Ebru Tarim

Early onset of subclinical atherosclerosis in women with gestational diabetes mellitus

Common carotid artery intima‐media thickness (CIMT) is a non‐invasively assessed marker of subclinical atherosclerosis. Our aim in this study was to investigate CIMT in women with gestational diabetes mellitus (GDM).

Endoscopy in hyperemesis gravidarum and Helicobacter pylori infection

Objectives: To establish a relationship between hyperemesis gravidarum (HG) and Helicobacter pylori (H. Pylori) infection by histologic testing. Methods: Twenty patients with severe HG (Group I) and 10 volunteer pregnant women without gastric complaints (Group II) were included in the study. Endoscopic evaluations were done in both groups and biopsies were obtained from the antrum and corpus for the histopathologic diagnosis of H. pylori. The groups were compared with the χ2‐test and Fishers exact test where appropriate. Results: H. pylori was diagnosed in 19 (95%) of 20 patients in Group I and 5 (50%) of 10 patients in group II. H. pylori densities in the antrum and corpus were higher in Group I and the differences between the two groups were statistically significant. The biopsy specimens revealed significant inflammation and H. pylori activation processes in patients with HG, and in 18 of 19 patients inflammation scores were greater than +2 on the scale. Pangastritis was demonstrated by endoscopic examination in 17 of 20 patients with HG. Enterogastric reflux was also diagnosed in 10 patients. In the control group, three patients had antral gastritis. Conclusions: We suggest that in patients with intractable nausea and vomiting during pregnancy, pangastritis and enterogastric reflux are the main endoscopic findings and that these findings are closely associated with H. pylori infection, which can be diagnosed histologically. The degree of gastric complaints may be associated with the density of H. pylori infection.

Detection of insulin resistance in Turkish adults: a hospital‐based study

Aim: The aim of the present study was to investigate the usefulness of insulin sensitivity check indices in our hospital population.

High maternal hemoglobin and ferritin values as risk factors for gestational diabetes.

A number of studies have linked high maternal serum hemoglobin (Hb) levels in pregnancy with increased incidence of adverse pregnancy outcomes such as low birth weight and small-for-gestational-age newborns pre-term births increased perinatal mortality and pre-eclampsia. Lao et al. Identified high maternal hemoglobin at the initial prenatal visit as a risk factor for gestational diabetes mellitus (GDM). This protective study was conducted on 253 non-diabetic Turkish women with singleton pregnancies whose serum Hb level and mean corpuscular volume (MCV) at the initial visit were > 10 g/dl or > 80 fl respectively. The exclusion criteria were first prenatal visit later than 14 weeks of gestation; pre-existing anemia or hemoglobinopathy chronic disease; such as diabetes mellitus renal or gastrointestinal disorder hypo- or hyper-thyroidism GDM diagnosed before 28 weeks gestation. Values signifying the 50th percentile for Hb (12.2 g/dl) and ferritin (Fe) (19.7 µg/l) were established based on these data and two sets of groups were formed based on the initial-visit-findings (Hb above and below the 50th percentile; Fe above and below the 50th percentile). The pairs of groups were compared with respect to maternal pregnancy and infant characteristics and incidence of GDM. At the first trimester prenatal visit; a blood sample from each subject was analyzed for complete blood count MCV fasting serum glucose level and serum levels of Fe vitamin B12 folic acid and insulin. Insulin sensitivity was calculated using the HOMA index. [(Formula: fasting glucose (mmol/l) X fasting insulin (µunits/ml)/22.5]. All women were screened for GDM between 24 and 28 weeks of gestation with a 50-g oral glucose any subject with serum glucose level > 135 mg is subjected to a 3-h 100-g load OGTT. All the OGTT results at 24-28 weeks gestation were interpreted according to the criteria of Carpenter and Coustan. (excerpt)

Comparison of the criteria for gestational diabetes mellitus by NDDG and Carpenter and Coustan, and the outcomes of pregnancy

This is a retrospective study to compare the criteria for diagnosis of gestational diabetes mellitus (GDM) by the National Diabetes Data Group (NDDG), and Carpenter and Coustan criteria, and to study the outcome of GDM when diagnosed by the more sensitive criteria. Six hundred and sixty-two pregnant women were included in this study from the medical records between September 1998 and April 2001. GDM was positive in 6.50% of patients according to Carpenter and Coustan and in 4.08% of patients according to NDDG criteria. Women with GDM were older, had higher fasting and glucose challenge test (GCT) glucose levels, and fetal weight than the normal women. Hypoglycemia was observed only in one infant. Regarding pre-term delivery and preeclampsia, there was no significant difference between the groups. Age, delivery week and fetal weight of patients who had caesarian delivery were significantly higher than spontaneous vaginal delivery. Prevalence of macrosomia in GDM group was higher than in the normal group. There was a significant correlation between the macrosomia and number of positive blood glucose values during OGTT. In multivariate analyses, fasting, GCT and second hour OGTT blood glucose levels, mean parity, and delivery week were independent risk factors for fetal weight. Carpenter and Coustan criteria is more sensitive than the NDDG criteria and women with GDM had a higher frequency of macrosomia and the frequency of macrosomia increases by the number of positive blood glucose levels during OGTT. Tight glycemic control might decrease the prevalence of caesarian delivery, pre-eclampsia, pre-term delivery and hypoglycemia of the infant.

Prophylactic red blood cell exchange may be beneficial in the management of sickle cell disease in pregnancy

Sickle cell disease (SCD) is associated with chronic hemolysis and painful episodes. Pregnancy accelerates sickle cell complications, including prepartum and postpartum vasoocclusive crisis, pulmonary complications, and preeclampsia or eclampsia. Fetal complications include preterm birth and its associated risks, intrauterine growth restriction, and a high rate of perinatal mortality. The purpose of this study was to evaluate pregnancy outcomes in patients with SCD who underwent planned preventive red blood cell exchange (RBCX).

Large pseudocyst of the umbilical cord associated with patent urachus

Cystic masses of the umbilical cord have been detected in the second and third trimesters of pregnancy in association with fetal abdominal wall defects and chromosomal anomalies. We present a case of an umbilical cord pseudocyst diagnosed using routine ultrasound at the 20 weeks of gestation. Serial sonography followed the progression of the cystic masses. A 2960‐g male infant was delivered at term, in whom a patent urachus was detected. The infant underwent repair with closure of the patent urachus and plastic reconstruction of the abdominal wall, and the postoperative course was uneventful. This case demonstrated an uneventful outcome despite the persistent multiple cord cysts.

Elevated plasma homocysteine levels in gestational diabetes mellitus

Objective.  This prospective study investigated the occurrence of hyperhomocysteinemia in a population of patients with gestational diabetes. The aim was to determine whether elevated plasma homocysteine is associated with gestational diabetes in Turkish women.

Vulvar syringoma aggravated by pregnancy

Syringoma is a benign tumors of eccrine sweat gland. They appear as multiple, tiny, firm, skin-colored papules. Vulvar involvement of syringoma is rare. Only 24 cases with vulvar syringoma have been previously reported in the literature. The majority of patients with vulvar syringomas are asymptomatic. A case of syringoma of the vulva exacerbated during pregnancy is presented. The case appears remarkable for the experienced aggravated pruritic symptoms of the patient during her pregnancy.

Fructus agni casti and bromocriptine for treatment of hyperprolactinemia and mastalgia

Hyperprolactinemia is the most common endocrine disorder of the hypothalamic–pituitary axis w1x. Research has proven that there is a causal connection between latent hyperprolactinemia and mastalgia w2x. The aim of this study was to investigate fructus agni casti as treatment for mild hyperprolactinemia and for mastalgia, and to compare its efficacy with that of bromocriptine (dopamine agonist ) therapy. This prospective study involved 40 women with cyclic mastalgia (Group 1) and 40 with mild hyperprolactinemia(Group 2). With respect to mastalgia, the exclusion criteria were purulenthemorrhagic breast discharge, severe endocrinopathy, malignancy, and requirement for breast surgery, simultaneous treatment with analgesics or non-steroidal antiphlogistics, pregnancy, lactation. With respect to hyperprolactinemia, the exclusion criteria were macroadenoma, other forms of endocrinopathy, and iatrogenic hyperprolactinemia due