Ahmet Karatas

Relationship of maternal serum resistin and visfatin levels with gestational diabetes mellitus

Abstract Introduction: Adiponectin, resistin and visfatin are thought to play role in the pathophysiology of gestational diabetes (GDM). In this study, we aimed to investigate the association of maternal second trimester serum resistin and visfatin levels with GDM. Materials and methods: Screening and diagnosis for GDM was performed between the 24–28th gestational weeks. About 40 women diagnosed with GDM and 40 non-diabetic women constituted the study and control groups, respectively. Groups were compared for second trimester maternal serum resistin, visfatin and HbA1c levels, HOMA-IR and postpartum 75 g OGTT results. Results: Mean serum resistin (p = 0.071) and visfatin (p = 0.194) levels were similar between the groups. However, mean BMI (p = 0.013), HOMA-IR (p = 0.019), HbA1c (p < 0.0001) and birth weight (p = 0.037) were significantly higher in GDM group compared to controls. Type 2 diabetes and impaired glucose tolerance were detected in 2 (5%) and 7 (20%) women in the GDM group, respectively, with 75 g OGTT performed at the postpartum 6th week. Resistin levels of patients with GDM and postpartum glucose intolerance were higher than those with GDM but no postpartum glucose intolerance (p = 0.012). Visfatin levels in the GDM group showed a positive correlation with biparietal diameter, head circumference, abdominal circumference and femur length (p < 0.05). Conclusion: Maternal serum resistin and visfatin levels are unchanged in GDM. In patients with GDM, second trimester resistin levels may be predictive for postpartum glucose intolerance and second trimester visfatin levels may be related with fetal biometric measurements. Further larger studies are needed.

Ghrelin, acylated ghrelin, leptin and PYY-3 levels in hyperemesis gravidarum

Abstract Objective: To assess the serum levels of gut and adipocyte-derived metabolic hormones that control appetite, adipocity, weight gain and energy hemostasis, namely total ghrelin (TG), acylated ghrelin (AG), leptin and PYY-3 in hyperemesis gravidarum (HG). Methods: Plasma samples of 86 women in their first trimester pregnancies with HG (n = 30), morning sickness of pregnancy (MSP) (n = 34) and control (n = 22) groups were obtained. Serum levels of TG, AG, leptin and PYY-3 were compared between the groups, and the correlations with severity of symptoms using modified PUQE (Pregnancy Unique Quantification of Emesis) scoring, BMI, E2, hCG and TSH were calculated. Results: Levels of TG, AG, PYY-3 and the TG/leptin ratio were significantly higher in HG group compared to MSP and the control groups (p ≤ 0.017). AG/TG ratio was significantly lower in the HG group compared to both MSP and control groups (p ≤ 0.017). There were either weak or no significant statistical correlations between the gut and adipose-related hormones and the modified PUQE scores, BMI, E2, hCG and TSH. Conclusion: Gut-derived metabolic hormones ghrelin, AG and PYY-3 may be involved in the HG pathophysiology.

Alterations in placental pendrin expression in pre-eclampsia.

Abstract Introduction: Pendrin is an integral membrane protein and plays a key role in extracellular fluid volume and blood pressure control. We aimed to investigate the relationship between pendrin immunostaining intensity in normal and pre-eclamptic placental tissue. Methods: Fifty-six placental tissues, of which 26 were in pre-eclamptic, and 30 were in control group were evaluated by immunohistochemical staining. Positive immunostaining was evaluated using a semiquantitative score: 0, negative; +, mild; ++, moderate; and +++, intense. Results: There was more positive immunstaining in the pre-eclamptic placenta compared to the controls (p < 0.001). A significant positive correlation was observed between immunostaining level and diastolic blood pressure (r = 0.533, p = 0.005) in the pre-eclamptic group. However, no significant correlation was observed between any condition and immunostaining level in the control group. Conclusions: Placentas in the pre-eclamptic group were significantly more immunostained with pendrin than were those in the control group. In addition, a positive correlation between immunostaining intensity with pendrin and both systolic and diastolic blood pressure were observed. Pendrin may play a role in the mechanism of severe hypertension in women with pre-eclampsia.

Bicuspid aortic valve and severe aortic stenosis in a newborn exposed to carbamazapine during pregnancy

The use of antiepileptic drugs increases the risk of major congenital malformations during pregnancy. Here, we report an infant who had a history of in-utero carbamazepine exposure and who was born with a cardiac malformation. The infant was born at 39 weeks of gestation vaginally to an epileptic mother who had been treated with carbamazepine throughout her pregnancy. He was referred due to cardiac murmur in the second week of his life. The mother had not received folic acid supplementation. Transthoracic echocardiography revealed bicuspid aortic valve, mild aortic stenosis, patent ductus arteriosus, patent foramen ovale and the renal ultrasound revealed mild left hydronephrosis. Follow-up echocardiography performed 14 weeks later showed increased severity of aortic stenosis and percutaneous balloon aortic valvuloplasty was performed. To our knowledge, there is only one case report in the literature mentioning the association of a bicuspid aortic valve and aortic stenosis with oxcarbazepine exposure, which is a structural derivative of carbamazepine. However, there are no reports for association with carbamazepine itself. Bicuspid aorta and aortic stenosis may be among the cardiac malformations that result from the teratogenic effect of carbamazepine.

Intraperitoneal Nigella sativa for Prevention of Postoperative Intra-Abdominal Adhesions in Rats

ABSTRACT Objective: To evaluate intraperitoneal administration of Nigella sativa (NS) to prevent postoperative intraperitoneal adhesion (PPA) after surgical manipulation of rat uterine horn. Materials and Methods: Two forms of NS were used in the study (Volatile oil (NSVO) and the ethanolic extract (NSEE)). A total of 50 rats were randomly assigned to the sham group (n = 10), control group (n = 10), NSVO group (n = 10), NSEE group (n = 10), and the Seprafilm group(n = 10). After 14 days, rats were sacrificed. Adhesions were examined macroscopically, and degree of adhesions was scored. A part of horn was excised, and superoxide dismutase (SOD) and glutathione peroxidase activities as well as malondialdehyde levels were evaluated, and histological score was calculated. Results: Total microscopic score of the NSEE group was significantly lower than the control group (p = .001) and was marginally significantly lower than the seprafilm group (p = .005). Collagen formation score was higher in the seprafilm group compared to the sham and NSEE groups (p < 0.001, p = .003, respectively). Apoptotic cells were lower in the NSEE group compared to the control group (p = .003) and also lower in the NSEE and NSVO groups compared to the seprafilm group (p = .001, p < .001, respectively). Only SOD activity was higher in the NSVO and seprafilm groups compared to the control group (p < .001). Conclusion: NSEE form seems to have a possible effect in the prevention of PPAs. This may occur by its effect in decreasing collagen formation and by decreasing apoptosis in the injured tissues. NSVO form seems to induce SOD. Therefore, combined use of NSVO with seprafilm may increase the adhesion preventive effect of seprafilm.

Endothelial Nitric Oxide Synthase Gene Polymorphisms (Promoter -786T/C, Exon 894 G/T and Intron G10T) in Unexplained Female Infertility

Background/Aims: Recent investigations in both males and females show that there may also be some genetic risk factors associated with infertility, and endothelial nitric oxide synthase (eNOS) has important functions in implantation. We aimed to investigate the association of three different polymorphisms of eNOS (promoter -786T/C, exon 894 G/T and intron G10T) with unexplained female infertility. Materials and Methods: Two groups of patients were included in the study: (1) women with unexplained infertility and (2) healthy, fertile women with normal menstrual cycles. eNOS polymorphisms were studied in genomic DNA of each patient by polymerase chain reaction-restriction fragment length polymorphism method. Results: Forty-one women with unexplained infertility and 40 fertile women were included. Baseline physical characteristics and hormonal parameters of the two groups were similar. For eNOS exon 894 G/T polymorphism, the GG homozygotes were significantly lower and the heterozygotes GT were significantly higher in the infertile group than in the control group (p < 0.05). eNOS gene polymorphism both for promoter and intron were similar in the two groups (p > 0.05). Conclusion: Altered eNOS protein caused by eNOS exon 894 G/T polymorphism might cause implantation failure, which may be a possible cause of unexplained female infertility.

Maternal metformin, obesity, and metabolic syndrome: the contribution of autonomic nervous system function

TO THE EDITORS: With great interest, we read the recent article by Desai et al 1 regarding the effect of maternal metformin treatment on fetal inflammation in a rat model of obesity and metabolic syndrome (MetS). The authors very clearly discussed the relation between metformin treatment and inflammation. They concluded that diet-induced obesity/ MetS during pregnancy significantly enhanced fetal and placental cytokine production. Maternal metformin reduced fetal cytokine levels, in addition; metformin treatment of a placental cell line suppressed tumor necrosis factor alphae induced interleukin-6 levels by nuclear factor kappa B inhibitor. In addition to their fluent discussion, we aimed to emphasize the possible other effective mechanism of metformin treatment on MetS and obesity: the contribution of autonomic nervous system function. MetS is a combination of metabolic abnormalities, such as abdominal obesity, dyslipidemia, hypertension, and impaired glucosemetabolism,whichisassociatedwithinsulinresistance. Recently, we found that autonomic nervous system function is also impaired in this disease group. Previously, Erdem et al 2 showed that the relationship between MetS and impaired autonomic nervous system function is detected by different methods,inMetSpatientswithoutcoronaryarterydiseasesand diabetes mellitus (DM). 2 Together with this, MetS-related impairment in autonomic nervous system function is thought to play a central role in the risk of cardiovascular death. Metformin is an insulin sensitizer that has been shown to reduce insulin resistance and hyperglycemia with DM and to reduce progression of impaired glucose tolerance to DM in those without DM. 3 Interestingly, Manzella et al 4 showed

Late Postpartum HELLP Syndrome 60 Hours after Delivery Associated with Mild Pre-eclampsia

The purpose of this report is to present a case of mild Pre-eclampsia which was complicated with postpartum HELLP syndrome. A 25-years-old pregnant woman with mild Pre-eclampsia at 36 weeks of gestation was admitted to our clinic with uterine contractions. A caesarean section was performed, due to her previous caesarean section history. Postpartum period was uneventful until the 2nd day after the caesarean section. Epigastric pain, nausea and vomiting appeared two days after her delivery. In evaluation of the case, laboratory findings which were associated with HELLP syndrome were found to include haemolysis, elevated liver enzymes and low platelet counts. The general condition and laboratory findings of the case returned to normal with supportive and steroid treatment after 3 days. It should be noted that HELLP syndrome can develop in the postpartum period. Therefore, caution should be exercised in patients with pre-eclampsia, for the development of the postpartum HELLP syndrome.

Ultrasound-Guided Hysteroscopic Removal of IUD with Missing Tails in a 15-Weeks' Pregnant Woman

Unexpected pregnancy with an intrauterine device (IUD) in situ is not an uncommon finding in daily practice. It is generally agreed that an IUD should be removed in the first trimester when its tail is visible vaginally. However, because of limited experience and data in the literature, uncertainty exists about the management and technique of IUD removal during pregnancy when the tails are inaccessible on examination, especially in the second trimester. The IUD may be left in situ or removed using a grasping tool under ultrasonographic guidance or by hysteroscopy. Here, we report a case of ultrasound-guided hysteroscopic removal of an IUD with retracted tail in a woman at 15 weeks’ gestation. We believe when the decision is made to remove an IUD, ultrasound-guided hysteroscopy may be a safer option in experienced hands compared with an ultrasound-guided grasping tool, especially during the second trimester.

ECTOPIC DECIDUA IN THE ADIPOSE TISSUE OF THE ABDOMINAL WALL

Ectopic decidual transformation is an uncommon condition in the abdominal wall during laparotomy for a cesarean section for pregnancy. It occurs most often in the ovary, cervix, but also presents omentum, appendix and peritoneum. A case of ectopic decidua found in the anterior abdominal wall incidentally in a 30-year-old pregnant female is described. The lesion, 3cm in diameter that formed a nodule. Microscopic evaluation revealed decidualized cells which were large polygonal and eosinophilic, some with vacuolated cytoplasm. Pregnancy related ectopic deciduous develops with the effect of progesterone in pregnancy and it is a benign lesion. Although, its histological appearance is characteristic, differential diagnosis should be done carefully.