Fatma Ferda Verit

Oxidative Stress in Nonobese Women with Polycystic Ovary Syndrome: Correlations with Endocrine and Screening Parameters

Aims: We investigated serum total oxidant status (TOS) and total antioxidant status (TAS) and whether oxidative stress is associated with endocrine and sonographic parameters in nonobese women with polycystic ovary syndrome (PCOS). Methods: Sixty-three nonobese normoinsulinemic PCOS women and 58 normoandrogenic ovulatory controls were enrolled in the study. Standard clinical examinations and ultrasonographic and endocrine screening including follicle-stimulating hormone, luteinizing hormone (LH), estradiol, progesterone, total testosterone, sex hormone-binding globulin and dehydroepiandrosterone sulfate (DHEAS) were performed. The insulin resistance was calculated by the measurement of fasting serum glucose and insulin levels, serum insulin response to an oral glucose tolerance test and homeostasis model assessment. TAS and TOS were assessed by automated colorimetric methods. Results: The women with PCOS had significantly higher TAS, TOS, LH, free androgen index and DHEAS levels. TAS, but not TOS, was positively correlated with LH, free androgen index and ovarian volume. However, there was no correlation between TAS and DHEAS. By multiple regression analysis, LH, TOS and ovarian volume were the independent variables that were associated with TAS. Conclusions: TAS was found to be increased in nonobese patients with PCOS, and this may account for some of the physiological changes.

No increase in sperm DNA damage and seminal oxidative stress in patients with idiopathic infertility

The most common cause of male infertility is idiopathic. Standard investigations reveal no abnormality in such cases. The aim of the study was to investigate the levels of sperm DNA damage and seminal oxidative stress and their relationships with idiopathic infertility. The study included 30 normozoospermic infertile men seeking infertility treatment and 20 fertile donors. Semen analysis was performed according to the World Health Organization guidelines. Sperm DNA damage was assessed by alkaline single cell gel electrophoresis (comet assay) after preparation with two-step discontinuous Percoll gradient. Seminal oxidative stress was measured by a novel automated method. DNA damage score, total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI) were not different in idiopathic infertile men compared with controls. No correlations were also found between DNA damage score and TAS, TOS levels and OSI in idiopathic infertile group. We did not find any relationship between sperm DNA damage and oxidative stress in normozoospermic infertile men. We think that the pathophysiology of idiopathic infertility cannot be explained by sperm DNA damage or seminal oxidative stress.

Low sexual function and its associated risk factors in pre- and postmenopausal women without clinically significant depression

OBJECTIVES To investigate the low sexual function and its associated risk factors in pre- and postmenopausal women without clinically significant depression. METHODS Cross-sectional study with 180 women aged between 19 and 60 years who admitted to our outpatient clinic. Sexual function was assessed by female sexual function index and clinically significant depression was measured by Beck depression inventory test. RESULTS The rate of low sexual function was 85.9% in postmenopausal (OR 2.9, 95% CI 1.8-4.8) and 47.7% in premenopausal women (OR 0.4, 95% CI 0.3-0.5) (p<0.0001). The postmenopausal group reported significantly lower desire, arousal, lubrication, orgasm, satisfaction and pain scores than controls (p<0.0001, for all of them). Low sexual function was positively correlated with age (r=0.37, p<0.0001), menopausal status (r=0.40, p<0.0001), gravidity (r=0.44, p<0.0001), parity (r=0.43, p<0.0001), abortion rates (r=0.27, p=0.001) and marriage period (r=0.40, p<0.0001). There were also significant negative correlations between low sexual function and education (r=-0.39, p<0.0001) and family income (r=-0.29, p<0.0001). However, multivariate regression analysis demonstrated that education, family income and menopausal status were the only independent variables for low sexual function after adjusted for age, gravidity, parity, abortion, marriage period and menopausal status. CONCLUSION Low sexual function was relatively high in postmenopausal women without clinically significant depression. Education, family income and menopausal status were the independent risk factors for low sexual function. Investigation of female sexuality was essential for these patients.

FOURNIER'S gangrene: the development of a classical pathology.

Necrotizing fasciitis, especially when termed Fournier’s gangrene (FG) when it initiates at the perineum, is a rare but rapidly progressive subcutaneous tissue infection characterized by extensive necrosis. Although it has been known for more than a century and considered as a cause of death, the basic medical principles have not changed for many years. We discuss what is new in the evaluation of this enigmatic pathology and speculate about its clinical metamorphosis. We reviewed reports of FG in the English language. The clinical characteristics of FG have been changing; atypical locations of necrotizing fasciitis, e.g. in the head and neck, and the incidence of patients with FG but no predisposing factors, has been increasing. While the role of anaerobic bacteria in FG is decreasing, that of atypical organisms is increasing, and thus hyperbaric oxygen therapy will probably cease to be a common treatment. We think that FG will not be as likely to cause death in future.

Paraoxonase‐1 Activity in Subfertile Men and Relationship to Sperm Parameters

Oxidative stress has been implicated in the pathogenesis of male infertility. Paraoxonase-1 (PON-1) is a high-density lipoprotein-associated antioxidant enzyme that prevents oxidative modification of low-density lipoprotein. Our aims in the study were to investigate 1) seminal PON-1 activity in subfertile men and 2) whether seminal PON-1 activity had any relationship to semen parameters. The study included 28 men with idiopathic subfertility, 32 subfertile men with abnormal semen parameters, and 30 fertile male volunteers. Seminal PON-1 activity was measured spectrophotometrically. Seminal total antioxidant status (TAS) and total oxidant status (TOS) were determined by using colorimetric methods. Oxidative stress index (OSI) was calculated as ([TOS/TAS] x 100). TOS and OSI were significantly higher and PON-1 activity and TAS were significantly lower in subfertile men with abnormal semen parameters than in men with idiopathic subfertility and fertile donors. PON-1 activity was also strongly correlated with sperm concentration (r = .68, P < .0001), motility (r = .58, P < .0001), and morphology (r = .62, P < .0001) in the overall group. The receiver operating characteristic curve analysis revealed a high diagnostic value for PON-1 activity with respect to male-factor subfertility, with an area under curve of .95 (95% confidence interval = 0.89-1.01), sensitivity = 97%, and specificity = 88%. Men with abnormal semen parameters have decreased levels of PON-1 activity in their seminal plasma. This may play an important role in the pathogenesis of male-factor subfertility.

Correlations of serum prolidase activity between bone turnover markers and mineral density in postmenopausal osteoporosis

Prolidase is a specific imidodipeptidase involved in collagen degradation. The increase in the enzyme activity is believed to be correlated with the increased intensity of collagen degradation. The aim of this study was to evaluate the serum prolidase activity and its relationship between bone turnover markers and bone mineral density (BMD) in postmenopausal osteoporosis. The study included 45 postmenopausal osteoporotic, 55 postmenopausal nonosteoporotic and 38 premenopausal healthy women. BMD was measured at the femoral neck and lumbar spine with DEXA. T score was more than 2.5 SD below the normal at the lumbar spine or femoral neck in postmenopausal osteoporotic patients. Serum levels of prolidase, C-terminal telopeptide of type I collagen (C-telopeptide), total alkaline phosphatase (ALP), osteocalcin (OC), urinary deoxypyridinoline (Dpd) and urinary creatinine were also assayed. C-telopeptide, total ALP, OC, urinary Dpd levels were significantly higher in postmenopausal osteoporotic group compared with premenopausal women. However, there was no statistical difference in serum prolidase activity between the three groups. There were also no significant correlations between serum prolidase and any biomarkers of bone turnover as well as BMD. To conclude, in postmenopausal osteoporotic women with increased bone turnover, serum prolidase concentration was not correlated with the biomarkers of bone formation or bone resorption and with BMD.

Is there any relationship between cardiovascular risk markers and young women with diminished ovarian reserve

Abstract Objective: It has been widely known that cardiovascular disease (CVD) risk is increased in menopause. The aim of the study was to evaluate whether this risk was elevated in young women with diminished ovarian reserve (DOR). Methods: A hundred women with DOR and 100 women with normal ovarian reserve (NOR) attending the infertility unit at Suleymaniye Maternity, Research &Training Hospital, were enrolled in the study. CVD risk markers such as insulin resistance (defined by the homeostasis model assessment ratio [HOMA-IR]), C-reactive protein (CRP), low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TC), and triglyceride (TG) were assessed. Results: HOMA-IR, CRP, TG, LDL levels were higher and HDL was lower among patients with DOR compared to the controls (p < 0.05 for all). There were positive associations between DOR and HOMA-IR, CRP, TG, LDL levels and a negative correlation with HDL (p < 0.05 for all). However, multivariate logistic regression analysis showed that HOMA-IR, CRP, TG, and HDL were independent variables that were associated with DOR. Conclusions: CVD risk markers were increased in women with DOR. Further studies with larger groups are needed to investigate the nature of the link in these patients. Chinese abstract 目的：现在广泛认为心血管系统疾病（cardiovascular disease，CVD)）发生风险在更年期增加。本研究的目的旨在探索在伴有卵巢储备功能减退（diminished ovarian reserve，DOR）的年轻女性中其发生风险是否也会升高。方法：本试验共纳入了在苏莱曼尼耶妇产医院—研究教学医院，生殖中心就诊的100名伴有DOR以及100名卵巢储备功能正常（normal ovarian reserve ，NOR)）的女性。对CVD风险标志物例如胰岛素抵抗[主要通过稳态模式评估法计算胰岛素抵抗指数（HOMA-IR）]，C反应蛋白（CRP），低密度脂蛋白（LDL），高密度脂蛋白（HDL），总胆固醇（TC）以及甘油三酯（TG）水平进行评估。结果：DOR女性与对照组女性相比，前者HOMA-IR，CRP，TG，LDL水平较高，HDL水平较低（(p<0.05）。DOR与HOMA-IR，CRP，TG，LDL水平之间存在正相关，与HDL间存在负相关（(p<0.05）。然而，多变量逻辑回归分析指出HOMA-IR，CRP，TG,及HDL为独立变量，与DOR有关。结论：CVD风险标志物在DOR女性中升高。进一步的研究需要更大的样本量，以揭示这些患者中关联的性质。

Progress in Female Sexual Dysfunction

Introduction: Female sexual dysfunction (FSD) is a significant age-related, progressive and highly prevalent problem that affects a substantial number of women that causes personal distress and has negative effects on quality of life and interpersonal relationships. Definitions: The female sexual response cycle consists of three phases: desire, arousal, and orgasm, and is initiated by non-adrenergic/non-cholinergic, e.g. vasoactive intestinal polypeptide and nitric oxide, neurotransmitters that maintain vascular and non-vascular smooth muscle relaxation resulting in increased pelvic blood flow, vaginal lubrication, and clitoral and labial engorgement. Furthermore, hormonal status may influence female sexual function. For the diagnosis of FSD, a detailed history should be taken initially, followed by a physical examination and laboratory studies. Conclusion: Due to the fact that there has been little research and attention on FSD, our knowledge in this field is quite limited and there is still no approved therapy. Future advances in evaluation and treatment of female sexual problems are forthcoming.

Paraoxonase-1 activity in patients with hyperemesis gravidarum

Abstract There is increasing evidence that oxidative stress may play a role in the pathophysiology of hyperemesis gravidarum. Serum paraoxonase-1 (PON-1) is a high density lipoprotein (HDL)-associated enzyme that prevents oxidative modification of low density lipoprotein. The aim of the study was to measure the serum levels of PON-1 activity in women with hyperemesis gravidarum. Thirty-four women with hyperemesis gravidarum and 31 healthy pregnant women were enrolled in the study. Serum PON-1 activity was measured spectrophotometrically. Lipid hydroperoxide (LOOH) levels were measured by iodometric assay. PON-1 activity was significantly lower and LOOH levels were significantly higher in pregnant women with hyperemesis gravidarum than in healthy pregnant women (P < 0.0001, for all). There were significant correlations between PON-1 and LOOH, triglyceride, total cholesterol, HDL, low density lipoprotein (LDL) and high sensitive C-reactive protein (HSCRP; P < 0.0001, for all). By using multiple regression analysis LDL, HDL, HSCRP and LOOH were independent determinants of serum PON-1 activity in the study. Decreased PON-1 activity might be related to increased oxidative stress and inflammation in pregnant women with hyperemesis gravidarum. Subjects with hyperemesis gravidarum might be more prone to the development of atherogenesis due to low serum PON-1 activity.

Neutrophil to lymphocyte ratio is superior to platelet to lymphocyte ratio as an early predictor of moderate/severe ovarian hyperstimulation syndrome.

Abstract Ovarian hyperstimulation syndrome (OHSS) is a state of exaggerated inflammatory response during controlled ovarian hyperstimulation (COH). Neutrophil:lymphocyte ratio (NLR) and platelet:lymphocyte ratio (PLR) are known to reflect systemic inflammation. The aim of this study was to investigate whether these inflammatory markers could be used as reliable markers in the early prediction of moderate-to-severe OHSS. The study group consisted of 54 patients who developed moderate-to-severe OHSS and the control group was 54 patients who did not develop OHSS undergoing IVF/ICSI. NLR and PLR were calculated from complete blood counts before the COH. NLR and PLR were significantly elevated in the OHSS group compared with the controls (3.2 ± 0.9 and 182.9 ± 49.8 vs 1.8 ± 0.5 and 160.6 ± 48.5, respectively) (p < 0.05, for all). However, only NLR had positive associations between OHSS risk factors (p < 0.05, for all). NLR was superior to PLR as an early predictor of OHSS with an area under the ROC curve of 0.91 (sensitivity = 85% and specificity = 78%). In conclusion, we found that NLR can be used as an early marker of OHSS.