Hatice Ender Soydinç

The protective effect of curcumin on ischemia-reperfusion injury in rat ovary

BACKGROUND To evaluate the protective effects of curcumin in experimental ischemia and ischemia/reperfusion (I/R) injury of rat ovaries. METHODS Forty-eight female adult Wistar Albino rats were used. Rats divided into six groups and designed: Sham, Torsion, Detorsion, Sham + Curcumin, Torsion + Curcumin, and Detorsion + Curcumin. Except for the Sham and Sham + Curcumin group, all groups were performed to bilateral adnexal torsion for 3 h. Bilateral adnexal detorsion was implemented in the Detorsion and Detorsion + Curcumin groups. The injection of curcumin was intraperitoneally achieved 30 min before the sham, torsion and detorsion. RESULTS Total oxidant status levels (TOS), oxidative stress index (OSI) and histologic scores values of ovarian tissue were higher in the torsion and detorsion groups than the sham group (p < 0.05). There was a strong correlation between the total histologic scores of I/R injury and the OSI (r = 0.809, p < 0.001). By the use of curcumin, a significant decrease was established in the mean levels of oxidant markers and histopathologic scores of the ovarian tissues. CONCLUSIONS Administration of curcumin is effective in reversing tissue damage induced by ischemia-reperfusion injury in ovarian torsion.

The Biochemical and Histologic Effects of Adnexal Torsion and Early Surgical Intervention to Unwind Detorsion on Ovarian Reserve An Experimental Study

Objective: The aim of the present study was to determine to what extent ovarian reserves are affected by ischemia–reperfusion injury, evaluating the number of growing follicles and the serum levels of the ovarian hormones. Study Design: Thirty female fertile adult Wistar albino rats, weighing 200 to 220 g, were previously numbered to randomization, and then randomly divided into 3 equal groups (n = 10): sham, torsion, and detorsion groups. In torsion and detorsion groups, bilateral adnexal torsion (3-hour ischemia) was carried out. Bilateral adnexal detorsion (3-hour reperfusion) was performed in the detorsion group. Results: The mean number of preantral and small antral follicles in detorsion group were lower than those of the sham group (P < .01). After torsion, anti-Müllerian hormone (AMH), estradiol, and inhibin B levels decreased significantly compared to the preoperative and postoperative periods (P = .003, P = .032, and P = .014, respectively). In detorsion group, only AMH levels were found to decrease significantly following the 3-hour ischemia and 3-hour reperfusion (P < .05). Conclusion: After adnexal torsion, a significant decrease in ovarian reserve has been detected for the first time in this study. Additionally, the results of this study suggest that conservative surgery alone is insufficient to protect ovarian reserve.

Prolidase, matrix metalloproteinases 1 and 13 activity, oxidative-antioxidative status as a marker of preterm premature rupture of membranes and chorioamnionitis in maternal vaginal washing fluids.

Objective: Etiology of premature preterm rupture of membranes (PPROM) is not yet completely known and chorioamnionitis is one of the most important complications of its. We aimed to evaluate whether prolidase, matrix metalloproteinases, oxidative-antioxidative status, and inflammation markers in vaginal washing fluid (VWF) were associated with etiology of PPROM and whether these markers could be used to predict chorioamnionitis in PPROM. Study Design: This prospective case control study enrolled fifty pregnant women with PPROM and 50 healthy pregnant women. The VWF samples were taken at the time of admission in the PPROM group and patients were followed for chorioamnionitis. Prolidase, matrix metalloproteinases, oxidative-antioxidative status, and inflammation markers in VWF were assayed. Results: VWF levels of prolidase, matrix metalloproteinases 1-13 (p< 0.001), oxidative stress parameters, total oxidative stress (TOS) (p < 0.001) and oxidative stress index (OSI) (p = 0.002), and hs-CRP (p = 0.045) were significantly higher in the PPROM group than in the controls. Antioxidative status parameters, levels of paroxanase (PON-1) (p < 0.001) and total antioxidant capacity (TAC) (p < 0.001), were significantly lower in the PPROM group than in the controls. Mean VWF levels of prolidase (p < 0.001), metalloproteinases (p<0.05), and oxidative-antioxidative status parameters (p<0.05) were significantly different in women with versus women without chorioamnionitis in the PPROM group. Prolidase, MMP-13, TOS, TAC, and PON-1 were found as important predictors for chorioamnionitis in the PPROM group by the multivariate logistic regression analysis. When the ROC curve analysis for prolidase, MMP-13, TOS, TAC, and PON-1 were performed, all of them were statistically significant for area under the curve (areas under the curve were 0.94, 0.90, 0.80, 0.25, and 0.19, respectively). Conclusions: This study showed that collagen turnover mediators, especially prolidase, and increased oxidative stress are significantly associated with PPROM. Also, chorioamnionitis can be predicted with prolidase, MMP-13, TOS, TAC, and PON-1 in PPROM patients.

New inflammatory markers in pre-eclampsia: echocardiographic epicardial fat thickness and neutrophil to lymphocyte ratio

Abstract Background: Increased epicardial fat thickness (EFT) has been proposed as a new cardiometabolic risk factor. The neutrophil/lymphocyte ratio (NLR) has predictive and prognostic value in several cardiovascular diseases. The aim of this study was to explore the association between EFT and NLR in patients with pre-eclampsia. Methods: Hundred and eight pregnant patients with a mean age of 30.6 ± 6.3 years were included in the study. Patients were divided into two groups based on the presence of pre-eclampsia. All participants underwent transthoracic echocardiography imaging, and complete blood counts were measured by an automated hematology analyzer. Statistical analysis was performed using the Chi-square, Mann–Whitney U, correlation and logistic regression tests, and receiver operating characteristic (ROC) analysis. Result: The mean EFT value of the pre-eclampsia group was significantly higher than the control group (6.9 ± 0.6 versus 5.6 ± 0.6; p < 0.001), and the NLR value of the pre-eclampsia group was also significantly higher than the control group (7.3 ± 3.5 versus 3.1 ± 1.1; p < 0.001). Multivariate analysis showed that increased levels of NLR and echocardiographic EFT are independent predictors of pre-eclampsia. In the receiver operating characteristic analysis, a level of EFT ≥ 6.2 mm and NLR ≥ 4.1 predicted the presence of pre-eclampsia with 77.8% sensitivity, 79.6% specificity and 83.3% sensitivity, 81.5% specificity, respectively. Conclusion: Unlike many other inflammatory markers and bioassays, NLR and echocardiographic EFT are inexpensive and readily available biomarkers that may be useful for risk stratification in patients with pre-eclampsia.

Circadian Variation of Blood Pressure Is Impaired in Normotensive Pregnant Women with Gestational Diabetes Mellitus

Data about circadian blood pressure (BP) in normotensive patients with gestational diabetes mellitus (GDM) are lacking. Thus, we sought to compare dipper and nondipper circadian variation of BP profile between normotensive women complicated with GDM and normal pregnant women. Forty-two women with GDM and 33 normal uncomplicated pregnant women who met the entry criteria for the study were enrolled in the study. Twenty-four-hour noninvasive ambulatory blood pressure monitoring and echocardiography to measure the left ventricle mass index and diastolic parameters were performed. Nocturnal blood pressure dipping was calculated as follows: (awake BP – sleep BP) × 100/awake BP. Patients with a nocturnal reduction in average daytime systolic BP and diastolic BP of less than 10% were classified as nondippers. Left ventricle mass index was higher in normotensive pregnant women with GDM group than in normal pregnant subjects (101.98 ± 24 g/m2 vs. 90.67 ± 15 g/m2, P < .018). Significant nocturnal systolic and diastolic nondippings were observed in GDM groups compared with normal subjects. From diastolic variables, the mitral E velocity and isovolumetric relaxation time were compatible with diastolic dysfunction relaxation abnormalities (P = .003 and P = .015, respectively) in nondipper group. From all confounding factors, only E velocity (P = .002) and diagnosis of GDM (P < .001) were predictive of nondipper circadian variation. This study shows that (i) circadian BP is impaired in normotensive pregnant subjects with GDM, (ii) the left ventricle mass index is higher in pregnant subjects with GDM than in normal pregnant subjects who despite a 24-hour BP are within normal limits, and (iii) in nocturnal nondipper group, the tendency to having diastolic relaxation abnormalities is noted.

Fibrinolytic Therapy of Prosthetic Mitral Valve Thrombosis During Pregnancy: Three Case Reports and Review of the Literature

The incidence of prosthetic valve thrombosis (PVT), which is a life-threatening complication, increased during pregnancy because of the hypercoagulable state. Despite adequate anticoagulation, the incidence of PVT has been estimated as 4% to 14% during pregnancy. Prosthetic valve thrombosis occurring during pregnancy requires urgent therapy including fibrinolytic therapy, valve replacement, and surgical thrombectomy due to high mortality. Although surgery has traditionally been the standard procedure for treatment of PVT, fibrinolytic therapy may be used as first-line therapy according to data from the recent reports. Data about the fibrinolytic therapy is scarce and controversial in the setting of pregnancies complicated with PVT. Herein, we share the outcomes of 3 pregnant women complicated with PVT and treated with recombinant tissue-type plasminogen activator.

Pregnancy and H1N1 infection in Southeast Turkey

INTRODUCTION H1N1 Influenza made a great impact a worldwide, as well as in Turkey, in 2009. Clinical experiences have shown that it had a more serious prognosis in pregnant women. In this report, we summarize the cases of 16 pregnant women with H1N1 Influenza. METHODOLOGY The study included 16 pregnant women hospitalized in Dicle University Hospital with complaints of fever, sore throat, cough and myalgia between October and December 2009. The diagnosis of pandemic H1N1 Influenza was confirmed on nasopharyngeal specimens using real-time reverse-transcriptase polymerase chain reaction (RT-PCR) in all patients. Patients who had the same complaints but were not diagnosed as H1N1 Influenza were excluded. The epidemiological, clinical, diagnostic, and outcome features of the patients were recorded. RESULTS The median age of the patients was 27 years (range 18-41 years). The mean gestational age was 25.4 weeks (range 5-38 weeks). Two cases were twin pregnancy. Two cases had co-morbid diseases including asthma and anemia. The most frequent admission symptoms were fever in 13 cases (81%), cough in 12 cases (75%) and dyspnea in 6 cases (37,5%). Antiviral treatment (oseltamivir 75 mg p.o. bid) was applied in 15 cases. Four cases needed intensive care monitoring and two of them died (12.5%) because of severe respiratory insufficiency. CONCLUSION Patients with late gestational age, the presence of co-morbid disease, and multiple pregnancy have poor prognosis. Immediate intervention with antiviral treatment is associated with reduced severity of the disease and duration of hospital stay.

Increased psychological trauma and decreased desire to have children after a complicated pregnancy.

OBJECTIVE Information about fertility desire and psychological sequelae after high-risk pregnancies are scarce in the literature. The aim of the present study is to investigate the psychological effects of high-risk pregnancies. MATERIAL AND METHODS The patients who had a history of severe preeclampsia, eclampsia or major hemorrhage during the peripartum period were enrolled as the study group and compared with the control subjects with respect to fear about new pregnancy, anxiety/ depression and post-traumatic stress disorder (PTSD) scores. The study was carried out by submitting a questionnaire form to the participants. Numbers of planned children before and after the last delivery were evaluated in both groups. RESULTS Fear about a new pregnancy was found to be significantly higher in the study group compared with the controls. There were no statistically significant difference between the two groups in terms of anxiety and depression. In terms of re-experience and avoidance in PTSD was significantly higher in the study group, however no significant difference was found for hyper-arousal. CONCLUSION Fear regarding new pregnancy is high and planning more children is decreased after high-risk pregnancies and PTSD symptom scores were higher after high-risk pregnancies.

A case of cerebral sinus venous thrombosis resulting in mortality in severe preeclamptic pregnant woman.

Cerebral venous sinus thrombosis (CVST) is a rarely encountered condition during pregnancy. A 21-year-old pregnant woman with labour pains was hospitalized in our clinic. Diagnosis of severe preeclampsia was made based on her clinical and laboratory findings. She suffered from convulsive episodes during postpartum period which lead to initiation of treatment for eclampsia. However neurological and radiological examinations were performed after emergence of additional neurological symptoms disclosed the diagnosis of CVST. In this paper, we aimed to present a case with CVST which diagnosis was confused with eclampsia and resulting in maternal mortality.

Platelet profile in patients with gestational diabetes: a retrospective study.

OBJECTIVE To assess and compare alterations in the morphology and function of platelets occurring in gestational diabetes and healthy pregnancies. MATERIAL AND METHODS A retrospective study was performed of 77 pregnant women: 42 cases with gestational diabetes and 35 healthy controls. The two groups were compared in terms of demographics and platelet parameters derived from complete blood counts. RESULTS The mean platelet volume (p=0.001) and HbA1c (p<0.001) were significantly increased in the patients with gestational diabetes. The mean platelet volume was well correlated with the platelet distribution width (rs=0.404, p<0.001) and the platelet count (rs=0.355, p=0.002). CONCLUSION The mean platelet volume and other platelet parameters may significantly aid the identification of diabetic pregnants at risk for vascular complications. The role and possible clinical relevance of these changes during diabetic pregnancy need to be investigated in further studies.