Evaluation of protective effects of GnRH agonist or antagonist on ovarian reserve with anti-Müllerian hormone and histological analysis in a rat model using cisplatin.

Introduction: The aim of this prospective trial was to evaluate the ovarian reserve with anti-Müllerian hormone (AMH), which is the best predictor of ovarian reserve, and perform histological analysis after exposure to cisplatin with a GnRH agonist or antagonist. Material and methods: Twenty-four Wistar albino rats were randomly divided into three groups, each consisting of eight rats. In the GnRH agonist group (group 1), rats received a single dose of 50 mg/m2 cisplatin with 1 mg/kg triptorelin. In the GnRH antagonist group (group 2), rats received a single dose of 50 mg/m2 cisplatin with 1 mg/kg cetrorelix. In the control group (group 3), rats received 50 mg/m2 cisplatin. Ovarian reserve was assessed by AMH and histology. Results: Primary follicle counts were higher in group 2 (4.50 ±1.47 vs. 3.50 ±1.70 vs. 3.00 ±3.54) and secondary follicle counts were higher in group 1 (2.96 ±1.11 vs. 1.74 ±1.03 vs. 1.37 ±3.11). Numbers of tertiary follicles were higher both in groups 1 and 2 than the control group (1.36 ±0.83 vs. 0.84 ±0.99 vs. 0.50 ±0.75). The total follicle count of the study groups were significantly higher compared with the control group (14.32 ±5.96 vs. 12.48 ±4.12 vs. 10.63 ±6.80). AMH was significantly higher in groups 1 and 2 compared with the control group (18.56 ±25.33 vs. 16.48 ±24.66 vs. 9.37 ±26.54). Conclusions: This is the first prospective randomized controlled study showing the protective effects of GnRH agonist and antagonist on ovarian reserve after cisplatin exposure in an animal model.

Betatrophin, elabela, asprosin, glucagon and subfatin peptides in breast tissue, blood and milk in gestational diabetes.

We investigated the presence of asprosin (ASP), betatrophin, elabela (ELA), glucagon and subfatin (SUB) in the milk of mothers with gestational diabetes mellitus (GDM) and compared their levels with blood levels. We also investigated whether these peptides are synthesized by the breast. We investigated 12 volunteer mothers with GDM and 14 pregnant non-GDM control mothers. The peptides were measured using ELISA and their tissue localization was determined using immunohistochemistry. Breast milk contains ASP, betatrophin, ELA, glucagon and SUB. The amount of the peptides ranged from highest to the lowest in colostrum, transitional milk and mature milk. The amount of peptides in the milk was greater than for blood. The peptides, except for ELA, were increased in milk and blood by GDM. Betatrophin and ELA are synthesized in the connective tissue of the breast. ASP, glucagon and SUB are synthesized in the alveolar tissue of the breast. These peptides in breast milk may contribute to the development of the gastrointestinal tract of newborns and infants.

Exposure of Pregnant Women to Intimate Partner Violence during the Pandemic in Turkey and Influencing Factors.

PURPOSE: This research was conducted to determine the exposure of pregnant women to intimate partner violence (IPV) during the Covid-19 pandemic and its influencing factors. DESIGN: Cross-sectional study. METHODS: This study included 456 pregnant women. The "Pregnant Information Form" and "Intimate Partner Violence During Pregnancy Questionnaire" were used to collect data. FINDINGS: Exposure frequency to IPV during the pandemic and curfews were 44.1% and 43.9%, respectively. A significant relationship was found between exposure to IPV and the partner having wage-earning employment, marital relationship during Covid-19, the effect of the pandemic on spousal relationships, and gravida. CONCLUSIONS: The prevalence of IPV in pregnant women during and after the pandemic did not change significantly from IPV in pregnant women before the pandemic. CLINICAL EVIDENCE: To prevent and reduce partner violence during pregnancy, there is a need to evaluate IPV among women who apply for routine pregnancy examinations.

The effects of gestational diabetes on lower urinary tract symptoms of pregnant women: a case-control study.

Gestational diabetes mellitus (GDM) and lower urinary tract symptoms (LUTS) are common health problems in pregnant women. The aim of this case-control study was to evaluate the effects of GDM on LUTS in pregnant women. This study was conducted with 44 pregnant women diagnosed with GDM and 44 pregnant without GDM. Patients with GDM had significantly lower likelihood of experiencing urgency (7.069-fold lower likelihood); whereas they had significantly greater likelihoods for urinary incontinence (UI) during sexual intercourse (OR: 0.185; 5.4-fold higher), need for clothing change due to UI (OR: 0.268; 3.7-fold higher), and adverse effects on daily life due to UI (OR: 0.338; 2.9-fold higher) compared to women without GDM (p < .05 for all). Although pregnant women with GDM appear to have a lower likelihood of urgency, this may be associated with the adverse effects of GDM since the likelihoods for UI-related outcomes were increased and quality of life was reduced among pregnant women with GDM compared to those without GDM.Impact statementWhat is already known on this subject? Lower urinary tract symptoms (LUTS) are very common among pregnant women, and negatively affect social, sexual and working life. There are many risk factors that affect the development of LUTS in pregnant women. It is stated that gestational diabetes mellitus (GDM) may be a predisposing factor in the development of LUTS in women.What do the results of this study add? Women with GDM experienced storage symptoms at a lower frequency (especially urgency) compared to the control group. In addition, we determined worse quality of life among women with GDM who experienced a greater frequency of urinary incontinence.What are the implications of these findings for clinical practice and/or further research? It may be beneficial to provide training on the prevention and management of LUTS to all pregnant women, especially women with GDM, and to increase the sensitivity of health professionals on the subject.

The impact of indomethacin on the number of oocytes retrieved and IVF outcomes in patients with poor ovarian response.

OBJECTIVE: The aim of this retrospective case-control study was to analyze the effect of administering indomethacin after triggering final oocyte maturation in patients with poor ovarian response (POR) on the cycle cancellation rate due to premature ovulation (PO), the number of oocytes retrieved and the clinical outcomes of IVF cycles. STUDY DESIGN: A total of 214 patients with POR, diagnosed according to the Bologna criteria, who underwent fresh IVF cycle via flexible gonadotrophin-releasing hormone antagonist (GnRH-ant) protocol were enrolled in the study. The control group consisted of 100 patients, whereas the indomethacin group included 114 patients who received 100 mg rectal indomethacin administered twice within the same day (twelve hours apart) -starting at twelve hours after triggering. Cycle cancelation rates (CCR), number of oocytes retrieved (nOR), implantation rates (IR), biochemical pregnancy (BP) and clinical pregnancy loss rates (CPL), ongoing pregnancy rates (OPR) and live birth rates (LBR) were compared between the indomethacin and control groups. RESULTS: The CCR rate was significantly lower in the indomethacin group (1.8%) compared to the control group (1.8% vs %12%, p = 0.01). In the control group, those with cycle cancellation were older than those without cycle cancellation (mean age 42.2 ± 2.3 years vs. 39.36 ± 4.3 years, p = 0.001) and had lower anti-Müllerian hormone levels and lower antral follicle count (0.59 ± 0.2 ng/mL vs 0.79 ± 0.2 ng/mL, p = 0.001 and 4 ± 0.6 vs 5.7 ± 1.7, p = 0.001, respectively). In multivariable analysis, when the dependent variable in the logistic regression model was coded as the absence of cycle cancellation, it was observed that only indomethacin had a statistically significant effect on cycle cancellation (ß = -1.931, standard error = 0.832, Exp(B) = 0.145, p = 0.020). nOR was higher in the indomethacin group than control group but the difference did not reach significance (p = 0.07). Moreover, the IR, OPR and LBR, BP and CPL values were similar in the indomethacin and control groups (p > 0.05). CONCLUSIONS: Based on data from this study, it can be concluded that indomethacin reduces cycle cancelation due to PO in patients with POR -without compromising implantation and pregnancy rates. However, further randomized controlled trials with larger sample sizes are required to clarify the definitive effect of indomethacin in the treatment of patients with POR.

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Discriminating Precancerous Pathologies from Cervical Cancer.

PURPOSE: We aimed to determine the predictive value of several hematological markers of inflammation on the presence/absence of cervical cancer and also to determine their ability in discriminating precancerous cervical pathologies from cervical cancer. MATERIALS AND METHODS: In this study, patients who presented to Acibadem Kayseri Hospital between May 2010 and June 2018 were evaluated. Forty patients with low-grade squamous intraepithelial lesions (LSIL), 40 patients with high-grade squamous intraepithelial lesions (HSIL), and 30 patients with cervical cancer (CC) were retrospectively included in this study. A control group of 70 healthy volunteers with normal cervical cytology was also included in the study. RESULTS: The neutrophil-to-lymphocyte ratio (NLR) was significantly higher in patients with CC than in controls. The platelet-to-lymphocyte ratio (PLR) was significantly higher in patients with CC compared to those with LSIL and HSIL diagnoses and also controls (p < 0.001). Logistic regression analysis revealed that age (OR: 1.075, 95% CI: 1.020-1.132, p=0.007), NLR (OR: 1.643, 95% CI: 1.009-3.142, p=0.047), and PLR (OR: 1.032, 95% CI: 1.003-1.062, p=0.029) were predictors for the presence of CC. ROC curve analysis revealed that both NLR and PLR were predictive of CC with a cutoff value of 2.02 for NLR (71% sensitivity and 60% specificity, AUC: 0.682, p=0.004) and 126.7 for PLR (83% sensitivity and 69% specificity, AUC: 0.752, p < 0.001). CONCLUSION: In addition to patients' age, determination of NLR and PLR values, which are simple, inexpensive, and readily available markers of systemic inflammation, may help in decision making precancerous pathologies of the cervix.

Severity of pain and circadian changes in uterine artery blood flow in primary dysmenorrhea.

OBJECTIVE: To investigate the severity of pain and circadian changes in uterine artery blood flow in primary dysmenorrhea cases. MATERIALS AND METHODS: The study included 27 cases diagnosed as primary dysmenorrhea and 25 individuals who had no dysmenorrhea complaint. Bilateral uterine artery systole/diastole rates (S/D), pulsatility indices (PI) and resistance indices (RI) of all cases were measured using transvaginal colour Doppler at 12.00-02.00 p.m. and 12.00-02.00 a.m. Severity of pain was evaluated in dysmenorrhea cases at the same hours using a verbal pain assessment scale. FINDINGS: Doppler measurements of dysmenorrhea cases conducted at 12.00-02.00 p.m. showed right uterine artery S/D: 3.37 +/- 0.26, RI: 0.73 +/- 0.07, PI: 2.38 +/- 0.34 and left uterine artery S/D: 3.33 +/- 0.37, RI: 0.74 +/- 0.14, PI: 2.41 +/- 0.15, while measurements carried out at 12.00-02.00 a.m. showed right uterine artery S/D: 3.88 +/- 0.12, RI: 0.87 +/- 0.14, PI: 2.94 +/- 0.21 and left uterine artery S/D: 3.90 +/- 0.27, RI: 0.92 +/- 0.12, PI: 2.93 +/- 0.21. Comparisons revealed significantly higher Doppler indices at night (P < 0.05) than in the day in dysmenorrhea cases. There was not any significant circadian difference in individuals who did not have dysmenorrhea (P > 0.05). Pain score in the verbal pain assessment of dysmenorrhea cases was found 3.6 +/- 1.4 in the day and 5.8 +/- 1.7 at night. The difference was found significant (P < 0.05). CONCLUSION: Uterine artery blood flow is reduced at night in dysmenorrhea cases. In correlation with this, the cases feel more pain at night. Our results may be important on the planning of working hours and their quality of life.

Uterine primitive neuroectodermal tumor: a case report.

BACKGROUND: Primitive neuroectodermal tumors of uterus (PNET) are extremely rare in tumors of the female genital system and therefore there is no sufficient information about their diagnosis, treatment, and follow-up. CASE: The case is a 32-year-old, operated in emergency conditions due to intra-abdominal hemorrhage, and discusses our diagnosis and treatment approaches in the light of literature data. CONCLUSION: To the best of our knowledge, this is first report of uterine PNET that presented with intraabdominal hemorrhage due to uterine rupture. Despite advances in therapy, the prognosis is poor. The low number of these cases precludes accurate standardization of therapy.

The effect of hysterectomy and bilaterally salpingo-oophorectomy on sexual function in post-menopausal women.

OBJECTIVE: To examine the effects of hysterectomy and bilaterally salpingo-oophorectomy (BSO) on Female Sexual Function Index (FSFI) in the post-menopausal women. METHOD: This study included 92 women who underwent vaginal hysterectomy (VH) and BSO (n:37) and who underwent abdominal hysterectomy (AH) and BSO (n:55). Estrogen replacement therapy (ERT) was given 21 women who underwent VH and BSO and 28 women who underwent AH and BSO in pre- and postoperative periods. All patients were evaluated preoperatively and postoperative 6th month in terms of FSFI scores. RESULTS: It was found that hysterectomies by abdominal or vaginal routes reduced FSFI scores significantly (P<0.05). The use of ERT were no effect on total score of FSFI in AH and BSO (P>0.05). ERT prevented deterioration of FSFI in women who underwent VH relative to preoperative values but AH. CONCLUSION: Hysterectomy causes unfavourable effects on sexual functions at least in the first 6 postoperative months and this negative effect can not be repaired by estrogen replacement therapy in AH and BSO.