Orkun Cetin

Impairment of thiol-disulfide homeostasis in preeclampsia

Abstract Aim: To investigate the effects of severity of preeclampsia on thiol-disulfide homeostasis (TDH). Material and methods: A total of 108 participants were divided into three groups: Group 1 was composed of pregnant women with no obstetric complications, Group 2 included pregnant women with mild preeclampsia, and Group 3 consisted of pregnant women with severe preeclampsia. TDH parameters were determined, and comparisons of clinical and routine laboratory test findings were made in all groups. Results: The serum native thiol level was 347.9 ± 27.4 in the control group, 237.2 ± 44.2 in the mild preeclampsia group, and 227.9 ± 53.1 in the severe preeclampsia group (p < 0.001). The serum total thiol level was 376.1 ± 31.9 in the control group, 261.8 ± 49.4 in the mild preeclampsia group, and 248.3 ± 57.4 in the severe preeclampsia group (p < 0.001). The disulfide level was 14.1 ± 5.6 in the control group, 12.3 ± 5.1 in the mild preeclampsia group, and 10.2 ± 4.8 in the severe preeclampsia group (p = 0.001). A significant correlation between impairment in degree of TDH and severity of preeclampsia was observed. Conclusion: TDH was impaired in women with preeclampsia, and this impairment increased with disease severity. Therefore, impaired TDH may have a role in the etiopathogenesis of the disease.

Comparison of placental elasticity in normal and pre-eclamptic pregnant women by acoustic radiation force impulse elastosonography.

The aim of this research was to study and compare placental elasticity with acoustic radiation force impulse (ARFI) elastography in pre‐eclamptic and normal pregnancies.

Short-Term Effects of Kinesio Taping in Women with Pregnancy-Related Low Back Pain: A Randomized Controlled Clinical Trial.

Background Pregnancy-related low back pain is a common condition during pregnancy. Kinesio tape is a drug-free elastic therapeutic tape used for treating various musculoskeletal problems. The aim of this study was to investigate the short-term effects of lumbar Kinesio taping on pain intensity and disability in women with pregnancy-related low back pain. Material/Methods A total of 65 patients with pregnancy-related low back pain were randomly allocated into either Kinesio taping (n=33) or control (n=32) groups. The intervention group was treated with paracetamol plus Kinesio taping, while the control group received only paracetamol. Kinesio taping was applied in the lumbar flexion position, and four I-shaped bands were used. Two bands were attached horizontally, with space correction technique. The remaining 2 bands, 1 on each side of the lumbar spine, were placed vertically, with inhibition technique. Low back pain intensity was measured on a 10-cm visual analogue scale (VAS), and the Roland-Morris Disability Questionnaire (RMDQ) was used for evaluation of disability. Results Pain intensity and RMDQ scores improved significantly in both groups at 5 days compared with baseline. Considering the degree of treatment effect (the change from baseline to day 5), the Kinesio taping group was significantly superior than the control group in all outcome measures (for all, P<0.001). Conclusions The results of this study indicate that Kinesio taping can be used as a complementary treatment method to achieve effective control of pregnancy-related low back pain.

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.

Local resection may be a strong alternative to cesarean hysterectomy in conservative surgical management of placenta percreta: experiences from a tertiary hospital

Abstract Objective: To evaluate and describe a surgical approach for uterine preservation and management of postpartum hemorrhage in placenta percreta. Methods: We analyzed the data of patients who were diagnosed with placenta percreta prenatally and subsequently underwent cesarean section in which local resection technique was used to manage postpartum hemorrhage and uterine preservation at our tertiary care center between 2013 and 2016. The technique includes local resection of placental invasion site and suturing the new uterine edges. Results: The technique of local resection described above was successful in preserving the uterus and stopping the bleeding in 8 of 12 cases. The diagnosis of placenta percreta in all cases was confirmed intraoperatively and postoperatively by histological examinations. Four cases were resorted to hysterectomy. The mean number of transfused erythrocyte suspension was 4.8 ± 2.6. One complication of bladder injury was encountered in which treated conservatively. Conclusion: Local resection of percreta site is an effective, safe and fertility preserving approach that can be applied to manage the postpartum hemorrhage and preservation of uterus in patients with placenta percreta.

The role of ovarian reserve markers in prediction of clinical pregnancy

Abstract To evaluate the role of ovarian reserve markers in the prediction of clinical pregnancy and embryo transfer accomplishment among poor responder IVF applicants. 304 female poor responder IVF applicants were included in this prospective cohort study conducted at the IVF-unit. Antral follicle count, FSH, LH, E2, AMH and IVF outcomes were compared in pregnant and non-pregnant groups as well as in ET vs. non-ET groups. The number of retrieved oocytes was significantly correlated positively with AMH and AFC, and negatively with FSH and age. Quartiles of FSH and AFC were similar to the rate of pregnancy. Quartiles of AMH (<25%/25–75% and <25%/>75%) were statistically significant. Mean serum levels for AMH were significantly lower in the non-ET group. Our findings seem to indicate that day 3 AMH values can predict ET accomplishment with a sensitivity of 96% and a specificity of 35%. Quartiles of AMH <25% (< 0.21 ng/mL) can predict the IVF results among poor responder IVF applicants. Impact statement Various cut-off values have been determined for day 3 serum AMH values. These values help to determine the groups that are expected to give normal, high or low response to stimulation and decide the treatment options. In contrast to other groups of patients, poor responders cannot reach the embryo transfer stage for several reasons. These are; absence of a mature oocyte after oocyte pick-up, fertilisation failure without male factor or poor embryo quality. In the present study; a cut-off value of 0.33 ng/mL for the prediction of ET accomplishment in poor responder patients was determined with a sensitivity of 96%. Additionally, clinical pregnancy could not be achieved under the value of 0.21 ng/mL day 3 AMH values. It is important to clarify the embryo transfer success of poor responder patients prior to expected treatment success. Pre-treatment counselling for these patients would lessen the disappointment that may develop after treatment. The cost-effectiveness of treatments below these AMH values can be determined by further studies.

Intracranial Meningioma Diagnosed during Pregnancy Caused Maternal Death

Brain tumors are rarely diagnosed during pregnancy. Accelerated growth of intracranial meningiomas during pregnancy sometimes requires urgent surgical intervention. We describe a 41-year-old pregnant woman with severe neurological decompensation requiring immediate neurosurgery. Cesarean section resulted in maternal death. Meningioma diagnosed during a viable pregnancy should be managed according to the severity of maternal neurological symptoms and gestational age of pregnancy. Early intervention for intracranial tumors during pregnancy may save maternal and fetal lives.

The maternal serum thiol/disulfide homeostasis is impaired in pregnancies complicated by idiopathic intrauterine growth restriction

Abstract Purpose: To investigate the maternal serum thiol/disulfide homeostasis in pregnancies complicated by idiopathic intrauterine growth restriction (IUGR) and to compare the results with healthy pregnancies. Materials and methods: This descriptive cohort study included 55 pregnant women complicated by idiopathic IUGR and 57 similar gestational aged healthy pregnant women in the third trimester of gestation. Maternal serum samples were collected at the day of diagnosis and the thiol/disulfide homeostasis was measured by using an automated assay method. The patients were followed up until delivery and perinatal outcomes were recorded. Results: Maternal serum native thiol (308.1 ± 40.7 μmol/L vs. 282.4 ± 60.6 μmol/L) and total thiol (346.8 ± 48.1 μmol/L vs. 324.0 ± 62.2 μmol/L) concentrations were significantly lower in IUGR group compared with healthy controls (p: .010 and p: .032, respectively), whereas disulfide (19.3 ± 8.7 μmol/L vs. 20.8 ± 7.8 μmol/L) concentrations were similar between the groups (p: .350). Maternal serum disulfide/native thiol and disulfide/total thiol ratios were higher in IUGR group compared with healthy controls (p: .014 and p: .017, respectively), whereas native thiol/total thiol ratio was significantly lower in IUGR group compared with healthy controls (p: .016). Conclusions: This study suggests that there is an impaired maternal thiol/disulfide homeostasis in pregnancies complicated by idiopathic IUGR during the third trimester of gestation.

Maternal serum thiol/disulfide homeostasis in pregnancies complicated by neural tube defects: report of a preliminary study.

Abstract Objective: To determine and evaluate the maternal serum thiol/disulfide homeostasis in pregnancies complicated by neural tube defects (NTD) via a novel method. Methods: Seventy-three pregnant women with NTD (study group) and seventy-one healthy control pregnant women (control group) were included in the study. A new and fully automated method was used to measure plasma native thiol, total thiol and disulfide levels, based on the reduction of dynamic disulfide bonds to functional thiol groups by sodium borohydrate. Results: The study and control groups were gestational age-matched. There were no statistical differences in demographic variables regarding age, gravidity, parity and body mass index. The serum native thiol levels (–SH) were 360.5 ± 50.3 and 353.3 ± 31.0 μmol/l in study and control groups, respectively, which was not statistically different (p = 0.308). The native thiol/total thiol, disulfide/native thiol and disulfide/total thiol ratios were not statistically significantly different (p > 0.05). Conclusion: Our preliminary results show that maternal serum thiol/disulfide homeostatis does not change in pregnancies complicated by NTD. Larger further studies are required to evaluate the relation of oxidative stress and development of NTD.

Primary Tubal Choriocarcinoma Presented as Ruptured Ectopic Pregnancy.

The primary tubal choriocarcinoma associated with ectopic pregnancy is very rare. A 31-year-old woman was admitted to the emergency room due to amenorrhea, left lower abdominal pain and fatigue. Her β-Hcg level was 29251.4 mIU/ml and transvaginal ultrasund revealed a 24x21 mm of left tubal ectopic pregancy mass with large amount of free fluid in pelvic cavity. The patient was diagnosed with ruptured tubal ectopic pregnancy and thus, she underwent laparotomy with left total salpingectomy. The pathological assessment was reported as primary tubal choriocarcinoma with the involvement of whole tubal layer. The patient was defined to have stage I choriocarcinoma with good prognostic factors and methotrexate monotherapy was administered. Serum β- Hcg levels of the patient gradually declined and eventually became negative at the first month of the treatment. With this case report we aimed to implicate that when diagnosing the ectopic pregnancy, even very rare, the tubal choriocarcinoma should be kept in mind.