Vaginal Microbiota and Proinflammatory Status in Patients with Polycystic Ovary Syndrome: An Exploratory Study.

Background/Purpose: Polycystic ovary syndrome (PCOS) is an endocrine-metabolic disease most common in patients of childbearing age. This pathology is associated with clinical, metabolic, and reproductive complications. We evaluated the diversity of the vaginal microbiota (VM), the vaginal inflammatory reaction (VIR), the proinflammatory state, and the activation of polymorphonuclear neutrophils (PMN) with the production of neutrophil extracellular traps (NETs). Methods: Thirty-three patients who attended a consultation at the Hospital UTPL-Santa Inés, Loja, Ecuador, from May to August 2023 who were diagnosed with PCOS participated in this study. Blood samples, vaginal discharge, and a survey were obtained. Results: A high number of patients, 23/33 (69.7%), presented altered microbiota in clinical variables associated with PCOS phenotypes A and B, sexual partners (>2), and oligomenorrhoea. A significant statistical association was only observed for sexually transmitted infections at sampling (p = 0.023) and insulin (p = 0.002). All eight cases studied with VIR had PMN/NETotic activity. A high frequency of proinflammatory states was observed in all vaginal microbiota states. Conclusions: These results suggest that the PCOS could trigger a proinflammatory state in the vaginal epithelium independently of the state of the vaginal microbiota. Furthermore, the presence of NETs observed in the cases studied could decrease fertility in these PCOS patients.

Serum Cortisol and Cortisone as Potential Biomarkers of Partial 11ß-Hydroxysteroid Dehydrogenase Type 2 Deficiency.

BACKGROUND: Pathogenic variations in HSD11B2 gene triggers the apparent mineralocorticoid excess syndrome (AME). There is scarce information regarding the phenotypes of subjects carrying heterozygous pathogenic variants in HSD11B2 gene. We investigated if serum cortisol/cortisone (F/E) ratio and cortisone are useful for identifying partial 11ßHSD2 deficiency in those heterozygous subjects. METHODS: We studied two patients diagnosed with AME and their families carrying either D223N or R213C mutation. We also evaluated 32 healthy control subjects (13 children and 19 adults) to obtain normal references ranges for all measured variables. Case 1: A boy carrying D223N mutation in HSD11B2 gene and Case 2: A girl carrying R213C mutation. We assessed serum F/E ratio and cortisone by HPLC-MS/MS, aldosterone, plasma-renin-activity(PRA), electrolytes, and HSD11B2 genetic analyses. RESULTS: The normal values (median [interquartile range]) in children for serum F/E and cortisone (µg/dl) were 2.56 [2.21-3.69] and 2.54 [2.35-2.88], and in adults were 4.42 [3.70-4.90] and 2.23 [1.92-2.57], respectively. Case 1 showed a very high serum F/E 28.8 and low cortisone 0.46 µg/dl. His mother and sister were normotensives and heterozygous for D223N mutation with high F/E (13.2 and 6.0, respectively) and low cortisone (2.0 and 2.2, respectively). Case 2 showed a very high serum F/E 175 and suppressed cortisone 0.11 µg/dl. Her parents and sister were heterozygous for the R213C mutation with normal phenotype, but high F/E and low cortisone. Heterozygous subjects showed normal aldosterone, PRA, but lower fractional excretion of sodium and urinary Na/K ratio than controls. CONCLUSION: Serum F/E ratio and cortisone allow to identify partial 11ßHSD2 deficiencies, as occurs in heterozygous subjects, who would be susceptible to develop arterial hypertension.

Neck Sonography and Suppressed Thyroglobulin Have High Sensitivity for Identifying Recurrent/Persistent Disease in Patients With Low-risk Thyroid Cancer Treated With Total Thyroidectomy and Radioactive Iodine Ablation, Making Stimulated Thyroglobulin Unnecessary.

OBJECTIVES: Follow-up of patients with low-risk differentiated thyroid cancer treated with total thyroidectomy and radioiodine requires neck sonography and thyroglobulin (Tg). The need to stimulate Tg is controversial. The goal of this study was to compare the diagnostic performances of sonography plus suppressed or stimulated Tg in low-risk thyroid cancer. METHODS: After total thyroidectomy and radioiodine, patients with low-risk thyroid cancer were retrospectively identified as having structural or biochemical persistence/recurrence. We compared the diagnostic performance of suppressed and stimulated Tg to detect persistence/recurrence. RESULTS: We included 148 patients with low-risk thyroid cancer who were followed for a median of 3.7 years. Persistence/recurrence was found in 8 patients (5.4%; 5 structural disease and 3 biochemical disease). Thyroglobulin was not stimulated in 72 patients (group 1) and stimulated in 76 (group 2). In group 1, 5 patients (6.9%) had structural neck persistence/recurrence (3 with suppressed Tg ≥ 1 ng/mL and 2 with suppressed Tg < 1 ng/mL). Four patients underwent surgery, and 1 was surveilled. All 5 patients had suppressed Tg lower than 1 ng/mL at the end of follow-up. In group 2, stimulated Tg did not identify additional cases of structural persistence/recurrence but classified 3 patients (3.9%) as having biochemical persistence/recurrence. One patient received a second dose of radioiodine, and the other 2 were surveilled; all were without disease at the end of follow-up. Suppressed and stimulated Tg had negative predictive values for persistence/recurrence of 97% and 100%, respectively. CONCLUSIONS: In low-risk thyroid cancer treated with total thyroidectomy and radioiodine, sonography and suppressed or stimulated Tg have similar negative predictive values for persistence/recurrence. Importantly, the coexistence of negative sonographic findings and suppressed Tg lower than 1 ng/mL makes the addition of stimulated Tg unlikely to identify clinically important disease.

Asociación entre enfermedad metabólica y severidad de aterosclerosis coronaria evaluada por Score de Gensini / Association between metabolic disease and the severity of coronary artery disease measured by Gensini Score

Introducción: La asociación entre cardiopatía coronaria (CC) y estados de disglicemia está bien establecida. Sin embargo, aún cuando la diabetes mellitus (DM) corresponde a uno de los principales factores de riesgo para CC, la asociación con el síndrome metabólico (SM) parece menos clara. Nuestro objetivo fue evaluar el grado de compromiso aterosclerótico del árbol coronario de acuerdo a la existencia de SM y DM. Pacientes y método: Se analizó los datos de 413 pacientes sometidos a coronariografía electiva en el período de un año. Se dividió la muestra en 3 grupos: pacientes diabéticos, pacientes con SM (no diabéticos) y pacientes sin enfermedad metabólica (no SM, no DM). Se consideró como portador de CC a todo paciente con estenosis >50 por ciento en cualquier arteria coronaria, la severidad de la enfermedad coronaria fue medida por el Score de Gensini. Se utilizó análisis de varianza (Barlett) con comparación múltiple de Scheffe y prueba no paramétrica de Krus-kal-Wallis en aquellos grupos con varianzas distintas. El protocolo fue aprobado por el Comité Ético Científico del Servicio de Salud Araucanía Sur. Resultados: La edad promedio fue 63.8 +/- 11,17 años. La prevalencia de SM fue 38 por ciento (n=158), DM 45 por ciento (n=186) y no tenían alteraciones metabólicas 17 por ciento de los pacientes (n=69). La prevalencia global de enfermedad coronaria fue 52,7 por ciento. La prevalencia en los distintos grupos fue 33.9 por ciento en aquellos sin enfermedad metabólica, 52.2 por ciento en los portadores de SM y 62.2 por ciento en los pacientes con DM (p=0.001). En cuanto a la severidad de la CC, el score de Gensini fue 18, 22,04 y 29,6 respectivamente (p=0,04). Conclusiones: Este estudio observacional sugiere que, comparados con sujetos sin enfermedad metabólica tanto la prevalencia de CC, como su severidad son mayores en pacientes con SM aislado y mayores aún en portadores de DM.

Introduction: The association between coronary artery (CAD) and dysglicemia is well established. Diabetes (DM) is recognized as one of the most important coronary risk factors, but the association of CAD and metabolic syndrome (MS) is less well defined. Our objective was to evaluate the degree of coronary atherosclerotic disease in relation to the presence of MS and DM . Patients and Method: The data of 413 patients electively studied with coronary angiography over a period of one year was analyzed. Patients were divided into three groups: Patients with DM, patients with MS (without DM) and patients without a metabolic disorder (no DM, no MS). The severity of CAD was measured by the Gensini Score. Results: Mean age was 63,8 +/-11,17 years. The prevalence of patients with MS was 38 percent (n=158), with DM 45 percent (n=186) and without a metabolic disorder 17 percent (n=69). The global prevalence of CAD was 52,7 percent. The prevalence of CAD in the different groups was as follows: Absence of metabolic disease 33.9 percent, patients with MS 52.2 percent and patients with DM 62.2 percent (p< 0.001). Conclusions: This observational study suggests that, compared to subjects without metabolic disease, the prevalence and severity of CAD are higher in patients with MS and even higher in patients with DM.