Maternal and fetal outcomes of COVID-19, SARS, and MERS: a narrative review on the current knowledge.

OBJECTIVE: Coronavirus infections, including SARS, MERS and COVID-19 have significant impact on global health as well as on pregnancies. The aim of this review was to enlighten and summarize the cumulative knowledge regarding the relationship between Coronavirus outbreaks and pregnancy. MATERIALS AND METHODS: Literature search was commenced in order to analyze the maternofetal effects of Coronavirus outbreaks. RESULTS: Fever and cough are the most common presenting symptoms of COVID-19 which mostly affects pregnant women in their 3rd trimester with a maternal mortality rate of  0-77%  and fetal and neonatal mortality rates of 1.2%. Fetal demise is common in critically ill pregnant. Pregnancy seems as a worsening factor for SARS and MERS epidemics and both infections affect prominently 3rd trimester pregnancies, although abortion (57%) is a significant risk for cases of early pregnancy. Clinical course of COVID-19, SARS and MERS may be rapid and worse in pregnant women than non-pregnant individuals. Cesarean section is the choice of delivery in most reported women due to mostly obstetrical reasons, although vaginal delivery seems not a worsening factor for the disease. CONCLUSIONS: COVID-19, SARS and MERS have significant detrimental effect on pregnancy. Rapid intervention, treatment, and intensive care support are essential for infected pregnant. Timely delivery is important in order to avoid intrauterine fetal death.

Relevance between clinical status and exhaled molecules related to neutrophilic inflammation in pediatric cystic fibrosis.

INTRODUCTION: Cystic fibrosis (CF) is characterized with chronic inflammation with neutrophil and related cytokines in airway secretions. We aimed to measure the levels of neutrophil related inflammatory markers as nitric oxide, IL-8, IL-17, leukotriene B4 and neutrophil elastase as well as e-cadherin in exhaled breath condensate (EBC), and to determine their relation with clinical findings. METHODS: We consecutively enrolled cystic fibrosis patients into our clinics between the age of six and eighteen years who could cooperate for exhaled breath condensate to this case-control study (n = 30). The age and sex matched control group (n = 26) was enrolled. Spirometry was performed during the stable period and EBC samples were obtained for measurement of the markers. RESULTS: The mean age of the subjects enrolled was 12.1(4.2) years and 40% were positive for P.Aeruginosa in sputum. Subjects who had P.Aeruginosa in sputum cultures had significantly lower FEV1, FVC and FEF 25/75 values compared to the ones without P.Aeruginosa (p = 0.002, p = 0.002 and p = 0.005 respectively). EBC neutrophil elastase levels were significantly higher in the CF patients compared to non-CF controls (3.11 ± 4.71 versus 0.90 ± 2.68, p = 0.04). Nitric oxide, IL-17, IL-8, e-cadherin, neutrophil elastase or leukotriene B4 levels in EBC of CF patients were not related to P.Aeruginosa s infection, FEV1 levels or hospital admission in the last year. CONCLUSION: In our study, neutrophil elastase levels in EBC are higher in CF patients compared to non-CF controls. This is independent of acute infection and is evidence to the persistence of neutrophilic lung injury. However, EBC NO, IL-8, IL-17, e-cadherin, neutrophil elastase and leukotriene B4 levels as inflammatory markers, are not correlated with disease progression or clinical findings.

COMPARISON OF FINASTERIDE, METFORMIN, AND FINASTERIDE PLUS METFORMIN IN PCOS.

The effects of finasteride on insulin resistance and of metformin on hyperandrogenism in patients with polycystic ovary syndrome (PCOS) are not clear. This study therefore compared the effects of finasteride, metformin, and finasteride plus metformin treatments on hormone levels, insulin resistance, and hirsutism score in women with PCOS. Fifty-two patients with PCOS were randomly assigned to receive finasteride 5 mg/day, metformin 1700 mg/day or finasteride plus metformin for 12 months. Body mass index (BMI), Ferriman Gallway score (FGS), serum concentrations of estradiol, sex hormone-binding globulin, free testosterone, dehydroepiandrosterone sulfate (DHEAS), androstenedione, and homeostasis model assessment of insulin resistance (HOMA-IR) index and areas under the curve (AUC) for insulin and glucose were evaluated before and after 12 months of treatment. Reductions in FGS, free testosterone, DHEAS, androstenedione, HOMA-IR, AUC-insulin, and AUC-glucose were significant within each group, whereas BMI and estradiol were not. Comparisons of changes in parameters in the 3 groups did not clearly show the superiority of any treatment modality. The treatment with finasteride alone significantly reduced both androgen levels and parameters of insulin resistance. In addition, metformin alone was effective, and not inferior to finasteride, in the treatment of hyperandrogenism.

Sequence of Quantum Phase Transitions in Bi2Sr2CaCu2O(8+δ) Cuprates Revealed by In Situ Electrical Doping of One and the Same Sample.

Our recently discovered electrical doping technique allows a broad-range variation of carrier concentration without changing the chemical composition. We show that it is possible to induce superconductivity in a nondoped insulating sample and to tune it reversibly all the way to an overdoped metallic state. This way, we can investigate the whole doping diagram of one and the same sample. Our study reveals two distinct critical points. The one at the overdoped side is associated with the onset of the pseudogap and with the metal-to-insulator transition in the c-axis transport. The other at optimal doping is associated with the appearance of a "dressed" electron energy. Our study confirms the existence of multiple phase transitions under the superconducting dome in cuprates.

GENETIC DISORDERS OF PITUITARY DEVELOPMENT IN PATIENTS WITH SHEEHAN'S SYNDROME.

INTRODUCTION: Genetic disorders associated with the development of the pituitary gland and cranial bones may cause a genetic tendency toward Sheehan's syndrome (SS). Our aim in this study was to investigate expression disorders in the genes responsible for the development of the pituitary gland and cranial bones in patients with SS. MATERIALS AND METHODS: Forty-four patients who were previously diagnosed with SS and 43 healthy women were compared in terms of the mean expression values of genes including the prophet of PIT-1 (PROP1), HESX homeobox 1 (HESX1), POU class 1 homeobox 1 (POU1F1), LIM homeobox 3 (LHX3), LHX4, glioma-associated oncogene homolog 2 (GLI2), orthodenticle homeobox 2 (OTX2), SIX homeobox 3 (SIX3), SIX6, T-box transcription factor 19 (TBX19), transducin-like enhancer protein 1 (TLE1), TLE3, distal-less homeobox 2 (DLX2), DLX5, MSH homeobox 2 (MSX2), and paired box 3 (PAX3). RESULTS: The mean expression values of the HESX1, TLE1, TLE3, and MSX2 genes were significantly different in the SS group from the healthy control group, while the mean expression values of the remaining genes were similar. CONCLUSION: The present study concludes that abnormal expressions of HESX1, TLE1, TLE3, and MSX2 genes may cause a genetic predisposition to the development of SS.

A comparison of low-dose ACTH, glucagon stimulation and insulin tolerance test in patients with pituitary disorders.

CONTEXT: Diagnosis of secondary adrenal insufficiency and GH deficiency requires evaluation by dynamic stimulation tests in most cases. Although insulin tolerance test (ITT) is accepted as the gold-standard test for the evaluation of both hypothalamo-pituitary-adrenal (HPA) and (GH)-IGF-1 axes, the test is cumbersome. In clinical practice, low-dose adrenocorticotrophic hormone (ACTH) stimulation test is a sensitive, safe and easily applicable alternative to ITT. Although it takes more time, glucagon stimulation test (GST) is also a good alternative to ITT and can evaluate both axes. OBJECTIVE: The primary aim of this study was to compare the ITT, low-dose ACTH and GSTs in the evaluation of HPA and GH-IGF-1 axes in patients with pituitary disorders and to evaluate the repeatability of all three tests. DESIGN: ITT, low-dose ACTH and GSTs were performed in all 129 patients, and the tests were repeated in 66 of these patients. SETTING: Erciyes University Medical School, Department of Endocrinology. PATIENTS OR OTHER PARTICIPANTS: One hundred and twenty-nine adult patients (76 women, 53 men) with pituitary disorder were included in the study. MAIN OUTCOME MEASURE(S): The cortisol and GH responses of patients to dynamic tests. RESULTS: Peak cortisol levels obtained during ITT were significantly lower than the values obtained during both low-dose ACTH and GSTs. Peak cortisol levels obtained during the GST were lower than those found during the low dose ACTH stimulation test. Peak GH responses were found to be higher in GST than in ITT. All three tests had good reproducibility. CONCLUSIONS: Any of 3 tests can be used in the evaluation of the HPA axis and either GST or the ITT can be used in the evaluation of the GH-IGF-1 axis but cut-off levels for the insufficiency of HPA or GH-IGF-1 axis should be individualized for each test.

Evaluation of long-term pituitary functions in patients with severe ventricular arrhythmia: a pilot study.

INTRODUCTION: Traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), stroke and cerebrovascular disease (CVD) are identified as risk factors for hypopituitarism. Pituitary dysfunction after TBI, SAH, and CVD may present in the acute phase or later in the course of the event. Chronic hypopituitarism, particularly growth hormone (GH) deficiency is related to the increased cardiovascular morbidity and mortality. In patients with serious ventricular arrhythmias, who need cardiopulmonary resuscitation, brain tissue is exposed to short-term severe ischemia and hypoxia. However, there are no data in the literature regarding pituitary dysfunction after ventricular arrhythmias. PATIENTS AND METHODS: Forty-four patients with ventricular arrhythmias [ventricular tachycardia (VT), ventricular fibrillation (VF)] (mean age, 55.6 ± 1.8 years; 37 men, 7 women) were included in the study. The patients were evaluated after mean period of 21.2 ± 0.8 months from VT-VF. Basal hormone levels, including serum free triiodothyronine (fT3), free thyroxine (fT4), TSH, ACTH, prolactin, FSH, LH, total testosterone, estradiol, IGF-1, and cortisol levels were measured in all patients. To assess (GH)-insulin like growth factor-1 (IGF-1) axis, glucagon stimulation test was performed and 1 µg ACTH stimulation test was used for assessing hypothalamic-pituitary-adrenal (HPA) axis. RESULTS: The frequencies of GH, gonadotropin and TSH deficiency were 27.2, 9.0, 2.2%, respectively. Mean IGF-1 levels were lower in GH deficiency group, but it was not statistically significant. CONCLUSION: The present preliminary study showed that ventricular arrhythmias may result in hypopituitarism, particularly in growth hormone deficiency. Unrecognized hypopituitarism may be responsible for some of the cardiovascular problems at least in some patients.

Predictive value of umbilical artery Doppler for adverse perinatal outcome in patients with HELLP syndrome.

OBJECTIVE: In this study, we aimed to evaluate in a prospective design the importance of pathologic umbilical artery (UA) Doppler findings as a predictive marker for neonatal outcome in patients with HELLP syndrome. PATIENTS AND METHODS: A total of 45 pregnant women at 24-42 weeks of gestation with a diagnosis of HELLP syndrome were included. The study group consisted of 20 patients with abnormal UA Doppler results, and the remaining 25 HELLP syndrome patients with normal UA Doppler results were assigned to the control group. All patients were followed up until delivery, and the neonatal characteristics were compared. RESULTS: Baseline characteristics of the groups were similar. In the study group, gestational week at delivery and infant birth weight were significantly lower (p < 0.05). The rates of significant neonatal morbidity, neonatal mortality, and neonatal intensive care unit (NICU) admission were significantly higher in study group patients (p < 0.05). CONCLUSIONS: UA Doppler abnormalities can be considered predictive of poor neonatal prognosis in patients with HELLP syndrome, as they were significantly related with higher rates of neonatal mortality and significant morbidity.

Successful management of spontaneous aortic dissection type B in the third trimester of pregnancy.

Acute aortic dissection is a life-threatening disease that requires immediate surgical intervention. Although aortic dissection is a rare condition during pregnancy, it is of high risk for both mother and foetus. Most cases of aortic dissection during pregnancy have certain risk factors, including Marfan syndrome and congenital heart diseases. In this study, we report on a case of acute aortic dissection developing spontaneously at 32 weeks of gestation. The patient delivered a baby through cesarean section, and medical management of the dissection was commenced. Both mother and neonate survived and recovered well.

XPD and XRCC1 gene polymorphism in patients with normal and abnormal cervical cytology by pap smear.

AIM: The purpose of the present study was to identify the role of abnormalities in DNA repair pathways by measuring the XPD and XRCC1 gene polymorphisms. MATERIALS AND METHODS: Thirty-five patients with abnormal cervical cytology (study group) and 10 women with normal cytology (control group) were included in the study. The polymorphisms of XRCC1 Arg194Trp, XRCC1 Arg399Gln and XPD Lys751Gln genes were investigated from the blood samples. RESULTS: There was no statistically significant difference in allele frequencies of XPD gene among the groups (p = 0.097), while XRCC1R399Q gene polymorphism was strikingly more frequent in the study group than that of control cases (p = 0.029). The prevalence of XRCC1R194W gene polymorphism on the other hand, was similar between the groups (p = 0.579). CONCLUSIONS: Patients with abnormal and normal cervical cytology have similar XPD gene polymorphism. However, the frequency of gene polymorphism in XRCC1 Arg 399 Gln codon was significantly higher in abnormal cervical cytology group.

Alarming rise of cesarean births: a single center experience.

BACKGROUND AND OBJECTIVES: The increase in cesarean section rates requires detailed investigation worldwide. The goal of this study was to analyze the distribution of indications and rates of cesarean sections in a developing country and to introduce the measures for controlling increased cesarean deliveries. MATERIAL AND METHODS: Electronic medical records of the patients who underwent cesarean section were retrospectively evaluated between the years of 2006 and 2008. RESULTS: Total of 42,547 vaginal delivery, 104 instrumental vaginal delivery and 28357 cesarean section were performed. The instrumental delivery and cesarean section rates were 0.14 and 39.9%, respectively. The most common indication was repeat cesarean that was present in 9224 patients (32.5%) followed by fetal distress in 6427 patients (22.6%). CONCLUSIONS: Encouraging vaginal delivery for patients with previous cesarean by community based national approaches seems the leading measure to control the increased rates of cesarean section in developing countries.

Removal of uterine fibroids during cesarean section: a difficult therapeutic decision.

PURPOSE OF INVESTIGATION: Myoma excision during cesarean delivery has traditionally been discouraged, however controversy persists among studies of myomectomy being performed during cesarean section. In this study, medical records of patients who underwent cesarean section our institution were evaluated retrospectively. METHODS: A total of 70 cases of cesarean myomectomy done during this period were included (group 1) and compared with the patients who underwent cesarean section alone (group 2). RESULTS: Mean surgical time of the myomectomy group was 58.1 +/- 23 minutes which was significantly increased (p < 0.01). Mean postoperative hemoglobin value was 9.6 +/- 1.5 in the myomectomy group and 10.8 +/- 1.01 in controls (p = 0.01). Length of hospital stay was significantly longer in the myomectomy group (p < 0.05). CONCLUSION: This study shows that myomectomy during cesarean section is a feasible procedure without any serious complications. The procedure is related with increased blood loss that does not require blood transfusion.

Severe preeclampsia and fetal virilization in a spontaneous singleton pregnancy complicated by hyperreactio luteinalis.

UNLABELLED: BACKGROUNDr: Hyperreactio luteinalis is a rare condition that stems from theca cell hyperplasia in the ovaries due to a high level of human chorionic gonadotropin during gestation. It occurs commonly in pregnant patients with trophoblastic disease, occasionally in multiple pregnancies, and rarely in normal singleton pregnancy. CASE REPORT: A 24-year-old pregnant woman, G3 P0, who was admitted to the Perinatology Clinic with increasing findings of virilization during pregnancy was presented. The patient had bilaterally enlarged multicystic ovaries on sonographic examination and elevated serum androgen levels She was managed conservatively until 38th week of gestation as a presumptive diagnosis of hyperreactio luteinalis. Elevated blood pressure and prominent proteinuria were detected during the follow-up of the patient and labor was induced. She underwent an emergency caesarean delivery because of fetal distress. During caesarean section, ovarian biopsies were taken and a histopathological diagnosis of hyperreactio luteinalis was determined. The female fetus also presented virilization. CONCLUSION: Although infrequent, hyperreactio luteinalis with both maternal and fetal virilization can occur in women with spontaneous singleton pregnancies. The clinical manifestations in such women may be complicated by severe preeclampsia.

Effectiveness of emergency cervical cerclage in patients with cervical dilation in the second trimester.

OBJECTIVE: Efficacy of emergency cerclage commensed in the second trimester is a controversial issue. In this study, we aimed to assess the success and associated complications of emergency cerclage in patients with cervical dilatation in the second trimester. MATERIAL AND METHODS: In this retrospective study, medical records of 75 pregnant women who had clinically and ultrasonographically confirmed cervical dilatation in the second trimester who had undergone cervical cerclage were analyzed. Pregnancy prolongation was the main outcome measure. RESULTS: Seventy-five women were included to the study. Mean age was 27 and mean gravidity of the patients was three. Mean cervical length was 28.5 mm (12-41 mm). The rate of spontaneous abortion, immature deliveries, prematurity and deliveries after 34 weeks were 2.7% (n = 2), 8% (n = 6), 12 (n = 9) and 77.7 (n = 58), respectively. Fetal survival rate was 89.1% (n = 65). Serious vaginal bleeding from the suture area was noted in two patients (2.6%). No postoperative complications occurred. CONCLUSION: Emergency cerclage is a simple surgical procedure with lower complication rates and can effectively prolong gestation to viability. It can be considered as a useful measure for patients with evidence of cervical changes in the second trimester.

Hydronephrosis of pregnancy associated with torsion of the fallopian tube: a case report.

Isolated tubal torsion accompanying pregnancy is an extremely rare condition. Preoperative diagnosis is generally difficult; most of the cases can be diagnosed intraoperatively. Here, we reported a 36-week pregnant with a complaint of acute pain in right lower quadrant that emanating to right lomber region. Abdominal utrasonography showed grade 3 hydronephrosis in right kidney, other findings were normal. A cesarean section was carried out and a twisted right tube were diagnosed. Right ovary was normal in appearance. The torsioned tube compressed the right ureter and caused ureteral dilatation. Right salpingectomy was performed. Postoperative follow-up of the patient was uneventful.

Extensive pelvic endometriosis with malignant change in tamoxifen-treated postmenopausal women.

The aim of this study was to document a case of tamoxifen-associated extensive pelvic endometriosis and attract the attention to this side effect of tamoxifen use in the postmenopausal patient. A 74-year-old woman with a history of breast carcinoma who received tamoxifen therapy for 2 years was admitted with uterine bleeding. Hysteroscopic polypectomy revealed a hyperplastic polyp. Extensive pelvic endometriosis was detected at the operation and due to dense adhesions, subtotal hysterectomy and bilateral salpingo-oophorectomy were performed. The patient continued to use tamoxifen. A supracervical pelvic mass was detected 14 months later. The cervix, rectum, and the accompanying mass were resected. Histopathologic examination revealed endocervical adenocarcinoma and endometriosis involving cervix uteri and the rectal muscular wall. The patient had two normal cervical smears within the last 3 years and no abnormal appearance was detected within the cervical canal in the hysteroscopic examination. As cervical cancer occurred in a short period, it might be speculated that tamoxifen might have stimulated the proliferative and mitotic activity of cervical endometrial tissue which has progressed into invasive cancer in time.

Polymorphonuclear granulocytes induce myocardial dysfunction during ischemia and in later reperfusion of hearts exposed to low-flow ischemia.

Polymorphonuclear granulocytes (PMNs) are known to contribute to reperfusion injury of the heart. However, whether PMNs compromise myocardial function of hearts exposed to a low-flow ischemia has not been determined. Moreover, not much is known about deleterious effects of PMNs at different times during ischemia and reperfusion. Isolated, working guinea pig hearts were subjected to 30 min of low-flow ischemia and reperfusion. Homologous PMNs were applied as 1-min boluses in the presence of thrombin during either ischemia or the first or fifth minute of reperfusion, and postischemic recovery of external heart work (REHW) and intracoronary PMN retention (PMNR) were quantified. In further experiments, the radical scavenger superoxide dismutase (SOD) was added. Compared with controls without PMNs (REHW, 92.4%), application of PMNs led to a significant loss of myocardial function, which was detected at all three examination times. Moreover, intracoronary PMNR increased significantly in comparison with that of controls with hearts not exposed to ischemia or reperfusion. On the other hand, addition of SOD significantly increased REHW. Intracoronary PMNR was not significantly changed by coapplication of SOD. We conclude that thrombin-stimulated PMNs applied at different times during ischemia and reperfusion significantly impaired cardiac function in hearts exposed to a low-flow ischemia.

A thrombocyte-induced myocardial dysfunction in the ischemic and reperfused guinea pig heart is mediated by reactive oxygen species.

In recent investigations, we could demonstrate that thrombocytes are able to contribute to ischemia- and reperfusion-induced injury of the heart. The aim of the current study was to investigate whether reactive oxygen species are responsible for induction of myocardial dysfunction under these conditions. Isolated, perfused, and pressure-volume work-performing guinea pig hearts were exposed to a 30-min low-flow ischemia (1 ml/min) and were reperfused (5 ml/min). Washed, homologous blood platelets were administered as a 1-min bolus (20,000 per microliter of perfusion buffer), either during the 15th minute of ischemia or in the first or fifth minute of reperfusion in the presence of thrombin (0.3 U/ml perfusion buffer)). The radical scavengers superoxide dismutase (SOD; 10 U/ml perfusate) and catalase (30 U/ml perfusate) were added during ischemia or in the first or fifth minute of reperfusion, respectively. Intracoronary platelet retention (in percentage of platelets applied) and recovery of EHW (postischemic EHW in percentage of preischemic EHW) were quantified. Ischemic and reperfused hearts with time-matched application of platelets but without administration of SOD or catalase served as controls. Interestingly, both administration of SOD during ischemia and in reperfusion significantly improved recovery of EHW (88.4 +/- 2%, 82. 6 +/- 1%, and 90 +/- 3%, respectively) as compared with the case of controls (56.2 +/- 3%, 42 +/- 2%, and 75 +/- 2%, respectively). Platelet retention, however, was not significantly influenced by administration of SOD during ischemia or reperfusion (26 +/- 2%, 31 +/- 2%, and 26 +/- 2%) compared with controls (30.5 +/- 3%, 33 +/- 2%, and 22 +/- 3%, respectively). Coadministration of catalase, on the other hand, exhibited some cardioprotective potential only in the first minute of reperfusion (recovery, 61% +/- 4%) as compared with the case of control (42 +/- 2%). We conclude that thrombocytes under conditions of ischemia and reperfusion are able to induce a myocardial dysfunction mediated by reactive oxygen species. Superoxide seems to play a major role in this respect.