Effects of ankylosing spondylitis and non-radiographic axial spondyloarthropathy on female sexual functions.

OBJECTIVES: Rheumatologic diseases may impair the quality of life (QoL) by affecting sexual functions in different ways. We aimed to evaluate sexual functions and the disease-related variables, physical and psychogenic states in female patients with ankylosing spondylitis and non-radiographic axial spondyloarthropathy. METHODS: A total of 98 women with axial spondyloarthropathy (axSpA) and 99 healthy females were included in the study. The axSpA group was divided into two subgroups as ankylosing spondylitis (AS) and non-radiographic axial spondyloarthropathy (nr-axSpA) (62 AS and 36 nr-axSpA). The patients' disease-related variables recorded. All the women in the axSpA and control groups were evaluated gynaecologically. The female sexual function index (FSFI), Health Status Questionnaire [Short Form (SF)-36], and Hospital Depression and Anxiety Scale (HADS) were applied to all participants. RESULTS: Clitoral and labial atrophy and speculum pain score were significantly higher in the axSpA group (p<0.05). The FSFI and QoL-SF-36 scores were significantly lower and the HAD-D and HAD-A scores were significantly higher of in the axSpA group than in the control group (p<0.05 for all). There was no significant between the axSpA subgroups in terms of the FSFI, QoL-SF-36 and HAD scores. CONCLUSIONS: In elderly women with axSpA, disease duration and limitation of movement are more effective in genital atrophy and sexual functions, but there is no difference between those with AS and nr-axSpA in relation to sexual functions and psychological burden.

Do Meteorological Variations and Climate Changes Affect Hyperemesis Gravidarum?

BACKGROUND: To estimate a possible association between the effects of daily meteorological variation and climatological changes (temperature, air pressure, humidity, sunniness level) on pregnant women with hyperemesis gravidarum (HG) according to symptoms grade and hospitalization state. METHODS: A retrospective study was conducted with 118 patients diagnosed and hospitalized with HG. HG patients were graded as mild, moderate, or severe according to the Pregnancy Unique Quantification of Emesis (PUQE-24) scale. Data regarding demographic characteristics, PUQE scale value, gestational week on hospitalization, hospital admission and discharge dates, weather conditions, daily meteorological values during hospitalization ( temperature, air pressure, humidity, sunniness level), seasonal averages, and daily changes were recorded. Weather records were obtained from the Ankara Meteorology General Directorate (Ankara, Turkey). Differences between groups were compared according to HG grade. RESULTS: HG cases were classified as mild (33.1%), moderate (44.9%), or severe (22.0%). The number of hospitalization days significantly differed between these three groups (p<0.05). In contrast, no statistically significant differences were identified between the HG grade level groups in regard to humidity, pressure, temperature, and sunniness level data (p>0.05). In addition, no statistically significant relationship was identified between HG grades and seasonal conditions according to the chi-square test (p>0.05). CONCLUSION: Changes in the meteorological and climate values examined were independent of symptom severity and hospitalization rate for our HG patients. However, it is possible that climate changes occurring around the world may affect the pregnancy period and should be further investigated.

Effects of primary Sjögren's syndrome on female genitalia and sexual functions.

OBJECTIVES: Sexual dysfunctions in patients with rheumatological diseases can negatively affect human sexual life, and thus lead to the deterioration of quality of life. This study aimed to determine the effects of primary Sjögren's syndrome (pSS) on female sexual organs and sexual functions. METHODS: A total of 68 women with pSS and 135 healthy female patients were included in the study. All the women in the study and control groups were evaluated gynaecologically, and genital findings during the examination and variables related to pSS were recorded. The women's sexual functions were evaluated with the Female Sexual Function Index (FSFI) and quality of life was evaluated using the Health Status Questionnaire-Short Form 36 (QoL-SF 36). RESULTS: There was no difference in terms of the ages of the patients between the pSS and control groups [50 (25-70) and 49 (23-70) years, respectively] (p=0.487). The FSFI and QoL-SF 36 scores of the pSS group were significantly lower than the control group (p<0.05). Although the age of the patients, duration of menopause, and presence of atrophy on genital examination significantly correlated with sexual dysfunction, there was no significant correlation between pSS activity-related variables and sexual dysfunction. CONCLUSIONS: It was determined that pSS led to sexual dysfunction by causing genital atrophy and vaginal dryness in women. Moreover, mood changes associated with the disease, especially depression, were revealed to be an independent risk factor for this condition.

Can preoperative complete blood count parameters be used in the diagnosis of patients with adnexal torsion: a case-control study.

OBJECTIVE: To determine whether there is a relationship between complete blood count parameters at adnexal torsion and to investigate the clinical utility of these parameters in preoperative diagnosis. METHODS: The retrospective, case-control study was conducted at a tertiary care hospital in Turkey and comprised data of patients who underwent adnexal torsion surgery from 2007 to 2017. Medical records of healthy controls who underwent various gynaecological surgeries during the period were used as the control group. Demographic characteristics and preoperative complete blood count parameters were retrieved from the medical records, and factors influencing adnexal torsion diagnosis were evaluated. Data was analysed using SPSS 21. RESULTS: Of the 296 subjects, 73(24.7%) were adnexal torsion cases and 223(75.3%) were controls. Demographic characteristics did not differ between the groups (p>0.05). Leukocytosis was present in 38(52%) cases. Mean white blood cell, neutrophil, and platelet counts and neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios were significantly higher, and mean platelet volume was significantly lower in the cases compared to controls (p<0.05). Logistic regression analysis identified an independent association between a low mean platelet volume and adnexal torsion (p<0.05). The optimal cutoff value was 10.35fL, with 77.4% sensitivity and 74.2% specificity. CONCLUSIONS: There was found to be a significant relationship between adnexal torsion and certain parameters of the complete blood count. Low mean platelet volume could be considered a useful additional tool for the preoperative diagnosis.

Accuracy of sonographic fetal weight estimation in full-term singleton pregnant women.

OBJECTIVES: To investigate the factors which might influence the sonographic fetal weight estimation (SFWE) accuracy. METHODS: This prospective study was conducted among 949 singleton term pregnant women who delivered at a tertiary center, from January 2017 to December 2017. All participants' maternal (i.e. parity, age, body mass index and gestational weight gain during pregnancy), fetal sonographic (i.e. fetal presentation, amniotic fluid index, localization of placenta and estimated fetal weight) and neonatal (birth weight and gender) characteristics were recorded. A p<0.05 was considered significant. RESULTS: The mean absolute percent error (APE) values of SFWE was 8.2±6.5 percent, and overall failure ratio (APE >10%) was 33%. In failure group, primiparous woman and cephalic presentation fetus were significantly more common compared to accuracy group (55.9% vs.44.8%; p=0.001 and 98% vs. 95.2%; p=0.03, respectively). In contrast, the mean neonatal birth weight (NBW) value was significantly lower in failure group compared to success group (3250±565 gr vs. 3404±410 gr; p=0.001). The correlation between SFWE and NBW was linear, however negative, and significant (p=0.001). Logistic regression analysis revealed that primiparous woman, cephalic presentation fetus and <3300 gr NBW were independent risk factors for the SFWE failure (relative risks were 1.6, 2.8 and 2.4 respectively, p<0.05). CONCLUSION: SFWE has a high correlation with NBW, however it's accuracy is still unsatisfactory, and depend on many unpredictable and inconsistent factors.

Is postmenopausal endometrial fluid collection alone a risk factor for endometrial cancer?

OBJECTIVE: To determine the usefulness of single-layer, ultrasonographic measurement of endometrial fluid collection (EFC) volume to predict endometrial pathology in asymptomatic postmenopausal patients. METHODS: One hundred fifty asymptomatic postmenopausal women were analysed retrospectively from January 2012 to December 2016. After patients with endometrial hyperplasia/neoplasia were included in Group-I, and those with insufficient tissue, endometrial atrophy, or endometritis were included in Group-II; Groups one and two were compared with respect to primary (correlations between endometrial thickness and EFC volume) and secondary (correlations between demographic characteristics and EFC volume) outcomes. RESULTS: There was no correlation between EFC volume and single-layer endometrial thickness (P = 0.36). Likewise, demographic characteristics were not related to EFC (P > 0.05). However, both EFC volume and single-layer endometrial thickness were thicker in Group-I compared to Group-II (4.8 ± 1.9 mm vs. 3.7 ± 2.5 mm; and 5.7 ± 9.4 mm vs. 2.7 ± 2.5 mm, respectively) (P values were < 0.05). CONCLUSION: Although a cutoff value for endometrial thickness and EFC volume could not be recommended based on our study findings, it should be noted that 2% is a clinically significant rate of malignancy. Thus, postmenopausal patients with EFC should be evaluated for endometrial sampling.

Sonographic measurement of the fetal thymus: Relationship with maternal obesity.

BACKGROUND: The purpose of this study was to evaluate the influence of maternal obesity on the size of the fetal thymus. METHODS: The study population consisted of 138 pregnant women who were divided into two groups based on their body mass index (BMI): Normal-weight group (n = 97; BMI: 18-25 kg/m2 ) and obese group (n = 41; BMI: ≥ 30 kg/m2 ). All participants underwent routine second-trimester prenatal ultrasound (US) screening at 20-25 weeks of gestation. Differences in US measurement of fetal thymus, fetal anthropometric measurements, subcutaneous adipose tissue thickness, fetal weight, gestational age, white blood cell count, and C-reactive protein (CRP) values between groups were compared. RESULTS: The mean thymus size was 18.7 ± 2.9 mm for normal-weight group, and 21.6 ± 3.7 mm for the obese group (p < 0.001). CRP values were also significantly different between groups (6.8 ± 4.4 mg/dl for normal-weight group, 14.8 ± 1.8 mg/dl for obese group, p < 0.001). CONCLUSIONS: Fetal thymus size was increased in obese women, and this increase may indicate immunologic abnormalities in fetuses. However, future large-scale studies are necessary to support this association. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:277-281, 2017.

A comprehensive assessment of redox balance in small for gestational age newborns and their mothers.

OBJECTIVE: The objective of this study was to assess oxidative stress in small for gestational age (SGA) newborns and their mothers by evaluating intra- and extracellular thiol homeostasis and the quantification of major oxidants and antioxidants. METHODS: A total of 75 mothers and their 75 newborns (43 SGA) were enrolled in this study. Thiol-disulfide homeostasis, serum myeloperoxidase, catalase, total oxidant, and antioxidant status were analyzed. Additionally, erythrocytic glutathione (GSH) homeostasis was measured. RESULTS: Although native and total thiol levels were decreased, disulfide levels were increased in SGA groups. Additionally, myeloperoxidase activity and total oxidant status levels were significantly elevated whereas total antioxidant status levels and enzymatic antioxidant systems were diminished in SGA groups. Similarly, intra-erythrocytic GSH homeostasis was shifted in favor of oxidants in SGA groups. CONCLUSION: Our results demonstrate that insufficient antioxidant systems in mothers and a robust source of oxidative stress in SGA might contribute to the pathophysiology of SGA births.

The evaluation of serum brain-derived neurotrophic factor levels in pregnant women with hyperemesis gravidarum.

OBJECTIVES: The aim of this study was to investigate the relationship between levels of brain-derived neurotrophic factor (BDNF), which is considered a cause of conditions such as depression and eating disorders, and hyperemesis gravidarum (HG). MATERIAL AND METHODS: This study was conducted as a prospective study at Ankara Ataturk Training and Research Hospital in the Department of Obstetrics and Gynecology. The study included 73 pregnant women with singleton pregnancies (32 pregnant women with HG and 41 pregnant women without hyperemesis). Serum BDNF levels were compared between the two groups. RESULTS: The mean age of the study group was 27.3 ± 3.5 years and the body mass index (BMI) was 22.4 ± 2.7 kg/m². There is no statistically significant difference between the study group and the control group in terms of demographic data (p > 0.05). The pregnant women with HG were found to have significantly higher serum BDNF levels compared to the control group (349.1 ± 94.6 pg/mL vs 292. 3± 86.01, p = 0.009) CONCLUSIONS: Serum BDNF levels that are low in psychiatric disorders such as depression or anxiety were found as high in pregnant women with HG.

Clinical and ethical perspectives of medical professionals towards female genital cosmetic procedures

Objective: To evaluate the attitudes of medical students and professionals towards female genital cosmetic procedures (FGCPs) in terms of medical justification, applicability in practical life, ethical concerns, patient autonomy, and the clinical/social/psychological benefits-harms of these procedures. Materials and Methods: A semi-structured questionnaire providing information about the attitudes of medical students and specialists (n=623) towards FGCPs including G-spot amplification, clitoral hood reduction, vaginoplasty, labia majora augmentation/reduction, labia minora augmentation/reduction, hymenoplasty, laser procedures, vulvar/perianal bleaching, and liposculpture, was completed by a target population and evaluated statistically. Results: Participants stated that FGCPs could be performed only upon patient request and there could rarely be a medical indication for their performance (p<0.05). Nearly half (44.5%) of the participants regarded hymenoplasty as controversial in terms of ethical issues, and 44.6% of participants do so for G-spot amplification. Over half (54.5%) of the participants agreed on the positive effect of FGCPs on improving the quality of life, 55.4% on improving self-esteem, and 54.1% on improving sexual functions of women. About half (49.3%) of respondents thought that the advertising and encouragement of FGCPs should be forbidden and 47% were indecisive about whether FGCPs constituted genital mutilation. Conclusion: The majority of the participants declared that FGCPs could be performed only upon patient request and improve self-esteem, quality of life, and sexual functions. The most controversial procedures in terms of ethics were hymenoplasty and G-spot amplification. Detailed guidelines for the protection of both patients and physicians are needed because the recommendations on FGCPs are insufficient to define the boundaries of medical justification, genital mutilation, advertising, and ethical concerns.

Soluble urokinase-type plasminogen activator receptor (suPAR) and interleukin-6 levels in hyperemesis gravidarum.

BACKGROUND: The aim was to compare serum soluble urokinase-type plasminogen activator receptor (suPAR) levels as well as interleukin-6 levels (IL-6) in pregnant women with hyperemesis gravidarum (HG) and asymptomatic pregnant women. METHODS: Our study population consists of voluntary first trimester-pregnant women who applied to the outpatient clinic of the department of obstetrics and gynecology of Ankara Ataturk Training and Research Hospital. Between February and May 2016, 60 pregnant women were included in our prospective study. Serum suPAR and IL-6 levels were evaluated with the ELISA method. Twenty-nine pregnant women with HG and 31 asymptomatic pregnant women were included in the study. RESULTS: Serum suPAR level in the HG group was measured as 0.36 ± 0.56 ng/ml, whereas this level in the healthy pregnant control group was measured as 0.15 ± 0.15 ng/ml (p < 0.05). The interleukin-6 level in the HG group was 5.69 ± 2.16 pg/ml, whereas in the control group it was measured as 3.88 ± 0.28 pg/ml (p < 0.05). CONCLUSION: Serum suPAR and IL-6 levels proved to be high in the HG group. It is likely that suPAR could play a role in the etiopathogenesis of hyperemesis gravidarum.

Evaluation of oxidative stress markers and intra-extracellular antioxidant activities in patients with endometriosis.

OBJECTIVE: The aim of the study is to evaluate alterations in intracellular and extracellular antioxidant enzymes activities and serum oxidative stress markers in patients with endometriosis. STUDY DESIGN: The current prospective study consisted of 31 female patients with endometriosis and 27 healthy controls. Serum total thiol, native thiol, disulphide, catalase, myeloperoxidase, and ceruloplasmin concentrations were measured. Laboratory and clinical data of all participants were recorded to compare the differences between the study and the control groups. RESULTS: Serum native thiol and total thiol levels in the study group were significantly lower than those in the control group [(p=0.009, p=0.03, respectively)]. Serum catalase levels are significantly higher in patients with endometriosis comparing to the control group (p=0.009). CONCLUSIONS: The finding that significant differences in serum total thiol, native thiol, and catalase levels observed in endometriotic patients supports that oxidative stress carries weigh in the pathophysiological aspects of endometriosis. Also significantly low levels of extracellular antioxidants and significantly high levels of intracellular antioxidants in endometriotic patients may arise from differences of free radicals in endometriosis and the activity levels of endometriosis. These non-invasive serum markers might give us an opportunity to monitor the disease's progress during the treatment.