Fatma Beyazit

Evaluation of Oxidative Stress in Women with Polycystic Ovarian Syndrome as Represented by Serum Ischemia Modified Albumin and Its Correlation with Testosterone and Insulin Resistance.

Objective Ischemia-mediated oxidative stress and inflammation have been reported to be important contributors to the pathogenesis of polycystic ovary syndrome (PCOS). Ischemia-modified albumin (IMA) is a novel marker generated under ischemic and oxidative conditions and may reflect disease activity in distinct disease states. Therefore, we investigated whether the serum IMA levels are affected in infertile PCOS patients. Methods Forty-six patients with infertile PCOS, 30 patients with unexplained infertility, and 31 age- and body mass index (BMI)-matched controls were included in this cross-sectional study. Biochemical parameters, serum IMA levels, and their correlations with serum testosterone and insulin resistance were determined for each subject. Results In patients with infertile PCOS, the serum IMA levels were significantly elevated (p=0.003) compared with unexplained infertility patients and controls. A correlation analysis suggested that the IMA levels only correlated with the serum free testosterone levels in PCOS patients (r=0.43, p=0.028). Conclusion Elevations in the serum IMA levels in infertile PCOS patients may suggest a possible additional role of oxidative stress mechanisms in disease pathophysiology. Moreover, correlation between serum IMA and testosterone levels may influence the quality of oocytes via alterations in the balance of critical follicular fluid factors in the follicular microenvironment.

Elevated circulating nitric oxide levels correlates with enhanced oxidative stress in patients with hyperemesis gravidarum

Abstract Since the biochemical and molecular mechanisms responsible for ongoing oxidative stress in hyperemesis gravidarum (HEG) patients have not yet been fully elucidated, the aim of this study was to evaluate the possible role of nitric oxide (NO), malondialdehyde (MDA) and other oxidative stress markers in the disease pathophysiology. Moreover, the relation between oxidative stress markers and Helicobacter pylori (H. pylori) infection was also investigated. Women with pregnancies complicated by HEG (nu2009=u200933) were compared with pregnant women without HEG (nu2009=u200930) and with healthy non-pregnant women (nu2009=u200931). Serum NO, MDA, total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI) and H. pylori infection status were determined for each subject. Serum NO levels and OSI index were found to be increased (pu2009=u2009.001 and .013, respectively) and TAS levels were decreased (pu2009<u2009.001) in HEG patients compared with both controls regardless of H. pylori infection status. Serum MDA and TOS levels were not different between the study groups. Helicobacter pylori infection rates were similar in each group. The reduced antioxidant activities, as well as the increased OSI and NO levels in HEG patients indicate possible oxidative stress conditions in HEG patients. Moreover, serum NO levels may be used as an adjunctive marker to distinguish HEG patients from other causes of emesis during pregnancy. Impact statement What is already known on this subject? Current evidence suggests that oxidative stress is a significant factor responsible for a number of complications during pregnancy. What do the results of this study add? Hyperemesis gravidarum is an oxidative stress condition, as reflected by increased nitric oxide (NO) and decreased total antioxidant status activity, regardless of H. Pylori infection. What are the implications for clinical practice and/or further research? Full disclosure of the association between circulating NO and hyperemesis gravidarum would shed light on underlying biological mechanisms and could help clinical management of similar pregnancy-associated morbidity states.

Evaluation of the hematologic system as a marker of subclinical inflammation in hyperemesis gravidarum: a case control study

OBJECTIVESnCurrent evidence suggests that subclinical inflammation plays a significant role in the development of hyperemesis gravidarum (HEG). Simple hematological markers, such as mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), have been shown to reflect inflammatory burden and disease activity in several disorders. This study aimed to determine the diagnostic value of these hematological parameters for HEG.nnnMATERIAL AND METHODSnA total of 54 HEG patients and 58 age- and gestational-age-matched control subjects were studied. NLR, MPV, PLR, platelet distribution width (PDW), and red cell distribution width (RDW) values in all patients were calculated and recorded from complete blood cell counts.nnnRESULTSnFor HEG patients, the median NLR was 3.2 (1.6-7.1), and the median PLR was 143.7 (78.1-334.6); for control subjects, the values were 2.1 (1.0-4.7) and 93.1 (47.3-194.7), respectively. Although both the NLR and PLR of HEG patients were found to be significantly higher than in the controls, no significant difference was found between the study groups in terms of MPV, RDW, or PDW. Correlation analysis revealed a significant correlation between NLR and CRP (r = 0.872, p < 0.001).nnnCONCLUSIONSnOur results show that peripheral blood NLR and PLR values can reflect inflammatory burden in HEG patients and can be used as markers for HEG.

Effect of Nausea and Vomiting on Anxiety and Depression Levels in Early Pregnancy

ObjectivenNausea and vomiting of pregnancy (NVP) have been reported to be associated with distinct physiological responses to psychosocial stress. In this study, we aimed to evaluate the impact of nausea and vomiting on anxiety and depression during pregnancy.nnnMaterials and MethodsnEighty-three pregnant women with nausea and vomiting and 83 healthy pregnant women were included. All participants completed the demography- and pregnancy-related questionnaire, including Rhodes Index of Nausea and Vomiting, Beck Anxiety Inventory (BAI), and Edinburgh Postnatal Depression Scale (EPDS).nnnResultsnThe median BAI and EPDS levels were 13 (min-max: 0-43) and 7 (min-max: 0-20) for the study group and 4 (min-max: 0-26) and 4 (min-max: 0-16) for control group, respectively. A univariate analysis revealed a statistically significant increase in terms of BAI levels (p<0.001) between the groups, but no significant difference was observed in terms of EPDS. In a logistic regression analysis, both anxiety (p=0.018) and depression (p=0.022) were found to be affected by NVP. The BAI levels of the NVP group correlated with the severity of NVP.nnnConclusionnAccording to the results of the present study, women with severe NVP experienced a higher level of anxiety and depression, which necessitates an extra awareness from healthcare professionals in order to be able to contribute effectively.

Determining the factors influencing the intimate relationship between sexual satisfaction and dyadic adjustment in postmenopausal women

Introduction Identifying and characterizing sexual dysfunction is crucial in order to improve the quality of the marital relationship in postmenopausal women. Regarding this, the present study aimed to determine the association of menopausal characteristics with sexual satisfaction and marital adjustment. Material and methods This cross-sectional study was conducted on 89 postmenopausal women chosen using an improbable randomized sampling method. A questionnaire that collects demographic characteristics, the Dyadic Adjustment Scale (DAS) and The Golombok Rust Inventory of Sexual Satisfaction (GRISS) index were used to collect relevant data during the survey. Results The mean age of postmenopausal women recruited to the present study was 54.6 ±6.7. The overall mean GRISS score and DAS score were 5.6 ±1.7 and 92.1 ±11.2 respectively. The mean GRISS scores were found to significantly increase as the ages of the women increased (p = 0.044). Mean DAS scores were lower in postmenopausal women that have menopause duration longer than 10 years (p = 0.035). Higher education level of the spouse is associated with lower GRISS scores (p = 0.024). No correlation was observed between marital adjustment and sexual satisfaction. Conclusions Although sexual satisfaction and marital adjustment levels are decreased in the postmenopausal period, these two parameters do not seem to be related to each other. Multidimensional factors must be taken into account when evaluating sexual and marital satisfaction in postmenopausal women.

Adalimumab mitigates ovarian ischemia-reperfusion injury in rats by regulating oxidative stress, apoptosis and resolution of inflammation: Adalimumab in ovarian torsion

Ovarian torsion is a rare but an important reason of acute lower abdominal pain in women and associated with serious morbidity and mortality, if not treated promptly. The aim of this study was to evaluate the effects of an antitumor necrosis factor‐α antibody on ovarian torsion in a rat model of ischemia–reperfusion (I/R) injury.

The prevelance of human papillomavirus (HPV) genotypes detected by PCR in women with normal and abnormal cervico-vaginal cytology

OBJECTIVESnCervical cancer is the second most common type of cancer for women worldwide with a great proportion proved to be related to human papillomavirus (HPV) infection. As infection with HPV is the strongest risk factor for cervical neoplasia, detection of HPV genotypes in cervical and vaginal specimens of women with normal and abnormal cytology seems to be of paramount importance in cervical cancer screening. The objective of the study is to evaluate the prevalence and HPV genotypes among women with normal or abnormal Pap smear tests.nnnMATERIAL AND METHODSnThis retrospective study was conducted in a tertiary care university hospital in western Turkey. A total of 201 patients in whom both HPV typing and Pap test was performed between 2012 and 2016 in our obstetrics and gynecology department were enrolled in this study. Clinical and laboratory data were obtained for all participants. Cervical smears of the patients were classified by the Bethesda system and HPV analyses were done using the polymerase chain reaction (PCR) method.nnnRESULTSnThis study included 201 women, 72 of whom had normal and 129 of whom had abnormal Pap smear results. HPV DNA was detected in 91 (45.2%) of the 201 investigated women. Out of 72 patients with normal cervico-vaginal cytology, HPV positivity was detected in 35 (49%) patients, whereas 33 (35%) patients out of 94 with ASCUS , 18 (62%) patients out of 29 with LSIL and 5 (83%) patients out of 6 with HSIL had HPV positivity. Out of 35 HPV positive women that had normal pap test results, 25 (75%) were found to have high risk HPV (HR-HPV) genotypes. In women with ASCUS, LSIL and HSIL, HR-HPV genotype rates were found to be 94%, 89% and 100% respectively. The most common identified HPV types were HPV58, HPV16, HPV31, HPV33, HPV11 and HPV35.nnnCONCLUSIONSnThe frequency of HPV infection was found to be higher in our study compared to previous reports. Moreover, although HR-HPV genotypes were also detected in patients with normal cervical cytology, a majority of patients with HR-HPV genotypes were associated with abnormal cervical smear cytology including high rates of atypical squamous cells of undetermined significance, low-grade squamous intraepithelial lesion, and high-grade squamous intraepithelial lesion.

Impact of distinct factors affecting serum homocysteine levels in preeclamptic women

In their article on a recent issue of Archives of Gynecology and Obstetrics, Maged and colleagues [1] briefly address the importance of maternal serum total homocysteine and uterine artery Doppler as predictors of preeclampsia (PE) and intrauterine growth restriction (IUGR). They conclude that the combined use of uterine artery Doppler velocimetry and serum total homocysteine improves the prediction accuracy of poor placentation disorders more than each predictor alone. However, we have some remarks concerning the lack of evaluation of distinct variables that could affect serum homocysteine levels. In the discussion section of the paper, authors mention that vitamins B6, B9, and B12 and folic acid are needed as cofactors for proper homocysteine enzyme functioning but there is no information on the rest of the manuscript regarding the serum status of vitamin B12 and folic acid of their patient population. Both of these vitamins are involved in one carbon metabolism and associated with increases in circulating plasma homocysteine levels and reduction in DNA methylation patterns resulting in genome instability events [2]. Although a majority of epidemiological studies have shown homocysteine levels correlate inversely more closely with plasma folate levels and less so with vitamin B12 and B6 levels, it has been shown that strict vegetarians are often at severe risk for hyperhomocysteinemia due to low plasma B12 levels [3, 4]. In this context, the Hordaland Homocysteine Study can be regarded as one of the biggest community-based studies of homocysteine and its determinants [5]. In this study, older age, male sex, smoking, coffee consumption, high blood pressure, unfavorable lipid profile, high creatinine, and the MTHFR 677C polymorphism are mentioned to be the factors associated with increased homocysteine levels and physical activity, moderate alcohol consumption, and a good folate or vitamin B12 status are associated with lower homocysteine levels. Among these variables age, smoking, sex and folate intake are reported to be the strongest determinants of serum total homocysteine concentration in the general population. For this reason, we think that in a study evaluating the role of homocysteine on preeclampsia and other placental complications, determining the effect of serum folate and vitamin B12 levels on placental functioning could be noteworthy in the context of this close relationship. In conclusion, although this trial provides a promising evidence for combined use of homocysteine and uterine artery Doppler in predicting placental abnormalities in preeclampsia in a setting of reduced uterine perfusion, it must be noted that folate and vitamin B12 deficiencies could also be related to the final outcome.

Obesity and Insulin resistance are significant predictors of serum leptin levels

To the Editor; In the December 2016 issue of your journal, Fakor et al. (1) presented an original article entitled “The association between levels of maternal serum leptin in the third trimester and the occurrence of moderate preterm labor” in which the authors elucidated the possible role of leptin in the development of preterm labor in 30 moderate preterm delivering women. The authors demonstrated that low serum leptin levels may have a substantial predictive value for preterm birth before 34 weeks’ gestation by altering cytokine balance, cytotrophoblast and angiogenic activity, in the feto-placento-maternal unit. Although the authors presented and discussed their study results effectively in the context of previous studies, we believe that like any other study, there are some methodologic issues related to the present paper. In this context, from a methodologic point of view, we have several concerns including unmatched body mass index (BMI) values of study participants, and the presence of a probable insulin resistance (IR), which is associated with preterm birth and serum leptin levels. First, as also stated by the authors, numerous factors are strictly related with serum leptin levels including obesity, insulin, glucocorticoids, and thyroid hormones via multiple signaling pathways (2). From these variables, obesity presents a unique importance while evaluating serum leptin levels because of the fact that obese subjects have higher serum leptin values, which correlates body weight percentage, than normal weight subjects (3). The importance of BMI on serum leptin levels was demonstrated in a study by Paul et al. (4). Serum leptin levels and differences between sexes were found to be significant in all body mass indices. In this context, when comparing two groups to evaluate serum leptin levels, it is crucial to match study groups in respect to BMI values. The significantly higher BMI levels of control subjects (p=0.017) could be the reason of elevated leptin levels. In order to rule out this bias, an additional statistical analysis is needed to understand if serum leptin levels are affected by the BMI values of study participants. Second, although the authors stated that they excluded patients with diabetes mellitus, they gave no information about the possible presence of IR in their study group. IR is especially important for a study investigating a connection between leptin and preterm labor because IR contributes to the relatively wide variation in leptin levels, which is seen even at similar levels of body mass (5, 6). Moreover, IR below the thresholds of gestational diabetes mellitus (GDM) can cause adverse maternal and perinatal outcomes. In a recent large-scale retrospective study by Temming et al. (7), it was demonstrated that even in the absence of GDM, IR was associated with increased risks of preterm birth. Based on these data, it is reasonable to suggest that the alterations on serum leptin levels could be associated with IR and resulting preterm labor. In conclusion, as we see an increasing number of obstetric complications including preterm labor, this study covers an important and interesting topic. We believe that the further understanding of the roles of adipocyte-derived hormones in human pregnancy will provide an insight into metabolic risks associated with preterm labor.

Hepatitis D infection should be taken in mind while evaluating neonatal outcomes related to maternal hepatitis B infection

In a recent issue of the Journal of Maternal-Fetal & Neonatal Medicine, Tan et al. [1] reported the impact of maternal hepatitis B surface antigen (HBsAg) carrier status on neonatal outcomes. The results of the study showed that maternal HBsAg positivity could be regarded as an independent risk factor for increased congenital anomalies. Moreover, HBsAg positivity was found to be associated with lower risk of macrosomia and non-significant higher risk of lower birth weight, which suggests a potential negative effect on newborn. It is obvious that the strength of the study is that it included a high number of study participants. Although the authors discussed the implications of their findings comprehensively, we would like to mention about one additional factor that could affect the results of their research. Hepatitis D (delta) virus (HDV) is a defective singlestranded RNA virus that necessitates hepatitis B virus (HBV) infection for its replication [2]. HBV-HDV infection is relatively common in regions like Mediterranean and South America where it is reported to affect nearly 5–13.5% of patients infected with HBV [3]. In China, chronic infection with HDV in HBV patients reported to be around 10% and China could be regarded as an endemic area for HDV [3]. A number of epidemiological studies have shown that additional infection with HDV infection increases the progression rate to liver diseases in affected individuals [4]. Moreover, despite varying degrees of histological damage, some chronic hepatitis patients could have normal laboratory parameters [5]. It means that persistently normal aminotransferase levels in pregnancy does not rule out ongoing liver damage due to chronic HBV/HDV infection. For this reason, we think that multiple virus infection during pregnancy could be an explanation for increased risk of fetal and neonatal malformation and higher risk of lower birth weight. Moreover, while evaluating HBV-related fetal and neonatal complications, it is important to take into account additional variables that could affect the eventual outcome. In summary, it is important for the clinician to evaluate all their pregnant patients with HBV for to undergo appropriate testing, assessment, and referral as for nonpregnants including testing with HDV. Although there is little known about HDV-related pregnancy outcomes in HBV-infected pregnants, a diversity of further studies is needed to clarify the relationship between adverse pregnancy outcomes and chronic HBV/HDV infection.