Nermin Köşüş

Do threshold values of ovarian volume and follicle number for diagnosing polycystic ovarian syndrome in Turkish women differ from western countries

OBJECTIVE To find diagnostic values and thresholds of ovarian volume and follicle number for Turkish patients with polycystic ovarian syndrome (PCOS) and to clarify whether the Rotterdam ultrasound criteria are optimal for the diagnosis of PCOS in Turkish patients. STUDY DESIGN Two hundred and fifty-one newly diagnosed PCOS cases according to Androgen Excess Society (AES) criteria (using clinical and biochemical parameters) and 65 regularly menstruating healthy, non-hirsute, normo-ovulatory volunteers as a control group were taken into the study. Evaluation of the ovaries and measurement of ovarian volumes of all cases were performed by transvaginal ultrasound. Ovarian volume (OV) and follicle number (FN) were recorded in all cases. RESULTS Mean and median OV were 12.5 ± 8.1 and 10.1cm(3) in PCOS cases. Mean and median FN in the PCOS group were 9.8 ± 2.8 and 10, respectively. In the control group, the mean and median OV were 5.4 ± 1.8 and 5.5 cm(3). Mean and median FN of controls was 5 ± 1.5 and 5, respectively. There were statistically significant differences in both OV and FN between PCOS patients and controls (all p < 0.001). Cut off values for ovarian volume in PCOS cases for the Turkish population were determined by receiver-operating characteristics (ROC) analysis. The areas under the curve (AUCs) for mean OV and mean FN were 0.938 and 0.998, respectively, indicating a good diagnostic power of the tested variables. Combining sensitivity and specificity using the Youden index, setting the cut off value for threshold OV and FN at 6.43 cm(3) and 8, respectively, yielded the best compromise between sensitivity and specificity. CONCLUSION There may be some differences in ultrasound characteristics of PCOS, resulting in differing diagnostic power and cut off points for different populations. OV and FN have powerful diagnostic value in determination of PCOS with different threshold values for different ethnicities.

Hyperemesis gravidarum and depression in pregnancy: is there an association?

Objective: The aim of this study was to evaluate the impact of hyperemesis gravidarum (HG) and sociodemographic parameters on depression during pregnancy. Study design: Between September 2010 and September 2011, 200 consecutive women with HG were defined as the study group and 200 consecutive pregnant women without any signs and symptoms of HG, and matched for age, parity, and gestational age were defined as the control group. The Beck depression inventory-II (BDI-II) questionnaire and sociodemographic questionnaire evaluating educational level, occupation, economic status, and obstetric history were given to all participants for self-completion. The forms were collected within 6 h of hospital admission. Groups were compared according to the presence of depression and predictors of depression were analyzed by regression analysis. Results: Median BDI-II scores in study and control groups were 15 and 5, respectively. The difference was statistically significant (p < 0.001). In the HG group, 35.1% of patients had mild depression, 26.0% moderate, and 17.8% had severe depression, while only 5% of patients in the control group had mild depression and 95% had no depression. Multivariate analysis showed that HG, age and family relationship were related to depression during pregnancy. Moreover, depression risk was increased 76-fold in patients with HG (odds ratio = 76.000; 95% confidence interval: 36.840–156.788; p < 0.001). Conclusion: Depression risk is increased in patients with HG, therefore not only medical therapy of HG, but also psychiatric evaluation should be considered for these patients.

Impact of adrenal versus ovarian androgen ratio on signs and symptoms of polycystic ovarian syndrome.

The aim of this study was to examine the effect of adrenal versus ovarian androgen (dehydroepiandrosterone sulfate/total testosterone [DHEAS/TT]) on clinical presentation and related metabolic disturbances in Turkish women with polycystic ovarian syndrome (PCOS). Two hundred eighty PCOS cases were taken into the study. For all cases, the DHEAS/TT ratio was calculated. The median value of this ratio was 4.40. Patients with an androgen ratio lower than 4.40 were included in Group 1 and cases with a ratio higher than 4.40 were Group 2. The two groups were compared in terms of hormonal, biochemical and clinical parameters. Body mass index and waist circumference were lower, the Ferriman–Gallwey score was higher and the cycle length was shorter in Group 2. High DHEAS level was associated with better lipid profiles and lower levels of inflammatory markers, meaning good metabolic control in these women, in spite of increased hirsutism rates. In patients with PCOS, both androgens are usually high in proportion to each other. Therefore, it would be more meaningful to use the DHEAS/TT ratio for an assessment of the metabolic and phenotypic effects of PCOS.

Comparison of standard mammography with digital mammography and digital infrared thermal imaging for breast cancer screening

Breast cancer is the most common malignancy in women. Screen-film mammography (SFM) has been considered the gold standard for breast cancer screening and detection. Despite its recognized value in detecting and characterizing breast disease, mammography has important limitations and its false-negative rate ranges from 4% to 34%. Given these limitations, development of imaging modalities that would enhance, complement, or replace mammography has been a priority. Digital mammography (FFDM) and digital infrared thermal imaging (DITI) are some of these alternative modalities.

Relation between abdominal subcutaneous fat tissue thickness and inflammatory markers during pregnancy.

Introduction Subcutaneous abdominal fat thickness (SCFT) is important for predisposition to metabolic and cardiovascular diseases. Our aim was to evaluate maternal SCFT and metabolic changes (such as insulin resistance and high inflammatory markers) during pregnancy. Material and methods A total of 92 pregnant women between 24–28 weeks of gestation were enrolled in the study. The SCFT was measured by ultrasonography and patients were divided into 2 groups according to thickness of maternal SCFT and body mass index (BMI). Groups were compared with each other for oral glucose loading test (OGL) results, and for haematological, biochemical and fetal biometric parameters. Results After analysis of frequency for SCFT, the most appropriate cut-off value for grouping patients was found to be 15 mm for SCFT. In 48 cases SCFT was over 15 mm. High C reactive protein (CRP) was found in 47.9% (23) of cases with SCFT over 15 mm. Serum haemoglobin A1c (HbA1c) level was significantly correlated with SCFT thickness. The most important factors for determination of OGL level were found to be serum HbA1c level, BMI and SCFT. In obese subjects (BMI ≥ 25 kg/m2), levels of inflammatory markers and SCFT thickness were higher. The CRP and γ-glutamyltransferase (GGT) levels were significantly correlated with BMI and SCFT. Conclusions High SCFT during pregnancy is associated with elevated inflammatory marker levels and HbA1c. Pregnant women with thicker SCFT may be susceptible to the development of metabolic complications of pregnancy, such as gestational diabetes mellitus (GDM) and hypertension, as well as risk of future metabolic and cardiovascular disease.

Gestational diabetes: comparision of the carpenter and the coustan thresholds with the new thresholds of Turkish women and implications of variations in diagnostic criteria

Objective: To find optimal 100-g 3-h oral glucose tolerance test (OGTT) threshold levels for diagnosis of gestational diabetes (GDM) in Turkish pregnant women. Methods: This study was conducted with 808 women screened for GDM between 24–28 weeks of gestation using the 1-h 50-g glucose challenge test (GCT) with a subsequent 3-h 100-g OGTT for confirmation if screen was positive. The glucose values obtained were analysed by both the Carpenter and Coustan (C&C criteria) and National Diabetes Data Group (NDDG) criteria for the diagnosis of GDM and IGT. Optimal OGTT cutoff values for Turkish population were calculated by ROC curve analysis. Results: The new diagnostic criteria, based on the result of the 100-g OGTT obtained from the healthy pregnant women, were 82.5, 171.5, 151.5, and 111.5 mg/dl at 0, 1, 2, and 3 h. The prevalence of GDM was 15.7% by the new criteria, 8.1% by C&C criteria, and 5.6% by the NDDG criteria. According to new criteria, 7.7% of infants of diabetic mothers had macrosomia. This ratio was 2.6% for non diabetic women. Conclusions: Ethnic differences, enviromental factors and nutritional habits may effect development of GDM. Application of some pre-determined nomograms to all races and ethnic groups can lead errors.

Effect of liquid-based gel application during speculum examination on satisfactory level of smear examination

PurposeThe aim was to evaluate the use of liquid-based gel during cytologic follow-up and the effect of liquid-based gel application during speculum examination on satisfactory level of smear.MethodsA total of 1,999 patients were taken into the study. Patients were divided into two groups as gel-applied group and control group. Age and menopausal status of patients, and the physicians taking the smear (resident or specialist) were recorded. In control group, dry speculum was used for the collection of smear sample. All specimens were evaluated for correlation of the cytopathology, the number of “unsatisfactory” samples, and any secondary diagnoses.ResultsAssessment of smear satisfactoriness revealed that 2.2% (43) of them were unsatisfactory. Unsatisfactory smear ratio was significantly high in gel-applied group. Screening done by residents increased unsatisfactory result risk for about 5.5 times. Evaluation of effect of menopausal status on smear adequency revealed no difference between premenopausal and postmenopausal women.ConclusionCervical smear seems to be more accurate without gel application. Experience of the physician is also important. Water-based gel can be used in some women who experience overt pain during speculum examination, but these patients must be warned about unsatisfactory results and the need of repeat test.

Effect of Hypericum perforatum on intraperitoneal adhesion formation in rats.

Introduction The aim of this study was to evaluate the efficacy of Hypericum perforatum for prevention of adhesion formation in rats. Material and methods Twenty-four female wistar rats underwent left uterine horn adhesion model. Rats were randomised into 4 groups. Group 1 (Control): Closure of abdominal incision without any agent administration. Group 2: Closure of incision after administration of intraperitoneal (i.p.) Ringers lactate solution. Group 3: Closure of incision after administration of i.p. olive oil (diluent of H. perforatum). Group 4: Hypericum perforatum extract (Ecodab®) was administered i.p. before the closure of incision. Fourteen days later, relaparatomy was performed and surgical adhesion scores, inflammation and fibrosis scores were noted. Groups were compared according to these scores. Results There was statistical significant difference between ringers lactate group and olive oil group according to surgical adhesion score (p = 0.009). However, groups were not different according to inflammation and fibrosis scores (p > 0.05). Conclusions Despite antiinflammatory, antioxidants and antimicrobial properties of H. perforatum, our results revealed no positive effect of H. perforatum on the prevention of intraperitoneal adhesion formation.

Fetal magnetic resonance imaging in obstetric practice.

Ultrasonography (USG) is the primary imaging method for prenatal diagnosis of fetal abnormalities since its discovery. Although it is the primary method of fetal imaging, it cannot provide sufficient information about the fetus in some conditions such as maternal obesity, oligohydramnios and engagement of the fetal head. At this stage, magnetic resonance imaging (MRI) facilitates examination by providing more specific information. The need and importance of fetal MRI applications further increased by the intrauterine surgery which is currently gaining popularity. Some advantages of fetal MRI over USG are the good texture of contrast, a greater study area and visualization of the lesion and neighbourhood relations, independence of the operators. Also it is not affected by maternal obesity and severe oligohydramnios. However, MRI is inadequate in detecting fetal limb and cardiac abnormalities when compared to USG. MRI is not used routinely in pregnancy. It is used in situations where nonionizing imaging methods are inadequate or ionizing radiation is required in pregnant women. It is not recommended during the first trimester. Contrast agent (Godalinium) is not used during pregnancy. It is believed that MRI is not harmful to the fetus, although the biological risk of MRI application is not known. MRI technique is superior to USG in the detection of corpus callosum dysgenesis, third-trimester evaluation of posterior fossa malformations, bilateral renal agenesis, diaphragmatic hernia and assessment of lung maturation. Especially, it is the method of choice for evaluation of central nervous system (CNS) abnormalities. Fetal MRI has a complementary role with USG. It provides important information for prenatal diagnosis, increases diagnostic accuracy, and in turn affects the prenatal treatment, prenatal interventions and birth plan.

Mean Platelet Volume as a Marker of Thrombosis in Patients with Missed Abortion

liability for thrombosis whether an abnormality in the embryo is present or not. We compared MPV values and platelet counts of 100 normal pregnancies resulting in live births and of 100 patients with missed abortions to determine whether MPV and platelet counts are useful tools for the identification of patients with unsuccessful pregnancy. Both groups had a gestational age range of 6–13 weeks. Patients who had anemia, hemoglobinopathy, any systemic or chronic disease, a history of bleeding or coagulation disorder or who were under anti-coagulant therapy Early pregnancy loss is a common pregnancy complication with an incidence ranging between 50 and 70% of all conceptions [1] . The exact cause of it is still unknown. Mean platelet volume (MPV), an accurate measure of platelet size, is considered a marker and determinant of platelet function. Larger platelets with higher MPV values are hemostatically more reactive and produce higher amounts of the prothrombotic factor thromboxane A 2 , increasing the propensity to thrombosis [2, 3] . In the case of a missed abortion, there may be a Received: September 6, 2010 Accepted after revision: November 22, 2010 Published online: January 20, 2011