Erdem Sahin

The effect of hyperemesis gravidarum on the 75 g oral glucose tolerance test screening and gestational diabetes mellitus

Abstract Objective: To clarify the effect of hyperemesis gravidarum (HG) on the 75u2009g oral glucose tolerance test (OGTT) and gestational diabetes mellitus. Methods: This retrospective cohort study was conducted via an evaluation of the hospital database medical records of 700 pregnant women. Of these, 60 were included in the study group as a result of hospitalization due to HG, 41 were excluded, and the remaining 599 formed a control group. The body mass index (BMI), urine ketone levels, and ages of all participants were separately recorded, both in the initial examination and during the 75u2009g OGTT. Results: At initial examination, no significant differences in maternal age and BMI were observed between the two groups. There was a significant decrease in BMI after 75u2009g OGTT in the study group. No significant difference in fasting serum glucose levels was found between the two groups, but significant differences in first and second hour serum glucose levels were observed. Conclusions: HG may improve in many women in the late second trimester, and loss of fatty tissue may affect the 75u2009g OGTT screening results. The appropriate cutoff value of 75u2009g OGTT for HG should be reevaluated following future, larger, studies.

High Immune Expression of Progesterone-Induced Blocking Factor in Epithelial Ovarian Cancer

Background: Progesterone-induced blocking factor, which is released from maternal lymphocytes during pregnancy mediates the immune effect of progesterone. According to new reports, it is suggested that proliferating cells, such as human trophoblasts, mesenchymal stem cells, and malignant tumors, can excrete progesterone-induced blocking factor at high ratio to escape from maternal immunity. It is shown in recent studies that progesterone-induced blocking factor is overexpressed in many malignant tumors such as breast, cervical, lymphoma, and leukemia. There are no data about progesterone-induced blocking factor expression in ovarian cancer cells. Hence, it is aimed to determine the progesterone-induced blocking factor expression levels in epithelial ovarian cancer. Methods: The study which was a retrospective cross-sectional study was conducted in a University Hospital. Twenty tissue specimens of patients with epithelial ovarian cancer and 20 tissue specimens of patients with healthy ovary were included in the study. Primary rabbit polyclonal anti- progesterone-induced blocking factor antibody was used to incubate the sections at a ratio of 1:300. Results: When the tissue sections were compared based on immunostaining with progesterone-induced blocking factor, we detected high stromal progesterone-induced blocking factor expression in the epithelial ovarian cancer group as check against to the normal ovarian group (P = .007). Similarly, we found high glandular progesterone-induced blocking factor expression in the epithelial ovarian cancer group as check against to the normal ovarian group (P < .001). Conclusion: Proving the existence of progesterone-induced blocking factor expression in epithelial ovarian cancer cells may lead new visions or new studies for epithelial ovarian cancer immunotherapy. As a result, epithelial ovarian cancer cells have greater levels of expression of progesterone-induced blocking factor protein than normal ovarian tissue according to immunohistochemistry. Further research is needed to understand the clinical importance of this finding, to learn outcomes of high levels of progesterone-induced blocking factor, and to investigate its underlying mechanisms.

The Effect of Anterior Uterocervical Angle on Primary Dysmenorrhea and Disease Severity

Background Primary dysmenorrhea, defined as painful menstrual cramps originating in the uterus without underlying pathology, is a gynecological disease that affects quality of life and school success. Our goal was to determine the effect of anterior uterocervical angle on primary dysmenorrhea and disease severity. Methods A total of 200 virgin adolescents, 16 to 20 years of age, were included in the study. The Andersch and Milsom scale was used to determine dysmenorrhea severity. Those with pathologies causing secondary dysmenorrhea were excluded from the study. Study subjects were grouped based on severity of pain. Demographic characteristics and uterocervical ultrasonographic measurements were compared among groups. Results Of the 200 participants enrolled in the study, 50 were healthy controls and 150 had primary dysmenorrhea. Those with primary dysmenorrhea had a significant family history of primary dysmenorrhea compared with controls (P < 0.001). Age (P=0.668), body mass index (P=0.898), menarche age (P=0.915), and length of menstrual cycles (P=0.740) were similar in all groups. The uterine corpus longitudinal axis, uterine corpus transverse axis, and uterine cervix longitudinal axis were also similar (P=0.359, P=0.279, and P=0.369, resp.). The mean uterocervical angle was 146.8u2009±u20096.0 in controls and 143.3u2009±u20097.3 in those with mild pain with no significant difference between the groups. In those with moderate pain, the mean uterocervical angle was 121.2u2009±u20097.3 compared with 101u2009±u20099.2 in those with severe pain, which was a significant difference. Additionally, there was also a significant difference in the uterocervical angle among those with mild, moderate, and severe pain (P < 0.001). Conclusion Our results indicate that a narrower anterior uterocervical angle is associated with primary dysmenorrhea and disease severity.

Effect of severe hyperemesis gravidarum on maternal vascular endothelial health: evaluation of soluble adhesion molecules

Abstract Purpose: This study aimed to clarify the effect of severe hyperemesis gravidarum (sHG) on maternal vascular endothelial health with evaluation of soluble adhesion molecules. Method: The study population consisted of two groups of pregnant participants between 18 and 35u2009years of age who were between 5 and 13u2009weeks of gestation: sHG group and a healthy control group. A group of 26 participants whose pregnancies were complicated by sHG was compared with 26 healthy participants regarding serum levels of the soluble adhesion molecules such as E-selectin, soluble intracellular cell adhesion molecule 1 (sICAM-1), and soluble vascular cell adhesion molecule one (sVCAM-1), as well as other biochemical markers. The two groups had similar baseline characteristics. Results: Maternal baseline characteristics were similar in both groups. Serum levels of E-selectin (pu2009<u2009.001), sICAM-1 (pu2009<u2009.001), and sVCAM-1 (pu2009<u2009.001) were higher in the sHG group compared with the control group. Higher blood urea nitrogen, creatinine, and sodium levels, serum osmolarity, and urine density (pu2009<u2009.001,u2009<u2009.001, .006, .041, and .001, respectively) were also observed in the sHG group compared with the control group. Conclusions: The findings of this study indicated that sHG could impact endothelial cell function and these changes represented hypovolemia and dehydration caused by severe vomiting. Large-scale studies are required to understand the clinical importance of this finding regarding the long-term consequences and underlying mechanisms of elevated sICAM-1, sVCAM-1, and sE-selectin synthesis.

Perinatal outcomes in uncomplicated late preterm pregnancies with borderline oligohydramnios

Abstract Purpose: The purpose of this study is to determine the adverse perinatal outcomes in uncomplicated late preterm pregnancies with borderline oligohydramnios. Methods: A total of 430 pregnant women with an uncomplicated singleton pregnancy at a gestational age of 34u2009+u20090–36u2009+u20096 weeks were included. Borderline oligohydramnios was defined as an amniotic fluid index (AFI) of 5.1–8u2009cm, which was measured using the four-quadrant technique. Adverse perinatal outcomes were compared between the borderline and normal AFI groups. Results: Approximately 107 of the 430 pregnant women were borderline AFI, and 323 were normal AFI. The demographic and obstetric characteristics were similar in both groups. Delivery <37 weeks, cesarean delivery for non-reassuring fetal heart-rate testing, meconium-stained amniotic fluid, Apgar 5u2009min <7, transient tachypnea of the newborn, respiratory distress syndrome, neonatal intensive care unit, and hyperbilirubinemia were not statistically different between the groups (pu2009=u2009.054, pu2009=u2009.134, pu2009=u2009.749, pu2009=u20090.858, pu2009=u2009.703, pu2009=u2009.320, pu2009=u2009.185, and pu2009=u2009.996, respectively). Although gestational age was full-term, induction of labor rates were significantly higher in the borderline AFI group (pu2009=u2009.040). In addition, fetal renal artery pulsatility index pulsatility index (PI) was significantly lower in the borderline AFI group than in the normal AFI group (pu2009=u2009.014). Conclusion: Our results indicated that borderline AFI was not a risk for adverse perinatal outcomes in uncomplicated, late preterm pregnancies.

Can it really predict prior to delivery? A new ultrasonographic method for prediction of short and long umbilical cords in full-term pregnancy

Abstract Objective: This study aimed to ultrasonographically determine the presence of short and long umbilical cords in full-term, uncomplicated pregnancies before delivery. Methods: A total of 681 pregnant women aged between 18 and 35 years who had a single pregnancy and an intact amniotic membrane, and who were past the 37th week of gestation, were included. Umbilical cord lengths were ultrasonographically evaluated using a new method, and were compared with postnatal umbilical cord length. Results: The mean index values for short, normal, and long umbilical cords were 2.96, 5.36, and 6.98, respectively. The cut-off index value for a short umbilical cord was 3.75 and the sensitivity and specificity were calculated as 67 and 97%, respectively, for a value ≤3, and as 92 and 80%, respectively, for a value ≤4. The cut-off index value was 6.25 for a long umbilical cord and the sensitivity and specificity were calculated as 75 and 78%, respectively, for a value ≥6, and as 85 and 64%, respectively, for a value ≥6.5. Conclusions: Calculation of the umbilical cord length index is a new ultrasonographic method that can be easily used to predict short and long umbilical cords during routine amniotic fluid evaluation in full-term pregnancies.

Induction of apoptosis by metformin and progesterone in estrogen-induced endometrial hyperplasia in rats: involvement of the bcl-2 family proteins

Abstract This study compared the antiproliferative effects of metformin and progesterone, via examination of the Bcl-2/Bax-caspase apoptotic pathway in estrogen-induced endometrial hyperplasia (EH) in 40 rats. Two rats died after bilateral oophorectomy, and 1u2009week after surgery, the remaining 38 were randomly divided into three groups: the first (control, nu2009=u200912) received 4u2009mg/kg 17β estradiol hemihydrate (E); the second (nu2009=u200913) received 4u2009mg/kg 17β estradiol hemihydrate and 50u2009mg/kg metformin (Eu2009+u2009M); and the third (nu2009=u200913) received 4u2009mg/kg 17β estradiol hemihydrate and 1u2009mg/day medroxiprogesterone acetate (Eu2009+u2009MPA). Histological markers and Bcl-2, Bax and caspase 9 expression were analyzed. Luminal epithelial thickness, density of gland and epithelial height was significantly higher in group E than in groups Eu2009+u2009M and Eu2009+u2009MPA. Histopathologic parameters were similar between the Eu2009+u2009M and Eu2009+u2009MPA groups. Bcl-2/Bax ratio was significantly decreased in the Eu2009+u2009M and Eu2009+u2009MPA groups and caspase 9 expression levels were significantly increased in the Eu2009+u2009M and Eu2009+u2009MPA groups, compared with the control group. In addition, Bcl-2/Bax ratio and caspase 9 expression were similar between the Eu2009+u2009M and Eu2009+u2009MPA groups. The data indicate that metformin reduces estrogen-induced EH in rats, via activation of the caspase-dependent mitochondrial apoptotic pathway, to the same degree as progesterone.

Cervical Local Immune Response for High-Risk Human Papillomavirus Infection: Involvement With Cervical Mucus SLPI Proteins

Purpose: To evaluate cervical mucus secretory leukocyte protease inhibitor (SLPI) concentrations in patients with high-risk human papillomavirus (hrHPV) 16 or 18 positive and low-grade squamous intraepithelial lesions (LGSIL) or high-grade squamous intraepithelial lesions (HGSIL). Method: Patients with HPV 16 or 18 positive from 30 to 45 years of age whose cervical cancer screening results reported cytologically LGSIL or HGSIL were included in the study. In the control group, we included participants in the same age with cytology negative and HPV-negative healthy women. All cytological LGSIL or HGSIL results were histopathologically confirmed with colposcopic biopsy specimens. Finally, the study consisted of a total of 3 groups each containing 25 participants as follows: (1) Pap smear and HPV-negative control group, (2) HPV 16 or HPV 18 and LGSIL-positive participants, and (3) HPV 16 or 18 and HGSIL-positive participants. Cervical mucus SLPI levels were analyzed using the enzyme-linked immunosorbent assay method. Results: The mean cervical mucus SLPI levels were 32.94 ng/mL (range: 23-41.29 ng/mL) in the hrHPV + LGSIL group, 29.40 ng/mL (range: 21.03-38.95 ng/mL) in the hrHPV + HGSIL, and 18.75 ng/mL (range: 13.58-29.24 ng/mL) in the healthy control group. Cervical mucus SLPI levels were found to be significantly higher in the hrHPV + LGSIL and hrHPV + HGSIL groups compared to the control group (P < .001). Conclusions: The data from the present study indicate that SLPI seems to be one of the important immunomodulatory proteins that provide local immune response in cervical mucosa.

The Effect of Oral Contraceptive Pills on the Macula, the Retinal Nerve Fiber Layer, and Choroidal Thickness

Background The aim of this study was to evaluate the effect of oral contraceptive pills (OCP) on the macula, the retinal nerve fiber layer (RNFL), and choroidal thickness (CT). Material/Methods A total of 24 healthy women taking monophasic OCP (3 mg drospirenone and 0.03 mg ethinylestradiol) for contraception only for at least one year were compared with a control group of 24 healthy women who were not taking an OCP. Optical coherence tomography (OCT) was used to evaluate the posterior ocular segments, and measurements were taken in the follicular phase (day 3) of the cycle in all women. Results No disparity in terms of age and body mass index between the groups was observed (p=0.436, p=0.538, respectively). In comparison of the macular region and CT between groups, we found that all variables except foveal center thickness and CT were significantly thinner in the OCP group. Nasal and temporal inferior parts of the RNFL and average RNFL were significantly slimmer in the study group versus the control group (p=0.013, p=0.018, and p<0.001, respectively). Conclusions OCP resulted in several structural changes in the posterior ocular segment. Thus, women using OCP for more than one year may have some eye problems. Therefore, it OCT should be performed for these women. Further clinical trials researching long-period effect of OCP on the eyes are needed.

Does Young Maternal Age Have Any Adverse Effect on Maternal and Fetal Health? A Retrospective Case Control Study

Objective: To reveal whether adolescent mothers are at higher risk of poor fetal and maternal outcomes compared with non-adolescent mothers. Study Design: 426 nulliparous women having a single pregnancy and gave birth with a birth-weight >500g or >24 weeks’ gestation were included. Participants were divided into three groups. 1. Group consisted of adolescents between ages of 16-17(n=56), 2. Group 18-19 ages(n=185) and 3. Group 20-24 ages(n=185). Adverse maternal and fetal outcomes compared among groups. Results: The mean maternal age was 16.6(±0.40), 18.1(±0.55), 22.6(±0.60) in groups, respectively. Antenatal visits number, smoking status, vaginal delivery, emergency cesarean delivery rates (fetal distress or cephalopelvic disproportion), perineal infection, postpartum hemorrhage, transfusion requirement, maternal death were not statistically significant among groups (p=0.871, p=0.935, p=0.450, p=0.961, p=0.737, p=0.112, p=0.996, p=0.859 and p=1, respectively). Induction of labour, delivery<37 weeks, low birth weight (<2500g), admission to NICU, meconium-stained amniotic fluid, severe neonatal conditions, respiratory distress syndrome, hypoxic ischemic encephalopathy, neonatal death rates were not statistically significant among groups (p=0.187, p=0.560, p=0.408, p=0.347, p=0.901, p=0.605, p=1, p=1 and p=1, respectively). Conclusions: The data from the present study indicates that when the adolescent period is grouped not as a whole but within itself, especially low gynecological age is associated with increased adverse fetal outcomes, and it does not carry any risk for the mother. Pregnancy in adolescents aged 18-19 years does not constitute a risk for both mother and child. If it is thought that an adolescent pregnant woman can not give birth vaginally, the cesarean ratio will increase unnecessarily. Hence maternal age should not be a criterion singly for cesarean delivery.