Managing life during the pandemic: communication strategies, mental health, and the ultimate toll of the COVID-19

Background/aim: The purpose of this review was to present the ultimate toll of the COVID-19 pandemic by focusing on the communication strategies and mental health. Materials and methods: We unsystematically reviewed the studies published between 2020 and 2021 from databases such as Google Scholar, Web of Science and ScienceDirect. Firstly, "new-normal" life challenges during the pandemic were discussed along with the public risk communication strategies. Later, mental health problems, posttraumatic growth, and protective factors were reviewed. Results: Literature highlighted that individuals mainly experience COVID-19 related fear, anxiety, stress, negative emotions and sleep problems. Furthermore, the rates of clinically significant depression, anxiety, obsessive compulsive disorder, and posttraumatic stress disorder suggest an increase. Specifically, COVID-19 stress syndrome, loneliness, and sleep problems were associated with mental health problems in the pandemic. However, some individuals seem to be resilient to the COVID-19 trauma and experience posttraumatic growth. Brief online intervention studies are promising for reducing the emotional toll of the COVID-19 as well as for making individuals more resilient. Conclusion: To conclude, the negative conditions of the pandemic seem to make some people, but not all, vulnerable to mental illness. In addition, framing the public warnings in an optimal emotional tone seems to be more effective to comply with the precautions.

The Use of Thiol/Disulfide as a Novel Marker in Premature Ovarian Failure.

The study aimed to compare the dynamic thiol/disulfide homeostasis between patients with premature ovarian failure (POF) and healthy women. A total of 77 women, 40 POF and 37 healthy controls, were recruited from a university hospital between December 2013 and June 2015. Blood samples were taken from patients to evaluate follicle stimulating hormone (FSH), luteinizing hormone, estradiol and thiol/disulfide levels. A new, fully automated method was used to measure plasma thiol, total thiol and disulfide levels. Disulfide levels, disulfide/native thiol and disulfide/total thiol ratios were significantly increased, native thiol/total thiol levels were significantly decreased in POF patients compared to controls (p < 0.001). FSH was negatively correlated with native thiol and native thiol/total thiol levels and positively with disulfide, disulfide/native thiol, and disulfide/total thiol levels. This is the first study demonstrating the thiol/disulfide homeostasis in women with POF and may help us understanding the pathophysiology.

A prospective comparative study to assess the effect of maternal smoking at 37 weeks on Doppler flow velocity waveforms as well as foetal birth weight and placental weight.

Maternal smoking is known to have adverse effects on the foetus. This study aimed to evaluate the effects of maternal smoking during pregnancy on arterial blood flow velocities in the foetal-placental-maternal circulation, and the pathophysiological relationship with placental and foetal birth weight. A total of 148 singleton pregnancies in 59 smokers and 89 non-smoking controls were examined during the 37th week of gestation. Blood flow in the maternal uterine, foetal umbilical and middle cerebral arteries was analysed with Doppler ultrasonography. Statistically significant differences in Doppler waveforms were detected in the foetal umbilical artery (UmbA) (p < 0.05), but neither in uterine nor foetal middle cerebral arteries (p > 0.05). Both infant birthweight and placental weight were significantly decreased by maternal smoking (p< 0.001 for both). Maternal smoking during pregnancy did not affect either maternal uterine or foetal middle cerebral arterial blood flow, but caused abnormal blood flow in the foetal UmbA.

Predicting gestational diabetes mellitus during the first trimester using anthropometric measurements and HOMA-IR.

PURPOSE: To determine the predictability of gestational diabetes mellitus (GDM) during the first trimester using the degree of insulin resistance and anthropometric measurements and to assign the risk of developing GDM by weight gained during pregnancy (WGDP). METHODS: A total of 250 singleton pregnancies at 7-12 gestational weeks were studied. Body mass index (BMI), waist/hip ratio (WHR), quantitative insulin sensitivity check index (QUICKI), homeostasis model assessment-insulin resistance (HOMA-IR) scores and WGDP were determined. The backward stepwise method was applied to estimate possible associations with GDM. Cutoff points were estimated using receiver operating characteristic curve analysis. RESULTS: GDM was found in 20 of 227 singleton pregnancies (8.8 %). The calculated HOMA-IR, QUICKI, BMI, WHR, WGDP, and parity were significantly associated with GDM. Logistic regression analyses showed that three covariates (HOMA-IR, BMI, WGDP) remained independently associated with GDM. It was calculated as OR 1.254 (95 % CI 1.006-1.563), AUC 0.809, sensitivity 90 %, specificity 61 % with cutoff = 2.08 for HOMA-IR; OR 1.157 (CI 1.045-1.281), AUC 0.723, sensitivity 80 %, specificity 58 % with cutoff = 25.95 for BMI; OR 1.221, (CI 1.085-1.374), AUC 0.654, sensitivity 80 %, specificity 46 % with cutoff = 4.7 for WGDP. Despite a HOMA-IR score of >3.1 in pregnant women, GDM was detected in only three of 29 patients (10.3 %) if WGDP was <4.7 kg at weeks 24-28. CONCLUSIONS: First trimester screening for GDM can be achieved based on maternal anthropometric measurements and HOMA-IR. In particular, if BMI is >25.95 kg/m(2) and the HOMA-IR score >2.08, controlling weight gain may protect against GDM.

A guide on how to build a novel home-made part task training simulator for cervical cerclage training.

Cervical cerclage is a experience demanding procedure and which is difficult for most of the residents and maternal fetal medicine fellows to have the first experience on real patients. In this study we presented an in-expensive and easy to build model for cervical cerclage training.

Comparison of the predictive value of plateletcrit with various other blood parameters in gestational diabetes development.

Gestational diabetes is the most encountered metabolic disease in pregnancy and affects both the mother and fetus adversely. Low-grade subchronic inflammation is associated with gestational diabetes development. Platelets (PLT) play role in blood coagulation and inflammatory process. We aimed to compare the various platelet indices in patients with GDM and healthy pregnant controls and to determine whether PLT indices are useful in Gestational diabetes diagnosis. The present study was performed at the Zonguldak Bulent Ecevit University, School of Medicine, Department of Obstetrics and Gynecology. Statistically significant relationships with plateletcrit, mean platelet volume, and platelet distribution width and patients with GDM were found (p < 0.001). Plateletcrit had higher sensitivity and specificity than other platelet indices. Although plateletcrit is a largely unknown or an underestimated parameter in complete blood count, it gives more precise information than platelet count and mean platelet volume. Platelet-related indices and their determination are inexpensive and routinely ordered markers, the significance of which is often ignored. They may be useful in screening for gestational diabetes as an adjunct to oral glucose tolerance test.

Does anticoagulant therapy improve adverse pregnancy outcomes in patients with history of recurrent pregnancy loss?

OBJECTIVES: Recurrent pregnancy loss (RPL) is a serious problem in the reproductive age women. We aimed to study the role of anticoagulant therapy on pregnancy complications and perinatal outcomes in pregnant patients with histories of RPL. MATERIAL AND METHODS: One hundred fifty-three pregnants, with RPL history and thrombophilia positivity, were grouped into two as 89 treated with anticoagulant therapy and 64 non-treated. Treated and untreated groups were compared for pregnancy complications, delivery weeks, abortion rates, fetal birth weights, APGAR scores, live birth rates, and newborn intensive care admission rates. RESULTS: Of the total 153 pregnant patients (63%) 97 developed pregnancy complications; 55 (56.7%) were in the untreated group and 42 (43.3%) were in the treated group, which was statistically significant (p = 0.003). The differences in pregnancy complications were produced by differences in the numbers of IUFDs and anembryonic fetuses among the groups. The average neonatal birth weights of infants whose mothers had taken LMWH + ASA were significantly higher (p=0.011). The prematurely delivered infants were admitted to the neonatal intensive care unit (NICU), and the NICU requirements were not statistically different between the groups (p = 0.446). However, live birth rates were significantly higher in the treated group than in the untreated group (p = 0.001). CONCLUSIONS: Anticoagulant therapy improves pregnancy complications and live birth rates in patients with RPL and hereditary thrombophilia.

Cholecalciferol (vitamin D3) prevents postoperative adhesion formation by inactivating the nuclear factor kappa B pathway: a randomized experimental study.

BACKGROUND: Postoperative peritoneal adhesions are major complications of abdomino-pelvic surgeries. We aim to investigate the preventive and therapeutic effects of cholecalciferol (vitamin D3) supplementation on postoperative peritoneal adhesion (PPA) in a rat model. MATERIALS AND METHODS: This randomized, controlled, single blinded animal study was performed in university laboratory. Thirty-two female Wistar albino rats were randomly separated into four equal groups as, group 1: (21-d vitamin-D treatment group), group 2: (21-d corn oil group), group 3: (14-d vitamin-D treatment group), and group 4: (control group). Uterine horns were traumatized with bipolar cautery for adhesion formation process. On postoperative day 14, all the animals were sacrificed and evaluated for adhesions. Adhesion extent, severity, degree, and total adhesion scores were evaluated macroscopically. Histopathologically, adhesions were evaluated for inflammation, fibrosis, and NFκB (nuclear factor kappa b) staining. RESULTS: On postoperative day 14, we found lesser peritoneal adhesion severity, degree, extent, and total adhesion scores with vitamin-D administration compared with control and corn oil-treated groups; the difference was statistically significant (P < 0.001). Histopathologic adhesion scores of inflammation and fibrosis were statistically different among the four groups (P < 0.001). NFκB staining was markedly increased in control and vehicle groups. The NFκB staining scores were statistically different between the groups (P < 0.001). The intensity of NFκB staining was lower in both vitamin 14 and 21-d vitamin-D groups. CONCLUSIONS: Vitamin D as a supplement and as a therapeutic medicine decreases the formation of PPA in an animal model. In future studies, the association of vitamin D deficiency and PPA should be studied. In addition, vitamin D should be investigated in future clinical studies for the prevention of PPAs.

Pycnogenol prevents peritoneal adhesions.

PURPOSE: This study tested the ability of pycnogenol, an extract from the bark of the French maritime pine (Pinus pinaster), to prevent intra-abdominal adhesions. METHODS: Thirty female Wistar albino rats were separated randomly into three equal groups: Group (1) the control group, which underwent surgery, but was given no drug; Group (2) given 10 mg/kg of pycnogenol dissolved in normal saline intraperitoneally for 10 days after surgery; and Group (3) given 0.1 mL of normal saline for 10 days intraperitoneally after surgery. On post-operative day 10, all of the animals were killed and any adhesions were evaluated macroscopically and histopathologically. RESULTS: The macroscopic adhesion scores (mean ± SD) for Groups 1, 2, and 3 were 2.5 ± 0.53, 0.60 ± 0.70, and 2.0 ± 0.82, respectively. The macroscopic adhesion score was significantly lower in Group 2 than in Groups 1 and 3 (p < 0.001). All three components of the histopathological evaluation (inflammation, fibrosis, and neovascularization) were significantly lower in Group 2 than in Groups 1 or 3 (p < 0.001, p < 0.001, and p = 0.004, respectively). CONCLUSIONS: Pycnogenol was found to be effective at preventing surgery-related adhesions in an animal model.

Which Body Density Equations Calculate Body Fat Percentage Better in Olympic Wrestlers?-Comparison Study with Air Displacement Plethysmography.

Although skinfold-derived equations seem to be practical for field application in estimating body fat percentage (BF%) and minimum body mass in Olympic wrestlers, prediction equations applied first need to be cross-validated in Olympic wrestlers to define the best prediction equation. This study aimed to evaluate the most accurate field method to predict BF% in Olympic wrestlers compared to BF% estimated by air displacement plethysmography (ADP). Sixty-one male (body mass 72.4 ± 13.5 kg; height 170.3 ± 7.0 cm; body mass index (BMI) 24.9 ± 3.5 kg.m-2; BF% 8.5 ± 4.9%) and twenty-five female wrestlers (body mass 60.3 ± 9.9 kg; height 161.3 ± 7.1 cm; BMI 23.1 ± 2.5 kg.m-2; BF% 18.7 ± 4.7%) undertook body composition assessments including ADP and nine-site skinfold measurements. Correlations, bias, limits of agreement, and standardized differences between alterations in BF% measured by ADP and other prediction equations were evaluated to validate measures, and multiple regression analyses to develop an Olympic wrestlers-specific prediction formula. The Stewart and Hannan equation for male wrestlers and the Durnin and Womersley equation for female wrestlers provided the most accurate BF% compared to the measured BF% by ADP, with the lowest bias and presented no significant differences between the measured and predicted BF%. A new prediction equation was developed using only abdominal skinfold and sex as variables, predicting 83.2% of the variance. The findings suggest the use of the new wrestler-specific prediction equation proposed in the study as a valid and accurate alternative to ADP to quantify BF% among Olympic wrestlers.

The Influence of Maternal Obesity on Pregnancy Complications and Neonatal Outcomes in Diabetic and Nondiabetic Women.

INTRODUCTION: This study aimed to investigate the influence of obesity on pregnancy complications and neonatal outcomes in diabetic and nondiabetic women. MATERIALS AND METHODS: This retrospective case control study was conducted on 1193 pregnant women and their neonates at a tertiary level maternity hospital between March 2007 and 2011. The pregnant women were classified into 2 groups according to the presence of diabetes mellitus. Six hundred and seven patients with gestational diabetes or pregestational diabetes formed the diabetic group (study group) and 586 patients were in the nondiabetic group (control group). Demographic characteristics, body mass index, gestational weight gain, obstetric history, smoking status, type of delivery, gestational ages, pregnancy complications, neonatal outcomes were recorded for each patient. Multivariable logistic regression analysis was performed to evaluate the effect of obesity and diabetes on the pregnancy complications and neonatal outcomes. RESULTS: The mean age and pre-pregnancy body mass indices of women with diabetes mellitus were significantly higher than the control group's (p < 0.001). Gestational weight gain and number of smokers were similar among the groups. Multiparity and obesity were more prevalent in the diabetic group compared to controls (both p < 0.001). Although gestational age at birth was earlier in the diabetic group, birth weights were higher in this group than in the control group (both p < 0.001). Cesarean delivery rates, the incidence of macrosomia, and neonatal intensive care unit admission rates were significantly higher in the diabetes group both with normal and increased body mass index (all p < 0.001). However, adverse pregnancy outcomes were comparable between the groups (p = 0.279). Multivariable logistic regression analysis showed that obesity is a significant risk factor for pregnancy complications (OR = 1.772 [95% CI, 1.283 - 2.449], p = 0.001) but not for adverse neonatal outcomes (OR = 1.068 [95% CI, 0.683 - 1.669], p = 0.773). CONCLUSION: While obesity increases risk of developing a pregnancy complication, diabetes worsens neonatal outcomes.

[Pudendal neuralgia diagnosed by electrophysiological examination].

A 62-year-old man with suspected pudendal neuralgia was admitted to a department of clinical neurophysiology for examination. The patient had experienced increasingly altered sensations in the groin, particularly in form of pain in a sitting position. The neurophysiological studies substantiated the suspicion. Pudendal neuralgia is a painful neuropathic condition. The most frequent cause is entrapment of the pudendal nerve in the pelvis. The diagnosis is made clinically by using Nantes criteria, and neurophysiological studies of the perineum are important supplements when pudendal nerve entrapment is suspected.

Are the women with Sjögren's Syndrome satisfied with their sexual activity?

OBJECTIVE: Females with Sjögren's Syndrome (SS) often experience vaginal dryness and dyspareunia, along with glandular and extraglandular symptoms. We aimed to evaluate sexual function and life quality in women with SS. METHODS: Forty-six premenopausal women with SS and 47 age-matched controls were studied. Age, duration of the disease, medications, and comorbid diseases were noted. Participants completed 36-Item Short Form Health Survey (SF-36) and Female Sexual Function Index (FSFI). Patients were asked about vaginal discharge and itching in the last month, and if they informed their rheumatologists about any sexual problems. Gynecologic examinations were performed and vaginal smears were taken on each participant. RESULTS: The median total scores of FSFI were significantly lower in the SS group than the controls [17.12 (2.4-27.8) and 27.4 (16.9-36.0), respectively, p<0.001]. In the SS group, 37 (80.4%) and in the control group 18 (38.3%) of patients were sexually dissatisfied (p<0.001). Vaginal dryness and lubricant use were significantly increased in patients with SS compared to controls (p<0.001). Life quality scores were significantly lower in patients with SS than the controls (p<0.001). Vaginal dryness was negatively correlated with FSFI total (r=-0.312, p=0.035) and subscores except desire and arousal. Physical functioning, role physical and role emotional scores were positively correlated with total FSFI scores (r=0.449, p=0.002, r=0.371, p=0.011, r=0.299, p=0.043, respectively). CONCLUSIONS: Women with SS experience less satisfaction with sexual activity, which can be affected by age, vaginal dryness, physical pain, and impaired function due to the disease. Therefore, rheumatologists should pay attention to these symptoms and management.

The immediate effect of vaginal and caesarean delivery on anal sphincter measurements.

OBJECTIVE: This study evaluated the effects of vaginal and caesarean delivery on internal and external anal sphincter muscle thickness using translabial ultrasonography (TL-US). METHODS: This prospective cohort study enrolled nulliparous women who either had vaginal or caesarean deliveries. The thickness of the hypoechoic internal anal sphincter (IAS) and hyperechoic external anal sphincter (EAS) at the 12, 3, 6, and 9 o'clock positions at the distal level were measured before delivery and within 24-48 h after delivery. RESULTS: A total 105 consecutive women were enrolled in the study: 60 in the vaginal delivery group and 45 in the caesarean delivery group. The IAS muscle thickness at the 12 o'clock position in the vaginal delivery group was significantly thicker before compared with after delivery (mean ± SD: 2.31 ± 0.74 mm versus 1.81 ± 0.64 mm, respectively). The EAS muscle thickness at the 12 o'clock position in the vaginal delivery group was significantly thicker before compared with after delivery (mean ± SD: 2.42 ± 0.64 mm versus 1.97 ± 0.85, respectively). CONCLUSIONS: There was significant muscle thinning of both the IAS and EAS at the 12 o'clock position after vaginal delivery, but not after caesarean delivery.

Are hypertension and diabetes mellitus risk factors for pelvic organ prolapse?

OBJECTIVES: Pelvic organ prolapse (POP) is an important problem for women with multifactorial etiology. This study aims to determine the role of hypertension (HT) and diabetes mellitus (DM) in POP. STUDY DESIGN: The study included 586 women admitted to Bulent Ecevit University Hospital between September 2013 and April 2015 for hysterectomy, comprising 186 patients with POP and 400 patients without. The demographic characteristics, age, body mass index (BMI), obstetrical history, type of delivery, associated medical diseases, and benign gynecological diseases were recorded. HT, DM, or both together were particularly considered as coexisting medical diseases. RESULTS: Median gravida, parity, and live birth numbers were significantly higher in POP patients (4 vs. 3, 3 vs. 2, and 3 vs. 2 respectively, p<0.001). POP patients were more obese than POP-absent patients (p<0.001). Vaginal history of birth increased POP frequency to 25.8% with statistical significance (p<0.001). There was no significant difference between groups regarding coexisting endometritis, endometrial polyp, endometriosis, endometrial hyperplasia (p>0.05). There was a significant difference between groups regarding comorbid diseases (p<0.001). Logistic regression analysis for risk factors of POP revealed age, BMI, vaginal parturition, and co-morbidity with HT+DM together significantly increased POP risk (p<0.05). HT+DM together significantly increased risks with OR of 1.9 (1.1-3.16). CONCLUSIONS: In addition to multiple factors increasing POP risk, comorbidities as HT+DM together should be considered as risk factors. Patients with these comorbidities should be encouraged to change their lifestyles to prevent POP.

Premenstrual syndrome and life quality in Turkish health science students.

BACKGROUND/AIM: The purpose of the present study was to investigate the incidence of PMS, risk factors affecting PMS symptoms, and life quality in health science students. MATERIALS AND METHODS: A total of 608 volunteer female students studying at the health campus of a state university in Turkey were included in the study. The participants were asked to fill out questionnaires on sociodemographic data, PMS symptoms, and SF-36 life quality tests. RESULTS: The overall frequency of PMS among participants was 84.5%. The average PMS and general health SF scores were 118.34 ± 37.3 and 20.03 ± 3.72, respectively. Students who had irregular breakfast, drank ≥2 cups of coffee/day, and consumed alcohol or fast food had higher PMS scores. Irregular menstruation and family history increased PMS scores and decreased life quality (P < 0.05). The life quality of the students significantly decreased as the severity of PMS increased (P < 0.001). CONCLUSION: Low body mass index, family history, irregular menstruation, bad eating habits such as fast food consumption and irregular breakfasts, and coffee and alcohol consumption increased PMS risk significantly. In order to improve their life quality, students should be informed about the symptoms, risk factors, and management options of PMS.

Can Plateletcrit be a Marker for Recurrent Pregnancy Loss?

AIM: To determine the utility of platelet (PLT) indices for the prediction of recurrent pregnancy loss (RPL). METHODS: In all, 208 patients who experienced 2 or more first trimester spontaneous abortions and 95 controls who had no abortions were studied. The hematological markers, including plateletcrit (PCT) and neutrophil (Neu) to lymphocyte (Lym) ratio (NLR), were measured. Thrombophilia genetic tests for factor V Leiden mutation, prothrombin G202I0A mutation, and methylenetetrahydrofolate reductase C677 T and A1298C mutations were performed. RESULTS: The PLT count, PCT, white blood cell count, red cell distribution width (RDW), Lym and Neu count, and NLR were significantly higher in patients with RPL than in controls. The RDW, PLT, and PCT values were higher in the low-risk group, whereas mean PLT volume values were lower than the high-risk group values. CONCLUSION: Plateletcrit is a low-cost, widely available marker for prediction of RPL in patients with a history of at least 1 abortus.

Factors Associated with Breastfeeding Initiation and Exclusive Breastfeeding Rates in Turkish Adolescent Mothers.

OBJECTIVE: This study aimed to determine the early initiation time of breastfeeding and exclusive breastfeeding (EBF) rates during the first 6 months and the main factors affecting EBF practice in Turkish adolescent mothers. STUDY DESIGN AND METHODS: A cross-sectional study was conducted with 200 adolescent mothers who were raising 6 to 24 month-old children. A face-to-face interview was conducted for sociodemographic characteristics, obstetric history, information about the baby, information about breastfeeding, and the factors affecting breastfeeding. We detected breastfeeding prevalence as well as its initiation time and duration. RESULTS: The mean age of the patients was 17.9 ± 1.15 years. The percentage of patients who started breastfeeding within 1 hour was 45.5%. Approximately, 74% of the adolescent mothers provided breastfeeding before any type of formula as the baby's first food. Women who initiated breastfeeding earlier had planned pregnancies, educated for breastfeeding, delivered vaginally, and had boy infants. The mothers who started breastfeeding earlier fed their babies significantly more frequently at night, had longer EBF times, and had longer total breastfeeding times than the mothers who started breastfeeding later than 2 hours. Planned pregnancy, vaginal delivery, and having a boy infant were significantly associated with early breastfeeding. Age, planned pregnancy, postpartum education, frequent breastfeeding at night, and formula initiation time were predictors of EBF. CONCLUSIONS: Adolescent pregnants may start breastfeeding earlier when had planned pregnancy, educated and encouraged for breastfeeding from the family and medical staff. Therefore, strategies should be formed to improve breastfeeding programs.

Is Xanthine oxidase activity in polycystic ovary syndrome associated with inflammatory and cardiovascular risk factors?

The aim of this study is to examine women with polycystic ovary syndrome (PCOS) to determine the relationship between xanthine oxidase (XO) and oxidative stress, inflammatory status, and various clinical and biochemical parameters. In this cross-sectional study a total of 83 women including 45 PCOS patients and 38 healthy women were enrolled. We collected blood samples for XO and superoxide dismutase (SOD) activity, hormone levels, cholesterol values, and inflammatory markers. Body mass index (BMI) , waist-to-hip ratio (WHR), and blood pressure were assessed. Blood samples were taken for hormonal levels, cholesterol levels, fasting plasma glucose (FPG), fasting plasma insulin (FPI), homeostatic model assessment-insulin resistance (HOMA-IR) index, quantitative insulin sensitivity check index (QUICKI), C-reactive protein (CRP), white blood cell and neutrophil counts, XO and SOD activities. The basal hormone levels, triglyceride (TG) levels, TG/HDL-C (high density lipoprotein-cholesterol) ratios FPG, FPI and HOMA-IR levels were higher in PCOS patients compared to controls (p<0.05). Platelet and plateletcrit (PCT) values, CRP, and XO activity were significantly increased, however SOD activity was decreased in PCOS patients (p<0.001). XO activity was positively correlated with LH/FSH and TG/HDL ratios, CRP, PCT, FPG, FPI, and HOMA-IR, and negatively correlated with QUICKI levels. In conclusion, XO is a useful marker to assess oxidative stress in PCOS patients. Positive correlations between XO and inflammatory markers and cardiovascular disease risk factors suggest that XO plays an important role in the pathogenesis of PCOS and its metabolic complications.