Investigation of serum apelin-13 and apelin-36 concentrations in pregnancies complicated by preeclampsia; a prospective case-control study.

OBJECTIVE: We aimed to investigate the relationship between preeclampsia and maternal serum apelin-13 and apelin-36 concentrations. METHODS: This cross-sectional study was carried out in the Gynecology and Obstetrics Clinic of Umraniye Training and Research Hospital. The preeclampsia group consisted of 40 pregnant women diagnosed with preeclampsia, and the control group consisted of 40 healthy pregnant women matched with the preeclampsia group in terms of age and body mass index. The two groups were compared in terms of maternal serum apelin-13 and apelin-36 concentrations. RESULTS: Both groups were similar in terms of demographic characteristics and the gestational week at blood sampling. Maternal serum apelin-13 and apelin-36 concentrations were significantly lower in the preeclampsia group than in the control group (p = 0.005, p = 0.001, respectively). The optimal cutoff value for the prediction of preeclampsia in receiver operator curve analysis for apelin-13 was determined as 1781.67 pg/ml with 60% sensitivity and 60% specificity, and 885.5 pg/ml for apelin-36 with 67% sensitivity and 65% specificity. We divided the preeclampsia group into two groups mild and severe and compared the three groups in terms of maternal serum apelin-13 and apelin-36 concentrations. The lowest apelin-13 concentration was detected in the severe preeclampsia group, while the lowest apelin-36 concentration was detected in the mild preeclampsia group (p = 0.020, p = 0.003, respectively). Considering the onset of the disease, we divided the preeclampsia group into two groups early and late-onset, then compared the three groups in terms of maternal serum apelin-13 and apelin-36 concentrations. The lowest maternal serum apelin-13 and apelin-36 concentrations were detected in the early-onset preeclampsia group (p = 0.016, p = 0.001, respectively). CONCLUSION: It was determined that serum apelin-13 and apelin-36 concentrations were significantly lower in preeclamptic pregnant women, this decrease was more significant in early-onset preeclampsia, and low maternal serum apelin-13 concentration was more associated with the severity of preeclampsia.

Evaluation of dry eye and meibomian gland function in pregnancy.

PURPOSE: To evaluate the signs and symptoms of dry eye in healthy pregnant women and investigate the effect of pregnancy on meibomian gland loss using non-contact meibography. METHODS: Healthy pregnant women and age-matched healthy non-pregnant women were included in the study. Subjective symptoms were assessed using the Ocular Surface Disease Index (OSDI). The first and average non-invasive break-up times (first-NIBUT and avg-NIBUT, respectively) were determined, and the Schirmer test was applied. Non-contact meibography was performed. RESULTS: The study included a total of 62 women, 30 pregnant (study group) and 32 non-pregnant (control group). There was no significant difference between the groups in terms of OSDI score and the Schirmer test (p > 0.05). The mean first-NIBUT and avg-NIBUT values of the study group (13.1 ± 5.3 and 13.7 ± 4.5 s) were significantly lower than the control group (16.0 ± 2.4 and 16.4 ± 1.5 s) (p: 0.015 and p: 0.040, respectively). The mean meibomian gland losses in the upper and lower eyelids were significantly higher in the study group (16.9 ± 8.2% and 11.6 ± 10.2%) compared to the control group (9.7 ± 6.2% and 5.6 ± 4.7%) (p < 0.001 and p: 0.011, respectively). CONCLUSIONS: It is considered that loss of the meibomian glands may occur during pregnancy, and this may predispose pregnant women to evaporative dry eye. Although dry eye does not cause significant ocular surface symptoms in pregnancy, NIBUT and non-contact meibography can be considered as effective diagnostic methods for the detection of dry eye in pregnant women.

Smooth muscle tumor of uncertain malignant potential (STUMP): a case-based analysis.

OBJECTIVES: The present study aimed to analyze of uterine smooth muscle tumors of uncertain malignant potential (STUMP) and the outcomes of patients with STUMP. MATERIAL AND METHODS: In this retrospective study, the data of patients diagnosed with STUMP in a single tertiary center between January 2005-January 2020 were reviewed. We assessed the demographic variables, treatment outcomes, time until recurrence, disease-free and overall survival of the patients. RESULTS: Twenty-five patients diagnosed with STUMP were included in the study. The mean age of the patients was 43.2 ± 10.3 years. Thirteen of the 25 patients (52%) were treated by myomectomy, others received diagnoses following hysterectomy. The median follow-up time was 45.2 months. Recurrence was observed in three cases (12%), two of which were followed up without hysterectomy, and the third patient died by peritonitis carcinomatosa 60 months after diagnosis although she received cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) treatment. CONCLUSIONS: This study evaluates the data of patients with STUMP. Our results reveal a STUMP recurrence of 12%, like those previously reported in the literature. Despite the possibility of malignant recurrence, fertility-preserving treatment with close follow-up should be tried, because of the relatively early age at diagnosis.

Can platelet indices be of value in pregnant women with malaria?

Malaria infection in pregnancy is a serious disease with feto-maternal adverse outcomes. In this study we evaluated and compared the haematologic parameters of pregnant women with and without malarial infection. This case-control study included a total of 145 participants (59 pregnant women with malaria and 86 aparasitemic pregnant women). Haematological parameters were evaluated using an automated hemo-analyser. Haemoglobin, platelet, white blood cell and platelet distribution width (PDW) of pregnant women with malaria were found to be significantly lower than pregnant without malaria. However, the mean platelet volume (MPV) of pregnant women with malaria was significantly higher than those without infection.Impact StatementWhat is already known on this subject? Malaria infection in pregnancy is a serious disease and may affect haematological parameters.What do the results of this study add? Platelet indices were significantly changed in malaria. Especially mean platelet volume (MPV) with malaria was significantly higher than those without infection.What are the implications of these findings for clinical practice and/or further research? Among the expected differences in haematologic parameters of pregnant women with malaria, the increase in MPV has been a novel finding. The increase in MPV level of pregnant with malaria should be investigated further to address the value of MPV as a prognostic factor.

Predictive factors of treatment success in two-dose methotrexate regimen in ectopic tubal pregnancy: A retrospective study.

OBJECTIVES: To investigate the predictive factors of success or failure in treating ectopic tubal pregnancies with two-dose methotrexate (MTX). METHODS: The records of patients treated for tubal EP with two-dose MTX were retrospectively reviewed. Patients were divided into two groups; the Group-I (failure) consisted of patients who did not respond to MTX therapy and the Group-II (success) included patients who were successfully treated with MTX. Parameters, including the week of gestation, presence or absence of fetal cardiac activity, gestational sac size, serum ß-hCG levels, and adverse effects were compared. RESULTS: Fifty patients were included in this study, 8 (16%) were in Group-I and 42 (84%) were in Group-II. Patients in Group-I required surgery after a mean duration of 6.7±3 days after administering the initial dose of MTX. There was no difference between the groups in terms of the week of gestation, presence or absence of fetal cardiac activity, gestational sac size, serum ß-hCG levels, and adverse effects. The average time to ß-hCG negativization was 31 days in Group-II. CONCLUSIONS: The two-dose MTX protocol has a reasonable success rate, which seems to be dependent on serum ß-hCG levels.

Comparison of body mass index and metabolic parameters with serum vaspin levels in women with polycystic ovary syndrome.

This study showed that there is a positive correlation between serum Visceral Adipose tissue derived Serine Protease Inhibitor (VASPIN) level and polycystic ovary syndrome (PCOS). In previous studies, this relation was attributed to the generalization of higher amount of adipose tissue in patients with PCOS. However, we detected that VASPIN is significantly high in patients with PCOS regardless of BMI. Besides, the metabolic parameters such as fasting insulin, HOMA-IR, triglycerides and LDL-C levels were also increased in lean women with PCOS.

Comparative cosmetic outcome of surgical incisions created by the PEAK Plasma Blade and a scalpel after cesarean section by Patient and Observer Assessment Scale (POSAS): A randomized double blind study.

OBJECTIVE: To compare the cosmetic result of the PEAK Plasma Blade with traditional scalpel in patients who had primary cesarean delivery by using POSAS (Patient and Observer Assessment Scale). MATERIAL AND METHODS: Fourty women between 20 and 40 years, who were planning to have primary cesarean delivery, were randomized for skin incision with PEAK Plasma Blade (n:20) and with scalpel (n:20) were blinded to their group allocation. At six months, the cosmetic outcome of the cesarean scar was assessed using the POSAS. Subjective scar rating was performed using the patient component of the POSAS. Objective scar assessment was performed by an observer dermatologist blinded to the patient's group allocation. RESULTS: The observer scores (p = 0,003), patient scores (p = 0,001) and the total scores (p = 0,001) of the POSAS scale were significantly lower in favor of the Peak Plasma Blade group with respect to the scalpel group. CONCLUSION: The PEAK Plasma Blade has superior cosmetic outcome compared to traditional scalpel skin incision at cesarean section.

Can serum vaspin levels predict clomiphene resistance in infertile women with PCOS?

OBJECTIVE: To determine whether serum vaspin levels can predict the success of ovulation induction and clomiphene resistance in anovulatory women with PCOS. STUDY DESIGN: We designed a prospective case control study. The study population (n=49) was composed of infertile women with PCOS who underwent ovulation induction with clomiphene citrate. Patients were divided into two groups based on their treatment response. Group I consisted of patients with failed ovulation induction, and group II consisted of patients with successful ovulation induction. The study group characteristics, including age, BMI, waist-to-hip ratio, parity, hormone profiles, fasting insulin and glucose levels, HOMA-IR, triglycerides, and cholesterol and serum vaspin levels, were compared between the study groups. RESULT(S): There were 29 patients in Group I with failed ovulation induction (59.2%), and Group II consisted of 20 patients with successful ovulation induction (40.8%). No differences in characteristics were found. However, serum vaspin levels were significantly lower in responders achieving ovulation (p=0.001; p<0.01). At a vaspin level of 3.74, the sensitivity, specificity, positive predictive and negative predictive values were 90%, 72.4%, 69.2% and 91.3%, respectively. The odds ratio was determined to be 14.87 (95% CI: 3.41-64.88) as the cut-off point. No significant correlation was found in serum vaspin measurements between pregnant and non-pregnant patients who had achieved successful ovulation induction (p=0.5). CONCLUSION(S): Serum vaspin level may be a useful marker for the prediction of ovulation induction success in treatment with clomiphene citrate, and increased vaspin levels (≥3.74ng/mL) are correlated with clomiphene resistance in patients with PCOS according to our study results.

Identification of patients at risk for preeclampsia with the use of uterine artery Doppler velocimetry and copeptin.

PURPOSE: To investigate the relationship between maternal copeptin levels and uterine artery Doppler examination and progress of preeclampsia. MATERIALS AND METHODS: A cross-sectional study was designed with women those were screened at 20 + 0 - 24+ 6 weeks' gestation between May 2014 and August 2014. The obstetric records of all normotensive women were examined. Uterine artery Doppler velocimetry results and serum copeptin levels were measured. The patients were divided into two groups according to normal (n = 67) and abnormal uterine artery Doppler (n = 21) findings. RESULTS: Maternal age was significantly lower in group 1 (n = 21, 23.9%) than in group 2 (n= 67, 76.1%) (p < 0.05). We found no differences in maternal characteristics, birth weight, gestational age at delivery and copeptin levels between the two groups. Maternal serum copeptin levels were higher in women who subsequently developed preeclampsia. There was also a significant correlation between copeptin levels and the presence of preeclampsia. (p = 0.002). CONCLUSIONS: Copeptin levels are significantly higher in patients who develop preeclampsia.

A comparison of normal and high post-void residual urine and urodynamic parameters in women with overactive bladder.

OBJECTIVE: To investigate voiding functions and assess the relationships of voiding parameters to overactive bladder symptoms and postvoiding residue volumes. MATERIALS AND METHODS: This is a retrospective study analyzing urodynamic parameters in patients who were diagnosed as having overactive in our urogynecology clinic between April 2014 and April 2016. A total of 290 women who met the selection criteria were included in the study. The patients were divided into two groups according to postvoiding residue volumes: group 1, postvoiding residue volumes <100 mL (n=135); group 2, postvoiding residue volumes ≥100 mL (n=155). RESULTS: A total of 290 women were included in the study; the mean age was 71.4 years. A total of 158 (54.5%) patients had detrusor over-activity during urodynamic testing. The mean maximum bladder capacity in elevated group 2 (postvoiding residue volumes ≥100 mL) was significantly higher than in group 1 (postvoiding residue volumes <100 mL) (p<0.01). Additionally, there was a significant difference between detrusor pressure at Qmax in both study groups (p<0.05). There were no significant differences in the first-sensation volume between the normal and elevated postvoiding residue volumes groups. CONCLUSION: In conclusion, patients with overactive with elevated postvoiding residue volumes showed increased maximum bladder capacity, but detrusor over-activity was not more prevalent in these women compared with women with normal postvoiding residue volumes.

The role of mean platelet volume and platelet distribution width in the prediction of placental abruption.

We determined the role of mean platelet volume (MPV) and platelet distribution width (PDW) in the prediction of placental abruption (PA) prior to caesarean section. Data obtained between January 2011 and July 2014 from patients (n = 33) with PA and healthy control subjects (n = 67) matched for age- and gestation-stage were analysed. Pre-operative and post-operative MPV and PDW were significantly different between the PA and control groups when cut-off values for MPV were set at 9.23; sensitivity at 87.8% and specificity at 46.2%; positive predictive value (PPV) at 48.3%; and negative predictive value (NPV) at 90.0%. When the cut-off value for PDW was set at 18.5, the sensitivity was 100% and specificity 71.6%, PPV 40.7% and NPV 59.3% for the prediction of PA. MPV and PDW levels were significantly higher in cases of PA. These results suggest that clinical evaluation of MPV and PDW displays reasonable sensitivity and specificity as a marker of PA, prompting the need for more research in this area of clinical study.

Could body mass index be an indicator for endometrial biopsy in premenopausal women with heavy menstrual bleeding?

PURPOSE: To evaluate the role of body mass index (BMI) in women with premenopausal heavy menstrual bleeding (HMB) to identify patients who should undergo endometrial biopsy. METHODS: This prospective cohort study included 1120 premenopausal women who presented to the Gynecology Clinic, Bakirkoy Dr. Sadi Konuk Training and Research Hospital in Istanbul, Turkey, due to HMB and who underwent endometrial sampling. The abnormal endometrial histopathological results were analyzed by separating patients into groups of all abnormal findings (hyperplasia without atypia + hyperplasia with atypia + carcinoma) and hyperplasia with atypia + carcinoma. Sensitivity and specificity of the abnormal histopathological results were calculated in both groups using BMI cut-off values as 25, 30 and 35 and age cut-offs as 40 and 45 years. RESULTS: The rate of hyperplasia with atypia and carcinoma was sevenfold higher in women with a BMI ≥30 compared to those with a BMI ≤30 (95 % CI 2.4-17.9). In the analyses, BMI was a stronger risk factor in women younger than 45 years of age. The risk of endometrial carcinoma and atypical hyperplasia was twofold higher in patients older than 45 years when compared with patients younger than 45 years (95 % CI 1.1-5.1). CONCLUSIONS: All women with a BMI ≥30 and presenting premenopausal HMB should undergo endometrial biopsy regardless of age.

Can Platelet Count and Platelet Indices Predict the Risk and the Prognosis of Preeclampsia?

OBJECTIVE: To compare the hematocrit, platelet count (PC), mean platelet volume (MPV), platelet distribution width (PDW), PC to MPV ratio in the mild preeclamptic (mPE), severe preeclamptic (sPE) and healthy normotensive pregnant women to evaluate whether these parameters have a predictive and prognostic significance in determining the risk and the severity of preeclampsia (PE). METHODS: A retrospective case-control study was designed including the patient population (N = 284) composed of 49 mPE, 70 sPE, 165 healthy normotensive pregnant women for controls. Preceding medical histories of all the cases were insignificant. RESULTS: In comparison of the preeclamptic patients with controls; there was statistically significant difference in PC (p = 0.023; p < 0.05), MPV(p = 0.023; p < 0.05), PC/MPV ratio (p = 0.005; p < 0.01). But there was no difference between sPE and mPE. Cut-off value for MPV was calculated as 9 for the diagnosis of PE (p < 0.01), the odds ratio was 1.999. The cut off value for PC was 190, the odds ratio was 1.932. The cut off value was 19.9 for the PLT/MPV, the odds ratio was 2.42. CONCLUSION: We suggest that the increasing platelet turnover in PE causes a decrease in the PC, an increase of MPV value and especially a decrease in PC/MPV ratio pointing that these parameters may play an important role in predicting the risk of PE while they have no role on predicting the severity of PE. According to our findings we can suggest that the patients with these cut-off values of PC and platelet indices, should be carefully followed for the development of PE.