Is hepcidin a new cardiovascular risk marker in polycystic ovary syndrome?

BACKGROUND/AIMS: Polycystic ovary syndrome (PCOS) is associated with reproductive and metabolic abnormalities and carries a number of cardiovascular risk factors. Low-grade chronic inflammation has been thought to play a role in the pathogenesis of atherosclerosis and PCOS patients have an increased rate of subclinical inflammation. In the present study, considering the major role that hepcidin plays in the regulation of iron metabolism and as an inflammatory marker, we investigated hepcidin in PCOS patients and its role in predicting cardiovascular disease (CVD) development. METHODS: Forty patients with PCOS and 40 age- and body mass index-matched healthy controls were included in the study. Iron metabolites, insulin resistance (IR), inflammatory markers and hepcidin levels were analyzed. RESULTS: IR parameters, inflammatory markers, iron parameters and hepcidin levels were similar between the PCOS and control groups. While the inflammatory markers were significantly high in the overweight and obese PCOS subgroup, the hepcidin levels were also high but this elevation was not statistically significant. CONCLUSION: Obesity is the principle mechanism of chronic inflammation and IR in PCOS patients. C-reactive protein and interleukin-6 should be used to predict and follow the risk of CVD development in PCOS cases. Hepcidin may be used as an additional marker in the follow-up of PCOS patients in the future.

Serum levels of visfatin and possible interaction with iron parameters in gestational diabetes mellitus.

BACKGROUND/AIMS: Visfatin is a novel adipokine with insulinomimetic properties that increases in diabetes. However, for gestational diabetes mellitus (GDM) there are conflicting reports. Recent studies have reported a positive association of serum ferritin concentrations with insulin resistance. Thus, we assessed serum levels of visfatin in pregnant women with varying degrees of glucose tolerance and investigated the possible interaction of visfatin with parameters of iron metabolism. METHODS: Visfatin levels were measured at 24-28 weeks of gestation in 88 women who were divided into three groups according to their response to a 50-gram glucose challenge test and a 100-gram oral glucose tolerance test: control group (n = 28), impaired glucose tolerance (IGT) group (n = 30) and GDM group (n = 30). RESULTS: Visfatin levels were significantly higher in the GDM and IGT group than in control (p < 0.001 for GDM vs. control, and p = 0.004 for IGT vs. control). Serum visfatin was significantly associated with serum ferritin, insulin, age, gravidity, and body mass index. In a linear regression model, the covariates explained only 17% of variability of serum visfatin concentration. Body mass index (p < 0.001) contributed independently to visfatin variance. CONCLUSION: Serum visfatin concentration is significantly higher in GDM and is correlated with ferritin levels.

Influence of gum chewing on postoperative bowel activity after cesarean section.

OBJECTIVE: To assess the effects of gum chewing on postoperative bowel function after cesarean section. MATERIAL AND METHODS: Women who underwent cesarean section were randomized to either a gum-chewing group (n = 74) or a non-gum-chewing group (n = 76). The two groups were compared with respect to the return of bowel activity, postoperative analgesic and antiemetic drug requirement and postoperative hospital stay. RESULTS: Bowel sounds appeared in a significantly shorter duration of time in the study group, the mean being 5.9 h as compared to 6.7 h in the control group (p < 0.01). The first passage of flatus postoperatively was 22.4 h in the gum-chewing group and 31 h in the control group (p < 0.001). The total length of hospital stay was shorter in the gum-chewing group (2.1 days) than in the control group (2.3 days), but it was not statistically significant (p > 0.05). Postoperative analgesic requirement in both groups was similar, but the postoperative antiemetic need in the gum-chewing group was lower than in the control group (p < 0.01). CONCLUSION: On the basis of the tolerability and results on bowel function, gum chewing provides a simple method for early recovery of bowel function after cesarean section.

Effect of maternal anxiety and music on fetal movements and fetal heart rate patterns.

OBJECTIVE: Aimed to investigate (a) the effect of non-stress test (NST) and music on maternal anxiety (b) the effect of maternal anxiety and music on fetal heart rate (FHR) changes. MATERIAL AND METHOD: The two hundred and one pregnant women coming for routine prenatal care were randomized to receive either music (n=96) or no music (n=105) during NST. Before and after the test, these women were asked to complete the Spielberg State-Trait Anxiety Inventory on two interviews; primary outcome was considered as a maternal state anxiety score before and after NST. Secondary outcome was the baseline FHR, the number of fetal movement, large accelerations, dubious NST, variable decelerations, and the minimum procedure time. RESULTS: Before NST, the mean state anxiety score of the music and control groups was found as 38.1 +/- 8.8 and 38.08 +/-8.2, respectively (p>0.05). On the other hand, after NST, the mean state anxiety score of the music and control groups was found as 35.5 +/- 8.2 and 40.2 +/- 9.2, respectively (p<0.001). While in control group, NST brought about a statistically significant increase in a state anxiety score (38.08 +/- 8.2 versus 40.2 +/- 9.2, p<0.001), listening to music during NST resulted in decrease in a state anxiety score of the study group but it was not statistically significant (38.1 +/- 8.8 versus 35.5 +/- 8.2, p>0.05). The baseline FHR of the music group was significantly higher than that of the control group (134.09 +/- 7.2 versus 130.3 +/- 5.7, p<0.001).The number of fetal movement in the music group was significantly higher than that of the control group (8.9 +/- 4.7 versus 5.9 +/- 3.9, p<0.001). The number of large accelerations in music group was significantly higher than that of the control group (5.7 +/- 2.1 versus 4.5 +/- 2.04, p<0.001). The minimum procedure time in music group was significantly lower than that of control group (13.4 +/- 5.2 versus 15.6 +/- 6.1, p<0.05). The number of dubious NST and variable decelerations was found to be similar for both groups (p>0.05). CONCLUSION: NST has anxiogenic effects on mothers and listening to music during the test has positive impact on both maternal and fetal parameters but it is an open question whether maternal anxiety during pregnancy may affect fetal accelerations to such an extent that it could influence clinical judgments.

Etonogestrel contraceptive implant (Implanon): analysis of patient compliance and adverse effects in the breastfeeding period.

OBJECTIVE: To analyse the compliance of patients and side effects of Implanon® during breast feeding. MATERIAL AND METHODS: Prospective study of 61 postpartum women who chose Implanon® for long term contraception between April 2007 and December 2009. Compliance, side effects and removals were recorded. RESULTS: Amenorrhoea, prolonged bleeding, frequent bleeding and infrequent bleeding were reported in 20 (32%), 13 (21%), 4 (6.5%) and 2 (3.2%) patients, respectively. Non-menstrual side effects experienced by participants included; weight gain reported by 10 patients (16%), anxiety by 6 (9.8%), breast tenderness by 4 (6.5%), headache by 4 (6.5%), pain at the insertion site by two (3.2%), hirstutism by two (3.2%), acne by 1 (1.6%), loss of libido by 1 (1.6%), weight gain and headache by two (3.2%), weight gain and anxiety by two (1.6%). The mean breastfeeding period was 16±7.4/months. During the follow up, Implanon® was removed from 24 patients (39%). CONCLUSION: If patients are well informed about its expected side effects before placement, Implanon® is well tolerated and i an acceptable choice for women who have recently experienced labor and are looking for long term reversible contraception.

Familial mediterranean fever: a diagnostic challenge in pregnancy.

Familial Mediterranean Fever (FMF) is an autosomal recessive disease which is characterized by recurrent, self-limiting, short attacks of serositis while abdominal pain is the most common symptom. The underlying clinical and pathological picture is that of acute peritonitis. These abdominal signs are often so striking that they mimic an acute abdominal calamity suggesting several possible gastrointestinal, gynecologic or urologic diagnoses. Diagnosis of acute abdomen in pregnancy also remains one of the most challenging conditions as the physiological consequence of pregnancy and nonspecific laboratory parameters. A limited number of studies addressed FMF in pregnancy and none of them mentioned the diagnostic challenging of FMF during pregnancy because the patients had al been diagnosed previously. In this paper, we discussed a 20 year old, gravida 1, parity 0 patient whose twin pregnancy wash complicated by an acute abdominal condition after amniocentesis and the difficulties of making the diagnosis of FMF with the complications during this diagnostic period in pregnancy.

Placement of bupivacaine-soaked Spongostan in episiotomy bed is effective treatment modality for episiotomy-associated pain.

STUDY OBJECTIVE: To investigate the efficacy of placing bupivacaine-soaked Spongostan (Ferrosan, Soeborg, Copenhagen, Denmark) in episiotomy beds for relief of postpartum pain. DESIGN: Randomized, controlled study (Canadian Task Force classification I). SETTING: University medical school. PATIENTS: Women with mediolateral episiotomy. INTERVENTIONS: Patients were recruited and randomized into 2 groups by using a random number table. Group I (control group) received local lignocaine infiltration 1% up to 20 mL. For group II (Spongostan group), in addition to local lignocaine infiltration, bupivacaine-soaked Spongostan was placed in the episiotomy bed. All patients received routine postpartum perineal care in addition to the regular pain drugs (75 mg of diclofenac every 4 hours if needed). The primary outcome for the study was severity of pain, rated on a 10-cm visual analog scale from 0 to 10. Rating was recorded at 0, 1, 1.5, 2, 6, and 24 hours after delivery. MEASUREMENTS AND MAIN RESULTS: In all, 48 women were randomized to group I (local lignocaine alone) and 51 women to group II (local lignocaine plus Spongostan). The Spongostan and control groups were similar with respect to maternal age, parity, gestational age, maternal weight, and neonatal birth weight (p >.05; CI for difference: -2.6/10, 0.1/0.3, 0.3/0.7, 6.9/1.7, and -7/1.9, respectively). Episiotomy length (both vaginal and perineal) and episiotomy depth were higher in Spongostan group than control group (p <.05; 95% CI: -0.9/0, -0.8/-0.1, and -0.6/0, respectively). However, episiotomy reconstruction time of both groups was similar (p >.05; CI: 1.7/6.2). The pain score of Spongostan group was lower than control group and it was statistically significant at all time intervals (0, 1, 1.5, 2, 6, and 24 hours) between the Spongostan and control groups (p <.05; CI: 0.6/1.9, 1.1/2.4, 1.0/2.5, 0.9/2.4, 0.3/1.9, and 0.5/1.8, respectively). Postpartum total analgesic requirement (mg/person) again was significantly lower in the Spongostan group than control group (p <.01; CI: 0.1/0.4). CONCLUSION: Placement of bupivacaine-soaked spongostan into the episiotomy bed resulted in decreased postpartum pain and drug requirement. It may be attributed to a higher drug concentration at episiotomy bed and prolonged drug effect.