Ilknur Inegol Gumus

Transcutaneous electrical nerve stimulation improves low back pain during pregnancy.

Background: To compare the efficiency of transcutaneous electrical nerve stimulation (TENS) with those of exercise and acetaminophen for the treatment of pregnancy-related low back pain (LBP) during the third trimester of pregnancy. Methods: This prospective study included 79 subjects (≥32 gestational weeks) with visual analog scale (VAS) pain scores ≥5. Participants were divided randomly into a control group (n = 21) and three treatment groups [exercise (n = 19); acetaminophen (n = 19); TENS (n = 20)]. The VAS and the Roland-Morris disability questionnaire (RMDQ) were completed before and 3 weeks after treatment to assess the impact of pain on daily activities. Results: During the study period, pain intensity increased in 57% of participants in the control group, whereas pain decreased in 95% of participants in the exercise group and in all participants in the acetaminophen and TENS groups. Post-treatment VAS and RMDQ values were significantly lower in the treatment groups (p < 0.001). VAS and RMDQ scores indicated a significantly greater degree of pain relief in the TENS group than in the exercise and acetaminophen groups (p < 0.001). No adverse effect of TENS application on pregnant women was observed during the study. Conclusion: TENS is an effective and safe treatment modality for LBP during pregnancy. TENS improved LBP more effectively than did exercise and acetaminophen.

Serum hepcidin is associated with parameters of glucose metabolism in women with gestational diabetes mellitus

Abstract Objectives: Hepcidin is considered a major regulator of iron metabolism. Despite previous studies showing elevated ferritin and hepcidin levels in type 2 diabetes mellitus (DM), no study has investigated hepcidin levels in pregnant women with gestational DM (GDM). Methods: A case-control study was conducted in 30 cases of GDM, 47 pregnant women with impaired glucose tolerance (IGT) and 72 pregnant women with normal glucose tolerance (control) between April 2009 and July 2011. Serum hepcidin and other iron metabolism parameters were analyzed in all groups. Results: Serum ferritin and serum iron were significantly elevated in the GDM group compared to controls (p = 0.014, p = 0.018, respectively) and to the IGT group (p = 0.021, p = 0.008, respectively). Hepcidin levels were elevated significantly in the diabetic patients compared to the IGT group (p = 0.011) and controls (p = 0.002). We found no correlation between hepcidin and other iron metabolism parameters (Hb, serum iron and ferritin), whereas positive correlations were found between hepcidin and parameters of glucose metabolism (fasting blood glucose, fasting insulin level and glucose value response to glucose challenge test). Conclusions: Serum hepcidin concentrations were increased in pregnant women with IGT and GDM and this was not related to inflammation parameters.

Increased thrombin-activatable fibrinolysis inhibitor antigen levels as a clue for prothrombotic state in polycystic ovary syndrome

Objectives. Our study was undertaken to evaluate the levels of thrombin-activatable fibrinolysis inhibitor (TAFI) antigen and also its relationship with other hemostasis markers in a group of patients affected with polycystic ovary syndrome (PCOS)–under Diane-35 (ethinyl estradiol 0.035 mg/cyproterone acetate 2 mg) treatment or not–as compared with a group of healthy controls. Methods. Forty-two women with PCOS and 30 age-matched healthy controls were involved in the study. Group A were on Diane-35 for at least 6 months; group B did not take any drug; group C served as a control group. Results. TAFI antigen levels of groups A and B were significantly higher than in controls, but no difference was observed between them. All of the other coagulation and fibrinolysis parameters (including prothrombin time, activated partial thromboplastin time, fibrinogen and D-dimer) were comparable between the three groups. Conclusion. The evidence presented herein suggests that women with PCOS have impaired fibrinolysis, as reflected by increased TAFI. This impairment can contribute to the risk of cardiovascular disease in PCOS. Elucidation of the modifiable mechanisms in PCOS can represent an opportunity for preventive therapy of the cardiovascular risks associated with PCOS.

Effect of music on labor pain relief, anxiety level and postpartum analgesic requirement: a randomized controlled clinical trial.

Background/Aims: The control of labor pain and the prevention of suffering are major concerns of clinicians and their patients. The aim of this study was to evaluate the effect of music on labor pain and anxiety, maternal hemodynamics, fetal-neonatal parameters and postpartum analgesic requirement in primiparous women. Methods: Overall, 156 primiparous women who expected vaginal delivery were recruited and randomly assigned to a music group (n = 77) or a control group (n = 79). Women in the music group listened to music during labor. Pain intensity and anxiety level were measured using a visual analogue scale (0-10 cm). The two groups were compared in terms of pain severity, anxiety level, maternal hemodynamics, fetal-neonatal parameters and postpartum analgesic requirement. Results: Mothers in the music therapy group had a lower level of pain and anxiety compared with those in the control group at all stages of labor (p < 0.001). A significant difference was observed between the two groups in terms of maternal hemodynamics and fetal heart rate after intervention (p < 0.01). Postpartum analgesic requirement significantly decreased in the music therapy group (p < 0.01). Conclusion: Listening to music during labor has a positive impact on labor pain and anxiety, maternal-fetal parameters and analgesic requirement.

Serum platelet-activating factor acetylhydrolase activity: relationship with metabolic syndrome in women with history of gestational diabetes mellitus

Objective. The aim of this study was to evaluate plasma platelet-activating factor acetylhydrolase (PAF-AH) activity in euglycaemic women with history of gestational diabetes (GDM), and to explore whether this activity is associated with metabolic syndrome (MS) in this group of women. Methods. The cross-sectional study included 36 women with history of GDM and 40 women with history of normal glucose tolerance in pregnancy (control group). Results. Compared to the controls, the GDM group had significantly higher mean values for serum glucose, insulin, HOMA-IR, triglyceride, GGT and plasma PAF-AH activity, and a statistically higher prevalence of MS. Within the GDM group, women diagnosed with MS had significantly higher PAF-AH activity than those without MS (p = 0.002). Conclusion. This is the first study to have shown that plasma PAF-AH activity and GGT levels may be significant for evaluating atherosclerosis risk and metabolic hepatic damage in women with history of GDM.

Efficacy of topical pimecrolimus in the treatment of chronic vulvar pruritus: A prospective case series – a non‐controlled, open‐label study

Background: Chronic vulvar pruritus has been a most distressing physical and sociologic disorder for many patients, as well as for their physicians. Potent topical steroids are the conventional therapy for this distressing condition. Side effects or steroid resistance can be encountered. A second‐line therapy is required. Objectives: A single‐centre, non‐controlled, open‐label study was designed to assess the efficacy of topical pimecrolimus in the treatment of chronic vulvar pruritus. Methods: Fifteen married adult women with symptoms of vulvar pruritus ⩾4 months were included in the study. The patients did not have any relief with topical steroids. There were no objective physical findings. Topical pimecrolimus 1% cream (Elidel cream®, Novartis) was applied twice daily to the vulvar region. Patients were followed up 4 weeks later. After the trial was stopped, the patients remained in regular review for 3 months. Results: Thirteen patients tolerated pimecrolimus. They showed a clinical response within 2–4 weeks. Ten patients showed a complete response, three showed a partial response. After the trial had stopped, the patients with complete response were followed‐up by telephone for another 3 months, and were found to be in remission. Conclusions: We found that topical pimecrolimus provides relief for chronic vulvar pruritus. Pimecrolimus can be chosen as the second‐line therapy in patients with vulvar pruritus.

Serum levels of visfatin and possible interaction with iron parameters in gestational diabetes mellitus.

Background/Aims: Visfatin is a novel adipokine with insulinomimetic properties that increases in diabetes. However, for gestational diabetes mellitus (GDM) there are conflicting reports. Recent studies have reported a positive association of serum ferritin concentrations with insulin resistance. Thus, we assessed serum levels of visfatin in pregnant women with varying degrees of glucose tolerance and investigated the possible interaction of visfatin with parameters of iron metabolism. Methods: Visfatin levels were measured at 24-28 weeks of gestation in 88 women who were divided into three groups according to their response to a 50-gram glucose challenge test and a 100-gram oral glucose tolerance test: control group (n = 28), impaired glucose tolerance (IGT) group (n = 30) and GDM group (n = 30). Results: Visfatin levels were significantly higher in the GDM and IGT group than in control (p < 0.001 for GDM vs. control, and p = 0.004 for IGT vs. control). Serum visfatin was significantly associated with serum ferritin, insulin, age, gravidity, and body mass index. In a linear regression model, the covariates explained only 17% of variability of serum visfatin concentration. Body mass index (p < 0.001) contributed independently to visfatin variance. Conclusion: Serum visfatin concentration is significantly higher in GDM and is correlated with ferritin levels.

Are patients with positive screening but negative diagnostic test for gestational diabetes under risk for adverse pregnancy outcome

Objective:  Our aim was to determine the obstetrics outcomes of patients with positive 1‐h glucose challenge test (GCT), but negative diagnostic test for gestational diabetes.

Laparoscopic supracervical hysterectomy, bilateral salpingo-oophorectomy, sacrocolpopexy and Burch colposuspension performed during the same operative session via a single port.

Laparoscopic methods that combine multiple surgical procedures are becoming more widely used, but few combined procedures performed through a single incision have been reported. A major difficulty with the single-incision approach is that all the instruments are necessarily oriented along the same axis. Here, we describe a patient in whom supracervical hysterectomy, bilateral salpingo-oophorectomy, sacrocolpopexy and Burch colposuspension were performed during the same operative session via a single umbilical port.

Effect of anti-vascular endothelial growth factor antibody during early fetal development in rats

Abstract Objective: To examine the effect of anti-vascular endothelial growth factor (VEGF) antibody Bevacizumab during early fetal development in rats. Methods: Presumed-pregnant rats received single intraperitoneal injection of Bevacizumab (0–20 mg/kg) on gestational day (GD) 3, 7, and 14 (n = 2 rats/group). After Study 1 (dose range finding study), Study 2 performed with intraperitoneal 20 mg/kg bevacizumab or saline on GD 7 (n = 6 rats/group including the Study 1). Blood samples were collected 3 and 7 d after the injection. Uterus and ovarian tissues were obtained 7 d after the injection. Number of gestational sacs (GS), size of GS and fetus, serum rat β chorionic gonadotropin (β-CG), and platelet endothelial cell adhesion molecule (PECAM) for immunohistochemical assessment of angiogenesis were evaluated. Results: Number of GS, size of GS, and fetus were lower in the study group than the control group. Serum rat β-CG levels were significantly increased in the control group and significantly decreased in the study group. Staining densities for PECAM in vascular structures in both corpus luteum and placenta were lower in the study group than the control group. Conclusion: Anti-VEGF antibody has an inhibitory effect on pregnancy development and caused litter death.