Aydan Biri

Role of Oxidative Stress in Intrauterine Growth Restriction

Aims: The objectives of this study were to determine the role of oxidative stress in intrauterine growth restriction (IUGR) and to investigate the possible molecular mechanism(s) leading to oxidant stress in IUGR. Methods: Parameters of the oxidative and antioxidant system were evaluated in maternal plasma, umbilical cord blood, and placental tissue of pregnant women with IUGR fetuses. The same samples were obtained from women with normal pregnancies and were evaluated. Results: The results of this study indicate that while the levels of malondialdehyde (MDA) and xanthine oxidase (XO) were higher in maternal plasma, umbilical cord plasma, and placental tissues of the patients with IUGR when compared to the control group [MDA: 142.8 ± 18.0 vs. 86.4 ± 22.5 nmol/ml, 151.6 ± 25.8 vs. 93.3 ± 7.4 nmol/ml, and 0.72 ± 0.19 vs. 0.42 ± 0.09 nmol/mg protein, respectively (for all p < 0.0005); XO: 1.251 ± 0.674 vs. 0.20 ± 0.019 mIU/ml (p < 0.0005), 1.97 ± 0.73 vs. 0.237 ± 0.143 mIU/ml (p < 0.0005), and 0.023 ± 0.0012 vs. 0.012 ± 0.004 mIU/ml (p < 0.025), respectively], the levels of antioxidant potential were identified to be lower in maternal plasma, umbilical cord plasma, and placental tissues of the patients with IUGR: 63.3 ± 11.9 vs. 198.0 ± 31.9 U/ml (p < 0.0005), 32.6 ± 3.7 vs. 206.5 ± 27.1 U/ml (p < 0.0005), and 0.56 ± 0.23 vs. 1.16 ± 0.29 U/ml (p < 0.0005), respectively. On the other hand, the activities of adenosine deaminase of the IUGR patients were higher than those of the control group in maternal plasma (204.8 ± 103.5 vs. 115.6 ± 31.8 U/l, p < 0.01) and umbilical cord blood samples (584.2 ± 285.2 vs. 147.9 ± 44.8 U/l, p < 0.0005) which may suggest that oxidative stress has a role in IUGR. Moreover, an increased superoxide dismutase activity in maternal plasma (128.2 ± 37.4 vs. 88.8 ± 16.6 U/ml, p < 0.005) and cord blood (162.1 ± 37.0 vs. 116.6 ± 20.7 U/ml, p < 0.005) and an increased glutathione peroxidase activity in maternal plasma (1.83 ± 0.26 vs. 1.47 ± 0.31 IU/ml, p < 0.01) and placental tissue (0.007 ± 0.0015 vs. 0.003 ± 0.0012 IU/ml, p < 0.0005) were detected, while decreased catalase activities in cord blood (23,717 ± 3,538 vs. 16,397 ± 2,771 IU/ml, p < 0.0005) and placental tissue (47.2 ± 17.2 vs. 70.7 ± 11.3 IU/ml, p < 0.005) were identified in IUGR groups. Conclusions: In the light of the results of this study, it can be stated that the oxidative stress increases in patients with IUGR. Providing high-risk patients with an antioxidant may be useful in the prevention or treatment of IUGR, although it is a condition with no certain treatment outcome.

The effects of rosiglitazone and metformin on insulin resistance and serum androgen levels in obese and lean patients with polycystic ovary syndrome

Aim: The aim of this study was to assess the effects of metformin and rosiglitazone on insulin resistance and serum androgen levelsin both obese and lean patients with polycystic ovary syndrome (PCOS). Materials and methods: Forty lean [body mass index (BMI) <25 kg/m2] and 40 overweight and obese (BMI>²5 kg/m2) patients were included in the study. Waist and hip measurements, serum sex steroid levels, insulin response to 75-g oral glucose tolerance test, fasting insulin, fasting C-peptide levels and homeostasis modelassessment of insulin resistance (HOMA-IR) were determined in all patients. The degree of hirsutism was determined by the Ferriman-Gallwey scoring system. Patients were divided into two groups, with 40 (20 overweight and obese; 20 non-obese) patients each. One group was treated with metformin (MET group) 850 mg bid while the other received rosiglitazone (ROSI group) 4 mg/day for 12 weeks. All measurements were repeated at the end of this period. Results: After the 12-week treatment period, HOMA-IR, area under the curve of insulin, fasting insulin and C-peptide levels were observed to have be decreased significantly in all groups. The decrease in the parameters mentioned above was similar in the four groups. The serum levels of free testosterone, androstenedione and DHEA-S decreased in all groups, but the decrease was statistically significant only in the ROSI groups. Within the lean MET group one patient became pregnant and was hence excluded from the final data analysis. Menstruations became regular after metformin therapy in 41.6% of lean and 35.7% of obese patients who had menstrual disturbance prior to the study. Rosiglitazone therapy improved menstrual disturbance in 61.5 % of lean and 53.8% of obese patients. Conclusions: Our data showed that both metformin and rosiglitazone increased insulin sensitivity in obese patients with PCOS as expected, and in lean patients as well. Rosiglitazone seemed to be more effective in decreasing the androgen levels and in achieving slightly greater improvement in menstrual disturbance than metformin.

Levels of lipoprotein and homocysteine in non-obese and obese patients with polycystic ovary syndrome

Aim. This study was designed to examine the relationship between homocysteine (Hcy), lipoprotein levels and insulin resistance in obese and non-obese patients with polycystic ovary syndrome (PCOS). Materials and methods. Eighty-five patients (38 obese, 47 non-obese) with PCOS and 50 healthy subjects (25 obese, 25 non-obese) were included in the study. PCOS was defined according to the Homburg criterion. Serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), dehydroepiandrosterone sulfate (DHEA-S), insulin, 17-hydroxyprogesterone, free testosterone, androstenedione, vitamin B12 and folate were measured. Also, serum concentrations of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), lipoprotein (a) (Lp(a)), apoprotein B (Apo B) and apoprotein A (Apo A) were determined. Plasma Hcy levels were measured. Insulin resistance was evaluated by homeostasis model assessment (HOMA). Results. Plasma Hcy levels were significantly higher in women with PCOS than in healthy women. HOMA-R (insulin resistance) was significantly higher in women with PCOS compared with healthy women. Serum fasting TC, LDL-C, TG, Apo B, vitamin B12 and folate levels were similar between PCOS and control groups. Lp(a) levels were higher in PCOS patients than in control subjects, whereas HDL-C and Apo A levels were lower. Compared with obese PCOS subjects, non-obese PCOS subjects had low HOMA-R, TC, LDL-C, TG, Apo B, Lp(a) and androgen levels. Plasma Hcy levels, serum HDL-C and Apo A levels were similar between obese and non-obese women with PCOS. Levels of HDL-C and Apo A were lower in both obese and non-obese PCOS patients than in obese and non-obese control subjects, whereas Lp(a) levels were higher. No correlation was observed between plasma Hcy, body mass index, HOMA-R, serum androgen levels, TC, LDL-C, HDL-C, Apo A, Apo B and Lp(a) levels. Conclusion. These results showed that elevated insulin resistance and plasma Hcy levels, and changes in serum lipid profile, which are possible risk factors for cardiovascular disorders, play important roles in the development of cardiovascular disease in both obese and non-obese patients with PCOS.

Assessment of DNA damage in women using oral contraceptives

The effect of the use of an oral contraceptive (OC) on the frequency of sister chromatid exchanges (SCEs) and on the response in the alkaline comet assay (single-cell gel electrophoresis (SCGE)) was investigated in 18 women taking contraceptive pills daily for 24 months. As controls, fertile women were included with regular menstrual cycles who received no OC drugs. A significant increase in the number of lymphocytes with DNA migration and an increased frequency of SCE per metaphase were observed in OC users as compared with their age-matched untreated controls (P<0.005). As higher incidences of spontaneous SCEs in peripheral blood lymphocytes have been reported to occur in females during pregnancy due to profound changes in the levels of certain sex hormones such as progesterone and estrogen, particularly during the last trimester, 17 pregnant women served as positive controls in this study in order to test the rate of genetic damage due to those changes. Higher frequencies of SCEs and comet responses were observed in pregnant women than in their matched controls. However, no statistically significant difference in DNA damage was observed between OC users and pregnant women (P>0.05). This study underscores the fact that prolonged and extensive use of these drugs in our daily life may be hazardous and also, that OC users should be aware of multifactorial risk factors (environmental, genetic and life style patterns) that may be responsible for additional DNA damage.

The mean platelet volume in gestational diabetes

AbstractObjective: To compare the platelet count and mean platelet volume (MPV) values of pregnancies diagnosed with gestational diabetes with those of healthy pregnancies. Material—method: Between June 2003 and September 2004, 100 healthy pregnancies and 100 pregnancies with gestational diabetes were studied at Gazi University, Department of Obstetrics and Gynecology. Results: While no statistically significant difference was observed in the platelet count between the two groups, the MPV of the gestational diabetes group (9.4 ± 1.6 fl) was evaluated to be significantly higher than the MPV of the healthy pregnancy group (8.3 ± 1.1 fl). Additionally, when linear regression analysis was performed an inverse relationship was observed between platelet number and MPV. Conclusion: There is a need for further research focusing on the platelet function in the observation and treatment of gestational diabetes, which can pose the risk of developing Type 2 diabetes for the mother and has negative consequences for the fetus.

The relationship of homocyteine, B12 and folic acid with the bone mineral density of the femur and lumbar spine in Turkish postmenopausal women

ObjectiveThe relationship of homocyteine, B12 and folic acid with osteoporosis has already been studied in various populations. We compared the important factors in the metabolism of homocysteine, such as homocysteine, B12 and folic acid levels, of Turkish postmenopausal women, and their relationship with the femur and lumbar spine bone mineral density.MethodsThis cross-sectional study was conducted at Gazi University, Department of Obstetrics and Gynecology. The study group consisted of 178 postmenopausal women. Serum homocysteine, folic acid and Vitamin B12 were measured. BMD was measured using DEXA at the right femoral neck and lumbar spine (L1–L4).ResultsUpon evaluation of both the femur and lumbar spine, it was determined that osteoporosis could be associated with a homocysteine level above the median and with a B12 value under the lowest quintile value.ConclusionPlasma Hcy and vitamin B12, but not folate levels, were associated with osteoporosis. Future interventional studies are needed to determine methods to reduce Hcy levels with dietary supplements and extra vitamin B12, which will restore bone health and reduce risk of fractures.

Intravenous leiomyomatosis treated with aromatase inhibitor therapy

[1]. The gonads of these patients develop into ovaries in utero, but then degenerate into streaks owing to the lack of a second X chromosome [1]. Cesarean is the usual mode of delivery in these patients [3], but in the present case the patient had a spontaneous vaginal delivery. Gonadal neoplasm can occur in up to 30% of cases and gonadoblastoma accounts for the majority of tumors [2]. Gonadoblastoma may synthesize estrogens or testosterone and is associated with dysgerminoma in 50% of cases [4]. In one case report 5 different histological subtypes of germ cell malignancies were described [4]. Early diagnosis is important and immediate gonadectomy is strongly recommended, as these tumors may even develop in infancy. A multidisciplinary approach with psychological support is important for the management of patients with pure gonadal dysgenesis. Normal uterine function including vaginal delivery is possible in these patients. References

Investigation of free radical scavenging enzyme activities and lipid peroxidation in human placental tissues with miscarriage.

Background: Miscarriage (early pregnancy failure) is a pregnancy-related disease, the pathophysiology of which is still not completely understood. Lipid peroxidation and alterations in antioxidant enzyme activities may be of importance in the pathogenesis of this disorder. This study was planned to investigate the possible relation between free radical scavenging enzyme activities and lipid peroxidation levels in placenta tissues with miscarriage. Methods: Placental tissue samples were obtained from 21 patients who had miscarried and 25 normal pregnant women undergoing elective abortion as a control group. Total superoxide dismutase (T-SOD), glutathione peroxidase (GSH-Px), and catalase (CAT) enzyme activities and levels of thiobarbituric acic reactive substances (TBARS), antioxidant potential (AOP), and nonenzymatic superoxide radical scavenger activity (NSSA) were measured in the placental tissues. Results: GSH-Px, CAT activities, and TBARS levels were found to be significantly increased, while T-SOD and NSSA values decreased in patients with early pregnancy failure when compared with women undergoing elective abortion (control group). However, there were no significant differences in AOP levels between the groups. Conclusions: Our results reflects oxidative stress in placenta tissues of early pregnancy failure, as the oxidative processes seem to be counteracted by the physiologic activation of antioxidant enzymes such as CAT and GSH-Px. Moreover, a compensatory mechanism might be developed against possible oxidative damage in patients with miscarriage.

Distribution of secreted aspartyl proteinases using a polymerase chain reaction assay withSAP specific primers inCandida albicans isolates

Secreted aspartyl proteinase (Sap) distribution among differentC. albicans isolates was determined usingSAP-specific primers in polymerase chain reaction (PCR) assay.SAP1, SAP2, andSAP3 were detected in 13 of 40 (32.5 %),SAP4 in 38/40 (95 %),SAP5 were detected in 30/40 (75 %),SAP6 in 23/40 (57.5 %) ofC. albicans strains isolated from blood cultures.SAP1-SAP3 were detected in 37 of 40 (92.5 %),SAP4 were detected in 3/40 (7.5 %),SAP5 in 3/40 (7.5 %),SAP6 in 5/40 (12.5 %) ofC. albicans strains isolated from vaginal swab cultures. Sap1, Sap2 and Sap3 isoenzymes were found to be related to the vaginopathic potential ofC. albicans, Sap4, Sap5 and Sap6 isoenzymes were found to be correlated with systemic infections.

Effect of different degrees of glucose intolerance on maternal and perinatal outcomes

Objective. To evaluate the effect of markedly elevated 50-g glucose loading test (GLT) (≥200 mg/dL) and equivocal 100-g GLT (one abnormal value) results on maternal and perinatal outcomes. Methods. Retrospective analysis of 2029 singleton pregnancies screened for gestational diabetes mellitus (GDM). Maternal and perinatal outcomes in five different groups with different degrees of glucose intolerance were compared. First group consisted of patients with normal 50-g test, second group was formed by patients with abnormal 50-g glucose test but a normal 100-g test. Third group included patients with one abnormal value after 100-g test. Patients in the fourth group were diagnosed to have GDM after an abnormal 100-g test. Patients in the fifth group had a value ≥200 mg/dL after 50-g test and were diagnosed to have GDM. Results. Macrosomia and large for gestational age incidence were highest in the group with one elevated glucose tolerance test (GTT) value. Hospitalisation rates, hypoglycemia, hyperbilirubinemia and polycythemia were more common in neonates born to mothers with one elevated GTT value and to mothers with a GLT > 200 mg/dL. Conclusion. Adverse maternal and perinatal outcomes in patients with one elevated GTT value and in patients with a GLT value > 200 mg/dL warrant close glucose monitoring and treatment in these groups even in the absence of a diagnostic abnormal GTT.