Mahmut Erdemoğlu

Risk factors for postmenopausal osteoporosis: anthropometric measurements, age, age at menopause and the time elapsed after menopause onset

Objectives. The aim of this study was to determine, how much the anthropometric measurements and age affect the femur and vertebra T-scores by using correlation and regression analysis in postmenopausal women. Methods. Data of 540 healthy postmenopausal women were included in this analysis. Bone mineral density was determined by dual energy X-ray absorptiometry (DXA). The data of the patients related to height, weight, age, age at menopause were obtained from records, and body mass index (BMI) was calculated (BMI = W (kg)/H(m2)). Statistical analyses were performed with SPSS 15.0 for Windows (SPSS, Chicago, IL). Results. Mean age and standard deviation of 540 postmenopausal women was 59.3 ± 8.4 years. The correlation coefficients among femur, vertebra T-scores, weight, the time elapsed after the menopause onset, age, BMI and height were found as follows, from higher to lower values with 0.465, 0.453, 0.411, 0.382, 0.232, respectively, and were statistically significant (p < 0.001). Conclusions. We determined the effects of the anthropometric measurements on osteoporosis from higher to lower influence as follows: weight, menopause age, age, BMI and height. Weight and menopause age of the patients were the major determinants for osteoporosis.

The relationship between thrombophilic mutations and preeclampsia: a prospective case-control study

BACKGROUND Preeclampsia and its association with thrombophilia remain controversial, due to inconsistent results in different studies, which include different ethnic groups, selection criteria, and patient numbers. The aim of this study was to determine the relationship between thrombophilia and preeclamptic patients in our region. METHODS In a prospective case-control study, we compared 100 consecutive women with preeclampsia and eclampsia (group 1) with 100 normal pregnant women (group 2). All women were tested two months after delivery for mutations of factor V Leiden, methylenetetrahydrofolate reductase (MTHFR), and prothrombin gene mutation as well as for deficiencies of protein C, protein S, and antithrombin III. RESULTS A thrombophilic mutation was found in 42 (42%) and 28 (28%) women in group 1 and group 2, respectively (P=0.27, OR 1.5, 95%CI 1.0–2.2). The incidence of Factor V Leiden mutation (heterozygous), prothrombin mutation (heterozygous), prothrombin mutation (homozygous), MTHFR mutation (homozygous) was not statistically significant in group 1 compared with group 2 (P>0.05). Also, deficiencies of protein S, protein C, and antithrombin III were not statistically significant in group 1 compared with group 2 (P >0.05). CONCLUSION There was no difference in thrombophilic mutations between preeclamptic patients and normal pregnant women in our region. Therefore, we suggest that preeclamptic patients should not be tested for thrombophilia.

The Effect of Flurbiprofen as Prophylactic Analgesic before Hysterosalpingography

Hysterosalpingography (HSG) is associated with pain during the four-step procedure. This prospective, double-blind, randomized, placebo-controlled study was conducted to investigate the effect of the analgesic flurbiprofen, administered prior to HSG, in 60 women. Thirty women were randomized to receive 100 mg of flurbiprofen, orally, 1 h prior to HSG and a further 30 women were randomized to receive placebo. Injection of contrast medium was more painful than the other steps in the HSG procedure in both groups; however, there was no significant between-group difference in terms of pain experienced in the individual steps of HSG. Pain scores at 5 and 30 min after the procedure were compared between the two groups. There was a significant decrease in the visual analogue scale pain score in the flurbiprofen-treated group compared with the placebo-treated group at both time points. Thus, the authors recommend flurbiprofen as a prophylactic analgesic to be administered before HSG procedures.

Assessment of bleeding disorders in Sheehan's syndrome: are bleeding disorders the underlying cause of Sheehan's syndrome?

Sheehans syndrome (SS) is an adenopituitary insufficiency caused by hypovolemia secondary to excessive blood loss during or after childbirth. However, the mechanism of postpartum hemorrhage and ischemia is not clear. We aimed to evaluate the bleeding disorders among patients with SS, in comparison with healthy controls. In addition, we investigated underlying causes in postpartum hemorrhage that begin the event. The present study was conducted at the Dicle University School of Medicine. Forty-eight patients with SS and 50 age-matched female healthy controls were included. Biochemical and hormonal variables were measured, as was platelet function by means of closure times (PFA-100 testing using collagen plus epinephrine and collagen plus ADP), von Willebrand factor (vWF) level, prothrombin time (PT), activated partial thromboplastin time (aPTT), international normalized ratio (INR), and coagulation factors. Although PT and INR were significantly higher in patients with SS (both P < 0.01), aPTT and levels of fibrinogen, vWF, and factors II, V, VII, VIII, IX, X, XI, and XII did not differ significantly. Closure times with collagen/epinephrine and collagen/ADP also did not differ significantly between patients with SS and control patients. The nonspecific etiology and presence of excessive postpartum hemorrhage in patients with SS suggest that coagulation disorders may play a role in their predisposition to bleeding. The increased PT and INR noted might implicate bleeding diathesis as the underlying etiology, although no significant decreases were noted in factor levels. Further studies are needed to elucidate this complex mechanism of this disorder.

Amniotic fluid amino acid levels in non-immune hydrops fetalis: a case-control study

In a prospective case-control study, we compared the amniotic fluid amino acid levels in non-immune hydrops fetalis (NIHF) and normal fetuses. Eighty fetuses underwent amniocentesis for different reasons at the prenatal diagnosis unit of the Department of Obstetrics and Gynecology, Faculty of Medicine, Dicle University. Forty of these fetuses were diagnosed with NIHF. The study included 40 women each in the NIHF (mean age: 27.69 ± 4.56 years) and control (27.52 ± 5.49 years) groups, who had abnormal double- or triple-screening test values with normal fetuses with gestational ages of 23.26 ± 1.98 and 23.68 ± 1.49 weeks at the time of sample collection, respectively. Amniotic fluid amino acid concentrations (intra-assay variation: 2.26-7.85%; interassay variation: 3.45-8.22%) were measured using EZ:faast kits (EZ:faast GC/FID free (physiological) amino acid kit; Phenomenex, USA) by gas chromatography. The standard for quantitation was a mixture of free amino acids from Phenomenex. The levels of 21 amino acids were measured. The mean phosphoserine and serine levels were significantly lower in the NIHF group, while the taurine, α-aminoadipic acid (aaa), glycine, cysteine, NH(4), and arginine (Arg) levels were significantly higher compared to control. Significant risk variables for the NIHF group and odds coefficients were obtained using a binary logistic regression method. The respective odds ratios and 95% confidence intervals for the risk variables phosphoserine, taurine, aaa, Arg, and NH(4) were 3.31 (1.84-5.97), 2.45 (1.56-3.86), 1.78 (1.18-2.68), 2.18 (1.56-3.04), and 2.41 (1.66-3.49), respectively. The significant difference between NIHF and control fetuses suggests that the amniotic fluid levels of some amino acids may be useful for the diagnosis of NIHF.

An increase of elastic tissue fibers in blood vessel walls of placental stem villi and differences in the thickness of blood vessel walls in third trimester pre-eclampsia pregnancies

This study has goals of examining whether pre-eclampsia may lead to an increase of elastic tissue fibers in blood vessel walls of placental stem villi or whether there are differences in the thickness of blood vessel walls within these villi when compared to normotensive pregnant women. Non-infarcted placental tissue samples from 28 participants with uncomplicated pregnancies and 26 patients with pre-eclampsia were obtained. After routine histological procedures, the sections were processed either for conventional Verhoeff staining for the demonstration of elastic fiber system. Paraffine sections from placenta biopsies prepared for light microscopic examination were gathered. In uncomplicated pregnancies, terminal villi blood vessels were observed with no stained elastic tissue fibers in most areas. In the pre-eclampsia pregnancy of human placenta, the elastic fibers significiantly increased in terminal villi blood vessel walls which were dark in color, using Verhoeff’s tissue stain, when comparing with the uncomplicated pregnancy group. Our results indicate that an increase of elastic tissue fibers in blood vessels of placental stem villus and terminal villi, and also an increase of wall thickness during pre-eclampsia.