A Decrease in Lactobacilli in the Vaginal Microbiota Is Independently Associated With HPV Persistence in Women With High-Risk HPV Infection.

Background Vaginal dysbiosis, an imbalance between species, can initiate some local changes in immune and metabolic signaling causing chronic inflammation. The mechanism of the clearance or progression of the HPV infection has not been uncovered yet. We hypothesized that vaginal dysbiosis may contribute to the persistence of the cervical HPV infection. Therefore we aimed to determine the association of lactobacillus dominancy index with cervical HR-HPV persistence. Methods A total of 100 women who were followed up because of high-risk HPV infection were defined as the target study group. The patients were evaluated in two groups; HPV positive (group with HPV persistence, n=43) and HPV negative (group with HPV clearance, n=57). Cervicovaginal swab samples and blood samples were evaluated for Nugent score, lactobacillus dominance, and white blood cell count. Statistical tests were performed by the IBM Statistical Product and Service Solutions (version 22, IBM SPSS Statistics for Windows, Armonk, NY) program. The continuous variables were presented using the mean±standard deviation (SD), and the categorical variables were presented as the number of cases and their percentage. A p value less than 0.05 (<0.05) was set as statistically significant. Results HPV persistence was observed in 43 (43%) patients. Univariate analysis revealed that age, menopausal status, and lactobacillus reduction were associated with HPV persistence (p<0.05). The median value of the Nugent score was similar among groups. After logistic regression analysis, lactobacillus reduction continued to be associated with HPV persistence, independent of age and menopause (OR: 2.668, 96% CI: 1.069-6.662, p<0.05) Conclusions A decrease in lactobacilli in the cervicovaginal microbiota is associated with the persistence of HPV, regardless of age and menopausal status in this study.

Retrospective clinical evaluation of indications for termination of pregnancies due to fetal anomaly

Objective: To assess the indications for termination of pregnancy (TOP) in pregnant patients who were followed up with suspicion of fetal anomaly in a Turkish tertiary referral center. Material and Methods: This retrospective study was carried out in patients who were followed up with suspicion of fetal anomaly between May 2016 and May 2019 at the Perinatology Clinic of Obstetrics and Gynecology Department in Pamukkale University Hospital, which is a tertiary hospital in Denizli province in Turkey. Women were divided into two depending on gestational period: group 1 ≤22 weeks; and group 2 (>23 weeks of gestation). Results: Four hundred and seventeen pregnant women were evaluated and TOP was performed at a mean gestational age of 27.7±6.3 weeks. There were 308 (73.8%) women in group 1 and 109 (26.2%) in group 2. The decision to terminate pregnancy was due to fetal anomaly in 117 (28.1%). The majority of termination pregnancies in group 2 were performed because of multiple malformations and/or central nervous system defects. All chromosomal diseases were detected in group 1. Conclusion: With a good perinatal screening program, fetal anomalies can be diagnosed early. Therefore, early TOP is possible. Thus, pregnancy termination can be made before reaching the life limit.

Predictors of Human papillomavirus (HPV) persistence after treatment of high grade cervical lesions; does cervical cytology have any prognostic value in primary HPV screening?

OBJECTIVE: This study aimed to determine the factors associated with Human Papillomavirus (HPV) persistence in women undergoing cervical excision for pre-invasive lesions, after they have been referred from a primary HPV screening program. METHODS: A retrospective study design involving patients who were treated at a Cervical Disease Screening and Treatment Unit, in a university hospital setting. After initial treatment, cervical HPV infection status was analyzed at the sixth month, first year and then subsequently after the second year. RESULTS: Totally, 395 patients who were diagnosed with pre-invasive cervical lesions and who subsequently undergone cervical excision were identified. In the first-year visit after cervical excision, HPV 18 was cleared in almost all (95.8%) cases, followed by HPV 16 (69.9%) and other hrHPV types (65.6%). Available data documented that 88.6% of women reached clearance after the two-year follow-up. Univariate analysis revealed a significantly higher proportion of HPV clearance among women who were younger (p = 0.019), premenopausal (p = 0.002), and who had been found to have a negative cytology result on their initial Pap test (p = 0.018). However, only cervical cytology result remained as the independent predictor of HPV persistence on a multivariate logistic regression (OR 0.43; 95% CI 0.21-0.87; p = 0.019). CONCLUSIONS: A low risk of HPV persistence was found among every HPV genotype in women undergoing cervical excision for pre-invasive cervical lesions. Initial cervical cytology result was the only independent predictor of HPV clearance during surveillance, which indicates the prognostic value of Pap test in primary HPV screening.

[Prevalence and genotype distribution of human papillomavirus in patients attending to gynecology polyclinics]. / Jinekoloji poliklinigine basvuran hastalarda insan papillomavirüs prevalansi ve genotip dagilimi.

Human papillomavirus (HPV) infection is the most significant risk factor of the development of cervical cancer. The distribution of HPV prevalence and genotype varies widely between regions. In this study, it was aimed to investigate the prevalence and genotype distribution of HPV, retrospectively. One thousand one hundred and seventy patients who applied to the department of obstetrics and gynecology were included in this study. Samples were collected from patients for cervical HPV DNA and Pap smear. The Pap samples taken for Pap smear were fixed with alcohol and analyzed according to the modified Bethesda system. HPV identification and typing were performed using the "Linear Array HPV Genotyping Test (Roche Molecular System, USA)". Patients were divided into 5 groups due to their age. Total HPV ratio was most frequently found among the patients who were between 17-30 years old, while HR-HPV was most frequently found between 51-60 years. Nine hundred seventy-eight of 1170 (83.6%) patients had normal cytologic findings whereas 192 (16.4%) had abnormal cytologic findings. HPV was detected in 37.2% of the total patients. high-risk HPV (HR-HPV) rate was 21.2%, probable high risk (PR-HPV) rate was 6.4% and low risk HPV (LR-HPV) rate was 9.5%. When the relationship between cytologic findings and HPV was examined, normal cytology/HPV negative 67.8%; abnormal cytology/HPV negative 37.5%, normal cytology/HPV positive 32.2%, abnormal cytology/HPV positive 62.5% were detected. The highest prevalence of HPV was 8.9% with HPV 16, followed by 6, 53 and 52/53/35/58. A total of 354 patients were biopsied, 177 of whom were normal, 111 of whom were cervical intraepithelial neoplasia (CIN) 1, 66 of whom were CIN 2 and over. In the group with normal pathological findings, HR-HPV ratio was found as 15.8%, while in CIN 1 44.1% in CIN 2-3 63.6%. Sensitivity, specificity, positive predictive value, and negative predictive value of screening tests were examined in CIN 2 and more lesions. Sensitivity and specificity for HR-HPV were 63.6% and 73.3%, respectively, the same rates were 81.8% and 58.7% for HPV. The highest sensitivity was found in combination of HRHPV and Pap smear, the highest specificity in HPV. In conclusion, the HPV prevalence and genotype distribution in our study are similar to those reported in the world, but higher than previous studies in our country. These results may be due to our methodology and hospital based nature of our study group. We conclude that only smear or HR-HPV testing are not sufficient as a single pronged screening test, and that the participation of other genotypes of HPV in screening increases the sensitivity.

Lipid peroxidation in follicular fluid of women with polycystic ovary syndrome during assisted reproduction cycles.

OBJECTIVE: To investigate the ovarian lipid peroxidation pattern in polycystic ovary syndrome (PCOS). STUDY DESIGN: Twenty-six women with PCOS who underwent in vitro fertilization and embryo transfer (IVF-ET) cycles between January 1999 and November 2000 at the hospital IVF unit were included in the study. Seventeen regularly cycling women with male factors (oligospermia or azoospermia) were enrolled as the control group. Malondialdehyde (MDA) levels in preovulatory follicular fluid were measured. RESULTS: There was a significant difference in follicular fluid MDA levels among the control (median, 2.23 nmol/mL; range, 0.98-4.93) and PCOS group (median, 3.53 nmol/mL; range, 1.51-4.81). Follicular fluid MDA and plasma progesterone levels correlated positively in the subjects (r = 0.55, p = 0.041) and PCOS group (r = 0.074, p = 0.0001). Plasma luteinizing hormone/follicle stimulating hormone (LH/FSH) levels correlated positively with follicular fluid MDA levels in the PCOS group (r = 0.72, p = 0.0001). CONCLUSION: The specific ovarian lipid peroxidation profile of PCOS patients is probably related to insufficient progesterone production and higher FSH/LH levels.

C-reactive protein levels in non-obese pregnant women with gestational diabetes.

A low-grade systemic inflammation is concomitant in diabetes. There is a pathophysiological relation between gestational diabetes mellitus and type 2 diabetes mellitus, which was further supported by significantly elevated risk of type 2 diabetes in women with a history of previous gestational diabetes mellitus. We investigated the relation between low-grade systemic inflammation expressed as C-reactive protein and gestational diabetes in non-obese pregnant women. This study included 20 non-obese pregnant women with gestational diabetes mellitus and 30 non-obese pregnant women without gestational diabetes mellitus as a control group. The body mass index of all the subjects were < 25 kg/m2. During 26-28 gestational weeks 100-g oral glucose tolerance test was performed and simultaneously fasting C-reactive protein levels were measured. Serum median C-reactive protein level was higher in patients with gestational diabetes mellitus (p = 0.0001). C-reactive protein was strongly associated with glycemic parameters and weight gain during pregnancy. A model consisting of glucose intolerance, age, parity, and weight gain during pregnancy accounted for 61% of the variance in log C-reactive protein. We demonstrated that serum C-reactive protein level was related with gestational diabetes mellitus and weight gain during pregnancy in late second and early third trimesters.

Serum levels of neopterin and interleukin-2 receptor in women with severe preeclampsia.

Preeclampsia continues to be a major cause of maternal and perinatal mortality and morbidity worldwide. The etiopathogenesis of preeclampsia is not fully understood. Neopterin and interleukin-2 (IL-2) production reflects cellular immunity. Our purpose was to determine the levels of neopterin and interleukin-2 receptor (IL-2R) in pregnant women with severe preeclampsia, and assess the implications of these findings in the pathophysiology of preeclampsia. Fourteen women with preeclampsia were compared with 14 healthy pregnant women. Serum levels of neopterin were measured by an enzyme-linked immunoassay (ELISA), and IL-2R levels were determined by an immunoassay method with an Immulite analyzer. The levels of neopterin and IL-2R were significantly higher in the preeclamptic subjects than in normotensive women (P<0.05). There was a significant correlation between neopterin and IL-2R. We found that serum neopterin and IL-2R levels are increased in women with severe preeclampsia. The results of this study suggest that a T-helper 1 (Th1) type immune mechanism is involved in the pathogenesis of preeclampsia.

The effects of postmenopausal Vitamin D treatment on vaginal atrophy.

OBJECTIVES: To evaluate the efficacy of Vitamin D for relieving vaginal atrophy. METHODS: In our cross-sectional study, 60 eligible women were consecutively identified among patients who were followed in physical medicine and rehabilitation's outpatient clinic, during the period March June 2001. The sample consisted of 30 postmenopausal women on 1,25-dihydroxy Vitamin D (calcitriol) treatment, 30 postmenopausal women taking neither hormone replacement nor osteoporosis treatment. Vaginal atrophy was determined by symptoms, physical examination and maturation index (MI). RESULTS: The mean physical findings score in Vitamin D treatment (VDT) group was significantly lower than the mean physical findings score in the group without treatment. Symptom scores were lower in both groups and there was not significantly difference between two groups. As maturation indices: in VDT group, superficial cells proportion was significantly higher and basal, parabasal cells proportion was lower than in the group without treatment. CONCLUSION: The results of current study seem to indicate that vaginal tissue may be a new target organ for therapeutically applied Vitamin D analogues.

[Investigation of human papillomavirus DNA in cervical specimens by hybrid capture assay]. / Servikal orneklerde insan papillomavirus DNA varliginin hibrid yakalama yöntemiyle arastirilmasi.

The aim of this study was to investigate the presence of human papillomavirus DNA (HPV-DNA) in cervical specimens of those randomly selected women, age between 18-62 years and applied to Gynecology and Obstetric Clinics in a six months period. Two hundred and six women were enrolled during the study. HPV-DNA in the cervical specimens were investigated with Hybrid Capture System (Digene Hybrid Capture System, UK) and also the cytologic specimens were examined simultaneously. HPV-DNA positivity was 4.9% overall. HPV-DNA positivity was found to be higher among younger population (30-39 age group: 7.3%), women with lower education level (6.9 %) and with lower income level (11.8%). Additionally, HPV-DNA positivity rate was found higher among women who experienced their first sexual intercourse at lower ages (15-19 age group: 6.3%) and who use oral contraceptives (7.7%). HPV-DNA positivity was found to be 2.1% in women with normal cervical cytology and 42.9% in women with epithelial cell abnormalities, and this difference was statistically significant (p=0.000). The presence of HPV together with high rates of epithelial cell abnormalities leading to cervical cancer, supported the association between HPV and malignancy. Thus, HPV-DNA testing should be included in the cervical cancer screening programmes.

Effects of low-dose 17-beta-estradiol plus norethisterone acetate and tibolone on fasting plasma homocysteine levels in postmenopausal women.

BACKGROUND: Many postmenopausal women currently receive hormone replacement therapy. The use of low-dose 17beta-estradiol plus norethisterone acetate and tibolone for hormone replacement therapy is not uncommon in postmenopausal women. Homocysteine, which is known to be an independent risk factor for the development of cardiovascular disease, is found in increased levels postmenopause. This study compared the effects of low-dose 17beta-estradiol plus norethisterone acetate and tibolone on the fasting plasma homocysteine level in healthy postmenopausal women. METHODS: Healthy postmenopausal women (n = 44) were enrolled in the study. Women randomly assigned received 1 mg of 17beta-estradiol plus 0.5 mg of norethisterone acetate or 2.5 mg tibolone during a period of 12 weeks. Fasting plasma homocysteine levels were measured at baseline, the 4th week, and the 12th week of therapy. RESULTS: In the 4th week there were no significant changes in plasma homocysteine levels in both groups (p > 0.05). However at the end of the 12th week the plasma homocysteine levels were reduced significantly in both groups (p < 0.05). CONCLUSION: Low-dose 17beta-estradiol plus norethisterone acetate and tibolone lower the fasting plasma homocysteine levels in healthy postmenopausal women.

Reperfusion injury after detorsion of unilateral ovarian torsion in rabbits.

OBJECTIVE: To determine if reperfusion injury takes place in ovarian tissue following the detorsion of the torsioned ovary. STUDY DESIGN: Fifty-four New Zealand mature nonpregnant female rabbits were divided into six groups. One group served to determine the basal values of thiobarbituric acid reacting substance (TBARS) and another group was sham. In the third and fourth groups, ovarian torsions and subsequent oophorectomy were performed in 1 and 3h, respectively. In the fifth and sixth groups, detorsions were carried out after unilateral ovarian torsion lasting 1 and 3h, respectively, then oophorectomies of the detorsioned ovaries were performed 2h after detorsion. The level of TBARS in ovarian tissues was determined in all subjects. Statistical analysis was performed using analysis of variance and Duncan's multiple range test. Differences were considered to be significant if P<0.05. RESULTS: The levels of TBARS were not different in the basal and sham groups (P>0.05), while ovarian torsion caused significant increase in TBARS in the ovary (P<0.05), and detorsion caused a further significant increase in ovarian TBARS (P<0.05). CONCLUSION: Reperfusion injury in ovarian tissue, following the detorsion after the torsion of the ovary lasting up to 3h was demonstrated biochemically in this study.

Relation of intra-abdominal fat distribution to metabolic disorders in nonobese patients with polycystic ovary syndrome.

OBJECTIVE: To investigate the relation between intra-abdominal fat distribution and metabolic disorders in nonobese patients with the polycystic ovary syndrome (PCOS). DESIGN: Prospective case-control study. SETTING: University-based hospital. PATIENT(S): Thirty nonobese patients with PCOS and 30 lean women with regular menstrual cycles (controls). All participants had a body mass index < 25kg/m(2). MAIN OUTCOME MEASURES: Subcutaneous and intra-abdominal visceral and preperitoneal fat thicknesses were assessed by ultrasonography. Glucose tolerance and insulin sensitivity were evaluated by standard 75-g oral glucose tolerance test and area-under-the-curve analysis. Serum hormones and lipid profile were measured. RESULT(S): The mean preperitoneal and visceral fat thicknesses were significantly greater in nonobese patients with PCOS. Subcutaneous fat mass was similar between the PCOS and control groups. Nonobese patients with PCOS had glucose intolerance, hyperinsulinemia, and dyslipidemia, manifested by high serum levels of triglyceride, total cholesterol, and high-density lipoprotein (HDL) levels and low serum low-density lipoprotein (LDL) levels. No correlation existed between subcutaneous fat thickness and the metabolic variables in nonobese patients with PCOS. However, serum triglyceride levels correlated with visceral fat and preperitoneal fat thickness. The mean HDL level correlated negatively with visceral fat and preperitoneal fat thickness. The area under the curve for insulin and mean fasting insulin levels correlated positively with visceral fat thickness. In multiple regression analysis, visceral fat thickness contributed significantly to high serum triglyceride and fasting insulin levels. CONCLUSION(S): Intra-abdominal preperitoneal and visceral fat accumulation may contribute to the development of glucose and lipid metabolism disorders in nonobese patients with PCOS.

[Evaluation of direct microscopic examination, acridine orange staining and culture methods for studies of Trichomonas vaginalis in vaginal discharge specimens]. / Vajinal akinti örneklerinde Trichomonas vaginalis arastirmasinda direk mikroskopik inceleme, akridin oranj boyama ve kültür yöntemlerinin degerlendirilmesi.

Trichomonas vaginalis is the causative agent of human trichomoniasis which is a sexually transmitted disease mainly in women. The infection may be asymptomatic or symptomatic such as severe vaginitis and cervicitis. The aim of this study was to compare direct microscopic examination, acridine orange stained examination and culture in Modified Diamond medium, for the detection of T. vaginalis from the vaginal swab samples of 310 patients (age ranges: 17-45 years old) who were complaining from vaginal discharge. Of them 40 (12.9%) samples were found positive with culture, 20 (6.5%) were positive with direct microscopy and 19 (6.1%) were positive with acridine orange staining method. The positive results were obtained in 17 cases by each of the three methods, in 3 cases by direct microscopy and culture, in 2 cases by acridine orange staining and culture, and in 18 cases by culture only. T. vaginalis has been detected in 19.5% of 41 patients with itching, 15.7% of 190 patient with groin pain and 23.2% of 43 patients with cervical erosion, in addition to vaginal discharge, by at least one of the methods. In conditional evaluation, there were no statistically significant differences between T. vaginalis positivity with age groups and the contraceptive methods used. As a result, it was concluded that for the laboratory diagnosis of T. vaginalis, acridine orange staining technique does not have any superiority over direct microscopy. Although direct microscopy is a practical and economical method, it has low sensitivity, so all of the suspected samples which are found negative by this method, should be cultivated for a definite diagnosis.