Asli Yarci Gursoy

Body satisfaction and eating attitudes among girls and young women with and without polycystic ovary syndrome.

PURPOSE The main goal of the current study was to examine the associations between polycystic ovary syndrome (PCOS) and body dissatisfaction and eating attitudes in a sample of adolescent girls and young women. Body dissatisfaction is 1 of the strongest predictors of the development of negative outcomes such as low self-esteem, and eating disorders. In adolescent age group of patients, both hirsutism and increased body mass index, appearing with PCOS, may be the leading symptoms also resulting or contributing to body dissatisfaction and eating disorder. MATERIALS AND METHODS The sample of 94 Turkish adolescent girls and young women [PCOS (n = 42) vs non-PCOS (n = 52)] completed measures of figure rating scale, the socio-cultural attitudes toward appearance questionnaire, body esteem scale, eating attitude test, and demographics. RESULTS AND CONCLUSION The results revealed that body esteem was important for predicting eating attitudes in both groups and sociocultural internalization of thinness ideal and body dissatisfaction were also significant factors in PCOS group. However, scores for major study variables (BMI, sociocultural attitudes toward awareness and internalized appearance ideals, body esteem subscales, body dissatisfaction and eating attitudes) in the PCOS group were not significantly higher than those for girls without PCOS.

Maternal and fetal blood levels of S100 and ischaemia modified albumin in term intrauterine growth restricted fetuses with abnormal umbilical artery Doppler values.

Abstract The purpose of this study was to investigate whether levels of fetal hypoxia markers, S100 and ischaemia modified albumin (IMA) change in cases of intrauterine growth restriction (IUGR). This case–control study included 15 intrauterine growth restricted fetuses and 20 age-matched controls. During delivery of the fetuses, cord blood and maternal blood S100 and IMA levels were studied. The fetal weight and umbilical cord pH values of IUGR fetuses were significantly lower than the control group. The mean maternal and umbilical cord blood values of S100 and IMA were similar in the two groups. IMA levels in cord blood of the IUGR group were significantly higher than maternal levels, whereas umbilical and maternal levels of IMA did not differ among control cases. In cases without brain sparing effect in Doppler ultrasonography, umbilical cord S100 and IMA levels do not change significantly in IUGR when compared with appropriate-for-gestational-age (AGA) fetuses.

Melatonin in aging women

Melatonin is a neurohormone secreted mainly by the pineal gland that controls circadian rhythm, which is primarily regulated by light. Although melatonin levels are known to be altered in individuals with sleep disorders, melatonin also has modulatory effects on other body systems, including the skeletal and immune systems. In addition, melatonin has been shown to interfere with carbohydrate and lipid metabolism and to have significant antioxidant effects, both directly and via its metabolites. Melatonin levels vary throughout human life and are known to decrease with age but the effects of declining melatonin levels are poorly understood. In women, this age-related decrease in melatonin levels coincides with the menopause. This review aims to summarize the impact of altered melatonin levels in aging women and the outcomes of exogenous replacement therapies.

Improved cycle outcomes after laparoscopic ovarian diathermy in hyper-responder patients with previous ART failure.

Abstract Excessive response to ovarian stimulation is common among hyper-responder patients undergoing assisted reproductive technology (ART). Cycle cancellations and severe ovarian hyperstimulation syndrome (OHSS) are all detrimental consequences observed within this cohort and several approaches have been proposed to enhance outcomes. The current study is designed to evaluate whether laparoscopic ovarian diathermy (LOD) improves ART outcomes and pregnancy rates by reducing Anti-mullerian hormone (AMH) levels in a group of patients who had a history of recurrent ART failure and high response. A total of 40 hyper-responder patients with history of previous ART failure were included. Group I consisted of 22 patients that underwent LOD prior to ART. Group II consisted of 18 patients that underwent only ART. Cycle outcomes of groups were compared. Following LOD, significant reduction in AMH levels were detected in group I (4.75 ng/mL to 2.25 ng/mL). Clinical pregnancies were similar among groups (40% versus 27.8% p = 0.65). There was no cycle cancellation in Group I, whereas there were three cycle cancellations observed due to OHSS in Group II. Our results indicate that LOD might offer enhanced fertility outcomes and may reduce the likelihood of cycle cancellations in hyper-responders with previous ART failures. Chinese abstract 高反应患者在辅助生殖过程(ART)中对卵巢刺激呈现过度反应是很常见的。在这些人群中，周期的终止和卵巢过度刺激综合征（OHSS）都属于已观察到的过度反应可导致的有害结果。为改善ART的结局已提出了一些方法。本研究被设计用于评估腹腔镜下卵巢打孔术（LOD）是否能通过降低抗苗勒氏管激素（AMH）而改善有ART反复失败史和高反应患者ART的结局和妊娠率。总计有40名高反应和ART失败史的患者被纳入了此项研究。一组包括22名患者，在ART前行LOD，二组包括18名患者，只进行了ART。两组的周期结局被拿来比较。在LOD后，一组观察到了AMH值的明显降低(4.75 ng/mL 到2.25 ng/mL)。两组临床妊娠率相似(40% versus 27.8% p=0.65)。一组无周期终止，而二组有三名患者由于OHSS而终止了周期。我们的研究表明LOD或可改善妊娠结局，减少有ART失败史的高反应患者终止周期的可能性。

Ischemia modified albumin in perinatology

Ischemia modified albumin is a novel marker of ischemia generated due to hypooxygenation and increased hydroxyl free radicals in low pH. The molecule has been licenced for clinical use as an early marker for acute coronary syndrome in cardiology. Since presence of ischemia might have serious and sometimes devastating effects in perinatology, various researches have evaluated its value in different clinical conditions. This narrative review aims to summarize the literature concerning the value of IMA in perinatology and guide for further research.

Comment on: 'Is nuchal cord justified as a cause of obstetrician anxiety?' by Narang et al.

Considering the literature about effects of nuchal cord on maternal and fetal morbidity, this article is of great importance to obstetricians so, we thank Narang et al. [1], for focusing on a quite frequent but undetermined subject. Most of the studies about this issue have reported conflicting results, mostly stressing on that, nuchal cord does not have an effect on perinatal outcomes [2]. But there are authors who correlated nuchal cord with some degree of hypoxia and even cerebral palsy [3, 4]. The current study seems to have some bias of design about patient selection which may lead to unintended outcomes regarding management of this patient population. The authors report that they have selected the patients with nuchal cord (single or multiple) who could give birth vaginally among 2,000 patients eligible for the study. They also claim that presence of nuchal cord had some statistically significant effects on umbilical artery acid–base status including pH and lactate but non-nuchal cord group had pathological range biochemical derangement [1] possibly regarding the pathologic cut-off for umbilical artery pH as 7.00 which is the most important parameter related with long-term outcomes. But the number of patients who were eligible for the study but delivered with cesarean section was not mentioned. Cesarean section incidence due to nuchal cord has been reported ranging between 11.1 and 35 % [5] and nuchal cord has been reported to be one of the four leading indications for cesarean delivery in the Chinese population [6]. Based on these reports, although nuchal cord is not an indication for cesarean section on its own, causal relationship with other factors such as decreased fetal heart rate variability or failure of descent may result with need of cesarean section. Although delivery is a complex process, the authors seem to eliminate any possible intervening factors which may interfere with the way of delivery and at this point, the number of patients who were referred to cesarean section gains importance as the only possible factor leading to cesarean might be ‘nuchal cord’ or the number of ‘nuchal cords’. This is why we suggest the authors to report about this aspect of the research. Only after then, it may be possible to claim that nuchal cord does not have a significance as a factor intervening with the process of delivery. In conclusion, retrospectively designed population studies up to now [2], reported about the effect of nuchal cord on acid base status of the umbilical artery to some extent, supporting the results of the current study but what we do not know yet is the significance of these effects in long-term for related subjects. This ‘unknown’ makes us reach more cautious conclusions regarding this issue.

The impact of route of anesthesia on maternal and fetal ischemia modified albumin levels at cesarean section: a prospective randomized study

Abstract Objective: Ischemia modified albumin has been shown to increase in ischemic situations, and has also been shown to increase in fetal cord blood in deliveries by cesarean section. The aim of this study is to reveal whether anesthesia has an impact on maternal and fetal cord ischemia modified albumin levels. Methods: Seventy two women with uncomplicated term pregnancies were randomized to spinal (n=37) or general anesthesia (n=35) groups. The blood pressure, oxygen saturation, and pulse rate of the patients were recorded during the procedure. Maternal blood samples of ischemia modified albumin (IMA) were taken 10 min from the start of the procedure. The fetal cord blood samples of IMA were taken immediately after birth. Results: Maternal (0.99±0.19 vs. 0.80±0.27) and fetal (1.00±0.21 vs. 0.70±0.26) IMA levels were significantly higher in the general anesthesia group. Fetal IMA levels were positively correlated with maternal gravidity (r=0.31; P=0.008), parity (r=0.25; P=0.028), and fetal birth weight (r=0.23, P=0.045). Also, as time from incision to delivery lengthens, fetal IMA levels increase (r=0.29, P=0.012). Conclusion: Fetal cord ischemia modified albumin levels were higher in the general anesthesia group, therefore, it is proposed that regional anesthesia should be the preferred route of anesthesia for an elective cesarean section, at least until the impact of high fetal cord IMA levels are manifested.

Ischaemia-modified albumin in preeclampsia: A critical view

Abstract The aim of the study was to compare ischaemia-modified albumin (IMA) levels, both original and corrected, in healthy pregnancies and pregnancies complicated with preeclampsia. Maternal and cord blood samples from study (n = 16) and control (n = 17) groups were collected at the time of delivery. IMA levels were given in absorbance units (ABSU). IMA levels, both original and corrected, were compared between study and control groups. No significant difference was found between maternal and cord blood IMA levels between the study and control groups [1.0 (0.3–3.5) vs 1.2 (0.2–1.4) ABSU, p = .053 and 1.0 (0.1–2.2) vs 0.9 (0.4–3.6) ABSU, p = .382, respectively]. The results were similar for maternal IMA levels, after correction of IMA levels [1.1 (0.3–5.1) vs 1.2 (0.2–1.6) ABSU, p = .292]. IMA is a novel marker for ischaemia, without precise conclusions about its value in preeclampsia. An absolute correction formula, considering all possible intervening factors, is required for more accurate results.

The prognostic value of first-trimester cystatin C levels for gestational complications

Abstract Aims: This study is designed to evaluate predictive value of first-trimester cystatin C levels for long-term pregnancy complications. Methods: The cross-sectional study population consisted of patients who admitted to outpatient clinic of a Maternity Hospital between September 2013 and December 2014. Among the 203 participants who accepted to participate in the study, 174 subjects who continued antenatal follow-up in the same clinic were included in the final analyses. Cystatin C, blood urea nitrogen, Creatinine levels and estimated glomerular filtration rates were evaluated in the first-trimester routine antenatal visit. Mode of delivery and gestational complications were noted. Results: First-trimester cystatin C levels were significantly higher in cases complicated with preterm delivery and premature rupture of membrane (PROM) compared to uncomplicated ones (0.58±0.07 vs. 0.55±0.07, P=0.041, and 0.58±0.07 vs. 0.55±0.07, P=0.036). With a cutoff value of 0.505 mg/L, sensitivity of cystatin C for preterm delivery and PROM was 91.9% and specificity was 27.7% with a negative predictive value of 92.3% and a positive predictive value of 26.6%. Conclusion: Detection of cystatin C levels in the first trimester of pregnancy for the prediction of preterm/PROM seems as a promising preliminary data. The relatively higher first-trimester cystatin C levels in complicated pregnancies are conspicuous. The results imply that in pregnancy cystatin C might be more than a marker for renal function.

Successful vaginal delivery at term following ventro-fixation procedure for uterine incarceration

Uterine incarceration during pregnancy is a rare complication with an incidence of 1 in 3000 pregnancies (Gibbons and Paley, 1969). Anatomic displacement of the growing uterus may cause adjacent organ distortion, with variable symptomatology. Common symptoms presented are abdominal pain, rectal pressure and urinary complaints such as retention or incontinence (Gardner et al. 2013). Early and accurate diagnosis for avoiding the devastating perinatal complications is critical. Here, we discuss the feasibility of ventro-fixation during pregnancy in cases of uterine incarceration to resume safe gestation and improve the chances of vaginal delivery.