The impact of hymenectomy on future gynecological and obstetrical outcomes.

Background: Imperforated hymen is a rare condition usually diagnosed at puberty due to amenorrhea accompanied by cyclic pelvic pain and sometimes other significant complications such as hematometra, endometriosis, and infertility. The accepted surgical treatment for imperforate hymen and some other hymenal malformation is hymenectomy. However, given low incidence rates, long-term obstetrical and gynecological outcomes in post-hymenectomy women remain poorly understood.Objective: To investigate long-term obstetrical and gynecological outcomes in nulliparous women who underwent a hymenectomy.Study design: Retrospective study comparing gynecological and perinatal outcomes of nulliparous women with and without hymenectomy, who delivered between the years 1988 and 2015 at the Soroka University Medical Center. Univariate analysis was performed as accepted with multivariate logistic regression model used to assess long-term effects of hymenectomy.Results: During the study period, 56 of 74,598 nulliparous women who delivered at the Soroka University Medical Center had previously undergone a hymenectomy. In a univariate analysis, cesarean deliveries were significantly more prevalent among women who had undergone a hymenectomy (30.4 versus 17.6% p = .01) as were infertility treatments (10.7 versus 4.4% p = .04) and dyspareunia (42.9 versus 0.2% p <.001). In a multivariate logistic regression model hymenectomy was found to be an independent risk factor for significant obstetrical and gynecological outcomes defined as one or more of the following: caesarean deliveries, cervical laceration, vaginal laceration, perineal laceration, preterm delivery, cervical incompetence, endometriosis, infertility, and dyspareunia (OR 2.5, 95% CI 1.26-4.93; p = .001).Conclusions: Hymenectomy is associated with significant long-term obstetrical and gynecological complications. Informing medical teams of these risks might promote early detection and minimize associated complications such as laceration-associated blood loss and preterm delivery.

Factors Enhancing the Antibacterial Effect of Monovalent Copper Ions.

This study continues the series of experiments that demonstrate the high antibacterial properties of monovalent copper ions (Cu+). While in previous study we examined different metals (copper and silver) and their metal states (mono- and divalent), showing that monovalent copper is best for controlling bacterial growth, the current study focuses on finding conditions which further enhance the antibacterial effect of monovalent copper. This approach may also shed light on mechanisms of Cu+ ions which still remain unknown. To this end, the influence of Cu+ ions on model gram-negative Escherichia coli bacteria at different pH levels with a variety of carbon sources and elevated temperatures was examined. It was found that in both aerobic and anaerobic conditions in a poor growth medium, Cu2+ ions barely suppress any growth of E. coli, whereas Cu+ ions even at very low concentrations dramatically deplete bacterial populations in a time scale of minutes at room temperature, and less than one minute at elevated temperatures. Acidic pH, unfavorable carbon sources, and elevated temperatures boost the antibacterial action of Cu+ ions. On the whole, the study confirms that monovalent copper ions are strongly superior to divalent copper ions in their antibacterial action across a wide range of tested conditions.

Endometrial Polyp Size and the Risk of Malignancy in Asymptomatic Postmenopausal Women.

OBJECTIVE: The appropriate management of endometrial polyps in asymptomatic postmenopausal patients remains controversial. The aim of the study was to evaluate the relationship between endometrial polyp size and malignancy risk among asymptomatic postmenopausal women. METHODS: This observational retrospective study investigated 472 postmenopausal asymptomatic women who underwent hysteroscopic polypectomy between 2010 and 2014 (Canadian Task Force Classification II-3). RESULTS: Of the 472 women, premalignant and malignant lesions were found in 11 (2.33%) cases; four (0.84%) had endometrial carcinoma, and seven (1.49%) had atypical endometrial hyperplasia. The incidence of premalignant or malignant lesions among various cut-offs of polyp size (10, 15, 20 mm) was not significantly different. CONCLUSION: In the current series no significant risk factor for malignancy was found among different cut-offs of polyp size.

Colostrum of Preeclamptic Women Has a High Level of Polyphenols and Better Resistance to Oxidative Stress in Comparison to That of Healthy Women.

Preeclampsia is a common pregnancy complication. Abnormal development of the placenta is the prevailing cause theory of this complication. Women with preeclampsia suffer from acute oxidative stress and high lipid oxidation in plasma. The aim of this study was to compare levels of polyphenols and lipid peroxidation in colostrum of nursing mothers with and without preeclampsia. The study was conducted at the Department of Obstetrics and Gynecology at Soroka University Medical Center. The study group consisting of 18 women, who were diagnosed with preeclampsia, was compared to the control group: 22 healthy women. The total phenolic content in the colostrum was determined by using the Folin-Ciocalteu method. Lipid peroxidation was determined by measuring MDA, using the TBARS assay. Polyphenol concentrations were significantly higher (about 33%) in the colostrum of the study group compared with the control group (p = 0.00042). Lipid peroxidation levels (MDA) were significantly lower (about 20%) in the colostrum of the study group compared with the control group (p = 0.03). Negative correlation was found between MDA concentration and the polyphenol level (R = -0.41, p = 0.02). In conclusion, we showed in this study a potential compensation mechanism that protects the newborn of a mother with preeclampsia from the stress process experienced by its mother.

Prevalence of Monovalent Copper Over Divalent in Killing Escherichia coli and Staphylococcus aureus.

This study opens the investigation series focused on antimicrobial effects of copper (Cu) compared to silver (Ag), which is currently used to treat wound infection in burn victims as well as in chronic wounds. Noticeably, in its ionized state, Cu is more commonly present as Cu2+ rather than as Cu+, while electronic configuration similarity of Cu+ and Ag+ indicates that actually it may be the active state. To test this hypothesis, effect of Cu+ and Cu2+, using Ag+ ions and metallic copper as controls on Escherichia coli and Staphylococcus aureus bacteria, was examined under anaerobic conditions. Cu+ was produced by two different methods, and its effect on microorganism growth was tested using a syringe and Petri dish methods. It was found that the presence of Cu+ causes a dramatic depletion in the viability of both microorganisms. Metallic copper did not have any effect on the viability, whereas Cu2+ and Ag+ ions had much lower activity than Cu+ ions. Minimal inhibitory concentration of Cu+ for E. coli was twice lower than that of Cu2+. The obtained results show that Cu+ proves to be a potent antimicrobial agent.

Antioxidants and Polyphenols: Concentrations and Relation to Male Infertility and Treatment Success.

Oxidative stress is induced by reactive oxygen substances (ROS) that are known to affect male fertility. The aims of this study were to prospectively investigate and characterize total antioxidant and specifically polyphenols concentrations and their relations to sperm quality and fertility treatment success. During their infertility treatment, sixty-seven males were prospectively recruited to this study. After separation of the sperm from the semen sample, the semen fluid samples antioxidants and polyphenols concentrations were determined. Antioxidant concentration was significantly associated with sperm concentration and total motile count. Antioxidants concentration in the group of male with sperm concentration ≥ 15 × 10(6) was significantly higher than in the group of male with antioxidants concentration < 15 × 10(6) (830.3 ± 350 µM and 268.3 ± 220 µM, resp., p < 0.001). Polyphenols concentration did not differ between the groups of sperm concentration above and below 15 × 10(6) (178.7 ± 121 µM and 161.7 ± 61 µM, resp., p-NS). No difference was found between fertilization rates and antioxidants or polyphenols concentrations. This is the first study that reports on polyphenols concentration within semen fluid. More studies are needed in order to investigate polyphenols role in male fertility.

Role of lycopene in preventing lipid peroxidation products, in commercial infant milk formula.

OBJECTIVES: The aim of the study was to investigate whether lycopene from natural sources (tomato extract) is able to protect newborns milk formula, against oxidative damage caused by exposure to hydroxyl radicals, and is there a difference between milk substitutes from various sources. METHODS: Four commercial brands of infant milk formula: two of the formulas were dairy milk (A-d and B-d) and two were based on soy bean vegan milk (A-s and B-s), were exposed to ionizing radiation radical (·OH). Lipid peroxidation was determined by measuring malondialdehyde (MDA) using thiobarbituric acid reactive substance test (TBARS). RESULTS: When suspensions containing the four brands of formula were subjected to oxidizing media produced by ionizing radiation (hydroxyl radicals), lipid peroxidation increased linearly as a function of the irradiation dose (R = 0.99). It was found that lycopene in a concentration of 0.6 mM, reduced the radiation damage only in the soy-based formula; decrease of ∼40% of the damage achieved in B-s, and ∼20% reduction in the damage caused to A-s, significantly p < 0.01. CONCLUSIONS: Lycopene in dairy milk did not protect against hydroxyl radicals; however, lycopene found to protect against hydroxyl radicals in soy milk. This result suggests different mechanisms of radical production that arises from high iron levels present in the soy milk and involving the high-valent iron peroxo species.

Facial Reconstruction of a Mucormycosis Survivor by Free Rectus Abdominis Muscle Flap, Tissue Expansion, and Ocular Prosthesis.

Invasive sinonasal mucormycosis is a rare fungal infection that usually occurs in immunocompromised or diabetic patients, and it is often fatal. The authors present a case of a woman patient suffering from systemic lupus erythematosus and diabetes mellitus treated with prednisone, presenting with a rapidly progressive rhino-orbital-cerebral mucormycosis. She was successfully treated with combined intravenous antifungal therapy and radical debridement followed by complex defect reconstruction with a free vertical rectus abdominis myocutaneous flap, tissue expander, and ophthalmic prosthesis.

Elements in maternal blood and amniotic fluid determined by ICP-MS.

OBJECTIVE: Knowledge about levels of toxic and non-toxic elements in amniotic fluid is limited. The aims of this study were: (1) to measure levels of trace elements Cu, Fe, Zn, B, Sr and Co in amniotic fluid and maternal serum during second trimester of pregnancy; and (2) to determine what correlations exists between elements levels in amniotic fluid and maternal serum. METHODS: The levels of, iron, copper, zinc, cobalt, strontium and boron were measured in blood and amniotic fluid during genetic amniocentesis using inductively coupled plasma mass spectrometry (ICP-MS). RESULTS: Concentrations of the elements: Fe, Cu, Zn, Co, Sr and B in amniotic fluid were significantly lower than in maternal blood. For iron, zinc, cobalt, strontium and boron there was a linear correlation between levels in amniotic fluid and maternal serum. CONCLUSIONS: The concentration of trace elements in amniotic fluid was found to be lower than maternal serum and linearly correlated to its level.

Perinatal outcome of pregnancies following in vitro fertilization and ovulation induction.

OBJECTIVE: To investigate pregnancy outcome in patient who conceived by assisted reproductive techniques. METHODS: A retrospective population-based study was conducted, comparing obstetrical complications and neonatal outcomes of singleton pregnancies conceived by in vitro fertilization (IVF; n = 1296) and ovulation induction (n = 1988) as compared to singleton pregnancies conceived spontaneously (n = 172 288). Multivariable models were constructed to control for confounders. RESULTS: A significant linear association (using the chi-square test for trends) was documented among the three groups in adverse outcomes such as gestational diabetes mellitus (17.3% in the IVF, 14.2% in the ovulation induction, 6.6% in the comparison group, p < 0.001), severe preeclampsia (2.7% in the IVF, 1.8% in the ovulation induction, 1.1% in the comparison group, p < 0.001) and perinatal mortality (3.3% in the IVF, 2.1% in the ovulation induction, 1.3% in the comparison group, p < 0.001). In vitro fertilization and ovulation induction treatments were found to be independent risk factors for gestational diabetes mellitus, using two different multiple logistic regression models controlling for confounders such as maternal age (adjusted OR = 1.77, 95% CI:1.52-2.07, p < 0.001 and adjusted OR = 1.93, 95% CI:1.69-2.21, p < 0.001; respectively). CONCLUSIONS: Pregnancies conceiving following assisted reproductive techniques are at an increased risk for adverse obstetrics outcomes. The risk is higher for pregnancies following IVF compared with these conceived following ovulation induction.

[Lycopene and tomatoes--their effect on prevention of prostatic cancer].

Prostate cancer is one of the most common types of cancer and it is the second most common cause of cancer-related death among men in the western world. Microscopic prostate cancer was found in up to 30% of men as early as 20-40 years old of age. Lycopene is a lipid soluble carotenoid molecule. It is found in high concentration in red fruit and vegetables. Lycopene has a significant anti-oxidative activity. There is laboratory evidence that explain it's function as an inhibitor of various tumors as well as epidemiological evidence that shows that lycopene-rich foods reduce the incidence of a few types of cancer and especially prostate cancer. This paper reviews the evidence that explain lycopene activity, its biological effect and availability and its effect on the prevention of prostate cancer.

Fatty acid composition of breastmilk of Israeli mothers.

We conducted this study to determine the fatty acid composition of breastmilk of Israeli women and compare it with baby milk substitutes. Samples of mature breast milk, from 29 lactating Israeli Jewish mothers were collected during feedings. Total milk lipids extracts were transmethylated and analyzed by using an improved gas-chromatographic method. About 72% of the total fatty acids in the investigated breast milk comprised oleic (18:1c; 31±4%), palmitic (16:0; 21±4%), and linoleic (18:2n-6; 20±4%) acids. Total saturated fatty acids represented 42±7% of total fatty acids. The monounsaturated fatty acids content was 33±5%, of which 94% was oleic acid, and the polyunsaturated fatty acids content was about 24±4%, of which 85% was linoleic acid. The a-linolenic acid level found in this study, 2.0±0.6%, was higher than the range of values reported for the world population (0.10-1.4%). The main fatty acids composition of the milk substitutes has very similar composition to the breast milk. Docosahexaenoic acid levels are particularly low among the population of Jewish nursing mothers in relation to the milk substitutes, containing docosahexaenoic acid in their formulations.

Saturated fatty acid composition of human milk in Israel: a comparison between Jewish and Bedouin women.

BACKGROUND: Breast milk is well established as the ideal source of nutrition for infants. Mature human breast milk generally contains 3.5-4.5% lipids comprising mostly triacylglycerols. In general, the fat composition of maternal human milk in developing countries shows higher levels of saturated fats, reflecting diets rich in carbohydrates. OBJECTIVES: To determine the profile of unsaturated fatty acids in the breast milk of two populations in southern Israel--urban Jewish and rural tent-dwelling Bedouin women. METHODS: This study involved 48 lactating Israeli mothers, 29 Jewish and 19 Bedouin (16-20 weeks postpartum), whose full-term infants were fed exclusively with breast milk. Total milk lipid extracts were transmethylated and analyzed by using an improved gas chromatographic method. RESULTS: The breast milk of the Bedouin women contained significantly higher levels of total major saturated fatty acids, lauric acid and palmitic acid (45.2 +/- 4.7% vs. 41.0 +/- 5.6%, P = 0.005; 5.2 +/- 2.1 vs. 6.8 +/- 2.0%, P = 0.03; and 22.7 +/- 2.4 vs. 20.6 +/- 3.8%, P = 0.02) respectively. No difference was found in the myristic acid level between the groups. The level of stearic acid was significantly higher in the Jewish group compared to the Bedouin group (5.7 +/- 1.1 vs. 5.1 +/- 1.1%, P = 0.04). There was a linear correlation between the levels of C14:0 and C12:0 in the Bedouin and lewish groups respectively (R = 0.87, R = 0.82, P < 0.001). CONCLUSIONS: Higher levels of saturated fatty acids were measured in the breast milk of Bedouin women, an economically weaker population. The results emphasize the importance of diet among lactating women and its influence on milk quality.

Does mode of delivery affect neonate oxidative stress in parturition? Review of literature.

PURPOSE: The production of reactive oxygen substances plays an important regulatory role in many physiologic reproductive processes. Excessive production may lead to oxidative stress (OS), and bring about pregnancy disorders. Growing evidence indicates that OS plays a major role in the pathophysiology of complications such as early pregnancy loss, placental insufficiency, preeclampsia, fetal growth restriction, and neonatal complications. Whether parturition induces oxidative stress is in dispute. In this review, we elaborate the influence of mode of delivery (vaginal delivery or cesarean delivery) on oxidative stress of neonates. METHODS: A review of old and recent literature was done. The studies were divided according to the impact of mode of delivery on oxidative stress in the newborn. RESULTS: There is a divergence in the oxidative stress production according to the mode of delivery. CONCLUSIONS: In view of neonatal oxidative stress measures, no major difference was found between uncomplicated vaginal delivery and elective cesarean section.

Role of radicals in the lipid peroxidation products of commercial infant milk formula.

Four commercial brands of infant milk formula were investigated, and the amount of shelf lipid peroxidation was determined by measuring malondialdehyde (MDA) or, more exactly, thiobarbituric acid reactive substance (TBARS) levels, which are the end products of lipid peroxidation. TBARS level, indicated by MDA concentration, was higher in the vegetarian brands. The vegetarian brands are, as expected, more prone to oxidation than dairy brands, as they contain more unsaturated fats. The introduction of formate anion diminishes the peroxide amounts initially present in the milk samples as well as those induced by radiation-induced oxidation.

Labor augmentation with oxytocin decreases glutathione level.

Objective. To compare oxidative stress following spontaneous vaginal delivery with that induced by Oxytocin augmented delivery. Methods. 98 women recruited prior to labor. 57 delivered spontaneously, while 41 received Oxytocin for augmentation of labor. Complicated deliveries and high-risk pregnancies were excluded. Informed consent was documented. Arterial cord blood gases, levels of Hematocrit, Hemoglobin, and Bilirubin were studied. Glutathione (GSH) concentration was measured by a spectroscopic method. Plasma and red blood cell (RBC) levels of Malondialdehyde indicated lipid peroxidation. RBC uptake of phenol red denoted cell penetrability. SPSS data analysis was used. Results. Cord blood GSH was significantly lower in the Oxytocin group (2.3 +/- 0.55 mM versus 2.55 +/- 0.55 mM, P = .01). No differences were found in plasma or RBC levels of MDA or in uptake of Phenol red between the groups. Conclusion. Lower GSH levels following Oxytocin augmentation indicate an oxidative stress, though selected measures of oxidative stress demonstrate no cell damage.

Trace element concentrations in follicular fluid of small follicles differ from those in blood serum, and may represent long-term exposure.

OBJECTIVE: To determine the levels of elements in follicular fluid (FF) of patients undergoing IVF and evaluate the relationship between the concentration of elements in FF, follicular volume, and blood. DESIGN: Prospective blinded study. SETTING: University-based IVF center. PATIENT(S): Follicular fluid/blood samples from 6/3 patients, respectively, undergoing IVF. INTERVENTION(S): Single follicular aspirations of 33 follicles were performed. Blood samples ( approximately 5 mL) were drawn at the time of oocyte retrieval from 3/6 patients only. The concentrations 26 elements were measured by inductively coupled plasma mass spectroscopy. MAIN OUTCOME MEASURE(S): Trace elements concentrations in follicular fluid and blood. RESULT(S): [1] Calcium and magnesium were the most abundant, followed by Cu, Zn, Fe, Cr, Rb. The elements V, Sr, Se, B, As, Pb, Al, Mo, Mn, and Cs were found in trace amounts. The elements Li, Be, Ag, Cd, Ba, Ti, Bi, U were not detected. [2] Element concentrations in small follicles frequently differed from those of large follicles. [3] Element concentrations in large follicles more closely resembled those in blood. CONCLUSION(S): Concentrations of elements in FF of small follicles can differ from those of large follicles in the same woman and from those of blood serum. When follicles grow they become filled with fluid of an elemental composition similar to blood. Concentrations of elements in small follicles may represent longer term element exposure, whereas those of growing follicles represents the coincident blood concentrations.

Neonatal blood is more resistant to oxidative stress induced by stable nitroxide radicals than adult blood.

Neonate erythrocytes are more susceptible to oxidizing drugs than adults; however, there are controversial reports in the literature regarding the total antioxidant capacity of neonate blood. Stable nitroxide radicals (NRs) are reduced by blood and some other biological materials to the corresponding hydroxylamines. The kinetics of the nitroxide's disappearance using electron paramagnetic resonance (EPR) spectroscopy, provides useful biochemical and biophysical information about the antioxidant properties of biological systems. In order to investigate the antioxidant properties in the newborn's blood, we applied this novel method on 38 umbilical vein blood samples and 40 healthy adults. The NR, 5-Dimethylaminonaphthalene-1-sulfonyl-4-amino-2,2,6,6,-tetramethyl-piperidine-oxyl (R), was used for this purpose. Ascorbate is the only known natural antioxidant that reduces R. We found that the reduction rates of R in neonate's whole blood are significantly higher (P < 0.001) than the reduction rates of R in adult's whole blood. However, there were no significant differences in the antioxidant capacity between the two groups. Newborn's blood has significantly higher ability to deal with oxidative stress, caused by R, in comparison with adult blood. We suggest that the system that responds to the recycling of ascorbate is more efficient in neonate blood than in adult's blood.

Oxidative stress as determined by glutathione (GSH) concentrations in venous cord blood in elective cesarean delivery versus uncomplicated vaginal delivery.

OBJECTIVE: To determine whether neonates are subject to oxidative stress by the labor process and the mode of delivery by measuring glutathione (GSH) concentrations in umbilical cord venous blood. STUDY DESIGN: Forty-eight women with singleton term pregnancies were prospectively recruited and classified as follows: 26 women had a spontaneous uncomplicated vaginal delivery (VD), and 22 women had an elective cesarean delivery (CD). GSH concentration in umbilical venous blood samples was determined by a spectroscopic method. RESULTS: Umbilical cord venous blood GSH levels were significantly lower in the elective CD group than in the VD group (2.2 and 2.7 mM, respectively, P = 0.0003). There was a significantly negative correlation between cord blood pO(2) and GSH levels; however, the negative correlation was significantly higher in the elective CD group (P < 0.05). CONCLUSION: Neonates delivered by CD were exposed to a higher oxidative stress as determined by GSH levels compared to those who had an uncomplicated VD.