Prognostic and clinicopathological significance of TMEFF2, SMOC-2, and SOX17 expression in endometrial carcinoma.

Background there is a need for novel biomarkers and targeting therapies for predicting Endometrial carcinoma (EC) progression and recurrence. TMEFF2 is a gene that was found to play a role in EMT. SMOC-2 is expressed in embryogenesis and it was identified as a recent stem cell-related gene that has a role in cancer progression. SRY-box 17 (SOX17) is a member of the SRY-related HMG-box (SOX) family of transcription factors. Dysregulation or downregulation of SOX17 expression was found in many cancer tissues. AIM: In the present study, we aimed to assess the tissue protein expressions of TMEFF2, SMOC-2, and SOX17 in EC using immunohistochemistry to evaluate their clinicopathological values and prognostic roles in EC patients. PATIENTS AND METHODS: This is prospective cohort study included 120 patients with EC. Sections from 120 paraffin blocks were retrieved and stained with TMEFF2, SMOC-2, and SOX17 using immunohistochemistry, the expression of markers in all tissue samples was assessed, analyzed and correlation of pathological parameters with the levels of expression was done. All patients were followed up till death or till the last known alive data for about 50 months (range from 25 to 60). RESULTS: TMEFF2, SMOC-2 expression was correlated with the presence of lymph node metastases (p = 0.023), distant metastasis (p = 0.039) recurrence of the tumor after successful therapy, overall survival, and disease-free survival (p < 0.001). SOX17 positive expression was positively correlated with low grade (p = 0.019), absence of lymph node metastasis (p = 0.001), absence of distant metastasis (p = 0.013), low stage (p = 0.03), and its negative expression was positively correlated with recurrence of the tumor after successful therapy, overall survival and disease-free survival (p = 0.001). In conclusion, we demonstrated that both TMEFF2 and SMOC-2 were highly expressed in EC and were associated with a shortened survival rate, dismal outcome, and poor prognosis in EC patients. While SOX17 expression was related to a favorable outcome and its down-regulation was associated with dismal EC patient's survival.

Indications and rate of first cesarean delivery in central region's maternity and children hospital.

OBJECTIVES: To investigate the indications of first (non-repeated) cesarean deliveries, to categorize those indications into absolute and relative according to established guidelines of cesarean deliveries, and to compare the women with absolute and relative indications by demography and pregnancy-related attributes.  Methods: A cross-sectional analysis of delivery data between September and October 2018, at the Maternity and Children Hospital, Buraidah, Al-Qassim, Saudi Arabia. Indications for cesarean deliveries of 200 primary cases were abstracted and were categorized into 'absolute' and 'relative' according to the Association of the Scientific Medical Societies in Germany guidelines.  Results: The leading indications were fetal distress (27.5%), non-progression of labor (22.5%), breech presentation (18%), and failed initiation of labor (4.5%). Of the 200 cases, 26.5% had absolute indications, 50% had relative indications, and 23.5% had indications that were neither absolute nor relative. Women with absolute indications had lower mean gestational age and a higher proportion with greater than 3 gravida than women with relative indications (p less than 0.05). Conclusion: The most common indications for first time cesarean, in decreasing order of frequency, were fetal distress, non-progression of labor, and breech presentation.

Intra-umbilical vein injection of carbetocin versus oxytocin in the management of retained placenta.

INTRODUCTION: Retained placenta can be defined as lack of expulsion of the placenta within 30 min of delivery of the infant. It is a significant cause of maternal mortality and morbidity throughout the developing world. AIM OF THE WORK: The aim of this study was to compare the efficacy of intra-umbilical vein injection of carbetocin versus oxytocin in the management of retained placenta. PATIENTS AND METHODS: A total of 200 women were included in this study. They were divided into two groups; each 100 women. The first group received intra-umbilical vein injection of 1 mL carbetocin (containing 100 µg carbetocin) diluted in 20 mL normal saline 0.9% and the second group received intra-umbilical vein injection of 20 IU oxytocin diluted in 20 mL normal saline 0.9%. RESULTS: Total blood loss (ml) and duration of the third stage of labor (minutes) were significantly lower in carbetocin group when compared to oxytocin group. Postoperative Hb concentration (g/dl) was significantly higher in carbetocin group. Also there was a highly significant difference between both groups as regard change in Hb concentration (g/dl) with less change in the carbetocin group. The need for additional uterotonic drugs following placental delivery and the occurrence of postpartum hemorrhage and the need for blood transfusion were significantly lower in the carbetocin group. CONCLUSION: Intra-umbilical carbetocin is more effective than intra-umbilical oytocin as a method for management of retained placenta. Intra-umbilical carbetocin seems to have more acceptable hemodynamic safety profile when compared to intra-umbilical oxytocin in the management of retained placenta.

Kisspeptin and body weight homeostasis in relation to phenotypic features of polycystic ovary syndrome; metabolic regulation of reproduction.

BACKGROUND: Polycystic ovary syndrome (PCOS) is a heterogeneous disorder characterized by a diverse collection of reproductive and metabolic abnormalities. kisspeptin (KISS) is novel peptides associated with regulation of metabolism, food intake, puberty and reproduction. The aim of the present study was to estimate KISS level in patients with PCOS, and to evaluate the possible relationship between KISS level with anthropometric measures as well as clinic-morphological features of PCOS. MATERIALS AND METHODS: cross section control study enrolled 90 control group and 105 patients with PCOS and they were stratified according to their body mass index (BMI) to; underweight (n = 9, BMI ˂19), normal weight (n = 25, BMI = 19.1-25), over weight (n = 34,BMI = 25.1-30), obese grade I (n = 12, BMI = 30.1-35) , obese grade II (n = 13, BMI 35.1-40) and obese grade III (n = 12, BMI˃40).Circulating KISS levels were measured using ELISA. RESULTS: Our results revealed that, KISS levels were higher in PCOS patients compared to controls. Among PCOS group, there were significant lower level of KISS levels in underweight, overweight and obese compared to normal weight group. Even more importantly, KISS levels decreased with increasing of BMI as the following, grade I, grade II and grade III. Moreover, it was negatively correlated to anthropometric measures, glycemic, lipid profile and positively correlated the phenotype characteristics of PCOS. Linear regression test observed that hirsutism score, HOMA-IR and LH were the main predictors of KISS levels in PCOS. CONCLUSION: circulating KISS is an important regulator of body weight and reproduction especially in PCOS women.

Association of miRNA - 320 expression level and its target gene endothelin-1 with the susceptibility and clinical features of polycystic ovary syndrome.

BACKGROUND: Polycystic ovary syndrome (PCOS) is a common reproductive endocrine disorder characterized by obesity, hyperandrogenism, and insulin resistance (IR). MicroRNAs (miRNAs) are small noncoding RNA associated with ovarian follicle development and female fertility. The objective of this study was to investigate the role of miRNA- 320 and its target gene endothelin-1 (ET-1) as a noninvasive biomarker of PCOS and to evaluate its possible relationship with IR as well as clinic-morphological features of PCOS. METHODS: Case-control study enrolled 60 patients with PCOS and 40 control group. We subdivided our PCOS women according to homeostasis model assessments of insulin resistance (HOMA-IR) to PCOS women with and without IR.ET-1 levels were measured by ELISA. We estimated the serum expression level of miRNA- 320 by real-time polymerase chain reaction. RESULTS: Our results revealed that serum miR-320 expression level was lower in PCOS patients compared to controls, in particular, PCOS women with IR. Moreover, it was negatively correlated to its target gene; ET-I as well as fasting serum insulin (FSI), HOMA-IR, PCOS phenotype; hirsutism score, ovarian volume and antral follicle count (AFC). In the PCOS group, linear regression analysis revealed that only hirsutism and HOMA-IR was the main predictor of expression levels of miRNA - 320 among other clinical and laboratory biomarkers of PCOS. The sensitivity and specificity of serum miR-320 expression levels in diagnosis PCOS was 80, and 97.5% respectively. CONCLUSION: The Expression serum levels of miR-320 were lower in PCOS compared to control and it could be a noninvasive diagnostic biomarker of PCOS.