Metoclopramide Test in Hyperprolactinemic Women With Polycystic Ovarian Syndrome: Old Wine Into New Bottles?

INTRODUCTION: Polycystic ovarian syndrome (PCOS) is the most frequent etiology of anovulation, hyperandrogenism and infertility in women. Its pathophysiology remains poorly elucidated. Hyperprolactinemia (hPRL) is common in women of reproductive age and may partially mimic the clinical phenotype of PCOS. The simultaneous finding of both conditions is therefore not rare, however there are conflicting studies on whether a link exists between them. MATERIALS AND METHODS: We conducted a retrospective monocentric study between 2015 and 2021 and among women who were referred for possible PCOS, we selected those who met the ESHRE/Rotterdam definition criteria. hPRL was defined as two values above the upper limit of normal with at least one measurement in our centre. RESULTS: A total of 430 women were selected, of whom 179 met the PCOS criteria. 50 out of 179 patients (27.9%) had at least one elevated value of PRL and 21 (11.7%) had hPRL according to our definition. Among the 21 women of the PCOS/hPRL cohort, 5 (23.8%) had a microprolactinoma and all of them had PRL level ≥ 60 ng/ml. The remaining cases were macroprolactinemia (n=5), iatrogenic hPRL (n=4), primary hypothyroidism (n=1) or unexplained (n=6) despite exhaustive investigations. The metoclopramide test resulted in an increase of basal PRL < 300% in all prolactinomas and ≥ 300% in all the other etiologies. CONCLUSION: hPRL was a common finding in PCOS women, secondary to a microprolactinoma in a quarter of cases. Metoclopramide test performed in women with hPRL below 60 ng/ml appeared as a helpful tool 1) to discriminate pituitary causes from others etiologies, 2) to potentially avoid unnecessary pituitary MRI.

Comparison of index systems for rating water quality in intermittent rivers.

Water quality indexes (WQI) are a practical way to evaluate and compare the level of chemical contamination of different water bodies and to spatially and temporally compare levels of pollution. The purpose of this study was to check if these indexes are appropriate for intermittent rivers under arid and semi-arid climates. A literature review enabled the comparison of 25 water quality indexes to discern their capability to evaluate spatial (inter and intra catchment) and temporal (high and low water flow conditions) variations in water quality in three Mediterranean intermittent rivers: the River Vène (France) and the Oued Fez and the River Sebou (Morocco). Hierarchical cluster analysis identified groups of WQI with similar behavior and brought to light the 6 most distinguishing indexes. Whatever the hydrological conditions at the two sites, both the ME-MCATUHE and NCS indexes, which were developed for Morocco and Greece, and the CCMEWQI and BCWQI indexes, which were developed for non-arid or semi-arid zones, gave appropriate water quality evaluations.

Rapid proliferation of Vibrio parahaemolyticus, Vibrio vulnificus, and Vibrio cholerae during freshwater flash floods in French Mediterranean coastal lagoons.

Vibrio parahaemolyticus, Vibrio vulnificus, and Vibrio cholerae of the non-O1/non-O139 serotype are present in coastal lagoons of southern France. In these Mediterranean regions, the rivers have long low-flow periods followed by short-duration or flash floods during and after heavy intense rainstorms, particularly at the end of the summer and in autumn. These floods bring large volumes of freshwater into the lagoons, reducing their salinity. Water temperatures recorded during sampling (15 to 24°C) were favorable for the presence and multiplication of vibrios. In autumn 2011, before heavy rainfalls and flash floods, salinities ranged from 31.4 to 36.1‰ and concentrations of V. parahaemolyticus, V. vulnificus, and V. cholerae varied from 0 to 1.5 × 10(3) most probable number (MPN)/liter, 0.7 to 2.1 × 10(3) MPN/liter, and 0 to 93 MPN/liter, respectively. Following heavy rainstorms that generated severe flash flooding and heavy discharge of freshwater, salinity decreased, reaching 2.2 to 16.4‰ within 15 days, depending on the site, with a concomitant increase in Vibrio concentration to ca. 10(4) MPN/liter. The highest concentrations were reached with salinities between 10 and 20‰ for V. parahaemolyticus, 10 and 15‰ for V. vulnificus, and 5 and 12‰ for V. cholerae. Thus, an abrupt decrease in salinity caused by heavy rainfall and major flooding favored growth of human-pathogenic Vibrio spp. and their proliferation in the Languedocian lagoons. Based on these results, it is recommended that temperature and salinity monitoring be done to predict the presence of these Vibrio spp. in shellfish-harvesting areas of the lagoons.

Spatial and temporal trends in water quality in a Mediterranean temporary river impacted by sewage effluents.

This paper analyzes how changes in hydrological conditions can affect the water quality of a temporary river that receives direct inputs of sewage effluents. Data from 12 spatial surveys of the Vène river were examined. Physico-chemical parameters, major ion, and nutrient concentrations were measured. Analyses of variance (ANOVA) and multivariate analyses were performed. ANOVA revealed significant spatial differences for conductivity and major ion but no significant spatial differences for nutrient concentrations even if higher average concentrations were observed at stations located downstream from sewage effluent discharge points. Significant temporal differences were observed among all the parameters. Karstic springs had a marked dilution effect on the direct disposal of sewage effluents. During high-flow periods, nutrient concentrations were high to moderate whereas nutrient concentrations ranged from moderate to bad at stations located downstream from the direct inputs of sewage effluents during low-flow periods. Principal component analysis showed that water quality parameters that explained the water quality of the Vène river were highly dependent on hydrological conditions. Cluster analysis showed that when the karstic springs were flowing, water quality was homogeneous all along the river, whereas when karstic springs were dry, water quality at the monitoring stations was more fragmented. These results underline the importance of considering hydrological conditions when monitoring the water quality of temporary rivers. In view of the pollution observed in the Vène river, "good water chemical status" can probably only be achieved by improving the management of sewage effluents during low-flow periods.

Implication of two in-stream processes in the fate of nutrients discharged by sewage system into a temporary river.

The aim of this study was to better understand the fate of nutrients discharged by sewage treatment plants into an intermittent Mediterranean river, during a low-flow period. Many pollutants stored in the riverbed during the low-flow period can be transferred to the downstream environments during flood events. The study focused on two processes that affect the fate and the transport of nutrients, a physical process (retention in the riverbed sediments) and a biological process (denitrification). A spatial campaign was carried out during a low-flow period to characterize the nutrient contents of both water and sediments in the Vène River. The results showed high nutrient concentrations in the water column downstream of the treated wastewater disposal (up to 13,315 µg N/L for ammonium and 2,901 µg P/L for total phosphorus). Nutrient concentrations decreased rapidly downstream of the disposal whereas nutrient contents in the sediments increased (up to 1,898 and 784 µg/g for total phosphorus and Kjeldahl nitrogen, respectively). According to an in situ experiment using sediment boxes placed in the riverbed for 85 days, we estimated that the proportion of nutrients trapped in the sediments represents 25% (respectively 10%) of phosphorus (respectively nitrogen) loads lost from the water column. In parallel, laboratory tests indicated that denitrification occurred in the Vène River, and we estimated that denitrification likely coupled to nitrification processes during the 85 days of the experiment was significantly involved in the removal of nitrogen loads (up to 38%) from the water column and was greater than accumulation processes.