspension (ES), fresh frozen plasma (FFP), and cryoprecipitate and thrombocyte suspension (TS) were found to be significantly lower in patients of group 1than vertical-vertical group (p = 0.008, p = 0.009, p = 0.001, p = 0.001, respectively). There was no difference in terms of total length of hospital stay between groups. CONCLUSIONS: In a subgroup of patients diagnosed for MAP, the transverse-transverse incision resulted in less bleeding, less blood and blood product use, and had better cosmetic results than vertical-vertical incision. Moreover, the total time of surgery, crucial for MAP patients, seems to be shorter also in transverse-transverse incision than in vertical-vertical incision.

The evaluation of ventricular functions by speckle tracking echocardiography in preeclamptic patients.

Preeclampsia is a maternal disorder of pregnancy characterized by concomitant increase in preload and afterload with end organ dysfunction. The aim of our study is to evaluate left ventricular (LV) and right ventricular (RV) functions with speckle tracking echocardiography in preeclamptic patients. Fifty-five preeclamptic (mean age: 30.7 ± 5.9 years) and 35 healthy pregnant women (mean age: 28.8 ± 5.7 years) of the same race, similar age and gestational week were consecutively included. The diagnosis of preeclampsia was based on the criteria proposed by the American College of Obstetricians and Gynecologists. LV and RV functions were assessed by both conventional and speckle tracking echocardiography after the 30th gestational week and at the postpartum 6th months. The preeclamptic patients had significantly larger left atrium, thicker interventricular septum, higher systolic pulmonary artery pressure and mitral E/e' ratio compared to controls during pregnancy while LV ejection fraction was similar. Preeclamptic patients had significantly lower LV and RV global longitudinal strain (GLS) during pregnancy compared to controls (- 18.0 ± 2.6% vs. - 19.8 ± 2.1% p = 0.001 and - 26.7 ± 3.3% vs. 28.9 ± 3.3% p = 0.002, respectively). In the postpartum period, while LVGLS values of preeclamptic patients increased significantly (- 18.0 ± 2.6% vs. - 20.4 ± 2.4% p < 0.001) and became similar to those of controls at the sixth month, the RVGLS decreased significantly (- 26.7 ± 3.3% vs. - 25.8 ± 2.7% p = 0.003) making the difference in RVGLS between the preeclamptic patients and controls more prominent. Preeclampsia may impair LV and RV function. Long-term follow up with larger sample is needed to determine the clinical relevance of the observed changes in strain.

Predictors of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy.

OBJECTIVES: Our objective was to evaluate in our clinic the perinatal outcomes of patients diagnosed with ICP based on pre-treatment maternal serum bile acid levels, attempt to identify the risk group and review the literature in light of this information. MATERIAL AND METHODS: In total, 370 patients diagnosed with ICP were included in the study, divided into two groups based on the fasting total serum bile acid level before UDCA (Group 1: 10 ≥ 40 µmol/L, and Group 2: ≥ 40 µmol/L). The groups were examined for clinical characteristics and pregnancy outcomes. RESULTS: It was found that preterm delivery and neonatal intensive care need increased at a serum bile acid cut-off value of 34 µmol/L. Regardless of serum bile acid, significantly higher rates of meconium-stained amniotic fluid and foetal distress were observed in patients whose diagnoses were made before 34 weeks of gestation. CONCLUSIONS: Foetal complications over 40 µmol/L of serum bile acid were significantly increased. However, slightly lower levels cut-off values (34 µmol/L) were obtained in terms of preterm birth and neonatal intensive care need. The incidence of meconium-stained amniotic fluid and foetal distress was higher in patients whose diagnosis were made before 34 weeks of gestation.

Long-term MBR performance of polymeric membrane modified with Bismuth-BAL chelate (BisBAL).

An ultrafiltration membrane prepared by polyethersulfone (PES) was modified with Bismuth-BAL chelate (BisBAL) and was used in submerged membrane bioreactor system. Moreover, a control membrane reactor was also tasked to evaluate the effect of BisBAL on the membrane performance. The flux profile, transmembrane pressure, the effect of chemical treatment, cake layer formation, anti-fouling properties against extracellular polymeric substances (EPS) and soluble microbial products (SMP) were studied. The UF modified membrane demonstrated a sustained permeability, low cleaning frequency, and longer filtration time. In terms of anti-EPS and SMP accumulation, the modified membrane showed a lower membrane resistance. It can be illustrated from scanning electron microscopy and confocal laser scanning microscope images that the modified membrane had presented better properties than bare PES membrane, as it was looser and thinner. Thus, the UF membrane proved to be more efficient in terms of permeability and lifetime.

The Happiness, Hardiness, and Humor Styles of Students with a Bachelor's Degree in Sport Sciences.

Happiness, psychological hardiness, and humor ("the 3Hs") are useful ways of assessing resilience to stress in positive psychology. The literature analyzing their confluence regarding sports is scarce. This study aims to analyze the participants' 3H levels and the relationships between those levels and specific variables. The Psychological Hardiness Scale (Psikolojik Dayaniklilik Olcegi, PDO), the Oxford Happiness Questionnaire Short Form (OHQ-SF), and the Humor Styles Questionnaire (HSQ) were used. Students in pedagogical formation training during the 2016⁻2017 fall semester have participated in the study (N = 211). Significant differences were found regarding the levels of psychological hardiness in relation to gender, type of sport, and years of participation, and, in humor types regarding the variables of gender, age, residence and perceived income. There were significant differences in all instruments regarding gender. Negative relationships were found between the "aggressive humor" and "challenge" and "self-commitment" sub-dimensions of PDO, while the relationships were positive between "self-enhancing humor" and PDO and OHQ-SF, and between "affiliative humor" style and PDO and OHQ-SF. This study enhances the positive socio-psychological account in the literature by incorporating the issues of 3H and provides an understanding of particularities that may help improve the practice of relevant experts and individuals.

Susceptibility-weighted magnetic resonance imaging for the evaluation of deep infiltrating endometriosis: preliminary results.

BACKGROUND: Knowledge of the precise sites of deep infiltrating endometriosis (DIE) lesions is essential for preoperative workup and treatment. Susceptibility-weighted imaging (SWI) has high sensitivity for blood products and have recently been applied in abdominal imaging. PURPOSE: To determine the value of SWI in the diagnosis of DIE. MATERIAL AND METHODS: Forty-three clinically suspected DIE patients with sonographically diagnosed ovarian endometriomas who had tenderness or palpable nodule(s) on rectovaginal examination were referred to pelvic magnetic resonance imaging (MRI) including SWI. Two patients were excluded from the study because of low quality of SWI series. Twenty-eight patients who were offered laparoscopic endometriosis surgery (LES) preferred medical treatment over surgical approach. Thirteen out of 41 participants had LES. Lesions were evaluated for their locations, signal intensities on T1-weighted (T1W) and T2-weighted (T2W) images, and presence of signal voids on SWI using 3T MRI and correlated with LES findings. RESULTS: A total of 18 endometriosis foci were laparoscopically removed from 13 patients. DIE lesions removed at laparoscopy were located at the uterosacral ligament (9/18), rectovaginal region (4/18), retrocervical region (2/18), and fallopian tubes (3/18). Eleven out of 18 (61%) DIE foci were detected by their high-signal intensities on T1W images whereas 16 out of 18 (89%) DIE foci were detected by signal voids on SWI. CONCLUSION: SWI imaging with its high sensitivity to blood products, contributes to the diagnosis of DIE by depicting different phases of hemorrhage not seen by conventional MRI sequences.

Comparing women doing regular exercise with sedentary women in terms of certain blood parameters, leptin level and body fat percentage.

This study aims to compare the women engaged in doing regular exercise and those having done exercise previously and now not doing it or never done it before in terms of such blood values as leptin, cholesterol, insulin, glucose, triglyceride levels and body fat percentage (BFP) and to investigate the effects of regular exercise on these values. The participants of the study consisted of 35 (sportswomen) women doing regular exercise and 35 healthy and sedentary female university students never involved in doing regular exercise before. With the permission of the ethics committee, measuring was made. The mean (X) age of those doing regular exercise was 18.03 +/- 0.81 years, X height was 163.62 +/- 5.28 cm, X weight was 57.12 +/- 5.77 kg, and training background 7.34 +/- 1.75 years. X age of sedentary group was 18.91 +/- 0.72 years, X height was 164.45 +/- 5.44 cm, X weight was 58.15 +/- 4.68 kg. Statistically significant differences were found between the two groups in terms of the values of HDL and Triglyceride (p < 0.05), Total Cholesterol (p < 0.01), leptin, BFP, and insulin (p < 0.001). The other variables exhibited no statistically significant difference (p > 0.05). The increase in serum leptin levels is directly correlated with BFP. It has also been observed that regular exercise, as it reduces BFP, suppresses serum leptin levels. Regular exercise is significant in the regulation of body weight and prevention of obesity. It is concluded that if regular and moderate exercise is supplemented by good nutrition to avoid cardiovascular risk factor, to reduce LDL level, to bring about an increase in the level of HDL, this creates a positive influence on hormones and body fats and that exercise could be an important factor in enhancing the quality of life.