Esengul Turkyilmaz

Expression of the imprinted IGF2 and H19 genes in the endometrium of cases with unexplained infertility

OBJECTIVE As genomic imprinting plays a critical role in the development of the placenta, the aim of this study was to detect whether the expression levels of the imprinted genes IGF2 and H19 in the endometrium differ between infertile and fertile women. STUDY DESIGN Total RNA was extracted from 30 (15 unexplained infertile and 15 fertile) womens endometrial tissue. cDNA was synthesized from total RNAs of each sample. IGF2 and H19 mRNA expression levels were measured quantitatively using the Real Time PCR method. In order to determine the allelic expression of IGF2 and H19, genomic DNA was extracted from endometrial tissues. RESULTS When compared with the control group, increased mRNA expression of IGF2 was detected (1.5-fold change, P=0.015) in the unexplained infertility group. In contrast, H19 expression was lower in the infertility group as compared to the control group (4-fold change, P<0.0001). Restriction analysis of cDNA-derived PCR product showed that all patients and controls indicated monoallelic expression of IGF2 and H19. CONCLUSION Our results showed that altered expression of these imprinted genes might affect implantation and that their timely and appropriate activation is important for proper functioning. To understand the molecular epigenetic basis of implantation and placental development, genomic imprinted genes should be further investigated.

Evaluation of oxidative stress markers and intra-extracellular antioxidant activities in patients with endometriosis.

OBJECTIVE The aim of the study is to evaluate alterations in intracellular and extracellular antioxidant enzymes activities and serum oxidative stress markers in patients with endometriosis. STUDY DESIGN The current prospective study consisted of 31 female patients with endometriosis and 27 healthy controls. Serum total thiol, native thiol, disulphide, catalase, myeloperoxidase, and ceruloplasmin concentrations were measured. Laboratory and clinical data of all participants were recorded to compare the differences between the study and the control groups. RESULTS Serum native thiol and total thiol levels in the study group were significantly lower than those in the control group [(p=0.009, p=0.03, respectively)]. Serum catalase levels are significantly higher in patients with endometriosis comparing to the control group (p=0.009). CONCLUSIONS The finding that significant differences in serum total thiol, native thiol, and catalase levels observed in endometriotic patients supports that oxidative stress carries weigh in the pathophysiological aspects of endometriosis. Also significantly low levels of extracellular antioxidants and significantly high levels of intracellular antioxidants in endometriotic patients may arise from differences of free radicals in endometriosis and the activity levels of endometriosis. These non-invasive serum markers might give us an opportunity to monitor the diseases progress during the treatment.

NLF2 gene expression in the endometrium of patients with implantation failure after IVF treatment.

The aim of this study was to analyze the expression of microfibril-associated protein 2 (MFAP2), microfibril-associated protein 5 (MFAP5) and nuclear localized factor 2 (NLF2) genes in patients with repeated IVF failure and compare with fertile population. Total RNA was isolated from 38 patients (repeated implantation failure, group 1, n=22; fertile patients, group 2, n=16). mRNA expression levels were measured quantitatively using real-time polymerase chain reaction. Our results showed that mRNA expression of NLF2 significantly decreased in the infertility group as compared to control group (P=0.023). In addition a marked decrease was observed in the expression of MFAP2 in women with repeated implantation failure. In conclusion, NLF2 gene expression levels and differences in MFAP2 and MFAP5 gene expressions (albeit being insignificant) between infertile group and control group draw attention to a genetic basis under implantation failure.

Recurrent mucinous cystadenoma: a laparoscopic approach

The second most common epithelial tumor of the ovary is mucinous-type, and it constitutes 8–10% of all ovarian tumors. The recurrence of mucinous cystadenoma is very rare after complete excision. Only four such cases have been reported till date. The case presented in this report is the fifth, who had her initial surgery performed by gynecologic oncology team by laparotomy and was followed up by the same group. After recurrence at the same ovary, the patient underwent laparoscopic evaluation and unilateral salpingoophorectomy was performed. The final histopathological diagnosis was mucinous cystadenoma, just the same as the initial cyst.

Preoperative Neutrophil-to-Lymphocyte Ratio Has a Better Predictive Capacity in Diagnosing Tubo-Ovarian Abscess

Background: The aim of this study is to identify the inflammatory markers which predict a tubo-ovarian abscess (TOA) in the most accurate way. Methods: This study involves 312 women. Preoperative inflammatory markers in the study group were compared with those in the healthy control group to identify the most efficient predictor of TOA with a high sensitivity and specificity. The recommended cutoff values of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), white blood cell count, and red cell distribution width were determined using receiver operating characteristic curve (ROC) analyses. Results: The area under the curve (AUC = 0.99) in the ROC analysis was found to be statistically significant for NLR (p < 0.001) with a cutoff value of ≥4.15 (95% CI 0.97-1.00, sensitivity 95.2%, specificity 99.4%). The positive predictive value of NLR was 99.2%, and the negative predictive value was 96.7% (p < 0.001). The recommended threshold for PLR was found to be 164.37 (AUC = 0.95, 95% CI 0.93-0.98, sensitivity 86.7%, specificity 92%), and the cutoff point of the white blood cell count in the ROC analysis was 9.55 × 103/μl (AUC = 0.90, 95% CI 0.87-0.95, sensitivity 78.68%, specificity 96.68%). Conclusion: Preoperative NLR and PLR improve the predictive value of serum markers for the presence of TOA.

Recurrent Scar Endometriosis Developing in the episiotomy

Received: 19.02.2016 accepted: 05.04.2016 1Department of Gynecology and Obstetrics, Atatürk Training and Research Hospital, Ankara, Turkey 2Department of Gynecology and Obstetrics, Yildrim Beyazit University, Ankara, Turkey 3Department of Gynecology and Obstetrics, Doktor Sami Ulus Hospital, Ankara, Turkey 4Department of Pathology, Atatürk Training and Research Hospital, Ankara, Turkey Yazışma adresi: Esengül Türkyılmaz, Department of Gynecology and Obstetrics, Ataturk Training and Research Hospital, Ankara, Turkey e-mail: turkyilmaz06@yahoo.com INTRODucTION

Impact of Bimanual Vaginal Examination on Pap Smear Test Results

Objective: The aim of the study is to evaluate the possible effects of the various conditions especially bimanual examination on the adequacy of pap smear test. Study Design: Presented here is a prospective controlled clinical trial carried out at Ankara Ataturk Training and Research Hospital between November 2013 and March 2014. Total of 1771 patients seen at the gynecology outpatient clinic were included in the study. The technique described by the American Society of Cytopathology Criteria 2000 for the preparation of the specimen was followed. Updated Bethesda system 2014 was used for reporting the results. Results: Number of subjects in smear before examination group was 1194 and in the smear after examination group was 577. Two percent (n=36 subjects) of the cervicovaginal report was inadequate. When other clinical conditions were not taken into consideration, the likelihood ratio for inadequate smear in the smear after examination group was 2.64 compared to smear before examination group (p=0,004). Conclusions: In some conditions cervicovaginal smear sampling may be carried out after bimanual vaginal examination instead of missing the chance to screen the women. However, the patients have to be informed that cervicovaginal smear result might be inadequate so that a repeat test has to be carried out.

Dynamic Thiol-Disulphide Status in Polycystic Ovary Syndrome and Its Association with the Pathogenesis of the Disease.

Background/Aims: This study aims to examine the differences in plasma thiol-disulphide levels that are related to oxidative stress among obese and nonobese women with polycystic ovary syndrome (PCOS) and their age/body mass index (BMI)-matched healthy controls. Methods: The participants were divided into 4 groups based on BMI (nonobese and obese). Serum thiol and disulphide levels were compared among groups. Results: Serum thiols were found higher in the obese PCOS group than those in the obese control group in the study (thiol: 407.33 ± 46.25 vs. 365.67 ± 67.03 µmol/l, p = 0.014). Disulphide levels were observed to be decreased in the obese PCOS group relative to its control (21.39 ± 1.33 vs. 23.53 ± 8.47 µmol/l, p = 0.021). Serum thiol levels were found to be higher in the nonobese PCOS group compared to nonobese controls (thiol: 434.7 ± 46.92 vs. 422.94 ± 46.61 µmol/l, p = 0.031). Significant differences of disulphide levels between the nonobese PCOS group and the nonobese control group were observed (18.07 ± 1.93 vs. 20.68 ± 3.79 µmol/l, p = 0.027). Conclusion: High antioxidant levels in women with PCOS may be related to either mechanisms involving anovulation, multiple follicular development, and apoptosis or to their compensatory system against oxidative load arising from obesity and overweightness.

Altered Maternal Serum Dynamic Thiol-Disulfide Interchange Reactions in Pregnant Women with Gestational Diabetes Mellitus

OBJECTIVE: We aimed to evaluate the alteration of dynamic thiol/disulfide homeostasis which basically shows the oxidative stress in body in pregnant women with gestational diabetes mellitus (GDM) by using a newly developed and automated analysis method. STUDY DESIGN: Study population consisted of body mass index and gestational age-matched pregnant women. Patients were subdivided into 3 groups based on their response to glucose challenge test (GCT) and oral glucose tolerance test (OGTT) results: (1) control group (normal GCT test results n= 87); (2) Impaired glucose tolerance (IGT) group ( n= 37); (3) GDM group (n=25). Maternal serum thiol and disulphide levels were compared among three groups. RESULTS: Maternal serum thiol values were found decreased and maternal serum disulphide levels were increased in GDM groups were compared to control and IGT groups (Thiols for controls: 398.19±30.49 µmol/L, for IGT group 395.92±35.52 µmol/L, and for GDM group 371.89±41.14 µmol/L p= 0.002). Disulphides for controls; 17.47±4.38 µmol/L, for IGT; 19.27±3.34 µmol/L, for GDM group; 25.46±4.21 µmol/L, (p=0.001). Disulphide/thiol ratio was found to be increased in GDM group comparing to other groups (Disulphide/thiol ratio: 0.044±0.012 for controls, 0.049±0.009 for IGT group, 0.068±0.0103 for GDM group p=0.001) CONCLUSION: Thiol- disulphide balance has shifted to the oxidative side in pregnant women with GDM. So blood glucose regulation is extremely crucial for reducing the oxidative stress which may lead to damages to vital organs of a mother or possibly to development of a fetus in women with GDM.

Multiple sclerosis; a disease of reproductive-aged women and the dilemma involving contraceptive methods.

Multiple sclerosis (MS) is an autoimmune disorder characterized by chronic inflammation in the central nerves system. Because the disease predominantly affects women of reproductive ages, having knowledge about contraception options for MS patients can make clinicians provide better counseling. Although most contraceptive methods are generally accepted as safe and effective in MS patients, recent studies have raised questions about their potential adverse effects on the disease. The use of contraceptive methods to avoid unintended pregnancies is crucial in MS patients, particularly during the relapse phase of the disease or the time when the disease is not completely under control. This review investigates the contraception options and their effects on female MS patients. Providing appropriate contraception options to multiple sclerosis patients will be one of the most challenging issues for clinicians to deal with. Recent studies have raised questions that the use of hormonal contraceptives may at least partly contribute to the rise in incidence of MS in women. This review investigates the contraception options and their effects on female MS patients.